Chiropractic

Chiropractor adjusting female patient

WHAT IS CHIROPRACTIC?

Chiropractic, which means “done with skill by hand”, is the third largest primary health care profession after medicine and dentistry.  Doctors of Chiropractic (D.C.) focus on disorders of the musculoskeletal and nervous systems, and how those disorders affect general health.  D.C.’s typically treat neck and back pain, but also treat other musculoskeletal conditions such as headache, joint disorders, and numerous other problems.  They focus on using conservative measures including manipulation, exercise, health advice, physiotherapy, nutrition and other non-drug, non-surgical approaches.

D.C.’s treat approximately 35 million Americans each year.  They are licensed in all 50 states, and are covered by most insurance plans, including Medicare, worker’s compensation, and private health plans. Virtually all major professional sports teams and many other athletes use chiropractic to not only treat injuries, but to promote optimal health and functioning. 1

As with medicine and dentistry, chiropractic education includes a 4 academic year program after college.

HOW EFFECTIVE IS CHIROPRACTIC?

Multiple peer-reviewed studies published in respected scientific journals attest to the effectiveness of chiropractic care, particularly in the treatment of conditions such as back pain, neck pain and headache, among others.  Studies suggest that chiropractic care is as effective as typical medical for these conditions, and is safer.

  • Multiple studies have shown that patient satisfaction with chiropractic care is significantly higher than that for medical care. 2,3,4,5
  • Respected medical organizations including the AMA, the American College of Physicians and the American Pain Academy recently recommend patients try chiropractic care before resorting to drugs or more invasive treatments. 3,4
  • Other studies show that patients who see a D.C. for their back pain first have significantly lowered likelihood of undergoing surgery. 6
  • Multiple studies have shown that chiropractic care is more cost effective than typical medical care.1

HOW SAFE IS CHIROPRACTIC?

Compared to alternatives for musculoskeletal conditions, chiropractic care is remarkably safe.  The truth is that all forms of treatment have some risks. Chiropractic care is typically safer than using over-the-counter medications or opioids, and far safer than surgery. While many patients show improvement immediately with chiropractic care, a small number experience transient soreness, for a day or two, similar to exercising. 7

In fact, a comprehensive review of the scientific literature on treatment of neck complaints  showed at least as much evidence supporting the safety and effectiveness of common chiropractic treatments, including manipulation, as compared with other treatments such as prescription and non-prescription drugs and surgery. 7

WHAT TO EXPECT AT THE CHIRORACTOR’S OFFICE

Your D.C. will begin with a thorough history of your complaints, and conduct a physical examination of those complaints, typically involving palpating the areas of pain, range of motion and related orthopedic tests.  He or she may take x-rays, but much less commonly done than in the past, and typically only after a trial of care if you are not progressing as expected. Most D.C.’s work with a range of medical specialists if your case requires it.

Once the doctor has evaluated you, they will develop a care plan, and explain to you its purpose, expected results, and alternatives.  They will explain any relevant risks and obtain your informed consent.

Evidence-based D.C.’s adhere to national Best Practice guidelines, and typically will do a trial of care, usually 6-12 visits at 2-3 times per week.  Periodic re-evaluations are done to confirm you are making progress, and if not, alternative approached will be tried, which may include referral to a physician or specialist.

Commonly used treatment approaches include:

  • Lifestyle, health or ergonomic advice
  • Manipulation
  • Massage or deep tissue work
  • Therapeutic exercise
  • Physiotherapy, including electrical muscle stimulation, traction or other treatments such as low level laser.

CHIROPRACTIC COSTS

Many insurance plans cover chiropractic care, resulting in a need to pay only a copay or percentage of the total costs. Many other patients pay cash for care. An initial examination can range from $60-130, and manipulation costs average about $45-60 depending on the number of body regions it is applied to.  Therapy costs vary from $20-$50. Some practices do offer discount plans and time-of-service discounts.

Sources:

1 https://handsdownbetter.org/about-chiropractic/

2 Bishop PB, Quon JA, Fisher CG, Dvorak MF. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine J. 2010; 10 (2):1055-1064.

3 Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491.

4 Paige MN, Miake-Lye IM, Booth MS, et al.Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460

5 Bronfort G, Evans R, Anderson A, Svendsen K, Bracha Y, Grimm R. Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine. 2012; 156(1):1-10.

6 Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KCG, Franklin GM. Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State. Spine. 2013;38(11):953-964. doi:10.1097/BRS.0b013e3182814ed5.

7 Hurwitz E, et al. Treatment of neck pain: noninvasive interventions. Spine 2008;33(4S): S123-S152.