Topic Overview

Chiropractic is an approach to health care that tries to relieve pain through spinal manipulation. It is most often used for back or neck pain. It is sometimes used for headaches or for pain in the arms or legs.

Most doctors of chiropractic (chiropractors) take a natural approach to promoting health through lifestyle changes, nutrition, and exercise.

Many chiropractors have extra training in physical rehabilitation and specific exercise therapy. Some also use nutritional analysis, herbal therapy, and acupuncture.

What does chiropractic treatment involve?

Chiropractic treatments usually involve spinal manipulation. Spinal manipulation is based on the theory that back pain is caused by problems with the muscles and other tissues of the spine and trunk. The manipulation can range from massage and slow pressing to a quick thrust. The goal is to increase movement in the joint and relax the muscles. Some chiropractors use heat, electrical stimulation, or ultrasound to help relax your muscles before doing spinal manipulation.

Other types of treatment may include:

• Heat or ice.
• Corsets or braces.
• Ultrasound.
• Strength and conditioning exercises.
• Biofeedback.
• Relaxation therapy.

Some chiropractors use X-rays to help diagnose conditions.

What to expect from your visit

If you've never been to a chiropractor before, you may be a little worried about what will happen. But the fact is, visiting a chiropractor for low back pain is simple, safe, and usually painless.

And a visit to the chiropractor results in immediate relief for many people.

Your first visit will be a lot like a first-time visit to any new doctor. It's likely to include:

• A health history. You will probably fill out a long form of questions about your health. The chiropractor may also ask additional questions, such as whether you have headaches or migraines or sleeping problems. He or she may also ask you about your diet and your activity level.
• A physical exam. You probably won't have to take off all of your clothes. The chiropractor may check your posture, looking for things that aren't normal, such as one shoulder or hip that is higher than the other. The exam may also include a muscle test. This involves pressing an arm or leg against the chiropractor's hand to test strength. You may also walk a short distance so that the chiropractor can check your gait or other arm or leg movements.

You may also have an X-ray of your spine. Many chiropractors use X-rays to diagnose back problems.

When the chiropractor has all the information, it's time to sit down with you and talk about treatment. If the treatment plan includes spinal manipulation, you could have it the same day or at a later appointment.

What do spinal adjustments feel like?

The most familiar type of spinal manipulation is the hands-on approach: You lie on a table while the chiropractor uses his or her hands to feel for certain parts of your spine and then make quick, gentle pressing motions. Some people call this "cracking" your back because of the popping sound that is sometimes made. But nothing is actually "cracking." The sound happens when the tissues of the spinal joint in question are stretched.

Spinal manipulations normally don't hurt. If you're already in pain because of your back, it may hurt to move. But the manipulations are aimed at making you feel better.

Some chiropractors use a drop table for manipulations. Parts of the table drop slightly when the chiropractor presses down on a patient's back. The table is noisy, but this method is gentler than the hands-on method.

Some chiropractors use a hand-held tool called an activator to do spinal manipulations. This is even more gentle.

How to choose a chiropractor

Ask your medical doctor to help you find someone. Some medical doctors aren't willing to consider chiropractic treatment. If you and your doctor can't agree on how to treat your low back pain, consider getting a second opinion or finding another doctor who is more aware of the benefits of chiropractic treatment.

Try to interview one or two chiropractors before you start treatment.

Look for someone who:

• Is willing to coordinate treatment with other health care professionals.
• Will tell you about home treatment and exercises.
• Diagnoses problems with a physical exam and an interview, using X-ray in unusual cases.
• Is willing to refer you to a specialist when needed. This may include an orthopedist, a neurosurgeon, or an oncologist for further testing, or a registered dietitian for nutritional counseling.

Chiropractors are not your only choice for providing spinal manipulation. Other practitioners who can do this include:

• Osteopaths.
• Physiatrists.
• Physical therapists.

Local laws may vary as to who can do spinal manipulation.