Misplaced Pages

Revision as of 20:43, 2 February 2014

Daniel David Palmer (founder)

Invented in 1895 in Davenport, USA

Chiropractic education

World Federation of Chiropractic

Schools · Accreditation

Chiropractic is a form of alternative medicine that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. It is a marginal health care profession. Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry. The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling. Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence, a vitalistic notion that brings ridicule from mainstream health care. A large number of chiropractors want to separate themselves from the traditional vitalistic concept of innate intelligence.

D.D. Palmer founded chiropractic in the 1890s, and his son B.J. Palmer helped to expand it in the early 20th century. It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy. Chiropractic is well established in the U.S., Canada and Australia. It overlaps with other manual-therapy professions, including massage therapy, osteopathy, and physical therapy. Most who seek chiropractic care do so for low back pain.

Throughout its history, chiropractic has been controversial. For most of its existence it has battled with mainstream medicine, sustained by pseudoscientific ideas such as subluxation and innate intelligence that are not based on solid science. Despite the general consensus of public health professionals regarding the benefits of vaccination, among chiropractors there are significant disagreements over the subject, which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing an antitrust case in 1987. Chiropractic has developed a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among medical physicians and health plans in the U.S., and evidence-based medicine has been used to review research studies and generate practice guidelines. Chiropractic remains at a crossroads, and that in order to progress it would need to embrace science and not ideological dogma.

Many studies of treatments used by chiropractors have been conducted, with conflicting results. A critical evaluation found that collectively, spinal manipulation failed to show it is effective for any condition. The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, but that there is no credible evidence or mechanism for effects on other conditions. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. Spinal manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.

Conceptual basis

Philosophy

Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism. A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic first principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness; a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.

Although a wide diversity of ideas currently exists among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Chiropractors examine the biomechanics, structure and function of the spine, along with its effects on the musculoskeletal and nervous systems and what they believe to be its role in health and disease. Some chiropactors say spinal manipulation can have an effect of a variety of ailments such as irritable bowel syndrome and asthma.

Chiropractic philosophy includes the following perspectives:

• Holism assumes that health is affected by everything in an individual's environment; some sources also include a spiritual or existential dimension. In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.
• Conservatism considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication.
• Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis.
• Straights tend to use an approach that focuses on the chiropractor's perspective and the treatment model, whereas mixers tend to focus on the patient and the patient's situation.

Straights and mixers

Straight chiropractors adhere to the philosophical principles set forth by D.D. and B.J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an "innate intelligence" exerted via the human nervous system and is a primary underlying risk factor for many diseases. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for chiropractic treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies into their practice style. Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care. Although considered the minority group, "they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers."

Mixer chiropractors "mix" diagnostic and treatment approaches from osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and they incorporate mainstream medical diagnostics and employ many treatments including conventional techniques of physical therapy such as exercise, massage, ice packs, and moist heat, along with nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback. Mixers tend to be open to mainstream medicine and are the majority group.

Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1100 North American chiropractors, which found that 88% wanted to retain the term "vertebral subluxation complex", and that when asked to estimate the percent of disorders of internal organs (such as the heart, the lungs, or the stomach) that subluxation significantly contributes to, the mean response was 62%. A 2008 survey of 6000 American chiropractors demonstrated that most chiropractors seem to believe that a subluxation-based clinical approach may be of limited utility for addressing visceral disorders, and greatly favored non-subluxation-based clinical approaches for such conditions. The same survey showed that most chiropractors generally believe a subluxation-based clinical approach as a majority utility concerning musculoskeletal/biomechanical disorders such as back pain.

Vertebral subluxation

Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn (innate) ability to heal itself. D.D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. D.D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic. This concept was later expanded upon by his son, B.J. Palmer, and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. In 1910, D.D. Palmer theorized that the nervous system controlled health:

"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory, their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality—too much or not enough action—which is disease."

Vertebral subluxation, a core concept of traditional chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades. In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community. This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions.

In 2005, the chiropractic subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity." This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays. The 2008 book Trick or Treatment states "X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist." Attorney David Chapman-Smith, Secretary-General of the World Federation of Chiropractic, has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on x-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static x-ray than a limp or headache or any other functional problem." The General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, states that the chiropractic vertebral subluxation complex "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease."

Scope of practice

Template:Image Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery, with special emphasis on the spine. Chiropractic combines aspects from mainstream and alternative medicine, and there is no agreement about how to define the profession: although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry. In 2011 research by Yvonne Villanueva-Russell found a range of opinions among chiropractors: some believed that treatment should be confined to the spine, or back and neck pain; others vehemently disagreed. For example, while one 2009 survey of American chiropractors had found that 73% classified themselves as "back pain/musculoskeletal specialists", the label "back and neck pain specialists" was regarded by 47% of them as a least desirable description in a 2005 international survey.

It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems, but the more expansive view of chiropractic is still widespread. Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM); and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.

Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine. Chiropractic is autonomous from and competitive with mainstream medicine, and osteopathy outside the US remains primarily a manual medical system; physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. Practitioners may distinguish these competing approaches through claims that, compared to other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.

Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and 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 advice.

Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States, (although New Mexico has become the first US state to allow "advanced practice" trained chiropractors to prescribe certain medications.). In the US, their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa, broadly allow treatment of "human ailments"; some, such as Delaware, use vague concepts such as "transition of nerve energy" to define scope of practice; others, such as New Jersey, specify a severely narrowed scope. US states also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements, or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.

A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in a few US states, but is not recognized by the American Chiropractic Association as being chiropractic.

No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM, some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.

Treatment techniques

Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care. Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint. Its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion. High-velocity, low-amplitude spinal manipulation (HVLA-SM) thrusts have physiological effects that signal neural discharge from paraspinal muscle tissues, depending on duration and amplitude of the thrust are factors of the degree in paraspinal muscle spindles activation. Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.

There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools. The following adjustive procedures were received by more than 10% of patients of licensed U.S. chiropractors in a 2003 survey: Diversified technique (full-spine manipulation, employing various techniques), extremity adjusting, Activator technique (which uses a spring-loaded tool to deliver precise adjustments to the spine), Thompson Technique (which relies on a drop table and detailed procedural protocols), Gonstead (which emphasizes evaluating the spine along with specific adjustment that avoids rotational vectors), Cox/flexion-distraction (a gentle, low-force adjusting procedure which mixes chiropractic with osteopathic principles and utilizes specialized adjusting tables with movable parts), adjustive instrument, Sacro-Occipital Technique (which models the spine as a torsion bar), Nimmo Receptor-Tonus Technique, Applied Kinesiology (which emphasises "muscle testing" as a diagnostic tool), and cranial. Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain.

Many other procedures are used by chiropractors for treating the spine, other joints and tissues, and general health issues. The following procedures were received by more than one-third of patients of licensed U.S. chiropractors in a 2003 survey: Diversified technique (full-spine manipulation; mentioned in previous paragraph), physical fitness/exercise promotion, corrective or therapeutic exercise, ergonomic/postural advice, self-care strategies, activities of daily living, changing risky/unhealthy behaviors, nutritional/dietary recommendations, relaxation/stress reduction recommendations, ice pack/cryotherapy, extremity adjusting (also mentioned in previous paragraph), trigger point therapy, and disease prevention/early screening advice.

A 2010 study describing Belgium chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine. The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%. A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a U.S. chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.

Practice guidelines

Reviews of research studies within the chiropractic community have been used to generate practice guidelines outlining standards that specify which chiropractic treatments are "legitimate" (i.e., supported by evidence) and conceivably reimbursable under managed care health payment systems. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims. Chiropractic remains at a crossroads, and that in order to progress it would need to embrace science; the promotion by some for it to be a cure-all was both "misguided and irrational". A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.

