Neck Pain Treatment in Singapore

Neck pain is one of the most frustrating conditions to live with. This is many people seek help from chiropractors in Singapore.

While it may be a scary experience, you don’t have to worry just yet! Most neck aches and stiffness are very treatable, and can be addressed with an evidence-based recovery.

For those of you who have been living with neck aches or stiffness, today we will discuss everything you need to know about neck and shoulder pain:

  • What is neck pain?
  • What causes neck pain?
  • What are the red flags for neck pain?
  • Why chronic neck pain should never be ignored
  • Where can I go to relieve neck pain?
  • Can a chiropractor help with neck pain?
  • Can I see a GP for neck pain
  • Which specialist is best for neck pain?
  • What neck pain treatments are available in Singapore?


What is neck pain?

Neck pain refers to discomfort or pain experienced in the structures of the neck. This can include the cervical spine, muscles, ligaments, tendons, and nerves. It is a common condition that can range from mild discomfort to severe pain, limiting movement and impacting daily activities.

Neck pain can have various causes such as:

1. Muscle Strain

neck muscles, muscle strain
There are 26 muscles in your neck alone. When a neck muscle strain may not seem complex, it can sometimes be difficult to treat due to the complexity of the neck musculature.

When you overuse your neck muscles or make sudden movements, you can strain the muscles in your neck. This often result in pain and stiffness. Repetitive or excessive strain, such as spending long hours at a computer or holding your head in an awkward position, can cause fatigue and tension in the neck muscles.

If you frequently slouch or hunch over, it puts added stress on your neck muscles and structures. This can create imbalances, with some muscles becoming tight and overactive while others weaken and stretch. These imbalances contribute to chronic neck pain and discomfort.

Sudden movements, like jerking your head quickly or experiencing a jolt during a car accident, can result in strained neck muscles. The forceful movement can cause microscopic tears in the muscle fibers, leading to pain, inflammation, and limited mobility.

2. Neck Injuries

When you experience whiplash from a car accident, sports-related injuries, or falls, it can lead to neck pain and discomfort. These incidents cause damage to the soft tissues or structures in your neck, resulting in symptoms such as pain, stiffness, and restricted movement.

Whiplash typically occurs when your head and neck are forcefully jerked backward and then forward. This causes rapid hyperextension and flexion of your neck. The sudden motion can strain or sprain the muscles, ligaments, and tendons in your neck.

Car accidents, particularly rear-end collisions, are a common cause of whiplash. The impact of the collision transfers energy to your neck. Injury occurs when your neck moves beyond its normal range of motion. Similarly, sports-related injuries involving collisions or falls can subject your neck to rapid movements, resulting in whiplash.

Symptoms of whiplash can include neck pain, stiffness, headaches, dizziness, shoulder pain, and sometimes even numbness or tingling sensations in your arms. These symptoms can vary in severity and may appear immediately after the injury or develop over time.

3. Neck osteoarthritis or cervical spondylosis

When you have osteoarthritis, you sometimes experience pain, stiffness, reduced joint mobility, and functional limitations. Osteoarthritis, also known as spondylosis, is largely age-related. However, mechanical factors, genetic predisposition, inflammation, biochemical changes within the joint, and altered cartilage metabolism can affect how much pain you have.

Research has revealed that the mechanism behind osteoarthritis is complex. While the exact cause is still poorly understood, it is not the result of wear and tear. Recent studies are able to show that people who exercise regularly experience less degeneration in their joints compared to sedentary individuals. Some early research also suggest that exercise and potentially facilitate joint remodelling and reverse some aspects of osteoarthritis. These suggest that osteoarthritis is not a wear and tear disease.

4. Spinal stenosis

Spinal stenosis is a condition characterised by the narrowing of the spinal canal or nerve root canals. In the neck, this narrowing can compress your spinal cord or nerve roots. When this occurs, you can get neck pain, weakness, numbness, or tingling sensations that may radiate into your arms or hands. The symptoms of these conditions can vary, but common signs include chronic neck pain, stiffness, limited range of motion, and possible neurological symptoms if nerve compression is involved.

