Chiropractic care, what it is for and where it stops

General chiropractic care is built around the adjustment: a quick, controlled movement of a joint that isn't moving well, usually in the spine, and often combined with exercise. It's used most often for low back pain, neck pain and certain types of headache. Here's how we explain it to people at Source Chiropractic in Clarksville.

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What is a chiropractic adjustment?

An adjustment is a controlled force applied to one specific joint, usually by hand, delivered quickly through a short range of motion. Most people hear a pop. That's gas coming out of solution in the fluid inside the joint capsule. It isn't bone moving against bone, and the sound doesn't tell either of us whether the adjustment did any good.

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

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What do the words in a chiropractic care plan mean?

An adjustment is a treatment. NCCIH, part of the National Institutes of Health, describes spinal manipulation as a controlled thrust applied to a spinal joint. That tells you what's done to the joint. It doesn't tell you what's wrong with it.

Words like "subluxation" or "misalignment" can turn up in a chiropractic care plan. We do talk about "subluxation." The idea behind it is one framework we use to explain spinal dysfunction. The word means something when it's tied to a specific finding on your exam, to how that finding connects to your symptoms, and to what change would count as progress. We'll go over what we found before we recommend anything. We cover the risks and the alternatives further down. And if you'd like to know how chiropractors are trained and licensed, our guide to chiropractic education and licensure covers that separately.

How do chiropractic techniques differ?

There are a lot of 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 a manual thrust doesn't suit, including older patients and people 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 doesn't suit you, saying so is useful information, not a complaint.

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What is spinal degeneration?

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

Two things matter here, because this topic gets oversold:

• These changes are extremely common and often painless. Disc degeneration and bone spurs show up routinely on the imaging of people with no back pain at all, so a finding on your X-ray or MRI can't simply be assumed to be the cause of your symptoms.
• They aren't a sign that something terrible is coming. Fused vertebrae, serious nerve damage and outcomes like them happen in specific conditions and specific circumstances. They aren't where an untreated stiff back ordinarily ends up.

Where degenerative change often does show up is in stiffness, movement and comfort, and those are fair things to want help with in their own right.

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What does the research on chiropractic care show?

We offer this care, so here's how we read the research. Manual therapy, including spinal manipulation, is used most often, and studied most, for low back pain, neck pain and certain types of headache. Each of those three has its own body of research, and the findings aren't identical across them, so one verdict covering all three would claim more than it can. What's fair to say is that reported effects are generally modest, not dramatic, and that when manual therapy has been compared with other active treatments such as exercise, it hasn't consistently come out ahead. Anyone telling you the effect is large, or that only chiropractic can deliver it, is going beyond what the research shows.

Outside the musculoskeletal system it's a different picture. Claims about general health, immunity, organ function or treating disease aren't supported by evidence of the same quality, and this page doesn't make them.

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When do we adapt care, and when is it the wrong choice?

We adapt treatment to the person. Age, bone density, previous spinal surgery, pregnancy, medications (including blood thinners) and existing diagnoses all change what's suitable and how much force, if any, is used. That's exactly why low-force and instrument-assisted approaches exist.

Some presentations rule out manipulation altogether. Picking those up is part of what the exam is for, and it's why your first visit starts with a history and an exam before anything else happens.

The risks, stated plainly. Manual treatment of the spine isn't risk-free. Short-lived discomfort, stiffness or a headache can follow a treatment. Serious spinal or neurological events have been reported, and nobody can accurately estimate how often they happen. Neck manipulation has been associated with tears in the arteries of the neck, called cervical artery dissections, which can lead to stroke. Whether manipulation causes those tears is still disputed, but patients should be told about the association before deciding on treatment. We decide suitability case by case, and sometimes the answer is no.

The alternatives, and what they offer. Exercise and physical therapy have a broad evidence base for back and neck pain, and you can keep them going on your own at home. Pain relievers and other medication, chosen with your doctor, address the symptoms directly. Massage and soft tissue work address the muscle side of the problem. For many acute episodes, time and changing your activity for a while are legitimate options, and they cost nothing. Any of these may be a better fit for you than chiropractic care, and several of them can be combined with it.

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When should you see a medical doctor instead?

Some back and neck pain needs a medical assessment, not an appointment with us. Please get 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 warning signs, and they aren't on the list above. A sudden, unusually severe neck or head pain is an emergency, particularly with any of these: double vision or vision loss, slurred speech, difficulty swallowing, weakness or numbness on one side, severe unsteadiness, or fainting. Call 911. Don't book an appointment with us instead.

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How we work at Source Chiropractic

We'll take your history, examine you, and tell you what we find, including when what we find is not something we treat. Every treatment plan here is customized, because every patient's condition, health history and needs are different.

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. If you're still not sure chiropractic is the right starting point for what's bothering you, that's a fair question to bring to a first visit.