Chiropractic; Types, Diagnosis/tests, Treatment Technique

Chiropractic is a form of alternative medicine mostly concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine.Proponents claim that such disorders affect general health via the nervous system.These claims are not backed by any evidence. The main chiropractic treatment technique involves manual therapy, especially spinal manipulation therapy(SMT), manipulations of other joints and soft tissues. Its foundation is at odds with mainstream medicine, and chiropractic is sustained by pseudoscientific ideas such as subluxation and “innate intelligence” that are not based on sound science.

Conditions for  Treatement for Chiropractic

Chiropractors use a variety of non-surgical treatments to treat patients with certain types of

While primarily focusing on treating neuromusculoskeletal disorders, chiropractors are not exclusively limited to problems with the nervous system and musculoskeletal system.

Disease condition for chiropractic

While we cannot go over every kind of arthritis, we will touch upon the most common types.

  1. Degenerative Arthritis -This is when the cartilage in your joints, that is the cushioning substance in between your bones, begins to break down and wear away. This means that bone is rubbing against bone and can cause swelling, stiffness, and pain. This can be caused by excess weight, family history, previous injury, or any combination of the three.
  2. Inflammatory Arthritis -Inflammatory arthritis is what occurs when your immune system goes off the rails and begins to attack your joints. It can also damage organs, eyes, and other parts of the body. Rheumatoid arthritis is the most common kind and may be tested through bloodwork. It is believed that family history and environmental factors can cause inflammatory arthritis.
  3. Metabolic Arthritis – This is caused when uric acid builds up in the joints and forms sharp crystals that cause severe pain. There are some treatments, but these symptoms often come and go for life.
  4. Vertebral subluxations – can be caused by the body’s inability to adapt to a wide variety of factors, what we’ll generally call stresses. These stresses can be physical (such as accidental trauma, sleeping posture, pillow and mattress condition, the birth process, sneezing, falling down, etc.), mental / emotional (in its many forms, probably the most familiar use of the word stress), or chemical (such as pollution, drugs, etc.), which are, unfortunately, regular parts of daily living for all age groups.  In short, a vertebral subluxation can occur for a multitude of reasons
  5. Neuromusculoskeletal disorders

    Treatment is usually for neck or low back pain and related disorders.For acute low back pain, low quality evidence has suggested no difference between real and sham spine manipulation, and moderate quality evidence has suggested no difference between spine manipulation and other commonly used treatments, such as medication and physical therapy

Chiropractic Examination

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

Consultation

The patient meets with the chiropractor and provides a brief 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).

Case history

The chiropractor identifies the area(s) of complaint and the nature of the back pain by asking questions and learning more about different areas of the patient’s history, including:

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

Physical examination

A chiropractor may utilize a variety of methods to determine the spinal segments that require chiropractic treatments, including but 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 may use additional diagnostic tests, such as:

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

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

In the 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:

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

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, spondylolisthesis, spinal stenosis

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.

Chiropractic Tests

When you visit your chiropractor for the first time, he/she will probably ask you to perform a series of simple tests to evaluate your posture and range of motion. You may be asked to bend forward,  backward or side-to-side. The chiropractor will also check the way you walk and how your posture looks sitting down and standing up.  Other tests may include:

  • Piriformis Test: The patient flexes and bends the knee while lying down.
  • Straight Leg Raise: One leg at a time is raised in a locked-knee position to check the sciatic nerve and flexibility of the hamstring muscle.
  • Measuring the length of each leg helps determine if there is a discrepancy in leg length or if the pelvis is out of balance.
  • Hand strength (grip)
  • Evaluation of reflexes and muscle testing

Sometimes you might hear a pop while the chiropractor is testing or adjusting you, which is perfectly normal. This is caused by small pockets of air or bubbles in the fluid that surrounds your joints. When joint tissues are stretched, those pockets of air “pop,” which creates the cracking sound you hear.

Diagnosis of Chiropractic

Once the chiropractor identifies the problem, he/she can recommend treatment options, and explain how many chiropractic visits are necessary to reach an expected outcome (eg, resolution of pain). He/she may also suggest improvements to your diet and lifestyle, such as quitting smoking or increasing/modifying certain activities. A chiropractor may also recommend certain types of exercises in conjunction with chiropractic treatment to stretch and/or strengthen the back and neck.

