Chiropractic care, what it is for and where it stops

If you are trying to work out whether chiropractic care is worth a visit, the useful information is what it actually is, what it is used for, where the evidence is strong and where it is thin, and when the honest answer is that you need someone else. That is what this page covers.

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What an adjustment is

An adjustment is a controlled force applied to a specific joint, usually by hand and usually quickly through a short range. Most people hear a pop. That sound is gas coming out of solution in the fluid inside the joint capsule. It is not bone moving against bone, and the sound is not a measure of whether anything useful happened.

The intended effect is on how the joint moves and on the muscles and nerves around it. A visit is usually short, you stay clothed, and the treatment itself takes a few minutes of a longer appointment.

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Understanding the words in a care plan

An adjustment is a treatment, not a diagnosis. NCCIH describes spinal manipulation as a controlled thrust applied to a spinal joint. If a care plan uses terms such as "subluxation" or "misalignment," ask what was found on your examination, how it relates to your symptoms, and what change would count as progress. Ask for the same explanation of the benefits, risks and alternatives before any technique is used. Our guide to chiropractic education and licensure explains the qualifications separately from the treatment.

Techniques differ, and the differences are real

There are many named chiropractic techniques. The practical differences between them come down to a few things:

• How the force is delivered. Some techniques use a specific hands-on thrust. Others use an instrument that delivers a light, measured impulse, or a table section that drops a short distance under the hand.
• How much force is used. Low-force and instrument-assisted approaches exist specifically for people for whom a manual thrust is not suitable, including older patients and those with bone density concerns.
• What gets treated. Some approaches focus on one region, others work through the whole spine, and many combine joint treatment with soft tissue work and exercise.

If a particular approach does not suit you, saying so is useful information, not a complaint.

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What spinal degeneration actually is

Spinal joints and discs change with age. Discs lose water content and height, joint surfaces wear, and the body lays down extra bone at the margins of a joint. Those bony margins are called osteophytes, or bone spurs.

Two things about this are worth knowing, because the topic is frequently oversold:

• These changes are extremely common and are often painless. Imaging findings of disc degeneration and osteophyte formation are found routinely in people with no back pain at all, and the presence of a finding does not establish that it is the cause of a symptom.
• They are not evidence of an approaching catastrophe. Fusion of vertebrae, significant nerve damage and similar outcomes occur in specific conditions and specific circumstances. They are not the ordinary destination of an untreated stiff back, and copy that implies otherwise is selling with fear.

What degenerative change does often affect is stiffness, movement and comfort, and those are reasonable things to want help with on their own terms.

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What the evidence supports, and what it does not

Manual therapy including spinal manipulation is used most often, and studied most, for low back pain, neck pain and certain headache types. Those three are studied separately and the picture is not identical across them, so a single verdict covering all three would be worth less than it sounds. What is fair to say is that reported effects are generally modest rather than dramatic, and that where manual therapy has been compared with other active treatments such as exercise it has not consistently come out ahead. Anyone telling you the effect is large or unique is going beyond what the research shows.

Outside the musculoskeletal system the picture is different, and claims about general health, immunity, organ function or disease treatment are not supported by evidence of the same quality. This page does not make them.

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When care is adapted, and when it is not appropriate

Treatment is adapted to the person. Age, bone density, previous spinal surgery, pregnancy, medications including blood thinners, and existing diagnoses all change what is appropriate and how much force, if any, is used. Low-force and instrument-assisted approaches exist for exactly that reason.

There are also presentations in which manipulation is not appropriate at all. That is what an examination is for, and it is the reason the first visit is a history and an examination before anything else happens.

A realistic assessment of the risk. Manual treatment of the spine is not risk-free. Short-lived discomfort, stiffness or headache can follow treatment. Serious spinal or neurological events have been reported, and their frequency cannot be estimated accurately. Neck manipulation has been associated with tears in arteries in the neck, called cervical artery dissections, which can lead to stroke. Whether manipulation causes these tears remains disputed, but patients should be told about the association before deciding on treatment. NCCIH explains the evidence and these risks. Suitability is decided case by case, and sometimes the answer is no.

The alternatives, and what they offer. Exercise and physiotherapy have a broad evidence base for back and neck pain and can be continued independently at home. Analgesia and medication chosen with your physician address symptoms directly. Massage and soft tissue work address the muscular component. Time and activity modification are legitimate for many acute episodes, and cost nothing. Any of these may be a better fit than chiropractic care, and several of them combine with it.

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When to see a physician instead

Some back and neck pain needs medical assessment rather than an appointment with us. Seek medical care, urgently where indicated, for:

• Loss of bladder or bowel control, new difficulty passing urine or a change in the sensation of passing urine, or numbness around the groin, buttocks or inner thighs, which is an emergency
• New or worsening weakness in a limb, or numbness that is spreading
• Back pain with fever, or with unexplained weight loss
• Pain that follows significant trauma such as a fall or a collision
• Back pain in someone with a history of cancer, or of osteoporosis with a new fracture risk

Neck pain has its own urgent presentations, and they are not on the list above. Treat as an emergency a sudden, unusually severe neck or head pain, particularly with any of: double vision or vision loss, slurred speech, difficulty swallowing, weakness or numbness on one side, severe unsteadiness, or fainting. Call 911 rather than booking an appointment.

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How we handle it here

We will take your history, examine you, and tell you what we find, including when what we find is not something we treat. If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider.

We evaluate every individual and treat every individual with the care that is specific to them. You are more than just a number on a chart at Source Chiropractic in Clarksville TN. If you want to know whether this is the right place to start, call us and ask.