Education, licensing, and regulation

Requirements vary between countries. In the U.S. chiropractors obtain a first professional degree in the field of chiropractic. Chiropractors often argue that this education is as good as or better than medical physicians', but most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing. Chiropractic curricula in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine. The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has been more similar than not, both in the kinds of subjects offered and in the time assigned to each subject.

Accredited chiropractic programs in the U.S. require that applicants have 90 semester hours of undergraduate education with a grade point average of at least 3.0 on a 4.0 scale. Many programs require at least three years of undergraduate education, and more are requiring a bachelor's degree. Canada requires a minimum three years of undergraduate education for applicants, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program.

CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally. Today, there are 18 accredited Doctor of Chiropractic programs in the U.S., 2 in Canada, 6 in Australasia, and 5 in Europe.

Regulatory colleges and chiropractic boards in the U.S., Canada, Mexico, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. There are an estimated 49,000 chiropractors in the U.S. (2008), 6,500 in Canada (2010), 2,500 in Australia (2000), and 1,500 in the UK (2000).

Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education. The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic. Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction. Depending on the location, continuing education may be required to renew these licenses. Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics.

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians.

The fourth year of chiropractic education persistently showed the highest stress levels. Every student, irrespective of year, experienced different ranges of stress when studying. The chiropractic leaders and colleges have had internal struggles. Rather than cooperation, there has been infighting between different factions. A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.

Ethics

A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical doctors, and the incident rate for fraud was nine times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical doctors (0.20). According to a 2006 Gallup poll of U.S. adults, when asked how they would "rate the honesty and ethical standards of people in these different fields", chiropractic compared unfavorably with mainstream medicine. When chiropractic was rated, it "rated dead last amongst healthcare professions". While 84% of respondents considered nurses' ethics "very high" or "high," only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists. Similar results were found in the 2003 Gallup Poll.

In 2001, the largest chiropractic associations in the U.S. and Canada were reported to have distributed patient brochures which contained unsubstantiated claims. Chiropractors, especially in America, have a reputation for unnecessarily treating patients. Sustained chiropractic care is promoted as a preventative tool, but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. A 2010 analysis of chiropractic websites found the majority of chiropractors and their associations made claims of effectiveness not supported by scientific evidence, including claims about the treatment of asthma, ear infection, earache, otitis media, and neck pain.

Some New Zealand chiropractors appeared to have used the title 'doctor' in a New Zealand yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true. In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the yellow pages under the heading of 'Chiropractors' fulfills this obligation when suitably qualified. If a chiropractor is not a registered medical practitioner, then the misuse of the title 'doctor' while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.

UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous. This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24 hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."

International reception

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries. It is viewed as a marginal complementary and alternative medicine health care profession.

Australia

In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.

United Kingdom

In the United Kingdom chiropractic is available on the National Health Service in some areas, such as Cornwall where the treatment is only available for neck or back pain. On the NHS Choices website, they make patients aware that there is "no scientific evidence to support the idea that most illness is caused by misalignment of the spine."

A 2010 questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed with patients the serious risk associated with manipulation of the cervical spine as a direct consequence of the fear that the patient would refuse treatment despite knowing the moral responsibility.

United States and Canada

The percentage of the population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada, with a global high of 20% in Alberta in 2006. In 2008, chiropractors were reported to be the most common CAM providers for children and adolescents, consuming up to 14% of all visits to chiropractors. In 2002-3, the majority of those who sought chiropractic did so for relief from back and neck pain and other neuromusculoskeletal complaints.

In the U.S., chiropractors perform over 90% of all manipulative treatments. Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.

Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient. The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate.

In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services. In Canada, there is lack of coverage under the universal public health insurance system.

History

Chiropractic was founded in 1895 by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease. The first chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer's office was located. He claimed that he had severely reduced hearing for 17 years, which started soon following a "pop" in his spine. A few days following his adjustment, Lillard claimed his hearing was almost completely restored. Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing and bonesetting; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health. Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic. One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment.

Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence, a vital nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions. D.D. and B.J. both seriously considered declaring chiropractic a religion, which might have provided legal protection under the U.S. constitution, but decided against it partly to avoid confusion with Christian Science. Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, among which they included the American Medical Association (AMA).

Chiropractic has seen considerable controversy and criticism. Although D.D. and B.J. were "straight" and disdained the use of instruments, some early chiropractors, whom B.J. scornfully called "mixers", advocated the use of instruments. In 1910 B.J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students. The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J.'s invention and promotion of the neurocalometer, a temperature-sensing device, was highly controversial among B.J.'s fellow straights. By the 1930s chiropractic was the largest alternative healing profession in the U.S.

Chiropractors faced heavy opposition from organized medicine. Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed. To defend against medical statutes B.J. argued that chiropractic was separate and distinct from medicine, asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease. B.J. cofounded the Universal Chiropractors' Association (UCA) to provide legal services to arrested chiropractors. Although the UCA won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974. The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an "unscientific cult" in 1966, and until 1980 advised its members that it was unethical for medical doctors to associate with "unscientific practitioners". This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.

In 2008 and 2009, chiropractors, including the British Chiropractic Association, used libel lawsuits and threats of lawsuits against their critics. Science writer Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian. A preliminary hearing took place at the Royal Courts of Justice in front of Justice David Eady. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question. An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights. The libel case ended with the BCA withdrawing its suit in 2010.

Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. In recent decades chiropractic gained legitimacy and greater acceptance by medical physicians and health plans, and enjoyed a strong political base and sustained demand for services. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.

Effectiveness

Opinions differ as to the efficacy of chiropractic treatment. Many controlled clinical studies of spinal manipulation have been conducted, but their results often disagree and they are typically of low methodological quality. A 2010 report found that manual therapies commonly used by chiropractors are effective for the treatment of low back pain, neck pain, some kinds of headaches and a number of extremity joint conditions. A 2011 systematic review of systematic reviews found that collectively, spinal manipulation failed to show it is effective for any condition. A 2008 critical review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition. Health claims made by chiropractors regarding use of manipulation for pediatric health conditions are supported by only low levels of scientific evidence that does not demonstrate clinically relevant benefits. Most research has focused on spinal manipulation in general, rather than solely on chiropractic manipulation. A 2002 review of randomized clinical trials of spinal manipulation was criticized for not making this distinction; however, the review's authors stated that they did not consider this difference to be a significant point as research on spinal manipulation is equally useful regardless of which practitioner provides it.

There is a wide range of ways to measure treatment outcomes. Chiropractic care, like all medical treatment, benefits from the placebo response. It is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. The efficacy of maintenance care in chiropractic is unknown.

Available evidence covers the following conditions:

• Low back pain. Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain remain inconsistent between countries. A 2012 overview of systematic reviews found that collectively, spinal manipulation failed to show it is an effective intervention for pain. A 2011 Cochrane review found strong evidence that there is no clinically meaningful difference between spinal manipulation and other treatments for reducing pain and improving function for chronic low back pain. A 2010 Cochrane review found no current evidence to support or refute a clinically significant difference between the effects of combined chiropractic interventions and other interventions for chronic or mixed duration low back pain. A 2010 systematic review found that most studies suggest spinal manipulation achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. A 2008 review found strong evidence that SM is similar in effect to medical care with exercise. A 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration. A 2007 review found good evidence that SM is moderately effective for low back pain lasting more than 4 weeks. In 2007 the American College of Physicians and the American Pain Society recommended that clinicians consider the addition of spinal manipulation for patients who do not improve with self care options. Methods for formulating treatment guidelines for low back pain differ significantly between countries, casting some doubt on their reliability.

• Radiculopathy. There is no consensus on the effectiveness of manual therapies for radiculopathies. There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute lumbar radiculopathy and acute lumbar disc herniation with associated radiculopathy. The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy.

