Expert: Gerald Anzalone, D.C. - 3/4/2008

Question
I recently went in for an evalution with a chiropractor that my boyfriend is seeing. They took xrays and found that my spine curves to the left and that the curve in my neck is reversed. I do not have any pain but my back muscles are tense. The chiro said it was because of the nerves in my back. He recommended six months of treatment- 2months 3x/wk and then 1x/wk. However, if I am not feeling any pain is this care necessary? He is also charging almost $3000 for this treatment which includes my insurance coverage. This seems very outrageous. I had already signed papers last night.. is there a way to get out of contract? Thank you.

Answer
Kate,

I am not a lawyer, so I can't advise you on the legalities of any contractual agreement to which you may have entered, but as a chiropractor, I can say that this is not a standard of care that makes any clinical sense to me.

A mild scoliosis is generally considered to be an idiopathic condition (that is, cause unknown), and the most common complaint patients with this condition have is, as you described, tense muscles (NOT "nerve" pain). For this, a chiropractor skilled in soft tissue techniques, a massage therapist, or an acupuncturist may help on a symptomatic basis.

A reversal of the cervical curvature may cause joint pain and degenerative joint disease; some chiropractic techniques purport to correct this condition, but as far as I know, these reports are based on case studies of proprietary techniques, and not a universal standard of care. Musculoskeletal-based chiropractors would only recommend manipulation of the spine if you're having joint pain. Again, for muscular pain, soft tissue techniques might be more appropriate.

In my opinion, the scheme you have described is based on a marketing strategy, not an acceptable standard of health care, one which I do not endorse. In fact, in many states, this "contract" may imply that the chiropractor is selling you a form of health insurance, since the implication is that by the end of this suggested treatment plan, your conditions will have improved, and by implying that without the recommended care, your condition may worsen. This may not be legally permissible, depending upon the laws of your state.

I recommend bringing this chiropractor's marketing strategy to the attention of the state board for chiropractors, and informing the chiropractor that you have reconsidered these recommendations and are not agreeing to the treatment plan (if that is your decision). You might also contact your insurance company to report this chiropractor's proposed treatment plan... a complaint with your insurance company may raise some red flags if there is no basis of medical necessity for the proposed care.

I'm sorry that your experience with this chiropractor was not a good one; there are excellent musculoskeletal-based chiropractors who do not abuse patient visits and who render top-notch care based on a sound clinical rationale. As in choosing any health-care provider, you need to do some research before picking a doctor with whom you feel comfortable.