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Doctors sceptical about value of new chiropractic technology

LOOKING at the skeleton suspended in front of me, I was shocked to see how crooked it was.

The hips tilted over to the right side, the spine to the left and the shoulders hunched over like someone very elderly.

It looked painful. And I knew it was, because this was my back, and it had been giving me problems for about 15 years. I was using virtual reality (VR) technology to see for the first time what could be triggering my back pain and stiffness.

Although I was sceptical at first, something clicked as I examined the 3D image. It suddenly seemed glaringly obvious that my poor posture was putting painful stress on my back and joints.

Seeing my problems “in the flesh” – albeit virtually – finally helped me understand why I might be in pain.

First step

“Understanding is the first step towards getting better,” said Matt Flanagan, a chiropractor at Back To Health, the West London clinic behind the technology.

‘If we can’t engage patients with what’s wrong, we’re not going to change their behaviour and get them to stick with their exercises,” he added.

“Virtual reality is a way of communicating we’ve never had before. Patients struggle to fully understand X-rays, but when they see the 3D image, they’re able to join the dots.”

Matt Flanagan and his team spent four years working with developers to perfect the software. It relies on patients having X-rays of the upper and lower spine from the front, back and sides.

The chiropractor reads these and inputs into the software how many degrees off the recognised standard curve each part of the spine is, generating a 3D image. Currently focused on spines, the technique will soon be available for hips, ankles, knees and shoulders, as well as muscles and tendons.

There are plans to licence the software, the first of its kind in the world, for use by private osteopaths and physiotherapists by the end of next year.

Colleagues recommended I try VR therapy, as they thought my posture – I spend hours each day slumped in front of my desk – was the cause of pain in my shoulders and lower back.

The process takes around 30 minutes, although it is being offered as part of two one-hour sessions, including chiropractic treatment.

At the clinic, a chiropractor took photos of my posture as I stood still and then took four X-rays. They immediately appeared on a digital screen and apparently showed my spine and hips were misaligned by several degrees, putting stress on my joints.

I nodded intently as Flanagan talked about numbers, but it was not until I put on the VR headset that what he meant really hit home. Through the headset, I could see an empty clinic with two spines suspended in the air – one normal, one mine.

If I moved my head, the view moved, meaning I could walk around the virtual spines and view them from every angle.

Seeing the difference between my spine and the normal one made me straighten up at once, and the effort it took was a wake-up call that I must exercise to improve my weak core muscles (the muscles in the belly and the mid- and lower-back that support the spine).

However, what I saw was not really my spine but a virtual reconstruction based on the reading of X-rays. If a practitioner misreads the X-ray, the 3D image patients see will not be accurate.

Furthermore, Roger Kerry, an associate professor of physiotherapy education at the University of Nottingham, warned that most back pain will not have its roots in poor posture.

“The idea that pain must be caused by structural faults in your spine has been conclusively refuted by research,” he said.

“We know people’s pain is prolonged if they have misguided beliefs about what is causing it, so this gimmick could impede evidence-based treatments patients should be having.”

Mo Akmal, a spinal surgeon at the London Spine Unit, was equally sceptical. “People get caught up with fancy images, but this doesn’t tell us why someone’s posture is like that or whether it’s advisable to alter it,” he said.

“The amount of radiation for an X-ray of the spine is huge. There are many non-invasive measures available to assess posture.”

NICE guidelines recommend patients are not offered back X-rays and scans because the normal age-related damage that shows up is rarely the cause of pain. As many as 80% of over-50s have some degeneration of the spine without displaying symptoms.

While I agree VR might be a gimmick, it helped me get a better understanding of my posture and how that could be linked to my back and shoulder pain. If nothing else, I’ll certainly be sitting up straighter from now on. – Daily Mail

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