This is done on every new patient in order to arrive at a treatable diagnosis. This consists of orthopedic maneuvers that target the pain sensitive tissue that may be creating your discomfort. This allows the chiropractic orthopedist to rule in or out his working diagnosis, and narrow down results. A series of neurological tests like muscle testing, reflexes, and sensory are done to find things that are not easily recognized by the patient that aid in proper diagnosis of the condition.

Possibly one of the most valuable portions of the visit as it pertains to the patient. In this portion, directly after the examination, your chiropractic orthopedist will go over all of their positive and negative findings and explain how they reached todays diagnosis, as well as what can be reliably excluded at this point. They will also address any additional concerns you may have. They will go over all of the pertinent anatomy and what it means for your condition. They will also go over treatment plan and reasonable expectations of recovery, and discuss any other forms of treatment.

In this part of the new patient work-up, it is important that the chiropractor or chiropractic orthopedist use everything in their office to aid in correct diagnosis so that the most effective treatment can be rendered. These include plain film x-rays and laboratory work and analysis. Some reasons these may be performed include:

• Past medical history of motor vehicle accidents.
• History of previous orthopedic surgeries like fusion and microdiscectomies.
• Labs for suspected arthritis or general health screen. Labs including urinalysis may help determine the cause of your pain especially if it is coming from other sources outside of the musculoskeletal system.

The chiropractor may or may not perform these on your first visit.

In this portion of your first visit, the chiropractic orthopedist will have staff provide the prescribed treatment. This is typically through the use of physical therapy modalities commonly used in the field of physical therapy, and is in the scope of practice of a chiropractic orthopedist. These modalities include:

• Interferential- pleasant electrical stimulation of the area of complaint to increase endorphin and enkephalin release. These are your body’s own pain killers and offers pain relief during, and after your visit.
• Pulsed ultrasound- can be used on the areas of complaint to stimulate the healing response of different connective tissues.
• Continuous ultrasound in combination with high-volt galvanic stimulation- this feels much like the interferential therapy and is used on extremity injuries and occasionally spinal regions. This uses continuous ultrasound to deliver the deepest heat available in a therapeutic modality. It also uses high-volt galvanic stimulation that changes tissue charges, this allows for nutrition wicking into the injured area.
• Bone healing- this is much like interferential but uses different settings to help with fracture healing. It is especially useful for fractures that are having trouble healing.
• Sprain healing- much like interferential but uses different settings to help heal sprains of any ligaments injured.
• Edema reduction- once again is much like interferential with different settings. Very helpful in reducing edema or swelling caused by injury.
• Rehabilitation- this is used to strengthen the supporting musculature of any joint that needs additional support. Most commonly used for the lower back and neck regions, but is also prescribed for areas like the shoulder and knee.
• Instrument assisted soft tissue mobilization- this uses a special metal tool that applied with force generates a healing response to any tendon or muscle. It will also help with swelling.

After therapy administration, your chiropractic orthopedist will begin the physical treatment of your area of complaint. This consists of trigger point therapy, traction, flexion and distraction (decompression), stretching, and manipulation if appropriate. They will go over any of the orthopedic devices they want you to use during your recovery, and why they are important. They will also briefly go over at home management during recovery.

Once all treatment is finished you will be sent home with information on your condition and home recommendations. Frequency is very important in the first three weeks.