A chiropractor is a health care professional or provider concentrated on the diagnosis and treatment of neuromuscular disorders, with an emphasis on treatment through manual adjustment and/or manipulation of the spine. Most chiropractors aim to lower pain and improve the functionality of patients as well as to educate them on how they could account for their own health via exercise, ergonomics, and other therapies to treat back pain. Chiropractic is normally classified as alternative medicine or complementary medicine.
Chiropractors: Fundamental Beliefs and Goals
Chiropractors concentrate on the intimate relationship between the nervous system and spine, and carry on the following beliefs:
- Biomechanical and structural derangement of the spine could affect the nervous system
- For many conditions, chiropractic treatment could restore the structural integrity of the spine, lower pressure on the sensitive neurological tissue, and therefore improve the health of the individual.
The treatment concept of chiropractic is to re-establish natural spinal mobility, which in turn soothes the irritation to the spinal nerve and/or re-establishes changed reflexes.
Conditions Treated
Chiropractors use a variety of non-surgical treatments to treat patients with specific types of:
- Lower back pain and/or leg pain (sciatica)
- Neck pain
- Repetitive strains
- Headaches
- Sports injuries
- Car accident injuries
- Arthritic pain
While mainly concentrating on treating neuro-musculoskeletal disorders, chiropractors are not exclusively restricted to problems with the nervous system and musculoskeletal system.
When appropriate, chiropractors refer patients to medical doctors or primary care physicians, or other health practitioners for treatment of lower back pain. Many chiropractors have a local reference network or work together with other spine specialists at a multi-disciplinary or multi-specialty spine clinic.
In many regards, a chiropractic exam is very similar to normal exam procedures administered by all health care providers. With that said, how chiropractors assess the structure and function of the spine and then determine certain chiropractic treatments separates chiropractic care from other disciplines.
CHIROPRACTIC EXAMINATION
Chiropractic Examination of Lower Back Pain
A primary or first chiropractic examination for back pain will generally have 3 parts: a consultation, case history, and physical exam. Laboratory analysis and X-ray exams might be performed.
- Consultation – The patient meets with the chiropractor and gives or provides a concise summary of his or her lower back pain, for example:
Duration and frequency of symptoms
Description of the symptoms (for example burning, throbbing)
Areas of pain
What makes the pain feel better (for example sitting, stretching?)
What makes the pain feel worse (for example standing, lifting)? - Case history – The chiropractor figures out the regions of complaint and the nature of the back pain by asking questions and learning more about different regions of the patient’s history, including:
Family history
Dietary habits
Background history of other treatments (chiropractic, osteopathic, medical and other)
Occupational history
Psychosocial history
Other regions to probe, usually based on responses to the above questions. - Physical exam – A chiropractor might make use of a variety of methods to determine the spinal segments that need chiropractic treatments, including but not restricted to static and motion palpation techniques determining spinal segments that are hypo mobile (limited in their motion) or fixated. Depending on the results of the above exam, a chiropractor might use additional diagnostic tests, for example:
X-ray to locate subluxations (the changed position of the vertebra)
A device that detects the temperature of the skin in the para-spinal area to find spinal regions with a significant temperature variance that needs manipulation.
Many chiropractors make use of a holistic, biomechanical concept of treating the bipedal structure in its completeness, in an attempt to balance the structure from the feet upward.
Chiropractors are general trained in multiple methods of evaluating lower back pain, including:
Evaluation and management services – Chiropractors are trained in evaluating the joints, bones, muscles, and tendons of the spine, head, extremities, and other regions of the body with the purpose of noting any incorrect alignment, tenderness, asymmetry, defects, or other problems.
Neurologic and other common physical exam procedures – Chiropractors are trained to perform an assortment of neurologic tests (nerve root compression/tension, motor strength, coordination, deep tendon, and pathological reflexes, etc.) and are skilled in performing orthopedic, cardiovascular, and many other common exams.
Specialized assessment – Chiropractors are trained to evaluate a range of motion, stability, muscle strength, muscle tone, and other evaluations with the lower back.
Common diagnostic studies – Chiropractors are trained in the use of diagnostic studies and tools for example radiography (X-rays), lab diagnostics, and neuro-diagnostics.
CHIROPRACTIC DIAGNOSIS
In the evaluation of lower back pain, differential diagnosis utilizing a “triage” concept of categorizing low back injuries into one of three categories helps to guide the doctor or primary care physician of chiropractic. These categories of chiropractic diagnosis involve:
- Potentially severe – Tumor, infection, fracture, major neurological issue (cauda equina), local open wound or burn, prolonged bleeding (hemophilia), artificial joint implant issues, pacemaker issues, joint infection
- Nerve problem – When the nerve root in the low back is squeezed or compressed, causing radiculopathy (sciatica). General causes of nerve root pinching include a lumbar herniated disc, spondylolisthesis, and spinal stenosis
- Non-specific – Mechanical back pain in the spinal column. This kind of lower back pain is the most common presentation and includes pain for which there is no recognizable cause.
