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| {{Short description|Chiropractic technique}} | |||
| {{For|the generic approach to manipulation of spinal joints|Spinal manipulation}} | {{For|the generic approach to manipulation of spinal joints|Spinal manipulation}} | ||
| ] | ] | ||
| '''Spinal adjustment''' and '''chiropractic adjustment''' are terms used by ] to describe their approaches to ], as well as some ], who use the term '''adjustment'''. | '''Spinal adjustment''' and '''chiropractic adjustment''' are terms used by ] to describe their approaches to ], as well as some ], who use the term '''adjustment'''. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease.<ref>{{cite web|title=Sense about Chiropractic|url=https://archive.senseaboutscience.org/data/files/resources/56/Sense-About-Chiropractic.pdf|access-date=31 December 2012|publisher=Sense About Science}}</ref> | ||
| Spinal adjustments were among many chiropractic techniques invented in the 19th century by ], the founder of |
Spinal adjustments were among many chiropractic techniques invented in the 19th century by ], the founder of chiropractic.<ref>{{cite web |last1=Kirkey |first1=Sharon |last2=Hall |first2=Brice |title=The first chiropractor was a Canadian who claimed he received a message from a ghost |url=https://thestarphoenix.com/health/the-first-chiropractor-was-a-canadian-who-claimed-he-received-a-message-from-a-ghost/wcm/e419ac76-d4d4-4f19-b2b3-448ea647eb57 |website=The Star Phoenix |language=en-CA |date=July 2, 2019}}</ref> Claims made for the benefits of spinal adjustments range from temporary, palliative (pain relieving) effects to long term wellness and preventive care. | ||
| ==Description== | |||
| == Adjustment/manipulation == | |||
| A chiropractic adjustment intends to affect or correct a vertebral joint's alignment, motion, and/or function. Specifically, adjustments are intended to correct "]s", a non-scientific term given to the signs and symptoms that are said by chiropractors to result from abnormal alignment of vertebrae.<ref name=crossroads/> In 2005, the chiropractic "]" was defined by the ] 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."<ref name=WHO-guidelines /> This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as ].<ref name=WHO-guidelines>{{cite book |author= World Health Organization |year=2005 |title= WHO guidelines on basic training and safety in chiropractic |publisher=World Health Organization |url=https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |isbn= 978-92-4-159371-7 |access-date=2008-02-29 |archive-url=https://web.archive.org/web/20220313162309/https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |archive-date=13 March 2022 |url-status=dead}}</ref> | |||
| This intention forms the legal and philosophical foundation of the profession, which ] law summarizes in this manner: | |||
| ⚫ | |||
| ⚫ | {{blockquote|Coverage of chiropractic services is specifically limited to manual manipulation of the spine to correct a subluxation... Medicare will not pay for treatment unless it is 'manual manipulation of the spine to correct a subluxation'.<ref name="Medicare">{{cite web |url=https://www.medicare.gov/coverage/chiropractic-services |website=Medicare|title=Coverage for Chiropractic Services}}</ref>}} | ||
| === Defined as unique to chiropractic === | |||
| ⚫ | Chiropractic authors and researchers Meeker and Haldeman write that the core clinical method that all chiropractors agree upon is ], although chiropractors much prefer to use the term spinal "adjustment", a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities."<ref name=crossroads>{{cite journal |journal= Ann Intern Med |year=2002 |volume=136 |issue=3 |pages=216–27 |title= Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine |vauthors=Meeker WC, Haldeman S |pmid=11827498 |doi=10.7326/0003-4819-136-3-200202050-00010|citeseerx=10.1.1.694.4126 |s2cid=16782086 }}</ref> | ||
| ⚫ | |||
| The ] (ICA) states: | |||
| === Intention: to correct vertebral subluxations === | |||
| ⚫ | {{blockquote|Chiropractic spinal adjustment is unique and singular to the chiropractic profession ... characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion. Chiropractic is a specialized field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession.<ref name=ICA_policy>. ].</ref>}} | ||
