Chiropractic Tools and Techniques
Chiropractic adjustments have been shown to be a safe and effective alternative treatment for pain and injury.
Chiropractors perform 95 percent of all adjustments in the world to correct the subluxations, or misalignments, of the vertebrae in the spine. Chiropractic adjustments are performed by applying gentle, yet firm pressure to a bone. The goal of any adjustment is to restore the bone to its natural, or original, position. The important thing to remember is that the act of adjusting frees - not forces - a vertebrae to allow it to find its natural position. This is accomplished by the body's innate intelligence.
Chiropractic adjustments are performed to treat a wide variety of conditions, including (but not limited to):
Adjustments can be performed while sitting, standing, or lying down. Some adjustments involve special instruments or tables.
Some common adjustment techniques include:
- Instrument adjustments, which involve a spring-loaded device.
- Lumbar roll, in which the chiropractor applies a firm, yet quick thrust to a misaligned vertebra while the patient lies on his or her side.
- Motion palpation, a hand technique the chiropractor uses to determine if your vertebrae are properly aligned.
- Release work, in which the chiropractor uses gentle pressure with the fingers to separate the vertebrae.
- Table adjustments, which entail lying on a specially designed table that drops when pressure is applied to a specific area. The dropping motion allows more gentle adjustments than some manual adjustments do.
- Toggle drop, which entails firm pressure applied on a specific area of the spine by using crossed hands.
Chiropractors take many factors - including size, weight, and muscle structure - into consideration when deciding on which adjustment to make. Sometimes, ice, electrical stimulation, or massage therapy (including traction massage) are used prior to a spinal manipulation in order to relax the muscles.
In some cases, it may necessary to perform an adjustment while you are sedated.
Spinal manipulation under anesthesia, which is considered a very safe procedure, is usually reserved for patients with conditions such as chronic neck, back, and joint pain, muscle spasm, shortened muscles, and fibrous adhesions.
Another form of adjustment called craniosacral therapy, or "CST," involves exerting very mild pressure to the body's craniosacral system, which is comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. This includes cranium - which is composed of the skull, face and mouth, and the "sacrum," or tailbone.
CST has been shown to provide relief from chronic neck and back pain, scoliosis, brain and spinal cord injuries, migraines, chronic fatigue, nervous system disorders, jaw joint problems, and stress disorders. (Such conditions as aneurysm and intracranial hemorrhage prohibit this kind of therapy.)
Adjustments almost always do not involve any pain or discomfort. The important thing for a patient to keep in mind is to remain relaxed, because stiffening up may impede the adjustment process. Popping sounds are sometimes heard during adjustments; these are usually pockets of air being released behind a joint or other bony structure.
Adjustments can leave you with a greater sense of well-being, calm, and most importantly, on the road to a life without pain. Following an adjustment, some patients experience mild aching or soreness in their spinal joints or muscles, which can usually be relieved by an ice or heat pack.
Adjustments have been shown to:
- Increase blood flow;
- Increase pain tolerance levels;
- Increase range of motion;
- Increase the body's secretion of "good" chemicals such as melatonin and endorphins;
- Reduce blood pressure
- Reduce tension and muscle pressure.
Corsets, Braces, and Splints
Corsets, braces and splints are used in chiropractic treatment. A common application of braces is used to treat children with idiopathic scoliosis, or curvature of the spine.
Back braces are only recommended for younger children (girls between 11 and 13, and boys between 12 and 14). The primary goal of orthotic treatment involving a back brace is to stop the progression of the curvature; braces do not normally reverse curvature that has already taken place.
Lifestyle and Nutrition Counseling
Chiropractors believe that when your body is in a state of homeostasis, or balance, all of its varied systems function properly to repair or reverse injury or disease.
It is a holistic approach to patient care, one that focuses on a patient's total wellness, or well-being, instead of specific diseases or ailments. This intricate physiological and biochemical interrelationship among various parts of your body - including its spinal, musculoskeletal, neurological, and vascular systems - is what chiropractors dedicate themselves to exploring and treating, with special attention to nutrition, exercise, and healthy emotional and environmental relationships. When one or more of these systems is impaired, your body ceases to function normally and your resistance to disease is compromised.
Lifestyle counseling is a critical part of what chiropractic care involves - from providing advice on lifting techniques, sleep, posture, exercise, and nutrition and diet, to ergonomic work environments and sports and recreational injury prevention.
