Frequently Asked Questions

·  Chiropractic

·  Acupuncture

·  Custom Orthotics

·  Massage Therapy

Chiropractic

1. What is the education of chiropractors?
2. Do I need a medical referral to see a chiropractor?
3. Is chiropractic treatment safe?
4. What about the safety of neck adjustments?
5. Do I need X-Rays when to see a chiropractor?
6. Once I see a chiropractor do I have to continue seeing forever?
7. Can chiropractic provide a preventative function?

What is the education of chiropractors?

Chiropractic students undergo a rigorous course of study similar to that of other health care professionals, and entrance requirements are also similar. At minimum, 3 years of undergraduate study of university is required before becoming eligible to apply for admission to the Canadian Memorial Chiropractic College (CMCC). The vast majority (greater than 80%) of students have already completed a baccalaureate degree before applying.  The chiropractic program itself is an additional four years of full-time study, including a year long internship in the College’s clinics.

The academic program at CMCC, like the other accredited health professionals, includes courses in anatomy, biochemistry, physiology, neurology, embryology, radiology, immunology, microbiology, pathology, nutrition, principles/ethics, and the clinical sciences. In addition to the academic program, chiropractic education requires hands-on clinical experience under direct supervision of highly-qualified chiropractic faculty. This experience includes clinical assessment, diagnosis, treatment, and referral protocols.

As well, chiropractors receive training in radiology which covers a range of topics from radiation biophysics and protection to clinical x-ray interpretation and diagnosis. Radiology training consists of more than 360 contact hours followed by application during clinical internship.

CMCC faculty is comprised of experts in such disciplines as medicine, pathology, psychology, biological sciences, as well as chiropractic.

Do I need a medical referral before seeing a chiropractor?

No. The chiropractic profession is legislated as a “primary-contact” profession, meaning patients can consult them directly. However, some chiropractors work very closely with medical doctors, welcoming referrals to manage or co-manage their patients’ conditions. Our office takes great pride in working with the local medical community to provide the best co-managed care possible for patients.

Is chiropractic treatment safe?

In a word – yes. Chiropractic is recognized as one of the safest, drug-free, non-invasive treatments available for back pain, neck pain, and headaches. In fact, during the last 25 years there have been six formal government studies of chiropractic, all of which have found the profession to be both safe and effective (1). Based on the results of more than 44 studies into the safety and efficacy of chiropractic treatment, no other profession can demonstrate greater effectiveness or a better safety record for the treatment of spinal pain syndromes.

What about the safety of neck adjustments?

Indeed there has been negative press pertaining to this subject -make no mistake, we do not take this subject lightly. Our office recognizes the concern and anxiety that exists over this procedure, 

and for this reason, we offer several other effective alternatives to the treatment of neck injuries (including: gentle mobilizations, soft tissue therapies, rehabilitative exercises, physical therapy modalities (TENS/IFC), acupuncture).

It should be noted, however – for the record - the risk of a serious adverse reaction (eg. stroke) as a result of traditional spinal manipulation is very, very low. The Canadian Medical Association Journal, based on the most factual data available, puts the risk at 1 in 5.8 million (1). To put that in perspective, the risk of a serious neurological complication from cervical spine surgery is greater than 15,000 per million, and the mortality rate is almost 7,000 per million (2). The risk of a serious gastrointestinal bleed from taking aspirin over an extended period is approximately 1 in 1000, or 400 times greater than the risk of damage from a neck adjustment (3).

Another recent study, conducted by the Institute for Clinical Evaluative Studies, concluded that the risk is so low that it is difficult to calculate an accurate risk ratio (4).

Most recently, a study published in the journal Spine, concluded that there is no more risk of suffering from a stroke from visiting a chiropractor’s office than visiting a physician’s office. (5). For more information on this study, you may read a Globe and Mail summary of this study.

In summary, this office does use alternatives to traditional neck manipulation in the treatment of neck injuries. We felt the need to address this important issue, however, and clarify what the published studies have concluded about the true risks of serious adverse reactions associated with neck manipulation.

References:

1. Arterial dissections following cervical manipulation: the chiropractic experience. Haldeman, S, Carey P, Townsend M, Papadopoulos, C, Canadian Medical Association Journal, Vol 165, No 7, 905-6, 2001.

2. A risk Assessment of Cervical Manipulation V. NSAIDs for the Treatment of Neck Pain. Dabbs V, Lauretti WJ. Journal of Manipulative and Physiological Therapeutics. 18:530-36, 1995.

3. Ibid.

4. Chiropractic Manipulation and Stroke: A Population-Based Case-Control Study. Rothwell, DM, Bondy Sj, Williams JI, Stroke, May 2001.

5. Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-crossover study. Cassidy JD, Boyle E, Cote P, He Y, Hog-Johnson S, Silver F, Bondy, SJ. Spine;33 (4S): S176-S183, 2008.

