Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system, the nervous system, and the effects of these disorders on general health. Chiropractic care is 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.
Doctors of Chiropractic, often referred to as chiropractors or chiropractic physicians practice a hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.
The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,” also called “chiropractic adjustment.” The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile or restricted in their movement. This 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 the sufferer. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain, muscle tightness, pressure on tender nerves, and allowing tissues to heal.
In many cases, such as musculoskeletal pain, chiropractic care may be the primary method of treatment. When other medical conditions exist, chiropractic care may complement or support additional medical treatment by relieving the musculoskeletal aspects associated with the condition.
Doctors of chiropractic assess patients through clinical examination, laboratory testing, diagnostic imaging and other diagnostic interventions to determine when chiropractic treatment is appropriate, what type, or when it is not appropriate.
The Value of Manipulation
The purpose of manipulation, sometimes called and adjustment, is to restore alignment and normalize mobility in joints that are essentially stuck in a position that does not allow the joint to move through its normal range of motion. Studies with bone pins implanted in both live and cadaveric subjects reveal bone movement of 1 – 2 millimeters and approximately 1 degree of rotation. They additionally reveal an increase in the joint space or gap (that should be there) between the bones that comprise a given joint. This movement results in a number of clinical benefits. It decreases pain, breaks adhesions, and frees trapped meniscoids (cartilage) between joint surfaces. It also has been found to dampen pain input into the nervous system, reduce muscle spasm and increase range of motion. Prone patients with spasm of their back muscles as evidenced by elevated EMG activity, respond to a manipulation by immediate quieting of these muscles. Specialized techniques like Cox decompressive flexion distraction provide additional benefits of increasing the size of the tunnel the nerve root passes through and decreasing pressure inside the discs. In summary there is evidence for both biomechanical and neurological mechanisms by which manipulation decreases pain and spasm, increases range of motion and even increases strength.
Types And Techniques Of Manipulation
Manipulation for some people conjures up image of painful contortions. These are inaccurate. Manipulation performed by experienced doctors, in most cases is painless and entirely comfortable.
There are numerous techniques used by osteopathic and chiropractic physicians. The vast majority in wide utilization today can be classified in one of the following categories: HVLA (High velocity Low amplitude), Cox type decompressive flexion distraction, Non-articulatory techniques, including muscle energy technique and facilitated positional release, myofascial techniques, and instrument assisted techniques. Part of the role of the manipulating physician is to maintain proficiency in a range of techniques and determine in a given patient and condition, which specific technique will be most effective. In our office our specialists utilize gentle techniques that are painless and comfortable.
Adjuncts To Spinal Manipulative Therapy
While spinal manipulation can be utilized as an effective stand-alone therapeutic procedure, it is often used in conjunction with ancillary modalities. These commonly include medications to reduce pain, spasm, and inflammation and additional physical treatments such as electric muscle stimulation, ice, heat, therapeutic ultrasound, support belts, collars and rehabilitative exercise. It also is commonly used in conjunction with trigger point injections and more invasive epidural injections as well as facet and selective nerve root blocks. Finally in patients who have had surgery that is technically successful but who continue to have pain and or disability, manipulation often can be used to correct a functional deficit that was standing in the way of pain relief or improved function.