| One author claims that this concept is now repudiated by mainstream chiropractic.<ref>{{cite book |pages=160 |title=The Chiropractic Profession: Its Education, Practice, Research and Future Directions |author=David Chapman-Smith |year=2000 |publisher=NCMIC Group |isbn=978-1-892734-02-0}}</ref> The definition of this procedure describes the use of a load (force) to specific body tissues with therapeutic intent. This "load" is traditionally supplied by hand and can vary in its velocity, amplitude, duration, frequency, and body location{{r|crossroads|p=118}} and is usually abbreviated HVLA (]) thrust.<ref name=Lisi>{{cite journal|first1=Anthony J.|last1=Lisi|first2=Mukesh K.|last2=Bhardwaj|title=Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome |journal=Journal of Manipulative and Physiological Therapeutics|year=2004|pages=574–578|volume=27|issue=9|doi=10.1016/j.jmpt.2004.10.002|pmid=15614245}}</ref><ref name=Gibbons>Peter Gibbons, Philip Tehan. </ref> | |||
| The intention of a chiropractic adjustment is to affect or correct the alignment, motion and/or function of a vertebral joint. Specifically, they are intended to correct "]s", the term given to the signs and symptoms that are said by chiropractors to result from abnormal alignment of vertebrae. (p. 218)<ref name=crossroads/> This intention forms the legal and philosophical foundation of the profession, and ] law formulates it in this manner: | |||
| ⚫ | |||
| ==Adjustment methods== | ==Adjustment methods== | ||
| ⚫ | Individual practitioners and institutions proposed and developed various proprietary techniques and methods as the chiropractic profession grew. While many of these techniques did not endure, hundreds of different approaches remain in chiropractic practice today. Not all of them involve HVLA thrust manipulation. Most cite case studies, anecdotal evidence, and patient testimonials as evidence for effectiveness. These techniques include: | ||
| ⚫ | *'''Toggle Drop'''—This is when the chiropractor, using crossed hands, presses down firmly on a particular area of the spine. Then, the chiropractor adjusts the spine with a quick and precise thrust. This is done to improve mobility in the vertebral joints. | ||
| ⚫ | |||
| ⚫ | *'''Lumbar Roll''' ({{aka}} side posture)—The chiropractor positions the patient on their side, then applies a quick and precise manipulative thrust to the misaligned vertebra, returning it to its proper position. | ||
| ⚫ | *'''Release Work'''—The chiropractor applies gentle pressure using their fingertips to separate the vertebrae. | ||
| ⚫ | *'''Toggle Drop''' |
||
| ⚫ | *'''Table adjustments'''—The patient lies on a special table with drop-down sections. The chiropractor applies a quick thrust when the section drops. The table's drop allows for a lighter adjustment without the twisting positions that can accompany other techniques. | ||
| ⚫ | *'''Lumbar Roll''' (aka side posture) |
||
| ⚫ | *'''Instrument adjustments'''—Often the gentlest methods of adjusting the spine. The patient lies on the table face down while the chiropractor uses a spring-loaded activator instrument to perform the adjustment. This technique is often used to perform adjustments on animals, as well. | ||
| ⚫ | *'''Release Work''' |
||
| ⚫ | *'''] (MUA)'''—This is performed by a chiropractor certified in this technique in a hospital-outpatient setting when the patient is unresponsive to traditional adjustments. | ||
| ⚫ | *'''Table adjustments''' |
||
| ⚫ | *'''Instrument adjustments''' |
||
| ⚫ | *'''] (MUA)''' |
||
| ===Techniques=== | ===Techniques=== | ||
| There are many techniques |
There are many techniques that chiropractors can specialize in and employ in spinal adjustments. Some of the most notable techniques include: | ||
| * ''']''' |
* ''']'''—Uses the Activator Adjusting Instrument instead of by-hand adjustments to give consistent mechanical low-force, high-speed impulses to the body. Utilizes a leg-length analysis to determine segmental aberration. | ||
| * '''Active Release Techniques''' |
* '''Active Release Techniques'''—Soft tissue system- or movement-based technique that treats problems with muscles, tendons, ligaments, fascia, and nerves. | ||
| * '''Bio-Geometric Integration''' |
* '''Bio-Geometric Integration''' is a framework for understanding the body's response to force dynamics. It can be utilized with many techniques. Each case presentation focuses on the body's full integration of forces and assesses the most appropriate adjustive force application, ranging from light pressure to traditional joint cavitation. | ||
| * '''Blair Upper Cervical Technique''' |
* '''Blair Upper Cervical Technique'''—An objective upper cervical technique focusing primarily on misalignments in the first bone of the spine (]) as it comes into contact with the head (]). | ||
| * ''' |
