Chiropractic treatment techniques

Many chiropractic treatment techniques/modalities are available for use by chiropractors. Although the chiropractic profession is primarily based on the use of the spinal adjustment, many other techniques exist for treating the spine, as well as other joints and tissues. A modern chiropractor may specialize in spinal adjustments only, or may use a wide range of methods intended to address an array of neuromusculoskeletal and general health issues. Examples include soft tissue therapy, strength training, dry needling (similar to acupuncture), functional electrical stimulation, traction, and nutritional recommendations. Chiropractors may also use other complementary alternative methods as part of a holistic treatment approach.

Overview

Procedures received by more than 1/3 of patients of licensed U.S. chiropractors (2003 survey)

procedure	% of DCs using it	% of patients getting it
Diversified technique	96.2	71.5
Physical fitness/exercise promotion	98.3	64.9
Corrective or therapeutic exercise	98.3	63.2
Ergonomic/postural advice	97.3	61.9
Self-care strategies	96.6	60.6
Activities of daily living	96.6	57.9
Changing risky/unhealthy behaviors	96.6	54.9
Nutritional/dietary recommendations	97.7	51.8
Relaxation/stress reduction recommendations	96.4	50.1
Ice pack/cryotherapy	94.5	48.5
Extremity adjusting	95.4	46.8
Trigger point therapy	91.0	45.3
Disease prevention/ early screening advice	90.8	39.7

Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care; in the U.S., chiropractors perform over 90% of all manipulative treatments. Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal physiological range of movement without exceeding the anatomical boundary limit; its defining factor is a dynamic thrust, a sudden force that causes an audible release and attempts to increase a joint's range of motion. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues; in chiropractic care SMT most commonly takes the form of spinal manipulation. The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. SMT gained mainstream recognition during the 1980s. Chiropractors consider themselves to be expertly qualified providers of spinal adjustment, manipulation and other manual treatments.

Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.

Spinal adjustment

Main article: Spinal adjustment

"Spinal adjustment" and "chiropractic adjustment" are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term "adjustment".

Claims made for the benefits of spinal adjustments range from temporary, palliative (pain relieving) effects to long term wellness and preventive care. Some claims are controversial, particularly with regard to indications and health benefits. There is debate concerning the safety of some of the procedures used in spinal adjustments, particularly those including upper cervical manipulations.

The original spinal adjustment was a variation of a procedure known today as spinal manipulation. This form of treatment has documented use as far back as Hippocrates and the ancient Egyptians and was carried through the ages by families of bonesetters. The modern form of spinal manipulation techniques have characteristic biomechanical features, and are usually associated with an audible "popping" sound. There is strong evidence that this sound is the result of a phenomenon known as cavitation.

Dry Needling

Main article: Dry Needling

Dry needling is technique sometimes used by doctors of chiropractic when treating musculoskeletal conditions. A 2010 review states, “its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews.”

The Tough et al review, one of the two cited above, states: “In conclusion, there is limited evidence deriving from one study that deep needling directly into myofascial trigger points has an overall treatment effect when compared with standardised care. Whilst the result of the meta-analysis of needling compared with placebo controls does not attain statistically significant, the overall direction could be compatible with a treatment effect of dry needling on myofascial trigger point pain.

The other review cited above, a Cochrane review, states, “The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain.

National Board of Chiropractic Examiners listing of the most frequently used techniques

Chiropractors may include any of hundreds of available techniques and methods in their practices. The National Board of Chiropractic Examiners has rated the following as the most frequently used techniques, here listed with percentages of chiropractors who use them and patients who are treated with them as of 2003:

Technique	% of Chiropractors using technique	% of Patients treated with technique
1. Diversified technique	96.2	71.5
2. Extremity manipulating/adjusting	95.4	46.8
3. Activator Methods	69.9	23.9
4. Thompson	61.3	28.2
5. Gonstead	57.2	26.2
6. Cox Flexion/Distraction	56.5	23.5
7. Sacro Occipital Technique [SOT]	49.6	15.3
8. Manipulative/Adjustive Instruments	40.3	15.7
9. Cranial	38.0	10.3
10. Applied Kinesiology	37.6	12.9
11. NIMMO/Receptor Tonus	33.6	13.4
12. Logan Basic	26.0	5.2
13. Palmer upper cervical [HIO] (Hole-in-One)	25.7	6.7
14. Pierce-Stillwagon	15.4	5.1
15. Meric	15.1	4.3
16. Other	12.5	10.4

WebMD listing of techniques

Over the years, many variations of these techniques have been delivered, most as proprietary techniques developed by individual practitioners. WebMD has made a partial list:

Activator technique Advanced BioStructural Correction Applied Kinesiology Atlas Orthogonal Auricular Barge Analysis Bio Magnetic Bio-Energetic Synchronization Bio-Geometric Integration Biomechanics

Blair Body Restoration Technique Carver Technique Cervical Care Cervical Drop Chiropractic Biophysics Chiropractic Manipulative Reflex Technique (CMRT) Clinical Kinesiology Concept Therapy

Contact Reflex Analysis Cox Chiropractic Cranial Technique Directional Non-Force Diversified technique Flexion-Distraction Gonstead Grostic Hole in one [HIO] Kale Leander Logan Basic

Manual Adjusting Meric Motion Palpation Network Neural Organization Technique Neuro Emotional Technique Neuro Muscular Technique Neuro Vascular Technique Nimmo Palmer Package

Pettibon Pierce Pierce Stillwagon Pro-Adjuster Receptor Tonus Sacro Occipital Technique (SOT) Soft Tissue Orthopedics Spinal Biomechanics Spinal Biomedical Engineering Spinal Biophysics

Thompson Thompson Terminal Point Toftness Toggle Recoil Torque Release Total Body Modification Traction Upper Cervical Vector Point Therapy Versendaal

Canadian Chiropractic Association outline according to purpose

Most of these techniques can be divided according to the purpose:

A. Manual Articular Manipulative and Adjustive Procedures:

1. Specific Contact Thrust Procedures
   1. high-velocity thrust
      1. high-velocity thrust with recoil
      2. low-velocity thrust
2. Non-Specific Contact Thrust Procedures
   1. mobilization
3. Manual Force, Mechanically Assisted Procedures
   1. drop tables and terminal point adjustive thrust
      1. flexion-distraction and traction-type tables
4. Mechanical Force, Manually Assisted Procedures
   1. pelvic blocks
      1. mechanical adjusting devices

B. Manual Non-Articular Manipulative Procedures:

1. Manual Reflex and Muscle Relaxation Procedures
   1. muscle energy techniques
      1. neurologic reflex techniques
         1. myofascial ischemic compression procedures
            1. miscellaneous soft tissue techniques

C. Miscellaneous Procedures:

1. Neural retraining techniques

D. Non-Manual Procedures:

1. Exercise and Rehabilitation
2. Back school/spinal care courses
3. Electrical Modalities
4. Laser Therapy
5. Thermal Modalities including Ultrasound
6. Nutritional counselling
7. Acupuncture

Manipulation under anesthesia (MUA) is spinal manipulation performed while the patient is under general anesthesia. This procedure is used in the hospital setting for patients whose condition is unresponsive to other forms of treatment.

See also

• Spinal manipulation - (The generic approach to manipulation of spinal joints.)