Should you be scared of your chiropractor???

When I meet with a patient for the first time, I’ll usually ask some version of this question,

“Are there fun or meaningful activities you’ve stopped doing because of the pain you’re experiencing?”

It should be obvious that as health and fitness professionals we would want to know what types of movement, exercise, sport, or leisure activities that are meaningful to people - and if they’ve stopped engaging in those activities because of their symptoms. Physical inactivity is the 4th leading cause of death worldwide according to the World Health Organization and is a major driver for disease and disability. So, if so one has become less active for any reason, it’s a big deal, and we should work towards getting them moving again. Pretty straightforward, right?

In the past 2 weeks, these are some of the responses I’ve received to that question…

“I used to love doing yoga but the twisting kept throwing my back out, so I stopped”

“I was told that deadlifts were how I injured my back in the first place, so I don’t really lift weights anymore”

“I was a runner but I stopped 2 years ago because I heard the pounding would lead to knee arthritis”

* the average age of these people was 26, btw

In each of these situations, the source of (mis)information about these activities being harmful was the same, the patient’s chiropractor. Unfortunately, these types of responses from patients have become so common that my wife and I have a name for this brand of chiropractic - we call it toxic chiropractic.

Toxic - “Very harmful or unpleasant in a pervasive or insidious way”

Chiropractic is a pretty diverse field. You have sports chiros, evidence-based chiros, whack and crack chiros, modality loving heat/electric stim/laser chiros and much more…Many iterations include hands-on interventions like spinal adjustments, soft tissue manipulation and assisted stretching and others include movement/exercise, nutrition and/or lifestyle-based counseling.

* Disclaimer: I’m not here to bash chiropractic or imply that chiropractors are the only ones guilty of this type of messaging, they’re not. You could replace the word ‘chiropractic’ with physical therapy, massage, medical doctor, acupuncture, etc, and the point would be the same.

There’s a lot to be said about the use of different techniques and approaches in the chiropractic world but that’s a conversation for a different day. What we refer to as toxic chiropractic actually has nothing to do with the type of hands-on or exercise-based techniques used in practice - you could be an exercise-focused sports chiro or an old-school chiro restoring ‘alignment’ and still be toxic AF. What makes a chiro toxic is the strategic use of FEAR.

Toxic chiropractic uses fear-based messaging, often disguised as ‘patient education’, as the foundation of their practice. This fear-based messaging leaves a legacy that extends far beyond the treatment room and can present in different forms, some obvious and some sneaky. Here are a few examples:

“Ahh, that explains it”

• “When we look at your posture from the side we see that your head is shifted forward 3 inches compared to the rest of your spine. Every inch your head shifts forward puts an extra 10 lbs of pressure on your spine so that’s a lot of extra stress! This explains why your neck hurts. No more slouching for you!”

• “You sit at a chair all day and then go squat heavy weights? Both of those things crush the discs in your spine and cause damage. No wonder you have lower back pain. You need to get a standing desk and should avoid squatting.”

“If you do ____, you’ll be in trouble”

• “Running causes excess wear and tear in your knee cartilage. My uncle was a runner and needed surgery by the time he was 42. It might not happen right away but eventually it will catch up to you.”

• “Everyone who deadlifts ends up in my office with back pain at some point. Deadlifts are not good for the spine, especially for someone who has misalignments like you.”

“If you don’t do ____, you’ll be in trouble”

• “This is only going to get worse if you don’t address it. Minor asymmetries can lead to early joint degeneration. Let’s get you set up to come in three times/week for 12 weeks to get ahead of this.”

Why is all of this bad?

Fear can be paralyzing. By nature, it makes you feel like you’re being threatened and puts you on high alert…and when you’re on high alert, you put your guard up.

If a chiropractor or other health care professional tells you that a physical activity is to be avoided, you might assume that something about your body is fragile and something about the physical space around you is dangerous. Instead of seeing the environment as an inviting place to walk, run, lift, bend, twist and explore - and your body as strong and adaptable - you might view activity as threatening and your body as a fragile. Fear blurs the lines between what is safe and what is dangerous, and if a healthcare provider is the one planting the seed of fear in the first place, we have a major problem.

There’s a time and place for restricting or modifying movements and activities, especially in the presence of acute injury or severe pain. But those modifications should be delivered with proper context, including a plan for self-management and a realistic timeline for return to activity.…Broad statements about the danger of postures/movements/exercises and the need for regular spinal alignments (or any other provider-delivered therapy) should be avoided at all costs.

Anticipation and sensitivity

If we tell someone that ______ is bad for them and will cause damage, pain, etc. - they’ll begin to anticipate threat as they move through the world. This anticipation can lead to:

• a hyper vigilant monitoring of sensations. If we’re constantly monitoring our bodily sensations and assuming that those sensations are harmful, it can lead to increased sensitivity. If Karen is told that squats are bad for her knees, she’s going to pay really close attention to how her knees feel when she sits in a chair, uses the restroom, etc. If there’s the slightest twinge, she might think that the squat is harming her knees (btw, none of this is Karen’s fault).

• additional tension, guarding, stiffness. If you’ve been told not to engage in certain positions or activities, you might chronically tense up to protect yourself as you move about the world. This might show up as a conscious or subconscious tension/guarding. Think of how your body acts when walking on ice or in a dark room where you might anticipate threat - you tense and stiffen your body to avoid danger. If we’re led to believe that normal parts of an active life - like slouching, running, deadlifting, etc are dangerous - we might end up walking around like we’re in a dark room, always anticipating danger and guarding against it.

• limited participation in physical activity. If we anticipate damage with certain postures/movements/activities we might go out of our away to avoid them. This could eventually lead to someone becoming deconditioned, which can lower the pain threshold and increase disability. Inactivity can snowball into a host of other health-related issues so, even through pain and injury, we want to find meaningful ways to engage ourselves physically.

The rub

The irony is that even though these chiros cover their patients in a proverbial bubble wrap of fear, their patients always end up back in the office for ‘maintenance care’ or with regular flare ups. Scaring patients into avoiding certain postures, movements, exercises, activities and getting people stuck in the seemingly endless loop described in the figure above is good for business.

*In reality, many of the chiros aren’t doing this maliciously and probably aren’t aware of the damage this messaging is doing - just like the well meaning parent who thinks they’re protecting their kid by not letting them climb a tree. But, from a consumer standpoint, it’s something that we need to be aware of in order to avoid.

In closing

The take-home point here is simple. Many chiros are stuck in an outdated, fear-based model that fundamentally shifts how their patients view their bodies and and how they interact with the world. Bringing awareness to these harmful narratives can help prevent patients from getting stuck in an endless cycle of treatment and fear of movement. Here’s a quick checklist, similar to some classic Fear-Avoidance Beliefs questionnaires, to see if you’ve been a toxic chiropractic:

• Are you told that certain movements or postures that are outright ‘bad for you’?

• Do you avoid activities out of fear of worsening symptoms based on the advice of a healthcare provider?

• Did treatment include a plan for self-management or do you need to rely on the provider for all treatment?

• Did you leave feeling a ‘glass half full’ or ‘glass half empty’ sorta way?

• Do you feel more broken when you walk out then when you walked in?

Stay tuned for part 2 where we’ll discuss a model for chiropractic that places activity, education and empowerment at the forefront of care.

Feel free to share experiences or questions below.