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Chiropractic, or chiropractic care, is a system of health care with an underlying principle that health problems can be prevented and treated using spinal adjustments in order to correct spinal dysfunction, or subluxations.

Some chiropractors infer a causal relationship between nerve interference or compression at the spine and subsequent problems in more distant parts or organ systems regulated by the nerve. Practitioners of chiropractic are called chiropractors, and in the United States of America they receive the degree Doctor of Chiropractic (D.C.) and are referred to as "doctor". Chiropractors are licensed in all jurisdictions of the United States, in addition to many other countries throughout the world.

There is some objective clinical data and peer-reviewed research that demonstrates the efficacy of certain therapeutic techniques used by chiropractors. The primary therapeutic technique used by chiropractors is joint manipulation (which they term "adjustment"), especially spinal manipulation (which is also used by some other healthcare professions). Spinal manipulation has been shown to have some value in the short-term relief of certain forms of back and neck pain, headaches, and other spine-related conditions. Studies done to demonstrate the efficacy of chiropractic care have produced conflicting results. For example, a 1979 study showed manipulation of the lumbar spine to have no "superior long-term effect compared to other methods of treatment", while a 2005 study stated that "the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs."

Like traditional medical care, chiropractic offices are often seen in professional buildings as well as shopping complexes, and the locker rooms of professional and Olympic athletes. (Chiropractic at the Winter Olympic Games) Medical and chiropractic doctors are found in private practice together partnering as a team for the benefit of the patient. Some chiropractic doctors also employ massage and physiotherapists as adjuncts to chiropractic care.

Because the chiropractic profession emphasizes the importance of healthy lifestyles and does not prescribe drugs or perform surgery, chiropractic care is appealing to health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices. According to a survey released in 2004 by the National Center for Complementary and Alternative Medicine, chiropractic was the fourth most commonly used complementary and alternative medicine therapy among adults in the United States (7.5%).Template:FnTemplate:Fn

History

The roots of chiropractic care can be traced all the way back to the beginning of recorded time. Writings from China and Greece written in 2700 B.C. and 1500 B.C. mention spinal manipulation and the maneuvering of the lower extremities to ease lower back pain. As early as 400 BCE the knowledge of a patient's spine was thought to be important in the treatment of many diseases, with Hippocrates, in his work On the Articulations, writing …knowledge is requisite in many diseases.

Chiropractic was founded by Daniel David Palmer in Davenport, Iowa, USA. Originally working as a magnetic healer, Palmer tried to find a single cause for 100% of all diseases. He reached a point where he even claimed to have succeeded in this mission: A subluxated vertebrae . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column. (From: Palmer DD. The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.)

In 1895, Palmer was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years prior, he felt a pop in his back and had been nearly deaf ever since. Upon examination, Palmer found what he described as a lump that was sore to the touch. He concluded that this lump was a misalignment in the spine and a possible cause of Lillard's deafness. After Palmer supposedly corrected this misalignment, Lillard could reportedly hear the wheels of the horse-drawn carts in the street below. (From: Palmer DD. The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.)

Palmer claimed that no other chiropractor had duplicated this feat:

There was nothing 'accidental' about this as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude' about this adjustment; it was specific so much so that no chiropractor has equalled it.

Lillard's own recollection of the event differs significantly from Palmer's recollection:

For the record, Lillard remembered the incident differently, relating that on the fateful day he had been swapping jokes with a friend in the hall outside Palmer's office. D. D. couldn't help overhearing a conversation loud enough for Harvey's ears, so he came out to join the group and was so amused by one story's punch line that he slapped the janitor on the back with a book he was carrying. A few days later, Lillard told Palmer he believed his hearing had improved, and it was then that Palmer began his experimentation with manipulative procedures. Whatever the exact course of events, Palmer's allegiance quickly shifted from magnetism to manipulation. - James C. Whorton, Nature Cures: The History of Alternative Medicine in America

The term chiropractic originated when Palmer asked a patient - Rev. Samuel Weed - to come up with a name from the Greek language to describe his practice. Of the several names submitted to him, Palmer accepted one which combined the words chiros and praktikos (meaning "done by hand") to describe his adjustment of a vertebra in the spinal column.

