I am regularly asked by my patients to recommend a “good” chiropractor. This usually happens because a patient is moving away from Evansville to a new town, is on vacation and got injured or because they are trying to help a friend or relative who does not live in Evansville pick a chiropractor who practices similarly to me. Below I provide some guidelines to help you choose a “good” chiropractor.
1. Ask about their “wellness” or “maintenance” treatment philosophy?
This is a common reason many medical doctors don’t refer to some chiropractors. If you feel great, are performing optimally mechanically and are in good health, and a chiropractor still wants to see you regularly, get a second opinion before continuing care. However, if you have some chronic conditions like degenerative joint disease or are an athlete, routine care (e.g., monthly or quarterly treatments) may be quite helpful. If the prospective chiropractor recommends maintenance care for EVERY patient then I would not recommend them.
2. Beware of some chiropractor’s marketing gimmicks.
There are a variety of “methods” designed by marketing experts to procure you as a patient. The most common one is a postural analysis. If you have poor posture but no pain or dysfunction, a “good” chiropractor should not want to manipulate or “adjust” you, but instead should design an at-home exercise routine for you, or refer you to a physical therapist, exercise physiologist or certified athletic trainer for such a program. Ask them what sort of personnel they have in their office, what sort of exercise rehabilitation facilities they have or to whom they refer their patients that require exercise rehabilitation.
A relatively new phenomenon in chiropractic (and other health professions I understand) is the concept of a “membership” plan providing you an “unlimited” number of visits for a set monthly or annual fee. This in particular should be a red flag. The chiropractic adjustment (i.e., spinal manipulation) is not without risk (even though the risks are small) and to indiscriminately offer unlimited treatments for a discounted fee is borderline unprofessional. Trust me on this one, you do not want to be a member of that chiropractor’s club.
This “membership fee” structure is not to be confused with a “case management fee” that some practitioners charge in lieu of a separate fee for each unique service rendered. A case management fee is a set price for care related to a specific condition or diagnosis. This is not how I operate, but I see no problem with it as this is exactly how orthodontists, plastic surgeons and many other providers operate.
5. Excessive or Aggressive Nutritional Supplementation.
Chiropractors receive many, MANY hours of nutrition training as well as instruction in the use of natural compounds for treatment of various conditions. In most places, chiropractors are licensed to use this training to help those so inclined with their health problems. However, beware of any chiropractor who says his supplements are the only ones that work. While the professional lines of supplements most chiropractors carry are as good as it gets, beware of any chiropractor that refuses to give you specific recommendations so you can go to a retailer or health-food store to purchase your products if you choose. In my office, we even offer to photocopy the labels of the products we recommend so they might shop for comparable products elsewhere.
6. Excessive or Unnecessary X-Rays.
“Good” chiropractors use x-rays only to rule out a fracture, dislocation, or bone disease. A “good” chiropractor will have a X-Ray facility on-site or will refer his patients to a convenient radiology department for examination. There are several acceptable reasons, in my opinion, to order X-rays:
- if you have sustained a recent traumatic injury and are in considerable pain;
- if your history and examination indicate a possible bone disease such as arthritis;
- if you have a scoliosis and we need to measure the severity or progression;
- or if you have long-standing pain in an area that has not responded or resolved with care.
If none of these criteria are applicable or if your chiropractor wants to continue treatment solely because of what an x-ray shows, get a second opinion before you continue care.
7. Beware of a high number of visits.
There is an old joke that goes like this:
Q: How many chiropractors does it take to change a lightbulb?
A: One, but it takes 50 visits.
Corny, I know. But in every joke or cliché there is a kernel of truth. Depending on the nature of your problem, after a few visits you should notice some improvement. After six to twelve visits, your pain should be reduced by 40-50 percent, depending on how severe your condition and how long you’ve had your original problem. Beware of any chiropractor who recommends a long-term treatment plan for every patient.
8. No man is an island.
Find out who the chiropractor refers his patients to if they should require surgery or pharmacological pain management. Which neurologists does she consult with for her patients with non-surgical neurological disease? Ask the chiropractor how often he communicates with his patients’ primary care providers. Ask the chiropractor what she will do if you are not getting the results you desire. You should not have to ask for a referral; your chiropractor should have a game plan ready to recommend to you.
Even the best chiropractors (and surgeons, and internists, etc) have patients that do not respond to their care. Every “good” healthcare provider knows this and has a group of top-flite people they work with should their patient need additional care or a fresh perspective.
Also, find out the professional organizations in which the chiropractor participates. Membership and involvement in these organizations is certainly not a guarantee of quality, but it is a good indication that the chiropractic physician in question seeks out ongoing educational and professional development opportunities.
9. Don’t Fix it if it Ain’t Broke
This recommendation is for existing chiropractic patients who are forced into looking for a new chiropractor. If you were getting good results with the care you are receiving from your existing chiropractor, you should seek out chiropractic physicians that can treat you similarly. This will require you to ask your existing chiropractor what techniques he/she was using that helped you so much and then asking the prospective chiropractor if they utilize those techniques.
Even though the new chiropractor may prefer to use different techniques, the fact that they are skilled in techniques that have proven to benefit you is a huge plus. If the new chiropractor balks at this and tells you their approach is better, find somebody else — his/her ego is more important to them than your care.
This also goes the other direction. If you are seeking out a different chiropractor because your old one was ineffective, it is a huge benefit to a “Good” chiropractor to know which techniques have not been helpful for you. A “Good” Chiropractor will have many skills and tools in their “bag” and can more often than not try a fresh approach, avoiding the technique that proved ineffective.
10. Chicken or Egg, which came first?
Soft-tissue (muscles/fasica, tendon, ligament) trauma can, and more often than not does, lead to joint dysfunction and vice-versa. Soft-tissue management is vital to the care my team and I deliver here at the Hamilton Clinic. Joint manipulations (Adjustments) are very effective at treating joint dysfunction, but the benefits for soft-tissue are sometimes short lived. This is why some chiropractor’s patients report to us that they felt great immediately after their adjustments but then hours later they feel like they did before they saw the doctor. If a chiropractor does not respect the role soft tissue dysfunction plays in your overall health then they are to be avoided.
A good way to evaluate their commitment to treating these myofascial issues is by looking at their staff. If they have licensed massage therapists or physical therapists as part of their clinic’s staff, odds are they understand and appreciate this vital component. The best solution is to have both professions represented in their facility and work with them as engaged members of your care team. This is how we operate at Evansville’s Hamilton Clinic.
The Best Way to Find a “Good” Chiropractor…
…is to ask people you trust and admire and respect who their chiropractor is. Also, ask your primary care provider where they refer their patients. Odds are, even in a big city, you will see patterns emerging. The cream always rises to the top!