Do I Need a Referral to See a Chiropractor?
No. In New Zealand you can book an appointment with a chiropractor directly. You do not need a referral from your GP, and you do not need to be referred by any other health professional.
Chiropractic is legally defined as a primary healthcare profession under the Health Practitioners Competence Assurance Act 2003. "Primary contact" means patients can come straight to us — the same way you would book a GP or a dentist without needing permission from someone else first.
That said, there are situations where involving your GP is useful, and some things worth understanding about what a chiropractor can and cannot do. Those are covered below.
Can My Doctor Refer Me to a Chiropractor?
Yes, and GPs do refer patients to chiropractors — but the referral is a recommendation, not a requirement. It carries no special access or funding. If your GP has suggested chiropractic care, you can simply book. If you found us yourself, that is equally fine.
Where a GP referral does add value is in continuity. If your doctor has already investigated your problem, ordered imaging, or is managing related conditions, that background helps considerably. With your consent we correspond with your GP so everyone is working from the same clinical picture.
Do I Need a Referral for ACC to Cover My Treatment?
No. ACC claims for injury are lodged directly at the practice. You do not need to see your GP first to start a claim, and you do not need a referral for ACC-funded chiropractic care.
If your injury is covered, ACC pays a portion of the cost and you pay a part-charge. Bring the details of any existing claim if you have one — if the injury is new, the claim is lodged at your first appointment.
Can a Chiropractor Diagnose?
Yes. Forming and communicating a diagnosis is explicitly part of the registered scope of practice for chiropractors in New Zealand. That includes differential diagnosis — the process of systematically working out which of several possible causes best explains your symptoms, and ruling out the others.
In practice, diagnosis is the most important part of the consultation. A treatment plan is only as good as the diagnosis it is built on, and a significant proportion of people who have not improved elsewhere have been treated accurately for the wrong problem.
Can a Chiropractor Refer Me for an X-ray, MRI or Scan?
X-rays, yes — directly. Chiropractors in New Zealand can take or order plain X-rays as part of an assessment.
MRI and CT scans work differently, and the distinction matters. A chiropractor can refer you for a private MRI or CT, which you pay for yourself. But funded imaging — through ACC or the public hospital system — has to be requested by a specialist. A chiropractor cannot order a funded MRI or CT directly, and neither can your GP in most circumstances.
So if you need a funded scan, the pathway runs through a specialist. What matters then is the quality of the referral that gets you there: a clear history, documented examination findings, and a specific clinical question. A well-made case moves faster and is more likely to result in the scan actually being approved.
Worth saying plainly: scanning early is one of the most common problems in back pain care. MRI frequently finds age-related changes that are present in people with no pain at all, and those incidental findings cause real and unnecessary worry. Imaging earns its place when the result would change the plan. Most of the time it would not.
Can a Chiropractor Refer Me to a Specialist?
Yes. Recognising conditions that require referral to another practitioner — and making that referral — is part of the scope of practice, and is treated as a core competency rather than an optional extra.
Referrals from this practice go out as full clinical correspondence: history, examination findings, working diagnosis and the specific question being asked. Where a referral needs to route through your GP for funding or public system access, that letter goes to your GP with the reasoning set out.
Is a Chiropractor a Specialist?
In New Zealand, "specialist" is a protected term with a specific legal meaning in medicine, and it does not apply to chiropractors. Chiropractic has one registered scope of practice rather than recognised specialty branches.
There are, however, post-doctoral board qualifications that sit above the standard registration. The Chiropractic Board scope explicitly provides for this: where a chiropractor holds postgraduate certification or diplomate status, they may use that additional training within their care.
Dr Nigel Peek holds Diplomate status with the International Academy of Neuromusculoskeletal Medicine (DIANM) — the board certification underpinning the title Chiropractic Orthopaedist — alongside a Postgraduate Diploma in Health Sciences with Distinction from the University of Otago, endorsed in Pain and Pain Management.
When Should I See My GP Instead?
Book with your GP first, or alongside chiropractic care, if you have any of the following:
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Loss of bladder or bowel control, or numbness around the groin and inner thighs — this needs same-day medical assessment
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Unexplained weight loss, fevers or night sweats alongside your pain
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Progressive weakness in an arm or leg that is getting worse rather than better
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A history of cancer with new, unexplained spinal pain
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Significant trauma — a fall from height or a vehicle accident
If any of these come up during an assessment here, the appropriate referral is made immediately. Knowing what not to treat is part of the job.
What Happens at a First Appointment?
A detailed history, a physical examination, and an explanation of what is going on in plain language. If imaging or referral is warranted, that is arranged. If chiropractic care is not the right approach for your problem, you will be told so directly.
Peek Practice is in Grey Lynn, Auckland. ACC registered. No referral required.
