How Doctors of Chiropractic Manage Back and Neck Pain

The basic premise of Chiropractic medicine is twofold; (1) to be as minimally invasive to the body as possible and (2) to potentiate the body's ability to heal itself. This is what is meant by the chiropractic professional when they say, "without the use of drugs or surgery". It must be kept in mind that chiropractic physicians are trained to recognize when the patient's ailment is beyond his or her scope of practice or expertise. When appropriate, Doctors of Chiropractic (DC) refer patients to other healthcare specialists for consultation.

Differential Diagnostic Method
Chiropractors are trained in the clinical sciences and taught to recognize what is and what is not within their ability to treat. DCs are trained in differential diagnosis. This means the DC distinguishes between two or more diseases by systematically comparing similar signs and symptoms; not unlike a medical doctor (MD).

A typical example is a patient with low back pain. First, the DC determines its etiology or cause. Many different conditions can cause low back pain. This list is extensive and includes musculoligamentous (muscles and ligaments) sprain/strain, disc disorder, nerve irritation, functional or structural short leg, poor posture and muscle tone, improper ergonomics (poor body mechanics while sitting, standing, walking, etc.), or arthritis.

Disorders of a more serious nature that contribute to low back pain include cancer, infection, tumor or diseases affecting the prostrate, kidney, or genitourinary system. Of course, disorders such as cancer, infection, and kidney disease are recognized as outside the Doctor of Chiropractic's scope and those patients would be referred to the appropriate specialist.

This is why state licensing laws recognize chiropractic physicians as having plenary diagnostic authority. This means the DC must be able to diagnose most human ailments, but has a limited treatment scope. This differentiates the physician from a technician. Chiropractors are classified by most state licensing boards as a class of physicians.

Straight Chiropractic
Techniques chiropractors use today are very diverse. The practitioner is privileged to practice as narrowly or widely within his or her defined practice scope. Some DCs choose to limit their practice to chiropractic adjustments to manage their patients' conditions. This is an example of straight chiropractic or a narrow practice scope.

Wider Practice Scope
A wider practice scope might include chiropractic adjustments and physiotherapy modalities. Modalities are treatments administered to the patient such as diathermy (heat), electrical muscle stimulation, massage therapy, traction, and ultrasound. Other treatments may include addressing the patient's nutritional needs and physical rehabilitation by implementing aquatic therapy, Pilates, therapeutic exercise, or yoga in the treatment regimen. In addition, the chiropractor may order laboratory testing (blood, urine). This author chooses to practice the wider scope.

Mixers
Some chiropractors, this author included, practice manipulation under anesthesia or conscious sedation. This type of manipulation is performed at a hospital or outpatient surgical center. These practitioners are referred to as mixers in the profession.

Manual Techniques
There are many types of manual techniques. The type of manual techniques a chiropractor uses is usually dependent on the school they attended. Some examples of these methods include Activator, Diversified, Gonstead, Grostic, Logan, Motion Palpation, and Palmer.

Areas of Specialization
Some Doctors of Chiropractic are board certified in internal disorders, neurology, nutrition, orthopaedics, physical rehabilitation, and/or radiology. Similar to other medical specialists, chiropractors may serve as expert witnesses and testify in court about medical cases.

Kinematic Chain
Chiropractors believe that structure, form, and function are interrelated. This is called the kinematic chain. The chain is either open or closed. The chain is only as strong as its weakest link. If breakdown occurs in any part of the chain, dysfunction follows. The desired result is biomechanical wellness.

The mechanics of a fine watch is a good example. A fine watch is constructed of many interdependent components. If one of these components breaks the watch either dysfunctions or stops working altogether. In the chiropractic setting, leg length inequality or short leg syndrome is a biomechanical example of interdependent components. This condition is commonly found in routine chiropractic practice.