"Soft-tissue methods" is a broad term that includes everything from varieties of stretching and strengthening exercises to fascial release techniques, instrument-assisted, soft-tissue mobilization and other techniques too numerous to mention. The point is that spinal adjustment/manipulation by itself for musculoskeletal problems, without the addition of soft-tissue methods, does not meet the criteria necessary for improving the function and disability of patients.
A recent study by Gross, et al.,1 updated 11 systematic reviews of randomized controlled trials for acute, subacute and chronic mechanical neck disorders. Dr. Arthur Croft cited this paper in DC earlier this year2 as strong evidence in justifying our care when questioned by a utilization review board or individual peer-reviewer. The findings of the study were divided between "level of evidence" (strong, moderate and limited) and "treatment category," such as manipulation, acupuncture, electrotherapy, etc. Under "strong evidence," they found that multimodal approaches (including stretching/strengthening exercise and mobilization/manipulation) for subacute/chronic mechanical neck disorders, neck disorders with headache and neck disorders with radicular findings reduced pain, improved function and resulted in favorable global perceived effect.
As Dr. Croft noted, medical or pharmaceutical therapies of any kind were not included in this category. Of interest, under the category of "evidence of no benefit" was home exercise, hot packs, electromechanical stimulation and ultrasound; and only short-term evidence was found for manipulation alone, various massage techniques, laser for myofascial pain, infrared light, static traction, spray and stretch, electrotherapies, galvanic current, iontophoresis, magnetic necklace and neck school, among others. (Read the article for additional treatment options.)
While the article did not enumerate any specific stretching or strengthening techniques, what stands out is that the multimodal approach including manipulation was more effective than manipulation alone. Further study as to what type of soft-tissue method is most applicable in any particular musculoskeletal type problem is an ongoing search. However, the most significant point is that manipulation alone cannot be considered an end-all therapy. Soft-tissue and rehabilitation methods must be emphasized to a greater degree in particular sections of the chiropractic world. Were the areas of muscle/fascial restriction still limiting the range of joint motion? Has the gait and posture improved? Is the core maintained? Are advanced stretching and strengthening necessary?
If your "maintenance" treatment is based solely on an adjustment, it is evident that your original evaluation did not include soft-tissue assessment.
References
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?
