Choosing a Chiropractor

What should you be looking for when choosing a chiropractor?

The chiropractic profession is varied, and there are many different styles of chiropractic treatment and practices out there. So how do you pick a chiropractor? I will list and discuss some key considerations when you are in search of a new chiropractor.

First, ask your family and friends for a recommendation, or even your primary doctor which chiropractors in the area they would see if they needed care. Friends, family, and your health care team will likely not recommend to you someone they don’t like and trust themselves.

Second, check online. You can do a quick internet search for the chiropractor’s name and the town or city they practice in and get an idea of their practice by looking at their website, checking reviews online, and even looking up their license to practice and check for irregularities. When you are choosing a chiropractor in your area, don’t neglect performing an online search.

Next, give their office a call. Did someone pick up right away or did you have to leave a message? If a receptionist, or even the doctor, answered, were they pleasant, easily understood, and helpful? Did you get a good first impression? These are important windows into the “feel” of the office.

Exterior photo of Omni Physical & Aquatic Therapy Center, Inc. in Meriden, CT where Dr. Erik Reich Chiropractor sees patients
Dr. Erik Reich practices in Meriden, CT at Omni Physical and Aquatic Therapy Center, Inc.

Things to consider when starting treatment.

Chiropractic treatment is varied, but there are certain considerations that you should be aware of when starting a treatment program. Many chiropractors utilize spinal adjustment or “manipulation” of the spine to alleviate neck or back pain. Adjustment of the extremities such as ankle or wrist may also be performed based on the presenting health issue.

As a patient, be extremely wary of any chiropractor who says they have a unique technique or treatment that only they can use or a new treatment which they discovered. Joint manipulation is practiced more frequently by chiropractors than other manual healthcare providers, but it is not exclusive or proprietary to chiropractors as a profession, and there are many different named adjusting techniques and styles but no one has a monopoly on getting someone better with an adjustment.

Furthermore, other treatment modalities practiced by any good chiropractic physician are not unique to the chiropractic profession. Education about your condition, an exercise program, stretching and other treatments of the muscles and tendons, and nutrition advise may be helpful and offered at a chiropractic visit, but none of these interventions are exclusive to the chiropractor. Be skeptical of any chiropractor who wants to sell you their own vitamins or supplements because they are the “best” or the only ones that work.

You should beware of excessive imaging. Years ago it was common for chiropractors to over-utilize x-rays for a variety of reasons. Be aware that current understanding and imaging guidelines do demonstrate their usefulness in ruling out fractures, dislocations, and other red flags. X-rays should not be taken in the absence of recent trauma or suspected disease, and x-rays are not indicated to monitor your progress as treatment progresses. If you are not in pain and the chiropractor wants to take x-rays, you should get a second opinion.

Avoid long term contracts, payment plans, and care which does not have a reasonable start and end point. When you see a chiropractor, you should start feeling better. Depending on the severity of the original injury or health issue, this may take 1 visit, 6 visits, or a month of visits, or even longer…but avoid any doctor who claims to know that you will need 3, 6, or 12 months of visits when they’ve only met you once or twice and want you to pre-pay for 6 months of care. Everyone responds and heals differently, but this can not be known that far in advance and especially not to the degree where you should pay up front.

What Makes a Good Chiropractor?

Choosing a chiropractor shouldn’t be difficult. However, because the market is so fractured with many different types of practices, and in America the healthcare system is so focused on profit and efficiency, patients need to be keenly aware of outdated and potentially harmful practices that are more focused on serving the doctor or benefiting the practice than providing benefit to you, the patient.

You need to look for a chiropractor who takes a patient centered approach, which uses best practices and current evidence to come up with an active treatment plan focusing on return to regular activity and eliminate or reduce pain.

A good chiropractor is therefore one who avoids gimmicky marketing tricks, reduces or eliminates unnecessary or wasteful imaging or other expensive tests, and works well with other members of your healthcare team including primary doctors, APRNs, orthopedists, neurologists, and specialists.

