Chiropractic is a health care discipline concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal manipulation (“chiropractic adjustment”) and other joint and soft-tissue therapies. Although it is one of the youngest of the natural healing arts, chiropractic has gained tremendous growth. Chiropractors are trained as non-pharmaceutical, non-surgical specialists of the spine and musculoskeletal system. While many chiropractors acknowledge the important use of medication and surgery in appropriate cases, they do not prescribe drugs or perform any invasive procedures, including injections. The primary treatment administered by chiropractors is spinal manipulation or other manual therapies. Often chiropractors will include exercise prescription, stretching, lifestyle modifications, and/or nutritional counseling in their treatments.

What is a Typical Visit Like?

On your initial visit, your chiropractor should perform a thorough examination, reviewing your past health, family and social history as well as your past/current treatments and medications. If indicated, your chiropractor may order imaging such as X-ray, MRI or CT.

Once a proper diagnosis has been established, your chiropractic physician should thoroughly review your condition with you and initiate a treatment plan that may consist of spinal manipulation or other manual therapies, exercise prescription, stretching, lifestyle modifications, and/or nutritional counseling. Subsequent treatment sessions typically last about 20 minutes. However, depending upon the depth and scope of care necessary, ranges of treatment duration may vary.

What is Spinal Manipulation?

Spinal manipulation is an intervention commonly administered by chiropractors or physical therapists with the goal of restoring proper joint function and decreasing pain. This therapy is most often done by hand (manually) in the form of a high-velocity low-amplitude (HVLA) thrust, or, in some cases, with the use of a special instrument or specifically designed table. Clinicians perform HVLA spinal manipulation by applying a rapid thrust to a targeted joint. Often when this is completed, a popping or clicking sound called “joint cavitation” occurs. This is thought to occur as a result of pressure changes within the normal fluid of the joint and is considered a natural and generally pain-free response.

Spinal mobilization, a similar form of manual therapy, is often interchangeably utilized with spinal manipulation. The goal of spinal mobilization is the same as spinal manipulation; to restore proper joint function and decrease pain. Spinal mobilization is typically performed by hand (manually) in the form of a lower-velocity low-amplitude thrust compared to HVLA spinal manipulation.

How Does Spinal Manipulation Work?

Currently, there is no specific explanation on how spinal manipulation works. The exact mechanism is not clear. Current models that may explain the treatment benefits appreciated following spinal manipulation include: release of entrapped synovial folds or plica, relaxation of hypertonic paraspinal musculature, disruption of articular/periarticular lesions, unbuckling of vertebral motion segments, facet joint distraction, and stimulation of neural and central nervous system mediated reflexes.

Is Spinal Manipulation Safe?

When the correct manipulation technique is paired with the appropriately selected patient, spinal manipulation is a safe procedure. Potential side effects and complications have been associated with spinal manipulation and have been identified in scientific literature. Most adverse events reported are considered “benign and transitory”. More common side effects can include temporary headaches, tiredness, or discomfort in the area of treatment.

Rare, yet concerning, potential complications have been identified with spinal manipulation, particularly when performed on the upper spine, such as vertebral basilar artery (VBA) injury. True incidence of such events is unknown and frequencies of serious adverse events associated with chiropractic utilization vary within scientific literature. However a 2008 study published in SPINE, encompassing 9 years of medical records and over 100 million patient years, found no evidence of increased risk of VBA stroke associated with chiropractic treatments, compared to primary medical care. Additional studies have indicated the risk of death associated with cervical spine manipulation is 100-400 times less than the risk of death for NSAID medication for osteoarthritis. Although it appears the relative risk of adverse events associated with cervical spine manipulation is low, recent studies show that adverse reactions are more likely to be reported ensuing cervical spine manipulation as opposed to cervical spine mobilization. It has been suggested that cervical spine mobilization may be a preferred treatment to cervical spine manipulation.

Can Chiropractic Treatment Help Me?

Chiropractors typically treat musculoskeletal ailments, particularly spine related disorders. Common conditions by chiropractors include:

• Mechanical/Non-Specific Back or Neck Pain

• Muscle or Soft Tissue Pain Syndromes

• Sprains/Strains of the Spine

• Sacroiliac Joint Pain

• Intervertebral Disc Disorders

• Certain Types of Headache

• Controlled Radiculopathies of Spinal Origin

• Sciatica

• Whiplash

• Pregnancy Related Back Pain

How Do I Identify a Qualified Chiropractor?

Although it is not necessary to obtain a referral, you may consider asking your primary care provider for a recommendation for a chiropractor. Additionally, The Journal of Family Practice (1992) has published the following guidelines to consider when selecting a chiropractor:

• Treats mainly musculoskeletal disorders

• Does not radiograph every patient

• Willing to be clinically observed

• Positive feedback from patients

• Communicates with the referring physician

• Administers reasonable treatment programs

• Does not charge a global, up-front fee

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