Trust me, I'm a Chiropractor!

Dr. Christopher Aysom, Principal Clinician
BChiroSc, MChiro (Chiropractor)

As with many professions, not all Chiropractors are made equal. In fact, the profession of Chiropractic is one with an incredible variety in terms of practitioner style and approach to healthcare. It’s not outside the realms of possibility that you could line up five different Chiropractors from five different practices, each evaluating and diagnosing the same patient, however, each arriving at a different diagnosis and suggesting a different treatment plan. That scenario is an extreme example, however if each provider arrives at a different diagnosis based on their style of practice, then that patient has seen at least four providers that are likely to be incorrect.

If you’re the patient, that is a tough spot to be in when you trust that your provider will reach an accurate diagnosis that represents the reality of your problem.

Chiropractors are still very well placed to help with your pain. But how can you find the Chiropractor that will give you the right diagnosis and provide an effective treatment? How do you find the Chiropractor that you can trust with your health?

There are 2 important questions that you need to ask.

1. What is the tissue-specific diagnosis and is there a diagnostic list?

This is an important question and the answer should be very clear. Without a robust and detailed diagnosis, any treatment is likely to be of poor value. A diagnosis that is tissue-specific, means that the provider knows exactly which joint, muscle, tendon, ligament or nerve is dysfunctional, what the pathology is and the associated level of severity.

It’s rare in chronic conditions that there is a single tissue that that can explain a patient’s pain. There may be a single “pain generating tissue”, however these problems rarely occur in isolation. Therefore, a list is required to fully explain the diagnosis. This diagnostic list is ordered according to importance, providing a clear representation of the patient’s presentation.

Here’s a handful of a weak diagnoses for a patient with chronic back pain:

• Slipped disc
• Disc tear
• Muscle spasm
• Myofascial pain syndrome
• Weak core
• Joint restriction

Here’s an example of a more robust diagnosis explained as a list, for the same patient:

1. L5/S1 disc degeneration, with sclerotogenous pain referral
2. Lumbar erector adhesion, grade 2, bilateral L4-S1
3. Lumbar supraspinous ligament adhesion, grade 1, L4-S1
4. Lumbar stabiliser deconditioning/weakness

A robust musculoskeletal diagnosis is multi-faceted and specific enough that another provider could pick-up the case notes and understand exactly what to do.  A weak diagnosis lacks detail and often uses the term “syndrome” to broadly describe the condition.

2. How do you measure progress?

This is an important question to consider as a patient. There needs to be some objective measurements to monitor progress, rather than just the obvious presence of pain. Of course pain is important – it’s probably the primary reason that you sought help in the first place. But if we don’t have other objective measures in place, then it’s akin to relying on the presence of absence of a toothache as a measure of your dental health.

PAIN is an important part of the picture, but your Chiropractor should also be highly focused on FUNCTION; that is, can your body move like it’s meant to move, or, if not, why not? We measure your range of motion to monitor your function. When a joint and its associated peripheral tissues are healthy, it will allow you to move more. We want to make sure that we can track your progress through treatment, each and every time you walk through the door. Pain is important, but it is also subjective. Range of motion is objective and the numbers don’t lie.

If we use the chronic lower back pain patient again as an example, this is what it might sound like using only pain as a clinical marker:

“Hey it’s great that your back pain has reduced since we started treatment. We recommend that you keep coming in for more treatment, or just call the office next time it hurts.”

But if we are tracking pain AND function, we could discuss the case like this: 

“Hey it’s great that your back pain has reduced. When you first came in your lower back function was at 60%, which has now increased to 84%. We expect you’ll need another 2-3 visits to get the maximum benefit from treatment.

I get it. Many people do not like Chiropractors and many people do not trust Chiropractors. 

The opinions are often polarizing. I’ve even had a prospective patient walk out of the practice after seeing my professional title displayed on the wall. He’d just spent several weeks and hundreds of dollars on Chiropractic treatment that didn’t help his condition and his pain had actually gotten worse in that time. After seeing that I was also a Chiropractor, he said that he needed a Physiotherapist and not another Chiropractor, so he left.

It’s hard to blame him, he had been burned before. But what he really needed was someone that would provide him with a thorough diagnosis and treatment plan to start addressing his problem.

Like any profession though, not all Chiropractors are made equal. As a patient, it can be a challenge to find the right practitioner to meet your needs. The profession of Chiropractic is well placed to help with chronic musculoskeletal pain, but it’s up to you as the patient to do your due diligence and connect with the right provider.