With chiropractic diagnosis of potentially severe injuries, the chiropractor will generally refer the patient to a relevant medical specialist and possibly a surgeon, and as appropriate, the chiropractor might co-manage the patient’s care with other back pain specialists. With this categorization, chiropractic manipulation is generally avoided over the relevant anatomy.
With chiropractic diagnosis of a nerve root issue causing sciatica and/or non-specific or general causes of low back pain, chiropractors generally describe the symptoms experienced on the following scale:
- Acute (symptoms lasting less than six weeks)
- Subacute (symptoms lasting between six and twelve weeks)
- Chronic (symptoms lasting for twelve weeks or more)
- Recurrent/flare-up (symptoms are identical to original symptoms and return sporadically or as a result of exacerbating circumstances).
These lower back pain or sciatica symptoms might be further broken down as mild, moderate, or severe in pain.
CHIROPRACTIC ADJUSTMENT
A chiropractic adjustment is also called chiropractic manipulation, manual manipulation, or spinal manipulation, is a normal therapeutic treatment for lower back pain. A chiropractic adjustment indicates a chiropractor using manipulation to the vertebrae that have abnormal movement patterns or fail to function generally. The objective of this chiropractic treatment is to lower the subluxation, with the goals of increasing range of motion, lowering nerve irritability, and improving function.
Chiropractic Adjustment Description
A chiropractic adjustment generally involves:
- A high-velocity or speed, short lever arm thrust or push applied to a vertebra
- An accompanying or following, audible or hearable release of gas or joint cavitation that is caused by the release of oxygen, nitrogen, and carbon dioxide, which releases joint pressure or cavitation
- A relieving feeling most of the time, however, minor discomfort has been reported (that generally lasts for a short time duration) if the surrounding muscles are in spasm or the patient tenses up during this chiropractic care.
It should be called that joint cavitation or cracking does not happen at times, generally as a result of significant muscle splinting or the patient not being sufficiently relaxed during the chiropractic manipulation. At times like this, it is sometimes best for the chiropractor to apply ice, have the patient rest, or do electrical stimulation and massage before attempting the chiropractic adjustment.
Chiropractic Adjustment Side Effects
The most normal reaction to a chiropractic adjustment is aching or tenderness in the spinal joints or muscles. If this aching or tenderness happens, it is generally within the first few hours post-treatment and does not last longer than 24 hours after the chiropractic adjustment. Application of an ice pack usually lowers the symptoms relatively quickly.
The focus on spinal adjustment is what makes doctors or primary care physicians of chiropractic unique in their approach to treating patients with spinal complaints. The chiropractic adjustment, although, might not be the only procedure a chiropractor might employ in managing a patient’s care. For instance, chiropractic care has utilized drugless therapeutics (natural therapies) since as early as 1912.
Natural agents for example heat, cold, water, massage, light, and exercise are some of the physiological therapeutic measures that are usually utilized by chiropractors. When controlled, these and other elements exert a beneficial influence on body functions and could help a number of common lower back pain problems.
CHIROPRACTIC SERVICES BEYOND ADJUSTMENTS
Common Types of Chiropractic Therapy
A few physiological therapeutic measures which are typically used in chiropractic care include:
- Heat and cold – Chiropractors might alternate between heat and ice therapy to help patients treat back pain. Ice packs might be used to numb the back for a ten to fifteen-minute period and then switched with a heating pad, heat wrap, or hot water bottle to restore blood flow to the region and promote faster healing.
- Exercise – Chiropractors can guide patients through an exercise program that focuses on stretching and strengthening the back.
- Massage – Chiropractors might massage the soft tissues to improve circulation, lower inflammation, and soreness related to back pain, and encourage quicker recovery.
- Dietary management – Many chiropractors will offer patients tips on how an improved diet might help with their back pain, and some might suggest dietary supplements after spinal manipulation.
- Ultrasound – With ultrasound, sound waves make deep heat therapy that is applied to the soft tissues and joints. Basically micro-massaging the soft tissues and joints, ultrasound therapy cannot only help lower back pain, solidness, and spasms but increase blood flow and accelerate or quicken the recovery process.
- Diathermy – A type of shortwave, electro-magnetic therapy that goes through the softer tissues and gives heat to denser tissues, diathermy relaxes the muscles and conjoining tissues, decreases muscle spasms, and quickens the recovery process by increasing circulation. In chiropractic treatment utilizing diathermy, the treated region will generally feel pleasantly hot.
- Hydrotherapy – Using water and changing its temperature and pressure via hot baths, whirlpools, saunas, or wraps, hydrotherapy concentrates on the body’s reaction to hot and cold stimuli. In chiropractic, hydrotherapy might be used to lower the sensitiveness of back pain by cold stimuli that numb the pain and the use of warm stimuli to promote blood flow and faster recovery.
- Electrical muscle stimulation – During this chiropractic therapy, electrodes are planted on the skin that sends light electrical pulses to different regions of the body with the purpose of lowering swelling, curtailing muscle spasms, and easing back pain.
