Chiropractic Adjustments

and other therapy and treatments

CHIROPRACTIC is the Science, Art and Philosophy that concerns itself with the restoration of good health by restoring and maintaining a properly functioning nervous system, without the use of drugs or surgery. Chiropractic is based on the scientific fact that your body is a self-regulating, self-healing organism.

These important functions are controlled by the brain, spinal cord, and all the nerves of the body. The skull protects the delicate tissues of the brain. The moving bones of the spine protect the vulnerable communication pathways of the spinal cord and nerve roots. If the nervous system is impaired, it can cause malfunction of the tissues and organs throughout the body. Doctors of Chiropractic call this the Vertebral Subluxation Complex. The Chiropractic adjustment has been proven to increase motion, increase circulation, reduce swelling and pain, and remove nervous irritation. Once this nervous irritation is removed, your body is able to do what it is designed to do – heal itself.

Chiropractors help in restoring nervous system function. Many chiropractors also focus on the biomechanics of the body such as joint motion. Helping to restore proper spinal biomechanics and improved nervous system function begins with a case history. Your case history is vital, as it reveals the background about your health such as surgeries, accidents, the onset of your condition, and other details, which brought you into the office. After reviewing your history and discussing your specific problem, a thorough orthopedic, neurological, and chiropractic examination is performed. X-rays may be taken which will help uncover structural and functional problems. Then, once the examination is complete, your chiropractor will explain the findings and outline a treatment plan. Progress is then monitored with periodic examination and follow-up reports.

Many studies have concluded that manual therapies commonly used by chiropractors are generally effective for the treatment of lower back pain1-2, as well as for treatment of lumbar herniated disc for radiculopathy3-4 and neck pain, among other conditions.5

In fact, when patients with non-specific chronic low back pain are treated by chiropractors, the long-term outcome is enhanced by obtaining maintenance spinal manipulation after the initial intensive manipulative therapy.6

Chiropractic Adjustment Description

A chiropractic adjustment typically involves:

  • A high velocity, short lever arm thrust applied to a vertebra
  • An accompanying, audible release of gas (joint cavitation) that is caused by the release of oxygen, nitrogen, and carbon dioxide, which releases joint pressure (cavitation)19
  • A relieving sensation most of the time, although minor discomfort has been reported (that usually 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 known that joint cavitation or cracking does not occur at times, typically as a result of significant muscle splinting or the patient not being adequately relaxed during the chiropractic manipulation. At times like this, it is sometimes best for the chiropractorto apply ice, have the patient rest, or do electrical stimulation and massage prior to attempting the chiropractic adjustment.

Chiropractic Diagnosis

In the assessment of lower back pain, differential diagnosis utilizing a "triage" concept of classifying low back injuries into one of three categories helps to guide the doctor of chiropractic. These categories of chiropractic diagnosis include:

    1. Potentially serious: tumor, infection, fracture, major neurological problem (cauda equina), local open wound or burn, prolonged bleeding (hemophilia), artificial joint implant problems, pacemaker problems, joint infection

See Cauda Equina Syndrome Symptoms

  1. Nerve problem: when the nerve root in the low back is pinched or compressed, causing a radiculopathy (sciatica). Typical causes of nerve root pinching include a lumbar herniated disc, spondylolisthesis, spinal stenosis
  2. Non-specific: mechanical back pain in the lumbar spine. This type of lower back pain is the most common presentation, and includes pain for which there is no identifiable cause.

With chiropractic diagnosis of potentially serious injuries, the chiropractor will typically refer the patient to a relevant medical specialist and possibly a surgeon, and as appropriate the chiropractor may co-manage the patient's care with other back pain specialists.7 With this classification, chiropractic manipulation is typically avoided over the relevant anatomy.

Common Forms of Chiropractic Therapy

Some physiological therapeutic measures that are often utilized in chiropractic care include:

  • Heat and cold. Chiropractors may alternate between heat and ice therapy to help patients treat back pain. Ice packs may be used to numb the back for a 10 to 15 minute period and then switched with a heating pad, heat wrap or hot water bottle to restore blood flow to the area and promote faster healing.
  • Exercise. Chiropractors may provide patients with instructions for an exercise program focusing on stretching and strengthening the back. For more information, see Exercise and Chiropractic Therapy.
  • Massage. Chiropractors may massage the soft tissues to improve circulation, reduce swelling and inflammation associated with the back pain, and encourage quicker healing. See Massage Therapy for Lower Back Pain.
  • Dietary management. Many chiropractors will provide patients with tips on how an improved diet may help with their back pain, and some may recommend dietary supplements after spinal manipulation.

Chiropractic Exam of Lower Back Pain

An initial chiropractic exam for back pain will typically have three parts: a consultation, case history, and physical examination. Laboratory analysis and X-ray examination may be performed.

  1. Consultation. The patient meets with the chiropractor and provides a brief synopsis of his or her lower back pain, such as:
    • Duration and frequency of symptoms
    • Description of the symptoms (e.g. burning, throbbing)
    • Areas of pain
    • What makes the pain feel better (e.g. sitting, stretching)
    • What makes the pain feel worse (e.g. standing, lifting).
  2. Case history. The chiropractor identifies the area(s) of complaint and the nature of the back pain by asking questions and learning more about different areas of the patient's history, including:
    • Family history
    • Dietary habits
    • Past history of other treatments (chiropractic, osteopathic, medical and other)
    • Occupational history
    • Psychosocial history
    • Other areas to probe, often based on responses to above questions.
  3. Physical Examination. A chiropractor may utilize a variety of methods to determine the spinal segments that require chiropractic treatments, including but not limited to static and motion palpation techniques determining spinal segments that are hypo mobile (restricted in their movement) or fixated. Depending on the results of the above examination, a chiropractor may use additional diagnostic tests, such as:
      • X-ray to locate subluxations (the altered position of the vertebra)
      • A device that detects the temperature of the skin in the paraspinal region to identify spinal areas with a significant temperature variance that requires manipulation.

    Many chiropractors utilize a holistic, biomechanical concept of treating the bipedal structure in its entirety, in an attempt to balance the structure from the feet upward.

Diagnostic Process

The medical diagnosis, also called a clinical diagnosis, serves to identify the underlying cause of the patient’s back pain.

Medical professionals determine the cause of the patient’s pain through a combination of the following two to three steps:

A Review of the Patient's Medical history
The physician will spend time asking the patient a series of questions, such as a description of when the low back pain, sciatica, or other symptoms occur, a description of how the pain feels, what activities, positions, or treatments make the pain feel better and more.

A Physical Examination
The physicians will conduct a thorough physical exam of the patient, such as testing nerve function and muscle strength in certain parts of the leg or arm, testing for pain in certain positions, and more. Usually, this series of physical tests will give the spine professional a good idea of the type of back problem the patient has.

Diagnostic Testing (Maybe)
After the physician has a good idea of the source of the patient’s pain, a diagnostic test, such as a CT scan or an MRI scan, may be recommended in order to confirm the presence of the suspected cause of the patient's pain. For example, if a disc problem is suspected, an imaging test can provided a detailed image showing the location and size of the herniated disc and affected nerve roots.

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Designed and Managed by Brian Kunz