Author: Dr. Travis White

You’re sitting at a stoplight patiently waiting and in an instant your life changes.  You were just rear ended by another driver playing on their cellphone.  The abrupt trauma sends you into a state of fight or flight as your consciousness begins to decipher what just occurred and you initiate a triage your situation.  Almost instantly your neck tightens up and you begin to feel a throb in the back of your head.  You begin to wonder what kind of medical care you may need. 

Yes, chiropractors treat whiplash.  A “properly trained” chiropractor is probably your best hope at a complete recovery from a whiplash injury. 

What is whiplash?

Dr. Arthur Croft of the Spinal Research Center of San Diego is the leading expert on whiplash injuries or what he calls CAD (cervical acceleration deceleration) injuries.  He defines these injuries as sudden changes in direction in the cervical spine in which the internal ligaments are damaged.  This sudden change indirection often is perceived as a “whipping” action of the head and neck.  Research shows us that the head DOES NOT actually “whip” during these injuries but more of less the cervical spine endures and abnormal shape change from its healthy C-shape to a very unhealthy S-shape.  

What will a chiropractor do for whiplash?

If you recently sprained your ankle on the basketball court, would you let a chiropractor adjust it? ABSOLUTELY NOT so why do some chiropractors feel like they should adjust a sprained neck i.e. whiplash? The answer is simple they are quacks.  They willfully neglect all of their education for the sake of “the pop”. If a chiropractor wants to “pop” your neck on the first visit and your whiplash injury is less than 2 weeks old then I professionally suggest your run.

A properly trained chiropractor will examine your injury thoroughly.  This often includes orthopedic, neurologic and dynamic radiographic examination.  Considering that a whiplash injury is torn ligaments in the neck the chiropractor will initiate a treatment protocol for stabilizing the area.  This should include rest, physical therapy, sometimes a neck brace, and often inflammation management either in conjunction with the PCP or through natural means.  

Never the less if you suffer a whiplash from an auto accident or other type of accident you should seek medical attention to ensure proper healing and rehabilitation.  If you choose to go to a chiropractor make sure they have experience with auto accidents by checking with your attorney or even your insurance adjuster because, 

Yes chiropractors can treat whiplash injury as long as they are properly trained.

We go to school for eight years.  We spend countless didactic hours in lecture halls learning about musculoskeletal and pathological disorders and how to diagnose and treat them.  We even learn how to read MRIs in the most basic sense and then the second we graduate with our “doctorate” we walk out the door and go right to the same quackery bullshit that got us our reputation over the past 127 years.  If someone needs an MRI then order the damn MRI has long been my philosophy

Yes, chiropractors can refer for MRI and should order MRI’s when clinically necessary.

When should my doctor order an MRI?

Doctors and chiropractors, or if you consider your chiropractor a doctor, should utilize MRIs appropriately just as they do all other diagnostic tools when assessing injury or suspected pathology.  Typically, a thorough physical examination coupled with less intensive diagnostic imaging or scans are utilized before an MRI is ordered; however in some cases MRI may be the first option especially when considering soft tissue involvement.  The truth of the matter is MRIs are expensive and should only be ordered when they are necessary for making clinical decisions. They are expensive for the cash paying patient as well as for insurance companies and you will find they are sometimes difficult to get approved so be patient with your doctor if they are ordering one.  

Can chiropractors order mri for Medicare patients?

No, Medicare and Medicaid patients are the exceptions when it comes to chiropractors ordering MRIs.  Much of this is due to outdated laws and bureaucracy surrounding government funded health entities.  It must be understood that Medicare and Medicaid are not insurance coverage but actual government entities that provide access to health care with much more stringent laws and reduced access to care.  They are the lowest reimbursing agencies when it comes to health care costs which often deters health care providers from contracting with them.  Usually, a few times a year I find myself frustrated that I cannot order an MRI for one of these patients, but a simple referral back to their PCP and discussion with the provider usually works and the images can be obtained in a round about way.  

Can chiropractor make sciatica pain worse?

There is one very large chiropractic franchise in the United States, which for legal purposes I wont name, that publishes the lack of use for imaging including MRI for patients with low back pain.  These quack shops often staffed by underpaid new graduates are a fantastic source of hopeful patients in my office.  I inevitably encounter at least 5 new patients a month that visited these $29 chiropractors who hurt them.  I blame both the business model and the “doctor” when these patients are injured.  This unnecessary negligence is the foundation for this entire blog.  If a physical exam including neurologic and orthopedic testing reveal a possible soft tissue component for sciatic pain then MRI should always be considered during patient care especially if the patient is unresponsive to conservative care after a short period of time (typically 4 weeks).  If these quacks don’t stop hurting patients due to their blatant incompetence, then patients will continue to suffer.  THE ONLY REASON THESE ENTITIES DO NOT UTILIZE IMAGING IS DUE TO COST AND TIME.  THEY WOULD RATHER BE A FACTORY RUNNING PATIENTS THROUGH THE DOOR THAN ACTUALLY DIAGNOSE AND PROPERLY TREAT FOR THEIR OWN FINANCIAL GAIN.