Palmer's interest in spiritualism had a major role in his claims regarding the spiritual origins of chiropractic. He claimed to have received the principles of chiropractic "from the other world" (during spiritistic seances), from a "supernatural source", the long dead medical physician, Dr. Jim Atkinson.

While D. D. Palmer founded chiropractic, it is generally recognized that his son, B. J. Palmer, is credited with initiating the research, development and promotion of chiropractic.

Chiropractic has gained general acceptance in the last 40 years as an appropriate treatment for certain back, neck and other spine-related problems. Today, it is covered by many health plans including major medical insurance, car and work-related injuries as well as Medicare in the United States.

Legal History

For decades, the American Medical Association (AMA) conducted a boycott of chiropractic claiming the practice was "unscientific". An antitrust suit brought against the AMA in 1976 - Wilk et al v. American Medical Association et al - by a group of chiropractic doctors charged the AMA, as well as the Joint Council on Accreditation of Hospitals and the American College of Physicians and other medical associations, with restraint of trade. In a landmark decision, the lawsuit was decided in favor of the chiropractic doctors in the Federal Appeals Court, finding the AMA guilty of conspiracy and restraint of trade. However, the court exonerated the Joint Council on Accreditation of Hospitals and the American College of Physicians. The court recognized a "patient care defense," but imposed a difficult burden. The defendants had to show their concern for patients could not have been adequately satisfied in a manner less restrictive of competition. Thus Wilk and later cases greatly limit the use of "quality of care" defense in boycott cases. The ruling means that in the US the right to carry on unrestricted business is very difficult to overcome. The AMA then asked the Supreme Court to hear the case, but the request was refused. The AMA has removed its restrictions on its members, allowing them to refer to, and receive referrals from, doctors of chiropractic.

Nowadays medical physicians and chiropractors look back at their animosity toward each other as a historical process. More and more, the public is demanding that professions work together for the patient's benefit. GPs, orthopedists, neurologists, radiologists and chiropractors consult with each other regarding patient care. The University of Alabama at Birmingham in association with its School of Medicine has a Chiropractic physician faculty member. They are believed to be the first academic institution to utilize chiropractic and provide services in conjunction with its more traditional medical services.

Chiropractic subluxation

Palmer imbued the term "subluxation" with a metaphysical and philosophical meaning. He held that certain dislocations of bones interfered with the "innate intelligence", a kind of spiritual energy or life force dependent upon God that connects the brain to the rest of the body. Palmer claimed that subluxations interfered with the proper communication of this innate intelligence with the rest of the body, and that by fixing them 100% of all diseases could be treated.

In the mid-1990s the Association of Chiropractic Colleges redefined a subluxation as follows: "A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health." In 1997 the Foundation for Chiropractic Education and Research defined a subluxation as "a joint problem (whether a problem with the way the joint is functioning, a physical problem with the joint, or a combination of any of these) that affects the function of nerves and therefore affects the body's organs and general health."

Most chiropractors subscribe to the principle that the body has an intelligent and self-healing physiology. One result of this is the general chiropractic belief that healthcare interventions should consider the person as a whole and that conservative (non-invasive) treatment approaches should be used where possible.

Philosophy of the subluxation

Both chiropractic and mainstream medicine hold that much of the body is controlled by nerve impulses sent to and from the brain along the spinal cord. Whether the brain commanding the foot to move, the foot signaling the brain that it is in pain, or even a simple patellar reflex, the spinal cord is involved. Outgoing impulses from the brain pass down the spinal cord and exit through the appropriate spinal nerve branch held between the vertebrae on either side of the spinal cord. There are 31 pairs of spinal nerves that emerge from the spinal cord; all of which are housed by vertebrae. If the vertebrae are misaligned (subluxated), chiropractic doctors believe that a spinal nerve can be squeezed or pinched and therefore message flow can be compromised. By aligning the vertebrae and removing restrictions on the spinal nerves, chiropractic claims to allow the spinal cord to more effectively relay messages to and from the brain; thus promoting better health.