Neurological symptoms of spinal stenosis can vary depending on the location and severity of the irritation of the spinal cord or nerve roots. These symptoms typically occur below the level of the stenosis. Numbness or tingling sensations may be experienced in your arms, hands, legs, or feet. Muscle weakness can develop in your limbs, which makes it difficult to perform certain tasks or activities. Some individuals may also experience sharp, shooting pain or electric shock-like sensations that radiate down the arms or legs.

Additionally, changes in reflexes, such as diminished or exaggerated reflex responses, may be observed during a physical examination. It is important to seek medical attention if you experience any neurological symptoms associated with spinal stenosis, as a healthcare professional can conduct a thorough evaluation, perform diagnostic tests, and recommend appropriate treatment options to help alleviate your symptoms and improve your overall well-being.

5. Disc herniations or slipped discs

disc herniation, neck pain
Disc herniation occurs when the soft, gel-like center (nucleus pulposus) of an intervertebral disc in the spine pushes through a weakened or damaged outer layer (annulus fibrosus). This can occur in the neck, upper back or low back.

Spinal discs, also known as intervertebral discs, are structures located between the vertebrae of your spine. They play a vital role in providing cushioning, shock absorption, and flexibility to the spine. Each disc consists of an outer layer called the annulus fibrosus and an inner gel-like core known as the nucleus pulposus. The annulus fibrosus is made up of strong fibrous cartilage that surrounds and supports the nucleus pulposus. It provides stability to the disc and helps contain the gel-like material within.

The nucleus pulposus, on the other hand, acts as a shock absorber. It is composed of a soft, jelly-like substance that consists of water, proteins, and other compounds. The gel-like core allows the disc to distribute forces evenly across the spine, reducing impact during various movements and activities.

However, as you age, the spinal discs undergo natural changes. They can lose water content and become less flexible. These age-related changes can lead to conditions such as degenerative disc disease, herniated discs, or bulging discs, which may cause pain, discomfort, and nerve compression.

When a disc in your cervical spine, bulges or ruptures, you can get neck pain. The bulging or ruptured disc may put pressure on the nearby nerves, resulting in neurological symptoms to a spinal stenosis. When your nerve is compressed or irritated, it can send abnormal signals to your body. This causes sensations such as weakness, numbness, or tingling in your arm.

6. Stress and Tension

When you experience emotional stress and tension, it can manifest physically as neck pain. You may notice tightness and discomfort in the muscles of your neck, along with a general sense of stiffness. This is because stress and tension often lead to muscle tightness and increased sensitivity to pain.

The connection between emotional stress and neck pain is complex. Stress can cause muscles to tighten, affecting various parts of your body, including the neck and upper back. When you are stressed, your body’s stress response triggers the release of hormones that can contribute to muscle tension and inflammation.

Additionally, emotional stress can influence your posture and movement patterns. You may find yourself hunching your shoulders or clenching your jaw when feeling stressed, placing additional strain on the muscles of your neck. Over time, these repetitive stress-related postures and movements can exacerbate muscle imbalances and contribute to ongoing neck pain.

How do you know if neck pain is serious?

While most cases of neck pain are not serious and resolve on their own with time and self-care, there are certain “red flags” that indicate the need for immediate medical attention. These red flags suggest the possibility of an underlying condition or injury that requires prompt evaluation and treatment. It is important that you are aware of these red flags and seek medical assistance as soon as possible!

Neck pain following a recent trauma, such as a car accident, fall, or sports-related incident, should never be ignored. It is essential to seek immediate medical evaluation as traumatic injuries can lead to fractures or dislocations. Prompt diagnosis and appropriate treatment is key to a successful recovery.

If you experience radiating pain, numbness, tingling, or weakness in your arms or legs, it could indicate nerve compression or spinal cord involvement. These symptoms warrant urgent medical evaluation. Loss of bladder or bowel control is a major red flag. If you experience loss of control or inability to urinate, it could be a sign of a serious spinal injury that requires immediate medical attention. You should head to hospital immediately.

Fever, headache, and stiffness in the neck could be indicative of meningitis. Meningitis is an infection of the membranes surrounding the brain and spinal cord and is a medical emergency that requires immediate evaluation.

If you experience any of these red flags or have concerns about your neck pain, it is recommended to consult with a healthcare professional. They can assess your symptoms, perform necessary examinations, and order appropriate tests to determine the underlying cause. Remember, early intervention is key to effectively managing serious conditions.