Can my chiropractor order MRI?

Yes, and they should order MRI when clinically necessary.  If your pain or symptoms are not improving after 4 weeks of chiropractic care then ask your doctor about advanced imaging like MRI or a referral.  If they want you to continue with your “care plan” then run out the door and call me.  I will get you to a practical chiropractor or maybe recommend a different medical provider.  

Sarah came into the office yesterday as she normally does every couple of weeks.  She’s an avid golfer who prefers and relies on regular care to stay at the top of her game.  We are just one of her tools in her arsenal of providers so when she mentioned that she has been experiencing shoulder pain in the top and front of her shoulder I told her we might be able to help.  “You can do that? I thought you guys only cracked backs”.

Shoulder pain plagues between 16%-21% of the population and is the third leading cause for musculoskeletal pain.¹ It often goes undiagnosed and untreated as patients fear the possibility of surgery, cortisone injections or other invasive procedures.  After working with the Minnesota Twins baseball team during my residency I developed a love for evaluating and treating this complex joint.  What patients didn’t realize was I suffered from my own right shoulder pain developed from an old weight lifting injury in high school.  

Empathizing with our patients and understanding the burden a shoulder injury puts on one’s life I began developing a conservative treatment program that is EFFECTIVE, CHEAP, and DURABLE.  The most important tool in our lineup is a piece of a new technology called acoustic wave therapy (AWT) or extracorporeal shockwave therapy (ESWT).  FDA approved and usually only available in high-end orthopedic clinics the device has exploded into the sports medicine world as a miracle machine. Couple this with a home exercise program developed by our physical therapists the outcomes are inevitable.  Since implementation, we have seen complete resolution of pain in 95% of our patients. 

After a couple of tests and 2 x-rays in house we determined that Sarah was likely suffering a labral tear.  Before ordering an expensive arthrogram to confirm the diagnosis and referring her to a surgeon we applied our shoulder protocol.  She reported immediate relief after yesterday after her first treatment of AWT and will likely have complete resolution after her 5^th treatments for well under a thousand dollars.  

I love seeing the look on our patient’s faces after their first treatment.  I can’t always tell if its relief from the pain or surprise that a “chiropractor” does more than just crack backs.  So, I guess when it comes to shoulders. Yeah, we can do that.

¹ Shoulder pain: diagnosis and management in primary care. BMJ. 2005 Nov 12; 331(7525): 1124–1128

I would be filthy rich if someone gave me a dollar for every person that comes into our office with low back pain that radiates down their leg (sciatica). Probably one of the most common reasons someone visits our office or any chiropractic clinic is for sciatica. Low back pain that shoots into the butt and down the leg, sometimes all the way to the foot can be the most debilitating pain a person will ever experience. “I’ve tried stretching, hot tub, ice, ibuprofen and some old muscle relaxers I had left over and nothing touches it” us a phrase that should be painted on the wall of all my treatment rooms. It’s almost as though every sciatica patient is given that scripted phrase. 

Yes, chiropractic treatment has been proven to be one of the most effective options for treating sciatica. And this isn’t coming from your local chiropractor alone. This has been proven by many medical studies. However, the most comprehensive assessment was done by “Spine” which looked at 51 different studies and compared the results.

“There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe. Multimodal programs may be a promising option.” – The Spine Journal Volume 18, Issue 5, P866-879, May 01, 2018

What is Sciatica?

Pain stemmed by irritation of the sciatic nerve is commonly called “sciatica.” This nerve is the largest in the body and starts in the lumbar spine. Originating from the L4, L5, S1, S2, S3 spinal nerves the sciatic nerve traverses through the gluteal muscles and down the leg. It controls many of the muscles it passes by such as the glutes, hamstrings, and calf muscles. It is not uncommon to have weakness of these muscles in conjunction with sciatica pain. 

What Triggers Sciatica? 

Sciatica is one of the most frustrating conditions to treat as a health care provider. It can be caused by a number of different condition however the most common reason is impingement of one of the spinal nerves listed above. L5 nerve root is the most commonly affected nerve when assessing sciatica and is usually triggered by a lesion of pathology of the intervertebral disc between the last lumbar vertebra and the sacrum or tail bone. These discs can be damaged for a variety of reasons from heavy lifting, to pathologic conditions, to prolonged wear and tear. 