Scientific support for chiropractic

A study in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing "clinically important differences in pain and disability improvement". A group of chronic low-back patients who underwent chiropractic treatment showed higher pain relief and satisfaction with the care and lower disability scores than a group that underwent medical care.

A 2002 investigation supports that spinal manipulation may benefit patients afflicted with asthma . A 2004 case study showed that spinal manipulation may benefit ADHD patients . Advocates of chiropractic claim that other recent case studies and research support chiropractic's claim to be effective with a range of conditions including autism, asthma and Irritable Bowel Syndrome, Bell's palsy , glaucoma , Crohn's disease , colic , ulcers , and Parkinson's disease , and, in one case, a combination of cortical blindness, cerebral palsy, epilepsy, and recurring otitis media . It's worthwhile to note that case studies are considered "Class V" evidence by medical science, and are thus the least suggestive of all forms of medical evidence.

Chiropractic education, licensure, and regulation

United States

In the United States, the Council on Chiropractic Education (CCE) is in charge of setting minimum guidelines for chiropractic colleges; however, additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice. In 2005, 15 chiropractic programs and 2 chiropractic institutions in the United States were accredited by the CCE. The process of credentialing varies widely by country.

Students often enter chiropractic school with a Bachelor's degree, or with three years of post-secondary education in the sciences and other appropriate coursework. However, in 2005 "only one chiropractic college required a baccalaureate degree as an admission requirement." The minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours. The minimum cumulative GPA for a student entering a chiropractic college is 2.50. Commonly required classes include: communication or language skills, psychology, social science or humanities, biology, organic and inorganic chemistry, and physics. Other common medical classes are: anatomy or embryology, physiology, microbiology, diagnosis, neurology, x-ray, orthopedics, obstetrics, and gynecology.

In the United States, chiropractic programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience. The last 2 years stress courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, orthopedics, neurology, geriatrics, physiotherapy, and nutrition. Coursework in Chiropractic school may also include study in gross anatomy, biochemistry, embryology, microbiology, anatomy and physiology in the first half of formal schooling.

Graduates of chiropractic schools have to complete 5 years of schooling and pass 4 national board exams in order to complete their education. To qualify for licensure, graduates of chiropractic schools must sit for State examination. Most State boards require at least 2 years of undergraduate education; an increasing number are requiring a 4-year bachelor’s degree. All boards require the completion of a 4-year program at an accredited chiropractic college leading to the Doctor of Chiropractic degree. Once licensed, most States require chiropractors to annually attend 12 to 48 hours of continuing education courses.

Chiropractic colleges also offer Postdoctoral training in neurology, orthopedics, sports injuries, nutrition, rehabilitation, industrial consulting, radiology, family practice, pediatrics, and applied chiropractic sciences. Once such training is complete, chiropractors may take specialty exams leading to “diplomate” status in a given specialty including orthopedics, neurology and radiology. Exams are administered by specialty chiropractic associations.

Practice styles and schools of thought

Contemporary chiropractic is divided into three schools of thought - straight, mixer, and reform - which differ in their approaches to patient care. All chiropractic approaches are based on non-invasive, non-medication approaches, with many based on the use of manipulation as a treatment for mechanical musculoskeletal dysfunction of the spine and extremities. The three schools of thought do not correspond exactly to the existing membership organizations, but there are clear trends, with adherents tending to favor certain organizations.