• Whiplash and other neck pain. There is no consensus on the effectiveness of manual therapies for neck pain. Systematic reviews have concluded that thoracic spine manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain; although the body of literature is still weak. A 2010 Cochrane review found low evidence that manipulation was more effective than a control for neck pain, and moderate evidence that cervical manipulation and mobilisation produced similar effects on pain, function and patient satisfaction. A 2010 systematic review found low level evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash. A 2009 systematic review of controlled clinical trials found no evidence that chiropractic spinal manipulation is effective for whiplash injury. A 2008 review found evidence that suggests that manual therapy and exercise are more effective than alternative strategies for patients with neck pain. A 2007 review found that spinal manipulation and mobilization are effective for neck pain. A 2005 review found consistent evidence supporting spinal mobilization for acute whiplash, and limited evidence supporting spinal manipulation for whiplash.

• Headache. There is no consensus on the effectiveness of manual therapies for headaches. Of two systematic reviews published in 2011, one found evidence that spinal manipulation might be as effective as propranolol or topiramate in the prevention of migraine headaches, but the other concluded that evidence does not support the use of spinal manipulation for the treatment of migraine headaches. A 2004 Cochrane review found evidence that suggests spinal manipulation may be effective for migraine, tension headache and cervicogenic headache. A 2006 review found inconclusive evidence supporting manual therapies for tension headache. A 2005 review found that spinal manipulation showed a trend toward benefit in the treatment of tension headache, but the evidence was weak.

• Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs. There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive. A 2008 systematic review found that the addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) resulted in significantly better pain relief and functional improvements in both the short and long-term. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, limited to low level evidence supporting chiropractic management of shoulder pain and limited or fair evidence supporting chiropractic management of leg conditions.

• Other. A 2012 systematic review found insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension. A systematic review in 2011 found moderate evidence to support the use of manual therapy for cervicogenic dizziness. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions. Other reviews have found no evidence of significant benefit for asthma, baby colic, bedwetting, carpal tunnel syndrome, fibromyalgia, gastrointestinal disorders, kinetic imbalance due to suboccipital strain (KISS) in infants, menstrual cramps, or pelvic and back pain during pregnancy.

Safety

Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis. Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.

Spinal manipulation is associated with frequent, mild and temporary adverse effects, including new or worsening pain or stiffness in the affected region. They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours; adverse reactions appear to be more common following manipulation than mobilization. Chiropractors are more commonly associated with serious manipulation related adverse effects than other professionals. Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. Estimates vary widely for the incidence of these complications, and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern. Adverse effects are poorly reported in recent studies investigating chiropractic manipulations. Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region. Estimates for serious adverse events vary from 5 strokes per 100,000, 1.46 per 10 million serious adverse events and death rate of 2.68 per 10 million, though it was determined that there was inadequate data to be conclusive. Several case reports show temporal associations between interventions and potentially serious complications. The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke. A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke. Many chiropractors state that, the association between chiropractic therapy and arterial dissection is not proven. However, in 2010 Edzard Ernst stated that the causality between chiropratic neck manipulation beyond the normal range of motion and vascular accidents is probable. or definite.

Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation. Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year. Practice guidelines aim to reduce unnecessary radiation exposure, which increases cancer risk in proportion to the amount of radiation received. Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based. Although, there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain.

Risk-benefit

A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation. A 2010 systematic review stated that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggested a precautionary principle in healthcare for chiropractic intervention even if a causality with vertebral artery dissection after neck manipulation were merely a remote possibility. The same review concluded that the risk of death from manipulations to the neck outweighs the benefits. Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation. Edzard Ernst stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors across the world."

A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is routinely associated with considerable harm and no compelling evidence exists to indicate that it adequately prevents symptoms or diseases, thus the risk-benefit is not evidently favorable. A 2008 summary found that the best evidence suggests that chiropractic care is a useful therapy for subjects with neck or low-back pain for which the risks of serious adverse events should be considered negligible. A 2007 systematic review found that with uncertain efficacy and definite risks, the risk-benefit balance of spinal manipulation can't be positive. A 2006 systematic review of systematic reviews found the risk-benefit balance does not favor spinal manipulation over other treatments like physical therapy.

Cost-effectiveness

A 2012 systematic review suggested that the use of spine manipulation in clinical practice is a cost-effective treatment when used alone or in combination with other treatment approaches. A 2011 systematic review found evidence supporting the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain; the results for acute low back pain were inconsistent. A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings.

A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain. A 2005 American systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention. The cost-effectiveness of maintenance chiropractic care is unknown.

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) which looked the chiropractic services utilization found that the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient costs associate with the following use of services by 60.2% for in-hospital admissions, 59.0% for hospital days, 62.0% for outpatient surgeries and procedures, and 85% forpharmaceutical costs when compared with conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame.

Gleberzon et al. identify "deliberate fraud" as a notably harmful element of the chiropractic profession, finding that dubious practice techniques can translate into "outlandish billing and utilization rates". Those at the "fringe of ethical behavior" present the profession with a challenge, they believe, and must be weeded out.

Public health

Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous, ineffective, and unnecessary. Some chiropractors have embraced vaccination, but a significant portion of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing. The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health. In addition to traditional chiropractic opposition to water fluoridation and vaccination, chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive lifelong chiropractic treatment.

Controversy

Throughout its history chiropractic has been the subject of internal and external controversy and criticism. According to Daniel D. Palmer, the founder of chiropractic, subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race. A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation. A 2008 critical evaluation found that research has not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, is effective for any medical condition, with the possible exception of treatment for back pain, whereas a 2010 study by Chiropractors found manual therapies in general to be effective for back pain, neck pain, some forms of headaches and some extremity joint conditions. Chiropractic has been controversial, though to a lesser extent than in past years.

