Chiropractic examination is very similar to the standard examination procedures which are administered by all health care providers.

Chiropractic Exam of Lower Back Pain

An initial chiropractic exam for back pain have 3 parts: a consultation, case history, and physical examination. Laboratory analysis and X-ray examination may also be performed.

1) Consultation The patient meeting with the chiropractor provides briefing synopsis of his or her lower back pain, such as:

– Duration and frequency of symptoms
– Description of the symptoms (e.g. burning, throbbing)
– Areas of pain
– What makes the pain feel better (e.g. sitting, stretching)
– What makes the pain feel worse (e.g. standing, lifting).

2) Case history The chiropractor identifies the complaint areas and the type of the back pain by patient’s history, including:

– Family history
– Dietary
– Past history of other treatments (chiropractic, osteopathic, medical etc.
– Occupational history
– Psychosocial history – Other areas to probe, often based on responses to above questions.

3) Physical examination. A chiropractor can utilize variety of methods to determine the spinal segments which require chiropractic treatments, including not limited to static and motion palpation techniques determining spinal segments that are hypo mobile (restricted in their movement) or fixated. Depending on the results of the above examination, a chiropractor can use additional diagnostic tests, such as:

– X-ray to locate subluxations (the altered position of the vertebra)
– A device which detects the temperature of the skin in the paraspinal region to identify spinal areas with a significant temperature variance which requires manipulation.

Many chiropractors also utilize a holistic, biomechanical concept of treating the bipedal structure in its entirety, in an attempt to balance the structure from the feet upward.

Chiropractors are specially trained in multiple methods of assessing lower back pain, including:

● Evaluation and management services. Chiropractors are trained in examining the joints, bones, muscles and tendons of the spine, head, extremities and other areas of the body with the purpose of knowing any misalignment, tenderness, asymmetry, defects or other problems.

● Neurologic and other common physical Examination procedures. Chiropractors are well trained to perform a variety of neurologic tests (nerve root compression/tension, motor strength, coordination, deep tendon and pathological reflexes, etc.) and are fully skilled in performing orthopaedic, cardiovascular and many other common examinations.

● Specialized assessment. Chiropractors are well trained to assess range of motion, stability, muscle strength, muscle tone and other assessments with the lower back.

● Common diagnostic studies.Chiropractors are also trained in use of diagnostic studies and tools such as radiography (X-rays), laboratory diagnostics and neurodiagnostics.

Dr. Ravinder Kumar, Ortho Neuro Physiotherapy/Chiropractic Adjustment Clinic While assessment of lower back pain, differential diagnosis utilizing a “triage” concept of classifying low back injuries into one of three categories helps to guide the doctor of chiropractic. These categories of chiropractic diagnosis include:

1. Potentially serious: tumor, infection, fracture, major neurological problem (cauda equina), local open wound or burn, prolonged bleeding (hemophilia), artificial joint implant problems, pacemaker problems, joint infection.

2. Nerve problem: when the nerve root in the low back is pinched or compressed, causing a radiculopathy (sciatica). Typical causes of nerve root pinching include a lumbar herniated disc, spondylits, spinal stenosis

3. Non-specific: mechanical back pain in the lumbar spine. This type of lower back pain is the most common presentation, and includes pain for which there is no identifiable cause.

With chiropractic diagnosing of potentially serious injuries, the chiropractor will refer the patient to a relevant medical specialist and possibly a surgeon, and as appropriate the chiropractor might co-manage the patient’s care with other back pain specialists. With this classification, chiropractic manipulation is typically avoided over the relevant anatomy.

With chiropractic diagnosis of a nerve root problem causing sciatica and/or non-specific causes of low back pain, chiropractors describe the symptoms experienced on the following scale:

• Acute (symptoms lasting less than 6 weeks)
• Subacute (symptoms lasting between 6 and 12 weeks)
• Chronic (symptoms lasting for 12 weeks or more)
• Recurrent/flare up (symptoms are similar to original symptoms and return sporadically or as result of exacerbating circumstances).

These lower back pain or sciatica symptoms may be further broken down as mild, moderate or severe in pain.

Chiropractic is a health care professional who is dedicated to the non-surgical treatment of disorders of the nervous system and/or musculoskeletal system. Generally, chiropractors maintain focus on spinal manipulation and treatment of surrounding structures.

It has been concluded that manual therapies commonly used by chiropractors are generally more effective for the treatment of lower back pain as well as for treatment of lumbar herniated disc for radiculopathy and neck pain, along with other conditions.

