Frequently Asked Questions About Chiropractic
What conditions do chiropractors treat?
Doctors of Chiropractic (DCs) care for patients of all ages, with a variety of health conditions. DCs are especially well known for their expertise in caring for patients with back pain, neck pain and headaches...particularly with their highly skilled manipulations or chiropractic adjustments. They also care for patients with a wide range of injuries and disorders of the musculoskeletal system, involving the muscles, ligaments, and joints. These painful conditions often involve or impact the nervous system, which can cause referred pain and dysfunction distant to the region of injury. DCs also counsel patients on diet, nutrition, exercise, healthy habits, and occupational and lifestyle modification.
Is chiropractic treatment safe?
Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small. Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness, stiffness or aching, just as they do after some forms of exercise. Current research shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.
Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck manipulation, when performed by a skilled and well-educated professional such as a doctor of chiropractic, is a remarkably safe procedure.
Some reports have associated high-velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection. However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have a pre-existing arterial disease. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or family physician—but that care is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare—about one to three cases in 100,000 patients who get treated with a course of care. This is similar to the incidence of this type of stroke among the general population.
If you are visiting your doctor of chiropractic with upper-neck pain or headache, be very specific about your symptoms. This will help your doctor of chiropractic offer the safest and most effective treatment, even if it involves referral to another health care provider.
When discussing the risks of any health care procedure, it is important to look at that risk in comparison to other treatments available for the same condition. In this regard, the risks of serious complications from spinal manipulation for conditions such as neck pain and headache compare very favorably with even the most conservative care options.
For example, the risks associated with some of the most common treatments for musculoskeletal pain—over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDS) and prescription painkillers—are significantly greater than those of chiropractic manipulation.
According to the American Journal of Gastroenterology, people taking NSAIDS are three times more likely than those who do not to develop serious adverse gastrointestinal problems such as hemorrhage (bleeding) and perforation. That risk rises to more than five times among people age 60 and older.
Moreover, the number of prescriptions for powerful drugs such as oxycodone and hydrocodone has tripled in the past 12 years. The Centers for Disease Control and Prevention (CDC) has reported that abuse of these commonly prescribed painkillers is among the leading causes of accidental death in the United States. Overdoses of opioid painkillers are responsible for some 15,000 deaths per year; that’s more than the number of deaths from cocaine and heroin combined.
Doctors of chiropractic are well-trained professionals who provide patients with safe, effective care for a variety of common conditions. Their extensive education has prepared them to identify patients who have special risk factors and to get those patients the most appropriate care, even if that requires referral to a medical specialist.
Does chiropractic treatment require a referral from an MD?
A referral is usually not needed to see a doctor of chiropractic (DC); however, your health plan may have specific referral requirements. You may want to contact your employer’s human resources department—or the insurance plan directly—to find out if there are any referral requirements. Most plans allow you to just call and schedule an appointment with a DC.
Is chiropractic treatment appropriate for children?
A: Yes, children can benefit from chiropractic care. Children are very physically active and experience many types of falls and blow from activities of daily living as well as from participating in sports. Injuries such as these may cause many symptoms including back and neck pain, stiffness, soreness or discomfort. Chiropractic care is always adapted to the individual patient. It is a highly skilled treatment, and in the case of children, very gentle.
Do insurance plans cover chiropractic?
Yes. Chiropractic care is included in most health insurance plans, including major medical plans, workers’ compensation, Medicare, some Medicaid plans, and Blue Cross Blue Shield plans for federal employees, among others. Chiropractic care is also available to active-duty members of the armed forces at more than 60 military bases and is available to veterans at more than 60 major veterans medical facilities.
What type of education and training do chiropractors have?
Doctors of chiropractic are educated as primary-contact health care providers, with an emphasis on diagnosis and treatment of conditions related to the musculoskeletal system (the muscles, ligaments, and joints of the spine and extremities) and the nerves that supply them. Educational requirements for doctors of chiropractic are among the most stringent of any of the health care professions. The typical applicant for chiropractic college has already acquired nearly four years of pre-medical undergraduate college education, including courses in biology, inorganic and organic chemistry, physics, psychology, and related lab work. Once accepted into an accredited chiropractic college, the requirements become even more demanding — four to five academic years of professional study are the standard. Doctors of chiropractic are educated in orthopedics, neurology, physiology, human anatomy, and clinical diagnosis including laboratory procedures, diagnostic imaging, exercise, nutrition rehabilitation and more. Because chiropractic care includes highly skilled manipulation/adjusting techniques, a significant portion of time is spent in clinical technique training to master these important manipulative procedures. In total, the chiropractic college curriculum includes a minimum of 4,200 hours of classroom, laboratory and clinical experience. The course of study is approved by the Council on Chiropractic Education, an accrediting agency that is fully recognized by the U.S. Department of Education.