Adjustment Techniques

A chiropractor is educated in dozens of ways to treat pain. Here is a sampling of the different techniques that may be used.

  • Toggle Drop – The chiropractor presses down firmly on a particular area of the spine followed by a quick and precise thrust.
  • Lumbar Roll – With the patient on his/her side, a quick thrust is applied to the misaligned vertebrae.
  • Release Work – The chiropractor uses gentle pressure with the fingertips to separate the vertebrae.
  • TENS (Transcutaneous electrical stimulation) – This device sends stimulating pulses across the surface of the skin and nerve strands to block pain signals along the nerves and release endorphins which are natural painkillers.
  • Cold/Heat Treatment – Chiropractors may alternate between ice and heat therapy to treat back or neck pain. Ice packs are used to reduce inflammation (swelling) for 15 minutes at a time. A heating pad (or another heat source) helps to increase circulation and may promote faster healing.
  • Table Adjustments – The patient lies on a special table with a “drop piece” then a quick thrust is applied when the table drops.
  • Instrument Adjustments – Instead of hands-on manipulation, the patient lies on the table face down while the chiropractor uses a spring-loaded activator instrument to perform the adjustment.
  • Manipulation Under Anesthesia – This is performed by chiropractors certified in this technique. The treatment is performed in a hospital outpatient setting.

Chiropractic Treatment technique

Direct thrust technique

This technique, also referred to as spinal manipulation, focuses on the spine and is perhaps the most well-known chiropractic adjustment. The chiropractor uses a high-velocity, low-amplitude thrust, which is a swift, short movement to encourage proper vertebral alignment because misaligned spinal components may cause restricted motion and resulting pain.

This technique frequently produces the cracking sound that many people have come to associate with chiropractic care. The popping sound is nothing to worry about and is actually the release of gas trapped between joints..

Spinal mobilization

For patients with conditions such as osteoporosis who require a gentler approach, spinal mobilization may be used in place of the direct thrust technique, although the goal of proper spinal alignment and optimal joint functioning is the same.With this form of chiropractic adjustment, slow movements including gentle stretches or firm pressure—as opposed to thrusts—are used to encourage spinal components into their rightful places.

 Drop Table Adjusting

I use a type of chiropractic adjusting table that allows for certain pieces to be lifted.  These drop pieces can be tensioned according to patient comfort so that when the appropriate amount of force is given the drop piece drops a few inches quickly.  This allows us to use momentum to cause the joint motion and thus requiring less of a push.  This may sound forceful, but it is generally considered quite comfortable.  Because the table has so many positional options, I have the flexibility to move the joints in a variety of different ways. While we don’t typically bring the joint through it’s a full range of motion, it’s speed allows for a quick joint stretch that may have similar benefits to manipulation. Additionally, I can use the drop table to perform postural adjustments that work well to supplement the patient’s prescribed postural exercises.

Instrument Assisted Adjusting

I often use a common chiropractic tool to help with either preparing the joints for greater movement or as a stand-alone treatment.  This works well for individuals with severe pain or spasm that have difficulty with either the body position required or the amount of pressure being used for more forceful maneuvers.  The type of instrument I use has three intensity settings and can be used with a single impulse or with a burst of impulses.  It is generally considered the most gentle of the types since it’s smaller surface area contact means that we need less force to provide a very quick stretch to the joints.

Articulatory

Articulatory chiropractic adjustments target injured joints and help to restore them to their full range of motion. To achieve this goal, the chiropractor slowly moves the arm, leg, or other extremity through its range of motions while applying force.Moving the joint through the full range of motion helps to remedy stiffness and improve mobility.

Myofascial release

This chiropractic adjustment targets myofascial tissue, which is a layer of membranes that cover, support, and connect the body’s muscles. This type of therapy is also sometimes done in massage. Stress or other causes can lead to stiff areas in myofascial tissue, called trigger points, which lead to pain.Pain is not always present at the area of the trigger point. Sometimes, the patient will feel it in another area of the body, which can make the points difficult to find. A chiropractor works with patients to uncover these stiff areas and release tension to reduce pain.In addition to causing stiffness, trigger points may further restrict the movement of joints and muscles, which can cause problems and pain throughout the body.

