Myth series 3rd installment
Updated: May 5
Do you need to be "cracked" every time? Is ice necessary? Let's dig into some chiropractic myths
Welcome to the third installment of the myth series. This one will be a combination of why do
they crack me and are x-rays necessary for the adjustment? Spoiler alert, NOPE.
Do you need to be adjusted every appointment? Most likely not, BUT guess who we as a
profession get paid, you guessed it. The lovely manipulation therapy. Now, that being said there
are a few variables driving this belief system or methodology. First background information on
manipulation. Currently there are five medical professionals in the USA that can perform AKA
manipulation, spinal manipulation, grade 5 manipulation or high velocity low amplitude (HVLA).
These professionals are Chiropractors, Osteopaths, Medical doctors and Physical therapists
and Athletic trainers. Athletic trainers are based on state scope of practice. There is no longer
the stigma of chiropractic manipulation and only use being scary. However anything bad that
happens gets reported as Chiropractic manipulation.
That being said, if the therapy is performed then the codes can be billed. Now the question is
are the professionals performing this therapy because they get paid for it or does the patient
need more movement? The real answer is it depends on what the assessment reveals and the
patient will either need more movement or control of the movement they have. The entire goal is
based on what rehabilitation program the patient needs and not everyone gets the same
stretches or exercises. For example if the patient has instability as a mechanism of pain then
manipulation is not indicated for this patient. Motor control with core stability is necessary to
resolve the pain.
The best approach is using passive therapies at first then moving to active therapies as soon as
the patient can tolerate the activity. If a patient is having an acute episode then utilizing ice/heat
packs, muscle stimulation, ultrasound, soft tissue manipulation, taping or dry needling is
appropriate. Once the patient is improving then moving into spinal manipulation as
tolerated/indicated, Neuromuscular re-education, rehabilitation exercises are now more
beneficial. If you want tissues to adapt and improve you have to appropriately load them. The
best way is exercise. I am not saying stopping the passive but they do need to be limited as
time moves forward.
Now for the questionable use of imaging everyone. It is illegal to offer a promotion for new
patients that include x-rays yet providers still do it. There is no correlation to spinal alignment
with x-rays, let the witch hunting begin because I said it out loud. I mentioned this in a prior post
as well in more detail. X-rays show it is broken or not immediately but bone will need to
breakdown for either 7 or 21 days before detecting bone loss. The most common defect with the
spine is a crooked spinous process. If a provider is basing the adjustment off a static image
there is really no correlation. A person's posture or muscular tightness from pain can show temporary changes that would not ordinarily be seen.
In the picture below are the clinical reasoning for ordering imaging. This image is courtesy of the
best Chiropractic Radiologist on the planet, Dr. Chad Warshel.
If you scanned briefly you would have noticed that there is no clinical reason for imaging
everyone. Over age 50 is the only immediate reason. You have to have care for four weeks
before the other ominous signs that should have been noted during a physical exam.
In summary if a groupon or promotion deal includes free x-rays, don’t go.
If they want to image you on the first appointment time to leave. If they are basing treatment off
of findings on the x-rays time to leave.
If they adjust you every time without validation of the treatment, it's time to find another provider. These are the untold truths of the secret imaging world.