Back when my baby sister was a young teen, she came with me to a chiropractic appointment. My chiropractor told me to lie on the table while he held my head in his hands and did the cracking-neck-twist thing.

“I’ve never done this before,” he said to my sister as he held my head in mid-air. I thought it was funny, but my sister is now 50 and still too traumatized to get herself adjusted.

Chiropractic treatments do scare some folks, but even among those who regularly enjoy chiropractic treatments, there’s a wide spectrum of belief about what’s safe and what’s effective.  Fans of “Network Chiropractic,” a gentle form of chiropractic, insist it’s the only way to go. Others eschew all methods except the “activator.” (That’s the spring loaded low-force thumping tool some chiropractors use.) Yet others want their doctor to practice kinesiology, and so on. There are more than 100 varieties of chiropractic technique, each with its advocates, but does it actually matter which methods your chiropractor employs?¹ Barrett, Stephen, M.D. “Chiropractic Technique List.” Chirobase. 19 July 2018. http://www.chirobase.org/06DD/techniquelist.html And if not, what does matter when choosing a chiropractor? Let me offer four key things to look for.

1. Get Recommendations. No matter how beautiful the website or how many techniques a practitioner offers, there’s no way of knowing if the claims translate into competent practice, unless others vouch for the doctor. A chiropractor can list twelve modalities and only practice one of them, or can do all twelve in a careless, brusque manner, or can be a terrible listener, and so forth. If you don’t personally know people to get recommendations from, join Nextdoor.com and ask via that network.

2. Are X-Rays Required? Some chiropractors administer x-rays to virtually every patient seeking services. Others don’t even have x-ray equipment. Those who do insist on x-rays as a matter of course say they need to make sure there aren’t structural spinal issues or tumors that could be exacerbated during treatment. They also say x-rays allow them to be more accurate in targeting adjustments. Retired chiropractor Dr. Christopher Leyden says, “You might not want to have a dentist start drilling on your teeth without first taking an x-ray to determine the exact cause of the problem. [In the same way], low dosage x-rays can be extremely helpful.”
On the other hand, keep in mind that some chiropractors have special certifications and a strong interest in radiology, and that may push them to overuse the technology, as might fear of lawsuits should a patient get injured. Also, chiropractors make money taking x-rays, which can contribute to their enthusiasm.

Many experts insist that x-rays should be taken only in special circumstances, such as if the patient has experienced a traumatic injury or isn’t healing after weeks of treatment.² Andrews, Kelly, D.C. “Chiropractic Health-Care and X-Rays.” 12 August 2013. Spine-Health. 19 July 2018. http://www.spine-health.com/treatment/chiropractic/chiropractic-health-care-and-x-rays Seniors and others at risk of osteoporosis may also be in that x-ray target group. Otherwise, a skilled chiropractor should be able to get a good enough sense of the injury by doing a manual examination, sans radiology. Chiropractor Dr. Samuel Hormola sums up this viewpoint on the Chirobase website: “Except in special cases, when there are “red flags” (serious warning signs) indicating possible fracture, bone disease, disc herniation, or some other serious problem, x-ray examination is rarely necessary during the first month of back or neck pain.”

If your chiropractor insists on x-rays, at least make sure that they use digital x-ray equipment only. Digital x-rays supposedly expose you to 80 percent less radiation than traditional x-rays, plus, they’re more accurate.³ “The Digital Difference: Digital X-Rays Vs. Traditional X-Rays.” 14 June 2017. Maryville Imaging. 20 July 2018. http://www.maryvilleimaging.com/blog/50-the-digital-difference-digital-x-rays-vs-traditional-x-rays Also, ask to limit x-rays to the area of injury rather than having a whole-spine set of images taken.

3. What Adjusting Methods Does the Chiropractor Use? As mentioned above, there are many approaches to chiropractic care and many different techniques available. Dr. Leyden says, “Having multiple methods of treating patients is always an advantage. Every individual is different and the health conditions they present can vary greatly, so having different ways to help them is imperative.”

As for which method to pursue, just know that some methods are “harder” than others, meaning the chiropractor applies more force.  For instance, the most widely used technique, “diversified,” employed by 96 percent of practicing chiropractors, relies on fast thrusts delivered manually to the patient’s spine. This method often results in a popping sound as vertebrae move.⁴ Stark, Andrew. “5 Popular Chiropractic Techniques for Neck & Back Pain.” GuideDoc. 23 July 2018. http://guidedoc.com/popular-chiropractic-techniques-neck-back-pain Another noisy technique is the toggle-drop, in which the patient lies on a table that suddenly “drops” in one place to move joints into alignment. In contrast, the “activator” method relies on a small spring-loaded instrument via which the chiropractor delivers gentle taps to the spine. Network chiropractic also employs gentle adjustments delivered in a specified order to encourage the spine to heal itself.⁵ http://www.wisegeek.com/what-is-network-chiropractic.htm

Most chiropractors draw on five or so different techniques, depending on patient needs. Just keep in mind that a “diversified” adjustment from a great chiropractor will feel totally different from a “diversified adjustment” from a mediocre practitioner and will most likely yield different results. Also, keep in mind that some chiropractors will warm you up by massaging muscles, putting you on a roller table or giving you electro-stim before delivering an adjustment, and that can help.

4. What Adjunctive Therapies are Offered? It’s important to know whether the chiropractor offers adjunctive services such as massage therapy, nutritional counseling, spinal decompression, ultrasound therapy, acupuncture, and so on. Some chiropractors offer manual adjustments and that’s it, which can be enough to get you better under normal circumstances. Other practices incorporate many rehabilitation modalities that can speed up or deepen healing. It can be of tremendous help in healing injuries if the clinic offers services such as electro-stimulation (also called Interferential Pain Therapy) to reduce swelling and release trigger points that may have muscles locked up, as well as laser therapy and ultrasound. If you have low back pain and disc issues, a practice with a flexion-distraction table can help free up space between discs and relieve pinched nerves. Likewise, massage therapy can help enormously with soft-tissue injuries which is why some practices employ a massage therapist.  You may also get relief from acupuncture, and some chiropractors are cross-trained or have an on-staff acupuncturist.

Finally, if you seek wellness beyond pain relief, some chiropractors have special certifications in specialties such as neurology. Dr. Leyden says, “While chiropractic is most often utilized for eliminating back pain, neck pain, sciatica, and headaches, its greatest benefit is how it affects the nervous system. This has far-reaching effects in that the brain and nervous system control every other organ and system in the body, impacting the immune system and all organ functions as well as musculoskeletal function.” According to Leyden, having regular adjustments with a skilled chiropractor knowledgeable in neurology can improve autism, ADHD, allergies, asthma, cardiac problems, digestive disorders, and much more.

There are many other factors to consider, including how much time the chiropractor spends with patients, whether your insurance will be accepted, whether the practice tries to upsell you products you don’t want or need, and so forth. But the most important factors are do you like and feel comfortable with the doctor, and are you getting better as you get treatments? If not, try someone else and see if it makes a difference.