Back Clinic Chiropractic Examination. An initial chiropractic examination for musculoskeletal disorders will typically have four parts: a consultation, case history, and physical examination. Laboratory analysis and X-ray examination may be performed. Our office provides additional Functional and Integrative Wellness Assessments in order to bring greater insight into a patient’s physiological presentations.
Consultation:
The patient will meet the chiropractor which will assess and question a brief synopsis of his or her lower back pain, such as:
Duration and frequency of symptoms
Description of the symptoms (e.g. burning, throbbing)
Areas of pain
What makes the pain feel better (e.g. sitting, stretching)
What makes the pain feel worse (e.g. standing, lifting).
Case history. The chiropractor identifies the area(s) of complaint and the nature of the back pain by asking questions and learning more about different areas of the patient’s history, including:
Family history
Dietary habits
Past history of other treatments (chiropractic, osteopathic, medical and other)
Occupational history
Psychosocial history
Other areas to probe, often based on responses to the above questions.
Physical examination: We will utilize a variety of methods to determine the spinal segments that require chiropractic treatments, including but not limited to static and motion palpation techniques determining spinal segments that are hypo mobile (restricted in their movement) or fixated. Depending on the results of the above examination, a chiropractor may use additional diagnostic tests, such as:
X-ray to locate subluxations (the altered position of the vertebra)
A device that detects the temperature of the skin in the paraspinal region to identify spinal areas with a significant temperature variance that requires manipulation.
Laboratory Diagnostics: If needed we also use a variety of lab diagnostic protocols in order to determine a complete clinical picture of the patient. We have teamed up with the top labs in the city in order to give our patients the optimal clinical picture and appropriate treatments.
Subluxation is when a joint shifts out of alignment, which can happen to any joint in the body. Spinal subluxation indicates a misalignment of one or more portions of the spinal vertebrae. It is common in the spine from all the reaching, bending, twisting, and flexing the body goes through. Spinal subluxations, if left untreated, can cause disc degeneration, permanent nerve damage, neurological conditions, and chronic pain symptoms. A subluxation chiropractor will realign and decompress the spine combined with massage therapy to relax the muscles and restore mobility and function.
Subluxation Chiropractor
Some subluxations don’t cause any problems or pain, but that doesn’t mean they aren’t affecting the back and body. A spinal subluxation can cause long-term problems by:
Research shows that spinal subluxations can affect many facets of the body. Long-term effects may include:
Sleep problems
Low energy
Brain fog
Mood swings
Anxiety and depression
Digestive issues
Respiratory problems
Bone spurs
Spinal arthritis
Chiropractic Care
When the spine is out of alignment, it can cause issues throughout the body. Changes in one area affect the rest of the body. A subluxation chiropractor looks at the spine’s neurological and mechanical components and aims to reset everything back into its proper position. Similar to the way a massage helps the mind and body relax and de-stress, a spinal adjustment helps by:
Increasing circulation
Relieving discomfort and pain
Releasing tension
Improving mood
Reducing stress levels
Improving sleep function
Increasing energy levels
When the spine is properly aligned, the body can operate at its full potential.
Green, J D et al. “Anterior subluxation of the cervical spine: hyperflexion sprain.” AJNR. American journal of neuroradiology vol. 2,3 (1981): 243-50.
Meyer, S. “Thoracic spine trauma.” Seminars in roentgenology vol. 27,4 (1992): 254-61. doi:10.1016/0037-198x(92)90004-l
Neva MH, Häkkinen A, Mäkinen H, et al. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopedic surgeryAnnals of the Rheumatic Diseases 2006;65:884-888.