Once I see a chiropractor do I have to continue forever?

The simple answer is no.  Most people initially consult a chiropractor for a specific complaint e.g. low back pain.  However, once they have experienced an increase in mobility and a decrease in pain related to that and other complaints, as well as experienced the education on exercise and other lifestyle issues, many patients consider their chiropractors valuable members of their health care team and elect to see them periodically (e.g. every 4-6 weeks ) for consultations and supportive care.  Chiropractors can advise as to the benefits of various types of care, and then it is up to each patient to decide whether they merely seek symptomatic care, or if they also wish to progress to stabilizing education and/or establish a longer term supportive care relationship with their chiropractor.

Do I need X-Rays to see a chiropractor?

No.  The use of x-rays as a diagnostic tool by chiropractors (and all health professions) is governed in Ontario by guidelines as set out by the Healing Arts Radiation protection Commission (HARP). X-rays can play an important role in diagnosis, but should only be taken when a need has been determined by a careful case history and physical examination. In our office, the vast majority of patients do not require x-rays.  At the Queen Spadina Medical Centre, when x-rays are required, our staff of medical doctors can refer you to a local radiology facility so that your x-rays will be 100% covered by OHIP.

Can chiropractic provide a preventative function?

Yes.  For example, in some chronic conditions, such as osteoarthitis, chiropractic care can decrease the intensity and frequency of pain, and improve mobility. However, in this case, chiropractic (nor any other treatment) can actually cure the (arthritic) condition. Another example is individuals who are in highly stressful situations, and or those who experience highly repetitive physical and postural strain from their daily activities. In this example, although chiropractic treatment cannot take away the stressful situation or the repetitive strain, it can address the physical response to the stress/strain. In other words, it can address the muscle tension, joint immobility, and associated pain that can be associated with the physical stressors.

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Acupuncture

1. What is Acupuncture?

2. What is medical acupuncture?

3. What conditions does medical acupuncture treat?

4. What are the benefits of acupuncture?

5. Is acupuncture safe?

6. Does acupuncture hurt?

What is Acupuncture?

Acupuncture is a therapeutic intervention involving the insertion of fine needles into specific points in the body. Combining thousands of years of anecdotal evidence with modern biomedical research, acupuncture has proven to be a valuable therapy in the treatment of many conditions, both acute and chronic.

What is medical acupuncture?

Medical acupuncture is a biomedical approach to acupuncture that combines traditional acupuncture and acupuncture theory with modern, biomedical knowledge, practiced by Western-trained health practitioners (e.g. chiropractors, physicians, physiotherapists). Coupling traditional Chinese acupuncture methods, with our current concepts in neuroanatomy, neurophysiology, and pathophysiology, allows Western practitioners to better organize clinical information to generate safe and more efficient treatments for their patients using acupuncture as a sole therapy, or in combination with other therapies. With medical acupuncture, healthcare practitioners take a proper, thorough history, and perform a physical and neurological examination to arrive at a diagnosis. Selection of relevant acupuncture needling sites follows.  (1)

What conditions does medical acupuncture treat?

Medical acupuncture may be used in the treatment of many acute and chronic injuries and conditions. Common problems that are responsive to acupuncture include:

The most common chronic condition treated (with excellent therapeutic effects) is osteoarthritis. It should be noted that acupuncture (nor any treatment) actually “cures” patients of osteoarthritis – but, rather, it is part of a pain-management solution, allowing for pain-relief, increased mobility, and ultimately, significantly improved quality of living.

In addition to the above-mentioned conditions, the World Health Organization recognizes the use of acupuncture in the treatment of various other conditions:

That said, at the Queen Spadina Medical Centre, the vast majority of acupuncture treatments we provide are focused on musculoskeletal  and pain based complaints.

What are the benefits of acupuncture?

The benefits of acupuncture have been widely studied. The main benefits can be summarized as follows (4):

Is acupuncture safe?

In the hands of a properly trained and qualified acupuncture practitioner, acupuncture is one of the safest therapeutic interventions in existence.  Acupuncture has a time-tested record of millions of treatments with extremely few significant side-effects. Nowadays, the use of sterilized, single-use, disposable needles has eliminated any risk of infections from needles.

Does acupuncture hurt?

In the vast majority of patients, acupuncture does not cause any significant discomfort. The needles are very fine, and do not cause any damage to tissues when inserted. A minority of patients may experience momentary discomfort upon needle insertion, drowsiness, or localized bruising. For many people, acupuncture is considered to be a pleasant, relaxing experience, enhanced by the known therapeutic effects that follow treatment.  At QSMC – Chiropractic clinic we primarily perform electroacupuncture where a gentle electrical current passes through the needles to accentuate the therapeutic interaction.  Many patients find the sensation so comfortable that they sleep through the majority of their treatment.