The three categorizations are currently used mainly within the profession and in discussions. Since the actual differences are very real, they are explained here for the benefit of the general public, which is generally unaware of these differences:

1. Straight chiropractors primarily concern themselves with vertebral subluxation correction. Practitioners often use varying vertebral manipulation techniques known as "adjustments" for the purpose of preventive medicine and pain relief. Straight chiropractors hold that only the body can cure the body. By aligning the vertebrae, straight chiropractors believe that they are clearing nerve impulse restrictions and therefore providing a more efficient dialogue between the brain and the rest of the body's systems, thus putting the body in a better position to cure (or heal) itself. Straight chiropractors represent a minority position, and tend to be members of the International Chiropractors Association (ICA), and the World Chiropractic Alliance (WCA).
2. Mixing chiropractors combine contemporary medical diagnosis and treatment with chiropractic adjustments. Mixing style practitioners utilize adjustments to treat chiropractic subluxations, as well as nutrition and naturopathic style remedies for other disorders. Methods used might include ultrasound, TENS, rehabilitation or the use of other diagnostic methods such as Applied Kinesiology (AK). Mixing chiropractic is itself divided into conservative and liberal groupsTemplate:Fn. Many mixers are members of the American Chiropractic Association (ACA), but there are also many exceptions.
3. Reform chiropractors are oriented at mainstream medicine, advocating a highly limited use of chiropractic care primarily for treatment of musculoskeletal conditions only.

In Australia, one of the first countries to widely accept chiropractic (since 1905), the deliniation into 'Straight' vs 'Mixer' type is all but relegated to history. The above categories are not commonly cited by the profession or the public.

Most universities teaching chiropractic in Australia, including Palmer in Davenport Iowa, USA, are utilizing rehab methods, exercise and physiological therapeutics and nutrition. The National College (now University) incorporated physical therapy as early as 1912, even before there was a profession bearing its name. The profession here continues to be divided only into specialities. Some do spine-only. Others prefer to do sports and rehabilitation. There are musculoskeletal foci and those who co-manage people with organic problems, MS or cancer along with their regular medical approaches. Spinal and musculoskeletal approaches to health can benefit the WHOLE person, and the general public accepts this. Chiropractic doctors diligently work with other professionals to benefit the patients overall well being.

Criticism of Chiropractic

Some traditional medical practitioners do not believe that chiropractic is science-based. There are many possible reasons for this. Partially this is due to the beliefs of Chiropractors themselves. University of Saskatchewan sociologist Leslie Biggs surveyed Canadian Chiropractors in 1997 and found that 74.3% of those interviewed (n=600) did not believe that controlled clinical trials were the best way to evaluate Chiropractic methods. The same study revealed that 68.1% believed that most diseases are caused by spinal malalignment.

In 1985, The National Council Against Health Fraud (NCAHF), a non-profit healthcare watch-dog group, issued a Position Paper critical of chiropractic. A newer Fact Sheet, authored by William Jarvis, Ph.D., has since been issued in 2001.

Safety

As with all interventions, risks may be associated with the practice of spinal manipulation. These risks, although rare, might include vertebrobasilar accidents, strokes, disc herniations, vertebral fracture, and cauda equina syndrome, according to Harrison's. Most serious complications occur after cervical (neck) manipulation. The practice of greatest concern is the rotary neck movement, sometimes called "Master cervical" or "rotary break", which has led to trauma, paralysis, strokes, and death among patients.

The Chiropractic community maintains that serious complications due to manipulation of the cervical spine are rare, being 1 in 3 or 4 million manipulations or fewer. This is based on an extensive review of spinal manipulation performed by the RAND corporation. However values in other studies vary, Dvorak cites figures of 1 in 400,000. .

With studies of this nature it is difficult to determine what percentage of incidents remain unreported. The RAND study, for example, assumed that only 1 in 10 cases would have been reported. Dr. Edzard Ernst surveyed all Neurologists in Britain for cases of serious neurological complication occuring within 24 hours after cervical spinal manipulation during the past year.

