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Chiropractic Care: Evidence-Based Guide to Conditions, Techniques & Patient Selection

Chiropractic = health profession focused on diagnosis, treatment, and prevention of neuromusculoskeletal disorders, emphasizing manual spinal manipulation (adjustment). U.S. DCs complete 4-year doctoral program (4,200+ hrs) + national boards + state licensure.

Evidence-Supported Indications (Per ACP, Cochrane, NIH)

ConditionEvidence StrengthTypical Course
Acute/Subacute Low Back PainStrong (Grade A)6-12 sessions over 2-4 wks
Chronic Low Back PainModerate (Grade B)12+ sessions + exercise
Neck Pain (mechanical)Moderate6-12 sessions
Cervicogenic HeadacheModerate8-12 sessions
Migraine (adjunct)Low-ModerateCo-management
Sciatica (radiculopathy)Low (manipulation contraindicated if progressive neuro deficit)Referral often needed

Conditions NOT Appropriate for Chiropractic Primary Care

  • Fracture, dislocation, spinal instability
  • Cauda equina syndrome (emergency)
  • Spinal cord compression, myelopathy
  • Spinal infection, tumor, metastasis
  • Inflammatory spondyloarthropathy (ankylosing spondylitis) – rheumatology first
  • Severe osteoporosis (fracture risk with HVLA)
  • Vertebral artery dissection signs (sudden severe headache, nystagmus, diplopia, dysphagia, ataxia)

Techniques Beyond HVLA (High-Velocity Low-Amplitude)

  • Mobilization: Low-velocity, graded oscillations (Grade I-IV Maitland).
  • Flexion-Distraction (Cox®): Table-assisted decompression for disc/herniation.
  • Activator/Instrument: Low-force impulse; preferred for osteoporosis, elderly, pediatric.
  • Soft Tissue: Myofascial release, Graston, ART, trigger point therapy.
  • Rehabilitation: McKenzie, DNS, core stabilization, ergonomics.

First Visit Protocol

  1. History (pain diagram, PSFS, ODI/NDI, red flag screen)
  2. Exam: posture, gait, ROM, orthopedic/neurologic tests, palpation, segmental motion
  3. Imaging only if red flags or trauma (Choosing Wisely: no routine X-rays)
  4. Diagnosis + prognosis + informed consent (risks: soreness 30-50%, serious AEs ~1/100,000-1M)
  5. Trial of care (4-6 visits) with measurable goals

Integration with Medical Care

Best outcomes: co-management. DC refers for imaging, labs, injections, PT, surgery. MD refers for conservative spine care. Shared EHR access ideal.

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