When patients with non-specific chronic low back pain are treated by chiropractors, the long-term outcome is enhanced by obtaining maintenance of spinal manipulation after the initial intensive manipulative therapy.

Core Chiropractic Treatment

The core of chiropractic usually revolves around the treatment of common lower back pain conditions through manual therapy:

● Spinal manipulation and manual manipulation. This type of manual manipulation refers to a high-velocity, short lever arm thrust which is applied to abnormal vertebra with the goal of improving the functionality, reducing the nerve irritability and restoring the range of motion in the back. It is also commonly known as “chiropractic adjustment”.

● Mobilization. Chiropractic mobilization refers to the low velocity manipulation, movement and stretching of the muscles and joints, with the goal of increasing the range of motion within those areas.

Chiropractic Treatment Plan

The main Goal setting for the chiropractic treatment plan is to drive the patient’s pain and disability issues and activity intolerance.

Main Motive among all guidelines of low back pain treatment is the prevention of chronicity. The use of active care (care that is patient-driven such as exercise, activity modification, ergonomic modifications, etc.) is emphasized on accomplishment of this goal.

Chiropractic adjustment at Ortho Neuro Physiotherapy/Chiropractic Adjustment Clinic, Ghaziabad. also known as chiropractic manipulation, manual manipulation, or spinal manipulation, is a common therapeutic treatment for lower back pain

A chiropractic adjustment refers to a chiropractor who is applying manipulation to the vertebrae that have abnormal movement patterns or fail to function normally.

The objective of this chiropractic treatment is to reduce the subluxation, with the goals of increasing the range of motion, reducing the nerve irritability and improving function.

Chiropractic adjustment typically involves:

• A high velocity, short lever arm thrust applied to a vertebra.
• An accompanying, audible release of gas (joint cavitation) that is caused by the release of oxygen, nitrogen, and carbon dioxide, which releases joint pressure (cavitation)
• A relieving sensation most of the time, although minor discomfort has been reported (that usually lasts for a short time duration) if the surrounding muscles are in spasm or the patient tenses up during this chiropractic care.

It should be known that joint cavitation or cracking does not occur at many times, typically as a result of significant muscle splinting or the patient not being adequately relaxed during the chiropractic manipulation. At times like this, it is sometimes best for the chiropractor to apply ice, have the patient rest, or do electrical stimulation and massage prior to attempting the chiropractic adjustment.

Ortho Neuro Physiotherapy/Chiropractic Adjustment Techniques:-

There are many different manipulative techniques that can be utilized in chiropractic, and there are certain skill level and “art” involved with high velocity, low amplitude adjustment or manipulation. It is perhaps most important for the chiropractor to determine when not to apply the adjustment.

Chiropractic Adjustment Side Effects

The main reaction to a chiropractic adjustment is aching or soreness in the spinal joints or muscles. If this aching or soreness occurs, it is usually within the first few hours of post-treatment and does not last longer than 24 hours after the chiropractic adjustment. Application of an ice pack often reduces the symptoms quickly

Ortho Neuro Physiotherapy/Chiropractic Adjustment Clinic Focus on spinal adjustment is what makes doctors of chiropractic unique in their approach towards treating patients with spinal complaints. The chiropractic adjustment, however, may not be the only procedure a chiropractor may use in managing a patient’s care.

Natural agents like heat, cold, water, massage, light, and exercise are some of the physiological therapeutic measures that are often utilized by chiropractors. When controlled, these and other elements exert a beneficial influence on body functions and can help a number of common lower back pain problems.

Common Forms of Chiropractic Therapy

Some physiological therapeutic measures that are often utilized in chiropractic care include:

Heat and cold. Chiropractors may use alternate between heat and ice therapy to help patients treat back pain. Ice packs may be used to numb the back for a 10 to 15 minute period and then switched to a heating pad, heat wrap or hot water bottle to restore blood flow to the area and promote faster healing.

Exercise. Chiropractors provide patients with instructions for an exercises program focusing on stretching and strengthening the back. For more information, see Exercise and Chiropractic Therapy.

Massage. Chiropractors can massage the soft tissues to improve circulation, reduce swelling and inflammation associated with the back pain, and encourage quicker healing. See Massage Therapy for Lower Back Pain.

Dietary management. Many chiropractors provide patients with tips on how an improved diet may help with their back pain, and some may also recommend dietary supplements after spinal manipulation.

