After his cancer radiation sessions, Nirmal Bhartiya started experiencing severe back pain in 2014-15. That is when, after many visits to several doctors, someone referred him to a chiropractor based in Delhi’s Nizamuddin East. “Within two weeks, my back pain was almost gone,” said Bhartiya, 65, a businessman. The first session lasted about 10-15 minutes, and he could feel the difference. He has now taken it upon himself to refer patients with chronic issues that need spinal adjustments to Dr Shiv Bajaj.
“Ninety per cent of orthopaedic condition should be treated conservatively; rarely you need surgeries. Surgeries should only be restricted to tumours, fractures and the like. It should not happen on the basis of back and neck pain,” said Dr Bajaj. While surgery has become commonplace in today’s medical field, chiropractic treatment administered at the right time by a licensed and trained chiropractic professional can prevent medications and surgical interventions, and is the “missing link” between physiotherapy and orthopaedics in India, Dr Bajaj, who has been practising for 11 years, said.
Rita Gupta, a 66-year-old housewife, who had severe sciatica pain — with her left leg experiencing numbness — agreed. “I was not able to stand properly. Surgeons suggested spine operation but I didn’t want that, so I took chiropractic treatment. While I was given a treatment window of six months, I was able to walk after two months, which was no less than a miracle.”
What is chiropractic treatment?
As a licensed healthcare profession related to understanding the nerves, chiropractic treatment involves manual therapy–using hands–and includes spinal manipulation. According to the US Department of Health and Human Services, chiropractors perform adjustments to the spine or other parts of the body. This simply means by correcting alignment problems, the patient’s pain is eased, which improves the body’s natural ability to heal itself.
“If there is spinal pain, we treat the imbalances in the joint or muscle rather than looking at exercises or spending an expensive amount on machines or medicines to kill the pain. A modern-day chiropractor does not only treat with hands. We use certain advanced technologies also,” said Dr Bajaj, who specialises in CT disc herniation. He added that spinal manipulation, manual techniques, and therapy instruments are some of the chiropractic approaches taken by practitioners.
“We are similar to orthopaedic surgeons. Our diagnosis, MRI, X-ray, radiology background are similar. The only difference is they would do the surgery when there is a pharma-surgical intervention. We can come in prior to that if it is not quite surgical such as in cases of disc problems or nerve compressions. Orthopaedic doctors or physiotherapists might do spinal manipulation, but chiropractors have expertise in specific spinal adjustments,” Dr Amit Jimmy Nanda, who represents India at the World Federation of Chiropractors, and is the chairman of the Indian Association of Chiropractic Doctors — the only registered association in India that is self-regulating at the moment — said.
“The doctor first scans all your reports to understand the root cause of the issue, and then they examine the elbow, spine, neck etc., for spinal manipulation,” said Madhav Inder Singh, 45, a Gurgaon-based business professional who met with an accident that caused him a spinal injury 18 years ago. Through his wife Simrit, a Canadian citizen, he was apprised about chiropractic treatment which is considered the “first line of treatment abroad”, and that is when he came in touch with Dr Nanda. “I underwent treatment for the first 6-8 months in Canada where I was required to go for the sitting thrice initially. It is better than popping pills. I could move my body within the first 6-8 months and that too without any invasive measures. Now, whenever there is even slight pain, I can visit the chiropractor at Gurgaon’s South Point Mall,” said Singh.
How is the treatment done?
Chiropractic treatment involves muscles, bones, joints and connective tissues such as cartilage, tendons and ligaments. In layman’s terms, imagine it to be cracking of the knuckles and back, world-ranked tennis player Yuki Bhambri who swears by the treatment, told indianexpress.com, “albeit in a much more professional way”.
During your first visit, the chiropractor will go through the medical history, and then follow it up with a physical examination where they will check for tenderness and tightness, as well as how well the spinal joint moves. “This involves extensive radiology, MRIs, X-rays, CT Scan reports to understand the root cause of the issue which can be mechanical (how the spine moves) or neurological (nerve-related),” explained chiropractor Dr Nanda, 43, based out of Canada. He added, “The treatment only targets the specific area of the nerve or muscle – where it is adjusted, and 99 per cent of the time, the patient feels the difference.”
