Although treatment from chiropractors can vary greatly depending on the philosophy and technique of the doctor, the doctor should always perform an objective evaluation of the patient’s complaint and complete a health history before any treatment is performed. Like treatment, this evaluation can vary between chiropractors, but this blog post will explain what a good chiropractor should do before adjusting your spine.
The first thing I always do when I see a new patient is a complete consultation. During this consultation, I will ask a number of questions designed to figure out exactly what may be causing the pain that brought you into the office. These questions include: How long have you experienced this pain? Have you ever had pain like this before? Is there any motion or activity that either helps or causes more pain? Have you seen any other doctors, or tried anything at home to help with the pain? Is the pain constant or does it tend to come and go? Is the pain worse first thing in the morning or does it get worse as the day goes on? Does the pain radiate down your arms or legs? A good consultation alone usually results in a proper diagnosis 90% of the time.
A complete health history is also part of a solid consultation. This includes whether you have issues with any organ systems such as the digestive, respiratory, or renal (kidney) systems. In addition I will ask if you have had any previous surgeries or take medications for any condition. Finally, I ask about any past traumas, like falls or car accidents. In my experience as a chiropractor, I have found that even very minor traumas can cause issues years later.
After the consultation, if I still believe that I can help a patient, I move on to a thorough examination of the spine and nervous system. My examination includes range of motion, orthopedic, neurologic and chiropractic tests. The orthopedic tests will reproduce pain if there is an issue with a specific joint. The neurologic tests tell me if there is any nerve damage, and the chiropractic tests let me know if you are a good candidate for chiropractic care.
I do not limit my examination to only the area of complaint. Meaning if a patient comes in with lower back pain, I do not look at only their lower back, I also examine the neck and mid back. The spine consists of 24 movable segments, so if something is wrong in one area of the spine it can easily affect another. I have found that I get better results when I look at the spine in its entirety instead of just focusing on one area.
If necessary I then move on to take x-rays of the spine after the consultation and examination. Although many chiropractors are moving away from taking x-rays, I have found that in many cases they are essential for the safety of the patient. Not only do x-rays give me a picture of exactly what your spine looks like, they also keep me from performing any treatment that could be harmful to the patient.
One very common case that I find on x-ray is what is called a spondylolisthesis. A spondylolisthesis is a condition in which one vertebra shifts forward in respect to the verteba below it. The most common area for a spondylolithesis is the final vertebra of the lower back (L5) slipping forward on the sacrum, or tailbone. Although most cases are minor and cause little to no symptoms, a severe spondylolisthesis can cause extreme pain and may require surgery. Most patients that I find a spondylolisthesis on x-ray have absolutely no idea that it is there.
A spondylolisthesis will not keep a chiropractor from treating you, however it is an area that they need to be very careful around. If the vertebra is already shifting forward, that is not an area that I want to be pushing on and potentially making any worse. Unfortunately, without x-rays a spondylolisthesis can not be diagnosed, therefore a chiropractor adjusting without an x-ray can unknowingly make the problem worse.
In rare cases, x-rays have also allowed me to find severe medical conditions that a patient did not even know they had. In my career, I have discovered cancer in patients three times. In each case, the patient had absolutely no idea, and it allowed me to refer them to oncologists for proper treatment. Had I not taken x-rays, and adjusted these patients, I could have possibly fractured vertebra due to cancer weakening the bone structure.
There is an old saying that states “To see is to know, to not see is to guess.” I think that this is true when it comes to x-rays. An x-ray allows me to be sure that there is absolutely nothing that would keep me from treating a patient. When it comes to your health, wouldn’t you prefer your doctor to know and not guess?
Report of Findings
The next step I take before treating a patient is explaining to them, in depth, what I have found based on the consultation, exam and x-rays, and how I believe that I can help them. During this time, any and all questions from the patient about their diagnosis or treatment are answered. A specific treatment plan is also reviewed with the number of visits and time frame for these visits. The cost of care, and any insurance information, is also covered at this time.
Finally, I give a patient a consent form which outlines any potential risks of chiropractic care, as well as the risk of going without treatment. However, with x-rays and a good consult and exam, we can eliminate almost all of these risk factors. I also explain exactly what the patient should expect before giving them their first adjustment.
Only after I have completed all of these steps do I move onto to treating the patient. If you ever see a chiropractor, or any type of doctor, that attempts to begin treatment without performing these procedures, it is probably time to find a new doctor.
I hope this blog post has helped give you an outline of what to expect when seeing a chiropractor for the first time. A consultation, examination and report of findings should always be performed before beginning any type of medical treatment. In some cases, x-rays may also be necessary to ensure that a proper diagnosis has been made and there is nothing that would keep the doctor from treating you.