Misplaced Pages

Revision as of 05:03, 21 January 2006

Chiropractic, also known as chiropractic care, is a health care discipline with an underlying principle that health problems can be prevented and treated using spinal adjustments in order to correct spinal dysfunction, or subluxations. Chiropractic maintains that the brain and nervous system control and coordinate all the body's functions in part through nerve branches that exit from the spinal cord between the vertebrae. Some chiropractors infer a causal relationship between nerve interference or compression at the spine and subsequent problems in more distant parts or organ systems regulated by the nerve.

Practitioners of chiropractic are called chiropractors or chiropractic physicians. In the United States they receive the degree Doctor of Chiropractic, (D.C.) and are referred to as doctor. Chiropractors are licensed in all jurisdictions of the United States of America, in addition to many other countries throughout the world.

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

History

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

…knowledge is requisite in many diseases.

Chiropractic was founded by Daniel David Palmer in Davenport, Iowa, USA. Palmer was born in Pickering, Ontario, and moved to the United States in 1865. Referred to by some historians as a "fish monger" because he sold fish commercially, Palmer practiced magnetic healing beginning in the mid-1880s in Burlington, Iowa. Palmer was well read in medical journals of his time and had great knowledge of the developments that were occurring throughout the world regarding anatomy and physiology.

During this time he tried to find a single cause for 100% of all diseases. He reached a point where he even claimed to have succeeded in this mission:

A subluxated vertebrae . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column.

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

Palmer's version of this event has always been disputed by Lillard's daughter, Valdeenia Lillard Simons. She says that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make it, then they both would share. But, it didn't happen."

The term chiropractic originated when Palmer asked a patient - Rev. Samuel Weed - to come up with a name from the Greek language to describe his practice. Of the several names submitted to him, Palmer accepted one which combined the words chiros and praktikos (meaning "done by hand") to describe his adjustment of a vertebra in the spinal column. Palmer had been a beekeeper, school teacher, and grocery store owner, and had an interest in the various health philosophies of his day such as magnetic healing, osteopathy, and spiritualism.

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

While D. D. Palmer founded chiropractic, it is generally recognized that his dynamic son, B. J. Palmer, bears the major responsibility for the later development and marketing of chiropractic.

Chiropractic subluxation

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

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

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

Philosophy of the Subluxation

Chiropractic philosophy holds that much of the body is controlled by messages sent to and from the brain along the nervous system. The medical community agrees that all messages - whether it is the brain commanding the foot to move or an organ telling the brain it is in need of repair - pass through the spinal cord; which acts as a kind of cerebral router. An outgoing message from the brain passes down the spinal cord and through the appropriate spinal nerve branch held between the vertebrae on either side of the spinal cord. There are 31 pairs of spinal nerves that emerge from the spinal cord; all of which are housed by vertebrae. If the vertebrae are misaligned (subluxated), chiropractors believe that a spinal nerve can be squeezed or pinched and therefore message flow can be compromised. By aligning the vertebrae and removing restrictions on the spinal nerves, chiropractic claims to allow the spinal cord to more effectively relay messages to and from the brain; thus promoting better health.

Usage

The use of manipulative therapy — especially as practiced by chiropractors — is regarded with controversy by medical authorities in many nations. Of interest is that Hippocrates, considered to be the Father of Medicine, describes manipulative therapy utilizing various methods of spinal realignment in his writings. Its use throughout history is well-documented. It is covered by many health plans such as Medicare in the United States. Although some medical doctors (MDs), many doctors of osteopathy (DOs), as well as some Physical Therapists do perform manipulative therapy, more than 90 percent of the treatment of back pain by manipulative therapy is performed by DCs (Doctors of Chiropractic).Template:Fn

Joint Manipulation itself creates "cavitation" within the joint. This "popping" sound is the release of tiny carbon dioxide gas bubbles from the synovial fluid which lines the joint. These bubbles are released due to the sudden pressure change within the joint during the manipulation. The most recent scientific research from the traditional medical community suggests that this "cavitation" creates a barrage of sensory information within the joint, which travels to the brain. This change in the sensory information received from the joint creates a change in the motor nerve output from the brain to the muscles acting on the manipulated joint. This can create an immediate reduction in muscle spasm. This is the most recent traditional medical model for the effects of Joint Manipulation, and is not accepted widely within the Chiropractic community.