Your First Visit - What to Expect
An initial consultation at this practice involves a full assessment of your complaint and your reason for seeking care. This involves information gathering in the form of a questionnaire followed by a full relevant examination, typically of the spine, musculoskeletal, and nervous system.
Your practitioner will assess your condition based on the information gathered, give a working diagnosis, and provide a suitable individualised treatment plan based on the best evidence suited to the management of your specific condition.
Please be assured that if we do not think that we can help you, or if our examination reveals any additional concerns, we will refer you appropriately and liaise with your general practitioner on your behalf.
Will I get treatment on my first visit?
Treatment is not always delivered on your first visit, this will depend on how various factors such as the complexity of your case and the need for further investigation should this be required.
Will I need X-Rays or other tests?
It is not necessary for you to undergo any X-rays or other tests before consulting with the chiropractors at Peek Practice. Diagnostic imaging such as X-rays and Ultrasound will only be acquired when clinically indicated
What is Chiropractic Treatment and How Does it Work?
Chiropractors and manual therapists use a range of hands-on techniques to move the body, including stretching tissues and moving joints to improve tissue mobility and motion.
In manual therapy practice we like to say, “motion is lotion”. Moving the tissues helps to improve the way the tissues and joints slide and glide and reduces mechanical stress on the human frame.
Spinal manipulation is a specific manual treatment technique that delivers a very controlled, rapid stretch to the joints and soft tissues of the spine.
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When we manipulate a painful or restricted joint, we are stretching it. This opens the joint surfaces and helps to reduce tension and improve range of motion (15-17)
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Stretching the segments of the spine also influences the discs of the spine, and may help to increase the water content of the disc (18)
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Some studies have shown that spinal manipulation improves the flexibility of the nerves exiting the spine (19, 20)
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Chemical effects. Studies have shown that certain inflammatory chemicals are reduced following spinal manipulation (21-26)
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Movement reduces pain. Stretching joints and muscles decreases and alters the flow of pain signals from spinal cord to brain (26-28)
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Improved strength. Muscle strength improves following spinal manipulation (38-40)
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Improved balance and movement control. Brain activity changes following spinal manipulation, and this may lead to better balance and more refined movement control (41)
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Reaction times. There is some evidence that spinal manipulation improves reaction times and reflex control (42)
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Brain effects. Several studies have looked at the effects of spinal manipulation on the brain, with promising research indicating that spinal manipulation may help re-organise and reshape brain connections (39, 43)
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The effects and mechanisms of spinal manipulation are complex.
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There is still much work to be done to define how it works.
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The benefits and mechanisms of action are likely a combination of factors.
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Benefits are likely to extend beyond pain relief and may improve quality of life.
Is Manipulation and Manual Treatment Effective for Neck and Back Pain?
Since pain is considered to be a multidimensional complex interaction of biological, psychological, and social dimensions, it is important to remember that there is no one technique or treatment that satisfies all its aspects.
Spinal Manipulation for back pain
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First-line
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Effective
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Safe
Some comprehensive systematic reviews (considered as the pinnacle of evidence) have not provided clear evidence that SM shows clear benefit over placebo (59, 60). However, there are a number of recent reviews that are beginning to build a picture in favour of SM in the treatment of back and neck pain (55, 61-64).
Despite historical criticism that the quality of evidence is poor for spinal manipulation, the recent momentum in favour of spinal manipulation as a first line approach with specific reference to back pain is compelling. This is illustrated in several best practice guidelines and high-level expert opinion pieces (3,4,63-66). A recent article in The Lancet, a prestigious medical journal, recommends spinal manipulation for the treatment of both acute and chronic back pain (4). Although the body of literature is not as comprehensive for neck pain, similar recent recommendations and reviews advocate spinal manipulation (3,63).
Comparative Effectiveness
Commonly prescribed medications are not supported by strong evidence for back and neck pain. Whilst there are several treatment approaches for neck and back pain, the research indicates that conservative measures should be utilised ahead of more invasive surgical and pharmaceutical treatments (4). The effectiveness of widely prescribed “first line” drugs such as anti-inflammatory medications (e.g., diclofenac or ibuprofen) have yet to be established. Recent substantive systematic reviews fail to highlight compelling benefits over placebo (67). These results are similar for other readily prescribed pain medications such as paracetamol (68). Other routine medical treatments such as steroid injections have yet to demonstrate superior efficacy (69).
A recent trial compared diclofenac to spinal manipulation and found “in a subgroup of patients’ spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo (70). Furthermore, commonly prescribed drugs and surgeries have well documented side effects and adverse reactions (71).
Safety
Your safety is our first concern, but this involves more than just the way in which you may be treated
Spinal manipulation has proven itself to be remarkably safe when used appropriately. The effectiveness and safety of any tool is only as good as the knowledge that underlies its use, and it is this dedication to knowledge that you can rely upon at Peek Practice.