Are Chiropractors Good for Sciatica?

One of the most searched questions of Google is “are chiropractors good for sciatica?”  And like many of my other posts I will simply say it depends on the chiropractor.  Most chiropractors are quacks.  Yes I am a chiropractor and I just told you that most of my colleagues practice pseudoscience with unproven results that are often unreproducible.  I spend hours educating patients to avoid chiropractors with quick fix techniques and especially those who are resistant to the idea of medicine as an adjunct therapy for treating sciatica.  This condition can be extremely complex and if the patient is unresponsive to chiropractic treatment after 3-4 weeks then the patient must be referred for either advanced testing like MRI or to another provider.  I want to scream at the top of my lungs when a patient seeks me out for a second opinion because they have been treating with their family chiropractor for 3 months and there “sciatic pain just won’t seem to go away doc”.  These are the quacks I am talking about.  

How do Chiropractors Adjust Sciatica?

This question makes me chuckle as we typically don’t “adjust the sciatic nerve”, but this is another one of those highly searched questions on Google so here we go.  As we discussed above sciatica is caused by impingement of the sciatic nerve most often by a disc but sometimes by a vertebral misalignment or peripheral entrapment like a muscle spasm or soft tissue injury.  A chiropractor MUST PROPERLY ASSESS, TEST AND DIAGNOSE SCIATICA TO DETERMINE THE CAUSE OF THE SYMPTOMS BEFORE THEY EVER LAY A HAND ON YOU! This is a theme I see all too often in my office.  The patient has never been given a diagnosis and the chiropractor is over there cracking away on their spine when all too often that is the last thing the patient needs.  

Treatments like spinal decompression and light adjusting are the most effective treatment modalities for treating sciatica.  If diagnosed and treated properly a chiropractor is one of the safest and most effective options for treating sciatica

How much does “it” cost? This is the most awkward question presented to a doctor, but certainly one that must be addressed at some point during care. It is up to us as business owners and health care providers to understand that everything does have a price and what a person values when it comes to their health is entirely subjective. I know how much a visit in my office costs; however, when I meet a new person in a public place the answer is not always so simple. The best answer. I can produce is the cost of chiropractic care can vary from $29-$400/visit or sometimes even more. 

Like every other healthcare profession, the cost of chiropractic care varies for a variety of reasons in Boise and the surrounding Treasure Valley. Reputation of the provider, how busy the office is, is insurance involved and the depth of evaluation and treatments offered, are just a few of the vast differences in cost. Like most other professions, you will find that the majority of practices will be very close in cost with only a couple of practices creating the “outliers” in the range. 

Typically when presented with this question I typically defer to my staff who understands out pricing structure, the patient’s insurance benefits and readapted to answering questions far better than I am when it comes to the cost of chiropractic care in Boise.

Quality of Care

The biggest determining factor in the cost of chiropractic care in our city is the quality of care. Do you want to just get your back “popped” or do you want met o utilize my 8 years of education and provide you a diagnosis, appropriate treatment, and accurate prognosis? If you just want your back popped then you can do that for $29 at a couple of places around the valley, but you put a lot of risk on the line if you choose this approach.

People will spend $50 on a dinner or $200 on a pair of designer shoes, but when it comes to their healthcare, many would prefer the cheapest option available assuming all healthcare is the same and equal. These are my favorite from patients– The soccer mom that woke up on Monday with a kink in her neck rushes to the cheapest place in town, is in and out of the office in 10 minutes, then presents to my office on a Tuesday now with pain shooting down her arm. Now I get it, soccer moms and everyone else in today’s society are very busy with little time for inconveniences, but had that Starbucks touting, Lululemon model spent just a little more time vetting her choice she may have prevented the lengthy and painful treatment in front of her aching neck and arm. 

If you want fas-food then expect that quality. Now don’t get me wrong, I love the quarter pounder too, but when it comes to my body I will pay for the steak dinner. This is more likely to be better for my body than that quarter pounder in the long run. 

Reputation of the Doctor

This one is a big determining factor and it usually correlates with the next topic “how busy is the office?” I will tell you right now that if you want to see. a well-known chiropractor, you are going to pay more than you would for the new kid, fresh out of school. As professionals, we spend our lives honing our craft. Some more than others will spend countless hours researching the latest medical journals, treatment modalities, and tech to improve patient outcomes. Obviously better outcomes and quality of care will produce amazing reputation allowing the doctor to set their prices however they want. The popularity of a clinic is directly related to patient outcomes and marketing efforts. You can have one without the other so it is important to read Google Reviews and also reach out on social media. Chances are one of your friends has seen the doctor you’re considering and they will provide an organic opinion of their experiences. Relying solely on Google, Yelp, and Facebook reviews is naive as these reviews can be bought and paid for.

