Your First Visit
The following describes the initial in office clinical exam, which generally includes 3 areas:
Patient History and Symptoms
In preparation for the chiropractic consultation, the patient will be asked to fill out forms that provide background information about his or her symptoms and condition. You will usually be asked to provide information on family medical history, any pre-existing medical conditions or prior injuries, and previous and current health providers and treatments.
Types of questions typically include:
When and how did the pain start?
Where is it located?
Describe the pain - is it sharp, dull, searing/burning, or throbbing? Does it come and go, or is it continual?
Did the pain start as a result of an injury?
What activities/circumstances makes it better or worse?
The Chiropractic Exam
A thorough chiropractic exam includes general tests such as pulse, respiration, and reflexes, as well as specific orthopedic and neurological tests to assess.
Range of motion of the affected part
Further chiropractic tests may be necessary to assess the affected area, such as having the patient move in a specific manner, posture analysis, or chiropractic manipulation of the affected body part
Based upon the results of the patient's history and chiropractic exam, diagnostic studies may be helpful in revealing pathologies and identifying structural abnormalities to more accurately diagnose a condition.
Diagnostic studies are not always necessary during the chiropractic exam, and should only be undertaken if the chiropractor has a good reason to believe that the X-ray or other test will provide information needed to guide the patient's treatment program.
The most common diagnostic studies during chiropractic exams include:
MRI (Magnetic Resonance Imaging) scan
Other laboratory tests
We can perform basic X-rays, but an MRI scan and more extensive imaging studies are usually referred to an outside center.
Findings from the combination of the above described history, physical examination and any required diagnostic studies lead to a specific diagnosis. Once the diagnosis is established, the chiropractor will determine if the condition will respond to chiropractic care.
At the end of the patient's initial visit, the chiropractor will explain the patient's:
Individualized chiropractic treatment plan (or other treatments)
Anticipated length of chiropractic care
Report of Findings
Most chiropractors begin treatment during the patient's first visit, although some may wait until the next appointment at the chiropractic clinic.
Chiropractic treatment goals and recommendations may include some or all of the following:
Adjustments to key joint dysfunctions
Modalities to improve soft tissue healing and pain control
Strengthening and/or stretching exercises to improve muscle balance, strength, and coordination
Patient education to improve posture and motor control, as well as possibly reduce anxiety
Other treatments such as massage, heat/cold application, and education on ergonomics and nutrition.
The chiropractor will establish specific goals for a patient's individual plan for treatment:
Short-term goals typically include reducing pain and restoring normal joint function and muscle balance
Long-term goals include restoring functional independence and tolerance to normal activities of daily living.
To reach these goals, a specific number of chiropractic visits will be recommended.
For an acute or chronic type of lower back pain, a treatment recommendation of 1 to 2 chiropractic visits per week for 1 to 3 week will be prescribed, after that and always based on your personal case the amount of visits will decrease, followed by a re-examination by the chiropractor
Goal setting for the chiropractic treatment plan is driven by the patient's pain and disability issues and activity intolerance.
Consistent among all guidelines of low back pain treatment is the prevention of chronicity. The use of active care (care that is patient-driven such as exercise, activity modification, ergonomic modifications, etc.) is emphasized to accomplish this goal.
There are well over 100 types of adjustment techniques used by chiropractors throughout the world. Typically, chiropractors will focus on and utilize 8 to 10 different approaches in their practice.
The common goal of most chiropractic techniques is to restore or to enhance joint function, with the general goals of resolving joint inflammation and reducing pain. Some approaches use some force (spinal manipulation), while others are more gentle (spinal mobilization).
The original chiropractic adjustment approach is generally referred to as spinal manipulation, and may also be called the diversified technique or the high-velocity, low-amplitude (HVLA) thrust. New chiropractic adjustment approaches typically evolve as a variation from an existing technique and are often named after the chiropractor who developed it.
This article reviews a number of the most commonly used spinal manipulation and spinal mobilization techniques currently used by chiropractors.
Chiropractors adapt treatment plans to meet the specific needs of each patient. Typically, chiropractic treatment plans involve some forceful and less forceful spinal adjustment techniques during the same visit or over the course of treatment (6 to 10 visits for a typical patient).
Spinal Manipulation (High-Velocity Low-Amplitude Thrust)
The most frequently used chiropractic technique, spinal manipulation, is the traditional high-velocity low-amplitude (HVLA) thrust. The manipulation often results in an audible "pop," as chiropractors use their hands to apply a controlled sudden force to a joint while the body is positioned in a specific way.
Spinal Mobilization (Low-Force or Gentle Chiropractic Techniques)
Some conditions (such as osteoporosis), pathology, the patient's size, patient comfort, or patient preference, may require a gentler approach generally referred to as spinal mobilization. In addition, some patients and/or clinicians prefer mild spinal mobilization techniques that do not involve twisting of the body or a forceful thrust.
In addition to manipulation, many chiropractors will employ adjunctive therapy, such as ice or heat or physical therapy modalities (such as active release, graston, etc.), as part of an overall treatment plan. Patients should discuss their symptoms and preferences with their chiropractor, whose role it is to perform a thorough examination to determine the best course of treatment.
Is the Audible Pop Necessary?
The sound often heard during an HVLA manipulation is called cavitation. The pop is caused by a release of gas when the joint is pushed a short distance past its passive range of motion of the joint. The mechanism is similar to cracking ones knuckles.
Some clinicians and patients consider an audible pop necessary for the treatment to be successful, although there is no scientific physiological data from studies with large patient populations to confirm this belief.