What is Chiropractic?
Chiropractic is a healthcare discipline concerned with the diagnosis, treatment and prevention of neuromusculoskeletal disorders and the effect of these disorders on general health. Chiropractic services are used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches. Chiropractic focuses on the spine and nervous system and how well both function and integrate with the muscular system. Chiropractic involves manual therapy, including chiropractic adjustment/manipulation, soft tissue treatment and health and lifestyle counseling. Chiropractors rely on non-invasive treatment methods and will refer patients to medical practitioners should medication or surgery be indicated.
How are Chiropractors trained?
Chiropractors are trained in anatomy, physiology, biomechanics, diagnostics, chiropractic manipulation, dry needling and various other modalities (such as interferential current therapy, therapeutic ultrasound and shockwave therapy. Chiropractic is a 6-year Master’s degree that includes the completion of a research dissertation. Chiropractors are entitled to use the prefix Doctor because the are trained to diagnose a broad scope of medical conditions (with the focus on neuromusculoskeletal conditions). Chiropractors are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling. Chiropractors may assess patients through clinical examination, laboratory testing, diagnostic imaging and other diagnostic interventions to determine when chiropractic treatment is appropriate or when it is not appropriate.
The deal with the spine
A chiropractor’s main concern is your spine and nervous system and how well both are functioning. The spine is made up of 24 individual moveable vertebrae. It starts just below the base of your skull and ends in the centre between the hips. Each consecutive vertebra is connected to the immediate vertebrae above and below it via joints. Consecutive vertebrae are connected by joint capsules, ligaments and muscles, which enable the entire spine to function as one dynamic unit. There are seven neck (cervical) vertebrae, 12 mid-back (thoracic) vertebrae and five lower back (lumbar) vertebrae, with a cartilaginous disc in-between each vertebra. This disc is there to help cushion and absorb shock, reduce friction between the vertebrae and to allow increased movement to occur within the spine. A pair of spinal nerves exits between each vertebra. Each one of the 31 pairs of nerves come from the spinal cord, which runs the length of the spine, and extends outward to form a complex network which ultimately supplies and influences every organ, tissue and cell in the body. It’s a chiropractor’s task to evaluate the biomechanical structure of the spine, to ensure that each one of the individual vertebrae are moving freely and are not restricted or fixed in anyway. Any such displacement or restricted vertebra can cause the spinal nerve, that exits from the intervertebral foramen/opening, to become irritated either through direct pressure or through indirect stimulation/irritation. Therefore, any problem in any one of the vertebral joints can affect the related part of your nervous system, which in turn can lead to such symptoms as pain in the back or neck as well as many other spinal problems.
What is Spinal Manipulation?
One of the most common and well known therapeutic procedures performed by doctors of chiropractic is spinal manipulation (sometimes referred to as a “chiropractic adjustment”). The purpose of spinal manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile – or restricted in their movement – as a result of a tissue injury. Tissue injury can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses, such as sitting in an awkward position with poor spinal posture for an extended period of time. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for an individual. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal. Chiropractic adjustment rarely causes discomfort. However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) that usually resolves within 12 to 48 hours. Compared to other common treatments for pain, such as over-the-counter and prescription pain medications, chiropractic’s conservative approach offers a safe and effective option.
What does the research say?
The results of a clinical trial showed that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone. The study, which featured 750 active-duty members of the military, is one of the largest comparative effectiveness trials between usual medical care and chiropractic care ever conducted. Goertz et al. (2018) JAMA Open Network “Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.” Keeney et al (2012), Spine “Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.” Bryans et al (2011), Journal of Manipulative and Physiological Therapeutics “Thirty-three references were used for this review. The current literature reports favorable results on the use of chiropractic care throughout pregnancy. Chiropractic evaluation and treatment during pregnancy may be considered a safe and effective means of treating common musculoskeletal symptoms that affect pregnant patients. The scarcity of published literature warrants further research.” Borggren (2007), Journal of Chiropractic Medicine “In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study’s findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.” Miller et al (2019), Journal of Manipulative and Physiological Therapeutics
What to expect from your first visit?
The doctor will start with the taking of a complete health history. Questions such as what type of pain you have, where the pain is, how did the pain start and so forth will be asked. He/she will also ask questions about your past health history, family history, and any other conditions that you might previously have suffered from. After the case history has been taken, a complete physical exam will be performed in order to assess your condition. It will include analysing your posture, testing your range of motion, testing reflexes and carrying out other neurological and orthopaedic tests. Together, all these tests will help give your chiropractor a greater knowledge of what the cause of the problem might be. X-rays or laboratory tests may be required. This is not always necessary, and your chiropractor will determine if such tests are required. If your chiropractor determines that your case can be treated through chiropractic care, the treatment you will receive will generally consist of highly specialised manipulative techniques often referred to as adjustments. Such adjustments are performed by hand and consist of a high velocity, low amplitude thrust being applied to a specific vertebra in the spine. Adjustments are safe, and some patients can experience immediate relief as the normal joint motion is restored and the nerve is freed of any restrictive pressure or irritation. However, some patients require a few treatments in order to correct the problem. No two patients are the same, so be patient as your body starts to realign itself and learns to adapt to the changes that are occurring.