Other technique models rely on little or no joint cavitation, and thus can not be defined as manipulation. Chiropractors within a great many instrument-assisted and upper cervical specific techniques do not perform adjustments with cavitations. A sound may, or may not be produced.

Scientific Support for Chiropractic

According to a survey released in 2004 by the National Center for Complementary and Alternative Medicine, chiropractic was the fourth most commonly used complementary and alternative medicine therapy among adults in the United States (7.5%).Template:FnTemplate:Fn

Chiropractic has gained general acceptance in the last 40 years as an appropriate treatment for certain back and neck problems. This was partly a result of the prolonged litigation between the powerful American Medical Association (AMA) and various chiropractors over the legitimacy of the field (see Wilk v. American Medical Association). The AMA is politically opposed to chiropractic as a healing discipline and disputes the concept of subluxation.

According to Harrison's Principles of Internal Medicine, a meta-analysis of nine studies found spinal manipulation to be effective in improving uncomplicated, acute back pain. The studies found no benefit to treating chronic pain or sciatic nerve irritation. However, more recent studies have found chiropractic to be cost effective in the treatment of chronic back pain.

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

A 2002 investigation supports that spinal manipulation may benefit patients afflicted with asthma . A 2004 study showed that spinal manipulation may benefit ADHD patients .Other recent case studies and research support chiropractic's claim to be effective with a range of conditions including Autism, Irritable Bowel Syndrome, Bell's Palsy, Glaucoma, Crohn's Disease, Colic, Ulcers and Parkinson's Disease.

Chiropractic education, licensure, and regulation

United States

In the United States, the Council on Chiropractic Education (CCE) is in charge of setting minimum guidelines for chiropractic colleges; however, additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice.

Chiropractors often enter chiropractic school with a Bachelor's degree, or with three years of post-secondary education in the sciences and other appropriate coursework.

Many chiropractic colleges in the United States require a four-year undergraduate degree, although the minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours. The minimum cumulative GPA for a student entering a chiropractic college is 2.50. Commonly required classes include:

• communication or language skills,
• psychology,
• social science or humanities,
• biology,
• organic and inorganic chemistry,
• physics

As well as the common medical classes in:

• anatomy or embryology,
• physiology,
• microbiology,
• diagnosis,
• neurology,
• x-ray,
• orthopedics,
• obstetrics, and
• gynecology.

However, the process of credentialing varies widely by country. The curriculum in a chiropractic school is quite rigorous, resembling medical school at the basic course level; however, the timeframe to attain a degree itself in a chiropractic school is much less than that of a medical school. Coursework in Chiropractic school may include study in gross anatomy, biochemistry, embryology, microbiology, anatomy and physiology in the first half of formal schooling. The last half of formal education focusses on clinical patient care through clinical rounds in various settings. Graduates of chiropractic schools have to complete five years of schooling and pass four national board exams in order to complete their education.

Graduates of chiropractic schools must sit for State examination to qualify for licensure. Once licensed, most States require chiropractors to annually attend 12 to 48 hours of continuing education courses.

Philosophical schools of chiropractic

Contemporary chiropractic is generally divided into three basic schools - straight, mixer, and reform - which differ in their approaches to patient care. However, all chiropractic approaches are, as a minimum, heavily based on the use of manipulation as a panacea for mechanical musculoskeletal dysfunction of the spine and extremities.

1. Straight chiropractors only concern themselves with vertebral subluxation correction. Practitioners often use varying vertebral manipulation techniques known as "adjustments" for the purpose of preventive medicine and pain relief. Straight chiropractors hold that only the body can cure the body. By aligning the vertebrae, straight chiropractors believe that they are clearing nerve impulse restrictions and therefore providing a more efficient dialogue between the brain and the rest of the body's systems, thus putting the body in a better position to cure (or heal) itself.
2. Mixing chiropractors combine contemporary medical diagnosis and treatment with chiropractic adjustments. Mixing style practitioners utilize adjustments to treat chiropractic subluxations, as well as naturopathic style remedies for other disorders. Methods used might include ultrasound, TENS, rehabilitation or the use of other diagnostic methods such as Applied Kinesiology (AK). Mixing chiropractic is itself divided into conservative and liberal groupsTemplate:Fn.
3. Reform chiropractors are a minority group oriented at mainstream science. The National Association for Chiropractic Medicine (NACM) represents a small group of chiropractors which advocates a highly limited use of chiropractic medicine. By openly rejecting some of the more controversial aspects of chiropractic, including the original chiropractic hypothesis that subluxations are the cause of 100% of all diseases, NACM members claim to receive mainstream approvalTemplate:Fn more so than practitioners of straight or mixing chiropractic. The NACM is a private organization that does not release membership data of its members, however, one outside estimate reported membership to be in the "low hundreds" .

