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Back to Health




Diagnosis, Treatment, Rehabilitation, Prevention

The type of treatment we recommend is based on the needs of the patient. In order to treat you effectively Back to Health will endeavor to

  • DIAGNOSIS To provide you with an accurate diagnosis
  • TREATMENT To manage your care with the most appropriate treatment.
  • PREVENTION To ensure to the best of our ability that the injury does not reoccur.
  • REHABILITATION To recommend the most effective form of rehabilitation.

The following treatment techniques are use by our clinicians:

  • Manual therapy – joint manipulation & mobilisation. This is a hands on treatment approach involving joint mobilisation and in many cases manipulation.
  • Massage – soft tissue mobilisation using many different massage techniques – the aim is to reduce inflammation and swelling and promote circulation.
  • Dry needling – a safe and effective method of deactivating muscle trigger points using acupuncture needles.
  • Ultrasound – this can help with soft tissue injury repair
  • Activator method – the use of a measured mechanical impulse on trigger points which are too acute to treat using mobilisation and manipulation therapy.
  • Pilates & rehabilitation exercise – functional exercise programmes for a return to sport or activities of daily living – we regard exercise as an essential part of the rehabilitation & prevention process at Back to Health.
  • Orthotics – we sometimes recommend orthotics to support the feet and help correct biomechanical function.
  • Talking therapy – pain is a psychological response to a physical stimulus – we use talking therapies to support our manual treatments
  • Biomechanical assessment – helps to analyse functional movement patterns
  • Musculoskeletal screening – can be specific to a sport or a work or home environment and is used to identify potential problems that may lead to injury; can also be used in conjunction with ergonomic assessment.

We may suggest combining the type of treatment to give you the best possible results and if we are unable to help you within the clinic we will contact a network of local health professionals on your behalf



Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves, especially related to the spine.


Chiropractic treatment mainly involves safe, often gentle, specific spinal manipulation to free joints in the spine or other areas of the body that are not moving properly. Apart from manipulation, chiropractors may use a variety of techniques including mobilisation, massage, ice & heat treatment, ultrasound, exercise, medical acupuncture as well as advice about posture and lifestyle.


Although chiropractors are best known for treating back and neck pain, patients also consult chiropractors regarding a range of other conditions such as sports injury and joint pain frozen shoulder.


Chiropractors typically focus on, but are not limited to:

  • Mid and lower back pain
  • Neck pain
  • Joint pain in the arms, shoulder and legs
  • Headaches
  • Trapped nerves (sciatica)

What happens during the first visit?

Good chiropractors do everything in their power to help relieve their patient’s symptoms as fast as possible with as few treatments as necessary, and also give advice on how to avoid future episodes of back pain. A chiropractic consultation typically lasts between 45 – 60 minutes.


In preparation for the chiropractic consultation, a patient will be asked to provide background information about the symptoms and condition. Types of questions the doctor of chiropractic might ask whilst taking the medical history include:

  • When and how did the pain start?
  • Where is it located?
  • Is it a result of an injury?
  • What activities/circumstances makes it better?
  • What activities/circumstances makes it worse?

Patients are also usually asked to provide information on family medical history, any pre-existing medical conditions or prior injuries, and previous and current health providers and treatments.


The Chiropractic examination

A thorough chiropractic exam includes general tests such as blood pressure, pulse, respiration, and reflexes, as well as specific orthopedic and neurological tests to assess:

  • Range of motion of the affected part
  • Muscle tone
  • Muscle strength
  • Neurological integrity

Further chiropractic exam tests may be necessary to assess the affected area (such as having the individual move in a specific manner, posture analysis, or chiropractic manipulation of the affected body part).


Diagnostic tests

Based upon the results of the history and chiropractic exam, diagnostic tests may be helpful in revealing pathologies and identifying structural abnormalities that can be used by the chiropractor to more accurately diagnose a condition. Diagnostic studies are often not necessary during the chiropractic consultation.


The most common diagnostic studies during chiropractic exams include:

  • X-ray exam
  • MRI (Magnetic Resonance Imaging) scan
  • Other laboratory tests

The chiropractor will refer you back to your GP if an X ray or an MRI scan is needed. Back to Health work alongside several local private providers of diagnostic tests.


Patient Diagnosis

History, physical examination and any diagnostic studies lead to a specific diagnosis. Once the diagnosis is established, the chiropractor will determine if the condition will respond to chiropractic care. This part of the consultation is called the report of findings.

The chiropractic doctor will explain a patient’s:

  • Diagnosed condition
  • Individualised chiropractic treatment plan (or other treatments)
  • Anticipated length of chiropractic care
  • Chiropractic Treatment Plan

In most cases the chiropractor will begin treatment during the patient’s first visit, although if certain diagnostic tests are needed it may be necessary to wait until the results are received.


