Palmer College Graduate Board Certified, DC Medicare Provider

REF-CT-2025 · Clinical Reference

A Clinical Reference of Conditions Treated at Cascade Spine

Every condition listed below is one we actively manage in clinic — with documented intake exams, evidence-graded protocols, and outcomes tracked through our EMR. We don't treat what we can't measure, and we don't promise outcomes outside the literature.

Spinal Conditions Peripheral & Extremity Headache & Neuro Auto & Work Injury Evidence & Outcomes Diagnostic Workflow

M-Codes · Axial Spine

Spinal Conditions

The majority of our caseload is axial — cervical, thoracic, and lumbar spine. Every spinal presentation is screened for red flags (cauda equina, progressive neurological deficit, fracture, infection, malignancy) before any manual care is delivered.

M54.5 · Low Back Pain

Mechanical Low Back Pain

Symptoms

Dull, achy lumbar pain that worsens with prolonged sitting, lifting, or sustained flexion. Often associated with paraspinal hypertonicity, sacroiliac restriction, and gluteal weakness. Typically resolves to baseline with appropriate manual care and corrective exercise.

Our approach — McKenzie-style directional assessment, joint mobilization or HVLA adjustment when appropriate, gluteal and core re-education following the Stuart McGill big-three progression, and ergonomic intake review.

M51.16 · Disc Disorder w/ Radiculopathy

Lumbar Disc Herniation

Symptoms

Localized low back pain with radiating leg symptoms below the knee, often dermatomal. May include numbness, paresthesia, or focal weakness in L4–S1 distributions. Aggravated by Valsalva, sitting, and forward flexion.

Our approach — Neurologic and orthopedic exam (SLR, slump, dermatome, myotome, reflex), MRI coordination when indicated, non-surgical spinal decompression (DRX-9000 protocol), nerve glides, and graded loading. Surgical co-management with local neurosurgery when red flags appear.

M54.16 · Lumbar Radiculopathy

Sciatica

Symptoms

Sharp, burning, or electric pain along the sciatic nerve distribution — usually unilateral, traveling from the gluteal fold into the posterior thigh, calf, and foot. May or may not have a disc origin; piriformis and lumbar facet referral are also common drivers.

Our approach — Differentiation between discogenic, piriformis-mediated, and facet-mediated presentations using slump test, FAIR test, and Kemp's. Care plan combines decompression or mobilization with neurodynamic mobilization and progressive McKenzie loading.

M54.12 · Cervical Radiculopathy

Cervical Radiculopathy

Symptoms

Neck pain with radiating arm symptoms, often C5–C7. Patients report relief with arm-abducted (shoulder-abduction) positioning and worsening with Spurling's compression. May include grip weakness or reflex changes.

Our approach — Cervical traction (manual and mechanical), HVLA cervical adjustments only when neurologic exam is stable, scapular stabilization rehab, and nerve flossing. Co-managed with PT and pain management for severe presentations.

M43.16 · Spondylolisthesis

Lumbar Spondylolisthesis

Symptoms

Pain that worsens with extension and standing, eases with flexion. Often presents in L5–S1 with hamstring tightness, anterior pelvic tilt, and a "step-off" on palpation. Imaging (flexion–extension X-rays) is essential for grading.

Our approach — Flexion-bias rehabilitation (lumbar stabilization, anti-extension), avoidance of end-range HVLA, deep abdominal recruitment, and load management. We do not adjust unstable Grade III–IV slips.

M48.06 · Lumbar Stenosis

Lumbar Spinal Stenosis

Symptoms

Neurogenic claudication — bilateral leg heaviness, cramping, or weakness with walking, relieved by sitting or leaning forward on a shopping cart. Most common in patients over 60. Frequently co-occurs with facet arthropathy.

Our approach — Flexion-distraction (Cox technique), recumbent biking for cardiovascular conditioning, hip flexor and thoracic mobility work, and progressive walking tolerance protocols.

M54.2 · Cervicalgia

Mechanical Neck Pain & Tech Neck

Symptoms

Posterior neck and upper trapezius pain associated with sustained forward head posture, desk work, and phone use. Often paired with thoracic kyphosis, suboccipital tenderness, and reduced cervical rotation.

Our approach — Cervical and thoracic mobilization, deep neck flexor activation (chin tucks, cranio-cervical flexion test), workstation ergonomic prescription, and dry needling for stubborn trigger points.

M41 · Scoliosis

Adolescent & Adult Scoliosis

Symptoms

Lateral spinal curvature confirmed on radiograph with a Cobb angle of 10° or greater. May be asymptomatic in mild curves; symptomatic patients report back fatigue, postural asymmetry, and respiratory restriction in larger curves.

Our approach — Cobb angle tracking on serial standing X-rays, Schroth-based three-dimensional corrective exercise referral, manual care for symptomatic segments, and orthopedic co-management for curves above 25°.

