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What Does a Chiropractor Do?

This is not a question that is easily answered. Not only does it require a lengthy response but it can even vary depending on which chiropractor you ask. This is unfortunate because it may appear confusing to the patient. Therefore, I will attempt to explain what exactly a chiropractor does in our office by taking you through the steps that a new patient would experience on their first visit.

When you enter our office with a specific physical complaint, the chiropractor will ask you many questions such as: what is your primary problem? when did it start? how did it start? and have you had it before? This is called taking a "history" from the patient. An examination of the affected area would then take place so that the chiropractor can identify what is wrong with you, form a diagnosis, and determine if we can help you. In our office, it is at this time that the chiropractor would explain to the patient what their problem is and how it would be treated. This is called the "report of findings".

I will use an example of a Mr. Smith who comes into our office with acute low back pain from lifting a box of peat moss to explain how a chiropractor could help him. After taking his history, completing an examination, determining a diagnosis and how to treat it, I would next explain all of this to him. It is important that each patient know exactly what is involved before anything is done. It is at this time that the actual treatment will begin. This generally starts on the first visit but there are exceptions.

It is often the public's perception that the chiropractor is "cracking the bones" or "putting the bones back into place". In our office, we stress to each patient that this is not what chiropractors are doing. Mr. Smith does not have a bone out of place and we are not cracking it. What Mr. Smith has is a "chiropractic subluxation" in his lower back. This is a confusing term because you may receive different definitions of it from medical doctors and possibly even other chiropractors.

A subluxation is really just a term to describe what is happening when a joint in the spine or limb is not working properly. This word is best explained if it is broken down into five simplified categories.

1) Decreased Joint Movement - a particular sprained joint in Mr. Smith's back may become very stiff or restricted in its movement. It may also become "locked" in a certain position, but always somewhere within the normal range of motion of the joint. The joint does not "go out of place".

2) "Pinching" or Irritatation of the Nerve -The nerves exiting the spine control pain, skin sensation, muscle activity, and many of your organs. They exit from the spinal cord and pass between the vertebrae or bones of the spine. When a joint or its surrounding soft tissues are not functioning properly, the nerves can be affected. It is important that you do not have to feel pain for a problem to be present. In most cases, there may be a physical pinching of the nerve or even just a chemical irritation from the swelling around the joint. For example, the leg pain some people get when they hurt their back, called sciatica, is really an irritation or pinching of the sciatic nerve. Another example is when the nerves in the upper neck are irritated.

3) Muscle Spasm - When Mr. Smith injured his low back, he may have strained or damaged the muscles at the same time and bruising will likely show. This would cause his muscles to be sore and in spasm. The more common scenario that we see in our office is that the nerves exiting his spine are being irritated as they pass by the injured and inflamed joint. When Mr. Smith's nerve is being irritated or pinched, it works in an overactive state. These nerves control the muscles of his back and legs. Therefore, the overactive nerves in Mr. Smith's back will tell the muscles to contract hard and go into spasm. When a muscle is in spasm, it causes pain and a lack of flexibility. Since these tight and inflexible muscles all attach to the bones, the mobility of the bones and their associated joints is further reduced.

4) Inflammation - There may also be swelling or inflammation in and around Mr. Smith's injured joint. Whenever our body is injured, inflammation always occurs. Just as if you sprained your wrist, it will likely become swollen. The inflammation has its purpose but it is beneficial to limit how much there is and eventually get rid of it as the joint heals. Think of Mr. Smith's sprained low back joint as a little mechanical pump, just like the fuel pump on your car. The more it is able to move, the better it will be able to "pump" the swelling out of the joint. When Mr. Smith's back has very tight muscles and stiff joints, the ability of the pump or joint to remove the excess swelling is reduced significantly.

5) Degeneration of the Joint - All joints in your body are made up of cartilage, ligaments, and the fluid inside the joint that lubricates and nourishes it. Whenever a joint remains very stiff or immobilized, it begins to change in a negative way. The fluid mentioned earlier thickens and the cartilage in the joint begins to break down. Scar tissue or adhesions will form inside the joint, further limiting how far it can move. If left untreated, it will eventually begin showing signs of arthritis.

So, back to Mr. Smith. He has a sprained joint in his low back. There is swelling in and around the joint, the potential movement of the joint is reduced, the muscles are in spasm, the nerves passing by the inflamed joint are being irritated, and the joint will start to degenerate if it is not able to move normally. He has what a chiropractor would call a "SUBLUXATION".

The chiropractor is specifically trained to address these subluxations by "manipulating" or "adjusting" the injured joints and restoring their mobility. Manipulation is simply when a controlled and specific motion by the hands of a chiropractor is used to move a joint slightly farther than a person can themselves but not far enough to injure it. This may or may not produce a "popping" sound. This is actually a gas bubble forming in the fluid of the joint and not the bones cracking. For example, if Mr. Smith has a specific joint in his back that is supposed to have a 90-degree range of movement but because it is injured it only has 50-degrees, the chiropractor's job is to eventually restore the movement back to the full 90-degrees. Once the joint in Mr. Smith's back has regained its mobility through chiropractic adjustments, he would be encouraged to keep his back moving so that the joint would not stiffen again. As well, this restored movement would allow the joint to more efficiently pump the swelling out of the injured area. Then, when the inflammation or swelling has decreased, the nerve irritation will lessen and the muscles will be able to relax. After the healing process has begun, his low back may require a few to numerous adjustments to maintain the mobility in the joint until his body can completely heal the injury. It is important to remember that only the body can actually heal itself. The chiropractor is simply helping it to occur faster, more completely, and without the use of drugs.

If Mr. Smith's low back joint were left untreated, his pain would likely dissipate eventually. However, it would likely take much longer and the full 90-degrees of potential movement in the joint may not be restored. This will make him more prone to having the problem reoccur whenever he challenges his back again and possibly even an earlier onset of arthritis.

Although chiropractors are most known for their successful treatment of low back pain, neck pain, and headaches, there are many other physical problems that they can address. The joints of your entire body are made up basically the same so chiropractic adjustments can be applied to other areas as well. There are many other problems treated by chiropractors. Some of which are listed in the "Conditions and Symptoms Treated By Chiropractors" section of this booklet.