How Much Does a Chiropractor Cost Without Insurance?

Insurance regulations guide this answer if the clinic accepts any kind of insurance and with the rising costs of healthcare, education of the doctor and overhead most offices cannot afford to be 
“cash only.” If they accept insurance then legally, they can only offer around 20% reduction in costs and services. Private insurers want to make sure that they are not paying more than the soccer mom who showed up with a crisp $100 bill and if the doctor is offering huge discounts to cash paying patients while charging insurance companies more than they are practicing fraudulently. If they are cash only practice plan on $29-$400. Remember you get what you pay for. 

How do Chiropractors Charge? 

We charge just like all other providers. Since we are covered by every major insurance including Medicare and Medicaid, we follow similar billing practices using Current Procedural Terminology (CPT coding) A typical chiropractic visit will consist of 3 codes typically.

1. The Exam: Depending on how complex your problem is this can range from $50-$250
2. The Imaging: Diagnostic imaging is it’s own world when it comes to billing but it usually only required on the initial visit X-Ray $50-$200 depending on medical necessity MRI $600+
3. Treatment: This is where costs can really vary. A typical adjustment will be $30-$100 in Boise but if they use other treatment modalities then plan on another $50-$150

The complexity of questions like “how much does a chiropractor cost in Boise” is why I usually defer to my billing staff. One of my mentors told me “Travis does’t make medical decisions for patients based on what you think they can afford. Present them with the most cost-effective treatments that are NECESSARY and let them make the choice. It’s not your health nor your checkbook!” To this day, that is what I practice and may be the reason our office is the Best in Idaho for the last 3 years.

Chiropractors are Quacks.  And I am a chiropractor. That seems like an odd way to start this post but its really the foundation for this whole website.  You see I spend a large portion of my days and weeks listening to the horror stories from my patients about their experiences at other chiropractic offices both local and afar.  Tales of massive care plans without scientific justification,”nutriceuticals”, vitamins, and snake oils mixed with far fetched impractical treatment modalities get trapped in my office. Justly these tales should be shouted from mountains on high for the rest of the world to hear so we can move forward out of the fairytale shadows of our “founders” into the light of mainstream healthcare where we might actually serve humanity instead of being the laughing stock of the industry.  

Chiropractors are not quacks in all honesty but are actually their own worst enemy.  Practicing in a world with information at the fingertips our patients are more educated than ever which demands our respect as provider to teach them the foundations of their illness and the science behind their treatments.  Very few chiropractors do this, leaving patients to rely on the internet for understanding and lets face it the internet is not friendly to chiropractors.  

Where did it start?

This is where I’m going to piss off some of my colleagues.  Our entire profession since that cloudy day on September 18, 1895 is based on a story of curing deafness with a chiropractic adjustment.  Tell someone today that you can cure their deafness by “popping their spine” and they are likely to run out the door and possibly report you to your professional board.  However; a small minority will hang around and hope for the best and there have been a handful of studies since 1895 that substantiate curing hearing loss with chiropractic: (http://www.ncbi.nlm.nih.gov/sites/entrez/8002367?dopt=Abstract&holding=f1000,f1000m,isrctn)

http://www.ncbi.nlm.nih.gov/sites/entrez/3590487?dopt=Abstract&holding=f1000,f1000m,isrctn

However; this is 2022, and if you are going to earn the respect of your patients as well as your fellow health care providers you better be prepared to educate properly to justify taking hundreds and sometimes thousands of dollars for non-conventional treatment options.  If you don’t you will look like a quack.

Being honest with patients

Allopathic medicine is the most diversified form of healthcare in the history of humanity.  There are specialists and subspecialists for every major system in the human body.  So why the hell do chiropractors think they can heal every condition in the MERC manual?  The truth is they are brainwashed in school that man’s “innate intelligence” can heal everything.  I wont lie, I have seen some miracles happen in my office, but I would never hang my hat on them until they were reproducible.  I once had a patient tell me they saw a chiropractor who claimed they could heal their Type 1 diabetes.  The patient walked out the door and never went back.  THE ONLY REASON I EVER SAW THAT PATIENT WAS BECAUSE THEY PRESENTED WITH LOW BACK PAIN AND THEY WERE REFERRED BY THEIR PRIMARY CARE PROVIDER.  

The take away…

I guess the main point of this rant and really this entire site is to show you that chiropractors should not be taken seriously until they earn your respect and confidence.  If it looks, sounds and acts like a “quack” then run! There are great chiropractors out there that can diagnose, educate, and treat when appropriate, but chances are you are going to have to see a few before you find the right one.