What’s standard of care for a chiropractic appointment?

[Agast]

I’m curious what happens during the visits, how long they are, etc. I figure there’s a reason they’re so popular. But someone told me they get adjusted for about 15 minutes and the rest sounds like a heat lamp + TENS unit.

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[bedrock]

I’m curious what happens during the visits, how long they are, etc. I figure there’s a reason they’re so popular. But someone told me they get adjusted for about 15 minutes and the rest sounds like a heat lamp + TENS unit.

I"m also curious. I'm particularly curious how much time the chiro actually spends there as from what I hear, other than the first visit, the chiro usually spends no more than 5 min with them in the future and the staff handles the rest. I saw chiros making more money than physicians in SoCal, which is one reason I decided that SoCal wasn't for me.

I'm still not certain how much patients generally pay per chiro visit, and how much is picked up by the average insurance company?

 

[deleted131481]

I spent a couple days with a chiropractor in clinic part of the 'alternative medicine' center for the hospital. If you imagine there's a wide variety in practice patterns for pain physicians, it's even larger for chiropractors. Kind of fuzzy on the details, but he described 3 philosophies of practicing chiros:

1) Those who believe in local spinal manipulation to relieve pain and nerve/muscle pathology - placed himself in this category
2) Those who believe spinal manipulation can alleviate other ailments (e.g. thoracic manipualtion for asthma)
3) Those who believe body primary issues are at the C1-C2 level and adjustment is routinely necessary here for pain, illness, etc.

He was very open to my questions and saw himself as an adjunct rather than competition - felt like he was trying to distinguish himself as more legitimate compared to other practices. I looked at a few of their schedules - news were 30-60 min. Notes very short. He spent a lot of time talking about posture and ergonomics. Adjustments were 15 mins. There is some usual history taking, he did look at some images. Then some exam and manipulation on a fancy table. Then a sort of 'schedule' for adjustments like 2x/week for 6 weeks Certain insurances had some coverage. Cash price would have been about $120-150 per hour.

Someone brought their 4 month old baby for their head "turning to the left" more often. I was actually very nervous he would do some manipulation on the baby, but was relieved when he just did some placebo stretching and that was it.

I actually had an adjustment myself. Was told my right SI was out of alignment - popped it back in and I didn't have to pay a thing! I wasn't having SI pain though so preventive care I guess.

 

[Agast]

I looked at a few of their schedules - news were 30-60 min. Notes very short. He spent a lot of time talking about posture and ergonomics. Adjustments were 15 mins. There is some usual history taking, he did look at some images. Then some exam and manipulation on a fancy table. Then a sort of 'schedule' for adjustments like 2x/week for 6 weeks Certain insurances had some coverage. Cash price would have been about $120-150 per hour.

So is each hour a couple minutes of adjusting and 45 minutes of talking? That’s the part that does not seem worth repeating to me. I had an hour of reflexology for $75 and that was hands on hard work for the masseuse. I wonder what my patients would think if I told them to do that instead.

 

[oreosandsake]

$60 an adjustment 3 x a week until you cannot afford it anymore.

how it plays out:
First visit build rapport, take weak history, do hocus Pocus exam, maybe get BS X-rays maybe for neuropathy, talk about the misaligned spine as the root for all their ills and failings in life, t use a few non sensical tools that make noises, tens unit plus heat pack, soft music, dark room. Wake them up after 20 minutes (enough time to repeat the same thing in the next room), Come back wake patient up. Proceed now with the soft tissue work and hvla. Hvla cracks are great for dramatic effect. Patients still in daze from nap and heat pack. Maybe dazed from intermittent hypoperfusion to the brain from the cervical hvla.

Smile big, feel better right?

That’ll be $300, we recommend you come back 3x a week for $80 a session until you’re stabilized or run out of money. Please buy some homeopathic goodies and CBD oils on your way out the door. When you aren’t cured of ddd, you will need our spine decompression machine for $300 a session, You have to sign up for 15 sessions up front.
No refunds.
It accomplishes the same thing as an inversion table.

No we would never accept insurance. Don’t forget to like us on social media. We also treat newborns for spine abnormalities. Oh and dogs, cats, and pet turtles.
Btw you could really benefit from stem cells for that problem. Which? Any of them.

yes, that is my exotic car outside with the license plate that says “gpa 2.3” I need a fast car to drive between my 3 offices

 

[oreosandsake]

$60 an adjustment 3 x a week until you cannot afford it anymore.

how it plays out:
First visit build rapport, take weak history, do hocus Pocus exam, maybe get BS X-rays maybe for neuropathy, talk about the misaligned spine as the root for all their ills and failings in life, t use a few non sensical tools that make noises, tens unit plus heat pack, soft music, dark room. Wake them up after 20 minutes (enough time to repeat the same thing in the next room), Come back wake patient up. Proceed now with the soft tissue work and hvla. Hvla cracks are great for dramatic effect. Patients still in daze from nap and heat pack. Maybe dazed from intermittent hypoperfusion to the brain from the cervical hvla.