Should I be worried about constant neck pain?

cost of chronic pain breakdown
Not only does chronic pain affect almost 10% of Singaporeans, it also cost our economy over a billion dollars every year!

Chronicity refers to the condition of persistent or long-lasting pain that extends beyond the expected healing time. When pain is left untreated or unmanaged for an extended period, it has the potential to become chronic. Unlike acute pain, which typically resolves as the underlying issue heals, chronic pain persists for months or even years.

When your pain becomes chronic, it can have a significant impact on your physical, emotional, and social well-being. It may lead to functional limitations, reduced quality of life, and increased dependency on medications or other interventions. Chronic pain can also contribute to mental health issues such as depression, anxiety, and sleep disturbances.

The longer pain persists, the more likely it is to become chronic. Early intervention and appropriate treatment for acute pain are crucial to prevent its transition into chronic pain. If pain is left unaddressed, the nervous system can undergo changes that amplify and perpetuate the pain signals, making it more difficult to break the cycle.

Delayed treatment for your neck pain means longer recovery with poorer results

The persistent pain in your neck can lead to deconditioning of the neck musculature. When you experience ongoing pain, it is natural to try to protect the affected area by limiting movement and resting more. However, excessive rest and avoidance of certain activities can result in further muscle weakness and loss of flexibility in the neck.

As your neck muscles weaken, they become less able to provide adequate support and stability to your neck. This can lead to a decrease in your neck’s overall robustness and resilience. Weakened muscles are more prone to strains and injuries, further exacerbating the pain and discomfort you experience.

The downward spiral of chronic pain, decreased movement, muscle deconditioning, and increased vulnerability to strains and injuries creates a cycle that perpetuates the pain and hinders recovery. The fear of pain and potential injury may also lead to avoidance of activities that could otherwise help improve strength and mobility, resulting in further deconditioning and functional limitations.

Do not load a weak and painful neck without professional supervision

pain-free, pain management
Many people don’t recover from their pain because of poor load management. By better understanding your condition and knowing what to do, you can successfully return back to your normal life!

Exercising when you have neck pain can be challenging and requires careful consideration. Be mindful of how certain exercises or movements worsen your pain. Overloading your already painful neck can cause more harm than good.

Moreover, neck pain often accompanies aberrant neck movement patterns. These abnormal movements can contribute to ongoing pain and dysfunction. Engaging in exercises on your own without proper guidance may inadvertently reinforce these faulty movement patterns, potentially causing more problems in the future.

To ensure a safe and effective approach to exercising with neck pain, it is advisable to seek guidance from our chiropractor. Our chiropractor Jesse Cai can assess your condition and provide personalised recommendations.

Prevention is always better than cure. However, when faced with pain or injury, seeking professional chiropractic help early is the next best step towards achieving a successful recovery. By seeing a chiropractor promptly, you give yourself the opportunity to receive an accurate diagnosis, appropriate treatment, and timely interventions. Early intervention can prevent the condition from worsening, minimize potential complications, and improve your chances of a full and speedy recovery.

Who is best to see for neck pain?

neck ache, neck and shoulder pain, neck pain
Jesse Cai guiding award-winning wakeboarder Clare Yau through a series of neck exercises. You can exercise your neck ache and soreness away!

When it comes to finding the best person to address your neck pain, the most important factor is finding the right fit for you. If you are seeking quick relief, a doctor can provide painkillers or medications to manage your symptoms. Alternatively, a chiropractor specialises in traditional adjustments that can alleviate pain temporarily. The problem with either approach is that they force you to be dependent on a practitioner for pain relief.

If you prefer taking charge of your own recovery, Square One Active Recovery may be the right fit for you. Our mission at our chiropractic clinic is to make our own services redundant to our client. To achieve this, we empower our clients to heal themselves. This reduces your reliance on ongoing treatments. Through guided exercise and lifestyle changes, we offer an evidence-based biopsychosocial aka biopsychosocial approach. Our goal is to provide you with the tools and knowledge to take control of your recovery, so you can achieve long-lasting results and eliminate the need for continuous treatment.

Can a chiropractor help with neck pain?