M-Codes · Extremity

Peripheral & Extremity Conditions

Our extremity-certified clinicians (CCEP) treat shoulder, elbow, hip, knee, and foot complaints with the same rigor we apply to the spine. Many extremity problems are downstream of axial dysfunction — we always assess the kinetic chain.

M75.10 · Rotator Cuff

Rotator Cuff Impingement & Tendinopathy

Symptoms

Lateral shoulder pain with overhead reaching, sleeping on the affected side, and a painful arc between 60–120°. Hawkins-Kennedy and Neer signs frequently positive; weakness in empty-can testing suggests supraspinatus involvement.

Our approach — Scapular dyskinesis screen, posterior capsule mobilization, rotator-cuff progressive loading (Cyriax or Alfredson-style eccentrics), and adjustment of the cervicothoracic junction when contributing.

M77.10 · Lateral Epicondylitis

Tennis Elbow

Symptoms

Lateral elbow pain at the common extensor origin, worsened by gripping, lifting with a pronated forearm, or wrist extension against resistance. Often persists for months in office workers and racquet sport athletes.

Our approach — Heavy slow-resistance eccentric loading per Tyler twist protocol, Graston/IASTM on the extensor tendon, mobilization with movement (Mulligan), and ergonomic input.

M72.2 · Plantar Fascia

Plantar Fasciitis

Symptoms

Sharp, stabbing heel pain on the first steps after waking or after periods of rest. Pain at the medial calcaneal tubercle; often associated with calf tightness, pes planus, and high training volumes.

Our approach — High-load progressive heel raises (Rathleff protocol), foot intrinsic strengthening, instrument-assisted soft tissue work on the gastroc-soleus complex, and a frank conversation about footwear.

M22.2 · Patellofemoral

Anterior Knee Pain (PFPS)

Symptoms

Diffuse anterior knee pain that worsens with stairs, squatting, prolonged sitting (the "movie sign"), and downhill running. Frequently driven by hip abductor weakness, foot mechanics, or quadriceps timing rather than the knee itself.

Our approach — Hip strength assessment (single-leg squat, Trendelenburg), patellar mobilization, vastus medialis and gluteal recruitment, and gait retraining for runners.

M65.4 · de Quervain

de Quervain Tenosynovitis

Symptoms

Pain at the radial styloid worsened by thumb and wrist motion. Finkelstein test positive. Common in new parents, hairdressers, and frequent texters. Often misattributed to "carpal tunnel."

Our approach — Relative rest with thumb-spica taping, eccentric loading of the APL/EPB tendons, soft tissue work, and adjustment of the carpal row.

G56.0 · Carpal Tunnel

Carpal Tunnel Syndrome

Symptoms

Nighttime numbness or tingling in the median nerve distribution (thumb, index, middle, radial half of ring finger). Positive Phalen's and Tinel's signs. Often associated with cervical or thoracic outlet contribution.

Our approach — Median nerve neurodynamic mobilization, carpal bone adjustment, cervicothoracic screen for double-crush syndrome, ergonomic input, and EMG/NCV referral when indicated.

G-Codes · Cephalgia

Headache & Neurological Conditions

Chiropractic management of headache is well-supported in the literature for cervicogenic and tension-type presentations. We screen carefully for primary headache disorders that require neurologic co-management.

G44.86 · Cervicogenic

Cervicogenic Headache

Symptoms

Unilateral occipital or temporal headache that originates from upper cervical joint dysfunction (C0–C3). Reproduced with cervical movement or pressure on the upper cervical facets. Often paired with reduced cervical rotation on the affected side.

Our approach — Upper cervical mobilization or HVLA, suboccipital release, cranio-cervical flexion retraining, and trigger point work on the upper trapezius and levator scapulae.

G44.2 · Tension Type

Tension-Type Headache

Symptoms

Bilateral, band-like pressure across the forehead or temples. Mild to moderate intensity. Usually not throbbing, not aggravated by routine activity. Often associated with stress, prolonged screen time, and poor sleep.

Our approach — Soft tissue release of the suboccipitals and masseter, cervical and thoracic adjustment, breathwork coaching, and behavioral input on sleep hygiene and screen breaks.

G43 · Migraine

Migraine (Co-Management)

Symptoms

Unilateral, throbbing headache with associated photophobia, phonophobia, nausea, or aura. Migraine is a primary neurologic disorder; we co-manage with the patient's neurologist or primary care to reduce frequency and intensity.

Our approach — Upper cervical care has Class B evidence for migraine frequency reduction. We track headache frequency, intensity, and duration in a structured diary and coordinate with prescribing physicians.

M53.0 · Cervicocranial

Post-Concussion Cervical Syndrome

Symptoms

Persistent headache, dizziness, and neck pain following concussion. Cervicogenic contribution to post-concussion symptoms is well-documented and frequently overlooked in standard concussion protocols.

