While I’ve long lived by the philosophy that our bodies are more than capable of healing themselves, I recently experienced a subluxation in my lower spine that left me pursuing outside measures. The Prolozone treatments I underwent were helping, but, I’ll admit, I was growing impatient. I wanted my life back—and fast—and so I booked a chiropractic session for the lumbar (L4) adjustment I knew I needed. (To note: The L4 is the second lowest vertebrae on your spine.) I went with a veteran chiropractor in the area who had not only 20 years of professional experience under his belt but also came highly recommended. His manipulations seemed sound; his bedside manner was great. But after dropping his entire body weight on the right side of my body in what’s known as a high-velocity manipulation, I was left with a dislocated rib that, a month later, has yet to fully heal.

Which got me thinking about chiropractic care in general. How many of us walk blindly into an office and end up with zero results, or, worse (way worse), an injury? How many of us still believe that chiropractic care is the only way to approach musculoskeletal pain? And how many of us know what to do when an injury, such as the one I endured, happens?

My recent experience notwithstanding, I believe chiropractors can work wonders, offering incredible relief and lasting healing. But, as U.S. News and World Report asserts, chiropractic care is “not without risk.” As with anything associated with your health, it’s imperative for you to be proactive—to paraphrase poet Mary Oliver, this is your one and precious life, and it must be handled wisely. With this in mind, here are the pros and cons of chiropractic care, the two primary techniques offered, how to choose a chiropractor—and the alternative forms of treatment you may want to seek out.

But first: What is chiropractic care, anyway?

Chiropractic care may seem like a modern invention but it dates back hundreds of years. The healing technique—which is derived from the Greek words “cheir” (or hand) and “praktos” (or done), and is translated as “done by hand”—is often attributed to Daniel David Palmer, an advocate of alternative medicine who maintained that he enabled a deaf man to hear again after conducting a spinal manipulation.

The lure of this persisted—and escalated. Today, the American Chiropractic Association reveals that there are more than 70,000 active chiropractors in the US. It’s the third most popular form of health care, right below primary care and dentistry. Canada, Australia, Great Britain and Japan are just a few of the other countries who “recognize and regulate” chiropractic care as a means of health care, the ACA reports.

To the 62% of Americans who have had neck and back pain significant enough to obtain help from a health care professional, the prevalence of chiropractic care may seem like a boon. And, indeed, it can be, in that a skilled chiropractor may be able to assist with everything from sciatica (a condition in which a pinched nerve in the lower spine results in leg pain and numbness) to headaches. Chiropractors live by the tenet that a host of health conditions—from back pain to achy wrists—result from misalignments in the body’s underlying structure, including the skeleton and joints. To this end, they use different adjustments to properly align your frame, working not only on the spine but also other parts of the body.

The Two Main Types of Chiropractic Adjustments—and Their Risks and Rewards

While there are well over 100 types of adjustment techniques used by chiropractors, most rely on roughly 10, Arizona Pain reports. Of these, the two most popular are the following:

Spinal Manipulation (High-Velocity Low-Amplitude Thrust). As Spine Health/Veritas reports, “The most frequently used chiropractic technique, spinal manipulation, is the traditional high-velocity low-amplitude (HVLA) thrust.” This manipulation, they also report, “often results in an audible ‘pop,’ as chiropractors use their hands to apply a controlled sudden force to a joint while the body is positioned in a specific way.”

While the ‘pop’ you may hear in this sort of adjustment shouldn’t be cause for concern—it’s gas being released by joints—a study in the American Journal of Medicine indicates that these manipulations are not risk-free. “Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation,” they report—which, while “minor,” is a lot. Meanwhile, more serious injuries can occur, such as disk herniation, dislocated ribs (as in my case), blood flow issues and cauda equina syndrome—a rare condition, affecting the nerves in the lower spine, that requires urgent surgery. Notably, in 2016, the “Queen of Snapchat,” Playboy model Katie May, died from a stroke believed to be induced by a chiropractor’s neck manipulation—two years after the American Heart Association released a statement stating that getting your neck adjusted by a chiropractor or osteopathic doctor may be linked to an elevated risk for stroke.

On another note, while the use of HVLA has declined in recent years, the Journal of Bodywork and Movement Therapies contends that the risks of this technique—the same I recently received—“are low, provided patients are thoroughly assessed and treated by appropriately trained professionals.” When it works, this manipulation can produce positive, though short-term, outcomes for people with low back pain, The British Medical Journal reports, but WebMD warns that people who have “osteoporosis, spinal cord compression, or inflammatory arthritis, or who take blood-thinning medications, should not undergo spinal manipulation.”

