How Chiropractors Diagnose Neck Pain: Patient History

Chiropractic and Neck Pain: Conservative Care of Cervical Disorders

Arn Strasser, DC
Chiropractor
Strasser Chiropractic Center
Portland, Oregon

History taking is the first step in diagnosing the cervical spine. Because chiropractors so often treat conditions that are “functional” in nature — that is conditions in which there are not a frank medical disease, and in which signs and symptoms are often important clues to diagnosis — chiropractors emphasize in-depth history taking.

Initially the chiropractor will want to know if there has been an accident or injury. A patient who has sustained a neck fracture will present with an abnormally stiff and painful neck. The chiropractor will want to know if there has been trauma to the neck from a fall or other traumatic incident. If there is suspicion of a neck fracture from such an incident, or secondary to an organic disease, the chiropractor will call for a spinal x-ray or imaging study prior to any further examination of the neck.

Chiropractic patient history taking is the same as in a typical medical office with some important differences. The “what, when, and how” of an injury, and the location and nature of the neck pain is supplemented with information on possible episodes of middle and lower back pain, as well as muscle and extremity joint pain. Even when neck pain is the primary presenting complaint, chiropractic always considers the whole spine, of which the neck is one part of an integrated biomechanical system.

 To better understand the chiropractic approach to treating the cervical spine, let’s look at four different patients who have consulted a chiropractor for neck pain. These examples will touch on four conditions treated in chiropractic practice:

(1) Postural and repetitive strain

(2) Traumatic injury

(3)“Slipped”, herniated and ruptured disc

(4) Neck pain associated with normal aging and osteoarthritis

Each Patient is Unique
Even though we are identifying four common conditions, an important principle of chiropractic is always to treat the patient as an individual with a unique clinical picture. “Treat the patient and not the problem” is one way to state this principle. At the same time, as diagnostic tools are used to match a patient’s symptoms and findings with a diagnosis, the chiropractor attempts to see what distinctive combination of factors might be contributing to the patient’s symptoms. Some of these factors are diverse and include mechanical findings, hereditary considerations, and lifestyle.

What will be evident as we discuss the chiropractic approach is that the image of the chiropractor “twisting” the neck is a caricature of what actually occurs in chiropractic practice. Chiropractors have a wide range of therapeutic tools that include gentle manipulation and adjusting, and non-force and soft tissue techniques. These manual approaches are augmented by exercise programs, nutrition and lifestyle suggestions, and a partnership concept of doctor/patient care to provide a unique chiropractic approach to health.