* '''Chiropractic Biophysics (CBP)'''—A technique that aims to correct improper curvatures of the spine with traditional chiropractic manipulation (SMT), focused rehabilitation exercises, and a unique form of spinal traction that utilizes mechanically-assisted and focused stretching to stretch and remodel the ligaments and related tissues of the spine. | ||
| * '''Cox Flexion-Distraction''' |
* '''Cox Flexion-Distraction''' is a decompression–focused procedure that utilizes specialized adjusting tables with movable parts. These tables stretch and decompress the spine's facets and ligaments in a gentle rocking motion. | ||
| * '''Directional Non-Force Technique''' |
* The '''Directional Non-Force Technique''' utilizes a diagnostic system for subluxation analysis consisting of gentle challenging and a unique leg check. It allows the body to indicate the directions of misalignment of structures producing nerve interference. A gentle but directionally specific thumb impulse provides a long-lasting correction to bony and soft tissue structures. | ||
| * '''Diversified''' |
* '''Diversified'''—The classical chiropractic technique developed by D.D. Palmer. It uses specific manual thrusts focused on restoring normal biomechanical function. It has been developed to adjust extremity joints, as well. | ||
| * '''Gonstead Technique''' |
* '''Gonstead Technique'''—Developed by an automotive engineer-turned-chiropractor, this technique uses a precise analysis method, including stereoscopes, full spine X-rays, and precise adjusting techniques. It condemns "torquing" of the spine, which may harm the intervertebral disc. | ||
| * '''Hole-in-one Technique/Toggle Recoil Technique''' |
* '''Hole-in-one Technique/Toggle Recoil Technique'''—Synonyms for the upper cervical technique developed by B.J. Palmer that uses a quick thrust and release and later incorporated a drop table, as seen in modern practice. | ||
| * '''Kale Technique (Specific Chiropractic)''' |
* '''Kale Technique (Specific Chiropractic)''' is a gentle technique that utilizes a special adjusting table to help adjust and stabilize the upper cervical region surrounding the brain stem. | ||
| * '''Logan Basic Technique''' |
* '''Logan Basic Technique'''—A light touch technique that works to "level the foundation" or sacrum. Its concept employs the use of heel lifts and specific contacts. | ||
| * '''NUCCA Technique''' |
* '''NUCCA Technique'''—Manual method of adjusting the atlas subluxation complex based on 3D x-ray studies, determining the correct line of drive or vector of force. | ||
| * '''Orthospinology Procedure''' |
* '''Orthospinology Procedure''' is a method of analyzing and correcting the chiropractic upper cervical subluxation complex based on vertebral alignment measurements on neck X-rays taken from three different directions. The adjustment can be delivered by hand, hand-held, or table-mounted instruments along a pre-calculated vector using approximately 1 to 7 pounds of force. The patient is in a side-lying posture with a solid mastoid support. The procedure is based on the work of John F. Grostic. | ||
| * '''Thompson Terminal Point Technique (Thompson Drop-Table Technique)''' |
* '''Thompson Terminal Point Technique (Thompson Drop-Table Technique)''' uses a precision–adjustable table with a weighing mechanism that adds only enough tension to hold the patient in the "up" position before the thrust is given. | ||
| Over the years, many variations of these techniques have been delivered, most as proprietary techniques developed by individual practitioners. ] has made a partial list:<ref name=WebMD_applications> ]</ref> | Over the years, many variations of these techniques have been delivered, most as proprietary techniques developed by individual practitioners. ] has made a partial list:<ref name=WebMD_applications> ]</ref> | ||
| Line 68: | Line 68: | ||
| * Cervical Care | * Cervical Care | ||
| * Cervical Drop | * Cervical Drop | ||
| * |
* Chiropractic Biophysics (CBP) | ||
| * Clinical Kinesiology | * Clinical Kinesiology | ||
| * Concept Therapy | * Concept Therapy | ||
| Line 90: | Line 90: | ||
| * Network | * Network | ||
| * Neural Organization Technique | * Neural Organization Technique | ||
| * NeuroEmotional Technique (NET) | |||
| * ] | |||
| * Neuro Muscular Technique | * Neuro Muscular Technique | ||
| * Neuro Vascular Technique | * Neuro Vascular Technique | ||
| Line 121: | Line 121: | ||
| ==Effects== | ==Effects== | ||
| === Musculoskeletal disorders=== | |||
