By Karen Finucan Clarkson

Once considered a truly alternative form of medicine, chiropractic is entering the medical mainstream.

"Primary care physicians have become increasingly educated about the benefits of chiropractic care," said Dr. Jay Greenstein, a Doctor of Chiropractic and CEO of Sport and Spine Rehab (online at www.sportandspinerehab.com), which has eight locations, including Rockville and Chevy Chase. "If you're looking for a referral to a chiropractor, ask them."

Chiropractors treat disorders of the musculoskeletal and nervous systems, focusing on the effects these disorders have on general health. Back pain, neck pain, pain in the joints of the arms or legs, and headaches are among the ailments chiropractors tend to, according to the American Chiropractic Association.

Like doctors of medicine or osteopathy, doctors of chiropractic receive four years of medical training after college, but from an accredited chiropractic college. Due to the hands-on nature of chiropractic and the intricate adjusting techniques, chiropractic students spend a significant amount of time in clinical training.

Both the American Chiropractic Association and the Maryland Chiropractic Association have referral services and databases with names of doctors of chiropractic. In Maryland, the Board of Chiropractic and Massage Therapy Examiners, which operates under the auspices of the Maryland Department of Health and Mental Hygiene, oversees the licensing of chiropractors. The board's Web site allows visitors to quickly verify licensure. In addition to ascertaining education and licensure, Greenstein suggests inquiring about any post-graduate degrees and continuing education coursework. "Use this information to search out folks who have a lot of expertise and experience," he said.

While all chiropractors must have graduated from an accredited school, "there is wide variation in chiropractic practice—more so than in conventional medicine," said Greenstein. "Determining what you need can be challenging for a prospective patient."

The variation in practice tends to have more to do with techniques than it does with types of practice, although some chiropractors specialize in specific parts of the body or certain types of injuries—sports-related, for instance.

To find the chiropractor who's right for you, "start with family and friends who've had a good experience," said Greenstein, "but be sure to ask what they were being treated for. Some chiropractors may have more experience with certain injuries or (may) have done post-graduate work in certain areas such as sports."

Greenstein recommends visiting a chiropractor's Web site. "Does it look schlock or cheap? Read a bit about the person. Do they have the experience, the background? You will probably get some clues about their personality as well," he said.

"Then, call the office. Most doctors will speak to you on the phone," said Greenstein. "As health care providers, so much of what we do is based on trust. So, you want to be sure your personalities match up."

Insurance coverage is another issue to explore. Many, but not all, plans cover chiropractic care, though some may limit the number of visits over a particular period of time. "Ask whether the doctor takes your insurance and whether he is a preferred or in-network provider," said Greenstein.

Another consideration is whether the chiropractor is a solo practitioner or part of a group or multi-specialty practice. "In our clinics we have doctors of chiropractic and physical therapy working together," said Greenstein. "Manipulation is a great tool, but it is just one tool. We also do soft tissue work and provide patient education on ergonomics and nutrition."

No matter what type of chiropractic practice a patient decides on, they need to feel confident in the care they receive and comfortable with the provider. "If not, they shouldn't hesitate to start the process over again," said Greenstein. "But I bet if they do their homework right the first time, the probability of having to switch is small."