Exercise plays an important role in the management of musculoskeletal disorders within evidence-based practice; and exercise in chiropractic is no exception to this model. Chiropractors in Australia undergo a rigorous 5-year university under- and post-graduate program to become accredited under the Australian Health Practitioner Regulation Agency (AHPRA). Within this 5-year program, chiropractic students must complete a series of units focusing on diagnosis and management, physical and functional assessment and clinical management. They develop the skills and concepts to manage patients with musculoskeletal disorders. One aspect of this management is rehabilitation, or exercise, which forms an important part of the overall treatment process and facilitation of active care.
Is exercise taught in the chiropractic curriculum at universities?
The chiropractic program within universities in Australia offer several units focused in developing students’ clinical reasoning skills by exposing them to a range of clinical scenarios, which may be encountered in chiropractic practice. Students will gain theoretical knowledge and practical skills for history taking, physical examination, functional analysis and clinical decision-making. Clinical reasoning is facilitated through integration and interpretation of the diagnostic findings. Additionally, the students are exposed to paradigms related to active care, the biopsychosocial model, and the use of outcome measures. One important clinical aspect within these paradigms is patient management through active care and rehabilitation, or exercise, of the spine and extremities.
The complexity of exercise, its concepts and application within the university program increases each year, building on previous study, so by the time students have graduated, they have developed the necessary skills and knowledge to manage an array of musculoskeletal conditions. Students must satisfactorily complete all components relating to rehabilitation to pass these units. Clinical reasoning and decision-making provides new-graduates a core framework of evidence-based practice, so that they can further their skills and knowledge through continued professional development.
What kind of exercises do chiropractors prescribe?
Chiropractors conservatively manage musculoskeletal disorders in an evidence-based paradigm; therefore, the type of exercises you would expect from your chiropractor, are generally the same you would expect from your physiotherapist or osteopath. Of course, every clinician practices differently: some have a focus on rehab and active care, while others practice with a more passive approach; and some clinicians use several tools and methods in their management, while others focus on one particular method. This variability in clinical practice means it is impossible to give definite answers regarding the type of exercises prescribed by chiropractors, and indeed primary healthcare professionals in general. Furthermore, other variabilities, such as the chronicity of pain and disability in patients, the compliance and capability of patients to perform the exercises, and the type of exercise that is clinically relevant and most effective to the present condition, all play an important role in determining the kind of exercise a chiropractor will prescribe.
Some examples of the type of exercise prescribed by chiropractors include: aerobic, endurance, strengthening and conditioning (with the use of various clinical apparatuses and tools, e.g., resistance bands, Swiss balls, free weights, rowing machines etc.), balance and proprioception, neurodynamics, stretching and mobility training, and injury prevention. However, how chiropractors go about prescribing these exercises may vary. Generally speaking, there is no standardised framework for prescribing exercises or performing them. This is mainly due to the extensive variability seen in clinical practice and musculoskeletal disorders, as mentioned previously. Pertinent aspects to look out for when seeking advice from a chiropractor include:
- Clear communication of your diagnosis, prognosis and possible treatment options, which may not just be the ones the chiropractor can offer;
- Honesty and open on advice about your injury; and,
- Giving you the tools and strategies to be more active in your management and avoid re-injury.
Take home message
Chiropractors are highly trained in rehabilitation and can offer an array of exercises to conservatively manage musculoskeletal disorders. However, no clinician is the same and generally there are no standardised frameworks for prescribing and performing exercises. If you are seeking a specific exercise regime or rehabilitation plan for your musculoskeletal complaint from a chiropractor, it is then best to seek the advice of a chiropractor who has a keen interest in sports and rehabilitation, or better yet, one who is an accredited sports chiropractor. Sports chiropractors have undergone vigorous training in rehabilitative methods and are able to prescribe sound exercises for musculoskeletal complaints.