References

1. ^ Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
2. ^ Nelson CF, Lawrence DJ, Triano JJ; et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat. 13: 9. doi:10.1186/1746-1340-13-9. PMC 1185558. PMID 16000175. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
3. ^ Villanueva-Russell Y (2011). "Caught in the crosshairs: identity and cultural authority within chiropractic". Soc Sci Med. 72 (11): 1826–37. doi:10.1016/j.socscimed.2011.03.038. PMID 21531061. {{cite journal}}: Unknown parameter |month= ignored (help)
4. ^ Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498. Cite error: The named reference "Meeker-Haldeman" was defined multiple times with different content (see the help page).
5. ^ Mootz RD, Shekelle PG (1997). "Content of practice". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002.
6. ^ Keating JC Jr (2005). "A brief history of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 23–64. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
7. ^ Keating JC, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17. PMC 1208927. PMID 16092955. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
8. ^ Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch. Intern. Med. 158 (20): 2215–24. doi:10.1001/archinte.158.20.2215. PMID 9818801. {{cite journal}}: Unknown parameter |month= ignored (help) Cite error: The named reference "Kaptchuk-Eisenberg" was defined multiple times with different content (see the help page).
9. ^ Martin SC (1993). "Chiropractic and the social context of medical technology, 1895-1925". Technol Cult. 34 (4): 808–34. doi:10.2307/3106416. JSTOR 3106416. PMID 11623404. {{cite journal}}: Unknown parameter |month= ignored (help)
10. ^ Tetrault M (2004). "Global professional strategy for chiropractic" (PDF). Chiropractic Diplomatic Corps. Retrieved 2008-04-18.
11. ^ Norris P (2001). "How 'we' are different from 'them': occupational boundary maintenance in the treatment of musculo-skeletal problems". Sociol Health Illn. 23 (1): 24–43. doi:10.1111/1467-9566.00239.
12. ^ Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002-03". BMC Health Serv Res. 6: 49. doi:10.1186/1472-6963-6-49. PMC 1458338. PMID 16600038.{{cite journal}}: CS1 maint: unflagged free DOI (link)
13. ^ Homola S (2006). "Chiropractic: history and overview of theories and methods". Clin Orthop Relat Res. 444: 236–42. doi:10.1097/01.blo.0000200258.95865.87. PMID 16446588.
14. ^ DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
15. ^ Joseph C. Keating, Jr., Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16. A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).{{cite web}}: CS1 maint: multiple names: authors list (link)
16. ^ Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103. Cite error: The named reference "Ernst-eval" was defined multiple times with different content (see the help page).
17. ^ Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". J Manipulative Physiol Ther. 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414.{{cite journal}}: CS1 maint: multiple names: authors list (link)
18. ^ Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics. 105 (4): e43. doi:10.1542/peds.105.4.e43. PMID 10742364.{{cite journal}}: CS1 maint: multiple names: authors list (link)
19. ^ Johnson C, Baird R, Dougherty PE; et al. (2008). "Chiropractic and public health: current state and future vision". J Manipulative Physiol Ther. 31 (6): 397–410. doi:10.1016/j.jmpt.2008.07.001. PMID 18722194. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
20. ^ Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues". Milbank Q. 81 (1): 107–38, table of contents. doi:10.1111/1468-0009.00040. PMC 2690192. PMID 12669653.
21. ^ Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med. 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303.
22. ^ Reggars JW (2011). "Chiropractic at the crossroads or are we just going around in circles?". Chiropr Man Therap. 19: 11. doi:10.1186/2045-709X-19-11. PMC 3119029. PMID 21599991.{{cite journal}}: CS1 maint: unflagged free DOI (link)
23. ^ Posadzki P, Ernst E (2011). "Spinal manipulation: an update of a systematic review of systematic reviews". N Z Med J. 124 (1340): 55–71. PMID 21952385.
24. ^ Singh S, Ernst E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6.
25. ^ Leboeuf-Yde C, Hestbaek L (2008). "Maintenance care in chiropractic--what do we know?". Chiropr Osteopat. 16: 3. doi:10.1186/1746-1340-16-3. PMC 2396648. PMID 18466623.{{cite journal}}: CS1 maint: unflagged free DOI (link)
26. ^ World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). ISBN 92-4-159371-7. Retrieved 2008-02-29. {{cite journal}}: Cite journal requires |journal= (help)
27. ^ Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. PMC 1905885. PMID 17606755. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)
28. ^ Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. PMC 1839918. PMID 17549134. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
    • Anderson-Peacock E, Bryans B, Descarreaux M; et al. (2008). "A Clinical Practice Guideline Update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc. 52 (1): 7–8. PMC 2258235. PMID 18327295. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
29. ^ Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002.
30. ^ Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
31. ^ Murphy, DR; Schneider, MJ; Seaman, DR; Perle, SM; Nelson, CF (2008). "How can chiropractic become a respected mainstream profession? The example of podiatry" (PDF). Chiropractic & osteopathy. 16: 10. doi:10.1186/1746-1340-16-10. PMC 2538524. PMID 18759966. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: unflagged free DOI (link)
32. Gay RE, Nelson CF (2003). "Chiropractic philosophy". In Wainapel SF, Fast A (eds.) (ed.). Alternative Medicine and Rehabilitation: a Guide for Practitioners. New York: Demos Medical Publishing. ISBN 1-888799-66-8. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
33. ^ American Chiropractic Association. "History of chiropractic care". Retrieved 2008-02-21.
34. "Chiropractic". NHS Choices. 1 May 2012. Retrieved January 2014. {{cite web}}: Check date values in: |accessdate= (help)
35. Freeman J (2005). "Towards a definition of holism". Br J Gen Pract. 55 (511): 154–5. PMC 1463203. PMID 15720949. {{cite journal}}: Unknown parameter |month= ignored (help)
36. ^ Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16.{{cite web}}: CS1 maint: multiple names: authors list (link) Cite error: The named reference "History-Primer" was defined multiple times with different content (see the help page).
37. ^ McDonald WP, Durkin KF, Pfefer M; et al. (2003). How Chiropractors Think and Practice: The Survey of North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 0-9728055-5-9. {{cite book}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Summarized in: McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and practice: the survey of North American chiropractors". Semin Integr Med. 2 (3): 92–8. doi:10.1016/j.sigm.2004.07.002. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)CS1 maint: multiple names: authors list (link)
38. ^ Smith M, Carber LA (2008). "Survey of US Chiropractor Attitudes and Behaviors about Subluxation" (PDF). Journal of Chiropractic Humanities. 15: 19–26.
39. Keating JC Jr (1995). "D.D. Palmer's forgotten theories of chiropractic" (PDF). Association for the History of Chiropractic. Retrieved 2008-05-14.
40. Palmer DD (1910). The Chiropractor's Adjuster: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland, OR: Portland Printing House Co. OCLC 17205743.
41. Rose KA, Adams A (2000). "A survey of the use of evidence-based health care in chiropractic college clinics" (PDF). J Chiropr Educ. 14 (2): 71–7.
42. Homola S (2006). "Can chiropractors and evidence-based manual therapists work together? an opinion from a veteran chiropractor" (PDF). J Man Manip Ther. 14 (2): E14–8.
43. David Chapman-Smith (2000). "Principles and Goals of Chiropractic Care". The Chiropractic Profession: Its Education, Practice, Research and Future Directions. NCMIC Group. p. 160. ISBN 1-892734-02-8.
44. "Guidance on claims made for the chiropractic vertebral subluxation complex" (PDF). General Chiropractic Council. Retrieved 2010-09-30.
45. Gleberzon BJ, Cooperstein R, Perle SM (2005). "Can chiropractic survive its chimerical nature?". J Can Chiropr Assoc. 49 (2): 69–73. PMC 1840015. PMID 17549192.{{cite journal}}: CS1 maint: multiple names: authors list (link)