- Transcutaneous electrical nerve stimulators (TENS) – The most common type of electrical stimulation, transcutaneous electrical nerve stimulators (TENS) units feature electrodes that are planted over the painful region with the user having the power to control the intensity or power of electrical stimulation. It is believed that transcutaneous electrical nerve stimulators (TENS) help obstruct the transmission of pain signals along the nerves and also release the body’s natural painkillers, endorphins.
- Traction – A chiropractic traction massage might include the patient lying face-up as a system of rollers moves about the back, all the while stretching and massaging the muscles in the back. Chiropractors might use other traction devices that stretch the spine, decompress the discs and lower the pressure on the nerve roots (a procedure called non-surgical spinal decompression).
- Infrared radiation – In chiropractic, a thermal camera might be used to image colored hues showing the blood flow in the back. For instance, red hues would indicate higher infrared radiation (IR) radiation and more blood flow in the back. Infrared radiation (IR) might be used by chiropractors to differentiate normal temperature changes from abnormal differences and to evaluate hidden conditions that are causing back pain.
- Cold laser therapy – With cold laser therapy, particles of energy are transported in a laser and absorbed by the cell membrane’s photoreceptors after entering the skin surface. The cells and tissues then convert this light energy into biochemical energy, fueling a biological process that is believed to lower inflammation, lower back pain, and swelling, and improve circulation.
- Ergonomics – During the course of chiropractic care, the chiropractor might suggest some modification for example a work station change that is applied at home and/or at work. The success or failure of obtaining patient satisfying outcome might be directly associated with applying an ergonomic/job-associated modification or a hobby-related irritating activity.
- Pelvic stabilization – When leg-length deficiency, flat feet, and/or subtalar instability are present, the chiropractor might place a small heel lift in the shoe on the short leg side and/or prescribe corrective arch supports to help balance the pelvis.
- Patient education – A chiropractor might advise a variety of lifestyle modifications, including diet and nutritional programs, self-care, and coping strategies, to the patient suffering lower back pain.
These procedures may or may not be utilized by the chiropractor in the course of a patient’s case management depending upon their certain requirements.
Chiropractic Manipulation and Therapies
Utilizing certain manipulations (chiropractic adjustments) in conjunction with one or a combination of the above, the chiropractor’s aim is to remove structural or nervous system irritation that might be an important contributing factor in a patient’s lower back pain.
Cardio-vascular and strengthening activities or exercising combined with chiropractic care are important in the management of low back pain.
If a patient has a past or history of cardiac issues, it is crucial for the patient to consult not only the doctor of chiropractic but their primary care physician to be specific that they could tolerate cardiovascular fitness-promoting activities or exercises. Specific directions are provided by the chiropractor regarding the appropriate exercise for the patient’s condition before starting any exercise program.
Generally, a reasonable amount of exercise that is performed every day and utilizes activities that are enjoyed is suggested for patients undergoing chiropractic treatment.
EXERCISE AND CHIROPRACTIC THERAPY
Exercise Benefits
Many researchers have reported the significance of exercises or activities in handling acute and chronic low back pain, strengthening the low back, stopping and keeping back patients working, and improving quality of life. The strength of the abdominal muscles was also discovered to be able to differentiate between those with vs. without chronic LBP.
Overall and when combined with chiropractic care, aerobic exercise helps promote good digestion, maintains the muscles in a good tone, and promotes improved circulation. Walking briskly or fast around the block at least once or twice is a convenient and popular activity.
Also, many types of work and/or household tasks could function as an exercise program. The crucial point is to exercise!
Types of Exercises
There are many applicable back exercises or activities that are available for patients also experiencing chiropractic care for lower back pain. One could categorize the chiropractic patient into a flexion or extension biased category to decide the variety that is best or correct for that patient.
For instance:
- If a patient feels best or better when bending over (flexion biased), exercises or activities that promote low back flexion for example pulling the knees to the chest, posterior pelvic tilts, bending forward from a sitting position, and others are generally helpful.
- If a patient is least symptomatic in extension, particularly if leg pain centralizes or decreases (extension biased), prone press-up type exercises or activities generally yield the best results.
Other exercises that could help lessen lower back pain include:
- Strengthening of the pelvic balancing muscles (trunk muscles)
- Stretching of hamstrings, adductors, and other postural muscles that are too short or tense
- Proprioceptive or balance promoting
Reported Effectiveness of Exercise in Chiropractic Care
As stated by the Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP):
- Strong evidence or proof supports exercise as being at least as effective as other non-surgical treatments for chronic low back pain
- Moderate evidence or proof supports the use of a graded-activity exercise program in occupational settings for subacute lower back pain
- Some evidence or proof shows that exercises are no more effective than other non-surgical treatments for acute lower back pain.
As with any chiropractic treatment, it is crucial for chiropractors to perform a focused re-assessment of an exercise program following its initial or first therapeutic trial to decide its effectiveness. Using a spinal range of motion as a measurement of the effectiveness of exercise is just one way in which chiropractors could make such determinations.
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