Finding The Best Chiropractors in St. Louis: Tips & Red Flags

When it comes to your health, particularly when it involves someone manipulating your joints, the significance of finding a highly qualified chiropractor cannot be overstated. 

In this post, I will highlight the American Chiropractic Association's recommendations and provide other valuable tips for finding a competent chiropractor while avoiding those that are not evidence-based.

Are All Chiropractors The Same?

When choosing a chiropractor, it's helpful to understand that different philosophies, styles, and techniques exist. For example, two competing philosophies within the chiropractic profession are evidence-based vs. subluxation-based.

Evidence-based chiropractors are much more likely to perform a thorough history and comprehensive examination to develop a proper diagnosis. They also incorporate a variety of treatment techniques supported by scientific research and match appropriate therapies for each patient's specific needs. Finally, these chiropractors assess the patient's condition and modify the treatment plan as needed.

Subluxation-based chiropractors adhere to a strict ideology from the late 1800s. They believe that chiropractic adjustments release a healing life force called innate intelligence. Because they believe this force is the most crucial aspect of healing, they typically do not concern themselves with diagnosing or providing comprehensive care.

Other differences between these two chiropractic philosophies are what they typically treat, session durations, and treatment plans. Evidence-based chiropractors are better for people interested in treating or managing an injury or pain. Scientific research supports the use of spinal manipulation, along with myofascial release, acupuncture, decompression therapy, and physical therapy, as effective low-invasive therapies to promote healing and relieve pain.

Tips for Finding The Best Chiropractor

The profession as a whole is shifting towards being evidence-based. However, the transition has been slow, and an estimated 40% of chiropractors are either subluxation-based or continue to hold many outdated opinions. 

Although it's impossible to define or determine a "best chiropractor" objectively, there are some tips to help you find a highly competent chiropractor. Here is a list of questions or topics to consider when searching for an evidence-based chiropractor.

1. Is the word subluxation used excessively? Chiropractors who use the word subluxation excessively tend to promote outdated ideas, prioritizing adjustments above all else. There are exceptions, and using this word alone shouldn't warrant an outright rejection. However, the disproportionate use of the word subluxation is a red flag.
2. Is an X-ray required or performed on every patient? The idea that chiropractors put bones back into place is outdated and unsupported by credible scientific studies. The most up-to-date understanding of spinal manipulations is that they promote improved and pain-free mobility. X-rays are usually unnecessary before treatment and should only be used in more complicated cases or when progress is not being made.
3. Are treatments tailored specifically for you? Unfortunately, some chiropractors perform the exact same treatments for every patient. Their sessions are usually short, with little concern regarding progress. If you feel like your sessions are "in and out" and you haven't received a diagnosis or answers, it's time to discuss that with your chiropractor or move on to a new one.
4. Are other therapies offered or recommended? Evidence-based chiropractors often incorporate myofascial release, stretching, and spinal decompression to complement manipulations. Additionally, consistent exercise programs almost always improve outcomes. If you find yourself constantly being adjusted with no direction for self-care, consider discussing this with your chiropractor or finding a new one.
5. Is it a good fit for you? Some chiropractors have an intuitive ability to go directly to problem areas and discover subtle connected links. Does your chiropractor easily find your problem areas, such as knots and kinks? If you continuously feel like your chiropractor is missing something, it may be time to consider making a switch.

Additional Red Flags to Consider When Choosing A Chiropractor

In addition to the tips discussed previously, there are some other red flags to be aware of. Any of the following should immediately raise concern.

1. Guarantees: There is no such thing as a 100% success rate when treating musculoskeletal conditions. Be cautious of any chiropractor who guarantees miraculous results, especially for conditions requiring a multifaceted treatment approach. 
2. Excessive visits: Skepticism is warranted if a chiropractor recommends an unusually high number of visits without a clear, individualized rationale. If your chiropractic office pushes a large package at the outset of treatment, you should definitely consider a second opinion.
3. Overemphasis on Supplements: Be cautious if a chiropractor heavily promotes the use of supplements or other products sold directly through their office as essential parts of the treatment plan.

American Chiropractic Association Recommendations For Choosing A Chiropractor

In an attempt to educate patients, the American Chiropractic Association has come up with five things to be aware of when choosing a chiropractor. My tips and red flags have already covered most of this. However, I wanted to provide this resource from the largest chiropractor governing body.

1. Avoid routine spinal imaging for patients with acute low back pain of less than six (6) weeks duration. Unnecessary imaging incurs monetary costs, exposes the patient to ionizing radiation, and can result in labeling patients with conditions that are not clinically meaningful, creating a false sense of vulnerability and disability. Indeed, several studies have shown that the routine use of radiographs in treating low back pain may result in worse outcomes than without their use.
2. Do not perform repeat imaging to monitor patients' progress. There is currently no data available to support a relationship between changes in alignment or other structural characteristics and patient improvement. This practice increases costs, exposes patients unnecessarily to ionizing radiation, and may distract from more meaningful outcomes.
3. Avoid prolonged use of passive therapies for back pain disorders. Overuse of passive treatments (heat, ice, electric stimulation, ultrasound) without the goal of increasing physical activity can be harmful, as it can lead to inactivity, prolonged recovery, and increased costs. The evidence demonstrates that both general physical activity and specific exercise regimens are the most effective strategies in treating and preventing low-back pain and may lead to better outcomes when combined with spinal manipulation. 
4. Do not provide long-term pain management without a psychosocial screening or assessment. The relationship between chronic pain and depression/anxiety is well established. Screening tools are available that will aid in the detection of potential depression/anxiety. When indicated, a referral may be most appropriate for more extensive evaluation and treatment. In addition, psychological factors such as catastrophizing and fear avoidance behavior may interfere with recovery and should be recognized by the clinician.
5. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain. While there may be limited benefits in the short term, the prolonged use of lumbar supports is not supported by the literature on the treatment or prevention of low-back pain. Numerous systematic reviews have found limited to no value for their use in this context. The literature clearly demonstrates that such passive therapies are contrary to the currently accepted central principle of low-back pain care, which is that the patient must engage in an active rehabilitative regimen to achieve the best outcomes. 

Chiropractor vs. The Joint

The joint is a relatively recent concept that has tried to fill a demand for fast and affordable chiropractic adjustments. Its website promotes that they are cheap, quick, and there is no wait. The subluxation-based model encourages members to purchase packages consisting of four monthly adjustments. This concept is excellent for anyone seeking routine adjustments without injury or pain.

The downside of using the joint for chiropractic services is that they do not provide a thorough exam and treatments based on a diagnosis. An evidence-based chiropractor is recommended for a comprehensive and individualized approach. In their own words, the joint promotes being cheap and fast. Those are two words not often associated with quality care.

Best St. Louis Chiropractor

Defining "The Best" chiropractor in any major city is impossible because there are too many criteria that can't be objectively compared. For example, awards are not given, and it's not possible to determine who performs the best spinal manipulations, orthopedic tests, etc. When searching for a chiropractor in St. Louis, look through websites, keeping in mind the tips and red flags mentioned previously. Also, type in some keywords that you're specifically interested in. For example, "chiropractor who performs myofascial release."

Reviews are also a valuable option when looking for a reputable chiropractor. Keep in mind that the quality of reviews is much more important than quantity. A common practice with small businesses today is providing incentives or gifts in exchange for reviews. Be wary if you discover that most reviews are just ratings with little to no feedback.

When choosing a chiropractor, the goal should be to find someone competent, experienced, and genuine in their desire to help people. Emboody Performance & Recovery is available if you have any questions or would like to schedule an appointment.

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