Muscle energy technique

This type of chiropractic adjustment is a form of myofascial release, but is active because it requires patient participation. It targets stiff areas of the body that have developed into trigger points and cause pain.As the patient uses specific muscles, the chiropractor applies counter-pressure. This technique is repeated several times, with each repetition lasting for several seconds followed by a brief period of rest. After each repetition, the chiropractor will shift the position slightly to ensure the technique targets the complete range of motion.Muscle energy technique strengthens weak areas, promotes mobility, works to release trigger points, and improves blood flow to promote healing and flexibility. The goal is to provide full mobility and reduce pain.

Indirect positional technique

Some people suffer pain from hypertonic muscles, which means they are overly toned. Many times, people think of muscle tone as a good thing, but too much muscle tone, or uneven tone, can lead to tightness and pain.

For example, a mostly sedentary person with a desk job who then lifts weights several times each week may have overly developed pectoral muscles that result in poor posture, with the shoulders rolled forward. In this case, the pectoral muscles would be considered hypertonic.The indirect positional technique seeks to correct hypertonic muscles and help the surrounding joints regain the full range of motion. This chiropractic adjustment involves the practitioner holding the joint in a neutral position before applying a specific force. Sometimes, the force is used to lengthen the muscle and other times it’s intended only to release tightness and encourage the muscle’s return to health.

Cervical spine manipulation

Problems in the cervical spine, which is the portion in the neck, may lead to headaches, upper back pain, discomfort in the shoulders or arms, or diminished range of motion. Chiropractors manipulating the cervical spine use the same techniques as with direct thrust or the more gentle chiropractic adjustment, spinal mobilization.

Functional technique

Functional technique targets joints to free them from restriction and improve overall mobility. To achieve this goal, chiropractors use a gentle force as they move the joint through its natural range of motion. Once a restriction is detected, the practitioner holds the joint at the point of restriction until it releases.

Criteria going through chiropractors 

Soft Tissue Therapy

Many chiropractors provide soft tissue therapy either on its own or in preparation for adjustment. During this treatment, you will rest in a comfortable position on a massage or adjustment table. Next, your practitioner will apply a special warming lotion, cream, moisturizer, or gel to prepare your skin. Your chiropractor will then massage your tissue, adjusting your muscles, ligaments, tendons, and other deeper tissue to loosen them. He or she may do so by hand, or with specially made steel, aluminum, or polymer tools. Your chiropractor may massage back and forth or in specific patterns across your back and up and down your limbs, depending on the area of your injury or discomfort.

Soft tissue therapy can help stimulate tissue regeneration by breaking down damaged, tightened scar tissue and encouraging new, healthier, more nutrient-rich tissue to replace it. It can also relax your muscles, alleviate uncomfortable symptoms, and expand your range of motion. Soft tissue therapy typically takes less than ten minutes to complete. Your skin may ache slightly or tingle after your treatment. You may also experience redness or bruising after soft tissue therapy, so you may need to apply ice. These side effects typically dissipate quickly, leaving you with loosened tissue and a calmer feeling.

Chiropractic instruments of Chiropractic

Heat Therapy

Your chiropractor may use heat therapy to help relax and loosen your tissues to temporarily relieve tension and prepare your tissues for more intensive manipulation or modification. Before or after an adjustment, soft tissue massage, hydrotherapy session, or another treatment, your chiropractor may place a hot water bottle, heating pad, or wrap over your treatment area for between 5 and 20 minutes. Your practitioner may also use more advanced diathermy treatment. This involves transmitting electromagnetic waves through your tissue through electrodes placed on the surface of your skin to precisely and evenly warm it.

Heat therapy can enhance your joint health by enlarging your blood vessels and allowing your joints to loosen. Improving circulation in the treatment area can also speed healing and make your joints more pliable so they can be more easily adjusted. Heat therapy should provide a pleasantly warm sensation in your skin and underlying tissue. While your skin may be slightly red after treatment, heat therapy should not burn it. Heat therapy is most often used in conjunction with other chiropractic treatments. In addition to providing it in his or her office, your chiropractor may recommend administering heat therapy to relax your joints at home and keep them loosened in between appointments.