Nourollahi, Maryam, et al. “Awkward trunk postures and their relationship with low back pain in hospital nurses.” Work (Reading, Mass.) vol. 59,3 (2018): 317-323. doi:10.3233/WOR-182683
Vernon, Howard. “Historical overview and update on subluxation theories().” Journal of chiropractic humanities vol. 17,1 (2010): 22-32. doi:10.1016/j.echu.2010.07.001
Diagnosing ankylosing spondylitis usually involves multiple tests. When doctors order blood tests to diagnose ankylosing spondylitis, an individual is experiencing worsening symptoms in their back and joints. Often, a blood test diagnosis means the doctor is looking for evidence of anything else that could be causing the symptoms. However, blood tests by themselves cannot definitively diagnose ankylosing spondylitis, but when combined with imaging and assessment, they can provide important clues that point to the answers.
Ankylosing Spondylitis Blood Test Diagnosis
Ankylosing spondylitis is arthritis that primarily affects the spine and hips. It can be difficult to diagnose as no single test can provide thorough information for a definitive diagnosis. A combination of diagnostic tests are utilized, including a physical exam, imaging, and blood tests. Doctors are not only looking for results that will point to ankylosing spondylitis, but they are looking for any results that might point away from the spondylitis results that might provide a different explanation for symptoms.
Physical Exam
The diagnostic process will begin with the individual’s medical history, family history, and physical exam. During the exam, the doctor will ask questions to help rule out other conditions:
How long have symptoms been presenting?
Do symptoms get better with rest or exercise?
Are the symptoms getting worse or staying the same?
Are the symptoms worse at a particular time of day?
The doctor will check for limitations in mobility and palpate tender areas. Many conditions can cause similar symptoms, so the doctor will check to see if the pain or lack of mobility is consistent with ankylosing spondylitis. The feature sign of ankylosing spondylitis is pain and stiffness in the sacroiliac joints. The sacroiliac joints are located in the lower back, where the base of the spine and pelvis meet. The doctor will look at other spinal conditions and symptoms:
Back pain symptoms caused by – injuries, posture patterns, and/or sleeping positions.
The HLA-B27 gene corresponds with ankylosing spondylitis; if an individual has it, one of their parents has it.
Imaging
X-rays often serve as the first step to a diagnosis.
As the disease progresses, new small bones form between the vertebrae, eventually fusing them.
X-rays work best at mapping the disease progression than the initial diagnosis.
An MRI provides clearer images in the early stages as smaller details are visible.
Blood Tests
Blood tests can help rule out other conditions and check for signs of inflammation, providing supportive evidence along with the results of imaging tests. It typically only takes about a day or two to get the results. The doctor may order one of the following blood tests:
Antinuclear antibodies, or ANA, go after the proteins in the cell’s nucleus, telling the body its cells are the enemy.
This activates an immune response that the body fights to eliminate.
A study determined that ANA is found in 19% of individuals suffering from ankylosing spondylitis and is higher in women than men.
Combined with other tests, the presence of ANA provides another clue to a diagnosis.
Gut Health
The gut microbiome plays an important role in triggering the development of ankylosing spondylitis and its treatment.
Tests to determine the gut’s health can give a doctor a complete picture of what is happening inside the body.
Blood test diagnoses for ankylosing spondylitis and other inflammatory conditions rely heavily on piecing together different tests alongside clinical exams and imaging.
Causes, Symptoms, Diagnosis, and Treatment
References
Cardoneanu, Anca, et al. “Characteristics of the intestinal microbiome in ankylosing spondylitis.” Experimental and therapeutic medicine vol. 22,1 (2021): 676. doi:10.3892/etm.2021.10108
Prohaska, E et al. “Antinukleäre Antikörper bei Spondylitis ankylosans (Morbus Bechterew)” [Antinuclear antibodies in ankylosing spondylitis (author’s transl)]. Wiener klinische Wochenschrift vol. 92,24 (1980): 876-9.
Sheehan, Nicholas J. “The ramifications of HLA-B27.” Journal of the Royal Society of Medicine vol. 97,1 (2004): 10-4. doi:10.1177/014107680409700102
Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK470173/
Xu, Yong-Yue, et al. “Role of the gut microbiome in ankylosing spondylitis: an analysis of studies in the literature.” Discovery medicine vol. 22,123 (2016): 361-370.