| ⚫ | The effects of spinal adjustment vary depending on the method performed. All techniques claim effects similar to other manual therapies, ranging from decreased muscle tension to reduced stress. Studies show that most patients go to chiropractors for musculoskeletal problems:<ref>{{cite journal |last1=Clijsters |first1=M |last2=Fronzoni |first2=F |last3=Jenkins |first3=H |title=Chiropractic treatment approaches for spinal musculoskeletal conditions: a cross-sectional survey |journal=Chiropr Man Ther |date=2014-10-01 |volume=22 |issue=1 |pages=33 |doi=10.1186/s12998-014-0033-8 |doi-access=free |pmid=25309722 |pmc=4193988}}</ref> 60% with low back pain, and the rest with head, neck and extremity symptoms. (p. 219)<ref name=crossroads/> Also the article "Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine" states that, “chiropractic was to be a revolutionary system of healing based on the premise that neurologic dysfunction caused by ‘impinged’ nerves at the spinal level was the cause of most dis-ease”. (p. 218)<ref name=crossroads/> The mechanisms that are claimed to alter nervous system function and affect overall health are seen as speculative in nature, however, clinical trials have been conducted that include “placebo-controlled comparisons comparisons with other treatments”. (p. 220)<ref name=crossroads/> The American Chiropractic Association promotes chiropractic care of infants and children under the theory that “poor posture and physical injury, including birth trauma, may be common primary causes of illness in children and can have a direct and significant impact not only on spinal mechanics, but on other bodily functions”.<ref>{{cite journal |journal= Dyn Chiropr |year=1994 |volume=12 |issue=17 |title= Infant and child care policy |author= American Chiropractic Association |url=http://chiroweb.com/archives/12/17/01.html}}</ref> | ||
| ⚫ | The effects of spinal manipulation have been shown to include: temporary relief of musculoskeletal pain, increased range of joint motion, changes in facet joint kinematics, increased pain tolerance and increased muscle strength. (p. 222)<ref name=crossroads/> Common side effects of spinal manipulative therapy (SMT) are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort. (p. 222).<ref name=crossroads/> | ||
| === Non-musculoskeletal disorders=== | |||
| Historically, the profession has falsely claimed that spinal adjustments have physiological effects on inner organs and their function, and thus affect overall health, not just musculoskeletal disorders, a view that originated with Palmer's original thesis that all diseases were caused by subluxations of the spine and other joints. With time, fewer chiropractors hold this view, with "a small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial."<ref name="Côté_Hartvigsen_Axén_Leboeuf-Yde_2/17/2021"/> | |||
| ⚫ | The effects of spinal adjustment vary depending on the method performed. All techniques claim effects similar to other manual therapies, ranging from decreased muscle tension to reduced stress. Studies show that most patients go to chiropractors for musculoskeletal problems: 60% with low back pain, and the rest with head, neck and extremity symptoms. (p. 219)<ref name=crossroads/> Also the article "Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine" states that, “chiropractic was to be a revolutionary system of healing based on the premise that neurologic dysfunction caused by ‘impinged’ nerves at the spinal level was the cause of most dis-ease”. (p. 218)<ref name=crossroads/> The mechanisms that are claimed to alter nervous system function and affect overall health are seen as speculative in nature, however, clinical trials have been conducted that include “placebo-controlled comparisons comparisons with other treatments”. (p. 220)<ref name=crossroads/> The American Chiropractic Association promotes chiropractic care of infants and children under the theory that “poor posture and physical injury, including birth trauma, may be common primary causes of illness in children and can have a direct and significant impact not only on spinal mechanics, but on other bodily functions”.<ref>{{cite journal |journal= Dyn Chiropr |year=1994 |volume=12 |issue=17 |title= Infant and child care policy |author= American Chiropractic Association |url=http://chiroweb.com/archives/12/17/01.html}}</ref> | ||
| A 2019 global summit of "50 researchers from 8 countries and 28 observers from 18 chiropractic organizations" conducted a systematic review of the literature, and 44 of the 50 "found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function."<ref name="Côté_Hartvigsen_Axén_Leboeuf-Yde_2/17/2021">{{cite journal | last1=Côté | first1=Pierre | last2=Hartvigsen | first2=Jan | last3=Axén | first3=Iben | last4=Leboeuf-Yde | first4=Charlotte | title=The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature | journal=Chiropractic & Manual Therapies | publisher=Springer Science and Business Media LLC | volume=29 | issue=1 | date=February 17, 2021 | issn=2045-709X | doi=10.1186/s12998-021-00362-9| pmc=7890602 | page=8| pmid=33596925 | doi-access=free }}</ref> | |||