Smile big, feel better right?

That’ll be $300, we recommend you come back 3x a week for $80 a session until you’re stabilized or run out of money. Please buy some homeopathic goodies and CBD oils on your way out the door. When you aren’t cured of ddd, you will need our spine decompression machine for $300 a session, You have to sign up for 15 sessions up front.
No refunds.
It accomplishes the same thing as an inversion table.

No we would never accept insurance. Don’t forget to like us on social media. We also treat newborns for spine abnormalities. Oh and dogs, cats, and pet turtles.
Btw you could really benefit from stem cells for that problem. Which? Any of them.

yes, that is my exotic car outside with the license plate that says “gpa 2.3” I need a fast car to drive between my 3 offices

P.s. I earned my doctorate. call me doctor

 

[deleted131481]

So is each hour a couple minutes of adjusting and 45 minutes of talking? That’s the part that does not seem worth repeating to me. I had an hour of reflexology for $75 and that was hands on hard work for the masseuse. I wonder what my patients would think if I told them to do that instead.

Most of the hour for new patient was just talking. The 15 minute adjustment sessions were mostly hands on - I want to say $40 each.

Again this was an employed chiropractor attached to the hospital. I'd guess very benign compared to others (most?) as in post above.

 

[geauxg8rs]

$60 an adjustment 3 x a week until you cannot afford it anymore.

how it plays out:
First visit build rapport, take weak history, do hocus Pocus exam, maybe get BS X-rays maybe for neuropathy, talk about the misaligned spine as the root for all their ills and failings in life, t use a few non sensical tools that make noises, tens unit plus heat pack, soft music, dark room. Wake them up after 20 minutes (enough time to repeat the same thing in the next room), Come back wake patient up. Proceed now with the soft tissue work and hvla. Hvla cracks are great for dramatic effect. Patients still in daze from nap and heat pack. Maybe dazed from intermittent hypoperfusion to the brain from the cervical hvla.

Smile big, feel better right?

That’ll be $300, we recommend you come back 3x a week for $80 a session until you’re stabilized or run out of money. Please buy some homeopathic goodies and CBD oils on your way out the door. When you aren’t cured of ddd, you will need our spine decompression machine for $300 a session, You have to sign up for 15 sessions up front.
No refunds.
It accomplishes the same thing as an inversion table.

No we would never accept insurance. Don’t forget to like us on social media. We also treat newborns for spine abnormalities. Oh and dogs, cats, and pet turtles.
Btw you could really benefit from stem cells for that problem. Which? Any of them.

yes, that is my exotic car outside with the license plate that says “gpa 2.3” I need a fast car to drive between my 3 offices

And then same patient comes to pain clinic after going to chiropractor for 15 years and feels better only the day at the chiropractor.
then has six days of pain until sees chiro again.

then sees pain management and is offered PT and an MRI and is now concerned about costs.
“Why do you need an expensive mri? My spine doc did X-rays and i am have an alignment problem at C2-3 causing my sciatica.”

 

[SommeRiver]

I got roped into doing this absurd adventure race in 2004 or 2005. We had a sponsorship so I couldn't say no to it. I had no pain or anything, but for some reason I decided to go see a chiropractor to keep me "right" for the race.

I prepaid for 12 visits. Total bill was $300 out of pocket, but they ran my insurance too.

XRAY on first visit - I was told my hips were "uneven." He showed me an AP pelvis and made a line across the pelvic brim and it wasn't "even." I was just standing there during the XRAY, and probably wasn't paying attention to posture, so of course I'm not "even."

That made me very nervous - I had no MSK pain or issues, but seeing that XRAY I was totally bought in to that dude.

He adjusted me, and I remember amazingly loud adjustments bc my SIJ was "out," and my God the cervical adjustments were loud and scary.

Always felt good for the rest of the day.

I only used like 5 of those 12 visits, ran that race, and felt fine.

I went back a few years later as I began competing in Brazilian Jiu-Jitsu tournaments, and I finished out the remaining visits just because...

Get this - I was going to fight in a kickboxing match in North Carolina (I think), and after I decided to do it I went in and his partner came in and did a "light as a feather, stiff as a board" trick.

He tested my quad strength, and really gave me 100% trying to overcome me. He then rubbed circles on my fibular head like 3x with his ring finger and then retested me and I could have held a piano on my leg.