How is a chiropractic adjustment performed?
Chiropractic adjustment or manipulation is a manual procedure that utilizes the highly refined skills developed during the doctor of chiropractic’s intensive years of chiropractic education. The chiropractic physician typically uses his or her hands--or an instrument--to manipulate the joints of the body, particularly the spine, in order to restore or enhance joint function. This often helps resolve joint inflammation and reduces the patient's pain. Chiropractic manipulation is a highly controlled procedure that rarely causes discomfort. The chiropractor adapts the procedure to meet the specific needs of each patient. Patients often note positive changes in their symptoms immediately following treatment.
Do adjustments hurt?
Chiropractic manipulation is a highly controlled procedure that rarely causes discomfort because minimal force and gentle pressure are used. In fact, most patients feel relief immediately following treatment. Any reported soreness after an initial adjustment has been described as similar to that associated with starting a new exercise program. Drinking plenty of water, using an ice pack, and engaging in light stretching after your first visit can help ease any discomfort promote healing.
Are all patients adjusted the same way?
Each patient’s care is unique and therefore customized to meet his or her specific condition and needs. Your chiropractor will modify adjustments based on your size, weight, age and health condition.
Will a chiropractic adjustment completely remove back pain?
For many, back pain can become chronic if left untreated. Chiropractic care has been shown to ease and even eliminate back pain for many patients.
Can I see a chiropractor if I am pregnant?
Many pregnant women find that chiropractic adjustments improve pregnancy experience and make delivery easier. Adjustments are adapted to accommodate the stage of pregnancy and the unique needs of each patient.
Is back pain common?
More than 80 percent of people experience lower back pain at some point in their lives. In fact, it is one of the most reported reasons people miss work and is the second most frequent reason patients visit the doctor.
Will I be required to remove my clothing at my appointment?
Some procedures may require you to remove some pieces of clothing, however, most do not. If you have any questions or concerns, bring them up immediately with your chiropractor.
Can I learn to adjust myself?
Chiropractors are trained to adjust in a very specific location and direction. As a result, it is virtually impossible to adjust oneself correctly and accurately.
Is chiropractic treatment ongoing?
The hands-on nature of the chiropractic treatment is essentially what requires patients to visit the chiropractor a number of times. To be treated by a chiropractor, a patient needs to be in his or her office. In contrast, a course of treatment from medical doctors often involves a pre-established plan that is conducted at home (i.e. taking a course of antibiotics once a day for a couple of weeks). A chiropractor may provide acute, chronic, and/or preventive care thus making a certain number of visits sometimes necessary. Your doctor of chiropractic should tell you the extent of treatment recommended and how long you can expect it to last.
Why is there a popping sound when a joint is adjusted?
Adjustment (or manipulation) of a joint may result in the release of a gas bubble between the joints, which makes a popping sound. The same thing occurs when you “crack” your knuckles. The noise is caused by the change of pressure within the joint, which results in gas bubbles being released. There is usually minimal if any, discomfort involved.
Frequently Asked Questions About Acupuncture?
What is acupuncture?
Let's first define the terms. 'Acupuncture' comes from the Latin 'acts' (point) and 'punctura' (to prick). The originally Chinese practice of inserting fine needles through the skin at specific points especially to cure disease or relieve pain. This seems as good a quick definition as any. We'll offer up another with a little more detail: Acupuncture is one of the oldest, most common and dependable medical therapies used in the world. It is by nature simple, safe and effective health care. Acupuncture practitioners use thin, sterile disposable needles inserted superficially into specific areas of the body in order to help the body's ability to heal itself. Over the three decades or so in which acupuncture has gained popularity in the United States, it has been proven by an increasing body of scientific evidence to be not only exceptionally safe but statistically effective as well.
Why would I want to get acupuncture?
People get acupuncture for many different reasons. For our purposes, we'll offer two main answers to this question.
A) Here is a list of conditions the World Health Organization has deemed appropriate for treatment with acupuncture. (skip down to page 23 of this 1979 report)
B) In addition, we'll offer up a list of 'no-brainer' conditions – that is, situations that should absolutely be treated with acupuncture without hesitation:
Athletic sprain/strain, acute back and/or neck strain, temporal mandibular disorder (TMJ), Bell's palsy, headaches (including migraines), palpitations, early stages of cold/flu, asthma, tendinitis, arthritis, insomnia (poor sleep), Raynaud's, anxiety, high levels of stress, addictions, irritable bowel syndrome, reflux, hemorrhoids, many gynecological issues (including PMS), herpes zoster (shingles) and pre-/post-surgery for accelerated healing.
