What do chiropractors treat?

By James Lehman

As a result of a motor vehicle incident, I injured my lower back.  Unfortunately, the condition caused severe pain and affected my ability to run because of back spasms. The team doctor was a medical doctor who had no idea why my back hurt.  Hence, I suffered with lower back pain and spasms for three years before an employer suggested I visit his brother for a chiropractic examination.

As a child, I was under the impression that chiropractors were “quacks.”  Yet, the pain was not going away, and I thought, why not see a chiropractor. I will never forget the first visit.  The doctor examined me and then told me that he could probably get rid of the pain. His confidence and reassurance that the treatment would not hurt me or make the pain worse made me less nervous about someone cracking my back.  To my surprise, after one treatment, the pain was resolved.  I suffered for years because I had no idea what a chiropractor could do for my back pain.

My chiropractor was kind enough to relieve my pain and then suggest that I consider chiropractic medicine as a career. I laughed because, at the time, I was studying to become a horticulturist.

I visited my chiropractor a couple of times that year for check-ups.  On each visit, my chiropractor asked if I gave any thought to becoming a chiropractor.  Finally, I asked him why I should become a chiropractor.  He said that he thought that I would be good at it and there was a chiropractic school in St. Louis, not far from my home in Belleville, Illinois.  The doctor then offered to take me for a tour of the college.  The visit convinced me to change my academic plans. My chiropractic journey then evolved from patient to potential chiropractic student.  

To my surprise, Logan College of Chiropractic accepted my application and suggested that I commence classes before the end of that summer. I thought the Dean of Admissions was going to thank me for my interest and then advise me to finish my undergraduate degree. Instead, I was told that with only two or more years of undergraduate studies, I could begin my academic training to become a chiropractor.

Now, 50 years later, I sit here writing an article that will address what chiropractors treat. At Logan, we were taught to perform comprehensive physical examinations, which included postural and musculoskeletal evaluation of the patient. The evaluation and management of the patient led to a diagnosis and then a consultation with the patient.  The report of findings normally included a treatment plan that addressed any biomechanical problems, but also prevention and wellness advice. At that time, it was unethical for a medical doctor to communicate with a chiropractor regarding patient care. In fact, the American Medical Association advised members that it was unethical to even be in the same building with a chiropractor. Hence, it was necessary for a chiropractor to be able to perform their own radiographic studies and lab work in addition to a comprehensive physical examination to complete a differential diagnosis.

Times have changed in healthcare. Medical doctors and chiropractors are permitted to work together, which enables each provider to specialize in their area of expertise. So, now, I pose the question, “What do chiropractors treat?”

Well, most often chiropractors treat humans in pain. 

Although some chiropractors pursue post-doctoral training and board certification to specialize in non-surgical orthopedics, neurology, rehabilitation, internal diagnosis, sports chiropractic, veterinary chiropractic medicine, radiology, and pediatrics, the majority of chiropractors are not board-certified specialists. The majority of chiropractors evaluate and manage patients complaining of pain. A recent study indicates that patients most often seek chiropractic care for low back pain, neck pain, and problems in the extremities.

Now, if I ended the article at this point, you would realize that patients in pain seek chiropractic care, but you would not comprehend the neuromusculoskeletal conditions that cause the low back pain, neck pain, and extremity problems. As a board-certified chiropractic specialist, an Associate Professor of Clinical Sciences at the University of Bridgeport, and a Post-Doctoral instructor in neuromusculoskeletal medicine, I assure you that performing a differential diagnosis is the key to successfully treating these patients in pain. The chiropractor must reveal the cause of the pain with a neuromusculoskeletal evaluation that leads to a working diagnosis. The chiropractor must reveal the painful tissue and treat it properly.

I want to share with you a couple of the more common diagnoses that cause the low back pain patients to seek relief from a chiropractic clinician and offer brief descriptions. Of course, acute low back pain is often the result of a soft tissue injury caused by athletic activities, motor vehicle incidents, or lifting injuries. The chiropractor must differentiate the soft tissue injury. Did that patient strain the low back muscles or sprain the lumbar ligaments? The treatment plan and prognosis will vary considerably based upon not only the severity of the injury but the tissue damaged.  A muscular strain will most often heal quicker that a ligamentous sprain. If the patient is also suffering with bio-mechanical joint dysfunctions, the chiropractor will most often provide spinal manipulations. Historically, spinal joint dysfunction has been referred to as a subluxation.[1]

Often, patients will present with chronic low back pain because of an acute lumbar strain/sprain that healed with residual biomechanical dysfunction of the spinal joints with resultant  compression and/or irritation of nerve roots or smaller branches off of the nerve roots in the thoracolumbar spine that have gone undetected and not treated. Dr. William Morgan wrote an excellent article that described Maigne’s syndrome, a common cause of acute or chronic low back pain. I offer an excerpt from his Clinicians Corner manuscript:

The French physician, Robert Maigne, proposed in his writings in the 1970 -80s that a thoracolumbar facet syndrome could be responsible for causing referred pain to the regions innervated by those segment’s posterior rami and the peripheral nerves which originate in that region.  Maigne also proposed other techniques, such as skin rolling, to determine the tissue quality and other clinically oriented criteria which could be used to diagnose thoracolumbar syndrome.  Dr. Maigne identified the syndrome which now bears his name with these observations:

• Unilateral lower back pain, usually in the sacroiliac region
• Inguinal or testicular pain
• Abdominal pain
• Gynecological symptoms or pain
• Pubic pain

Normally, Maigne’s syndrome responds very well to chiropractic care including spinal manipulation and soft tissue treatments that decompress the cluneal nerves.

These are just a dozen of the diagnoses that cause spinal pain and problems with the extremities that are treated by chiropractors:

1. Degenerative joint and disc disease of the spine
2. Myofascial Pain Syndrome
3. Thoracic Outlet Syndrome
4. Cervico-brachial neuralgia
5. Radial Tunnel Syndrome
6. Wartenberg’s Syndrome
7. Lumbar or cervical discopathy
8. Sciatic neuralgia
9. Piriformis Syndrome
10. Spondylotic spondylolisthesis
11. Axillary nerve compression
12. Cervicogenic headaches

In future articles, I will address these specific neuromusculoskeletal conditions that cause painful conditions, which chiropractors evaluate and manage with non-pharmacological, chiropractic treatments.