The Chiropractic Cure
Three primary clinical goals guide chiropractic intervention:
■ The first goal is to reduce or eliminate people’s pain. Typically this goal is the
client’s primary, and often only goal.
■ The second clinical goal is to correct the subluxation, thereby restoring bio-
mechanical balance to reestablish shock absorption, leverage, and range of
motion. In addition, muscles and ligaments are strengthened by spinal reha-
bilitative exercises to increase resistance to further injury.
■ The third clinical goal is preventative maintenance to assure the problem
does not recur. This goal is comparable to the idea of having teeth cleaned
periodically to prevent decay. Maintenance intervals vary from person to per-
son depending on lifestyle.
Back pain is a leading cause of disability and the second most common reason (after
the common cold) people visit a doctor. Chiropractors have two times the number of
visits for back pain as conventional physicians. Most chiropractors also treat periph-
eral joints—elbows, knees, and shoulders. In 1994, a panel for the Agency for Health
Care Policy and Research of the United States Department of Health and Human
Services concluded that spinal manual therapy speeds recovery from acute low back
pain and recommended it either in combination with or as a replacement for nons-
teroid, anti-inflammatory drugs. At the same time the panel rejected many methods
used for years by conventional medicine such as bed rest, traction, and various other
physical therapy modalities and cautioned against spinal surgery except in the most
severe cases.
Chiropractors manipulate their clients’ spines by using their hands to apply pressure
in specific locations and directions. The skill lies in the ability to be specific about
which joint is being manipulated, which is especially important in the presence of
any unstable joints. A chiropractor has 10–20 different ways of manipulating every
movable joint in the body. Chiropractors also practice soft-tissue manipulation to
stretch contracted muscles and decrease muscle spasms.
High-velocity, low-amplitude (HVLA) thrust adjustment is the most common form of
manipulation. It is performed by manually moving a joint to the end-point of its
normal range of motion, isolating it by local pressure on bony prominences, and
then giving a swift, specific, low-amplitude thrust.
Often a series of these thrusts are applied to the back and neck. When the facet
joints are forced apart, a small vacuum is created and then released, which creates a
popping sound much like when people crack their knuckles. This manipulation does
CHAPTER 10 CHIROPRACTIC PRACTICE 137