Chiropractic treatment recommendations may include some or all of the following:

  • Adjustments to key joint dysfunctions
  • Methods for improving soft tissue healing & pain control, such as ultrasound, electrical stimulation, and medical acupuncture.
  • Exercises to improve muscle balance, strength and coordination
  • Patient education to improve posture and motor control
  • Other complimentary treatments such as massage, heat/cold application, and education on nutrition, talking therapies.


Goals of the Chiropractic Treatment Plan

The chiropractor will establish specific goals for a patients individual plan for treatment:

  • Short-term goals include reducing pain and restoring normal joint function and muscle balance
  • Long-term goals include restoring functional independence and tolerance to normal activities of daily living.

To reach these goals, a specific number of chiropractic visits will typically be prescribed. 2 visits per week for 2 weeks followed by 1 visit per week for another 2 weeks followed by a reexamination would be a typical treatment plan.


A typical chiropractic treatment at Back to Health will take between 20 and 30 minutes. It is important to recognise that the fees are a recognition of the expertise of the chiropractor and not for the time being treated (similar to a dentist!).During each visit, the chiropractor will make small manipulations to the joints of the spine, sometimes causing a slight popping noise to be heard. The treatment is usually painless, but some people experience a temporary increase in their symptoms, stiffness or tiredness. Massage, exercise prescription and stretching are routinely used in the management. There is a large emphasis on self-help, home exercise and lifestyle advice.


At the re-evaluation, the chiropractic doctor will measure the response to treatment and determine whether to:

  • Continue chiropractic treatment if appropriate
  • Release the patient from chiropractic care if treatment goals have been met
  • Refer the patient to another health care specialist if treatment goals have not been fulfilled.

How are chiropractors regulated?

Chiropractic is regulated in the same way as medical doctors and dentists. It is a statutorily regulated healthcare profession governed by the General Chiropractic Council www.gcc.gov.uk.


In addition to being regulated by the GCC each chiropractor is required to be represented by a professional association. Back to Health chiropractors are members of The British Chiropractic Association (www.chiropractic-uk.co.uk) which represents the majority of chiropractors in the UK. Members of the BCA must abide by the GCC Code of Conduct and Standard of Proficiency.


The association only accepts graduates who have gone through a minimum four-year full-time internationally accredited degree course at a recognised college of chiropractic education. Peter Wagenaar, Clinic Principal, studied for a Masters degree in Chiropractic at AECC (www.aecc.ac.uk) in Bournemouth. Prior to this he completed a Bsc Hons in Physiology at Bristol University.


Chiropractic care and the NHS

At this moment in time, in the Wrexham area, chiropractic care is only available privately. GP’s are able to refer to chiropractors but the patient would still need to pay for the cost of their care. Back to Health are currently lobbying the local Health Board to provide chiropractic care on the NHS. You can support us by asking your GP for an NHS referal for chiropractic care. It is the goal of Peter Wagenaar, Principal of Back to Health to widen access to chiropractic care and to be able to provide care through the NHS. In 2009 NICE guidelines for the treatment of chronic low back pain recommended the use of manipulation, mobilisation and massage to treat low back pain which has been going on for more than 6 weeks. They recommend chiropractic care, acupuncture and exercise rehabilitation and as such Back to Health are following these best practice recommendations.


Insurance cover

Chiropractic care is covered by all the major private medical insurers. Each insurance policy is individualised and we would ask all patients to bring a copy of their insurance policy along to their first visit at the clinic so that we can check the amount of coverage for chiropractic care, whether any GP or consultant referals are needed & whether an excess is payable.



Chiropractic evidence

“Chiropractic intervention and posture training can limit episodes of acute pain. Spinal rehabilitation, which may include components such as education, lifestyle change, weight loss, general fitness and specific low-back training exercises, may be required.” NICE 2006


“In a Randomised controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counselling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.” British Medical Journal (2003).

“There is strong evidence that manipulation is more effective than a placebo treatment for chronic low-back pain or than usual care by the general practitioner, bed rest, analgesics and massage.” Spine (1997).


“…patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.” Journal of Manipulative and Physiological Therapeutics (1997).

“Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.” Duke Evidence Report (2001).

“[Elderly] chiropractic users were less likely to have been hospitalised, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. In addition, they were less likely to use prescription drugs.” Topics in Clinical Chiropractic, Coulter et al. (1996).

“First contact chiropractic care for common low back conditions costs substantially less than traditional medical treatment and “deserves careful consideration” by managed care executives concerned with controlling health care spending. Medical Care, Stano and Smith (1996).

In 2010, the UK evidence report by Professor Gert Bronfort on the ‘Effectiveness of Manual Therapies’ was published. It concluded that spinal manipulation/mobilisation is effective in adults for acute, subacute, and chronic low back pain; for migraine prevention and cervicogenic headache, and a number of upper and lower extremity joint conditions. Thoracic spinal manipulation/mobilisation is effective for acute/subacute neck pain, and, when combined with exercise, cervical spinal/manipulation is effective for chronic neck pain.