The Adams forward bend test is a simple screening method that can help with scoliosis diagnosis and help in developing a treatment plan. The exam is named after the English physician William Adams. As part of an examination, a doctor or chiropractor will look for an abnormal side-to-side bend in the spine.
Scoliosis Diagnosis
The Adams forward-bend test can help determine if there are indicators for scoliosis.
It is not an official diagnosis, but the results can be used as a starting point.
The Adams test will reveal signs of scoliosis and/or other potential deformities like:
Uneven shoulders
Uneven hips
Lack of symmetry between the vertebrae or the shoulder blades.
The head does not line up with a rib hump or the pelvis.
Detection of Other Spinal Issues
The test can also be used to find spinal curvature issues and conditions like:
Kyphosis or hunchback, where the upper back is bent forward.
Scheuermann’s disease is a form of kyphosis where the thoracic vertebrae can grow unevenly during a growth spurt and cause the vertebrae to develop into a wedge-like shape.
The Adams test by itself is not enough to confirm scoliosis.
A standing X-ray with Cobb angle measurements above 10 degrees is required for diagnosing scoliosis.
The Cobb angle determines which vertebrae are tilted the most.
The higher the angle, the more severe the condition and the more probable it will produce symptoms.
Computed tomography or CT and magnetic resonance imaging or MRI scans can also be used.
Forward Bend Test
References
Glavaš, Josipa et al. “The role of school medicine in the early detection and management of adolescent idiopathic scoliosis.” Wiener klinische Wochenschrift, 1–9. 4 Oct. 2022, doi:10.1007/s00508-022-02092-1
Grossman, T W et al. “An evaluation of the Adams forward bend test and the scoliometer in a scoliosis school screening setting.” Journal of pediatric orthopedics vol. 15,4 (1995): 535-8. doi:10.1097/01241398-199507000-00025
Letts, M et al. “Computerized ultrasonic digitization in the measurement of spinal curvature.” Spine vol. 13,10 (1988): 1106-10. doi:10.1097/00007632-198810000-00009
Senkoylu, Alpaslan, et al. “A simple method for assessing rotational flexibility in adolescent idiopathic scoliosis: modified Adam’s forward bending test.” Spine deformity vol. 9,2 (2021): 333-339. doi:10.1007/s43390-020-00221-2
Middle back pain is usually caused by unhealthy posture, improper lifting or twisting, and minor injuries like muscle strains, sprains, and herniated discs. Thoracic herniated discs are less common than neck or low back herniations because of the thoracic vertebrae’s size and rigidity, but they do happen. Chiropractic care can treat thoracic herniated discs and prevent future episodes.
Thoracic Herniated Disc
The 12 thoracic vertebrae between the neck and the lumbar spine make up the largest and least flexible area. The rib cage adds:
Protection
Support
Stabilization of the spine
Symptoms
Herniated discs happen when the soft, gel-like layer of the shock-absorbing intervertebral disc bulges into or leaks through the disc’s tough outer layer. Due to the location, a herniated disc can cause various issues to the middle back, chest wall, and/or abdominal areas around the injured vertebrae. This displacement can cause:
Inflammation
Compression to the spinal nerves or spinal cord
Tingling
Numbness
Pain
Weakness
If the lower thoracic region is herniated, symptoms can radiate to one or both lower extremities.
Radiculopathy
If the herniation compresses a thoracic spinal nerve, it can cause radiculopathy or pain that radiates down the nerve and out from the spine into the surrounding muscles. The symptoms can present around the rib cage or upper abdominal area. A large disc herniation can compress the spinal cord inside the spinal canal. This is a condition called myelopathywhich can cause:
Numbness
Tingling
Weakness in one or both lower extremities
Sometimes bowel and bladder dysfunction
In severe cases, paralysis
Causes
Degenerative disc disease and trauma like vehicle collisions or falls are the most common causes of thoracic herniation.
Individuals between 30 and 50 are more likely to be affected.
