How To Select The Best Chiropractor

Choosing a chiropractor

Chiropractic manipulation is a recognized and popular pain relief treatment, with an estimated 250,000 chiropractic visits each year. Because chiropractic is a profession with an unusually large variety of practice philosophies and techniques, selecting a good chiropractor can be a challenge.

A good place to start is to ask a primary care physician for names of chiropractors who appear competent and trustworthy. It also helps to ask friends, co-workers and neighbors for recommendations. Exercise caution, however, because one person’s definition of a good chiropractor may be quite different another person’s definition. In general, if multiple resources recommend the same chiropractor, chances are good that the chiropractor is reliable.

While recommendations can be valuable, it is also important to find a practitioner who can meet an individual’s specific needs. Asking the right questions up front can help ensure that there is a good fit. Below are guidelines of questions to ask when interviewing a chiropractor that can help assess the skills, qualifications and style of the chiropractor. Before starting treatment with a chiropractor, it is usually best to conduct a telephone interview or request an office consultation to find out more about how he or she practices.

Chiropractor technique

There are many different approaches to treating a person through chiropractic. Some chiropractors adjust with their hands, while others use various instruments. Additionally, some chiropractors adjust more deeply, while others have a lighter touch. This is a very individual preference by both the doctor and the patient. Some patients prefer the immediate feeling of relief offered by the “joint popping” type of manipulation while others cringe at the mere thought, and request a low-force technique.

Questions to ask about chiropractic technique:

• Which techniques does the chiropractor use and why?

• Does the chiropractor use his or her hands or an instrument for the manipulation?

• Does the chiropractor employ deeper, joint-popping adjustment or low-force adjustment?

• How much experience does the chiropractor have treating similar types of problems as the patient’s?

It should be a warning sign to stay away if any practitioner claims to be the only one with a “special new technique” that no other chiropractor can use. Also, if after the first visit, the chiropractor claims to be able to “cure” various conditions such as diabetes, cancer, or some other long-term, chronic condition, another choice may be appropriate. Similarly, a long-term treatment plan such as 3 times/week adjustments for 6-12 months, 2 times/week for another 6-12 months, and 1 time/week for 6-12 or more months is a strong warning sign of unrealistic forecasting.

Chiropractic case management

Depending on the nature and extent of the specific back problem, a few visits to the chiropractor should help the patient feel noticeably better. Within one to four weeks, the pain for non-complex musculoskeletal conditions should typically be reduced by 40 - 80%, and the frequency of visits should decrease as the patient’s pain and function improve.  If symptoms are not improving in that timeframe, either there is another mechanical problem that is being overlooked, there is repeated ergonomic stress that reproduces the pain, or there is a complicating condition that may need further diagnostic evaluation or may benefit from some other form of treatment.

Good chiropractors do everything in their power to help their patients feel better as fast as possible with as few treatments as necessary, and also give advice on how to avoid future problems by evaluating lifestyle ergonomics, implementing an exercise approach and reducing care to an as- needed plan. In general, in the absence of progressive worsening of a condition in spite of care, a common treatment plan is 3 times/week for 2 to 4 weeks with a re-evaluation. If improvement is noted, a tapering of treatment frequency is appropriate while introducing a self-help, home-based exercise program and/or ergonomic modifications to activities of daily living. If the patient is not getting relief after the first 4 to 8 weeks, depending on the specific case, the chiropractor should recommend a referral to another practitioner – either another chiropractor or another type of spine specialist, such as a physiatrist, physical therapist, pain medicine specialist or spine surgeon.

Questions to ask about the chiropractic treatment program:

• What is the chiropractor’s typical practice pattern or treatment program?

• What services does the chiropractor offer? Some chiropractors offer additional services such as massage, exercise instruction, rehabilitation and strength training, and nutritional counseling.

• What is the chiropractor’s recommendation if the treatment doesn’t seem to help? A good chiropractor will recommend that the patient consult another practitioner if these or other methods of treatment (such as medications or surgery) are indicated.

It is advisable to avoid practitioners who tend to find the same thing wrong with every patient and treat every patient identically. Also, beware of any chiropractor recommending a lengthy (e.g. 3-, 6-, or 12-month) treatment plan after one or two consultations.

Chiropractic education and qualifications

Doctors of chiropractic undergo a four-year degree program, and most states now require an undergraduate bachelor’s degree in science prior to admission to chiropractic university. In chiropractic universities, the first two years are focused on coursework in the basic sciences, after which training focuses on diagnosis-related courses (such as pathology and pathophysiology) and manual medicine or manipulation (use of hands) as an alternative to drugs or surgery.

Some chiropractors also pursue post-graduate diplomat programs in various specialties, such as orthopedics, sports medicine, rehabilitation, neurology, nutrition and other disciplines.

Chiropractors need to be licensed to practice in their state, and need to have completed the National Board examinations. In addition to Part 1 and Part 2, Part 3 of the National Boards is necessary if the chiropractor plans to use physiological therapeutics in practice. Part 4 of the National Boards tests three practical skill areas, including diagnostic imaging, chiropractic technique and case management. In some states, Part 4 may be used in place of a state-specific practical examination.

Check to see if there have been any disciplinary actions against the chiropractor. This information is available from each state’s Chiropractic Board of Examiners, which can usually be found on the state’s website. Be sure the chiropractor is accredited by the Council on Chiropractic Education, as well.

Questions to ask about chiropractic training and education:

• From which chiropractic school did the chiropractor graduate?

• Does he or she have a bachelor’s degree?

• Where did he or she complete undergraduate/prerequisite schooling?

• How many years has the chiropractor been in practice?

• Does the chiropractor have a post-graduate specialty?

September 6, 2007