Chiropractic care is a highly effective form of treatment for many cervical or neck-related conditions. But how do chiropractors determine what’s causing the pain and what approach to take to manage the patient’s condition? Let’s take a look at what chiropractors do when a patient presents with neck pain.

HISTORY: In the detective part of the job, the chiropractor has to determine 1) pain generation or tissue involvement; 2) ruling in/out dangerous “red flags” (cancer, infection, spinal cord injury, fracture) that would require referral to the patient’s medical physician, a specialist, or the emergency room; and 3) identifying and tending to “yellow flags” (barriers to recovery like depression, anxiety, poor coping strategies, and more). This process starts with taking a history of the complaint to identify how long the patient has experienced the condition, where the pain is felt and if it radiates to other parts of the body, grading the severity of pain, when the pain worsens or improves, and more. Questionnaires are often used to help identify the red and yellow flags and to determine how the condition affects activities, mood, and other aspects of the patient’s life.

EXAMINATION: The examination phase begins by identifying the pain generator(s). To do this, chiropractors use various tests to assess pain provocation or reduction, pain radiation, and the patient’s “pain behavior” associated with the “positive” or “negative” test result. For example, if bending the head forward (chin to chest) often feels better and looking up often hurts and sometimes provokes radiating pain into an arm, then the chiropractor will perform other tests that assess nerve conductance such as strength, sensory, and nerve compression tests. The examination may also include the use of diagnostic tools, like X-ray, if necessary.

TREATMENT: Once the history and examination are complete, the doctor of chiropractic will be able to make a diagnosis and formulate a treatment approach. This can consist of manual therapies (spinal manipulation, mobilization, soft tissue work, etc.) performed in the office, possibly including modalities like traction, TENS, or cold laser. Patients may also receive instruction on the use of heat, ice, activity modifications, and nutritional/dietary information to help reduce inflammation. Additionally, the chiropractor may prescribe the patient exercises to perform at home to aid in the healing process.

Following an initial course of care—such as three visits a week for two weeks—the chiropractor may reassess the patient to determine if visits should be tapered down or if the patient can be released from care to return on an as-needed basis.