So you’ve recently scheduled your first chiropractic visit. Having never been to a chiropractor before, you aren’t sure what to expect. You’ve seen the YouTube videos, heard many stories, both good and bad, with everyone seemingly having a unique experience with a chiropractor. In this post I’ll outline what you can expect on your first chiropractic appointment.
The following article outlines a typical new patient exam at Mile High Spine & Sport. Most evidence based chiropractic clinics will follow a similar plan for a new patient visit.
History (10-15 minutes)
Once in the treatment room, the doctor will ask you a series of questions related to your area of complaint. Questions asked will include the location of pain and if there are any referred symptoms. Referred symptoms refer to pain, numbness, tingling, and/ or weakness that may be stemming from the main area of pain. The doctor will ask for a detailed description of how the pain came on, whether it happened in a single traumatic incident, or if it came on more gradually over time. The doctor will ask which activities specifically make the pain worse (i.e. sitting vs. standing, bending forward, turning, lifting an object off the floor, etc.) and also if there’s anything specific that makes the pain better (heat vs. ice, Advil, relieving postures or positions, etc.). The doctor will ask about your treatment history – any past injuries or surgeries, and whether any imaging (X-ray, MRI, CT) have been taken recently, so be prepared with this information if necessary.
A doctor who treats the entire body and not just the site of pain will ask you a variety of other questions regarding your overall health and lifestyle choices. The doctor will ask about your diet because the foods we eat can affect the way the body experiences pain and recovers from injury. They will ask about any medications or supplements you are currently taking, as well as what you like to do for exercise because activity modifications may be necessary while you recover from your pain. The doctor will ask about your sleep quality as sleep is the most fundamental human function necessary to heal. Additional questions will be asked regarding any drug/ alcohol/ or tobacco use, as abuse of any of these can magnify the inflammatory pain response and slow healing. Interview over! Now the doctor has a clear picture of your current chief complaint, your past medical history, and knows the kind of lifestyle you are living.
Exam (15-20 minutes)
Vladimir Janda, a renowned Czech physician, always taught that ‘Time spent in assessment, will save time in treatment.’ With this in mind, chiropractors like to perform detailed, in depth exams to determine what specifically is causing your pain or dysfunction. It’s important to assess the entire body and not just the site of pain, because dysfunctions elsewhere in the body may be contributing to the site of pain. For instance, a shoulder problem may be related to poor function of the hip on the opposite side of the body, a chronic knee issue may be stemming from poor ankle mobility on that side, or low back pain may be related to diminished mobility and/or stability in the hips.
The doctor will start by taking your vitals, which includes blood pressure, heart rate, respiratory rate and body temperature. More specific exams such as an eye exam, cranial nerve exam, ear exam, lung exam, cardiac auscultation, abdominal exam, and nasal exam will performed on an as needed basis.
Next, the doctor will perform a comprehensive neurologic exam. They will test your deep tendon reflexes (think patellar knee jerk as a little kid), muscle testing, and sensation testing of your skin. These tests are meant to test the integrity of your nervous system. Other neurologic tests include single leg balance testing, your ability to stand with the eyes closed, the ability to sense vibration in your fingers and toes, and even your ability to distinguish smells such as coffee and cinnamon. The purpose of these tests are to screen for any pathology that is damaging your central nervous system and may include a disc herniation, spinal or brain tumor, or disease process. The vast majority of neurologic exams come up as normal, and the vast majority of positive findings in a neurologic exam are related to non-pathologic processes that can be corrected in the chiropractic office.
The next portion of the exam is the orthopedic exam. These tests help the doctor figure out exactly which tissues are injured, i.e. is it the meniscus, ACL, PCL, joint, or muscle? Orthopedic exams are meant to elicit pain and will most likely recreate your pain. Do not be worried about these tests damaging your tissues, they are only performed once and will help the doctor figure out the best course of treatment for you.
The final portion of the exam will be the functional movement exam. The doctor will take you through a series of functional tests such as a SL squat, SL balance, lunge, push-up, active range of motion, passive range of motion, and muscle testing among many others. These tests are meant to recreate the demands of daily living and the basic requirements for healthy human movement. When a dysfunction is found in the functional movement exam, the doctor is given valuable insight into which specific exercises will be beneficial for you.
Will X-rays be taken as part of the exam?
At our clinic, we do not take X-rays on the majority of our patients. Most presenting problems can be diagnosed and treated without the use of X-rays. While radiation exposure during an X-ray is minimal, we still opt to only order X-rays or advanced imaging when absolutely necessary. Minor anomalies and asymmetries will be found on the majority of X-rays, but these issues rarely correlate to pain and can often confuse the patient into thinking they should have pain because of what the image shows
Review of findings (5 minutes)
After completing the exam, the doctor will have a solid idea of what is driving the pain and the best course of treatment. The doctor will suggest which tissues are damaged and what other contributing factors are adding to the pain or dysfunction. Additionally, the doctor will explain the different treatments they want to use, including potential adverse side effects such as soreness or mild bruising for 1-2 days after treatment.
Treatment (20-25 minutes)
With the history, exam, and review of findings complete, the doctor can start the treatment. Treatments will address the joints, nerves, muscles, tendons, ligaments, and any movement compensations you may have. The most commonly utilized treatments used at our clinic include:
Active Release Technique (ART) – considered the gold standard in soft tissue therapies.
Dynamic Neuromsucular Stabilization (DNS) – functional movement protocol based on principles of neuro developmental kinesiology.
Instrument Assisted Soft Tissue Manipulation (IASTM) – the use of metal tools to decrease tone of tight and tender muscles.
