The patient came into my office with obvious back problems. He was leaning to the side with his hand on his hip; the classic antalgic posture. My staff quickly helped him check in so we could get him in the back and evaluate his condition. After the formalities of paperwork, we got down to business.
As we talked, he explained how he had twisted his back working in the yard over the weekend and couldn't take the spasms anymore. He also commented that he had experienced similar problems before and that chiropractic had always helped - that's how he ended up in my office. During the course of my examination, I performed some basic orthopedic checks on his neck. He stopped me and noted an additional history of neck pain. Then he stated that he didn't want his neck adjusted, because he had heard how dangerous that could be.
Let that sink in a minute - a previous chiropractic patient who was afraid of having his neck worked on, not because of a bad experience, but because of what he had heard somewhere else along the way.
The dangers of cervical manipulation have certainly helped in the campaign against chiropractic. The negative propaganda put out by various groups plays on patients' fears and is very difficult to overcome. Most patients equate neck manipulation with karate moves they saw in a Chuck Norris movie on TV. Many medical doctors have not been educated enough to know that good chiropractic care involves more than a violent twisting of the head just to make the neck crack. Clearly the neck is the most exposed and susceptible part of the spine, even when it is not injured. It takes a tremendous amount of trust on behalf of the patient to lay his or her neck in your hands so you can "spin their head around." When dealing with any patient, proper evaluation of the neck is critical. Most chiropractors I know are great adjusters and their patients have great respect for their skill. However, skill alone is not adequate. You must be able to objectively show there is a problem that needs to be corrected, and be able to define that problem in terminology another doctor, insurance company or attorney can understand.
Standard of care dictates that a patient's complaints must be evaluated locally (the area of complaint) and globally (any related or affected structures). In today's medical-legal climate, you must be aware of how one area of the body can affect another. In previous articles, I discussed how irritation in the neck can cause hand and wrist problems1 and how the neck and lower back will compensate for each other.2 Therefore, when a patient presents with any spinal complaint, it is reasonable to perform a full-spine exam.
My basic evaluation of the neck is not complicated; I can run through it in a matter of seconds. However, the tests I use give me great insight into what is going on.
These are a few quick basic tests that can give you a quick understanding of what structures in the neck are irritated, and where the irritation lies. Certainly there is a lot more you can add in. Palpation is critical; there is no good orthopedic test just for trigger points. Basic neurologic testing is also necessary (if there is paresthesia in the C5 dermatome, you know what nerve root is irritated). Finally, it must be noted that neck pain and headache - particularly migraine - can be an indicator of a vertebral artery dissection. Symptoms related to CVA frequently include unilateral, unprompted posterior cervical pain of acute onset. These symptoms may precede stroke by several days and must be considered important warning signs.6 The absence of orthopedic findings in a patient with recent, insidious onset headache also should be considered a red flag.
So, what have I learned? Even when there is no neck pain, make it a habit to check the neck; you may pick up on an associated or referred problem. This will make your documentation easier; it will give you good information to explain your findings to the patient, and it helps you justify your treatment. Sure, it takes a few extra moments, but the extra information is well worth the effort.
References
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When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
