Diagnostic and Treatment Methods Used by Chiropractors: A Random Sample Survey of Canada’s English-speaking Provinces

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SOURCE:   J Can Chiropr Assoc. 2015 (Sep); 59 (3): 279–287

Aaron A. Puhl, MSc, DC, Christine J Reinhart, PhD, DC, and H. Stephen Injeyan, PhD, DC

Department of Pathology and Microbiology,
Canadian Memorial Chiropractic College,
Toronto, ON, M2H 3J1

OBJECTIVE:   It is important to understand how chiropractors practice beyond their formal education. The objective of this analysis was to assess the diagnostic and treatment methods used by chiropractors in English-speaking Canadian provinces.

METHODS:   A questionnaire was created that examined practice patterns amongst chiropractors. This was sent by mail to 749 chiropractors, randomly selected and stratified proportionally across the nine English-speaking Canadian provinces. Participation was voluntary and anonymous. Data were entered into an Excel spreadsheet, and descriptive statistics were calculated.

RESULTS:   The response rate was 68.0%. Almost all (95.1%) of respondents reported performing differential diagnosis procedures with their new patients; most commonly orthopaedic testing, palpation, history taking, range of motion testing and neurological examination. Palpation and painful joint findings were the most commonly used methods to determine the appropriate joint to apply manipulation. The most common treatment methods were manual joint manipulation/mobilization, stretching and exercise, posture/ergonomic advice and soft-tissue therapies.

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CONCLUSIONS:   Differential diagnosis is a standard part of the assessment of new chiropractic patients in English-speaking Canadian provinces and the most common methods used to determine the site to apply manipulation are consistent with current scientific literature. Patients are treated with a combination of manual and/or manipulative interventions directed towards the joints and/or soft-tissues, as well as exercise instruction and postural/ergonomic advice.

KEYWORDS:   chiropractic; diagnostic testing; differential diagnosis; survey; treatment methods

From the FULL TEXT Article:


Doctors of Chiropractic (DC) focus on the evaluation and management of disorders of the musculoskeletal system [1] and there is a movement towards adopting a role as primary spine care providers. [2, 3] The appropriate management of a patient requires the DC to diagnose the complaint, determine the best course of treatment and finally, provide that treatment, or refer to another healthcare provider for appropriate care. DCs are taught numerous diagnostic and therapeutic procedures during their undergraduate education and clinical internships and perhaps just as important, they are also able to obtain certifications through seminars and continuing education courses to employ a diversity of assessment and treatment techniques that may not be introduced within the context of their formal educational settings. It is imperative that we understand how Canadian DCs diagnose and treat their patients in order to guide research, guide the undergraduate, post-graduate and continuing educational chiropractic curricula, as well as to inform all stakeholders, including the public, insurance companies and government agencies about chiropractic practice.

While previous studies have investigated similar topics among Canadian DCs [4-7], those previous examinations are limited by the age of the analysis [4], limited sampling [5-7], or poor response rates [6, 7], resulting in poor reliability and generalizability. Moreover, no previous study has specifically investigated what methods Canadian DCs are using in clinical practice to decide where to apply joint manipulation, which is the most notable treatment method used by chiropractors. [8] The objectives of this descriptive analysis of DCs in English-speaking Canadian provinces were to

1)   determine if DCs are performing differential diagnosis procedures and describe the methods used for this purpose;2)   describe the tests/procedures used to determine the site of joint manipulation and the frequency of their use; and3)   describe the treatment methods used and the frequency of their use.

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