References:

1. Fargas-Babjak A, Claraco AE. Clinical Applications of Medical Acupuncture. The Canadian Journal of CME. September 1999.

2. Ibid.

3. World Health Organization (WHO) Consultation on Acupuncture, Guidelines. 1996.

4. Neuro-anatomical Acupuncture Volume 1: Musculo-Skeletal Disorders. Wong JY. 1999

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Custom Orthotics

1. What are orthotics?

2. Why are chiropractors concerned with the feet?

3. How are they made?

4. What conditions can orthotics help?

5. Are orthotics covered by insurance?

6. How do I know if I can benefit from orthotics?

What are orthotics?

Orthotics are orthopedic devices that are designed to alter or modify foot function/mechanics for the purpose of treating musculoskeletal conditions.

Orthotics can be simple, over-the-counter devices sold commercially at drug stores – these can provide some support and cushioning, but little more and they are rarely if ever covered by insurance plans. The most effective orthotics are custom-made, designed by professionals, for your foot alone. The process of designing custom-made orthotics, after a thorough orthopedic examination and gait analysis has been performed, involves taking an impression of the foot, called a cast. The cast, and computer technology, with recommendations from the chiropractor, are used by technicians in a professional orthotic laboratory to design a device that corrects misalignments and other skeletal abnormalities. The finished orthotic supports the foot and reduces abnormal foot mechanics by promoting proper foot alignment.

Why are chiropractors concerned with the feet?

To properly answer this question, first, consider these facts:

The feet play an enormous role in locomotion, in shock-absorption, and in stability. Abnormal foot mechanics affects the entire kinetic chain – that is, the knees, hips, pelvis and low back. All of these joints and the muscles that attach to them are forced to compensate for problems in the foot, causing them extra stress and strain, and eventual injury. Yes, the feet can and do contribute to pain, not just in the feet themselves, but all the way up the kinetic chain to the spine.

Chiropractors have extensive training in the diagnosis and treatment of musculoskeletal injuries, not just in the back, but throughout the body. They are ideally suited for the treatment of foot, gait, and related problems.

How are they made?

After a thorough history is taken, and a physical assessment and gait analysis is performed, an impression  is taken of the feet using either foam or plaster casting, and sent to a Professional Podiatry laboratory where a custom-molded orthotic is constructed, with any necessary recommendations from the chiropractor incorporated into them. Variations will be made in such aspects as cushioning, rigidity and arch support. Furthermore, the orthotics will be customized according to the type of shoe that they will be worn in (casual, athletic, dress, etc).

What conditions can orthotics help?

Orthotics may be used to help with foot pain, plantar fasciitis, flat feet, high and rigid arches, gait abnormalities, heel spurs, bunions, calluses, shin splints, knee pain, hip pain, low back pain. Foot problems related to diabetes can be helped as well. Furthermore, athletes, people who do a lot of walking, and those people who have to regularly walk on concrete floors can benefit from orthotics.  

Are orthotics covered by insurance?

Most extended health plan provide 100% coverage for orthotics, while some provide partial coverage (often greater than 80% of the cost). OHIP does not cover the cost of orthotics.

If you are unsure of your coverage, you are always best to contact your insurance provider prior to booking your appointment.  Questions that you should always clarify with your insurance provider are:

1. Do I need a medical/MD referral for orthotics?
2. Can a chiropractor cast and dispense my orthotics?
3. What is the dollar amount that I am permitted for custom orthotics?
4. How frequently can I get additional pairs? (This ranges from 2 pairs per year to one pair every few years)
5. Do I require pre-approval for the orthotics prior to submission of my claim?

Custom orthotics are usually listed in extended health plans as medical devices and do not count towards your chiropractic coverage for the year.

How do I know if I can benefit from orthotics?

Ask Dr. Mueller for further information. An appointment can be made with Dr. Mueller for a consultation, an assessment, and if warranted, casting for an orthotic insert.  

1. Is massage therapy covered my insurance?

2. What type of massage is offered?

3. Does massage therapy hurt?

Is massage therapy covered by insurance?

Yes!  Although there is no OHIP coverage for RMT services, most extended health plans cover massage therapy when delivered by an RMT.  Contact your plan provider for specific details on what coverage you may have.

What type of massage therapy is offered?

Laura is skilled in many types of massage from swedish relaxation style massage to deep tissue, rehabilitative and sports massage.  She is also trained to provide hot stone therapy and may add that to her service list at QSMC - Chiropractic Clinic in the future.

Does massage therapy hurt?

Massage therapy never has to hurt.  Depending on the condition, some discomfort may be experienced during treatment of deeper tissues.  Talk to Laura about what to expect during your massage and she will be able to customize the treatment to your fit your specific needs.