A good chiropractor takes a thorough health history and performs a detailed physical examination before working with you on a treatment plan that is individualized to your goals and preferences. Also, a good chiropractor will offer education, support, exercises, and lifestyle modification advice, to encourage active participation in the process of getting you well, and not rely solely on passive interventions such as heat, adjustments, ultrasound, etc.

Concussion Advice for Adolescents

New Guidelines Following Recent Studies on Earlier Return to Activity Following Concussion

Girl having bike helmet put on for safety and to avoid concussion or head trauma in case of a fall.  Dr. Erik Reich Meriden Chiropractor.
Healthy children depend on play and sport as vital parts of their day.

You may have heard the advice in the past that if a child suffers a concussion they should avoid all activity, sit in a dark quiet room, and not use any electronics. This view was popular because it was thought the brain needed total rest to recover following a traumatic injury. But these concussion guidelines for adolescents have recently been updated following the release of some important studies on the effect of return to activity after a mild traumatic brain injury or concussion.

Each concussion is unique, and the cookie-cutter approach of total rest goes against current understanding and recent studies. Following a concussion it remains true that the child should be taken out of play immediately. However, while rest may be appropriate for one or two days, many days of inactivity can lead to feelings of isolation, depression, and anxiety.

Furthermore, while electronic device and TV use following concussion may worsen symptoms, there are no good studies showing their use is detrimental. Like other potential triggers for post-traumatic headache, electronics and TV use should be monitored and limited if symptoms worsen.

As a chiropractor in Meriden, CT I have seen many cases of concussion in my office, both adults and children. Head injuries and mild traumatic brain injury like concussion can be difficult to treat in young people because they may not be as communicative about what they are feeling. Children may also be more concerned about returning to play, getting back to a favorite activity or sport, or disappointing friends or teammates. It is important for parents to ask kids how they are feeling, and pay attention to behavior that seems abnormal for your child. Children are resilient and heal quickly, with proper guidance and avoidance of aggravating factors or advice known to prolong recovery following injury.

Does My Child Need Imaging?

The older guidelines as well as the newer guidelines do not recommend routine imaging in all cases of concussion, as most cases of concussion will not show up on CT scan or MR imaging. If red flags such as uncontrolled vomiting, or potential hemorrhage or skull fracture is suspected, then the appropriate imaging is necessary. But there are harms with unnecessary imaging such as exposure to radiation which is associated with heightened risks of developing cancer. Children are believed to be more at risk for cancer because they are still developing and growing. Advanced imaging is also expensive when it has been estimated that up to 2/3 of CT scans following head injury are not necessary.

Child walking with an adult.  Walking at a comfortable pace without increase in symptoms is a good way to manage return to activity following concussion.  Dr. Erik Reich Meriden Chiropractor.
Walking can be a great way to return to activity following a head injury

So What do the New Guidelines Recommend?

Treatment should be tailored to each individual. It is no longer recommended that a person be symptom free before resuming activity. In fact, patients who rested for five days of strict rest, had symptoms that persisted longer than those study participants who resumed light activity within 48 hours following their injuries.

Light aerobic activity such as walking, as long as symptoms do not worsen, has been shown to benefit recovery times. Again, prolonged rest can lead to anxiety, social isolation, and feelings of depression, so earlier return to a child’s normal routine, even if activity duration is reduced at first, is going to benefit recovery better than complete rest. Maybe the child can return to school on a half day basis for several days or a week. It might be the case that these half days do not worsen headaches or other symptoms, and full resumption of school can be attained quickly.

Parents, teachers, coaches, health care teams, and children should be included to make a plan for faster return to activity, school, play, and sport, with careful monitoring and observation that activities do not worsen symptoms. But complete rest is to be avoided in the absence of red flags, triggering activities, or other exacerbating factors. Routine imaging following concussion should also be limited to cases where fracture, hemorrhage, or severe injury is suspected.