Yes, chiropractors can help with neck pain. Chiropractors are allied healthcare professionals who are trained to diagnose and treat musculoskeletal disorders. Chiropractors primarily focus on the spine and its surrounding structures, but can also treat other muscle and joints usually. Manual adjustments is a popular technique used by chiropractors to alleviate pain.

Chiropractors may also utilise other therapies such as soft tissue mobilisation, therapeutic ultrasound, electrical stimulation, and spinal traction to support the healing process.

Many of the techniques used by traditional chiropractors are considered passive treatments. Passive treatments are therapeutic interventions or techniques that are performed on you by a practitioner without requiring your active participation. The problem with passive treatments is that the pain relief is dependent on other person. In other words, the pain relief tends to be short-lived. This why repeated treatments are often required and there is no true freedom from pain.

What happens when a chiropractor adjust your neck?

chiropractor singapore, jesse cai
Our chiropractor Jesse Cai use to perform chiropractic adjustments for neck pain patients. Although many clients do experience an immediate relief, they are often temporarily. This is why we have stopped offering manipulations and now take an active recovery approach.

When a chiropractor adjusts your neck, precise force to the joints of your neck. The purpose of this adjustment is to improve joint mobility, relieve pain, and restore proper alignment and function to your cervical spine. During the adjustment, the chiropractor may use different techniques, such as manual manipulation or instrument-assisted adjustments, depending on their assessment of your condition.

The goal of the adjustment is to address any restrictions or misalignments in your neck joints. By applying this force, the chiropractor aims to restore normal joint movement and alleviate pressure on surrounding tissues, including nerves. While this often provides pain relief, it can be painful for some people.

You may hear a popping or cracking sound during the adjustment, which is known as cavitation. This sound occurs when gas bubbles are released from the joint fluid as the joint is manipulated. It is typically painless and not a cause for concern.

After the neck adjustment, you may experience various effects. Some individuals report immediate relief from pain, increased range of motion, and improved overall comfort. Others may temporarily experience some soreness or stiffness, which usually self-resolves.

Cervical manipulations are not typically considered a long-term pain solution. While they can provide temporary relief by addressing certain mechanical issues or joint restrictions, they do not address muscular imbalances or lifestyle factors. Additionally, neck manipulation is not something you can perform yourself. In other words, you need to always go back for more treatments! A comprehensive approach that includes exercise and lifestyle changes is often necessary for long-term pain management.

How is neck pain at Square One Active Recovery different?

At Square One Active Recovery, we focus on active recovery. Active treatments require active participation and effort from the individual receiving the treatment. These treatments typically involve physical activity, exercises, and lifestyle modification. The aim is to improve your body’s own robustness and resilience so you are less likely to experience pain and injury. In doing so, you will also see improvements in strength, flexibility, endurance, and overall physical function.

You can also prevent future injuries through addressing imbalances, weaknesses, and faulty movement patterns. This lead to long-term benefits because you are addressing underlying causes. By also working on your physical well-being, you are taking a holistic approach to recovery.

Lastly, an active recovery approach increases independence and self-empowerment. Since you actively participate in your recovery, you are taking control of your condition. This gives a sense of empowerment over your well-being and reduce helplessness often associated with persistent pain.

Why won’t my neck pain go away?

Your neck pain is not going away because you are not doing the right thing for it. If it has been more than 12 weeks, you should consider professional help.

Most people try to help themselves by doing home stretches or self-medicate. While your efforts are commendable, these strategies are often not enough for you to achieve long-term outcomes.

chiropractor singapore, pain solution

As a chiropractor that focuses on long-term solutions, we work with clients with chronic pain and help them develop self-management strategies. After taking a thorough medical history and physical examination, we work with you to develop an effective neck pain treatment programme.

Instead of asking you to come back multiple times a week until you feel better, we use a test-retest process to find out what’s going on. This allows us to develop a truly personalised solutions for you.

Based on how you respond to various exercises and advice, we are able to predict how your unique symptoms behave, and subsequently design a recovery programme that works just for you.

Does stress cause neck pain?

pain solutions, chronic pain, chiropractor singapore
When we think of pain, we only thing of “something wrong”. Fortunately for us, pain is a much more complex process and the right treatment can lead to very favourable outcomes. Source: Common Sense Model

We know about the biopsychosocial model for health for some time now.

However, not many — if at all — chiropractors or physiotherapists actually address pain in a holistic, whole-person approach.