Acupuncture – needling technique used for thousands of years to treat pain and organ dysfunction. Acupuncture is based on needling along specific ‘meridian’ pathways that have specific uses for healing in the body.
Kinesiology taping – special type of tape that provides support to joints and muscles without causing disuse atrophy of the muscles as is the case with traditional orthopedic braces.
Cupping – effective decompressive technique which lifts the skin away from the muscles allowing increased blood flow and lymphatic drainage at the site of treatment.
Internal medicine blood testing – functional medicine blood testing to assess for specific nutrient deficiencies, digestive irregularities, and hormonal imbalances that can be an underlying cause of pain and chronic disease.
A typical treatment plan at our clinic is 2x/ week for two weeks, 1x/ week for two to four weeks, once every other week for 2-4 weeks, then once a month for maintenance care if the chief complaint pain is resolved. Most patients feel significant relief after 6-8 visits. Additionally, most patients feel even stronger and more flexible compared to their first visit because of the exercises they’ve been given at our clinic.
Now you know what to expect in your first chiropractic visit, hope to see you soon!
Post written by Dr. Riley Kulm, DC MS. Check out his bio here.
Brief History of Yoga
Yoga originated in ancient India circa 3,000 BC and offers an excellent blend of meditation, respiratory training, and movement. Practitioners of yoga enjoy the relaxing benefits of a class, most commonly performed in a heated room. Anyone who has taken a yoga class understands the mental focus and physical resiliency required to successfully complete a practice. In fact, the breathing practice utilized in yoga called ‘pranayama’ is very similar to the diaphragmatic breathing exercises we teach our patients in the clinic.
Should I be doing yoga?
Yoga has gained immense popularity in this country over the last decade. As a result, many patients ask for advice on whether or not they should be practicing yoga. My overwhelming answer is yes! Any physical practice that promotes movement, whether it is yoga, pilates, weightlifting, or running – is beneficial to the human body and should always be encouraged. However, the main caveat I give my patients when it comes to yoga is they need to understand which movements are healthy for their body’s and which movements are potentially damaging. Certain injuries or movement deficiencies can put the body at risk if you don’t know when to modify the yoga pose or to avoid it all together.
Low back pain and yoga
Let’s look at some examples. Chiropractors treat many patients with low back pain. Many patients experience increased back pain with sitting, picking items up off the floor, and bending forward to tie their shoes. The common theme is rounding postures of the low back, termed ‘flexion’ is provocative for these patient’s low backs. We term this type of back pain ‘flexion intolerant low back pain’. A patient with flexion intolerant low back pain should avoid flexion based activities while their low back is in the healing stages. Very often, these patients respond well to exercises or static positions that place the low back in extension – adhering to the natural lordotic curve of the lumbar spine.
If after assessment in the clinic the Chiropractor decides the patient will benefit from extension based exercises or static positions, the patient will be counseled to avoid all flexion based activities or postures for the low back (bending forward, prolonged sitting, etc.) during the initial stages of rehabilitation. If you have taken a yoga class, you are familiar with the numerous forward folds and sustained toe touches that are done during the class to stretch out the calves and hamstrings. If a patient is experiencing flexion intolerant low back pain, performing 20-30 forward folds in an hour practice is harmful to the body. In a patient prone to back pain, persistent forward bending places stress on the discs, nerves, ligaments, and muscles of the low back. Even Child’s pose position places the low back in end ranges of flexion and should be avoided for most acute back pain patients. Instead of forward folding, perform the downward dog position which will give similar benefits of stretching the calves and hamstrings while keeping a neutral spine.
Shoulder/ neck pain and yoga
Another example is a patient with shoulder and/or neck pain. Handstands, headstands, and other inversion based poses are very popular in yoga. Teachers cite the benefit of reversing the gravitational flow of blood in the body for improvements in circulation. While I agree with this notion, patients with shoulder and neck pain should not be putting this amount of stress on their muscles and joints. Performing a proper head or hand stand requires extreme levels of shoulder and scapular stability – something many beginning yogis do not possess. If you have shoulder or neck pain and are new to yoga, do not try and impress the rest of the class by forcing yourself into an inversion pose. Instead, ask your teacher to show you a regressed version that does not place as much stress on your neck and shoulders.
Knee pain and yoga
Last, the athlete with knee pain needs to be careful with certain yoga postures. Patient’s with current knee pain or a history of knee pain and surgery need to be cautious with certain yoga poses. Popular poses that impose large amounts of stress on the knee joint include the full squat (frog pose), hero pose (sitting on heels and laying backwards), pigeon pose (lying body weight on top of figure 4 pose), and standing tree pose. The common theme with these positions is they add load to the knee joint in extreme ranges of flexion and rotation. When the knee is forced into end ranges of flexion and rotation, the muscles and ligaments of the knee are placed under stress, which is amplified if previous or current injury exists. Instead of fighting through the pain to complete the class, work on poses like the lunge, warrior 1 and 2, bridge pose, and chair pose. These poses will strengthen the muscles and ligaments of the knee in less extreme ranges of motion.
Your Yoga Practice
Practicing yoga should be challenging but pain free and relaxing at the same time. If you are constantly fighting through pain in yoga, you are missing out on the many benefits of a successful practice. Do not feel bad about modifying your practice to work around injuries. Always remember it is YOUR practice, and not everyone else in the room. Make sure to communicate all injuries to teachers before the class starts so they can help you with modifications to make sure you get the same benefits as everyone else. As always, if you have a lingering injury that does not seem to be getting better, make sure to consult a health care professional who can diagnose and correct your specific issue.
Post written by Dr. Riley Kulm, DC. Check out his bio here.