Curvesday Thursday: Back to Basics

A chiropractor is a health care professional focused on the diagnosis and treatment neuromuscular disorders, with an emphasis on treatment through manual adjustment and/or manipulation of the spine.

Most chiropractors seek to reduce pain and improve the functionality of patients as well as to educate them on how they can account for their own health via exercise, ergonomics and other therapies to treat back pain.

Chiropractic is generally categorized as alternative medicine or complementary medicine.

Chiropractors: Fundamental Beliefs and Goals

Chiropractors focus on the intimate relationship between the nervous system and spine, and hold true the following beliefs:

  • Biomechanical and structural derangement of the spine can affect the nervous system
  • For many conditions, chiropractic treatment can restore the structural integrity of the spine, reduce pressure on the sensitive neurological tissue, and consequently improve the health of the individual.

The treatment concept of chiropractic is to re-establish normal spinal mobility, which in turn alleviates the irritation to the spinal nerve and/or re-establishes altered reflexes.17

Conditions Treated

Chiropractors use a variety of non-surgical treatments to treat patients with certain types of:

  • Lower back pain and/or leg pain (sciatica)
  • Neck pain
  • Repetitive strains
  • Headaches
  • Sports injuries
  • Car accident injuries
  • Arthritic pain.7
While primarily focusing on treating neuromusculoskeletal disorders, chiropractors are not exclusively limited to problems with the nervous system and musculoskeletal system.

When appropriate, chiropractors refer patients to medical doctors or other health practitioners for treatment of lower back pain. Many chiropractors have a local referral network or work together with other spine specialists in a multi-disciplinary or multi-specialty spine clinic.

In many regards, a chiropractic examination is very similar to standard examination procedures administered by all health care providers. With that said, how chiropractors examine the structure and function of the spine and then determine specific chiropractic treatments separates chiropractic care from other disciplines.

Chiropractic Exam of Lower Back Pain

An initial chiropractic exam for back pain will typically have three parts: a consultation, case history, and physical examination. Laboratory analysis and X-ray examination may be performed.

    1. Consultation. The patient meets with the chiropractor and provides a brief synopsis of his or her lower back pain, such as:
      • Duration and frequency of symptoms
      • Description of the symptoms (e.g. burning, throbbing)
      • Areas of pain
      • What makes the pain feel better (e.g. sitting, stretching)
      • What makes the pain feel worse (e.g. standing, lifting).
    2. Case history. The chiropractor identifies the area(s) of complaint and the nature of the back pain by asking questions and learning more about different areas of the patient’s history, including:
      • Family history
      • Dietary habits
      • Past history of other treatments (chiropractic, osteopathic, medical and other)
      • Occupational history
      • Psychosocial history
      • Other areas to probe, often based on responses to above questions.
  1. Physical examination. A chiropractor may utilize a variety of methods to determine the spinal segments that require chiropractic treatments, including but not limited to static and motion palpation techniques determining spinal segments that are hypo mobile (restricted in their movement) or fixated. Depending on the results of the above examination, a chiropractor may use additional diagnostic tests, such as:
    • X-ray to locate subluxations (the altered position of the vertebra)
    • A device that detects the temperature of the skin in the paraspinal region to identify spinal areas with a significant temperature variance that requires manipulation.

Many chiropractors utilize a holistic, biomechanical concept of treating the bipedal structure in its entirety, in an attempt to balance the structure from the feet upward.

Chiropractors are typically trained in multiple methods of assessing lower back pain, including:

  • Evaluation and management services.7 Chiropractors are trained in examining the joints, bones, muscles and tendons of the spine, head, extremities and other areas of the body with the purpose of noting any misalignment, tenderness, asymmetry, defects or other problems.
  • Neurologic and other common physical examination procedures.7 Chiropractors are trained to perform a variety of neurologic tests (nerve root compression/tension, motor strength, coordination, deep tendon and pathological reflexes, etc.) and are skilled in performing orthopedic, cardiovascular and many other common examinations.
  • Specialized assessment.7 Chiropractors are trained to assess range of motion, stability, muscle strength, muscle tone and other assessments with the lower back.
  • Common diagnostic studies.7 Chiropractors are trained in use of diagnostic studies and tools such as radiography (X-rays), laboratory diagnostics and neurodiagnostics.

In the assessment of lower back pain, differential diagnosis utilizing a “triage” concept of classifying low back injuries into one of three categories helps to guide the doctor of chiropractic. These categories of chiropractic diagnosis include:

  1. Potentially serious: tumor, infection, fracture, major neurological problem (cauda equina), local open wound or burn, prolonged bleeding (hemophilia), artificial joint implant problems, pacemaker problems, joint infection
  2. Nerve problem: when the nerve root in the low back is pinched or compressed, causing a radiculopathy (sciatica). Typical causes of nerve root pinching include a lumbar herniated disc, spondylolisthesis, spinal stenosis
  3. Non-specific: mechanical back pain in the lumbar spine. This type of lower back pain is the most common presentation, and includes pain for which there is no identifiable cause.

With chiropractic diagnosis of potentially serious injuries, the chiropractor will typically refer the patient to a relevant medical specialist and possibly a surgeon, and as appropriate the chiropractor may co-manage the patient’s care with other back pain specialists.7 With this classification, chiropractic manipulation is typically avoided over the relevant anatomy.

With chiropractic diagnosis of a nerve root problem causing sciatica and/or non-specific causes of low back pain, chiropractors typically describe the symptoms experienced on the following scale:

  • Acute (symptoms lasting less than 6 weeks)
  • Subacute (symptoms lasting between 6 and 12 weeks)
  • Chronic (symptoms lasting for 12 weeks or more)
  • Recurrent/flare up (symptoms are similar to original symptoms and return sporadically or as result of exacerbating circumstances).7
These lower back pain or sciatica symptoms may be further broken down as mild, moderate or severe in pain.

A chiropractic adjustment, also known as chiropractic manipulation, manual manipulation, or spinal manipulation, is a common therapeutic treatment for lower back pain.18 A chiropractic adjustment refers to a chiropractor applying manipulation to the vertebrae that have abnormal movement patterns or fail to function normally. The objective of this chiropractic treatment is to reduce the subluxation, with the goals of increasing range of motion, reducing nerve irritability and improving function. The most common reaction to a chiropractic adjustment is aching or soreness in the spinal joints or muscles. If this aching or soreness occurs, it is usually within the first few hours post-treatment and does not last longer than 24 hours after the chiropractic adjustment. Application of an ice pack often reduces the symptoms relatively quickly.

 

Think chiropractic could help you? We agree! Call our office at (304) 263-4927 today to schedule an appointment. Dr Terry Chambers is a Board certified chiropractor and acupuncturist licensed in WV.

Source: http://www.spine-health.com/treatment/chiropractic/what-a-chiropractor

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