| ⚫ | The effects of spinal manipulation have been shown to include: temporary relief of musculoskeletal pain, increased range of joint motion, changes in facet joint kinematics, increased pain tolerance and increased muscle strength. (p. 222)<ref name=crossroads/> Common side effects of spinal manipulative therapy (SMT) are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort. (p. 222)<ref name=crossroads/> | ||
| ==Safety== | ==Safety== | ||
| {{See also|Spinal manipulation#Safety}} | {{See also|Spinal manipulation#Safety}} | ||
| There |
There has been limited research on the safety of chiropractic spinal manipulation, making it difficult to establish precise estimates of the frequency and severity of adverse events.<ref>{{Cite journal |last=Ernst |first=E. |date=July 2007 |title=Adverse effects of spinal manipulation: a systematic review |journal=Journal of the Royal Society of Medicine |volume=100 |issue=7 |pages=330–338 |doi=10.1177/014107680710000716 |issn=0141-0768 |pmc=1905885 |pmid=17606755}}</ref><ref>{{Cite journal |last1=Gouveia |first1=Liliana Olim |last2=Castanho |first2=Pedro |last3=Ferreira |first3=Joaquim J. |date=2009-05-15 |title=Safety of chiropractic interventions: a systematic review |url=https://pubmed.ncbi.nlm.nih.gov/19444054/ |journal=Spine |volume=34 |issue=11 |pages=E405–413 |doi=10.1097/BRS.0b013e3181a16d63 |issn=1528-1159 |pmid=19444054|s2cid=21279308 }}</ref><ref name=":0">{{Cite journal |last1=Swait |first1=Gabrielle |last2=Finch |first2=Rob |date=2017 |title=What are the risks of manual treatment of the spine? A scoping review for clinicians |journal=Chiropractic & Manual Therapies |volume=25 |pages=37 |doi=10.1186/s12998-017-0168-5 |issn=2045-709X |pmc=5719861 |pmid=29234493 |doi-access=free }}</ref> Adverse events are increasingly reported in ]s of spinal manipulation but remain ] despite recommendations in the 2010 ] guidelines.<ref name=Gorrell2016>{{cite journal|last1=Gorrell|first1=LM|last2=Engel|first2=RM|last3=Brown|first3=B|last4=Lystad|first4=RP|title=The reporting of adverse events following spinal manipulation in randomized clinical trials-a systematic review| journal=The Spine Journal|volume=16|issue=9|pages=1143–51|date=September 2016|pmid=27241208|doi=10.1016/j.spinee.2016.05.018|type=Systematic Review}}</ref><ref name=Ernst-2012>{{cite journal |vauthors=Ernst E, Posadzki P | title = Reporting of adverse effects in randomised clinical trials of chiropractic manipulations: a systematic review | journal = N Z Med J | volume = 125 | issue = 1353 | pages = 87–140 | year = 2012 |pmid=22522273}}</ref> Chiropractic spinal manipulation is frequently associated with mild to moderate temporary ], and also serious outcomes which can result in permanent disability or death,<ref name="Ernst-adverse">{{cite journal |author=Ernst E |year=2007 |title=Adverse effects of spinal manipulation: a systematic review |url=http://www.jrsm.org/cgi/content/full/100/7/330 |journal=] |volume=100 |issue=7 |pages=330–8 |doi=10.1177/014107680710000716 |pmc=1905885 |pmid=17606755}}</ref><ref name="Nordqvist 2007">{{cite web | last=Nordqvist | first=Christian | title=Spinal Manipulation Should Not Be Routinely Used, New Study Warns | website=MedicalNewsToday | date=July 2, 2007 | url=https://www.medicalnewstoday.com/articles/75754}}</ref> which include ], ], vertebral and rib fractures and ].<ref name=crossroads/><ref>{{cite journal |vauthors=Senstad O, Leboeuf-Yde C, Borchgrevink C |title=Frequency and characteristics of side effects of spinal manipulative therapy |journal=Spine |volume=22 |issue=4 |pages=435–40; discussion 440–1 |date=February 1997 |pmid=9055373 |doi= 10.1097/00007632-199702150-00017|s2cid=7482895 }}</ref> A scoping review found that benign (mild-moderate) adverse events such as musculoskeletal pain, stiffness, and headache were common and transient (i.e., resolved within 24 hours), and affected 23–83% of adults.<ref name=":0" /> Serious outcomes are thought to be very rare, yet remain less studied than mild-moderate adverse events.