Choosing the Right Chiropractor

As a preface to those reading this page, this is a list of scams used by unscrupulous chiropractors throughout the country. It is not intended to be an attack on any of the local chiropractors in the surrounding area. There are a number of different schools, belief systems, and management styles within the chiropractic profession. This should be used as a guide for those who have never sought care from a chiropractor, are unhappy with their current chiropractor or are wary of chiropractors in general.

Be Wary of the Following Chiropractic Practices

Many Chiropractors have a number of different methods of soliciting unnecessary care and office visits out of their patients. Some knowingly do this as a way to make more money, others likely do it out of a blind belief in their own model of care for their patients. These methods include but are not limited to:

  • A large lump sum down payment up front prior to the initiation of any form care, it may also include a schedule of all of your future appointments/therapies.

  • Mandatory x-rays for every patient who walks in the door, regardless of presentation. Please see below for a more indepth explanation!

  • Utilization of an expensive piece of equipment on a routine basis, even for conditions that would benefit from another type of manipulative therapy or another branch of health care all together (most common example is a practice that just purchased a $10,000 spinal decompression table and wants to recoup the money by putting every patient that walks into the office on the table).

X-Rays

There are cases where x-rays are determined to be medically necessary prior to the initiation of care as a means of ruling out more ominous causes of pain (i.e. cancer, fractures, other diseases). However, the general concensus amongst most evidence-informed chiropractors is that x-rays do not necessarily have to be required prior to the initiation of treatment if there aren't any signs/symptoms that necessitate further investigation.

With that said, some chiropractic treatment techniques call for x-rays before, during, and after a course of treatment as a means of measuring progress and a response to treatment. Ask plenty of questions, if you feel that you are responding well to care then continue as you and your chiropractor see fit. However, if you feel that you aren't responding well and the repeated x-rays are adding up without any notable benefits, voice your concern.

Maintenance Care

  • Some chiropractors are very persistent in trying to convert patients to a "wellness or maintenance care" model of care. In other words, having patients come in to receive treatment during times of absolutely zero pain. Current evidence supporting this form of chiropractic therapy is lacking, but luckily for the profession more and more research emerges with each passing year. Until that point, it is very hard to push this type of care on every patient that walks through the front door. The following are some points to be aware of regarding "wellness/maintenence care".

1) This should be determined on an individual basis with the patient making an informed decision to enroll in wellness or maintenance care and this type of care should not be forced onto the patient as part of the "treatment plan".

2) Some patients with chronic pain syndromes do benefit from periodic manipulation, however there should be a set treatment plan in place with achievable goals (i.e. sustained lower pain levels, keeping the patient eligible to work, etc).

3) Research has shown that maintenance care can be beneficial for some conditions, such as chronic non-specific lower back pain (meaning lower back pain that is localized in the lower back without radiating into the legs).

-Senna MK, Mchaly SA. Does maintained spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome? Spine 2011; 1427-1437.

-Descarreaux M, Blouin J-S, Drolet M, Papadimitriou S, Teasdale N. Efficacy of preventive spinal manipulation for chronic low back pain and related disabilities: A preliminary study. Journal of Manipulative and Physiological Therapeutics 2004; 27(8): 509-514.

4) As part of a comprehensive geriatric assessment program, the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were not and found that the individuals under continuing chiropractic care were:

*Free from the use of a nursing home [95.7% vs 80.8%];
*Free from hospitalizations for the past 23 years [73.9% vs 52.4%];
*More likely to report a better health status;
*More likely to exercise vigorously;
*More likely to be mobile in the community [69.6% vs 46.8%].

Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes
of the cohort of patients experiencing substantially fewer costly healthcare interventions.

-Coulter ID, Hurwitz EL, Aronow HU, Cassata DM, Beck JC. Chiropractic patients in a comprehensive home--based geriatric assessment, follow-up and health promotion program. Topics in Clincial Chiropractic 1996; 3(2): 46-55.

5) A second review of a larger cohort of elderly patients across the United States compared direct expenditures [hospital care, physicians' services, nursing home] between groups of patients who were under maintenance chiropractic care and those who were not. Nearly a threefold savings of mean annual expenditures was reported as follows:

*$ 3,105 : Maintenance care
*$10,041 : No maintenance care

-Rupert RL, Manello D, Sandefur R. Maintenance care: Health promotion services administered to U.S. chiropractic patients age 65 and older. Journal of Manipulative and Physiological Therapeutics 2000; 23(1): 10-19.

6) One study involving elderly populations reviewed the consequences of implementing an on-site industrial chiropractic program which included the early detection, treatment, prevention and occupational management of musculoskeletal injuries 2 days per week. For the 21 months after implementation of the program, the total number of days of lost time, costs per claim, rate premiums, and especially the number of surgeries decreased dramatically. Cost savings from avoided surgeries alone amounted to $900,000 for these preventive measures.

-Cooper SR, Pfefer MT. Development of an on-site industrial chiropractic program. Proceedings of the 9th Biennial Congress of the World Federation of Chiropractic, Vilamoura, PORTUGAL, May 17-19, pp. 202-204.

  • Clearly there appear to be some benefits related to, and that's the key word, related to chiropractic maintenance manipulation. However, as with any treatment more research is needed in order to make the more broad suggestion that every patient needs maintenance care.

Ignoring the Important Details

Some Chiropractors blindly believe that every single person alive should be seen and "adjusted" once a week for the rest of their lives without any rational, evidence-based thought process behind the belief. Many times, those practitioners believe so blindly in their model of health care that they neglect to perform a thorough history and examination on their patients. It is very important to pay attention to how the Chiropractor questions and examines you prior to the initiation of treatment.

Avoid Chiropractors Who:

-Bring you into the room, ask you very few questions (usually not specific questions) during the initial visit, lay you down on the table and begin treating you immediately.

-Treat areas of the spine that are unrelated to the area of chief complaint (i.e. Chiropractors who adjust the cervical spine in patients who present for evaluation and treatment of lower back pain only).

-Do not provide you with a Review of Findings and cover an Informed Consent prior to the initiation of treatment and continue updating their informed consent as you are seen and treated for other conditions.