Why Do People visit the Chiropractor?
What Are the Assessments, Goals, and Treatments
at a Typical Chiropractic Office Visit?
The most recent authoritative review of Chiropractic appeared in the December issue of the prestigious orthopaedic medical journal Spine, titled (1):
The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults:Results From the 2012 National Health Interview Survey
The data for this study was from the National Health Interview Survey (NHIS), which is the principle and reliable source of comprehensive health care information in the United States. The NHIS dataset provides a large-scale nationally representative sample regarding chiropractic use.
The study noted that 63% of patients go to Chiropractors for low back pain and 30% for neck pain.
They found that only 3% of patients reported that Chiropractic care did not help them.
The authors also made the following points:
“The most common complaints encountered by the Chiropractor are back pain and neck pain and this is in line with the recent systematic reviews identifying the substantial evidence on the efficacy of Chiropractic for neck pain and back pain.”
“Chiropractic services are an important component of the healthcare provision for patients affected by musculoskeletal disorders (especially for back pain and neck pain) and/or for maintaining their overall well-being.”
What Are the Chiropractic Clinical Assessments?
Some spinal pain can be serious. These usually involve compressive neuropathology. Examples of compressive neuropathology include disc herniations, lateral recess stenosis, and central canal stenosis. Although each of these conditions can be successfully managed by Chiropractors, they often need advanced diagnostics (MRIs, etc.), and sometimes require surgical intervention. Chiropractors are well trained to examine and recognise cases of compressive neuropathology and to make appropriate referrals when necessary. Statistically, compressive neuropathology is quite rare, constituting only 1-2% of Chiropractic clinical practice.
As well as the standard orthopaedic and neurological tests used to determine if a patient has compressive neuropathology, chiropractic clinical assessments can include X-rays, posture analysis and joint range of motion. These assessments show a patient’s proprioceptive integrity. A large majority of Chiropractic pain patients have lack of proprioception, causing joint pain and immobility in the area.
An important study was published by the Institute of Occupational Health, Helsinki, Finland, in 1987, by physician T. Viderman, MD. in the journal Clinical Biomechanics, and titled Experimental Models of Osteoarthritis: The Role of Immobilization (2)
Dr. Viderman noted that when there is a lack of joint motion for any reason, the tissues surrounding the joint adapt to the shortest distance between its origin and insertion. This significantantly alters musculoskeletal function. Viderman makes the following points:
“Whenever the periarticular shrinkage stems from immobilisation, the process does not affect articular cartilage only; instead the whole joint is involved.”
“Immobilisation, for whatever reason, is one of the pathogenic factors in musculoskeletal degeneration.”
“With respect to patients, it can be postulated that immobilisation, for whatever cause, will initiate a pathogenic chain of musculoskeletal degenerative changes.”
Dr. Viderman also discusses the value of mobilisation to prevent and reverse the pathological consequences of immobilisation. He notes:
“If immobilisation, irrespective of its cause, cannot be avoided, it would be therapeutically logical to take every possible step to limit its extent and duration.”
“When the adverse effects of immobilisation have already become apparent, the earlier they are treated the better.”
“The evidence reviewed shows very clearly that early mobilisation is essential.”
Chiropractors focus on the treatment and management of spinal pain syndromes.
Chiropractors first rule out or confirm the presence of compressive neuropathology. A series of orthopaedic and neurological tests are carried out, usually with imaging, such as x-rays or possibly an MRI. If a compressive neuropathology is present, the Chiropractor may decide to treat the condition, refer the patient to another provider, or co-treat the patient with another provider.
Once compressive neuropathology is ruled out, the Chiropractor will assess the status of the patient’s proprioceptive signals. This classically involves three interrelated mechanical assessments:
1. Postural alignment
2. Regional spinal range of motion (cervical, thoracic, and lumbar)
3. Segmental range of motion (joint motion integrity)
Discovered mechanical problems are dealt with mechanically, including ergonomically, exercise, traction, tissue work, and spinal adjusting.
When spinal joints do not have optimum movement, the pain gate at that level is open. Chiropractic adjusting (specific manipulation) increases the firing of the proprioceptors, creating a neurological sequence of events that closes the pain gate. The reduction in pain is often immediate, depending on levels of concomitant inflammation.
The quality of proprioception is a significant factor in the state of the pain gate. Improved proprioception closes the pain gate. Chiropractic adjusting improves proprioception. Consequently, chiropractors are noted for their treatment and management of pain syndromes, especially for spinal pain syndromes.
1. Adams J, Peng W, Cramer H, Sundberg T, Moore C; The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults; Results From the 2012 National Health Interview Survey; Spine; December 1, 2017; Vol. 42; No. 23; pp. 1810–1816.
2. Viderman T; Experimental Models of Osteoarthritis: The Role of Immobilization; Clinical Biomechanics; November 1987; Vol. 2; No. 4; pp. 223-229.