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Daniel David Palmer (founder)

1895 · Davenport, USA

D.C. MSc.Chiro, MTech.Chiro File:The chiropractic symbol big.jpg

World Federation of Chiropractic

Schools · Accreditation

Doctor of Chiropractic (D.C.) is a doctoral degree for chiropractors in North America. In some countries it is a professional doctorate where training is entered after obtaining between 90 and 120 credit hours of university level work (see second entry degree) and in most cases after obtaining a Bachelors Degree. The World Health Organization lists three potential educational paths involving full‐time chiropractic education across the globe. This includes: 1 – 4 years of pre-requisite training in basic sciences at university level followed by a 4 year full‐time Doctorate program; DC. A 5 year integrated bachelor degree; BSc (Chiro). A 2 - 3 year Masters degree following the completion of a bachelor degree leads to the MSc (Chiro). In South Africa the Masters of Technology in Chiropractic (M.Tech Chiro) is granted following 6 years of university. No less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to practice, chiropractors must be licensed. The regulatory boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Currently, chiropractors practice in over 100 countries in all regions of the world, however chiropractors are most prevalent in North America, Australia and parts of Europe.

Scope of practice

Chiropractors emphasize manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders Chiropractors are generally regarded as primary contact, portal of entry health care providers. Although chiropractors have many attributes of primary care providers, chiropractic has more attributes of a limited medical specialty like dentistry or podiatry. Chiropractors are licensed to communicate a neuromusculoskeletal diagnosis and order X-rays and may use broad diagnostic methods including skeletal imaging, observational and tactile assessments as well as orthopedic and neurological evaluation. A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle counseling. When indicated, chiropractors may also refer a patient to an appropriate specialist, or co-manage with another health care provider.

Due to the historical differences in philosophy and treatment approaches, there are range of 'broad' and 'narrow' scopes of practice for American chiropractors which tend to reflect 'straight' or 'mixer' underpinnings. A focus on evidence-based research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. However, the majority of chiropractors currently view themselves as "back/neck pain musculoskeletal specialists The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;most do so specifically for low back pain. Although it is generally accepted that chiropractic care is appropriate for musculoskeletal complaints, there is considerable debate on their role in treating visceral disorders. Certain jurisdictions allows the practice of animal chiropractic, whereby licensed chiropractors and veterinarians practice manual and manipulative therapies on animals for musculoskeletal disorders. Increasing evidence-based practice and aligning with conventional medicine has been suggested to obtain more university affiliation and access to hospitals and long-term facilities; aligning with the complementary and alternative medicine movement could bring more patients looking for non-medical approaches. In 2005, the World Health Organization developed chiropractic guidelines on basic training and safety to help standardize formal accreditation and licensure of chiropractors in countries where they remain unregulated. Currently, chiropractic medicine is regulated and practiced in over 100 countries, however chiropractors are most prevalent in North America, Australia and parts of Europe. The majority of mainstream health care and governmental organizations classify chiropractic as traditional or complementary alternative medicine

Philosophy

The philosophy of chiropractic is rooted in traditional and complementary medicine; it shares both vitalistic and mechanistic viewpoints. Chiropractic medicine embraces naturalistic principles that suggest decreased "host resistance" of the body facilitates the disease process. Chiropractors propose manual, conservative and natural interventions are preferable towards optimizing health and functional well-being. Chiropractors emphasize manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders The relationship between structure, especially the spine, and function as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. Chiropractors examine the biomechanics of the spine and other joints of the neuromusculoskeletal system and examines its role in health and disease. It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction, described by chiropractors as the vertebral subluxation complex.The majority of practitioners currently accept the importance of scientific research into chiropractic.

Investigations

Spinal dysfunction/subluxation

Spinal dysfunction, dubbed subluxation by chiropractors, is hypothesized to interfere with optimal biomechanics, thereby altering proper neurological function. Chiropractic theory suggests spinal dysfunction/subluxation may contribute to neuromusculoskeletal and visceral disorders via aberrant spinal segmental and suprasegmental reflexes. While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. Chiropractors suggest spinal manipulation normalizes spine biomechanics, and as a consequence, normalizes afferent input to the central nervous system resulting in optimized neurological function and improved health outcomes.