Serious adverse events following spinal manipulation are rare. Risks should also be weighed against the benefits of treatment, and patients should be given the opportunity to choose, based on the information provided to them about potential risk
Adverse Events Following Spinal Manipulation
Many important and common treatments carry risks; however, these should be put into context. Spinal manipulation is not risk free. However, whilst serious events are considered very rare, the risks should be disclosed to patients prior to treatment (73).
The following is a basic overview.
Minor events: usually involve a transient increase in symptoms, generally occurring within 24 hours of treatment. These include muscle soreness, tiredness, nausea, light-headedness, tingling in the arms. These symptoms usually resolve within 24-48 hours and are reversible (73).
Moderate events; including rib fractures, vertebral fractures, and disc injuries. These are usually reversible but cause significant discomfort and distress. These are classified as rare to very rare (1 in 100 000 treatments) (73). Research also tells us that underlying and pre-existing problems are likely present prior to the event occurring - for example, a disc injury was present prior to treatment (76).
Major, serious events; including spinal cord injury, stroke and blood vessel trauma. These are serious and may be irreversible, disabling, and in extremely rare cases, death has been reported (risk range is between 1 in 230 thousand to 1 in 3.8 million treatments)
Research also tells us that underlying and pre-existing problems are likely present prior to the event occurring and symptoms of the injury or disease are present prior to delivery of treatment (73, 76-80).
In other words, the symptoms that the person presented with were likely to evolve into a worsening state independent of whether they received treatment or not.
Common pain medications and medical procedures have significant risk profiles. Let’s compare the risks of spinal manipulation with some common medications and medical procedures prescribed for back and neck pain.
Medications and Steroid Injections
Diclofenac (Voltaren®) Ibuprofen (Brufen®) are common pain-relieving/anti-inflammatory drugs readily prescribed for back and neck pain. Side effects and adverse events include kidney failure, heart complications, gastrointestinal bleeds, and stroke (27). Some reports from the United States estimate 16 500 deaths as a direct consequence of anti-inflammatory medications (81, 82). One author suggests that for every $1 spent on anti-inflammatories 0.66c was spent for treating the related adverse events (83).
Steroid Injections
Epidural corticosteroid injections are a commonly utilised medical intervention for back and neck pain. Whilst considered uncommon, these are significant. (84).
Severe adverse events for spinal injections include infection, spinal cord injury, blindness, brain bleeds, stroke, cardiac arrest, anaphylaxis and death (84).
The Stroke Issue
One commonly discussed topic is the risk of a stroke following spinal manipulation of the neck. This has led some to propose a complete ban on neck manipulation (72, 85).
What is the underlying mechanism? Studies have linked damage to one of the main arteries in the neck to the development of a type of stroke. Some of these strokes have occurred following spinal manipulation. This type of stroke is a rare event, and this event is infrequently associated with spinal manipulation (1 in 228,050–1,000,000 manipulations (86). The concern raised however is that even though this is a rare event, the consequences could be severe, disabling, and at times life threatening (72, 85).
What the evidence says
Numerous studies have been conducted in large populations to assess the risk of stroke following neck manipulation (77-79, 87). This research demonstrates an association between spinal manipulation of the neck and stroke; however, when these researchers compared this to patients who had recently seen their general practitioner, they found the same association. In other words, strokes were equally associated with chiropractic visits and general practitioner visits (77-80, 87).
“There is no convincing evidence to support a causal link between chiropractic manipulation and stroke” (24)
What does this mean?
General practitioners do not perform neck manipulation, but they do consult patients for pain. Therefore, patients will consult either a GP or a manual therapist for pain. The most common symptoms of early onset of stroke are head and neck pain i.e. the symptoms of the event lead to the patient seeking care. This explains an association, not a direct cause and effect relationship (77-79, 87).
Further research on this topic has looked at the stress applied to the artery during spinal manipulation, and these authors found that stresses applied during spinal manipulation were lower than those produced during simple range of motion testing (88-90)
Conditions We Treat
What do you treat? Do you help with more than back and neck pain?
Peek Practice treats a wide range of conditions beyond neck and back pain, including
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Headache and migraine disorders
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Dizziness and balance disorders
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Fibromyalgia and Widespread Pain Disorders
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Nerve pain and sciatica
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Carpal tunnel syndrome
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Tingling and numbness in the limbs
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Sports injuries
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Repetitive strain injuries
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Mechanical chest wall pain
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Pain between the shoulder blades
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Postural problems
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Shoulder problems
What other treatment approaches do you use? Can you help me without cracking my back and neck?