<ref name=NHSChoicesChiropracticSafety>{{cite web |url=http://www.nhs.uk/Conditions/chiropractic/Pages/Safetyandregulation.aspx |title=Safety and regulation of chiropractic |publisher=] |date=20 August 2014 |access-date=22 September 2016}}</ref><ref name=":1">{{Cite journal |last1=Chu |first1=Eric Chun-Pu |last2=Trager |first2=Robert J. |last3=Lee |first3=Linda Yin-King |last4=Niazi |first4=Imran Khan |date=2023-01-23 |title=A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy |journal=Scientific Reports |language=en |volume=13 |issue=1 |pages=1254 |doi=10.1038/s41598-023-28520-4 |pmid=36690712 |pmc=9870863 |bibcode=2023NatSR..13.1254C |issn=2045-2322}}</ref> One retrospective study examining 960,140 sessions of chiropractic spinal manipulation found two severe adverse events, both being rib fractures in older women with osteoporosis (incidence of 0.21 per 100,000 sessions).<ref name=":1" /> There are several contraindications to chiropractic spinal manipulation, including poor bone integrity, cervical arterial pathology, spinal metastasis, and spinal instability.<ref>{{Cite journal |last1=Chu |first1=Eric Chun-Pu |last2=Trager |first2=Robert J |last3=Tao |first3=Cliff |last4=Lee |first4=Linda Yin-King |date=2022-10-01 |title=Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness |journal=The American Journal of Case Reports |volume=23 |pages=e937991 |doi=10.12659/ajcr.937991 |issn=1941-5923 |pmc=9597265 |pmid=36258651}}</ref><ref name=":1" /> | ||
| ==See also== | ==See also== | ||
| * ] | * ] | ||
| * ] | * ] | ||
| * ] | * ] | ||
| * ] | * ] | ||
| ==References== | ==References== | ||
| Line 142: | Line 149: | ||
| ==External links== | ==External links== | ||
| * - RAND Health | |||
| * - Keating, Hyde, Menke, Seaman, Vincent, Wyatt | |||
| * - Nathan Cintron, D.C. | |||
| * - Frank M. Painter, D.C. | |||
| * | |||
| {{Chiropractic}} | {{Chiropractic}} | ||
Latest revision as of 04:33, 29 November 2024
Chiropractic technique For the generic approach to manipulation of spinal joints, see Spinal manipulation.
Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease.
Spinal adjustments were among many chiropractic techniques invented in the 19th century by Daniel David Palmer, the founder of chiropractic. Claims made for the benefits of spinal adjustments range from temporary, palliative (pain relieving) effects to long term wellness and preventive care.
Description
A chiropractic adjustment intends to affect or correct a vertebral joint's alignment, motion, and/or function. Specifically, adjustments are intended to correct "vertebral subluxations", a non-scientific term given to the signs and symptoms that are said by chiropractors to result from abnormal alignment of vertebrae. 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.
This intention forms the legal and philosophical foundation of the profession, which US Medicare law summarizes in this manner:
Coverage of chiropractic services is specifically limited to manual manipulation of the spine to correct a subluxation... Medicare will not pay for treatment unless it is 'manual manipulation of the spine to correct a subluxation'.
Chiropractic authors and researchers Meeker and Haldeman write that the core clinical method that all chiropractors agree upon is spinal manipulation, although chiropractors much prefer to use the term spinal "adjustment", a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities."
The International Chiropractor's Association (ICA) states:
Chiropractic spinal adjustment is unique and singular to the chiropractic profession ... characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion. Chiropractic is a specialized field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession.
One author claims that this concept is now repudiated by mainstream chiropractic. The definition of this procedure describes the use of a load (force) to specific body tissues with therapeutic intent. This "load" is traditionally supplied by hand and can vary in its velocity, amplitude, duration, frequency, and body location and is usually abbreviated HVLA ( high-velocity low amplitude) thrust.
Adjustment methods
Individual practitioners and institutions proposed and developed various proprietary techniques and methods as the chiropractic profession grew. While many of these techniques did not endure, hundreds of different approaches remain in chiropractic practice today. Not all of them involve HVLA thrust manipulation. Most cite case studies, anecdotal evidence, and patient testimonials as evidence for effectiveness. These techniques include:
- Toggle Drop—This is when the chiropractor, using crossed hands, presses down firmly on a particular area of the spine. Then, the chiropractor adjusts the spine with a quick and precise thrust. This is done to improve mobility in the vertebral joints.