As the body ages, the disc’s soft inner layer loses hydration, making it less effective as a shock absorber.
The tough outer layer loses elasticity, increasing the risk of disc tears.
Chiropractic Care
A chiropractor or neurologic physical therapist can personalize a herniated disc exercise treatment plan to reduce pain, improve strength and posture, and increase mobility.
Therapeutic massage can be useful in managing pain and decreasing inflammation.
Spinal epidural injections can be used with physical therapy to help manage pain and allow the body to heal independently.
Recommendations
Avoid bending, lifting, reaching, and twisting.
Apply an ice pack or cold compress for 15- to 20-minute intervals every two hours.
Sit in chairs with a firm back to support the spine.
When sleeping, place a small pillow under the head and knees to keep the spine in a neutral position to prevent pressure on the herniated region.
Avoid too much rest, which can worsen the injury.
Gentle physical activity will maintain circulation and keep the muscles strong.
Surgery
Most cases of thoracic herniation do not require surgery. Surgery could be recommended if there is intolerable pain, neurological issues, and conservative treatments are not working. A spine specialist can determine if surgery is necessary based on the injury’s size, type, and location. Spinal surgery will remove all or part of the herniated disc compressing a nerve root. Common surgical procedures include:
Court, C., E. Mansour, and C. Bouthors. “Thoracic Disc Herniation: Surgical Treatment.” Orthopaedics & Traumatology: Surgery & Research 104, no. 1 (2018). doi.org/10.1016/j.otsr.2017.04.022.
Dydyk, Alexander M, Ruben Ngnitewe Massa, and Fassil B Mesfin. “Disc Herniation – Statpearls – NCBI Bookshelf.” National Library of Medicine, January 18, 2022. www.ncbi.nlm.nih.gov/books/NBK441822/.
Yoon, Wai Weng, and Jonathan Koch. “Herniated Discs: When Is Surgery Necessary?” EFORT Open Reviews 6, no. 6 (2021): 526–30. doi.org/10.1302/2058-5241.6.210020.
Dislocations impact the joint and are injuries that force/knock the bones out of position. Dislocations can be caused by a motor vehicle collision, falls, sports trauma, or weakened muscles and tendons. However, less impact/force is needed to dislocate smaller joints. Dislocations commonly occur at the shoulders, ankles, knees, hips, elbows, fingers and toes, and the jaw. The experience causes swelling, inability to move, and pain. A joint dislocation chiropractor can manipulate, reset, rehabilitate and strengthen the affected area and rebalance the body.
Joint Dislocation
The region where two or more bones come together is a joint. Each has a primary function, but their functions overlap. The joints allow the bones to move/articulate the skeletal system. Maintaining the body’s balance requires mobility and stability.
Mobility is the ability to move the body without restriction.
Stability is maintaining equilibrium, healthy posture, and support during movement.
The stable joints do not dislocate easily because their structures are not as flexible.
Mobile joints are at an increased risk, as they can move in almost any direction.
The kinetic chain is a sequence of joints forming an alternating pattern of stability and mobility that create a solid platform for dynamic movement. However, any joint can become dislocated, causing the affected area to become unsteady or immobile, strain or tear the surrounding muscles, nerves, and tendons which are the tissues that connect the bones to a joint.
A joint can be partially dislocated/subluxation or fully dislocated.
Joints dislocated previously have an increased risk of re-dislocating because the surrounding tissues that hold the joint have been torn or overly stretched.
Symptoms
Symptoms vary depending on the severity and location of the injury. Common symptoms include:
Instability
Loss of ability to move
Swelling
Bruising
Pain
Visible deformation
Increased Risk
Various factors can lead to joint dislocation, including:
Weakness of the supporting ligaments and muscles from natural wear and tear/age or lack of physical conditioning.
Older individuals with poor balance are more vulnerable to falls that can knock joints out of place.
Young children developing have more elastic supporting ligaments and are prone to falls, collisions, and other injuries.