Exercise and other kinds of physical activity can go far in keeping your body strong and healthy, able to fight disease and ward off injuries from pulling, pushing and lifting. A healthy and fit body also generally recovers faster from injury and pain. Like exercise, proper nutrition provides a wealth of benefits - both physical and emotional - that contribute to your body's strength and its ability to avert disease and disability. A healthy diet translates into a healthy body; the proper mix of vitamins, minerals and other nutrients are the best recipe for ensuring that your skeletal, muscular, nervous and circulatory systems function smoothly.
A neurological examination is sometimes performed to determine if any part of your body has incurred damage to its central nervous system. Many health problems have been associated with nerve damage, and such, this exam can significantly improve the chances of making a thorough diagnosis.
A neurological exam involves a thorough exploration of the body's arms, legs, and trunk.
If you have a neurological exam, your chiropractor may look for signs of:
- Bowel or bladder problems;
- Gait problems (walking, running, climbing stairs, etc.);
- Muscle spasms or twitching;
- Numbness, tingling, or pain and whether changing positions relieves those symptoms;
- Problems with balance;
- Weakened muscle strength and tone;
- Weakened reflexes (a sign of possible damage to the spinal cord, nerves, or
- muscles); and
- Weakness (consistent or intermittent) in your arms or legs.
Because the body's nerves are electrical conductors, medical professionals have long held that stimulating nerve endings with small electrical currents can produce beneficial results.
The theory behind electrotherapy as part of chiropractic care is that such stimulation to affected nerves and muscles encourages the body to release pain-killing chemicals, such as opiates and endorphins, and blocks pain signals from being transmitted to the brain.
Electrotherapy is a pain management technique, and as such, is part of an overall chiropractic treatment regimen. The technique is usually involved in the early treatment stages, especially right after an injury. Ice and heat therapy may be combined with electrotherapy to boost its pain-killing powers.
Electrotherapy normally involves placing small adhesive pads on the skin at various points on the body. Generally, electrotherapy is not painful. The adhesive pads may cause a minor skin irritation after being removed, and in some instances, patients may feel a mild stinging after therapy.
Common types of electrotherapy include:
- Galvanic stimulation (GS) - High voltage pulsed galvanic stimulation has been used in acute low back pain to reduce muscle spasm and soft tissue edema (swelling). It is commonly used despite the lack of hard scientific evidence for its efficacy. Its effect on muscle spasm and pain is felt to occur by its counter-irritant effect on nerve conduction and a reduction in muscle contractility.
- Radiofrequency rhizotomy - Normally used for chronic cases of facet joint syndrome, a degenerative condition in which joint cartilage wears thin, causing stiffness, inflammation, muscle spasms, and later osteoarthritis. This procedure applies heated radio-frequency waves to the joint's nerves that carry painful impulses
- Transcutaneous Electrical Nerve Stimulation (TENS) - This is the most common type of electrical stimulation used today. TENS therapy is normally used to treat chronic, or long-term pain in the lower back. Small electrodes are placed inside an elastic-type belt worn around the lumbar region. Percutaneous electrical nerve stimulation (PENS), an enhanced and newer type of pain management therapy, makes use of very thin needles (much like those in acupuncture), which are inserted in the lower back by the chiropractor. Small, battery-powered TENS units also are available for use at home, work, or other activities. The patient is able to control the level and frequency of stimulation, and self-administer impulses during episodes of pain.
- Interferential current (IFC) - This is a kind of TENS therapy in which high-frequency electrical impulses are introduced deep into the tissues near the center of the pain.
Exercise therapy is a form of chiropractic treatment used to help manage pain, rehabilitate damaged soft tissues such as muscles, ligament and tendons, and restore normal range of motion and function.
Such therapy has been shown to alleviate pain, improve overall muscle strength and range of motion, improve balance, as well as avoid further deterioration of muscle tissues. The overall goal of an exercise therapy program is to promote healing and prevent further damage and injury to your body's musculoskeletal system. Exercises programs also help in minimizing scar tissue formation following an injury or surgery.
Most exercise programs are designed to improve cardiovascular conditioning and bolster your strength. Many exercises involve flexing and extending specific parts of the body.
As a patient, you play a pivotal role in the outcome of any therapeutic exercise program. Your dedication to following the steps outlined in the program will go a long way in ensuring its success.