46. Redwood D, Hawk C, Cambron J, Vinjamury SP, Bedard J (2008). "Do chiropractors identify with complementary and alternative medicine? results of a survey". J Altern Complement Med. 14 (4): 361–8. doi:10.1089/acm.2007.0766. PMID 18435599.{{cite journal}}: CS1 maint: multiple names: authors list (link)
47. Theberge N (2008). "The integration of chiropractors into healthcare teams: a case study from sport medicine". Sociol Health Illn. 30 (1): 19–34. doi:10.1111/j.1467-9566.2007.01026.x. PMID 18254831. {{cite journal}}: Unknown parameter |month= ignored (help)
48. ^ Pettman E (2007). "A history of manipulative therapy". J Man Manip Ther. 15 (3): 165–74. doi:10.1179/106698107790819873. PMC 2565620. PMID 19066664.
49. Baer HA (2006). "The drive for legitimization by osteopathy and chiropractic in Australia: between heterodoxy and orthodoxy". Complement Health Pract Rev. 11 (2): 77–94. doi:10.1177/1533210106292467.
50. ^ Parkman CA (2004). "Issues in credentialing CAM providers". Case Manager. 15 (4): 24–7. doi:10.1016/j.casemgr.2004.05.004. PMID 15247891.
51. Occupational And Professional Licensing, Chiropractic Practitioners, Chiropractic Advanced Practice Certification Registry. Retrieved 2010-05-03.
52. Occupational And Professional Licensing, Chiropractic Practitioners, Chiropractic Advanced Practice Certification Registry (PDF). Retrieved 2010-05-03.
53. ^ Morrison P (2009). "Adjusting the role of chiropractors in the United States: why narrowing chiropractor scope of practice statutes will protect patients". Health Matrix Clevel. 19 (2): 493–537. PMID 19715143. Cite error: The named reference "Morrison" was defined multiple times with different content (see the help page).
54. Ramey DW (2003). "Regulatory aspects of complementary and alternative veterinary medicine". J. Am. Vet. Med. Assoc. 222 (12): 1679–82. doi:10.2460/javma.2003.222.1679. PMID 12830858. {{cite journal}}: Unknown parameter |month= ignored (help)
55. ACA House of Delegates (1994). "'Veterinary' chiropractic". American Chiropractic Association. Retrieved 2008-07-05.
56. Anderson, Chantal (2009-01-22). "Physical therapists, chiropractors square off over bill". The Seattle Times. Retrieved 2010-09-23.
57. Hilliard JW, Johnson ME (2004). "State practice acts of licensed health professions: scope of practice". DePaul J Health Care Law. 8 (1): 237–61.
58. ^ Christensen MG, Kollasch MW (2005). "Professional functions and treatment procedures". Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners. pp. 121–38. ISBN 1-884457-05-3. {{cite book}}: |access-date= requires |url= (help); |format= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
59. ^ Winkler K, Hegetschweiler-Goertz C, Jackson PS; et al. (2003). "Spinal manipulation policy statement" (PDF). American Chiropractic Association. Retrieved 2008-05-24. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
60. Pickar JG, Sung PS, Kang YM, Ge W (2007). "Response of lumbar paraspinal muscles spindles is greater to spinal manipulative loading compared with slower loading under length control". Spine J. 7 (5): 583–95. doi:10.1016/j.spinee.2006.10.006. PMC 2075482. PMID 17905321.{{cite journal}}: CS1 maint: multiple names: authors list (link)
61. Cooperstein R, Gleberzon BJ (2004). Technique Systems in Chiropractic. Churchill Livingstone. ISBN 0-443-07413-5.
62. Dagenais S, Mayer J, Wooley JR, Haldeman S (2008). "Evidence-informed management of chronic low back pain with medicine-assisted manipulation". Spine J. 8 (1): 142–9. doi:10.1016/j.spinee.2007.09.010. PMID 18164462.{{cite journal}}: CS1 maint: multiple names: authors list (link)
63. Ailliet L, Rubinstein SM, de Vet HC (2010). "Characteristics of chiropractors and their patients in Belgium". J Manipulative Physiol Ther. 33 (8): 618–25. doi:10.1016/j.jmpt.2010.08.011. PMID 21036284. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
64. Ndetan HT, Rupert RL, Bae S, Singh KP (2009). "Prevalence of musculoskeletal injuries sustained by students while attending a chiropractic college". J Manipulative Physiol Ther. 32 (2): 140–8. doi:10.1016/j.jmpt.2008.12.012. PMID 19243726. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
65. Joseph C. Keating, Jr. (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq. 21 (4): 37–43.
66. Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
67. Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther. 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
68. "Glossary". National Center for Education Statistics, U.S. Dept. of Education. Retrieved 2009-06-05.
69. Marcus DM, McCullough L (2009). "An evaluation of the evidence in "evidence-based" integrative medicine programs". Acad Med. 84 (9): 1229–34. doi:10.1097/ACM.0b013e3181b185f4. PMID 19707062.
70. Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M (1998). "A comparative study of chiropractic and medical education". Altern Ther Health Med. 4 (5): 64–75. PMID 9737032. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
71. "Prospective students". Association of Chiropractic Colleges. Retrieved 2009-07-23.
72. "Standards for Doctor of Chiropractic Programmes" (PDF). Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. 2008-04-05. Retrieved 2009-04-23.
73. "About Us". Councils on Chiropractic Education International. Retrieved 2010-09-30.
74. "Accredited Doctor of Chiropractic programs". The Council on Chiropractic Education. Archived from the original on 2008-02-14. Retrieved 2008-02-22.
75. "Accreditation of educational programmes". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. Retrieved 2009-06-05.
76. "Program Accreditation Status". Council on Chiropractic Education Australasia. Retrieved 2010-09-30.
77. "Institutions holding Accredited Status with the ECCE". European Council On Chiropractic Education. 2009-07-23. Retrieved 2009-07-25.
78. "Canadian Chiropractic Association FAQs". Canadian Chiropractic Association. Retrieved 2010-10-02.
79. "Federation of Chiropractic Licensing Boards FAQ". Federation of Chiropractic Licensing Boards. Retrieved 2010-10-02.
80. "Chiropractors". U.S. Bureau of Labor Statistics. 2007. Retrieved 2008-07-05.
81. "Canadian Chiropractic Association: Chiropractic in Canada". Canadian Chiropractic Association. Retrieved 2010-10-02.
82. Chapman-Smith D (2000). "Current status of the profession". The Chiropractic Profession: Its Education, Practice, Research and Future Directions. West Des Moines, IA: NCMIC. ISBN 1-892734-02-8.
83. "Media Relations". Canadian Memorial Chiropractic College. Retrieved 2010-12-14.
84. "Degree Authority in Ontario". Ontario Ministry of Training, Colleges and Universities. Retrieved 2010-12-14.
85. "State chiropractic licensure". Life University. 2008. Retrieved 2009-06-05.
86. "Becoming a chiropractor". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. Retrieved 2009-06-05.
87. Grod JP (2006). "Continuing health education in Canada". J Can Chiropr Assoc. 50 (1): 14–7. PMC 1839972. PMID 17549163.
88. Stuber KJ, Grod JP, Smith DL, Powers P (2005). "An online survey of chiropractors' opinions of Continuing Education". Chiropr Osteopat. 13 (1): 22. doi:10.1186/1746-1340-13-22. PMC 1282582. PMID 16242035.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
89. Coulter ID, Adams AH, Sandefur R (1997). "Chiropractic training". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research (PDF). Rockville, MD: Agency for Health Care Policy and Research. pp. 17–28. OCLC 39856366. Retrieved 2008-05-11. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)CS1 maint: multiple names: authors list (link) AHCPR Pub No. 98-N002.
90. Hester, H.; Cunliffe, C.; Hunnisett, A. (2013). "Stress in chiropractic education: a student survey of a five-year course". J Chiropr Educ. 27 (2): 147–51. doi:10.7899/JCE-13-4. PMID 23957319. {{cite journal}}: Cite has empty unknown parameter: |month= (help)
91. Johnson, C. (2010). "Reflecting on 115 years: the chiropractic profession's philosophical path". J Chiropr Humanit. 17 (1): 1–5. doi:10.1016/j.echu.2010.11.001. PMID 22693471. {{cite journal}}: Unknown parameter |month= ignored (help)
92. Foreman SM, Stahl MJ (2004). "Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians". J Manipulative Physiol Ther. 27 (7): 472–7. doi:10.1016/j.jmpt.2004.06.006. PMID 15389179. {{cite journal}}: Unknown parameter |month= ignored (help)
93. "Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics". Dynamic Chiropractic. 25 (3). 29 January 2007.