In Australia, one of the first countries to widely accept chiropractic (since 1905), the deliniation into Straight vs Mixer chiropractor is all but relegated to history. The above categories are not commonly cited by the profession or the public. Most universities teaching chiropractic in Australia, including Palmer in Davenport Iowa, USA, are utilizing rehab methods, exercise and physiological therapeutics and nutrition. The National College (now University) incorporated physical therapy as early as 1912, even before there was a profession bearing its name. The profession here continues to be divided only into specialities. Some do spine-only. Others prefer to do sports and rehabilitation. There are musculoskeletal foci and those who co-manage people with organic problems, MS or cancer along with their regular medical approaches. Philosophically, spinal and musculoskeletal approaches to health can benefit the WHOLE person, and the general public accepts this. At any rate, straight chiropractors, who do nothing but adjust spinal subluxations, diligently work with other professionals such that they are needed to benefit the patients overall well being.

Criticism of chiropractic

Critics, including many mainstream medical doctors and scientists, often reject the claims of some chiropractic associations and schools as pseudoscience, quackery, or fraud.

Advocates believe at least some of this criticism was encouraged by the American Medical Association during the 1970s and early 1980s in what they have labeled "anti-chiropractic prejudice". In a carefully worded statement, the judge in a trial against the AMA recognized that this skepticism was also the inspiration for the AMA's actions in instituting an illegal boycott of chiropractic:

In 1987, federal court judge Susan Getzendanner concluded that during the 1960s "there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious." The judge also noted that chiropractors still took too many x-rays. However, she ruled that the AMA had engaged in an illegal boycott. She concluded that the dominant reason for the AMA's antichiropractic campaign was the belief that chiropractic was not in the best interest of patients. But she ruled that this did not justify attempting to contain and eliminate an entire licensed profession without first demonstrating that a less restrictive campaign could not succeed in protecting the public. Although a minority of chiropractors trumpet the antitrust ruling as an endorsement of their effectiveness, the case was decided on narrow legal grounds (restraint of trade) and was not an evaluation of chiropractic methods.

It is, however, factual that this policy of containment was also dispersed within the Australian Medical Association as late as 2001. Nowadays medical physicians and chiropractors look back at their animosity toward each other as a historical process. More and more, the public is demanding that professions work together for the patient's benefit. Many GPs work with chiropractors.

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

Safety concerns

Critics cite major medical risks associated with spinal manipulation in their opposition to the practice of chiropractic. These risks include vertebrobasilar accidents, disc herniations, vertebral fracture, and cauda equina syndrome, according to Harrison's. Most serious complications occur after cervical (neck) manipulation. The practice of greatest concern is the rotary neck movement, sometimes called "Master cervical" or "rotary break", which has led to trauma, paralysis, strokes, and death among patients.

Many chiropractors report that these serious complications due to manipulation of the cervical spine remain rare, having been documented at 1 in 3 or 4 million manipulations or fewer . Such estimates are believed to be highly unreliable based on the possibility of vast (up to 100%) underreporting of problems. While still rare, the true incidence could be higher, and further research may shed more light on this situation. Still, the safety of manipulation, by all accounts in current literature, appear to be superior to many non-steroidal anti-inflammatory drugs, and spinal surgical procedures. The safety issue is again made controversial by the fact that much reported manipulation that resulted in stroke was not actually performed by chiropractors (see Terrett, AG). Also, stroke appears to be a random event in people of all ages, including babies.