If you go to a chiropractor complaining of lower back pain, they check the entire spine–neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). “It’s important to examine the entire spine because even though it’s just your lower back that hurts, other regions of the spine may be affected,” explained Dr Nanda.
Taking the instance of how chiropractors are readily available in labour rooms in the USA for checking the newborn’s spine to treat the “dis-functions right at the start”. Dr Nanda explained how for some patients with symptomatic causes, a sample visit works; some chronic cases may see results in a few months’ time. Early diagnosis and timely treatment help one to get back to their daily life more quickly and organically.
It is known to help with neck and lower back pain, back sprain injuries, sciatica, inflammation, chronic headaches, neurological conditions as well as blood pressure. Dr Nanda quoted a research article Mahatma Gandhi’s Health Restored by Chiropractic published in The National Chiropractic Journal that documented how in 1942, Mahatma Gandhi could not attend rallies because of high blood pressure. “So, he had a British chiropractor from Calcutta (present-day Kolkata) who moved in with him for three months; and that was the remedy. Then, he was able to go to rallies. Chiropractic treatment has an amazing history. But unfortunately, when the British left so did the educational system,” he mentioned.
Challenges in the field
While physiotherapy and orthopaedic fields are known, there is not much awareness about chiropractic treatment. “India has no school teaching chiropractic. Now, a lot of people claim to be chiropractic but very few, in fact, only 14 chiropractors in India are registered with the association are licensed practitioners,” mentioned Dr Nanda.
Dr Bajaj said the number of actual practitioners, at any given time in the country, “fluctuates between 7-10”. “Mostly expats or visiting doctors are there. The lack of awareness is because of regulatory issues as a certain number of doctors need to be there before government regulation kicks in. “This makes it challenging. We are right now, self-regulatory as an association. Without regulation, it is difficult to start a college for a proper doctorate. One needs to understand chiropractic is not a certification; it is not a technique, it is a profession,” explained Dr Bajaj, while differentiating how the study of doctor of chiropractic takes eight long years, unlike physiotherapy that takes four.
Notably, chiropractic schools are only available in USA, Australia, France, UK and Canada, whereas physiotherapy institutes are available across India.
“On international grounds, chiropractors are doctors. So, we have the right to diagnose and treat. We are not therapists. It is completely a new domain for India and a huge opportunity. Close to 400-500 physiotherapists label themselves as chiropractors and there are no regulations. You can’t take any action against them. The public suffers at large,” he rued.
Dr Alison Bale, 54, a British chiropractor who was practising in Goa shared how the practice was “great” for her until COVID-19 struck. “I came to India in 2007 because I wanted the adventure of working in a new country. It has been a fulfilling experience. I have ceased my practice because of COVID-19 since January 2020, as well as some other pressing personal reasons. As a foreign national, working in a service-oriented sector has its own challenges because it takes at least 3-4 years for people to get to know you,” Dr Bale, who graduated in chiropractic from the United Kingdom, and is currently taking online classes as a mindfulness teacher, explained.
There are 70,000 chiropractic doctors in the US, as it is the third-largest health profession in the world after general practice and dentistry; Canada with a population of about 33 million people has over 7,000 doctors, while India — with 7-10 licensed chiropractors — is a “stark contrast”. “Licensed chiropractors are easily accessible in the US. You have to really search for one here. I think people have not really picked it up in India because it requires just five minutes of your time and, therefore, is not appreciated. Taking more time for treatment equals better recovery is a wrong perception,” explained Bhambri, adding how he and a lot of other tennis professionals vouch for this treatment for its ability to improve the body’s range of motion (which is necessary as restricted spinal motion or when the spine doesn’t move as well as it should, can cause back pain).
What does the future hold for the practice in India?
“Right now, the plan is to open up three schools — including in Gujarat and Haryana — and start with a full-doctorate programme. We are right now working through the legalities. End of 2021, we could possibly have the first batch,” said Dr Nanda, stating the schools will be operated in association with the American chiropractic school Life Chiropractic College West, San Francisco.