Cold Therapy

Your chiropractor may also use cryotherapy, or cold treatments, to enhance your care. During this treatment, your practitioner will apply ice or a cold compress to your affected area for between 5 and 20 minutes, similarly to heat therapy. Cryotherapy shrinks your blood vessels to desensitize treatment areas, relax your muscles, and alleviate uncomfortable symptoms. Many chiropractors combine heat and cold therapy, alternating the two for excellent results. As with heat therapy, your practitioner may suggest at-home cold therapy treatment. Cryotherapy is particularly helpful directly after experiencing an injury, since it can reduce inflammation and relieve discomfort. As with heat therapy, your cold therapy application should not be so extreme as to damage your skin, but should feel comfortably cool and numbing.

Nutrition Therapy

Since chiropractic treatment is a holistic therapy, many practitioners also provide nutrition therapy. This involves assessing patients’ diets, making suggestions to improve them, and prescribing appropriate vitamins and supplements. Many natural substances, such as glucosamine and chondroitin, can improve joint health, while others, such as turmeric or ginger, can reduce inflammation. Enhancing your nutrition can help you achieve optimal results from other chiropractic treatments and better your overall wellbeing.

Exercise Programs

A woman stretching before a run

Improving your joint health is an ongoing process that requires consistent effort, so your chiropractor may recommend an exercise regimen to accompany your in-office treatments. To maintain your flexibility, range of motion, posture, and general wellbeing between appointments, your chiropractor may suggest a regimen of exercises. Aerobic exercise can stimulate better digestion and encourage circulation. In addition, building and toning your muscles can help them remain in alignment. Your chiropractor may also suggest targeted stretches to promote healing and rehabilitation. These could include balance exercises, flexion conditioning to improve your mobility, and extension activities to lengthen and loosen your joints. Overall, exercise programs can help you maintain the results of your chiropractic treatment and help you alleviate uncomfortable symptoms at home.

Lifestyle Modification Counseling

Many aspects of your daily life can affect your joint health and posture. Your chiropractor can provide lifestyle modification counseling to help you improve your:

  • Weight: Heavier patients may suffer from a greater risk of strain, misalignment or other chiropractic disorders.
  • Overall stress: Anxiety or tension can tighten your muscles and impact your general health. Your practitioner can cooperate with you to improve your emotional and physical wellbeing, which contributes to your general health.
  • Work and home environment: Investing in ergonomic furniture and changing the way you sit, stand, and recline could enhance your chiropractic treatment.
  • Habits: Smoking or drinking excessively can negatively impact your joint and general health.
  • Medication usage: Many patients seek chiropractic care for their conditions because they would like to reduce their prescription drug usage. Your practitioner can help you alleviate your symptoms and assist you in the process of becoming less reliant on medications.

Your chiropractor may liaise with your nutritionist, general practitioner, orthopedic surgeon, or any other relevant medical professionals to create a comprehensive lifestyle modification plan that suits your needs and wishes.

Ultrasound Therapy

A man undergoing ultrasound therapy

As a precursor or alternative to other chiropractic treatments, your practitioner may provide ultrasound therapy. During this treatment, he or she will dress you in a medical gown, apply medicated gel, and pass a small handheld ultrasound device over your tissue. This appliance will transmit ultrasonic waves through your joints, providing heat to relax them, diminish swelling, stimulate blood flow, and promote healing. Each ultrasound therapy session can last between 10 and 45 minutes, depending on the size of the treatment area and your preferences.

Hydrotherapy

Some chiropractors provide hydrotherapy, which involves using water to manipulate your joints. Hydrotherapy can combine the following treatment techniques:

  • Chiropractic adjustment– Precise, pulsating jets of water can take the place of your practitioner’s hands or devices in repositioning your body.
  • Soft tissue therapy – Swirling waves of water can put pressure on your tissue to loosen it, much like the massage techniques of soft tissue therapy.
  • Heat and cold therapy – Your chiropractor may have you rest your treatment area in warm or cool water to experience the benefits of hot and cold therapy. As with these treatments, heat can help loosen your joints and improve blood circulation, while cold can numb affected areas.
  • Traction therapy – Some hydrotherapy systems combine water with traction tools such as rollers for more effective massage.

