Some back and neck pain needs a doctor today, not a chiropractor. Some back and neck pain is not a case for a chiropractor and needs a doctor the same day. Go to an emergency room, not to us, if you have numbness in the groin or inner thighs, if you have lost control of your bladder or bowels, if a leg is becoming weak rather than just painful, if the pain followed a serious fall or a car crash, if you have a fever with back pain, if you have unexplained weight loss alongside it, if you have a history of cancer, or if a headache came on suddenly and is the worst you have ever had. We would rather you rang your doctor and never rang us at all.
Every clinic says exercise matters and most of them hand you a photocopied sheet on the way out. The sheet goes in a drawer, nobody asks about it again, and the treatment quietly becomes the whole plan. That arrangement works well for a clinic's schedule and badly for a patient, and it is the single biggest difference between somebody who is fine in three months and somebody who is still coming in.
The reason loading matters is straightforward. Most musculoskeletal pain is a mismatch between what a tissue can currently tolerate and what is being asked of it. Hands-on treatment reduces pain and improves range, which is genuinely useful and which does not change capacity at all. Only loading does that — progressively, over weeks, in a way that can be measured. Everything else buys the window in which the loading is possible.
So the programmes we write are short, specific and boring, and there are never more than three things on them at a time. They take under ten minutes. You do them in front of us before you take them home, because a movement done wrong for three weeks is worse than not doing it. And they are progressed on a written rule rather than left at the same yellow band for two months, which is the other common way a programme quietly stops working.
How a programme is built
Four principles that make the difference between a programme that works and a sheet in a drawer.
Fewer things, done properly
Two or three exercises, never eight. A long programme is a programme that does not get done, and the compliance data on this is unambiguous. We would far rather you did three movements four times a week than owned a sheet of twelve you did twice. If what we give you does not fit into your actual life, tell us and we will trade it for something that does.
Specific to your examination
The programme comes out of what your assessment found — the hip that could not hold, the deep neck muscles with no endurance, the calf that failed at eight repetitions when it should manage twenty-five. A generic back sheet handed to everybody is not rehabilitation, it is paperwork.
A written progression rule
Not just what to do but when to make it harder, and by how much. Programmes stall because nobody ever changed them, and an exercise that was appropriately hard in week one is doing nothing by week four. You get a rule you can apply yourself between visits rather than having to wait to be told.
Watched before you leave
You do the movements in front of whoever wrote them, and they get corrected. This is why the rehabilitation floor exists and why some visits are booked as a rehabilitation session rather than a treatment. A movement performed wrong for three weeks is worse than one not performed at all.
What the sessions look like
Half an hour on the floor rather than twenty minutes on a table.
Assess under load
Squat, hinge, step, lunge, carry, push, pull, hop — whichever apply. Watching somebody move under load tells us things a static examination cannot: the knee that collapses inward on a single-leg landing, the shoulder that loses control at the top of a press, the back that only hurts on the eleventh repetition.
Teach and correct
Most of a first rehabilitation session is coaching. Where the weight goes, what should be working, what it should feel like, what it should not, and how to tell the difference between the ache of effort and the pain of provocation. That last distinction is the one people most need and are most rarely given.
Set the numbers
Sets, repetitions, tempo, load and frequency, written down. Vague instructions produce vague compliance. There is a real difference between three sets of twelve, twice a week, and do some of these when you can, and only one of them produces a measurable change.
Review and progress
At each visit we look at what has changed, adjust the load, and swap out anything that is not being done — because an exercise you are not doing is not a moral failing, it is a design error on our part. Programmes that get reviewed keep working; programmes that do not, stop.
Things people get wrong
The four we correct most often.
Stopping when the pain stops
Pain usually improves well before capacity is restored, so the point at which somebody feels fine is roughly halfway through the job. Stopping there is the single most common reason for a second episode two months later. The last few weeks of a programme are the ones that make the difference and they are the ones nobody wants to do.
Believing all pain during exercise is damage
It usually is not. A moderate ache during and shortly after rehabilitation exercise is expected and acceptable, provided it settles within about twenty-four hours and is not getting worse week on week. We give you an explicit rule for this, because without one people either avoid everything or push through things they should not.
Doing it all on Sunday
Three sessions spread across the week beats the same volume crammed into one day, both for adaptation and for soreness. Little and often is the whole principle, and it is also considerably easier to keep up. Ten minutes on four days is a better programme than forty minutes once.