Spinal Mobilization (Low-Force or Gentle Chiropractic Techniques). The aim of Spinal Mobilization mirrors HVLA—to restore and improve function—but it utilizes a slower, gentler approach. Chiropractors, or patients themselves, may choose to use this milder method for a number of reasons, including osteoporosis, bone pathology, obesity, and sensitive nervous systems.

Several techniques are called upon under this version of chiropractic therapy, but one of the most popular is what’s known as the activator method. Using a hand-held, spring-loaded, manual tool, which offers a low-force impulse, a chiropractor uses this technique to evaluate “leg length, perform muscle testing, and adjust the spine or extremity joints using the Activator tool,” says Steven Yeomans, DC, FACO. Several studies have shown enhanced range of motion after spinal mobilization, as well as improved sciatica, low back pain, and shoulder movement. What’s more, while this more moderate approach to treatment may result in tenderness and even some pain, it is overall safe, the National Institutes of Health reports.

What to Look for in a Chiropractor—and What to Do When You Enter Their Office

Don’t go with the first chiropractor in your area that pops up on a Google search. Rather, ask your primary care physician or naturopathic doctor for a referral, or ask a trusted loved one to recommend someone—the caveat being, of course, that every personality and body is different and you shouldn’t work with someone who feels intuitively wrong to you. Ensure they’re licensed, and have obtained a Doctor of Chiropractic degree from a Council on Chiropractic Education (CCE) accredited college. Find out how long they’ve been practicing, and learn whether they specialize in a certain field, such as sports medicine.

Once you’ve found someone you believe you can trust, be sure to tell them about the nuances of your condition and your physical form. For example, years of yoga, as well as completion of my yoga teacher training, has rendered me flexible, which makes me harder to adjust, and when not adjusted correctly could put me at an increased risk for spinal manipulation injuries. Other yogis—as well as dancers, springboard divers, gymnasts, and athletes that require a great deal of flexibility to excel in their sport—may also have a difficult time with HVLA adjustments. People who have an inherited condition called Ehlers-Danlos Syndrome, which results in a defect in the production of collagen and hyperelastic joints, should also not receive HVLA manipulations. And those with osteoarthritis need to make their severity of pain clear to their chiropractor. If I had it to do over, I would have asked for the low-force adjustment with an activator instead of the high-velocity adjustment.

Further, be sure the chiropractor explores your different treatment options with you. Refrain from going with chiropractors who insist on “packages,” or who don’t take a holistic perspective of your health. Ask your chiropractor to tell you what they plan on doing during your session, and empower yourself to say no when something doesn’t seem right. Acknowledge that soft tissues—your ligaments and tendons—are what pull bones out of place, and take a good amount of time to heal. (In other words, don’t rush it.)

Should you suffer an injury at a chiropractor’s hands, be aware—and persistent—about what you, as a patient, deserve. Seldom is legal action the solution (although this is case by case) but care and compassion are an enormous part of the overall healing process—and this should manifest in their foll0w-up treatment, communication, and compensatory efforts.

Here’s what happened in my follow-up after my injury… I called the practitioner and told him that I thought my rib could be broken. He told me to follow up and let him know if it was. He did text me after the X-ray. I had conflicting interpretations—the MD I saw thought it was broken even though it didn’t show up on the X ray, while my other MD thought it was dislocated. Now I know that it was most likely dislocated because of how much better I’m feeling. The chiropractic doctor that I had seen in the past—who he was subbing for—called me and had me in for a free follow-up visit. She did some deep tissue work and acupuncture and she and her office manager called numerous times to check in afterwards. Meanwhile, the chiropractor who injured me didn’t follow up until weeks later. I told his office manager he gets an F in follow up. Of course, I know that I will never get the HVLA kind of adjustment again.

Alternative Forms of Treatment

If you’re one of the 85% to 90% of people who suffer from back pain (or other musculoskeletal issues), do know that chiropractic care isn’t the only form of treatment available.

* Massage may offer effective, albeit modest relief.

* Acupuncture can provide respite for those who have chronic back pain, osteoarthritis, and headaches, with minimal side effects (although keep in mind that the results of several studies on acupuncture have had limitations).
* Osteopathic Manipulative Medicine has demonstrated efficacy as well, with data showing that it can be not only valuable for treating chronic low back pain but also have results lasting up to a year.
* Dozens of targeted exercises can alleviate pain, while researchers show that exercising in general can increase blood flow to the lower back area, which can decrease stiffness and accelerate the healing process. Strengthening your body, and making it more resilient, can improve musculoskeletal complications as a whole.

* Yoga is as effective as standard physical therapy for treating moderate to severe chronic low back pain, reports the National Institutes of Health. Which, after having learned my lesson, is precisely what I’ll be doing to restore my L4.

Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.