Expert: Gerald Anzalone, D.C. - 8/7/2007

Question
I have had chronic neck pain for 15 years.  Recently my lower back has begun
to ache too.  I take Ultram and Lyrica to be able to pain free part of the day.  I
have always remained under traditional care until now.  I just started seeing a
Chiropractor.  He wants me to come in every day for adjustments.  He also
recommends stretching, icing and deep breathing as often as possible.  

Yesterday I went to my first yoga class for people with back problems.  The
yoga instructor says she works with a Chiropractor who is very gentle and
also works with the muscles and connective tissues of the body.  

Each Chiropractor is very different.  Which one is better for me and what
should I expect from a Chiropractor?  

Thank you for any advice you can offer.

Answer
Barbara,

To answer your question, a responsible Doctor of Chiropractic first takes a thorough case history and performs a physical examination to try to determine the nature of the patient's problem. If necessary, additional lab testing may be ordered (i.e., x-rays, MRI, CT scan, blood work, etc.). The chiropractor should note all medications that the patient is taking, as this may reveal a serious medical problem which contra-indicates a particular treatment modality. If necessary, the chiropractor may speak with the patient's medical specialist about the patient's problem for additional information.

The chiropractor should provide the patient with a diagnosis, discuss a proposed treatment plan, review the risks and benefits of receiving or refusing the recommended care, and if necessary, make an appropriate referral to another health care specialist.

The fact that you are taking some rather potent pain medications (you mentioned an opioid and a medication prescribed to patients suffering from diabetic pain, nerve pain related to shingles, or seizures) indicates that you suffer from chronic pain, and your case may be more complicated than the average patient with musculoskeletal problems.

What was the diagnosis that you were given that warrants daily care (and for how long)? Were other treatment options discussed? I can think of very few, if any, diagnoses that would warrant a recommendation for daily care. However, I don't have the benefit of your medical information and case history to comment further on this.

Moreover, the treatment (whether it includes joint manipulation/adjustments, joint mobilization, soft tissue therapy, rehabilitative exercises, or other modalities) must be based on the most reasonable working diagnosis possible. Patients with joint dysfunction may respond best to manipulation/adjustments or mobilization, but soft tissue therapy is more appropriate for individuals with muscular problems, or for those individuals for whom manipulation may not be a good idea. If the patient fails to respond within a reasonable time to a particular treatment approach, the practitioner should consider implementing a different treatment or referring the patient to another specialist for additional evaluation and/or management.

You are correct... many chiropractors differ in their approach. However, there are standards of care that each chiropractor must follow. The problem is that these standards may change often and vary greatly from region to region. If you don't feel comfortable with the treatment approach or recommendations that have been offered to you, you should ask questions. If you feel that you aren't receiving answers to your satisfaction, then you should consider seeing another chiropractor.

I hope that this answer has been of help to you. I am also including links from the American Chiropractic Association that might help you in choosing a good chiropractor in your area.

See the section on Spinal Health:

http://www.amerchiro.org/level2_css.cfm?T1ID=13&T2ID=170

See the section on Frequently Asked Questions:

http://www.amerchiro.org/level2_css.cfm?T1ID=13&T2ID=70