Chiropractic: Healing with a Human Touch
Doctors of chiropractic (DCs) are primary health care professionals focused on diagnosis, care and prevention of disorders of the spine as well as other parts of the musculoskeletal system*, and the associated effects on the neurological system. Chiropractic services are used most often to care for neuro-musculoskeletal complaints**, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches. These disorders impact 44.6 million Americans annually, with an estimated cost to society of $267.2 billion2, and are increasingly the result of poor posture, workplace and sports-related injuries, motor vehicle accidents or simply sedentary lifestyles.
The Chiropractic Perspective and Practice
The relationship between structure--primarily the spine and musculoskeletal system--and function--as coordinated by the nervous system--is central to chiropractic’s approach to patient care, health and well-being.
Doctors of chiropractic acknowledge the importance of the nervous system in the control, coordination and regulation of the body, and that spinal or extremity joint dysfunction, termed subluxation* or subluxation complex, can adversely affect nerve function,16 and the body’s ability to regulate and maintain health.17 The core purpose of chiropractic practice and procedure is to address disturbed joint biomechanics and the associated effects on nerve system function. This is achieved through the skilled procedure termed the spinal adjustment or manipulation.
Chiropractic is an inherently conservative approach to health care, and the profession values the intrinsic biologic ability or innate tendency of the body to self-regulate, restore and maintain health through compensating homeostatic mechanisms, reparative processes and adaptive responses to environmental challenges. The chiropractic paradigm represents a holistic biopsychosocial** philosophy of health rather than a biomedical one, and embraces a belief in optimizing health through good nutrition, constructive exercise, stress management, and a focus on the importance of good posture, as well as proper spinal and extremity joint biomechanics.
Chiropractic patient management includes manual techniques with particular competency in joint adjustment and/or manipulation, rehabilitation exercises, patient education in lifestyle and nutritional modification, and the use of adjunctive therapeutic modalities, orthotics and other supports. Current accreditation and state licensing standards in the United States give doctors of chiropractic the responsibility as a primary portal of entry provider, with the requirement to establish a diagnosis, determine indications for providing chiropractic care, and to consult with or refer to other health care practitioners when appropriate.
The First Visit to the Chiropractor: What to Expect
The doctor of chiropractic starts by taking a patient’s history, and then performs a physical examination, to include the assessment of spinal and musculoskeletal joint function. The chiropractic examination focuses on evaluation of joint pain or tenderness, asymmetry, changes in range of joint motion, muscle tone and strength, posture and spinal or other joint stability. Lab tests or imaging such as MRI, CT scan or X-ray may be indicated.
The combination of the history, examination, and diagnostic studies help determine whether chiropractic services are appropriate for the patient’s condition. As part of this process, the doctor will explain the clinical findings, recommend a treatment plan and review the risks and benefits of all procedures.
Through a process of shared decision-making, the patient and doctor will determine if it is appropriate to proceed with a short trial of chiropractic services. If the examination findings indicate that the patient would be more appropriately managed or co-managed by another health care professional, the chiropractor would make the proper referral.
Based on the clinical indications, timing or severity of the patient’s condition, chiropractic interventions may require a series of visits in order to relieve pain and improve joint function. Patients may also receive advice on home care, lifestyle modifications, exercise instruction and nutritional advice.
The Chiropractic Adjustment
Doctors of chiropractic are extensively educated in the assessment and management of conditions affecting the spinal and extremity joints and associated neurology, and based on examination findings and indication for care, the chiropractor will recommend a short course of care to help relieve pain and improve function.
Chiropractic care involves spinal adjustment or extremity manipulation, and may include mobilization, muscle stretching and soft tissue therapy, along with exercise, the use of modalities (i.e. traction, ultrasound or laser) and rehabilitation and active care. Chiropractors are also trained to provide recommendation on injury prevention strategies.
The chiropractic adjustment or manipulation is a manual procedure applying a force, sometimes mild, sometimes firm, directed to one or more dysfunctional hypomobile joint segments, and is a procedure that requires highly refined skills developed during the doctor’s intensive years of chiropractic education. The adjustive procedures and techniques are precise and controlled and designed to introduce motion into a dysfunctional joint.
The patient is positioned on a specifically-designed adjusting table, chair, or other specialized equipment. The doctor typically uses his or her hands, or an instrument, to then skillfully apply a controlled force directing motion into the joints of the body in order to restore proper alignment or movement within the normal ranges of motion. Particular attention is directed to the areas of the spine where vertebral joint dysfunction has been detected. The adjustment often helps restore joint mobility and function, resolves joint inflammation and reduces the patient’s pain.
Adjustment or manipulation of a joint may be accompanied by an audible popping sound. The noise is a result of a change of pressure within the joint, as part of the application of the adjustment, and is caused by dispersion of microscopic gas bubbles within the joint. This is a natural occurrence and is similar to one cracking the knuckles.
The chiropractor adapts the adjustive technique and procedure to address the age, condition, and specific needs of each patient. Patients often note positive changes in their symptoms immediately following care. The chiropractic adjustment rarely causes discomfort.