When the muscles supporting the lower spine need to be strengthened, lumbar stabilization may be used in your chiropractic treatment as a form of physical therapy. Lumbar stabilization helps you to develop strength, flexibility, and endurance and also has been shown effective in alleviating lower back pain.
The key to lumbar stabilization is achieving a "neutral spine" position. The neutral spine position is that which is the least painful but most sound posture for your lower back.
When your spine is in a neutral position:
- The discs and vertebrae are able to absorb shocks and other forces acting on the spine in an optimal way,
- There is less tension on the ligaments and joints of your spine, and
- Your posture is centered.
Once you learn how to go to your neutral spine position, lumbar stabilization teaches you how to maintain that position through a technique called "proprioception." Proprioception teaches you how to know where your joints are at any given time.
Lumbar stabilization helps you:
- Better control the movements affecting your spine;
- Heal muscle strains, sprains, and damaged ligaments;
- Know how to avoid future injuries; and
- Reduce pain in your lower back.
In many cases, temporary pain, and even additional injury, can be minimized and even avoided by a simple application of ice. Ice, applied in a timely manner and in an appropriate way, can reduce inflammation. Inflammation left unchecked can allow the source of the pain to continue doing damage to muscles, ligaments, tendons, and other structures.
Ice causes the veins in the affected tissue area to constrict. This reduces the flow of blood while acting as a kind of anesthetic to numb the pain. But when the ice is removed (and this is key), the veins compensate by opening large, allowing a large volume of blood to rush to the affected area. The blood brings with it important chemicals that aid in the healing process.
Back and neck injuries frequently involve muscle sprains and strained ligaments, which can spasm and become inflamed.
Ice massage, or cryotherapy, is effectively used to treat many kinds of injuries, including those associated with back or neck pain.
Ice massage can provide a number of benefits, including:
- Assisting the body in minimizing tissue damage,
- Mitigating muscle spasms, and
- Reducing or eliminating pain by numbing sore soft tissues.
Ice therapy is not recommended as a form of treatment for any kinds of rheumatoid arthritis, Raynaud's Syndrome (a circulatory disorder of blood vessels of the extremities), colds or allergic conditions, paralysis, or areas of impaired sensation.
While ice therapy is used to reduce swelling, heat therapy is used to relax the muscles and increase circulation. Both kinds of therapy help reduce pain.
Heat therapy is often used in patients who have chronic or long-lasting pain. The therapy can involve many kinds of methods, from simple heating pads, wraps, and warm gel packs, to sophisticated techniques, such as therapeutic ultrasound.
Back injuries can create tension and stiffness in the muscles and soft tissues of the lumbar region, or lower back. In many cases, your circulation may be impeded.
The tension in the muscles can sometimes escalate to spasms.
- Dilates the blood vessels of the affected muscles, allowing them to relax and begin healing;
- Helps lower discomfort by reducing the amount of pain signals going to the brain; and
- Increases the ability of your muscles to easily flex and stretch, thereby decreasing stiffness.
Heat therapy, as well as ice therapy, are normally parts of an overall chiropractic treatment plan and rarely accomplish maximum results without such a plan.
Heat therapy is not used on swollen or bruised tissues, or for patients who have dermatitis, deep vein thrombosis, diabetes, peripheral vascular disease, open wounds, and cardiovascular conditions such as hypertension.
Many of us have heard about how ultrasound is used as a diagnostic test to explore disease process and injury in the human body. Diagnostic ultrasound, for example, can be used to look at joints, nerve roots, tendons, ligaments and muscles, and to pinpoint signs of inflammation and scar tissue. In some cases, ultrasound helps the chiropractor identify the proper course of treatment.
But ultrasound has another exciting application in the form of deep heat therapy.
Therapeutic ultrasound uses heated sound waves and applies that energy to soft tissues and joints. The fast-moving waves essentially massage soft tissues effortlessly, and in most cases, painlessly.
- Alleviates muscle spasms,
- Helps increase blood flow,
- Improves range of motion,
- Lowers pain and stiffness, and
- Reduces inflammation and swelling.
Therapeutic ultrasound is typically applied using a small, hand-held wand.
Therapeutic ultrasound is often used as one method to treat lower back pain. It is not used to treat acute inflammatory conditions or in patients who have had a laminectomy.