94. "USA TODAY/Gallup poll". USA Today. 11 December 2006.
95. Gallup chart
96. "Public Rates Nursing as Most Honest and Ethical Profession." Gallup Poll, 2003
97. Grod JP, Sikorski D, Keating JC (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther. 24 (8): 514–9. doi:10.1067/mmt.2001.118205. PMID 11677551. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
98. Ernst, E; Gilbey, A (2010). "Chiropractic claims in the English-speaking world". The New Zealand medical journal. 123 (1312): 36–44. PMID 20389316.
99. ^ Gilbey A (2008). "Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy". N. Z. Med. J. 121 (1278): 15–20. PMID 18670471. {{cite journal}}: Unknown parameter |month= ignored (help)
100. Bale K (2008). "Chiropractic Board New Zealand response to "Dr Who?" editorial". N. Z. Med. J. 121 (1280): 78–9. PMID 18791634. {{cite journal}}: Unknown parameter |month= ignored (help)
101. Ernst E (2009). "UK chiropractic: regulated but unruly". J Health Serv Res Policy. 14 (3): 186–7. doi:10.1258/jhsrp.2009.008183. PMID 19541879. {{cite journal}}: Unknown parameter |month= ignored (help)
102. ^ Lucas Laursen. "The Great Beyond: Chiropractic group advises members to 'withdraw from the battleground'". Nature.com. Retrieved 20 June 2009.
103. Lucas Laursen. "The Great Beyond: Complaints converge on chiropractors". Nature.com. Retrieved 20 June 2009.
104. Xue CC, Zhang AL, Lin V, Myers R, Polus B, Story DF (2008). "Acupuncture, chiropractic and osteopathy use in Australia: a national population survey". BMC Public Health. 8: 105. doi:10.1186/1471-2458-8-105. PMC 2322980. PMID 18377663.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
105. "Chiropractic treatment available on NHS in Cornwall". BBC. August 13, 2013. Retrieved August 18, 2013.
106. "Chiropractic - NHS Choices". Retrieved August 18, 2013.
107. Langworthy JM, Forrest L (2010). "Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine". Chiropr Osteopat. 18: 27. doi:10.1186/1746-1340-18-27. PMC 3161389. PMID 20977721.{{cite journal}}: CS1 maint: unflagged free DOI (link)
108. Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review". Chiropr Osteopat. 15: 2. doi:10.1186/1746-1340-15-2. PMC 1784103. PMID 17241465.{{cite journal}}: CS1 maint: unflagged free DOI (link)
109. Crownfield PW (2007). "Chiropractic in Alberta: a model of consumer utilization and satisfaction". Dyn Chiropr. 25 (6).
110. ^ Kemper KJ, Vohra S, Walls R (2008). "American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics". Pediatrics. 122 (6): 1374–86. doi:10.1542/peds.2008-2173. PMID 19047261. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
111. Daniel C. Cherkin, Robert D. Mootz (2010). "Chiropractic in the United States:Training, Practice, and Research". Chirobase. Retrieved 2010-10-01.
112. Gaumer G (2006). "Factors associated with patient satisfaction with chiropractic care: survey and review of the literature". J Manipulative Physiol Ther. 29 (6): 455–62. doi:10.1016/j.jmpt.2006.06.013. PMID 16904491.
113. Tindle HA, Davis RB, Phillips RS, Eisenberg DM (2005). "Trends in use of complementary and alternative medicine by US adults: 1997-2002". Altern Ther Health Med. 11 (1): 42–9. PMID 15712765.{{cite journal}}: CS1 maint: multiple names: authors list (link)
114. Garner MJ, Birmingham M, Aker P; et al. (2008). "Developing integrative primary healthcare delivery: adding a chiropractor to the team". Explore (NY). 4 (1): 18–24. doi:10.1016/j.explore.2007.10.003. PMID 18194787. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
115. ^ Baer HA (1987). "Divergence and convergence in two systems of manual medicine: osteopathy and chiropractic in the United States". Med Anthropol Q. 1 (2): 176–93. doi:10.1525/maq.1987.1.2.02a00030.
116. Palmer DD (1911-05-04). "D.D. Palmer's Religion of Chiropractic: Letter to P.W. Johnson, D.C" (PDF). Retrieved 2008-06-29.
117. Cherkin D (1989). "AMA policy on chiropractic". Am J Public Health. 79 (11): 1569–70. doi:10.2105/AJPH.79.11.1569-a. PMC 1349822. PMID 2817179. {{cite journal}}: Unknown parameter |month= ignored (help)
118. Godlee F (2009). "Keep libel laws out of science". BMJ. 339: b2783. doi:10.1136/bmj.b2783.
119. Eden, R (2008-08-16). "Doctors take Simon Singh to court". The Daily Telegraph. London. Retrieved 2008-12-12.
120. Boseley, Sarah (14 May 2009). "Science writer accused of libel may take fight to European court". London: The Guardian (UK). Retrieved 2009-05-19.
121. "Unjust burdens of proof". Nature. 459 (7248): 751. 2009. doi:10.1038/459751a. PMID 19516290. {{cite journal}}: Unknown parameter |month= ignored (help)
122. Pallab Ghosh (2010-04-15). "Case dropped against Simon Singh". BBC News.
123. Mark Henderson (2010-04-16). "Science writer Simon Singh wins bitter libel battle". London: Times Online.
124. ^ Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMC 1420782. PMID 16574972. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help); Unknown parameter |month= ignored (help)
125. Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW (2008). "The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review". Spine. 33 (8): 914–8. doi:10.1097/BRS.0b013e31816b4be4. PMID 18404113. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
126. ^ Bronfort G, Haas M, Evans R, Leininger B, Triano J (2010). "Effectiveness of manual therapies: the UK evidence report". Chiropr Osteopat. 18: 3. doi:10.1186/1746-1340-18-3. PMC 2841070. PMID 20184717.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
127. ^ Gotlib A, Rupert R (2008). "Chiropractic manipulation in pediatric health conditions--an updated systematic review". Chiropr Osteopat. 16: 11. doi:10.1186/1746-1340-16-11. PMC 2553791. PMID 18789139.{{cite journal}}: CS1 maint: unflagged free DOI (link)
128. Ernst E (2009). "Chiropractic manipulation, with a deliberate 'double entendre'". Arch. Dis. Child. 94 (6): 411. doi:10.1136/adc.2009.158170. PMID 19460920. {{cite journal}}: Unknown parameter |month= ignored (help)
129. ^ Ernst E (2002). "Chiropractic". Annals of Internal Medicine. 137 (8): 701 author reply 702. doi:10.7326/0003-4819-137-8-200210150-00025. PMID 12379081. {{cite journal}}: Unknown parameter |month= ignored (help)
130. Khorsan R, Coulter ID, Hawk C, Choate CG (2008). "Measures in chiropractic research: choosing patient-based outcome assessments". J Manipulative Physiol Ther. 31 (5): 355–75. doi:10.1016/j.jmpt.2008.04.007. PMID 18558278. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
131. Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?". Annals of Internal Medicine. 136 (11): 817–25. doi:10.7326/0003-4819-136-11-200206040-00011. PMID 12044130. {{cite journal}}: Unknown parameter |month= ignored (help)
132. Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of spinal manipulative therapy" (PDF). Aust J Physiother. 52 (2): 135–8. doi:10.1016/S0004-9514(06)70049-6. PMID 16764551.{{cite journal}}: CS1 maint: multiple names: authors list (link)
133. ^ Murphy AY, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
134. Posadzki P (2012). "Is spinal manipulation effective for pain? An overview of systematic reviews". Pain Med. 13 (6): 754–61. doi:10.1111/j.1526-4637.2012.01397.x. PMID 22621391.
135. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (2011). Rubinstein, Sidney M (ed.). "Spinal manipulative therapy for chronic low-back pain". Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304.{{cite journal}}: CS1 maint: multiple names: authors list (link)
136. Walker BF, French SD, Grant W, Green S (2010). Walker, Bruce F (ed.). "Combined chiropractic interventions for low-back pain". Cochrane Database Syst Rev (4): CD005427. doi:10.1002/14651858.CD005427.pub2. PMID 20393942.{{cite journal}}: CS1 maint: multiple names: authors list (link)
137. Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010). "NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain". Spine J. 10 (10): 918–40. doi:10.1016/j.spinee.2010.07.389. PMID 20869008. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
138. Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J. 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469.{{cite journal}}: CS1 maint: multiple names: authors list (link)
139. Lawrence DJ, Meeker W, Branson R; et al. (2008). "Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis". J Manipulative Physiol Ther. 31 (9): 659–74. doi:10.1016/j.jmpt.2008.10.007. PMID 19028250. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) An earlier, freely readable version is in: Meeker W, Branson R, Bronfort G; et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. Retrieved 2008-11-28. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
