People in Taiwan are exercising more and engaging in more sports. Extreme sports such as marathons, triathlons, and cycling races, as well as intense workout regimens such as CrossFit are becoming increasingly popular. But with all of this exercise comes the risk of injury, particularly in middle-aged office workers who otherwise lead sedentary lives. Further, as Taiwan’s population rapidly ages, efforts to encourage more active lifestyles among the elderly can run into the challenges of arthritis and joint pain that can inhibit those same people from getting adequate exercise.
But do Taiwanese have access to proven treatments that foster recovery from musculoskeletal injury and infirmity to enable more active lives? Unfortunately, no, according to medical experts, who fault the inadequacy of the National Health Insurance (NHI) system for failing to provide effective physical therapy (PT) for those in need, while continuing to reject proven treatments such as chiropractic that play an important role in maintaining joint health around the world.
“When you are in the national healthcare system, you are limited in access to real care,” asserts Dr. David Hang, head of the Shin Kong Orthopedic Sports Medicine clinic in Taipei, who trained in sports medicine at UCLA. “Even though we are getting adequate care here, certainly we are not getting the best care.”
Ailments that might impede movement range from joint injuries such as ACL (knee ligament) sprains or tears, to muscle cramps and strains, and include osteoarthritis, tendonitis, and back pain. Under NHI, patients have a range of options for treatment, including PT clinics, conventional orthopedic surgery, and traditional Chinese remedies such as acupuncture, acupressure, and “bone cracking” or spinal manipulation.
Despite that range of options, the treatments available may be insufficient. First, although many doctors in Taiwan claim to do “sports medicine,” a subspecialty of orthopedics specialized in sports-related injury and rehabilitation, the discipline is undeveloped in Taiwan, according to Hang. After years of experience treating acclaimed athletes and celebrities at UCLA’s sports medicine clinics, Hang was recruited by Shin Kong to provide sports medicine guidance and treatment to Taiwan’s athletes and weekend warriors alike.
“We have six professional basketball teams and eight professional baseball teams; somebody needs to take care of these athletes,” he says “They usually went to the U.S. or somewhere else, but when I came back, they all came to me.”
Hang contrasts the typical treatment for joint pain and back discomfort provided at a local PT clinic with the U.S.-style treatment provided at his clinic. “In the NHI system you come in and they put you on the electrical stimulator and the traction table – all of which are minimally labor-intensive. One helper can set up 10 patients on stimulators, but we know that these things are the least effective,” he says. By contrast, “our therapist here spends the whole hour taking care of a patient. They do a lot of manipulation and a lot of massage and adjustment. These are the things that really work. With all therapy it’s been proven that manual treatment is what works.”
The difference between these two PT regimens is clear also in the price. While an hour of PT in a local clinic typically costs NT$50, an hour in Hang’s clinic costs NT$1,000-$1,500, as the treatment is not covered by NHI.
Within sports medicine, opinions differ on the efficacy of electrostimulation, ultrasound, and massage therapy in physical rehabilitation. Research findings are often contradictory, perhaps owing to the complexity of the conditions and differences in how individuals respond to treatment.
Chiropractic is another alternate to the typical PT offered in Taiwan’s clinic, but despite global acceptance it is not recognized in Taiwan as a professional discipline, let alone covered by NHI.
Chiropractic is a field of alternative medicine focused on the treatment of musculoskeletal conditions primarily through spinal manipulation. Chiropractic treats “Subluxations” – which the discipline describes as spinal nerve transmission blockages caused by misalignments or dislocations in the spine. Albert Lee, a Taiwan-born but U.S.-raised doctor of chiropractic, explains that subluxations are at the root of a variety of diseases and illnesses, and that through spinal manipulation, the pressure on the spinal nerves can be eased, allowing the body to heal itself through “innate intelligence,” a term used in chiropractic that Dr. Lee interprets as the “immune system.”
Lee says that he first learned about chiropractic when his mother received successful treatment from a chiropractor for chronic pain resulting from a car accident. He subsequently sought chiropractic treatment for a stubborn case of tennis elbow, which was also quickly relieved.
“I was familiar with traditional Chinese medicine and with acupuncture and also conventional medications, but this was something new,” he recalls. “So I wanted to learn more about chiropractic, and once I learned more I decided I wanted to be a chiropractor.”
While chiropractic’s track record of relieving pain and promoting mobility – safely and without surgery or medication – is longstanding, Taiwan is one of the only places in the world where the field is not officially accepted. Lee attributes that situation to opposition from the Taiwan Medical Association, which has considerable influence over the Ministry of Health and Welfare. Treatment at Dr. Lee’s clinic costs NT$1,000 per session.