Do the needles hurt?
Not really much at all. However, getting an acupuncture treatment isn't always painless. More than anything a treatment should be a deeply relaxing and sleepy slice of time for you. Here's what we'd like our patients to know: You may feel a bit of a pinch when the needles are tapped in, but this should ease right away. If you continue to feel a pinching or a burning sensation at the needle site any longer than this, let us know. It means we haven't placed that needle really well. If on the other hand, you are feeling a slight ache or heavy feeling near the needle, this is usually a good sign – a clue that the body is reacting in a productive way.
The bottom line is that as long as the feelings around the needled areas don't keep you from closing your eyes and napping for a little while, we say let them be.
Do you sterilize your needles?
When people ask this, we think there may be an assumption that we are re-using needles. This is not the case at all. For the last 15-20 years, acupuncturists have used one-time use, sterilized, disposable needles as the industry standard. So there is no re-using of needles even from one part of the body to another.
Sterile package opened, needle in, needle out and put into a biohazard box to dispose of responsibly and that's it.
Why do I feel sleepy once the needles are in?
To be honest, we're not sure. There have been many attempts at explaining why this happens and why acupuncture works in general. Our sense is, the presence of the needles causes our central nervous system to move into a clear pattern of rest (parasympathetic), allowing for our quickest healing and recovery to take place. Not unlike when we sleep at night.
This may explain why acupuncture is so effective at helping people overcome the many troubles associated with high-stress levels – a state we can find ourselves in which is characterized by our nervous systems staying in a “fight or flight mode' (sympathetic) for extended periods of time.
Remaining in this state for long periods of time can keep us from recovering in an ideal way, leading to nagging injuries, sleeplessness or illness.
We can tell you, helping people get into a sleepy state is one of the most predictable and best effects acupuncture has to offer.
What are you injecting through the needles to make this work?
Nothing. And we couldn't if we tried. Needles that acupuncturists use are a filiform type, which means they are solid, not hollow like the type of needles 'shots' are given through (hypodermic syringe).
In fact, a standard-sized hypodermic syringe can hold about a dozen average-sized acupuncture needles inside of it.
So....how does all this work?
This is really the million-dollar question. The easiest answer we can offer, in bio-medical terms, is that no one has a definitive explanation. There have been many attempts to nail down The One Reason acupuncture works, but to our knowledge, no one has got it - yet.
In all likelihood there isn't one factor, but that many reactions going on at once involving different systems - including the central nervous system – that allow acupuncture to have such wide, strong and lasting effects. This can be seen by people predictably being eased out of the “fight or flight” response (sympathetic) into the “rest and recuperate” state (parasympathetic) once needles are placed during treatment.
If you have been told or have read that there is one factor to account for how acupuncture works, that explanation is probably not the whole picture.
The most commonly referenced studies on the topic of how acupuncture works have been directed and written by Dr. Bruce Pomerantz, an American physician. Through his ongoing studies, he and his colleagues have found that the body produces measurable amounts of endorphins (natural 'pain-killing' chemicals) when receiving acupuncture. For a time, this was thought to be the breakthrough understanding of the mechanism of acupuncture's effect.
In our opinion, however, there are limits to this explanation. For instance, his initial landmark study involved some very aggressive acupuncture needling followed by electricity added to the needles. It was only under these circumstances that the measurable amounts of endorphins were identified. This does little to explain how much subtler needling (like the sort seen in most acupuncture clinics) would initiate changes and cause a reduction in pain or improve function, for example.
Dr. Pomerantz seems to acknowledge that his research conducted to this point, offers partial explanations.
Do I have to take my clothes off for treatment?
Absolutely not. Occasionally, we may need to have access to areas just above the knee or up to the shoulder joint, in which case we'd ask you to wear shorts or a tee shirt.
But by and large, all it takes to get ready for treatment is to roll up pant legs and shirt sleeves, as points on the lower arms and legs are the most commonly used in community clinics. No need to take any other clothes off.
Preparing for Your Visit with a Physical Therapist
Physical therapists are highly educated, licensed health care professionals who help patients improve or restore mobility, and in many cases helping patients reduce pain, and avoid the need for surgery and the long-term use of prescription medications and their side effects.>br/> Physical therapists examine, evaluate, and treat patients whose conditions limit their ability to move and function in daily life. Your physical therapist's overall goal is to maintain, restore, or improve your mobility and help reduce your pain.