- Lumbar Roll (a.k.a. side posture)—The chiropractor positions the patient on their side, then applies a quick and precise manipulative thrust to the misaligned vertebra, returning it to its proper position.
- Release Work—The chiropractor applies gentle pressure using their fingertips to separate the vertebrae.
- Table adjustments—The patient lies on a special table with drop-down sections. The chiropractor applies a quick thrust when the section drops. The table's drop allows for a lighter adjustment without the twisting positions that can accompany other techniques.
- Instrument adjustments—Often the gentlest methods of adjusting the spine. The patient lies on the table face down while the chiropractor uses a spring-loaded activator instrument to perform the adjustment. This technique is often used to perform adjustments on animals, as well.
- Manipulation under anesthesia (MUA)—This is performed by a chiropractor certified in this technique in a hospital-outpatient setting when the patient is unresponsive to traditional adjustments.
Techniques
There are many techniques that chiropractors can specialize in and employ in spinal adjustments. Some of the most notable techniques include:
- Activator technique—Uses the Activator Adjusting Instrument instead of by-hand adjustments to give consistent mechanical low-force, high-speed impulses to the body. Utilizes a leg-length analysis to determine segmental aberration.
- Active Release Techniques—Soft tissue system- or movement-based technique that treats problems with muscles, tendons, ligaments, fascia, and nerves.
- Bio-Geometric Integration is a framework for understanding the body's response to force dynamics. It can be utilized with many techniques. Each case presentation focuses on the body's full integration of forces and assesses the most appropriate adjustive force application, ranging from light pressure to traditional joint cavitation.
- Blair Upper Cervical Technique—An objective upper cervical technique focusing primarily on misalignments in the first bone of the spine (Atlas) as it comes into contact with the head (occiput).
- Chiropractic Biophysics (CBP)—A technique that aims to correct improper curvatures of the spine with traditional chiropractic manipulation (SMT), focused rehabilitation exercises, and a unique form of spinal traction that utilizes mechanically-assisted and focused stretching to stretch and remodel the ligaments and related tissues of the spine.
- Cox Flexion-Distraction is a decompression–focused procedure that utilizes specialized adjusting tables with movable parts. These tables stretch and decompress the spine's facets and ligaments in a gentle rocking motion.
- The Directional Non-Force Technique utilizes a diagnostic system for subluxation analysis consisting of gentle challenging and a unique leg check. It allows the body to indicate the directions of misalignment of structures producing nerve interference. A gentle but directionally specific thumb impulse provides a long-lasting correction to bony and soft tissue structures.
- Diversified—The classical chiropractic technique developed by D.D. Palmer. It uses specific manual thrusts focused on restoring normal biomechanical function. It has been developed to adjust extremity joints, as well.
- Gonstead Technique—Developed by an automotive engineer-turned-chiropractor, this technique uses a precise analysis method, including stereoscopes, full spine X-rays, and precise adjusting techniques. It condemns "torquing" of the spine, which may harm the intervertebral disc.
- Hole-in-one Technique/Toggle Recoil Technique—Synonyms for the upper cervical technique developed by B.J. Palmer that uses a quick thrust and release and later incorporated a drop table, as seen in modern practice.
- Kale Technique (Specific Chiropractic) is a gentle technique that utilizes a special adjusting table to help adjust and stabilize the upper cervical region surrounding the brain stem.
- Logan Basic Technique—A light touch technique that works to "level the foundation" or sacrum. Its concept employs the use of heel lifts and specific contacts.
- NUCCA Technique—Manual method of adjusting the atlas subluxation complex based on 3D x-ray studies, determining the correct line of drive or vector of force.
- Orthospinology Procedure is a method of analyzing and correcting the chiropractic upper cervical subluxation complex based on vertebral alignment measurements on neck X-rays taken from three different directions. The adjustment can be delivered by hand, hand-held, or table-mounted instruments along a pre-calculated vector using approximately 1 to 7 pounds of force. The patient is in a side-lying posture with a solid mastoid support. The procedure is based on the work of John F. Grostic.
- Thompson Terminal Point Technique (Thompson Drop-Table Technique) uses a precision–adjustable table with a weighing mechanism that adds only enough tension to hold the patient in the "up" position before the thrust is given.