140. Chou R, Huffman LH (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Annals of Internal Medicine. 147 (7): 492–504. doi:10.7326/0003-4819-147-7-200710020-00007. PMID 17909210. {{cite journal}}: Unknown parameter |month= ignored (help)
141. Chou R, Qaseem A, Snow V; et al. (2007). "Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society". Annals of Internal Medicine. 147 (7): 478–91. doi:10.7326/0003-4819-147-7-200710020-00006. PMID 17909209. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
142. ^ Leininger B, Bronfort G, Evans R, Reiter T (2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review". Phys Med Rehabil Clin N Am. 22 (1): 105–25. doi:10.1016/j.pmr.2010.11.002. PMID 21292148. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
143. Hahne AJ, Ford JJ, McMeeken JM (2010). "Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review". Spine. 35 (11): E488–504. doi:10.1097/BRS.0b013e3181cc3f56. PMID 20421859. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
144. ^ Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783.
145. Huisman PA, Speksnijder CM, de Wijer A (2013). "The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review". Disabil Rehabil: 1. doi:10.3109/09638288.2012.750689. PMID 23339721. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
146. Cross KM, Kuenze C, Grindstaff TL, Hertel J (2011). "Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review". J Orthop Sports Phys Ther. 41 (9): 633–42. doi:10.2519/jospt.2011.3670. PMID 21885904. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
147. Gross A, Miller J, D'Sylva J; et al. (2010). "Manipulation or mobilisation for neck pain: a Cochrane Review". Man Ther. 15 (4): 315–33. doi:10.1016/j.math.2010.04.002. PMID 20510644. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
148. Shaw L, Descarreaux M, Bryans R; et al. (2010). "A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research". Work. 35 (3): 369–94. doi:10.3233/WOR-2010-0996. PMID 20364057. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
149. Ernst E (2009). "Chiropractic spinal manipulation for whiplash injury? A systematic review of controlled clinical trials". Focus Altern Complement Ther. 14 (2): 85–6. doi:10.1111/j.2042-7166.2009.tb01939.x.
150. ^ Hurwitz EL, Carragee EJ, van der Velde G; et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
151. Conlin A, Bhogal S, Sequeira K, Teasell R (2005). "Treatment of whiplash-associated disorders--part I: Non-invasive interventions". Pain Res Manag. 10 (1): 21–32. PMID 15782244.{{cite journal}}: CS1 maint: multiple names: authors list (link)
152. Chaibi A, Tuchin PJ, Russell MB (2011). "Manual therapies for migraine: a systematic review". J Headache Pain. 12 (2): 127–33. doi:10.1007/s10194-011-0296-6. PMC 3072494. PMID 21298314. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
153. Posadzki P, Ernst E (2011). "Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials". Cephalalgia. 31 (8): 964–70. doi:10.1177/0333102411405226. PMID 21511952. {{cite journal}}: Unknown parameter |month= ignored (help)
154. Bronfort G, Nilsson N, Haas M; et al. (2004). Brønfort, Gert (ed.). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
155. Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.{{cite journal}}: CS1 maint: multiple names: authors list (link)
156. Biondi DM (2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306. {{cite journal}}: Unknown parameter |month= ignored (help)
157. Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA (2011). "Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review". J Physiother. 57 (1): 11–20. doi:10.1016/S1836-9553(11)70002-9. PMID 21402325.{{cite journal}}: CS1 maint: multiple names: authors list (link)
158. French HP, Brennan A, White B, Cusack T (2011). "Manual therapy for osteoarthritis of the hip or knee - a systematic review". Man Ther. 16 (2): 109–17. doi:10.1016/j.math.2010.10.011. PMID 21146444. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
159. Herd CR, Meserve BB (2008). "A systematic review of the effectiveness of manipulative therapy in treating lateral epicondylalgia". J Man Manip Ther. 16 (4): 225–37. doi:10.1179/106698108790818288. PMC 2716156. PMID 19771195.
160. McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
161. Pribicevic M, Pollard H, Bonello R, de Luca K (2010). "A systematic review of manipulative therapy for the treatment of shoulder pain". J Manipulative Physiol Ther. 33 (9): 679–89. doi:10.1016/j.jmpt.2010.08.019. PMID 21109059.{{cite journal}}: CS1 maint: multiple names: authors list (link)
162. Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W (2009). "Manipulative therapy for lower extremity conditions: expansion of literature review". J Manipulative Physiol Ther. 32 (1): 53–71. doi:10.1016/j.jmpt.2008.09.013. PMID 19121464. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
163. Mangum K, Partna L, Vavrek D (2012). "Spinal manipulation for the treatment of hypertension: a systematic qualitative literature review". J Manipulative Physiol Ther. 35 (3): 235–43. doi:10.1016/j.jmpt.2012.01.005. PMID 22341795.{{cite journal}}: CS1 maint: multiple names: authors list (link)
164. Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV (2011). "Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review". Chiropr Man Therap. 19 (1): 21. doi:10.1186/2045-709X-19-21. PMC 3182131. PMID 21923933.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
165. Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680. {{cite journal}}: Unknown parameter |month= ignored (help)
166. Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review". Scoliosis. 3: 2. doi:10.1186/1748-7161-3-2. PMC 2262872. PMID 18211702.{{cite journal}}: CS1 maint: unflagged free DOI (link)
167. Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (2007). "Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research". J Altern Complement Med. 13 (5): 491–512. doi:10.1089/acm.2007.7088. PMID 17604553. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
168. Ernst E (2009). "Spinal manipulation for asthma: a systematic review of randomised clinical trials". Respir Med. 103 (12): 1791–5. doi:10.1016/j.rmed.2009.06.017. PMID 19646855. {{cite journal}}: Unknown parameter |month= ignored (help)
169. Hondras MA, Linde K, Jones AP (2005). Hondras, Maria A (ed.). "Manual therapy for asthma". Cochrane Database Syst Rev (2): CD001002. doi:10.1002/14651858.CD001002.pub2. PMID 15846609.{{cite journal}}: CS1 maint: multiple names: authors list (link)
170. Kaminskyj A, Frazier M, Johnstone K, Gleberzon BJ (2010). "Chiropractic care for patients with asthma: A systematic review of the literature". J Can Chiropr Assoc. 54 (1): 24–32. PMC 2829683. PMID 20195423. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
171. Baby colic:
     • Ernst E (2009). "Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials". Int J Clin Pract. 63 (9): 1351–3. doi:10.1111/j.1742-1241.2009.02133.x. PMID 19691620.
     • Husereau D, Clifford T, Aker P, Leduc D, Mensinkai S (2003). Spinal Manipulation for Infantile Colic (PDF). Technology report no. 42. Ottawa: Canadian Coordinating Office for Health Technology Assessment. ISBN 1-894978-11-0. Retrieved 2008-10-06.{{cite book}}: CS1 maint: multiple names: authors list (link)
172. Glazener CM, Evans JH, Cheuk DK (2005). Glazener, Cathryn MA (ed.). "Complementary and miscellaneous interventions for nocturnal enuresis in children". Cochrane Database Syst Rev (2): CD005230. doi:10.1002/14651858.CD005230. PMID 15846744.{{cite journal}}: CS1 maint: multiple names: authors list (link)
173. O'Connor D, Marshall S, Massy-Westropp N (2003). O'Connor, Denise (ed.). "Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome". Cochrane Database Syst Rev (1): CD003219. doi:10.1002/14651858.CD003219. PMID 12535461.{{cite journal}}: CS1 maint: multiple names: authors list (link)
174. Fibromyalgia:
     • Sarac AJ, Gur A (2006). "Complementary and alternative medical therapies in fibromyalgia". Curr Pharm Des. 12 (1): 47–57. doi:10.2174/138161206775193262. PMID 16454724.
     • Schneider M, Vernon H, Ko G, Lawson G, Perera J (2009). "Chiropractic management of fibromyalgia syndrome: a systematic review of the literature". J Manipulative Physiol Ther. 32 (1): 25–40. doi:10.1016/j.jmpt.2008.08.012. PMID 19121462.{{cite journal}}: CS1 maint: multiple names: authors list (link)