What to Expect During Your First Visit
Your physical therapist will begin by asking you lots of questions about your health and about the specific condition for which you are seeing the physical therapist. Detailed information about you and your condition will help the physical therapist determine whether you are likely to benefit from physical therapy and which treatments are most likely to help you.
Your physical therapist will perform a detailed examination. Depending on your symptoms and condition, the physical therapist might evaluate your strength, flexibility, balance, coordination, posture, blood pressure, and heart and respiration rates. Your physical therapist might use his or her hands to examine or "palpate" the affected area or to perform a detailed examination of the mobility of your joints, muscles, and other tissues.
Your physical therapist also might evaluate:
- How you walk (your "gait")
- How you get up from a lying position or get in and out of a chair ("functional activities")
- How you use your body for certain activities, such as bending and lifting ("body mechanics")
Your physical therapist might ask you specific questions about your home or work environment, your health habits, and activity level, and your leisure and recreational interests so that the therapist can help you become an active and independent as possible.
Your physical therapist will work with you to determine your goals for physical therapy and will begin to develop a plan for your treatment. In many cases, the physical therapist will make a diagnosis and begin treatment almost immediately.
One of the main goals of treatment is almost always to improve or maintain your ability to do your daily tasks and activities. To reach this goal, the physical therapist may need to focus on pain, swelling, weakness, or limited motion. Your physical therapist will constantly assess your response to each treatment and will make adjustments as needed.
In most cases, an important aspect of your physical therapy treatment will be education. Your physical therapist might teach you special exercises to do at home. You might learn new and different ways to perform your activities at work and at home. These new techniques can help minimize pain, lessen strain, avoid re-injury, and speed your recovery.
Your physical therapist will evaluate your need for special equipment, such as special footwear, splints, or crutches. If the evaluation indicates that you are at risk for falling, your physical therapist might recommend simple equipment to help make your home a safer place for you. The therapist will know what equipment you need and can either get it for you or tell you where you can find it. If you do need special equipment, your physical therapist can show you how to use it properly.
Your physical therapist will communicate the important information from your examination to your physician and to other health care professionals at your request.
Your physical therapist will continually recheck your progress and work with you to plan for your discharge from physical therapy when you are ready. Make sure you talk with your physical therapist about what you should do after discharge if you have questions, or if your symptoms or condition worsen.
Keeping Your Appointments
- Arrive for treatment sessions at the scheduled time or a few minutes early so you are prepared. Late arrival may affect not only your 1-on-1 time with the therapist but that of other patients in the clinic.
- Actively participate in the discussion to determine visit frequency and work in partnership with the physical therapist to achieve your treatment goals.
- Show up for appointments. Failure to show for an appointment and not calling to cancel the visit may result in a fee and is disruptive to the physical therapist’s schedule. If an emergency prevents you from attending, try to provide adequate notice. It is important to review the facility’s financial and cancellation policy prior to the start of treatment.
- If you plan to discontinue therapy or change the frequency of treatment because of personal or financial considerations, discuss this with your physical therapist.
You will get out of therapy what you put into it. Sufficient effort, as agreed between you and the physical therapist, is necessary to maximize benefit from each treatment session.
Observe all precautions as instructed by your physical therapist. This may include modifying an activity, reducing weight on 1 limb while walking, avoiding certain movements, or restricting the use of a specific body part. Lack of compliance with treatment precautions may cause injury and result in delayed recovery.
If special devices such as splints, walkers, canes, or braces are provided for home use, follow the physical therapist’s exact instructions. Be sure to ask questions if you are unclear, as incorrect use may be harmful.
The therapist may advise physical modifications in your home such as removing throw rugs, rearranging furniture, and installing safety rails. For your safety, it's essential to comply with these recommendations.
Follow the home program as instructed by the physical therapist. Your ongoing performance and commitment to the home program are essential to your recovery. If the instructions are unclear, ask for clarification. Only perform exercises at the therapist-specified repetition, frequency, and resistance (such as weight or resistance band color). More is not always better and may cause injury!
After your physical therapy care is completed, continue to follow the after-care instructions provided by the physical therapist.
Changing the Rehabilitation Setting
Physical therapy can occur in a variety of settings including hospitals, skilled nursing facilities, rehabilitation facilities, at home or in an outpatient clinic. Depending on your condition and recovery, your medical team may recommend your transfer from one setting to another. For example, if you are discharged from the hospital, physical therapy treatment may be continued in an inpatient rehabilitation facility, your home, or an outpatient clinic depending on the level of care you need.
It is important that your rehabilitation is disrupted as little as possible during the change in setting. Case managers are available in most hospitals and rehabilitation centers to help ensure a smooth transition.
If you are returning home from another facility, ask the physical therapist what special equipment or family support is needed prior to the transfer