San Francisco – Chiropractors are licensed health professionals who treat common musculoskeletal conditions primarily through manual methods. Although there are several chiropractic techniques, they all center on the spinal adjustment. Also called spinal manipulation, a spinal adjustment is a maneuver done by hand to impart movement to a joint. It can be used to move vertebrae in the cervical (neck), thoracic (torso area), and lumbar (lower back) regions of the spine. The purpose of the adjustment is two-fold: to impart movement to a restricted or immobile joint and to help re-align it relative to the rest of the joints in the spine. A third benefit is the stimulation of spinal nerves involved in muscle tone. The benefits of a properly aligned, flexible spine are better movement, balance, and nerve function.

Chiropractors contend that the spinal column plays a large role in maintaining health and preventing injuries. Since the spine is the structure on which other parts of the body are attached, it follows that any structural problems with the spine will in some way affect other parts of the body. More importantly, the spine encases the spinal cord, which is an extension of the brain. If the bones (vertebrae) of the neck are out of proper alignment, it may place direct pressure on the spinal cord. Since the brain and spinal cord control muscle function, sensory function, and organ function it follows that pressure to the spinal cord may adversely interfere with these processes, leading to symptoms and diseases like back pain, headaches, light headedness, and indigestion.

A visit to a chiropractor will start out like a typical visit to any doctor: the patient will be asked to fill out a patient history. Here the patient will describe in detail the problem she is experiencing: how it happened, when it happened, how often it is felt, how severe; related symptoms, and so on. The doctor will try to pinpoint the causation by asking other questions involving any hobbies/ activities, diet, work environment, and medical history of the patient’s immediate family members.

Next, vital signs may be taken: heart rate, blood pressure, respiratory rate, temperature, pulse rate. And depending on the presenting symptoms and complaints, certain orthopedic and neurological tests may be performed. These are tests used to locate the structures involved in the condition and often attempt to provoke the symptoms. For example, if the patient were to come in for low back pain, the chiropractor may conduct a straight-leg raise test, where the doctor raises the leg of the patient as she is lying down on her back. If it causes low back pain, the test is positive for a herniated disc. The chiropractor may also conduct Kemp’s Test, where the standing patient bends backwards and twists to one side. Pain going down the leg is positive for disc herniation on that side. There are orthopedic tests to evaluate problems affecting the neck, thorax, pelvis, and extremity joints. The chiropractor will also palpate, or feel the spine for signs of spinal dysfunction such as joint restrictions, muscle spasm, trigger points, edema, hyperemia, and changes in skin temperature.

Neurological tests are done to evaluate the motor (strength) and sensory function of major nerves. These tests include the cranial nerve tests to test hearing, smell, taste, eye movement, pupil dilation, swallowing, facial muscles, and others; deep tendon reflexes (using the reflex hammer) to test the major nerve roots in the upper and lower extremities; muscle strength tests, and dermatomal tests to evaluate the sensory component of the nerves and nerve roots.

An X-ray of the area may be taken and compared to the exam findings. If the X-ray study is inconclusive, an MRI (magnetic resonance imaging) may be taken to visualize soft tissue structures such as the discs, muscles, spinal cord, and nerve roots.

The chiropractor will then correlate all the exam findings, come up with a diagnosis, and prescribe a treatment plan for the patients. This may include a series of spinal adjustments, physiotherapy such as ice/heat, electric muscle stimulation, ultrasound, and low level laser therapy; and exercises. Often, the chiropractor may suggest supplements and dietary measures to help prepare the body for healing the injured area. The treatment sessions are usually 2-3 visits per week for 2-4 weeks, reducing in frequency until the condition has resolved. Home care is usually prescribed after the acute (painful) phase has subsided. This can include special exercises, home traction, and supports.

So that is what a typical chiropractic experience involves. If you are experiencing musculoskeletal pain or symptoms that are not resolving on their own, calling a chiropractor would be a good place to start.

Dr. Dan Perez

Dan Perez, D.C. is a Chiropractor in San Francisco.