Chiropractic is a profession and is not defined by one specific approach or technique. At Peek Practice we offer a contemporary approach to management of spine and spine related disorders – in addition to the more traditional chiropractic approach we also offer alternative treatment strategies that the best science supports. This includes the use of soft tissue treatments (including massage), joint mobilisations and lower force techniques that don’t involve “joint cracking”. The treatment approach will be determined by your preferences and the best advice based on current knowledge of your specific condition.
The word chiropractic in a literal sense means treatment by hand. Our practitioner is a registered chiropractor with a 6-year master’s degree in chiropractic. Whilst chiropractic is our primary professional label, this clinic applies a range of interventions beyond traditional chiropractic practises. At Peek Practice we utilise a range of current evidence-based approaches to treat your area of concern. These may include joint mobilisations and manipulations, soft tissue treatments (including massage), acupuncture and dry needling.
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We do not just "crack backs", chiropractic is a healthcare profession; it is not defined solely by the use of one technique.
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Spinal manipulation or spinal adjustments are used in this clinic where indicated, we also use a number of other techniques that may be less "invasive" and more appropriate, particularly if you are apprehensive about joint cracking.
A key focus at this clinic is to deliver patient-centred care, this involves a combination of your treatment preferences and goals, the practitioners experience, and a current evidence-based approach to the management of your condition. We also aim to encourage self-efficacy beyond treatment and provide you with the tools to develop a healthier and more active lifestyle.
What to Expect During and After Treatment
Spinal manipulation, mobilisation, soft tissue therapy techniques involve movement of tissues to restore function, at times during treatment there may be mild associated discomfort. Similarly, with needling procedures discomfort around the needle is usually experienced. This is considered to be part of treatment. Most patients find the treatment process relieving and understand this to be an important part of treatment and for some the significant relief immediately following treatment is significant. However, if you are in significant discomfort during treatment, please advise your practitioner so they can modify their technique (we are all different in our preferences).
Whilst some may find significant relief following treatment, it is not uncommon to experience a transient increase in your symptoms in the first 24 to 48 hours following an appointment. This is not always a desirable effect; however, this slight aggravation or general soreness may also be a sign that changes are occurring, and you are responding favourably.
If you are concerned about any changes in pain or other symptoms, contact your practitioner. We do provide you with a mobile contact for after-hours advice and care.
It is also important to understand that meaningful changes in your symptoms may take time. This is particularly the case if you have experienced pain for an extended period of time. Remember, pain fluctuates, and some days will be better than others. This is normal.
What we notice is that when people improve from treatment, they have good days and bad days, eventually over the course of time the good days outweigh the bad days. Also understand that back pain has a habit of returning and many or most patients will experience further episodes in the future. The important thing to remember is not to panic or overthink it when pain returns, seek help, remain active as best you can and stay positive.
Recovery Tips
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There may be some discomfort during and following treatment.
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Treatment for back and neck pain is a process; it can take time to get results.
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Pain comes and goes; some days are better than others.
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Pain may return in the future.
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Remain optimistic and positive about the future.
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Patients that do well with treatment often display the following characteristics.
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They are optimistic and open to treatment.
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They take and active interest in the issue and want to know more about it.
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They are accepting of pain as a function of life.
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They challenge their pain and focus on the future.
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They comply with treatment recommendations and advice.
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They are active and have healthy sleep and dietary habits.
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How to Get Best Results from treatment
A number of studies have shown that the benefits from manual treatments including manipulation are enhanced when combined with other treatments. More specifically the addition of prescribed home exercises and an overall increase in movement and exercise in general (6, 7). Recent reviews also indicate that chiropractic care in combination with usual medical care was superior to usual medical care alone (8).
Equally, spinal manipulation is not an absolute remedy for back and neck complaints, there are a myriad of other treatment modalities that show promising results in the treatment of back and neck pain (9). It is also important to note that contemporary chiropractic and manual therapy practice utilises treatment tools best suited to the individual and the presenting complaint, considering best practice guidelines and patient preferences (10).
Alternative treatment methods
Manual therapists use joint mobilisations, stretching techniques, soft tissue techniques, exercise prescription, lifestyle advice, pain education tools, hot and cold therapy, acupuncture and dry needling and in some practices, ultrasound, laser therapy and other electrical modalities. These additions to treatment all have merit and when combined can often produce significant benefits and accelerated recovery.
The chiropractic profession has been modelled on the use of spinal manipulation; however, this one treatment approach should only be applied when best suited to the patient’s condition and specific needs.
Tips for best results
Stay active during your treatment
Follow advice
Adhere to exercise prescription
Be positive in your outlook
Be open to treatment
Be patient (results may take some time)
Communicate effectively about your progress and give feedback
Be honest about your preferences
Show up to your appointments
Remember
There is not one treatment for back and neck pain, this is why there is a huge healthcare industry involving multiple disciplines and practices to address this burden.
Back and neck pain are complex phenomena, and it is important that patients and doctors work together to find the best solution