Chiropractic services beyond adjustments

The focus on spinal adjustment is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. The chiropractic adjustment, however, may not be the only procedure a chiropractor may employ in managing a patient's care. For example, chiropractic care has utilised drugless therapeutics (natural therapies) since as early as 1912.

​Natural agents such as heat, cold, water, massage, light and exercise are some of the physiological therapeutic measures that are often utilised by chiropractors. When controlled, these and other elements exert a beneficial influence on body functions and can help a number of common lower back pain problems

Common forms of chiropractic therapy

Some physiological therapeutic measures that are often utilised in chiropractic care include:

• Heat and cold. Chiropractors may alternate between heat and ice therapy to help patients treat back pain. Ice packs may be used to numb the back for a 10 to 15 minute period and then switched with a heating pad, heat wrap or hot water bottle to restore blood flow to the area and promote faster healing.
• Exercise. Chiropractors may provide patients with instructions for an exercise program focusing on stretching and strengthening the back. For more information
• Massage. Chiropractors may massage the soft tissues to improve circulation, reduce swelling and inflammation associated with the back pain, and encourage quicker healing.
• Dietary management. Many chiropractors will provide patients with tips on how an improved diet may help with their back pain, and some may recommend dietary supplements after spinal manipulation.

These methods may or may not be utilized by the chiropractor in the course of a patient's case management depending upon their specific needs.

Chiropractic manipulation and therapies

Utilising specific manipulations (chiropractic adjustments) in conjunction with one or a combination of the above, the chiropractor's goal is to remove structural or nervous system irritation that may be a major contributing factor in a patient's lower back pain.

Exercise and chiropractic therapy

Cardiovascular and strengthening exercises combined with chiropractic care are important in the management of low back pain.
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If a patient has a history of heart problems, it is important for the patient to consult with not only the doctor of chiropractic but their primary care physician to be certain that they can tolerate cardiovascular fitness-promoting activities. Specific instructions are given by the chiropractor with respect to proper exercise for the patient's condition before beginning any exercise program.

In general, a reasonable amount of exercise that is performed daily and utilises activities that are enjoyed is recommended for patients undergoing chiropractic treatment.

Types of Exercises

There are many applicable back exercises that are available for patients also undergoing chiropractic care for lower back pain. One can classify the chiropractic patient into a flexion or extension biased category to determine the variety that is best for that patient.
For example:

• If a patient feels best when bending over (flexion biased), exercises that promote low back flexion such as pulling the knees to the chest, posterior pelvic tilts, bending forward from a sitting position and others are usually helpful.
• If a patient is least symptomatic in extension, especially if leg pain centralises or diminishes (extension biased), prone press-up type exercises usually yield the best results.

Other exercises that can help reduce lower back pain include:

• Strengthening of the pelvic stabilising muscles (trunk muscles)
• Stretching of the hamstrings, adductors, and other overly short or tight postural muscles
• Proprioceptive or balance promoting.

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References

1.Bigos S, Bowyer O, Braen G, et al., "Acute low back problems in adults. Clinical practice guideline No. 14. AHCPR Publication No. 95-0642," Rockville, MD; Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services (1994).
2.Chiropractic & Osteopathy, 2010, 18:3
3.Chou R, MD, Qaseem A, MD, PhD, MHA, et al., "Diagnosis & Treatment of LBP: A Joint Clinical Practice Guideline from the American College of Physicians & the American Pain Society," Annals of Internal Med, 2007;147:478-91. (3)
4.Mayer J, DC,PhD. Mooney V, MD, Dagenais S, DC PhD, "Evidence-informed management of CLBP with lumbar extensor strengthening exercises," T Spine J, 2008;8:96-113. (3)
5.Keller, MD, et al., "Trunk Muscle Strength, Cross-sectional Area, and Density in Patients With CLBP Randomized to Lumbar Fusion or Cognitive Intervention and Exercises," Spine, 2004 29(1): 3-8 (3)
6.Bigos S, MD, Holland J, MD, MPH, Holland C P, et al., "High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults," T Spine J, 2009;9:147-68. (4)