Treatment

Chiropractors use a conservative approach to neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:

• manual procedures, primarily spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;
• exercise, rehabilitative programmes and other forms of active care;
• psychosocial aspects of patient management;
• patient education on spinal health, posture, nutrition and other lifestyle modifications;
• emergency treatment and acute pain management procedures as indicated;
• other supportive measures, such as the use of back supports and orthotics;
• recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Manual and manipulative therapy

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.It describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. Spinal manipulation gained mainstream recognition and acceptance during the 1980s,which has led to increased collaboration between chiropractors and medical doctors. Currently they are developing inter-professional pathways of care for manual and conservative treatment of neuromusculoskeletal disorders. It is the most common intervention used in chiropractic care. In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by osteopathic medicine and physical therapy. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine. Although serious injuries and fatal consequences can occur and are likely to be under-reported, these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.

Evidence-based practice guidelines

The 1990s resulted in a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines. In the current advent of the evidence-based medicine era, chiropractic scholars have generated evidence-based systematic reviews and practice guidelines with respect to the management of acute and chronic low back pain, thoracic pain, neck pain, headache, radiography, as well as extremity conditions; tendinopathy myofascial pain/trigger points, and non-musculoskeletal conditions.

Training

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed. All Chiropractic Examining Boards require candidates to complete a 12 month clinical internship to obtain licensure. Licensure is granted following successful completion of all state/provincial and national board exams so long as the chiropractor maintains malpractice insurance. Nonetheless, there still some variations in educational standards internationally depending on admission and graduation requirements. chiropractic medicine is regulated in North America by state/provincial statute. The regulatory boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.

Regulation and Accreditation

Chiropractic is governed internationally by the Councils on Chiropractic Education International (CCEI). This body is officially recognized by the World Federation of Chiropractic and the World Health Organization as the accrediting agency for schools of chiropractic across the world. The minimum prerequisite for enrollment in a chiropractic college set forth by the CCEI is 90 semester hours, and the minimum cumulative GPA for a student entering is 3.0 on a 4.0 scale. Common prerequisite classes include those of the biological, chemical, & physical sciences, including: human anatomy and physiology, embryology, genetics, microbiology, immunology, cellular biology, exercise physiology, kinesiology, general chemistry, organic chemistry, analytical chemistry, biochemistry, toxicology/pharmacology, nutrition, nuclear medicine, physics, biomechanics, and statistics. Chiropractic programs require at least 4,200 hours of combined classroom, laboratory, and clinical experience.

United States

American chiropractors received their Doctorate in Chiropractic (D.C.) following a minimum of 7 years of university. There are currently 18 schools of chiropractic in the United States.: Unique to to the United States, schools of chiropractic following either a 'mixer' or 'straight' paradigm leading to two national bodies Internal Chiropractic Association and the American Chiropractic Association. Mixers form the majority of American chiropractors however straights are believed to have a disproportionate influence as "purists"

Australia

In Australia, a minimum of five-years worth of chiropractic education is needed before one may register as a practicing chiropractor. Chiropractic is taught at four public universities: RMIT in Melbourne, Murdoch University in Perth, Macquarie University in Sydney and new in 2012 Central Queensland University in Mackay. The RMIT, UCQ and Macquarie programs graduate chiropractors with a bachelors degree followed by a masters degree while Murdoch University graduates attain a double bachelors degree, any of which is necessary for registration with state registration boards.

A graduate of RMIT will have attained a Bachelor of Applied Science (Chiropractic) and a Master of Clinical Chiropractic. Similarly, a typical graduate of Macquarie University will have a Bachelor of Chiropractic Science followed by a Master of Chiropractic. Murdoch University graduates possess the double-degree of Bachelor of Science (Chiropractic Science) / Bachelor of Chiropractic. Students at University of Central Queensland graduate with a Bachelor of Science (Chiropractic) followed by a Master of Chiropractic Science.