It was totally BS and I never went back...Never had that kickboxing fight either, because the promotion got shut down...Hahaha.

 

[Ducttape]

last time I went to a chiropractor was over 10 years ago.

standard waiting room.

come back, be seen by an "assistant". get vitals, brief history, ie prior back problems, surgeons, which chiro did you see...
had to stand up against some sort of wall mounted "alignment machine", which printed out some paper with lots of red on it. assistant mutters, walks out of room with paper...

im sitting in chair and "doctor" comes in, greets himself, asks some questions, brandishes this paper saying that I am subluxed - I believe at least 3/4 of my segments. told that I would need a "few" manipulations to get back in to alignment and to stay there. told to lie on table, heat and TENS applied to back. he left. returned in about 15 minutes. probably more than enough time for him to greet his next 2 victims. gentle massage of the back, pushes on back firmly and quickly to crack it, then lifts up one leg at a time, and pulls it up while pressing on small of back (im guessing for SI?), cracks back again, a little more massage, then done.

 

[SommeRiver]

I can't recommend enough that any of you doing work comp please read those chiro notes on your pts.

They're amazing.

 

[jonnylingo]

I can't recommend enough that any of you doing work comp please read those chiro notes on your pts.

They're amazing.

This is an interesting read:

 

[SommeRiver]

This is an interesting read:

I'm already weak and pitiful today bc of Moderna # 2 and you had to make it worse...OMG.

 

[Agast]

Well, I just met someone whose children are chiropractors and she is religiously signing up for decompression over here on their advice, so I guess at least they believe in what they're selling.

 

[Baron Samedi]

25-50% of my day is spent writing HPIs and ordering XR for chiropractors.

Oh the wonders of military medicine.

 

[drusso]

25-50% of my day is spent writing HPIs and ordering XR for chiropractors.

Oh the wonders of military medicine.

WTF?

 

[Baron Samedi]

WTF?

So the military has decided that chiro must be good because so many service members were paying out of pocket for it. As a result, many military hospitals now have chiros on staff. Most of the time, this is fine because if people want to go their PCM will just refer them. My hospital decided that all these patients have to see Pain Management first in order to get a chiro referral. I am the only Pain Management doctor, so they all funnel through me.

 

[MD87]

So the military has decided that chiro must be good because so many service members were paying out of pocket for it. As a result, many military hospitals now have chiros on staff. Most of the time, this is fine because if people want to go their PCM will just refer them. My hospital decided that all these patients have to see Pain Management first in order to get a chiro referral. I am the only Pain Management doctor, so they all funnel through me.

Do the chiros call you to tell you that you missed 7 subluxations when reviewing the x-rays?

 

[SommeRiver]

Why are they allowed to misuse established medical terminology?

 

[MD87]

Why are they allowed to misuse established medical terminology?

I would love to know this as well. Charging people money to irradiate them and then giving them objectively false diagnoses should be illegal. And yet, it’s commonplace where I work.

 

[Ligament]

Chiropractic is great for a lot of spine related issues. If I have a patient doing well under chiropractic care a few times per month vs. time/cost of a few hours of PT or side effects known or unknown of the various pain meds we use vs. risk of sticking my needle in them I'm all for it. Chiro visit takes 15 mins and is cheap and almost zero risk. Gets them back to work.

Yeah of course nobody supports the 3x/week model for life. Or chiros as PCPs. Or radiologists.

Believe it or not, there are many people that do great 0-2x/month.

 

[Baron Samedi]

Chiropractic is great for a lot of spine related issues. If I have a patient doing well under chiropractic care a few times per month vs. time/cost of a few hours of PT or side effects known or unknown of the various pain meds we use vs. risk of sticking my needle in them I'm all for it. Chiro visit takes 15 mins and is cheap and almost zero risk. Gets them back to work.

Yeah of course nobody supports the 3x/week model for life. Or chiros as PCPs. Or radiologists.

Believe it or not, there are many people that do great 0-2x/month.

I actually agree. Most of these patients I am seeing have low level chronic axial low back pain and don't need meds or procedures. I have no problem with these folks trying less invasive things even if I don't fully understand it. I wish my own practice didn't involve it quite so much but good for them if these patients find something low risk that works for them.

 

[perromaxfilm]

As a DO I have agree that select spine patients may benefit from manipulation - whether from DO or chiropractor. But I am always stunned at the high degree of pseudoscience in both. It is modern phrenology - this bump on your head means you're creative but grumpy. In the spine it's extended from personality to other health conditions - thoracic pain may be associated with your liver. How do private citizens and public institutions continually support the quackery aspects? How do we as physicians emphasize the distinction while acknowledging the benefits of manipulation?