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Health professionals may know better in theory, but often underestimate how easily patients are alarmed by hard evidence of spinal degeneration. To the average person, if something like that shows up on a scan, it’s like proof: it has got to hurt. But the evidence clearly contradicts that! Pain has many possible minor causes; degeneration is often painless and rarely serious even when it is causing trouble. BACK TO TEXT

Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[171][172] Depending on the location, continuing education may be required to renew these licenses.[173][174] Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics.[175]
The World Health Organization found chiropractic care in general is safe when employed skillfully and appropriately.[46] There is not sufficient data to establish the safety of chiropractic manipulations.[13] Manipulation is regarded as relatively safe but complications can arise, and it has known adverse effects, risks and contraindications.[46] Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints.[46] Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.[46] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[138] Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a chiropractor.[4]
Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.[46] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[54] Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle advice.[3]

Studies have not confirmed the effectiveness of prolotherapy or sclerotherapy for pain relief, used by some chiropractors, osteopaths, and medical doctors, to treat chronic back pain, the type of pain that may come on suddenly or gradually and lasts more than three months. The therapy involves injections such as sugar water or anesthetic in hopes of strengthening the ligaments in the back.
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