35 such cases had been seen by the 24 who responded, and none of those cases had been reported. His survey led him to conclude that underreporting was closer to 100%, rendering estimates "non-sensical."

A 2001 study in the medical journal Stroke, found that vertebrobasilar accidents (VBAs) are five times more likely to occur in those aged <45 years who have visited a chiropractor within 1 week prior to the VBA, than for controls who have not visited a chiropractor.

Commenting on the safety of chiropractic, the report from the New Zealand Commission reported, "We are satisfied that chiropractic treatment in New Zealand is remarkably safe." (Report of the Commission of Inquiry Into Chiropractic 1979:pg 77)

References

• From ChiroWeb:
  • Template:Fnb Cherkin, Daniel C.; Mootz, Robert D. (1997) Chiropractic in the United States: Training, Practice, and Research, available online
  • Template:Fnb Healey, James W. (1990) "It's Where You Put the Period", Dynamic Chiropractic, Volume 08, Issue 21 (October 10, 1990) available online

• From the National Center for Complementary and Alternative Medicine (NCCAM) (nccam.nih.gov):
  • Template:Fnb More Than One-Third of U.S. Adults Use Complementary and Alternative Medicine, According to New Government Survey (Press Release), May 27 2004, available online
  • Template:Fnb Complementary and Alternative Medicine Use Among Adults: United States, 2002 (Report), May 27 2004, available online (PDF format)

• Template:Fnb National Association for Chiropractic Medicine (NACM)

1. Moritz U (1979). Evaluation of manipulation and other manual therapy. Criteria for measuring the effect of treatment. Scand J Rehabil Med 11(4):173-9. PMID 161070 Abstract
2. Nelson CF, Metz RD, LaBrot T (2005). Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain. J Man Phys Ther 28(8):564-569. Abstract

See also

• Applied kinesiology
• Naprapathy
• Osteopathy
• Phrenology
• Reflexology

External links

Advocacy

Chiropractic organizations

• American Chiropractic Association (ACA)
• British Chiropractic Association (BCA)
• Canadian Chiropractic Association (CCA)
• Japanese Association of Chiropractors (JAC)
• International Chiropractors Association (ICA)
• World Chiropractic Alliance (WCA)
• World Federation of Chiropractic (WFC)

Chiropractic colleges

• Anglo-European College of Chiropractic
• Association of Chiropractic Colleges
• Canadian Memorial Chiropractic College
• Cleveland Chiropractic College
• Life Chiropractic College West
• Life University School of Chiropractic
• Logan College of Chiropractic
• McTimoney Chiropractic College (UK)
• New York Chiropractic College
• New Zealand College of Chiropractic
• Palmer Chiropractic College
• Parker College of Chiropractic (Dallas, TX)
• Sherman College of Straight Chiropractic (Spartanberg, SC)
• Texas Chiropractic College
• University of Bridgeport College of Chiropractic
• Western States Chiropractic College

Descriptions of chiropractic procedures

• Chiropractic treatments for back pain by Spine-health.com
• Glossary of Chiropractic Terms
• Lower Back Pain Answers

Other resources

• 3D Spine Simulator -- Interactive nerve chart, body posture and subluxation / degeneration models
• Mercola -- alternative health website with many articles about chiropractic treatment
• Chiropractic Resource Organization
• Dynamic Chiropractic Online
• Planet Chiropractic
• Today's Chiropractic magazine

Critiques

• A Different Way To Heal? -- PBS - Scientific American Frontiers, Web Feature
• Chirobase.org -- a "Skeptical Guide to Chiropractic History, Theories, and Practices", Stephen Barrett
• Commentary: The Specter of Dogma -- Joseph C. Keating, Jr., PhD
• Faulty Logic and Non-skeptical Arguments in Chiropractic -- Joseph C. Keating Jr, PhD
• National Association for Chiropractic Medicine

• Chiropractic