     • Ernst E (2009). "Chiropractic treatment for fibromyalgia: a systematic review". Clin Rheumatol. 28 (10): 1175–8. doi:10.1007/s10067-009-1217-9. PMID 19544042.
175. Ernst E (2011). "Chiropractic treatment for gastrointestinal problems: A systematic review of clinical trials". Can J Gastroenterol. 25 (1): 39–49. PMC 3027333. PMID 21258667.
176. Brand PL, Engelbert RH, Helders PJ, Offringa M (2005). "". Ned Tijdschr Geneeskd (in Dutch). 149 (13): 703–7. PMID 15819137.{{cite journal}}: CS1 maint: multiple names: authors list (link)
177. Proctor ML, Hing W, Johnson TC, Murphy PA (2006). Proctor, Michelle (ed.). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev. 3 (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988.{{cite journal}}: CS1 maint: multiple names: authors list (link)
178. Pennick VE, Young G (2007). Pennick, Victoria (ed.). "Interventions for preventing and treating pelvic and back pain in pregnancy". Cochrane Database Syst Rev (2): CD001139. doi:10.1002/14651858.CD001139.pub2. PMID 17443503.
179. Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine. 32 (21): 2375–8. doi:10.1097/BRS.0b013e3181557bb1. PMID 17906581.{{cite journal}}: CS1 maint: multiple names: authors list (link)
180. ^ Gouveia LO, Castanho P, Ferreira JJ (2009). "Safety of chiropractic interventions: a systematic review". Spine. 34 (11): E405–13. doi:10.1097/BRS.0b013e3181a16d63. PMID 19444054.{{cite journal}}: CS1 maint: multiple names: authors list (link)
181. Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM (2005). "Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study". Spine. 30 (13): 1477–84. doi:10.1097/01.brs.0000167821.39373.c1. PMID 15990659. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
182. ^ E Ernst (2010). "Deaths after chiropractic: a review of published cases". Int J Clinical Practice. 64 (8): 1162–1165. doi:10.1111/j.1742-1241.2010.02352.x. PMID 20642715.
183. Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics. 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID 17178922.{{cite journal}}: CS1 maint: multiple names: authors list (link)
184. Ernst E, Posadzki P (2012). "Reporting of adverse effects in randomised clinical trials of chiropractic manipulations: a systematic review". N Z Med J. 125 (1353): 87–140. PMID 22522273.
185. Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 23787298, please use {{cite journal}} with |pmid= 23787298 instead.
186. Cassidy, JD (15 Feb 2008). "Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study". Spine. 33 (4 Suppl): S176–83. doi:10.1097/BRS.0b013e3181644600. PMID 18204390. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
187. Paciaroni M, Bogousslavsky J (2009). "Cerebrovascular complications of neck manipulation". Eur Neurol. 61 (2): 112–8. doi:10.1159/000180314. PMID 19065058.
188. Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.{{cite journal}}: CS1 maint: multiple names: authors list (link)
189. ^ Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ. (2012). "Assessing the risk of stroke from neck manipulation: a systematic review". International Journal of Clinical Practice. 66 (10): 940–947. doi:10.1111/j.1742-1241.2012.03004.x. PMC 3506737. PMID 22994328.{{cite journal}}: CS1 maint: multiple names: authors list (link)
190. Ernst E (2010). "Vascular accidents after neck manipulation: cause or coincidence?". Int J Clin Pract. 64 (6): 673–7. doi:10.1111/j.1742-1241.2009.02237.x. PMID 20518945.
191. ^ Bussières AE, Taylor JAM, Peterson C (2008). "Diagnostic imaging practice guidelines for musculoskeletal complaints in adults—an evidence-based approach—part 3: spinal disorders". J Manipulative Physiol Ther. 31 (1): 33–88. doi:10.1016/j.jmpt.2007.11.003. PMID 18308153.{{cite journal}}: CS1 maint: multiple names: authors list (link)
192. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects Research, U.S. National Research Council (2006). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press. ISBN 0-309-09156-X.{{cite book}}: CS1 maint: multiple names: authors list (link)
193. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 18722195, please use {{cite journal}} with |pmid= 18722195 instead.
194. ^ E Ernst (2011). "Response to critiques of deaths after chiropractic". Int J Clin Pract. 65 (1): 106. doi:10.1111/j.1742-1241.2010.02568.x. PMID 21155949.
195. Ernst E (2009). "Chiropractic maintenance treatment, a useful preventative approach?". Prev Med. 49 (2–3): 99–100. doi:10.1016/j.ypmed.2009.05.004. PMID 19465044.
196. Rubinstein SM (2008). "Adverse events following chiropractic care for subjects with neck or low-back pain: do the benefits outweigh the risks?". J Manipulative Physiol Ther. 31 (6): 461–464. doi:10.1016/j.jmpt.2008.06.001. PMID 18722202.
197. Michaleff ZA, Lin CW, Maher CG, van Tulder MW (2012). "Spinal manipulation epidemiology: Systematic review of cost effectiveness studies". J Electromyogr Kinesiol. 22 (5): 655–62. doi:10.1016/j.jelekin.2012.02.011. PMID 22429823.{{cite journal}}: CS1 maint: multiple names: authors list (link)
198. Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW (2011). "Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review". European Spine Journal. 20 (7): 1024–1038. doi:10.1007/s00586-010-1676-3. PMC 3176706. PMID 21229367.{{cite journal}}: CS1 maint: multiple names: authors list (link)
199. Mootz RD, Hansen DT, Breen A, Killinger LZ, Nelson C (2006). "Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession". J Manipulative Physiol Ther. 29 (9): 707–25. doi:10.1016/j.jmpt.2006.09.001. PMID 17142165.{{cite journal}}: CS1 maint: multiple names: authors list (link)
200. Canter PH, Coon JT, Ernst E (2006). "Cost-Effectiveness of Complementary Therapies in the United Kingdom—A Systematic Review†". Evid Based Complement Alternat Med. 3 (4): 425–32. doi:10.1093/ecam/nel044. PMC 1697737. PMID 17173105.{{cite journal}}: CS1 maint: multiple names: authors list (link)
201. van der Roer N, Goossens MEJB, Evers SMAA, van Tulder MW (2005). "What is the most cost-effective treatment for patients with low back pain? a systematic review". Best Pract Res Clin Rheumatol. 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007. PMID 15949783.{{cite journal}}: CS1 maint: multiple names: authors list (link)
202. Sarnat, Richard L. (May 2007). "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update". Journal of Manipulative and Physiological Therapeutics. 30 (4): 263–269. doi:10.1016/j.jmpt.2007.03.004. PMID 17509435. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
203. Gleberzon, Brian J.; Cooperstein, Robert; Perle, Stephen M. (2005). "Can chiropractic survive its chimerical nature?". Journal of the Canadian Chiropractic Association. 49 (2): 69–73. PMC 1840015. PMID 17549192.
204. Ehreth J (2003). "The global value of vaccination". Vaccine. 21 (7–8): 596–600. doi:10.1016/S0264-410X(02)00623-0. PMID 12531324.
205. Russell ML, Injeyan HS, Verhoef MJ, Eliasziw M (2004). "Beliefs and behaviours: understanding chiropractors and immunization". Vaccine. 23 (3): 372–9. doi:10.1016/j.vaccine.2004.05.027. PMID 15530683.{{cite journal}}: CS1 maint: multiple names: authors list (link)
206. Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success" (PDF). Am J Public Health. 79 (10): 1405–8. doi:10.2105/AJPH.79.10.1405. PMC 1350185. PMID 2782512.{{cite journal}}: CS1 maint: multiple names: authors list (link)
207. Jaroff, Leon (27 February 2002). "Back Off, Chiropractors!". Time. Retrieved 7 June 2009.
208. Palmer DD (1910). The Chiropractor's Adjuster: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland, OR: Portland Printing House Co. OCLC 17205743. A subluxated vertebra ... 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.

Further reading

• Long PH (2013). Barrett S (ed.). Chiropractic Abuse: An Insider's Lament. American Council on Science & Health. {{cite book}}: Unknown parameter |editorlink= ignored (|editor-link= suggested) (help); Unknown parameter |isbn13= ignored (help)
• Homola S (2002). Shermer M (ed.). Chiropractic: Conventional or Alternative Healing?. Vol. 1. ABC-CLIO. pp. 308–. ISBN 978-1-57607-653-8. {{cite book}}: |work= ignored (help)

External links

Template:Z148

• Template:Dmoz

• Alternative medicine
• Chiropractic
• Healthcare occupations
• Therapy
• Physical exercise
• Manipulative therapy
• Pseudoscience