The status quo is chiropractors trying to adjust or manipulate your joints or physiotherapists trying to breakdown scar tissue or release tension.

Both structural (and problem-based) approaches are considered to be outdated not not congruent with best evidence practice.

With advancement in neuroscience, we know that people your state of mind can change how your brain process pain. Similarly, we also know that you can change your brain — even to a structural extent — with mindfulness practice.

Other research has shown that stress can make a person more susceptible to pain and it is only of the potential reasons why some people experience chronic pain.

A 2018 study looking at 2339 neck pain sufferers and 3290 healthy participants found that anxiety/depression symptoms are associated with neck pain.

A later study in 2019 examining depression and anxiety in lower back pain patients found anxious and depression patients to experience more severe pain.

In short, the neck discomfort you experience is NOT strictly physical.

Take a few minutes to consider your own experience.

Are you able to identify stressful or busy periods when you experience more severe symptoms than usual?

Acute neck pain

Occasionally, we may accidentally strain our neck muscles or sprain the joints in our necks in our day-to-day life (e.g., poor sleeping position).

This is totally normal and part of the human experience.

The sensation is usually very painful at the onset but will subside with time. Such muscle spasm and ligament pain episodes can last for a couple of days to up to six weeks. In such cases, do consider applying some load management principles to avoid aggravating your pain.

A heat pack will also help.

Current clinical guidelines suggestion avoiding bed rest and neck brace, and to keep active as much as possible.

Cervical radiculopathy

slipped disc, disc herniation, cervical radiculopathy
Intervertebral disc herniations may seem scary. However, over 70-80% of patients with cervical radiculopathy respond well to conservative treatment. Surgical treatment is optional. Source: Spine Universe

Some of you may have been told that you have a pinched nerve.

It is indeed possible for pinched nerve roots or bone spurs (e.g., narrowing of spinal canal) to contribute to your neck pain experience.

They typically come with numbness and tingling (known also as radiculopathy) down your arms.

As uncomfortable as they may sound, pinched nerve are minor problems that mostly resolve on their own with time.

If you are worried about slipped disc, understand that herniated discs will resorb over time. That is, it will “unslip” itself back into place.

For more information about radiculopathy and the various treatment approaches for that, check out our post on sciatica.

When to worry about your neck problems

red flags, radicular neck pain, mri
If you are experiencing any of the above symptoms, you should seek emergency care with for neck pain. Source: American Family Physician

Over 90% of neck pain are not serious medical conditions. While the pain may be intense and feels worrisome, most patients with neck symptoms do not need immediate medical attention.

If you experience one of the following “red flags” signs and symptoms, please seek medical advice as soon as possible:

  • Unexplained weight loss or weight gain
  • Unexplained fever, chills, or night sweats
  • Unable to bend your neck forwards
  • Loss of bladder or bowel control
  • Numbness or weakness on only one side of your face, arm, or leg
  • Difficulty speaking or swallowing
  • Visual disturbances – sudden loss of vision, tunnel vision
  • Sudden tension headache onset that is unlike those you have had before

If your neck muscles hurt for more than six weeks, you may want to consider seeking professional help from a chiropractor or physiotherapist.

Your chiropractor will be able to help you manage your symptoms.

A good chiropractor will prescribe you with exercises to give you long-term relief. They may also address the lifestyle changes (e.g. better sleep quality, more physical activity, better stress management) to help you manage your symptoms.

It is unlikely that you will need to consult a spine surgeon. In the rare cases where there may be brain and spinal cord involvement (e.g. spinal stenosis), your chiropractor will refer you to an orthopaedic surgeon or neurologist.

What exercises help neck pain?

I know your neck soreness is real and it is a distressing experience. The best thing you can do for yourself at this stage is to relax. If you are having trouble directing your attention away from your cervical spine, you might want to consider mindfulness practice.

Once you are fairly relaxed, there are a few neck pain exercises you may consider trying:

1) Resistance Neck Exercises

2) Range of Motion Exercises

3) Resisted Range of Motion Exercises

(Videos to come.)

The latest clinical practice guideline for neck injury does not support the use of pain killers.

