Chiropractors utilize three main treatment methods: joint manipulative therapy, physical therapeutic modalities, and rehabilitative exercise. Any or all may be used in a specific case. The primary form of treatment is joint manipulation, a gentle, painless procedure designed to improve joint ranges of motion. The gentle manipulative thrust increases the joint's mobility slightly, as a result of which greater movement, closer toward normal, is now available.

How does increased joint mobility make you feel better? Using joint manipulation to achieve more normal motion reduces irritation due to mechanical stresses on muscles, tendons and ligaments. Loads are balanced and weights are distributed efficiently and effectively. One tangible result is soft-tissue healing and decreased frequency and intensity of pain. Simply, your injuries heal and you begin to feel better. Manipulation is a powerful method for treatment of biomechanical and musculoskeletal problems.

And, there's more to chiropractic care than joint manipulation. In order to fully restore a person's health and well-being other key elements are necessary, including rest, diet, exercise, and mental attitude. Exercise is a critical part of chiropractic treatment. If you're only receiving manipulative therapy and not exercising, you'll improve up to the limit of your current conditioning and no further. On the other hand, if you experience various biomechanical breakdowns and are only exercising, you'll only improve to a certain limit. Breakdowns will continue to occur until more normal joint mobility is restored by manipulation. The combination of joint manipulative therapy and specific exercise provides for a relatively rapid return to full function. All of my patients receive exercise recommendations, in the context of what is needed for recovery and what that person is actually willing to get up and do.

Joint manipulation describes a variety of procedures. Manipulation can refer to range-of-motion techniques, known as "mobilization", and also to rapid, rotational movements utilized in the neck and lower back to bring a joint to the limit of its motion and then slightly beyond that limit. All of these methods are gentle and painless. Most chiropractors utilize a variety of mobilization techniques. I've developed a number of new methods and use them preferentially for many patients when manipulation would not be appropriate. Of course, the skilled physician has many strings to his bow, and will use the most effective method to improve the status of his patient.

The goals of treatment are:

1. to reduce and/or resolve pain
2. return to function
3. restore previous levels of fitness by reestablishing an exercise program
4. learn techniques and procedures (lifestyle modification, physical activities) that keep a person healthy

Some cases can be resolved in several visits, others may require up to ten visits or so. The large majority of patients should expect their treatment plan to reflect that. The minority of cases, those that are either more acutely severe or more lingering and chronic, require more extended treatment plans. The goal should always be to complete active treatment, having trained the person in both the stretching procedures and rehabilitative exercises that will keep them well.

Be proactive when choosing a chiropractic physician, as you would when selecting a surgeon, electrician, or investment advisor. Ask questions. How long does it take to get the average new patient well? Ten to twelve visits is a good median, representing both the one-to-three-visit cases and the more chronic, twenty-visit cases. Is the chiropractor expert in the treatment and prevention of sports-related injuries? Has he or she taken postgraduate education in this area? Does he or she consistently utilize rehabilitative exercise in the management of patients? Does the chiropractor develop a differential diagnosis for each case? These few questions will provide a quick, useful profile of that particular chiropractor's expertise.

Your chiropractic treatment experience should be positive and beneficial. Occasionally, it may take a little while to notice results, but usually small, observable improvement occurs shortly after treatment has begun. Rehabilitative stretches and exercises are started as soon as is appropriate, and your pain begins to resolve and your function begins to improve.

Dr. David Lemberg, the author of Commitment to Fitness: Real Fitness for Real People, is a board-certified chiropractic orthopedist in his twentieth year of private practice on Manhattan's Upper East Side. He has been published in national trade magazines such as Muscle & Fitness and Dancemagazine, the peer-reviewed Topics in Clinical Chiropractic, the Florida Chiropractic Society Review, and The Chiropractic Journal. Dr. Lemberg is a member of the postgraduate faculty of Los Angeles College of Chiropractic, and for the last ten years has taught orthopedics to chiropractors in venues across the United States and in Canada. He was Clinical Editor of the quarterly journal, Spinal Manipulation, published by the Foundation for Chiropractic Education and Research, from 1990 through 1995.

Commitment to Fitness: Real Fitness for Real People may be ordered through Dr. Lemberg's web site. His office is accepting new patients: 212-535-7429.