Ultrasound. With ultrasound, sound waves can create deep heat therapy which is applied to the soft tissues and joints. Basically micro-massaging the soft tissues and joints, ultrasound therapy can not only help in reducing back pain, stiffness, and spasms, but increase blood flow and accelerate the healing process.

Diathermy. A form of shortwave, electro-magnetic therapy which passes the softer tissues and provides heat to denser tissues, diathermy relaxes the muscles and connective tissues, decreases the muscle spasms, and accelerates the healing process by increasing circulation. In chiropractic treatment utilizing diathermy, the treatment area will typically feel pleasantly warm.

Hydrotherapy. Water and its varying temperature and pressure via hot baths, whirlpools, saunas or wraps, hydrotherapy focuses on the body’s reaction to hot and cold stimuli. In chiropractic, hydrotherapy may also be used to reduce the sensitivity of back pain through cold stimuli that numb the pain and the use of hot stimuli to promote blood flow and faster healing.

Electrical muscle stimulation. During chiropractic therapy, electrodes are placed on the skin that send light electrical pulses to different areas of the body with the purpose of reducing inflammation, curtailing muscle spasms and relieving on back pain.

Transcutaneous electrical nerve stimulators (TENS). The most common form of electrical stimulation, TENS units features on electrodes that are placed over the painful area with the user having the power to control the intensity of electrical stimulation. It is also believed that TENS help to block the transmission of pain signals along the nerves and also release the body’s natural painkillers, endorphins.

Traction. A chiropractic traction massage also include the patient lying face up as a system of rollers move about the back, all the while stretching and massaging the muscles at the back. Chiropractors may use other traction devices that stretch the spine, decompress the discs and reduce the pressure on the nerve roots (a procedure known as non-surgical spinal decompression).

Infrared radiation. In chiropractic, a thermal camera may also be used to image colored hues indicating the blood flow in the back. For example, red hues would indicate higher IR radiation and more blood flow at the back. Infrared radiation may be used by chiropractors to differentiate normal temperature changes from abnormal differences and to assess the underlying conditions that are causing back pain.

Cold laser therapy. With cold laser therapy, particles of energy are carried in a laser and absorbed by the cell membrane’s photo receptors after penetrating in the skin surface. The cells and tissues then convert this light energy into biochemical energy, fueling a biological process which is believed to decrease swelling, reduce back pain and inflammation, and improve the circulation.

Ergonomics. During chiropractic care, the chiropractor may also recommend some modification such as chainage at work station that is applied at home and/or at work. The success or failure of obtaining the patient satisfying outcome may be directly related to applying an ergonomic/job-related modification or a hobby-related irritating activity. For more information see our Ergonomics Health Center.

Pelvic stabilization. In leg-length deficiency, flat feet and/or subtalar instability are present, the chiropractor may place a small heel lift in the shoe on the short leg side or prescribe corrective arch supports to help stabilize the pelvis.

Patient education. A chiropractor advises a wide variety of lifestyle modifications, including diet and nutritional programs, self-care and coping strategies, to the patient experiencing lower back pain.

These methods may or may not be utilized by the chiropractor in the course of a patient’s case management depending upon their specific needs.

Chiropractic Manipulation and Therapies

Utilizing on specific manipulations (chiropractic adjustments) in conjunction with one or a combination of the above, the chiropractor’s goal is to remove structural or nervous system irritation that may be the major contributing factor in a patient’s lower back pain.

In Ortho Neuro Physiotherapy/Chiropractic Adjustment Clinic Cardiovascular and strengthening exercises are combined with chiropractic care are important in the management of low back pain.

A patient having a history of heart problems, it is important for the patient to consult with not only the doctor of chiropractic but their primary care physician to be certain that they can tolerate cardiovascular fitness-promotional activities. Specific instructions are given by the chiropractor with respect to proper exercise for the patient’s condition before beginning any exercise program.

In general, a reasonable amount of exercise that is performed daily and utilizes activities that are enjoyed is recommended for patients undergoing a chiropractic treatment.

Exercise Benefits

The importance of exercises in managing acute and chronic low back pain, strengthening the low back, preventing and keeping back patients working, and to improvement in quality of life. The strength of the abdominal muscles was also found to be able to differentiate between those with vs. without chronic LBP

Aerobic exercise helps to promote proper digestion, keeps the muscles in proper tone and promotes better circulation. Walking briskly around the block at least once or twice is a convenient and popular activity.