Can chiropractors help neck pain?

jesse cai, neck pain, chiropractor singapore
Paul Foster, star of Netflix reality show Singapore Social, receiving a neck massage for chronic neck pain. While manual therapy is not a long term pain solution, it does provide temporary pain relief. P.S. I no longer offer short-term relief at Square One Active Recovery

The biggest difference between a chiropractor and a massage therapist or stretch therapist is the training they received. Chiropractors are musculoskeletal (i.e. muscle and joints) health experts who had undergone years of chiropractic clinical training to diagnose and treat your symptoms.

On the other hand, masseuse do no have clinical training and by extension cannot diagnose your neck pain. It is common for massage therapist to treat your pain with only manual therapy (soft tissue massage, trigger point therapy, etc).

Chiropractors are trained to provide  an array of treatments such as chiropractic adjustments, dry needling, exercise rehabilitation, physical therapy, ultrasound or laser therapy.

To become an accredited doctor of chiropractic in Australia, chiropractors trained for a minimum of five years at a university level.

How can I relieve my “stiff neck”?

If you are thinking of choosing between a chiropractor or a massage for your stiff neck, choose neither.

Believe it or not, the best treatment for neck pain is actually exercise.

While common passive treatments as such chiropractic adjustments, dry needling, IASTM, trigger point therapy are great for providing some short term relief, exercise + education/coaching is the best approach to long term pain free living.

Instead of focusing solely on pain relief, exercise therapy also takes into consideration your capacity for your current lifestyle.

A good massage may help you feel better for a few days but the discomfort almost certainly always comes back.

Forget the “stiff neck remedy”, a good exercise prescription program will address factors that contributes to your pain so you can achieve long term results.

If you spend eight hours at the computer and your neck starts to ache after two hours, a bad chiropractor or physiotherapist will ask you to spend less time at a computer.

Focus on increasing how much you can do rather than how little pain you feel.

On the other hand, good chiropractors will look at why your symptoms start after two hours and increase your capacity to sit to beyond eight hours. This can be achieve through neck strengthening exercises.

The direct result? You get less pain.

Manual therapy tend to focus on relaxing the muscle strain in neck or removing trigger points. None of these approaches are supported by current research. A paper published earlier this year on the 11 best recommendations for musculoskeletal pain advise for hands-on therapy to be used only as an adjunct.

As for what you can do for yourself at home, you may want to gentle stretching to relieve pain.

If you have a heat pack or heating pad, they tend to help with aches and soreness as well.

I do not recommend that you apply ice because evidence to support icing – even in acute or sport injury cases – is lacking.

Chiropractic treatment for neck pain

Traditional chiropractors believe that chiropractic subluxations are the common cause of neck symptoms. Their approach to your pain consequentially revolve around treatments to remove subluxations. However, no reasonable quality research to date has been able to demonstrate the existence of chiropractic subluxation.

Read more about how subluxation is dogma rather than science.

In addition to that, results with subluxation-based chiropractors tend to be slow and/or short term. It is not uncommon to hear about them selling packages from 12 up to over 40 sessions.

Unfortunately, there are few chiropractic adjustment benefits. Most of which are short-term. This may be why chiropractors who only do adjustments need to sell packages. To learn more, check out our blog post on spinal manipulation.

Chiropractor for stiff neck

Evidence-based chiropractors are completely different from the traditional chiropractors. We take into consideration the latest research on what works the best for your neck pain.

Because we are willing to adapt and embrace the latest research, we offer more than just spinal adjustments. As a result, you get better results with us than traditional chiropractors.

Square One is one of the only practices in Singapore to offer an evidence-based approach to your neck pain. Over 80% of our clients will experience resolution of their symptoms within four to seven visits. This could be you.

In your treatment program, I will take into consideration your current lifestyle (sedentary vs. athletic) and work with your goals.

If your goal is to sit at the computer for eight hours, I am going to help you achieve that.

If you have a tendency to sprain your neck during your weekly tennis games, I will work with you to address the factors that are contributing to your neck sprain.

Square One likely offers the most holistic approach to neck pain relief and we deliver true long term results.

What now?

Take your time to process what it means to be living with neck pain. If we are looking to start chiropractic treatment for neck pain with Square One, you can book an appointment with us via the form below. We are located at Bukit Pasoh Road, just two minutes away from Outram Park MRT (purple line, Dorsett Hotel exit).


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.