There are many types of hydrotherapy systems your chiropractor might use in his or her practice. To provide treatment, your practitioner may have you sit, lie, stretch, exercise, or undergo massage and adjustment in a sauna, bath, or hot tub. He or she could also use moist wraps to complement other therapies. Some chiropractors may invest in advanced hydrotherapy massage tables, in which you rest in water while the machine treats your tissue with pressurized hot or cold water.

Electrical Muscle Stimulation

Many chiropractors also treat patients using electrical muscle stimulation, a therapy that involves applying electrodes to specific areas of the body and passing low level currents through them. This causes them to flex and contract, exercising them so that they release tension and become stronger. Electrical muscle stimulation also stimulates the production of hormones, which help diminish discomfort and reduce swelling. During this treatment, most patients feel just a slight tingling sensation and then some measure of immediate symptom relief.Once he or she attaches the electrodes to your skin, your chiropractor will begin the electrical muscle stimulation, gradually increasing the energy level according to your comfort and treatment plan. Electrical muscle stimulation usually takes about ten minutes to complete, after which your practitioner may apply cold therapy. Chiropractors often use electrical muscle stimulation to help patients with sports injuries, headaches, or back, neck, and shoulder pain.

TENS Therapy

“TENS” stands for Transcutaneous Electrical Nerve Stimulation. This therapy is extremely similar to electrical muscle stimulation, but you as the patient control the electrode placement and the level of the current. You can undergo TENS treatment either in your chiropractor’s practice or in the comfort of your own homeIn either case, your practitioner will provide you with the TENS equipment (usually a small box with connected electrodes) and provide general guidelines about where to place the electrodes and how to adjust the current. A lighter current creates a milder tingling sensation, while a strong current exercises your muscles more rigorously with its vibrations. TENS therapy should not cause pain and should provide some form of immediate relief. Causing your muscles to repeatedly contract with TENS can assist with muscle spasms and aches by scrambling your nerve impulses and diminishing inflammation.

You may utilize TENS therapy for sessions between 10 and 40 minutes in length, depending on your chiropractor’s suggestions. TENS should not be used during driving or sleep, while exposed to water, or while simultaneously using heat or cold therapy. You should ensure that your skin is clean where the electrodes are placed and report any rashes or skin damage to your chiropractor.

Traction Therapy

Chiropractors may use traction therapy to stretch your muscles, release tension, reduce inflammation, and improve your postural alignment. This treatment involves using various techniques to decompress and expand your tissues. There are three primary forms of traction therapy:

  • Some practitioners use what is called “anti-gravity” traction therapy, positioning patients on an inversion table so they are partially upside down. During this type of traction therapy, patients’ own weight pulls and elongates their spines and other tissues.
  • Mechanical traction involves the use of rollers or other handheld tools to accurately manipulate and open up the tissues. Your chiropractor may use special devices for different areas of tissue. For example, in a mechanical traction therapy called spinal decompression, chiropractors use motorized or manual appliances to stretch the spinal tissues. Some practitioners also invest in manual traction tables, automated pieces of chiropractic equipment that massage and elongate tissue as you sit or recline on them.
  • As a distinctive form of soft tissue therapy or massage, your chiropractor may focus on manual traction. This means that your practitioner will use his or her bare hands to lengthen your tissues and release tension with repeated motions. Some practitioners may also use weights or a pulley system to enhance manual traction therapy.

Your chiropractor can more thoroughly explain the types of traction therapy he or she offers at your initial consultation.

Wellness Care

Many chiropractors are also concerned with wellness care. This means that they provide holistic treatments to enhance your overall health. In addition to treating your tissues with chiropractic therapies, your practitioner may liaise with other health professionals to ensure that your care is as effective as possible. Nutritional therapy, exercise programs, and lifestyle modification counseling also fall under the heading of wellness care. Chiropractors who emphasize wellness care may also work with patients that do not have any clear musculoskeletal, spinal, or health issues, but simply want to enjoy more ideal alignment, comfort, flexibility, and quality of life.

Interventions

Skilled, specific hands-on techniques, including manipulation and mobilization, are used to diagnose and treat soft tissues and joint structures, to reduce pain and to increase range of motion and general health.

The approach is generally conservative, and treatment may include:

  • manual procedures, including spinal or joint manipulation or mobilization, soft‐tissue and reflex techniques;
  • exercise, and other active care;
  • psychosocial aspects of patient management;
  • patient education on spinal health, posture, nutrition and lifestyle modifications;
  • emergency treatment and acute pain management;
  • other supportive measures, including the use of back supports and orthotics;
  • recognition of the limitations of chiropractic care, and of the need for referral to other health professionals.