Previous dislocations with overstretched or torn supporting tissues.
Repeated dislocations are likely to follow the shoulder, knee, and hip.
Physical activities like extreme sports, contact sports, or sports that involve quick body shifts, twists, and turns on the feet.
Physically demanding job.
Operating heavy machinery/equipment.
Joint hypermobility is common in children and around 5% of adults. It can be caused by weak or loose ligaments, weak or loose muscles, and/or shallow joint sockets.
Joint Dislocation Chiropractic
Treatment will vary based on the severity of the injury and the dislocated joint. Depending on the location and severity, a chiropractor will perform different movements/manipulations to realign the joint and strengthen the area.
Significant force could be necessary to pull the bones apart to realign them back into their proper position.
The joint may need to be pulled out and rotated slightly before being put back.
The focus is on increasing ligament strength.
Once the joint is back in place, it may need to remain immobile, possibly using a sling or splint to help fully heal the injury.
Physical therapy exercises will be recommended to strengthen the muscles and ligaments around the joint to support it optimally.
Shoulder Pain Chiropractic
References
Dizdarevic, Ismar, et al. “Epidemiology of Elbow Dislocations in High School Athletes.” The American journal of sports medicine vol. 44,1 (2016): 202-8. doi:10.1177/0363546515610527
Hodge, Duncan K, and Marc R Safran. “Sideline management of common dislocations.” Current sports medicine reports vol. 1,3 (2002): 149-55. doi:10.1249/00149619-200206000-00005
Prechel, Ulla et al. “The Treatment of Temporomandibular Joint Dislocation.” Deutsches Arzteblatt international vol. 115,5 (2018): 59-64. doi:10.3238/arztebl.2018.0059
Skelley, Nathan W et al. “In-game Management of Common Joint Dislocations.” Sports health vol. 6,3 (2014): 246-55. doi:10.1177/1941738113499721
Forearm pain refers to soreness, aches, or discomfort between the wrist and the elbow. An injury or inflammation can affect any tissues, including muscles, bones, blood vessels, tendons, and the skin. The causes usually include overuse injuries, pinched nerves, accidents causing trauma, lifting or heaving heavy objects, sports injuries, and fractures. If left untreated, issues like chronic muscle pain and decreased and disrupted blood/nerve circulation can develop, leading to numbness and weakness. Chiropractic treatment can release tension, massage, reset, and stretch the muscles to expedite healing.
Anatomy
The forearm comprises the radius and ulna, which extend the forearm’s length and cross at the wrist.
The Radius
This bone starts at the elbow and connects to the wrist on the thumb side.
Ulna
This bone begins at the elbow and connects to the wrist on the side of the little finger.
Muscles
Several muscles operate to rotate the forearm up/supination and down/pronation and flex and extend the fingers.
Causes
Forearm pain can happen to anyone and is usually related to traumatic or repetitive use injury. In other cases, pain may be associated with a benign growth, like a cyst or possibly a malignant tumor. Common causes include:
Pulled and/or strained muscles
Muscle ruptures or small tears
A direct blow, fall, or any extreme twisting, bending or jamming action.
Tendonitis from tennis or golfers elbow.
Tennis elbow is caused by inflammation or tiny tears in the forearm muscles and tendons outside the elbow.
Golfers’ elbow is on the inside of the elbow.
Carpal Tunnel Syndrome is a repetitive stress disorder that affects the nerves and tendons of the wrist and forearm.
Musculoskeletal Causes
The musculoskeletal causes involve issues in how the forearm components operate together.
Repetitive actions like lifting, gripping, and typing can compress nerves and blood vessels throughout the forearm.
Forearm problems like dislocations or sprains can also lead to chronic inflammation and pain.
Traumatic Causes
Traumatic causes include those that result in injury to components of the forearm.
Anything that causes a direct injury to the forearm, including an automobile crash or accident, fall, or a direct hit, can fracture bones in the forearm.
A sprain can twist or stretch a ligament or tendon.