Also, many forms of work and/or household tasks also function as an exercise program. The important point is to exercise!

Types of Exercises

There are many back exercises that are available for patients who are undergoing chiropractic care for lower back pain. One can classify the chiropractic patient into a flexion or extension biased category to determine the variety that is best for that patient.

• If a patient feels best on bending over (flexion biased), exercises which promote low back flexion such as pulling the knees to the chest, posterior pelvic tilts, bending forward from a sitting position and others are usually helpful.
• If a patient is least symptomatic in extension, especially if leg pain centralizes or diminishes (extension biased), prone press-up type exercises usually yield the best results.

Other exercises that can help reduce lower back pain include:

• Strengthening of the pelvic stabilizing muscles (trunk muscles)
• Stretching of the hamstrings, adductors, and other overly short or tight postural muscles
• Proprioceptive or balance promoting.

According to the Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP):

• Strong evidence supports on exercise as being at least as effective as other non-surgical treatments for chronic low back pain
• Moderate evidence supports the use of a graded-activity exercise program in occupational settings for sub acute lower back pain
• Some evidence shows that exercises are more effective than other nonsurgical treatments for acute lower back pain.

As with any chiropractic treatment, it is important for chiropractors to perform a focused re-evaluation of an exercise program following its initial therapeutic trial to determine its effectiveness. Using spinal range of motion as a measurement in the effectiveness of exercise is just one way in which chiropractors can make such determinations.

When you visit Ortho Neuro Physiotherapy & Chiropractic Clinic, Ghaziabad for your chiropractic appointment you’ll be greeted by our friendly staff while you fill out your quick & easy paperwork & take Consultation. You’ll be seen right away and as you can see, the treatment on your first visit is effective and provides immediate relief with visible results.

So now that you know what to expect during your first time at the chiropractor, what are you waiting for?

Questions to Ask About Chiropractic Techniques

• Is the chiropractor friendly and courteous?
• Does the patient feel comfortable talking with the chiropractor?
• Does the chiropractor fully answer all questions asked by the patient?
• Does the chiropractic doctor listen to the patient’s complete explanation of symptoms and treatment concerns/preferences?
• How many years has the chiropractor been in practice?
• Does the chiropractor have a specific undergraduate or post-graduate specialty?
• Although not necessary, some chiropractors pursue post-graduate diplomat programs in various specialties, such as orthopedics, sports medicine, rehabilitation, neurology, nutrition

Chiropractic & X-Rays Relation:-

There are arguments on both for and against the use of X-rays as a part of chiropractic health care.

But in Ortho Neuro Physiotherapy/Chiropractic Adjustment Clinic Many patients do not require X-rays; however, some chiropractors take them as a standard procedure, either as a defensive practice to rule out pathology (such as a possible tumor or fracture) and/or to aid in determining where to adjust the spine.

In most cases of non-traumatic musculoskeletal low back pain, an X-ray is not needed. One retrospective review found that in a sample of 350 X-rays, only 15% showed a significant pathology that changed treatment recommendations. For the other 85%, there were no clinically significant findings on the X-ray. The conclusion of this review and other similar reviews is that unless a thorough clinical evaluation specifically indicates the need for X-ray testing, it is not warranted and exposes the patient to unnecessary radiation.1 With that said, it may be reasonable to consider an x-ray after several weeks if there is an absence or plateau in symptom improvement.

As a general guideline Ortho Neuro Physiotherapy/Chiropractic Adjustment Clinic X-rays are recommended in the following cases:

• If the patient sustained a significant traumatic injury, as a bone may be broken or a joint may be dislocated.
• If an infection may be the cause of the patient’s pain.
• If any significant disease is suspected, such as cancer or a possible tumor
• If any type of joint disease is suspected, such as arthritis causing joint pain.
• If the patient is over age 50 and has experienced any type of trauma (even a minor one)
• For patients over 65 years of age.
• Anyone who has been diagnosed with or who may be at risk for osteoporosis. The X-ray may be important to identify or rule out a possible vertebral fracture from osteoporosis.
• Any suspected spinal instability.
• If the patient has had long-standing pain that has not responded to or resolved with previous health care treatment

As a general guideline, an X-ray is indicated if it is likely to inform the type of treatment recommended for the patient. In any of the above cases, an X-ray would likely provide critical information that will direct treatment protocols and/or referral options for the patient.