Chiropractic therapy is a type of complementary and alternative medicine (CAM) and is concerned primarily with mechanical disorders of the musculoskeletal system, especially those concerning the spinal column. The key principle of chiropractic therapy is a manual manipulation of the spine, joints and soft tissues. The main aim of good chiropractic therapy is the application of force to the areas of the spine that are stiff or hypomobile, while avoiding areas of hypermobility or instability. These manoeuvres are referred to as adjustments and spinal adjustments are the most important component of chiropractic therapy. Spinal manipulation or adjustment is a manual treatment where a vertebral joint is passively moved between the normal range of motion. It is most commonly used by chiropractors but is also occasionally employed by osteopaths, physiotherapists and physicians. Practically all chiropractors use spinal manipulation regularly to treat low back pain and other musculoskeletal pain. Spinal manipulation therapy consists of two broad concepts – manipulation and mobilisation. Manipulations move a joint through its normal range of motion passively by employing techniques such as – nonspecific, long‐lever techniques or specific, short‐lever, high‐velocity, low‐amplitude techniques (the most common forms of chiropractic adjustment). Mobilization is where the joint remains within a passive range of movement and no sudden thrust or force is applied. In addition to manipulation and mobilisation, chiropractors also use manual traction, passive stretching, massage, ischemic compression of trigger points and reflex techniques designed to reduce pain and muscle spasm. Besides spinal manipulation therapy, chiropractors also recommend and prescribe therapeutic exercise and stretching, spinal traction, manual soft tissue therapy, transcutaneous electric nerve stimulation (TENS), ultrasound wave therapy, diet and nutritional counselling and lifestyle modification for a holistic approach to treatment. Although evidence suggests that chiropractic therapy may not have a role in preventive medicine as prophylaxis, it does help as a complementary treatment to allopathic medicine for back pain, joint pain and musculoskeletal pain. Chiropractic treatments can be used in children, adults and the elderly who do not have any contraindicating factors towards it.

  1. Common chiropractic techniques
  2. Indications for chiropractic therapy
  3. Preparation for chiropractic therapy
  4. Procedure of chiropractic therapy
  5. Contraindications for chiropractic therapy
  6. Complications associated with chiropractic therapy

Some common adjustment techniques and procedures used in modern day chiropractic therapy include:

  • Gonstead technique: As the patient lies on their side, the chiropractor practitioner adjusts the pelvis and lower back by realigning joints to reduce stiffness and pain and increase mobility.
  • Activator technique: Using a handheld device, called the activator, the chiropractic practitioner delivers an impulse to the vertebral segments of the spinal column. The patient perceives the sensation as a light thumping and remains quite comfortable throughout the process. This technique is suitable to treat back pain, headaches and even migraine. Elderly patients are well suited to receive activator technique treatment.
  • Flexion distraction, also known as Cox technique or decompression manipulation: It requires the patient to be situated on a special adjustment table. Patients are expected to only feel a gentle stretching movement. It is used to manage disc herniations, facet joint pain and scoliosis among other conditions. 
  • Thompson technique, also known as the drop table technique, is used for manipulation and adjustment of the spine and extremities. The patient is placed on a special table with padded platforms that drop an inch downward every time the chiropractor delivers a thrust. This downward drop is perceived by the patient as a slight soothing vibration.
  • Diversified technique: Very similar to the Gonstead method, the diversified technique is used for adjustments of the spine and extremities. In order to realign, adjust and restore mobility to the spine, precisely positioned thrusts are delivered by the chiropractor in a controlled manner. Diversified technique is the most widely-practised form of chiropractic treatment and yields good results for the patients.
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Chiropractic therapy and adjustment procedures are not substitutes for modern medical treatment. However, studies have substantiated the claims of beneficial improvement with their use in musculoskeletal pain, joint pain and spine-related pain. The applications of chiropractic therapy are wide-ranging as an add on, or complementary, therapy to improve the quality of life of the patients. As of now, studies have not demonstrated or proven any benefits of chiropractic therapy in healthy individuals. Chiropractic treatments do not have protective or preventive value against ailments and such claims have not been substantiated presently. Some conditions where the use of chiropractic therapy is recommended, used and helpful include:

