The focus on spinal adjustment is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. The chiropractic adjustment, however, may not be the only procedure a chiropractor may employ in managing a patient's care. For example, chiropractic care has utilized drugless therapeutics (natural therapies) since as early as 1912. 1 Jaskoviac PA, Schafer RC. Applied Physiotherapy: Practical Clinical Applications with Emphasis on the Management of Pain and Related Syndromes. ACA Press, Arlington, Virginia, 1986.

See Understanding Spinal Manipulation

Natural agents such as heat, cold, water, massage, light, and exercise are some of the physiological therapeutic measures that are often utilized by chiropractors. When controlled, these and other elements exert a beneficial influence on body functions and can help a number of common lower back pain problems.

Common Forms of Chiropractic Therapy

Some physiological therapeutic measures that are often utilized in chiropractic care include:

Heat and cold

Chiropractors may alternate between heat and ice therapy to help patients treat back pain. Ice packs may be used to numb the back for a 10 to 15 minute period and then switched with a heating pad, heat wrap or hot water bottle to restore blood flow to the area and promote faster healing.


Chiropractors may provide patients with instructions for an exercise program focusing on stretching and strengthening the back. For more information, see Exercise and Chiropractic Therapy.


Chiropractors may massage the soft tissues to improve circulation, reduce swelling and inflammation associated with the back pain, and encourage quicker healing. See Massage Therapy for Lower Back Pain.

Dietary management

Many chiropractors will provide patients with tips on how an improved diet may help with their back pain, and some may recommend dietary supplements after spinal manipulation.



With ultrasound, sound waves create deep heat therapy that is applied to the soft tissues and joints. Basically micro-massaging the soft tissues and joints, ultrasound therapy can not only help reduce back pain, stiffness, and spasms, but increase blood flow and accelerate the healing process.


A form of shortwave, electro-magnetic therapy that passes the softer tissues and provides heat to denser tissues, diathermy relaxes the muscles and connective tissues, decreases muscle spasms, and accelerates the healing process by increasing circulation. In chiropractic treatment utilizing diathermy, the treated area will typically feel pleasantly warm.



Using water and varying its temperature and pressure via hot baths, whirlpools, saunas or wraps, hydrotherapy focuses on the body's reaction to hot and cold stimuli. In chiropractic, hydrotherapy may be used to reduce the sensitivity of back pain through cold stimuli that numb the pain and the use of hot stimuli to promote blood flow and faster healing.

Electrical muscle stimulation

During this chiropractic therapy, electrodes are placed on the skin that send light electrical pulses to different areas of the body with the purpose of reducing inflammation, curtailing muscle spasms and relieving back pain.

Transcutaneous electrical nerve stimulators (TENS)

The most common form of electrical stimulation, TENS units feature electrodes that are placed over the painful area with the user having the power to control the intensity of electrical stimulation. It is believed that TENS help block the transmission of pain signals along the nerves and also release the body’s natural painkillers, endorphins.


A chiropractic traction massage may include the patient lying face up as a system of rollers move about the back, all the while stretching and massaging the muscles in the back. Chiropractors may use other traction devices that stretch the spine, decompress the discs and reduce the pressure on the nerve roots (a procedure known as non-surgical spinal decompression).

Infrared radiation

In chiropractic, a thermal camera may be used to image colored hues indicating the blood flow in the back. For example, red hues would indicate higher IR radiation and more blood flow in the back. Infrared radiation may be used by chiropractors to differentiate normal temperature changes from abnormal differences and to assess underlying conditions that are causing back pain.

Cold laser therapy

With cold laser therapy, particles of energy are carried in a laser and absorbed by the cell membrane’s photo receptors after penetrating the skin surface. The cells and tissues then convert this light energy into biochemical energy, fueling a biological process that is believed to decrease swelling, reduce back pain and inflammation, and improve circulation.


During the course of chiropractic care, the chiropractor may recommend some modification such as a work station change that is applied at home and/or at work. The success or failure of obtaining patient satisfying outcome may be directly related to applying an ergonomic/job-related modification or a hobby-related irritating activity. For more information see our Ergonomics Health Center.

Pelvic stabilization

When leg-length deficiency, flat feet and/or subtalar instability are present, the chiropractor may place a small heel lift in the shoe on the short leg side and/or prescribe corrective arch supports to help stabilize the pelvis.

Patient education

A chiropractor may advise a variety of lifestyle modifications, including diet and nutritional programs, self-care and coping strategies, to the patient experiencing lower back pain.

These methods may or may not be utilized by the chiropractor in the course of a patient's case management depending upon their specific needs.

Chiropractic Manipulation and Therapies

Utilizing specific manipulations (chiropractic adjustments) in conjunction with one or a combination of the above, the chiropractor's goal is to remove structural or nervous system irritation that may be a major contributing factor in a patient's lower back pain.

Further Reading: Understanding Spinal Manipulation

  • 1 Jaskoviac PA, Schafer RC. Applied Physiotherapy: Practical Clinical Applications with Emphasis on the Management of Pain and Related Syndromes. ACA Press, Arlington, Virginia, 1986.

Dr. Steven Yeomans is a chiropractor and partner at the Yeomans-Edinger Chiropractic Center. He is board certified by the Academy of Chiropractic Orthopedists and has over 40 years of experience using chiropractic manipulation and pain management techniques to treat patients with spine conditions.