Chiropractors may also use exercise and other conservative treatments and advice.

Effectiveness of 

There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain. Generally, the research carried out into the effectiveness of chiropractic has been of poor quality. Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results. Research published by chiropractors is distinctly biased. For reviews of SM for back pain chiropractic authors tend to have positive conclusions, while others did not show any effectiveness.

There is a wide range of ways to measure treatment outcomes. Chiropractic care, like all medical treatment, benefits from the placebo response. It is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. The efficacy of maintenance care in chiropractic is unknown.

Available evidence covers the following conditions:

  • Low back pain – A 2013 Cochrane review found very low to moderate evidence that SMT was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain. The same review found that SMT appears to be no better than other recommended therapies. A 2016 review found moderate evidence indicating that chiropractic care seems to be effective as physical therapy for low back pain. 2012 overview of systematic reviews found that collectively, SM failed to show it is an effective intervention for pain. A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between SMT and other treatments for reducing pain and improving function for chronic low back pain. A 2010 Cochrane review found no current evidence to support or refute a clinically significant difference between the effects of combined chiropractic interventions and other interventions for chronic or mixed duration low back pain. A 2010 systematic review found that most studies suggest SMT achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. Specific guidelines concerning the treatment of nonspecific (i.e. unknown cause) low back pain are inconsistent between countries.
  • Radiculopathy – A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following SM, when compared to usual care, and suggested that SM may be considered. There is moderate quality evidence to support the use of SM for the treatment of acute lumbar radiculopathy and acute lumbar disc herniation with associated radiculopathy. There is low or very low evidence supporting SM for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration and no evidence exists for the treatment of thoracic radiculopathy.
  • Whiplash and other neck pain – There is no consensus on the effectiveness of manual therapies for neck pain. A 2013 systematic review found that the data suggests that there are minimal short- and long-term treatment differences when comparing manipulation or mobilization of the cervical spine to physical therapy or exercise for neck pain improvement. A 2013 systematic review found that although there is insufficient evidence that thoracic SM is more effective than other treatments, it is a suitable intervention to treat some patients with non-specific neck pain. A 2011 systematic review found that thoracic SM may offer short-term improvement for the treatment of acute or subacute mechanical neck pain; although the body of literature is still weak. A 2010 Cochrane review found low-quality evidence that suggests cervical manipulation may offer better short-term pain relief than a control for neck pain, and moderate evidence that cervical manipulation and mobilization produced similar effects on pain, function and patient satisfaction. A 2010 systematic review found low-level evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash.
  • Headache – A 2011 systematic review found evidence that suggests that chiropractic SMT might be as effective as propranolol or topiramate in the prevention of migraine headaches. A 2011 systematic review found evidence that does not support the use of SM for the treatment of migraine headaches. A 2006 review found no rigorous evidence supporting SM or other manual therapies for a tension headache. A 2005 review found that the evidence was weak for the effectiveness of chiropractic manipulation for a tension headache and that it was probably more effective for a tension headache than for a migraine. A 2004 Cochrane review found evidence that suggests SM may be effective for a migraine, tension headache and cervicogenic headache.
  • Extremity conditions – A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief than a supervised exercise program alone and suggested that manual therapists consider adding manual mobilization to optimize supervised active exercise programs. There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however, this evidence could be considered to be inconclusive. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, limited to low-level evidence supporting chiropractic management of shoulder pain and limited or fair evidence supporting chiropractic management of leg conditions.
  • Other – A 2012 systematic review found insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension. A 2011 systematic review found moderate evidence to support the use of manual therapy for cervicogenic dizziness. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions. Other reviews have found no evidence of significant benefit for asthma, baby colic, bedwetting, carpal tunnel syndrome, fibromyalgia, gastrointestinal disorders, kinetic imbalance due to suboccipital strain (KISS) in infants, menstrual cramps, insomnia, postmenopausal symptoms, or pelvic and back pain during pregnancy. As there is no evidence of effectiveness or safety for cervical manipulation for baby colic, it is not endorsed.

References

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