Over the years, many variations of these techniques have been delivered, most as proprietary techniques developed by individual practitioners. WebMD has made a partial list:
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Effects
Musculoskeletal disorders
The effects of spinal adjustment vary depending on the method performed. All techniques claim effects similar to other manual therapies, ranging from decreased muscle tension to reduced stress. Studies show that most patients go to chiropractors for musculoskeletal problems: 60% with low back pain, and the rest with head, neck and extremity symptoms. (p. 219) Also the article "Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine" states that, “chiropractic was to be a revolutionary system of healing based on the premise that neurologic dysfunction caused by ‘impinged’ nerves at the spinal level was the cause of most dis-ease”. (p. 218) The mechanisms that are claimed to alter nervous system function and affect overall health are seen as speculative in nature, however, clinical trials have been conducted that include “placebo-controlled comparisons comparisons with other treatments”. (p. 220) The American Chiropractic Association promotes chiropractic care of infants and children under the theory that “poor posture and physical injury, including birth trauma, may be common primary causes of illness in children and can have a direct and significant impact not only on spinal mechanics, but on other bodily functions”.
The effects of spinal manipulation have been shown to include: temporary relief of musculoskeletal pain, increased range of joint motion, changes in facet joint kinematics, increased pain tolerance and increased muscle strength. (p. 222) Common side effects of spinal manipulative therapy (SMT) are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort. (p. 222).
Non-musculoskeletal disorders
Historically, the profession has falsely claimed that spinal adjustments have physiological effects on inner organs and their function, and thus affect overall health, not just musculoskeletal disorders, a view that originated with Palmer's original thesis that all diseases were caused by subluxations of the spine and other joints. With time, fewer chiropractors hold this view, with "a small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial."
A 2019 global summit of "50 researchers from 8 countries and 28 observers from 18 chiropractic organizations" conducted a systematic review of the literature, and 44 of the 50 "found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function."
Safety
See also: Spinal manipulation § SafetyThere has been limited research on the safety of chiropractic spinal manipulation, making it difficult to establish precise estimates of the frequency and severity of adverse events. Adverse events are increasingly reported in randomized clinical trials of spinal manipulation but remain under–reported despite recommendations in the 2010 CONSORT guidelines. Chiropractic spinal manipulation is frequently associated with mild to moderate temporary adverse effects, and also serious outcomes which can result in permanent disability or death, which include strokes, spinal disc herniation, vertebral and rib fractures and cauda equina syndrome. A scoping review found that benign (mild-moderate) adverse events such as musculoskeletal pain, stiffness, and headache were common and transient (i.e., resolved within 24 hours), and affected 23–83% of adults. Serious outcomes are thought to be very rare, yet remain less studied than mild-moderate adverse events. One retrospective study examining 960,140 sessions of chiropractic spinal manipulation found two severe adverse events, both being rib fractures in older women with osteoporosis (incidence of 0.21 per 100,000 sessions). There are several contraindications to chiropractic spinal manipulation, including poor bone integrity, cervical arterial pathology, spinal metastasis, and spinal instability.
See also
References
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- Kirkey, Sharon; Hall, Brice (July 2, 2019). "The first chiropractor was a Canadian who claimed he received a message from a ghost". The Star Phoenix.
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- American Chiropractic Association (1994). "Infant and child care policy". Dyn Chiropr. 12 (17).
- ^ Côté, Pierre; Hartvigsen, Jan; Axén, Iben; Leboeuf-Yde, Charlotte (February 17, 2021). "The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature". Chiropractic & Manual Therapies. 29 (1). Springer Science and Business Media LLC: 8. doi:10.1186/s12998-021-00362-9. ISSN 2045-709X. PMC 7890602. PMID 33596925.
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- Nordqvist, Christian (July 2, 2007). "Spinal Manipulation Should Not Be Routinely Used, New Study Warns". MedicalNewsToday.
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- "Safety and regulation of chiropractic". NHS Choices. 20 August 2014. Retrieved 22 September 2016.
- ^ Chu, Eric Chun-Pu; Trager, Robert J.; Lee, Linda Yin-King; Niazi, Imran Khan (2023-01-23). "A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy". Scientific Reports. 13 (1): 1254. Bibcode:2023NatSR..13.1254C. doi:10.1038/s41598-023-28520-4. ISSN 2045-2322. PMC 9870863. PMID 36690712.
- Chu, Eric Chun-Pu; Trager, Robert J; Tao, Cliff; Lee, Linda Yin-King (2022-10-01). "Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness". The American Journal of Case Reports. 23: e937991. doi:10.12659/ajcr.937991. ISSN 1941-5923. PMC 9597265. PMID 36258651.
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