Canada

Canadian chiropractors received their Doctorate in Chiropractic (D.C.) following a minimum of 7 years of university. There are currently two schools of chiropractic in Canada: Canadian Memorial Chiropractic College, in Toronto, Ontario and the Universite du Quebec a Trois Rivieres, in Trois Rivieres, Quebec. Both programs are fully accredited by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. In 2010, the majority of students (87%) entering the CMCC program had completed a baccalaureate university degree, and approximately 3% have a graduate degree.

South Africa

In SA (South Africa) there are two schools of chiropractic: the Durban Institute of Technology and the University of Johannesburg. They are both 6-year full-time courses leading to an MTECH or Masters of technology in Chiropractic. It's a legal requirement that chiropractors must be registered with the Allied Health Professions Council of SA (AHPCSA) the governmental statutory body in order to practice Chiropractic in SA. Being a member of the Chiropractic Association of SA (CASA) is voluntary. CASA is the only voluntary national association in the country and aims to promote the profession through publications in newspaper, interviews, internet and public enquires over the phone.

United Kingdom

In 1993 Princess Diana visited the Anglo-European College of Chiropractic and became its patron by calling for legislation to prevent unqualified individuals from practicing Chiropractic in the UK. In 1994, Parliament passed legislation regulating the practice of Chiropractic, like other health care professions, and creating the General Chiropractic Council as the regulatory board. Since that time, it is illegal to call oneself a Chiropractor in the UK without being registered with the General Chiropractic Council.There are three UK chiropractic colleges with chiropractic courses recognised by the General Chiropractic Council (GCC), the statutory governmental body responsible for the regulation of chiropractic in the UK. McTimoney College of Chiropractic offers an Undergraduate Master Degree in human Chiropractic and two post-graduate Masters programmes in Animal Manipulation, plus a masters in Paediatric Chiropractic. The Anglo-European College of Chiropractic and the University of Glamorgan chiropractic graduates with the Masters degree (MChiro).

New Zealand

As of 2005, the New Zealand College of Chiropractic (NZCC). obtained accreditation by the CCEA (Council on Chiropractic Education Australasia) and subsequently the CCEI.

Chiropractic specialities

Chiropractic scientists (DC/PhD)

Chiropractors can conduct clinical and basic scientific research and publish in peer-reviewed journals during training and after graduation. Chiropractors can also pursue a Ph.D degree in various health care disciplines including including epidemiology, biomechanics, neurophysiology and kinesiology,

Fellowships and other credentials

Chiropractors, like other health care professionals, can pursue post-graduate education in various chiropractic specialties. Most are 2 year post-graduates degrees in chiropractic specialities such as including clinical sciences, sports chiropractic, radiology, animal chiropractic and others.There are some other chiropractic credentials, however that are not post-graduate degrees but other means of continuing education they may or may not be recognized by the major health care organizations, medical or chiropractic communities. The following is a comprehensive list of the various designations that chiropractors can attain with further continuing education and post-graduate education programmes.

Ethics and medicolegal issues

Chiropractors, like other health care professionals, are self-regulated and have a fiduciary responsibility to protect the public and ensure competent, professional and ethical behaviour. Chiropractors have been noted to have increased instances of fraud, abuse and quackery compared to other health professions. Internal criticism identified dubious practice techniques that promote high-volume treatments (which can increase dependency) and far-reaching and outlandish claims regarding the clinical significance of joint dysfunction/subluxation and its role in health and disease

References

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2. ^ http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf
3. Facts & FAQs
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47. Facts & FAQs
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52. RMIT Chiropractic
53. Macquarie University Department of Chiropractic
54. Murdoch University Chiropractic
55. CQU - Bachelor of Science (Chiropractic)
56. "Accreditation of Educational Programmes". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. Retrieved 2009-10-16.
57. "An Overview of CMCC Admissions - Shortcuts: Admissions Brochure". Canadian Memorial Chiropractic College. Retrieved 2011-08-21.
58. "CASA : Student Info". Retrieved 2009-10-19.
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See also

• Doctor of Medicine
• Doctor of Osteopathy

• Chiropractic
• Applied sciences
• Health care
• Musculoskeletal disorders
• Manipulative therapy
• Natural sciences