Daniel Redwood DCWhat is a chiropractor? Chiropractors are health professionals who focus on the relationship between the body’s structure (primarily the spine) and its function (coordinated by the nervous system). While the spinal dysfunctions or imbalances that chiropractors call the vertebral subluxation complex may influence all areas of the body via the nervous system, the vast majority of chiropractic patients seek care for disorders of the musculoskeletal system. Foremost among these are back pain, neck pain, associated arm and leg pain, and headaches. The centerpiece of chiropractic practice is the spinal adjustment (manipulation), a specific pressure applied by hand to normalize joint movement and relieve any reflex effects in other areas of the body.
What should I expect on the first visit? An initial visit to the chiropractor generally lasts 30-60 minutes. The practitioner takes a case history and performs an orthopedic and neurological exam to arrive at a diagnosis and screen for conditions that require referral to another specialist. He or she also palpates the spine and other joints in search of abnormalities in joint movement and muscular imbalances, and may request x-rays and/or laboratory tests. The chiropractor’s scope of practice includes radiology; most DCs have an in-house x-ray machine, while others refer radiology work to medical or chiropractic radiologists.
Once the chiropractor reaches a diagnosis, treatment can begin. Depending on the individual case, the first treatment may be delivered at the first or second visit. The DC’s repertoire includes a variety of adjustment styles, which are tailored to the needs of the individual patient. The most common adjustments are of the classical or “osseous” type, which often elicit a cavitation, or “popping” sound. This is generally not uncomfortable, but can be surprising the first time. Many chiropractors also utilize “low force” methods which involve lighter contacts. In some cases (such as elderly patients with advanced osteoporosis), only low force methods are appropriate. In all but a few states, the chiropractor’s scope of practice includes therapies such as hot and cold applications, ultrasound, and electronic muscle stimulation. In some states it also includes acupuncture. Chiropractors teach patients corrective exercises as part of a rehabilitation program, and when appropriate may provide supportive collars, braces, support belts or shoe inserts. Within the limits of state law, chiropractors may also offer dietary counseling, which in some cases includes vitamin, mineral, or herbal supplements.
How many treatments will I need? As with any type of treatment, this varies depending on the specifics of the individual case. In acute cases, treatment may be needed 3 or more times per week for a few weeks, with the frequency of visits gradually being decreased as improvement is noted. If no easing of symptoms occurs within the first four weeks of care, current guidelines advise the chiropractor to refer the patient to another practitioner. If improvement is occurring, a longer course of care is appropriate, with a diminishing frequency of visits. If a chiropractor recommends treatment for much more than a month in the absence of improvement in symptoms, this is clear sign that you should seek a second opinion. The average chiropractic case involves approximately 10-15 visits, but this includes cases that only require relatively few visits as well as more severe cases that legitimately require extended courses of care lasting many months.
What conditions respond well to chiropractic? Treatment of musculoskeletal pain—primarily back pain, neck pain, and headaches— is the mainstay of chiropractic practice. Research supports the use of chiropractic for each of these conditions. Low back pain guidelines in many nations endorse the use of spinal manipulation, as do the 2007 guidelines jointly endorsed by the American College of Physicians and the American Pain Society.1 Pain in the shoulders and other joints of the arms and legs is also frequently responsive to manipulation and other therapies employed by chiropractors. Chiropractic is widely utilized for sports injuries, with chiropractors serving on the U.S. Olympic Committee (USOC) medical staff and on the staffs of numerous professional sports teams. As of 2011, the top two positions on the USOC medical staff are filled by chiropractors, Drs. Michael Reed and Bill Moreau.
Chiropractic success in treating internal organ problems is far less predictable and has not been thoroughly researched, though virtually all chiropractors have seen individual cases of dramatic improvement that appear to be attributable to chiropractic treatment. Conditions in this category include but are not limited to hypertension,2 infantile colic,3 and ear infections in children.4
How can I find a qualified practitioner? All 50 states license and regulate doctors of chiropractic (DC), who undergo a minimum of six years of rigorous, college-level studies to become healthcare professionals. Your doctor may refer you directly to a chiropractic physician. If you decide to consult a chiropractor on your own, you can obtain a list of practitioners in your area from the American Chiropractic Association (800-986-4636 or http://www.amerchiro.org) or International Chiropractors Association (800-423-4690 or http://www.chiropractic.org).
Will insurance cover chiropractic? In the United States, chiropractic services are covered by most group health insurance policies, including most managed care policies, although the amount of reimbursement varies widely. Automobile accident insurance generally covers chiropractic treatment. Medicare provides partial coverage. Medicaid and workers’ compensation coverage varies from state to state.
References
1. Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. Oct 2 2007;147(7):492-504.
2. Bakris G, Dickholtz M, Sr., Meyer PM, et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens. May 2007;21(5):347-352.
3. Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther. 1999;22(8):517-522.
4. Fallon J, Edelman MJ. Chiropractic Care of 401 Children With Otitis Media: A Pilot Study. Altern Ther Health Med. 1998;4(2):93.
Daniel Redwood, DC is a Professor at Cleveland Chiropractic College – Kansas City. He is editor-in-chief of Health Insights Today (www.healthinsightstoday.com) and serves on the editorial boards of the Journal of the American Chiropractic Association, Journal of Alternative and Complementary Medicine, and Topics in Integrative Healthcare.
Tom Ferguson MD
