Chiropractic Technique and Case Management
This domain tests technique selection and case management as one decision: what to do, to whom, when, and how to know whether it is working. Questions often combine diagnosis, contraindications, informed consent, treatment frequency, home care, and referral.
Core rules
- Match the technique to the diagnosis, tissue irritability, patient size, age, bone quality, and preference. High-velocity low-amplitude manipulation is not the only option; mobilization, flexion-distraction, instrument-assisted methods, soft-tissue work, and exercise can be appropriate.
- Screen for absolute and relative contraindications before manual therapy: fracture, dislocation, unstable ligamentous injury, spinal infection or tumor, cauda equina syndrome, severe osteoporosis, and unstable spondylolisthesis. Anticoagulation and inflammatory arthritis may require modified force or technique.
- Obtain informed consent that names the technique, expected benefits, material risks, alternatives, and the right to refuse.
- Write measurable goals and a planned trial of care. Re-evaluate symptoms, function, and neurological status at defined intervals; continue only if objective improvement supports it.
- Use active care early: reassurance, activity modification, rehabilitation exercises, and ergonomic advice. Refer or co-manage when progress stalls or red flags appear.
Worked example
A 38-year-old with acute low back and L5 radicular pain has no red flags. The examination shows limited flexion and a positive straight-leg raise, with stable motor and sensory findings. A reasonable plan is a two-week trial of low-force manual therapy, soft-tissue treatment, and directed stabilization exercise, while avoiding loaded end-range flexion that provokes symptoms. Reassess at two weeks with repeat neurological examination. If pain and function are improving, continue and progress; if deficits worsen or fail to improve, obtain imaging or refer.
Traps
Adjusting before establishing a diagnosis. Ignoring a relative contraindication because the patient feels better after a trial. Continuing indefinite visits without documented re-evaluation. Failing to document informed consent, technique used, and response. Promising a cure or using the same technique for every presentation.