Chiropractic Rehabilitation
The Chiropractic Rehabilitation domain tests whether you can build, dose, and progress active care for neuromusculoskeletal conditions. Expect questions on tissue healing, exercise prescription, motor control, functional assessment, and outcome measures - and on when manual therapy or modalities are adjuncts rather than the plan.
Core rules and concepts
- Tissue healing phases: inflammation (0–7 days), proliferation (1–6 weeks), remodeling (up to 12 months). Load tissue within tolerance; avoid aggressive stretching during early inflammation.
- SAID principle: Specific Adaptation to Imposed Demands. Exercise must mimic the target function, and overload must progress via load, volume, or complexity.
- FITT-VP for exercise prescription: Frequency, Intensity, Time, Type, Volume, Progression. For strength, a common starting dose is 2–3 days/week, 2–4 sets, 6–12 reps at 60–80% 1RM; for endurance, 3–5 days/week, 20–60 minutes.
- Motor control: train local stabilizers (transversus abdominis, multifidus, pelvic floor) with breathing and low-load activation, then integrate into global movements.
- Periodization: linear (steadily increasing load) versus undulating (frequent variation); include deload weeks.
- Outcome measures: Oswestry Disability Index (MCID about 10 points), Neck Disability Index (about 5–7), NPRS (about 2), Patient-Specific Functional Scale (about 2), and Global Rating of Change. Reassess at 2–4 weeks.
- Manual therapy and modalities are time-limited adjuncts; the active plan must drive functional change.
Worked example
A 38-year-old with chronic nonspecific low back pain has an ODI of 42%, a PSFS of 3/10, and high fear-avoidance. Phase 1 (weeks 1–2): pain education, graded exposure, breathing, dead bug, bird dog, and 10 minutes of daily walking. Phase 2 (weeks 3–6): add hip hinge, goblet squat, and cable row; 2–3 sets of 8–12 reps, 2 days/week, progressing load when technique is stable. Reassess the ODI at 4 weeks; a drop of at least 10 points is clinically meaningful. If unchanged, review adherence, fear-avoidance, and dosage before adding passive care.
Traps that cost marks
- Prescribing exercise without a baseline outcome measure or functional goal.
- Progressing load by pain alone while ignoring the healing phase and irritability.
- Using passive modalities as the main intervention.
- Missing psychosocial flags such as fear-avoidance or catastrophizing that alter prognosis.
- Failing to document exercise dosage: sets, reps, load, frequency, and tempo.