Our approach — Co-managed with neurology. Cervical mobilization, vestibular-ocular screening, and graded return-to-activity. We do not perform HVLA on patients with active vestibular symptoms.

S-Codes · Post-Traumatic

Auto & Work Injury Care

We are a contracted provider for California Workers' Compensation and accept all major personal injury and MedPay claims. Our intake includes the documentation, narratives, and impairment ratings that adjusters and attorneys require.

S13.4 · Whiplash

Whiplash-Associated Disorder (WAD)

Symptoms

Neck pain, headache, and reduced cervical range of motion following a rear-end or side-impact motor vehicle collision. We grade WAD I–IV per the Quebec Task Force classification and document delta-V and impact direction in our intake.

Our approach — Acute-phase modalities (gentle range-of-motion, ice, soft tissue) for the first 72 hours; progressive active care thereafter. Imaging only when red flags are present. Full QTF-compliant documentation for billing and legal review.

S33.5 · Lumbar Sprain

Post-MVC Lumbar Sprain/Strain

Symptoms

Low back pain and stiffness following a motor vehicle collision, with or without sciatic symptoms. Frequently underreported in the first 48 hours due to adrenaline masking. We re-examine at 72 hours and 7 days.

Our approach — Conservative manual care, ergonomic input for return to driving, and coordination with primary care for medication management. We provide ongoing impairment narratives to attorneys and adjusters.

M62.83 · Work Strain

Repetitive Strain & Work Injury

Symptoms

Cumulative musculoskeletal pain related to repetitive workplace tasks — keyboarding, lifting, overhead work, or sustained postures. Includes diagnoses ranging from lateral epicondylitis to thoracic outlet syndrome to mechanical low back pain.

Our approach — California Workers' Comp-credentialed clinicians. We provide PR-2 progress reports, work-status forms, and return-to-work recommendations. Job-task analysis available on request.

S43 · Shoulder Trauma

Post-Traumatic Shoulder Pain

Symptoms

Shoulder pain following falls, lifting injury, or seatbelt restraint trauma. May include AC joint sprain, labral injury, or rotator cuff partial-thickness tear. MRI coordination as needed.

Our approach — Orthopedic shoulder examination (O'Brien's, apprehension, drop arm), staged loading rehabilitation, and orthopedic surgical co-management for full-thickness tears.

Literature Review

Evidence & Outcomes

A condensed reference to the highest-quality evidence supporting the conditions we treat. Strength of recommendation graded per the U.S. Preventive Services Task Force scale.

Grade A

Spinal manipulation for acute low back pain. Multiple systematic reviews and the 2017 American College of Physicians clinical guideline list spinal manipulation as a first-line non-pharmacologic intervention.

ACP 2017 · Cochrane 2019

Grade A

Manual therapy + exercise for cervicogenic headache. The Jull et al. trial and subsequent systematic reviews demonstrate sustained reduction in headache frequency at six months.

Spine J · 2002, 2017

Grade B

Spinal manipulation for chronic low back pain. Moderate-quality evidence supports clinically meaningful pain reduction at 6–12 months when combined with active care.

Cochrane 2011 · Eur Spine J 2018

Grade B

Cervical manipulation for mechanical neck pain. NICE and the Bone & Joint Decade Neck Pain Task Force include manipulation and mobilization as recommended interventions.

NICE 2016 · Bone Joint Decade

Grade B

Non-surgical spinal decompression for disc herniation. Small but consistent body of evidence supports decompression as a non-surgical adjunct for radicular pain.

J Manip Physiol Ther 2018

Grade C

Upper cervical care for migraine frequency. Emerging evidence; recommended as adjunctive care alongside neurologic management.

Headache J 2019

Process

How We Diagnose Before We Treat

Every new patient — regardless of presenting complaint — moves through the same four-step diagnostic workflow. This is what makes our care reproducible and why our outcomes track in the EMR.

History & Red Flag Screen

Structured intake covers onset, mechanism, severity, aggravating and easing factors, and a screen for cauda equina, fracture, infection, and malignancy.

Neuro-Orthopedic Exam

Region-specific orthopedic tests, dermatome / myotome / reflex exam, and postural and movement screen. Documented with quantitative range-of-motion values.

Imaging When Indicated

Digital X-ray and MRI coordination guided by ACR Appropriateness Criteria. We do not image to justify care — we image when imaging will change the plan.

Care Plan & Outcomes Tracking

Written plan with frequency, duration, expected outcomes, and re-exam intervals. Outcome measures (NDI, ODI, NPRS) tracked at intake, mid-plan, and discharge.

Don't see your condition listed?

This is a reference, not an exhaustive list. Call our front desk or request a free 15-minute clinical screening call — we'll tell you honestly whether chiropractic care is the right fit, or refer you elsewhere if it isn't.

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