  • Sciatica: Sciatica refers to the neuropathic pain produced by the irritation or compression of the sciatic nerve. The sciatic nerve is the largest nerve in the body made of the nerve roots of the lumbar plexus of nerves supplying the lower limbs. Sciatic nerve pain is usually one-sided. It originates in the lower back, radiates deep into the buttock, and travels down the leg. A common cause of sciatica is intervertebral disc herniation. While disc herniation needs to be corrected to permanently resolve this problem, the pain usually does not respond very well to conventional therapy. Injections of corticosteroids are recommended to treat it. Modest relief is awarded in cases of sciatica following active manipulation by chiropractors.
  • Osteoarthritis: It is a type of arthritis or inflammation of joints that commonly affects large joints like the knees and hips. The wear and tear of the joint cartilage cause the underlying bone to become exposed and break down. The pain of osteoarthritis can be assuaged further with mild and gentle forms of chiropractic treatment.
  • Fibromyalgia: Fibromyalgia is a chronic generalised painful condition in which the patient has a heightened response to the application of pressure. The causation of fibromyalgia is not very well understood but it is known to have links with mental health disorders like depression. Treatment includes medicines and exercise. Chiropractic therapy can help with chronic pain and stiffness.
  • Myofascial pain: Another disorder characterised by widespread chronic muscular pain. Although similar to fibromyalgia, it is associated with predominantly muscular pain and no other additional symptoms of fibromyalgia. Chiropractic treatment can help manage pain better.
  • Chest wall pain: Sometimes chest pain can be due to organic causes like those affecting the lungs or the heart. But muscular causes of chest pain are also common. The latter variety of chest pain can be improved with add on chiropractic treatment.
  • Neck pain: Cervical spine adjustment can help with chronic pain in the neck.
  • Headaches: Headaches, particularly those due to poor posture, can be improved with spinal manipulation.
  • Lower back pain: The most common and widely treated application of chiropractic spinal manipulation therapy is lower back pain.

Before choosing to opt for chiropractic therapy, it is important to consult with your treating doctor. After deciding to get chiropractic adjustments, one should make an appointment with a licensed and trained practitioner. The chiropractor will begin by taking a thorough medical history to rule out any of the extensive absolute or relative contraindications. A physical examination will also be conducted in order to rule out neurological deficits (like sensory loss or motor loss) in any part of the body due to spinal or nerve involvement. An orthopaedic examination may be necessary before proceeding and can involve a referral with an orthopedician. X-rays may be needed to rule out disc prolapse or fracture before initiating therapy.

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The first visit with a chiropractor may last for around 45 minutes whereas the future follow-up visits are much shorter, lasting about 20 minutes. No special precautions need to be taken leading up to the chiropractic session. The chiropractic practitioner positions the patient in different positions on a special chiropractic table, that is usually padded for a comfortable experience and manipulates and mobilises the joints of the body. The joints are passively stretched to their full range of motions and well-placed pressure and thrusting force is applied. Force is applied to the areas of the spine that are stiff or hypomobile, while avoiding areas of hypermobility or instability.

After a chiropractic treatment session, mild reactions are common and expected. It is normal to feel fatigued and experience mild discomfort in areas where manipulations were performed. This resolves in some time. Adequate rest and relaxation can speed the process.

Modest pain relief and comfort should be expected. Although a useful tool to improve the overall outcome of a condition, chiropractic therapy cannot bring about transformative results.

Some preexisting conditions render the use of chiropractic therapy completely impossible in patients, while other factors call for modification of treatments as a precaution. As a rule of thumb, chiropractic treatment should be avoided if:

  • Severe osteoporosis is present with a T score of less than -2.5 on a DEXA scan for bone mineral density or pathological fractures
  • Numbness, tingling or loss of strength in an arm or leg
  • Cancer in your spine, including metastatic deposits, is present 
  • An increased risk of stroke with a history of previous stroke or atrial fibrillation
  • A known bone abnormality in the upper neck like a cervical rib or Arnold Chiari malformation.

Following are the absolute contraindications to spinal manipulative therapy:

  • Acute fracture
  • Spinal cord tumour
  • Acute infection such as osteomyelitis, septic discitis and tuberculosis of the spine
  • Meningeal tumours
  • Hematomas or blood pooling, whether in the spinal cord or intracanalicular
  • Malignancy or cancer of the spine
  • Frank disc herniation with accompanying signs of progressive neurological deficit
  • Basilar invagination of the upper cervical spine
  • Arnold‐Chiari malformation of the upper cervical spine
  • Dislocation of a vertebra
  • Aggressive types of benign tumours, such as an aneurysmal bone cyst, giant cell tumour, osteoblastoma or osteoid osteoma
  • Internal fixation/stabilization devices used for vertebral fracture fixation 
  • Neoplastic disease of muscle or other soft tissue
  • Positive Kernig’s or Lhermitte’s signs 
  • Congenital, generalized hypermobility
  • Signs or patterns of instability
  • Syringomyelia
  • Hydrocephalus of unknown aetiology
  • Cauda equina syndrome

Absolute contraindications to joint manipulation therapy:

  • Inflammatory disorders in the region of the joint to be treated like rheumatoid arthritis, seronegative spondyloarthropathies, demineralization of bone or ligamentous laxity with partial or complete dislocation.
  • Fractures and dislocations, or healed fractures with signs of ligament rupture or instability
  • Atlantoaxial joint instability in the cervical spine or neck
  • At areas of malignancies, including malignant bone tumours
  • Infection of bone and joint
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