Never making it harder
The same band, the same reps, for two months, is maintenance rather than rehabilitation. Tissue adapts to what it is regularly asked for, so if the ask never changes the adaptation stops. This is why the written progression rule exists and why we ask what you are currently lifting rather than whether you are still doing the exercises.
Rehab Exercise in western Queens
The least glamorous thing we do and the one that carries the most weight. Two or three specific things, written down, ten minutes a day, reviewed and progressed.
Every course of care here starts the same way: a full hour, a proper history, an examination, and then a plain statement of what we think is going on and how confident we are about it. You are told what we propose, roughly how many visits it ought to take and what should have changed by when — and we agree a date to stop and look at whether it worked. If the honest answer at any point is that this needs somebody else, you get that instead, and we write to them the same week.
Chiropractic care is not a substitute for medical diagnosis. Chiropractic care is not a substitute for medical diagnosis, and nothing on this website is medical advice for your particular problem. We are not physicians: we do not prescribe medication, we do not perform surgery, and we do not treat disease. What we do is examine how your spine and joints move, work on them by hand, and give you something to do between visits. If your problem turns out to be outside that, we say so and refer you — which happens often enough that you should expect it as a normal outcome rather than a failure.
What chiropractic does not treat. We treat musculoskeletal problems: the spine, the joints, the muscles and the nerves that are irritated by them. We do not claim that adjusting a spine treats asthma, allergies, ear infections, colic, digestive disease, high blood pressure, infertility, immune function or any other internal illness. Chiropractors who make those claims are making them without good evidence, and you should be wary of anybody who does. If somebody has told you that spinal care will fix a condition on that list, we will tell you honestly that it will not.
Questions
Rehab Exercise — the questions we are asked most
Will exercise make my pain worse?
A moderate ache during and shortly after is expected and acceptable, provided it settles within about a day and is not getting worse week on week. That is the rule we give people, in writing, because without an explicit threshold most people either avoid everything or push through things they should not. Sharp pain, pain that lasts into the next day, or symptoms travelling further down a limb means stop and tell us.
How long before I see a difference?
Pain often improves within two to three weeks, and genuine capacity takes longer — typically eight to twelve weeks for a tendon, and often longer for something that has been building for years. The frustrating part is that pain improves first, which makes people stop at the halfway mark. The last few weeks are the ones that decide whether it comes back.
I have no time. What is the minimum that works?
Under ten minutes, three or four days a week, done consistently, beats a longer programme done sporadically — and that is not a compromise version, it is genuinely what we prescribe. If even that does not fit, tell us what will and we will build around it. A programme you actually do is worth more than a better one you do not.
Do I need a gym membership?
No. Almost everything we prescribe can be done at home with body weight, a resistance band and something to step onto or hold. Some people benefit from loading heavier than that eventually, and if you are already training we will work with what you have access to. Nobody is required to join anything.
Why do I need a session for this? Cannot you just tell me?
We can, and for straightforward things we do — it goes in your notes and you take it home. Where it earns a proper session is when the movement needs coaching, when there is more than one thing to co-ordinate, or when doing it slightly wrong would make it useless or provocative. A movement done wrong for three weeks is worse than one not done at all.
What if I stop doing them?
Tell us, and tell us why. That is genuinely useful information rather than something to be embarrassed about — it usually means the programme is too long, too dull, too hard, or scheduled at a time that does not exist in your week. All of those are fixable by us. What is not fixable is a programme that is quietly not being done while everybody pretends otherwise.
Related
Often seen alongside this
Hands-On Therapies
Soft Tissue Therapy
Hands, thumbs and elbows applied to muscle and the tissue around it. For a lot of stiff necks and locked-up backs this is where most of the relief actually comes from.
Read more
Hands-On Therapies
Therapeutic Massage
An hour in a quiet room with the lights down. Genuinely useful for muscular pain, sleep and stress, and honestly described rather than sold as something it is not.
Read more
Hands-On Therapies
Spinal Decompression
A motorised table that applies slow lengthening through the spine. It suits some disc-related problems well and does very little for others — and we will tell you which we think you are.
Read moreA fee agreed before the visit, not after it
Book an appointment
Pick a chiropractor and an hour from the calendar — it shows only the times each of them genuinely has free. A first visit is a full hour and costs $95 for the examination on its own, or $145 if we treat you at the same appointment. You decide which after the examination, not before.