Chiropractic medicine focuses on the diagnosis, treatment, and prevention of disorders affecting the musculoskeletal system, especially the spine. This practice uses a hands-on, non-surgical, and drug-free approach to health and wellness. Muscle relaxers are prescription medications that act on the central nervous system to reduce skeletal muscle spasms and alleviate associated pain. Patients with acute back or neck pain often seek a quick solution like a prescription from their Doctor of Chiropractic (DC). However, the legal framework governing chiropractic care dictates a specific boundary for pharmacological interventions.
Prescription Authority and Scope of Practice
Doctors of Chiropractic (DCs) operate with a scope of practice that is fundamentally defined as non-pharmacologic and non-surgical within the United States. While a DC is a licensed and trained physician capable of diagnosis, their statutory authority does not extend to prescribing scheduled medications, including muscle relaxers, opioids, or most anti-inflammatory drugs. The practice acts that regulate the profession limit the DC to manual adjustments, physical therapies, and lifestyle counseling.
The core of a DC’s license focuses on restoring proper alignment and function to the spine and joints, primarily through manual techniques. Prescribing pharmaceuticals falls outside the standardized educational curriculum and licensure requirements for most chiropractors. Even recommending specific over-the-counter medications can sometimes fall outside their legal scope in certain jurisdictions. When a patient presents with a condition that warrants pharmaceutical intervention, the DC must adhere strictly to the legal boundaries of their license.
State-Level Differences in Practice Laws
The specific limitations of a chiropractor’s practice are determined at the state level, creating some variations across the country. These state laws govern what physical therapy modalities a DC can use, the extent of nutritional advice they can provide, and whether they can order specific diagnostic imaging or lab tests. Despite these geographic differences in scope, the prohibition against prescribing muscle relaxers and other scheduled prescription drugs remains nearly universal for DCs across all 50 states.
There are a few instances where a state may grant limited prescriptive authority to a DC who has completed extensive, board-certified post-doctoral training. For example, in New Mexico, certain chiropractors with this additional certification may have the ability to prescribe a very narrow range of non-controlled medications related to their scope of practice. This is a rare exception that requires significant additional training and does not represent the standard scope for the vast majority of practicing DCs.
Chiropractic Approaches for Muscle Pain
Since DCs cannot prescribe medication, they focus on non-pharmacological methods to address the underlying causes of muscle spasm and associated pain. The primary therapeutic procedure is spinal manipulation, or the chiropractic adjustment, which involves applying a controlled, sudden force to a joint that has become restricted. This technique aims to restore mobility to the joint, which can immediately reduce nerve irritation and alleviate the reflex muscle guarding that causes spasms.
Non-Pharmacological Techniques
Chiropractors also utilize various forms of soft tissue mobilization to directly target tense muscles. These manual therapies, which can include trigger point therapy and therapeutic massage, help to alleviate muscle tension and improve local circulation. Therapeutic exercises are also a major component of care, focusing on strengthening weakened muscles and improving flexibility to prevent future episodes of spasm. Physical therapy modalities, such as electrical stimulation, therapeutic ultrasound, and the application of heat or ice, are commonly used to reduce localized inflammation and pain without the use of drugs.
Collaborative Care and Referrals
When a patient presents with pain that the chiropractor determines is severe or complex enough to warrant short-term pharmacological intervention, the DC initiates a process of collaborative care. The DC’s role includes a thorough screening and diagnosis to rule out conditions requiring immediate medical attention. If muscle relaxers or prescription anti-inflammatories are necessary to manage acute, debilitating symptoms, the chiropractor will communicate their findings with a licensed prescribing practitioner. This process involves an appropriate referral to a medical doctor (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner (NP), or Physician Assistant (PA). The goal of this multidisciplinary approach is to ensure the patient receives necessary relief from severe pain while continuing with the long-term, restorative benefits of chiropractic care.