Activities that cause bending, twisting, quick sudden movement or direct impact can result in sprained multiple ligaments in the forearm.
Chiropractic Treatment
Healing forearm pain depends on the type of injury, location, and cause of the pain. Chiropractic addresses arm pain, tingling, and numbness in ways often overlooked by general physicians.
A chiropractor will perform a physical examination to determine if there are any underlying causes.
They may apply an ice pack to help control inflammation before the massage.
The chiropractor will perform gentle adjustments to the wrist, arm, and shoulder.
They may recommend a forearm brace to help retrain positioning and movement.
They will recommend exercises and stretches to strengthen and maintain the adjustments.
Carpal Tunnel Pain Treatment
References
Ellenbecker, Todd S et al. “Current concepts in examination and treatment of elbow tendon injury.” Sports health vol. 5,2 (2013): 186-94. doi:10.1177/1941738112464761
Shamsoddini, Alireza, and Mohammad Taghi Hollisaz. “Effects of taping on pain, grip strength and wrist extension force in patients with tennis elbow.” Trauma monthly vol. 18,2 (2013): 71-4. doi:10.5812/traumamon.12450
Suito, Motomu, et al. “Intertendinous epidermoid cyst of the forearm.” Case reports in plastic surgery & hand surgery vol. 6,1 25-28. 28 Jan. 2019, doi:10.1080/23320885.2018.1564314
Motorized non-surgical decompression helps relieve pain, removes pressure on the nerves, promotes healing, and increases blood flow to the spine. Spinal discs cannot attain nutrients from the blood without circulation. Decompression opens the spine, flooding the discs with nutrients that result in quicker and optimal healing. This, combined with manual chiropractic adjustments and therapeutic massage, can help get an individual to a pain-free lifestyle.
Spinal Discs
The soft disc material that separates each spinal bone can lose hydration, causing the material to dry out and compress. The discs can also compress from pressure from added weight, trauma from an automobile accident, work, school, and sports injury. Often the soft gel center of the discs spills out, causing a disc herniation. This is usually accompanied by:
Numbness
Tingling
Soreness
Stiffness
Sharp pain
Dull pain
Achiness
Muscle Weakness
Stinging/Burning sensation
Leg pain
Poor balance
These are often indicators of a nerve or nerve bundle, including the sciatic nerve becoming compressed by a herniated disc, bulging disc or slipped disc, stenosis, facet syndrome, or degenerative disc disease. When this happens, the symptoms may be felt in the back or neck area, and/or they may spread out into the arms, hands, legs, or feet.
We focus on providing expert chiropractic treatment that incorporates the most current research and technology into personalized treatment plans. Our goal is to help the individual heal as quickly as possible while educating and training them to use tools to maintain health and wellness.
What Is Spinal Decompression?
References
Andersson, G B, and R A Deyo. “History and physical examination in patients with herniated lumbar discs.” Spine vol. 21,24 Suppl (1996): 10S-18S. doi:10.1097/00007632-199612151-00003
Apfel, Christian C et al. “Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study.” BMC musculoskeletal disorders vol. 11 155. 8 Jul. 2010, doi:10.1186/1471-2474-11-155
Cherkin, DC, and F A MacCornack. “Patient evaluations of low back pain care from family physicians and chiropractors.” The Western journal of medicine vol. 150,3 (1989): 351-5.
Koçak, Fatmanur Aybala et al. “Comparison of the short-term effects of the conventional motorized traction with non-surgical spinal decompression performed with a DRX9000 device on pain, functionality, depression, and quality of life in patients with low back pain associated with lumbar disc herniation: A single-blind randomized controlled trial.” Turkish Journal of physical medicine and rehabilitation vol. 64,1 17-27. 16 Feb. 2017, doi:10.5606/tftrd.2017.154
Urban, Jill PG, and Sally Roberts. “Degeneration of the intervertebral disc.” Arthritis research & therapy vol. 5,3 (2003): 120-30. doi:10.1186/ar629
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
