Scope of Practice and Permitted Modalities
What the license covers
New Hampshire defines chiropractic around the detection and correction of subluxations and the conservative management of neuromusculoskeletal conditions. The core modality is manual adjustment or manipulation of the spine and extremities. Within the chiropractic encounter, licensees also perform history and physical examination, use radiographs for chiropractic diagnosis, provide adjunctive physiotherapy modalities such as heat, cold, electrical stimulation, ultrasound, traction, and therapeutic exercise, and give ergonomic, nutritional, and rehabilitative advice. The license does not authorize surgery, obstetrics, prescription of legend drugs, or invasive procedures.
Modalities and boundaries
- Manual therapy: adjustment, mobilization, manipulation, and soft-tissue work.
- Adjunctive care: supervised physiotherapy modalities and exercise within training and rule limits.
- Imaging: radiographs ordered and interpreted for chiropractic purposes; do not hold yourself out as a radiologist.
- Referral: red flags, progressive neurologic deficit, fracture, infection, or tumor suspicion require medical referral, not repeated manipulation.
- Documentation: record the indication, modality, parameters, and patient response.
Worked example
A patient presents with acute low back pain and no red flags. The chiropractor takes a history, performs an examination, obtains a lumbar radiograph because of trauma history, adjusts the lumbar spine, applies electrical stimulation, and prescribes home exercises. Each step is within scope: examination and radiograph support diagnosis; adjustment is the core chiropractic act; electrical stimulation is an adjunctive modality; exercise advice is conservative care. If the chiropractor instead prescribed an opioid, the act would be outside scope regardless of the patient's pain.
Traps
Equating "musculoskeletal" with unlimited practice; using a modality without documented training; failing to refer when red flags appear; and billing an imaging interpretation as if the chiropractor were a radiologist.