Patients do not need a referral from an M.D. (doctor of medicine) to see some practitioners of manipulation therapy, such as an osteopathic physician or a chiropractor. Depending on insurance coverage and location, individuals may need a referral for some other practitioners.

The practitioner often begins by reviewing the patient’s medical history (including a list of medications) and conducting a physical examination.

Patients may be asked to describe the pain in a pain assessment. They may be given a diagram of the body and asked to mark areas where they are experiencing pain. Questions to assess the pain may include:

• Can you describe the pain?
• Where does the pain occur?
• How long have you experienced the pain?
• Have you experienced this type of pain in the past?
• Is the pain constant or does it come and go?
• Are there any movements that make the pain worse?
• Do you have limited movement?

Manipulation therapy sessions vary widely according to the type of treatment technique used. With most treatments, patients have numerous visits over a period of time.

Some practitioners, such as chiropractors, may use modalities (physical agents) such as thermotherapy, cryotherapy or electrical therapy. Many therapies include preventive techniques in which patients learn special exercises or other methods to prevent pain in the future.