The chiropractic physician consistently assesses a number of back pain risk factors
that are critical to diagnosis. Individual factors contributing to back pain include
older age, tallness, obesity, smoking, decreased muscle strength, decreased flexibility,
lack of physical conditioning, and multiple pregnancies. Other health conditions are
considered, such as osteoporosis, multiple myeloma, osteoarthritis, scoliosis, and
ruptured disc. Psychological factors include the person’s levels of anxiety, stress, and
pain tolerance. Occupational risk factors for back pain include heavy physical work;
frequent bending, twisting, lifting, pushing, pulling; repetitive strain; and injury or
accidents. Recreational risk factors include hockey, football, gymnastics, golf, rac-
quetball, bowling, squash, handball, tennis, backpacking, wrestling, skiing, and
other high-impact sports. All applicable risk factors are noted during the history.
Relying heavily on hands-on procedures, the chiropractic physician uses palpation
to determine both structural and functional problems. These hands-on procedures
are complemented by a neurological physical examination, testing nerve function,
reflexes, coordination and muscle function. It is the same neurological assessment
done by a conventional physician.
Following the neurological evaluation is the motion palpation exam in which the
chiropractor physically examines the spine, noting how it feels, as well as how the
client says it feels. The client is gently moved into and out of various postures during
this part of the exam. Some postures are done standing while others are done while
lying down. This process often informs the chiropractor what movements or posi-
tions reproduce or aggravate the pain. X-rays to confirm diagnostic findings may or
may not be done.
Hypermobility of spinal joints is diagnosed by the sound of a repeated click when a
joint is moved through its normal range of motion. This unstable type of subluxa-
tion is related to flaccid ligaments and is more problematic than the fixated type of
subluxation. Hypermobile joints should not be forcibly manipulated since manipu-
lation can move the joint beyond the safe range of motion and increase the degree
of hypermobility. Rather, nearby joints that have become immobile to compensate
for the unstable joint can be manipulated, and muscle strength and tone can be
increased with exercise.
The chiropractor rules out pathologies that are contraindicative to spinal manual
therapy (SMT). For example, advanced, degenerative joint disease would rule out all
forms of SMT that use significant force on the joint. Chiropractic treatment is not
appropriate in the case of spinal infections, fractures, or tumors, which fortunately
are fairly rare. In addition, SMT is not done on a woman in late pregnancy or on
people whose pain is increased with manipulation. Diagnosis determines appropri-
ate chiropractic treatment, referral for appropriate conventional medical care, or
concurrent care.136 ABSOLUTE BEGINNER’S GUIDE TOALTERNATIVE MEDICINE