Chiropractor examination and diagnosis

The patient history helps the chiropractor to identify the area(s) of complaint. Questions about family history, dietary habits, past history of other treatment(s) (chiropractic, osteopathic, medical and other), occupational history, psychosocial history, and other areas will be asked by the chiropractor to help determine the nature of the illness.

Following the chiropractic consultation and case history, a physical examination that may include laboratory analysis and x-ray examination will be performed in accordance with the chiropractor’s clinical judgment. There are many different methods that a chiropractor may use for determining the spinal segments that require manipulation. Most commonly, static and motion palpation techniques are utilized for identifying spinal segments that are hypomobile or fixated. Another method of locating subluxations is the use of x-ray, where segments classified by the Houston Conference Classification are identified and treated with manipulation.

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

Identifying weak links in the kinetic chain, sometimes quite distant from the area of complaint, the chiropractor treats the given area. This chiropractic process may include both articular manipulation as well as muscular balancing through strengthening of under-active muscles and/or inhibiting over-active muscles to acquire a balanced structure. The chiropractor might also stabilize the pelvis by placing a small heel lift in the shoe on the short leg side (which is determined radiographically).

Pelvic stability can also be achieved by the use of corrective arch supports prescribed by the chiropractor. This chiropractic treatment is typically used when ankle pronation, pes planus (flat feet), and/or subtalar instability are present. Combinations of any of these chiropractic treatment approaches along with exercises that strengthen the weak, underactive muscles of the trunk and pelvis and stretch the tight, overactive muscles usually results in a more beneficial, long term result.

Chiropractor low back pain assessment
In the assessment of low back pain, differential diagnosis utilizing a "triage" concept of classifying low back injuries into one of three categories helps to guide the chiropractor (4). These categories of chiropractic diagnosis include:

Potentially serious: tumor, infection , fracture, major neurological (cauda equina)
Sciatica: Nerve root
Non-specific: mechanical low back pain (most common type of presentation)

Goal setting for the chiropractic treatment plan is driven by the patient’s pain and disability issues and activity intolerance. Patient education with the guidance of the chiropractor is important to reduce anxiety levels that often accompany intense low back pain. The guidelines recommend a chiropractic treatment plan of 3-5 visits/week over 1-2 weeks. If no demonstrable improvement is noted, the compliance and sincerity of the patient should be evaluated and the risk factors that may prolong recovery identified followed by discharge, referral to another chiropractor, or the initiation of a different treatment approach at 3-5 visits/week for 2 weeks (4).

Consistent 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.) are emphasized to accomplish this goal (4-22).