For Medical Providers

Seven Things You Should Know About Chiropractors and Chiropractic Treatment

  1. Which patients should be I consider for chiropractic care?
  2. How much care is necessary for a patient to improve with chiropractic treatment?
  3. Is chiropractic manipulation safe?
  4. How does manipulation work?
  5. Why is there so much variation in treatment among chiropractors?
  6. With all the variation in chiropractic, how does one identify a qualified chiropractor?
  7. How ell educated are chiropractors?

1. Which patients should I consider for chiropractic care?

  • The outcomes for Chiropractic treatment are optimal for patients with acute/chronic mechanical/myofascial cervical, thoracic and lumbosacral spinal pain. Diagnostic classifications include whiplash, radiculopathy, lumbar stenosis, facet syndrome, costo-transverse capsulitis, sacro-iliac joint pain, spinal sprain/strain, non-specific spinal pain, discogenic low back pain, myofascial pain syndromes cervical headaches.
  • Patients with cervical or lumbar intervertebral disc herniation commonly respond positively to chiropractic management. Treatments are likely to include forms of traction, McKenzie (extension) therapy and positional release techniques.
  • Our patients with repetitive strain injuries (tendonitis), carpal tunnel syndrome, thoracic outlet syndrome and other musculoskeletal disorders also appreciate excellent outcomes.

2. How much care is necessary for a patient to improve with chiropractic treatment?

  • Patients with spinal pain commonly appreciate functional improvement and pain relief within a few treatment sessions, while others require more extensive care. The acute, uncomplicated spine pain patient should appreciate significant relief with 2-4 weeks of care. Chronic or complicated patients may require 4-5 weeks of treatment before a cumulative symptom response is appreciated.
  • Patients with chronic or permanent conditions may be treated under a "disease management" model. Once the patient has reached a point of maximum therapeutic benefit in a comprehensive treatment program, manipulation and adjunctive therapies may be provided on a periodic basis to maintain functional and symptom gains. Our goal is to encourage independence from treatment.

3. Is chiropractic manipulation safe?

When the correct manipulation technique is paired with the appropriately selected

patient, spinal manipulation is a very safe procedure. There are relative and absolute contraindications to spinal manipulations that have been identified in the physical medicine literature.

  • A history of spinal surgery, osteoporosis, healed fracture, disc herniation without significant or progressive neurological deficit, scoliosis, chronic arthropathies, degenerative changes, and joint instability are not absolute contraindications to treatment.

Absolute Contraindications to Spinal Manipulation Include:

  • Severe or progressive neurological deficits
  • Infections
  • Malignancies
  • Acute bone demineralization
  • Acute fracture/dislocation
  • Acute arthropathies

A contraindication to manipulation in one region of the spine rarely precludes treatment in another region. If techniques cannot be modified to accommodate the patient's condition, the manipulation is withheld.

4. How does manipulation work?

  • Spinal manipulation has been shown to result in an immediate post treatment increase in range of motion, decreased adjacent soft tissue tenderness, improved joint function and decreased pain.
  • Though the mechanism is complicated research has identified the following benefits from spinal manipulation therapy (SMT):
      • motion segment (joint and disc complex) unbuckling
      • meniscoid inclusion release
      • release of intra-articular adhesions
      • stimulation of joint mechanoreceptors
      • relaxation of hypertonic muscles

      Centrally mediated reflexes are also being investigated.

5. Why is there such variation in treatment among chiropractors?

  • The chiropractic profession is philosophically divided into two primary groups; (1) those who adhere to many of the traditional chiropractic theories that promote lifelong care, and (2) those who work on an integrated, evidenced based care model.
  • Philosophically based chiropractors advocate that spinal manipulation improves health through reducing sub-clinical neurologic impairment by correcting vertebral joint dysfunction (referred to as "subluxation"). Theoretically, spinal adjustments are directed at restoring neural homeostasis, rather than administered to treat a clinical disorder. Most of these chiropractors do not seek a clinical diagnosis other than "subluxation", and do not exercise standard examination and treatment procedures.
  • Evidenced based chiropractors commonly work on a physical medicine model to diagnose and treat their patients. Spinal manipulation is one component of the management strategy, which also draws from those therapies that are shared with physical therapists and physiatrists. These chiropractic physicians administer therapeutic treatment modalities such as ultrasound, electrical muscle stimulation, hot/cold therapies and instruct their patients in rehabilitative exercises, stretches, lifestyle changes and proper diet. Many evidenced based chiropractors work cooperatively within hospitals and integrated care centers.

6. With all of the variation in chiropractic, how does one identify a qualified chiropractor?

The Journal of Family Practice (1992) 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

7. How well educated are chiropractors?

  • Candidates for entry into most chiropractic schools are required to complete a four-year undergraduate program. Ten trimesters of chiropractic school (four years) must be completed to graduate. The first eight trimesters are primarily didactic training. Courses include human anatomy and dissection, physiology, pharmacology, diagnostic imaging, nutrition, rehabilitation, spinal manipulation and medical patient management strategies. The ninth and tenth trimesters are completed through an internship under the direction of a licensed chiropractor. Upon graduation, most chiropractors enter private practice after successfully passing national and state board examinations.
  • Residency programs after chiropractic training are optional and include specialties in Orthopedics, Diagnostic imaging, Clinical studies, Rehabilitation and Research.
  • All licensed chiropractors are required to undergo a minimum of twenty four hours of continuing education on a yearly basis to keep their license in good standing with their state boards.


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