Highly specific spinal adjusting procedures have been developed to address vertebral subluxation of the high neck region (upper cervical) using x-ray imaging. A controlled, linear, low force adjustment is slowly applied to the top vertebra (Atlas), removing the need for more forceful, rapid adjustive procedures. Development of this upper cervical technique technology by the National Upper Cervical Chiropractic Association in the U.S.A. first started in the 1960's in Monroe, Michigan by Dr. Ralph Gregory DC. This work is being carried further today, with the establishment of Atlas Orthogonal Technique (AOT) in 1981, by Dr Roy Sweat of Atlanta, USA. Both AOT and NUCCA have advanced Gregory's work to develop programs endorsed by some chiropractors, dentists, and medical doctors in psychiatry, orthopaedics and neurology, who consider it to be a safe and effective way of dealing with kinematic disorders of the upper cervical joint complex. All upper cervical work is a legacy of the enormous dedication and nurturing by Dr. B.J. Palmer of Davenport, Iowa, USA, in the early 1900's. He advocated the HIO (Hole In One) concept, where he claimed that it was only necessary to adjust the top vertebrae in the spine, making it unnecessary to adjust any of the other vertebrae. He later modified this position.

Misuse of science reports

Some doctors who have submitted research backing up the medical benefits of limited forms of spinal manipulation have found their claims incorrectly applied to the entire field of chiropractic manipulation. Perhaps the most well-known case of this occurred in response to The RAND report on The Appropriateness of Spinal Manipulation for Lower-Back Pain. This study was a meta-analysis of 22 controlled experiments; the conclusion was that certain forms of spinal manipulation were successful in treating certain types of lower back pain. Many chiropractors seized upon these results as proof that chiropractic theory was sound and that chiropractic had reliable results; in fact, the authors of the report said no such thing. Misuse of this report reached such an extent that the RAND report authors were forced to issue a public statement. In 1993 Dr. Paul Shekelle rebuked the chiropractic industry for making false claims about RAND's research:

...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....RAND's studies were about spinal manipulation, not chiropractic, and dealt with appropriateness, which is a measure of net benefit and harms. Comparative efficacy of chiropractic and other treatments was not explicitly dealt with.

See also

• Naprapathy
• Osteopathy
• Phrenology
• Reflexology

References

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

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

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

• Template:Journal reference issue

External links

Advocacy

Chiropractic organizations

• American Chiropractic Association (ACA)
• British Chiropractic Association (BCA)
• Canadian Chiropractic Association (CCA)
• Christian Chiropractors Association (CCA)
• Congress of Chiropractic State Associations (COCSA)
• Federation of Straight Chiropractors and Organizations (FSCO)
• Foundation for the Advancement of Chiropractic Education (FACE)
• General Chiropractic Council (GCC) - UK
• International Chiropractic Pediatric Association (ICPA)
• International Chiropractors Association (ICA)
• World Chiropractic Alliance (WCA)
• World Federation of Chiropractic (WFC)

Chiropractic Colleges

• Parker College of Chiropractic (Dallas, TX)
• Anglo-European College of Chiropractic
• Association of Chiropractic Colleges
• Life University School of Chiropractic
• Life Chiropractic College West
• McTimoney Chiropractic College (UK)
• New York Chiropractic College
• Palmer Chiropractic College
• University of Bridgeport College of Chiropractic
• Western States Chiropractic College
• Canadian Memorial Chiropractic College

Descriptions of chiropractic procedures

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

Other resources

• Chiropractic History Archives -- Joseph C. Keating, Jr. PhD
• Chiropractic Resource Organization
• Dynamic Chiropractic Online
• Planet Chiropractic

Critiques

• Adjusting the Joints -- PBS - Scientific American Frontiers, Web Feature
• Answers to Questions about Chiropractic -- Samuel Homola, D.C.
• Bonesetting, Chiropractic, and Cultism -- Samuel Homola, D.C.
• Chirobase -- Skeptical Guide to Chiropractic History, Theories, and Practices
• ChiroLinks -- Resources, Articles & Links
• Chiropractic: science and antiscience and pseudoscience side by side -- Joseph C. Keating, Jr, PhD
• Chirotalk: -- The Skeptical Chiropractic Discussion Forum
• Chirowatch -- Terry Polevoy, MD
• Faulty Logic and Non-skeptical Arguments in Chiropractic -- Joseph C. Keating Jr, PhD
• Keeping Your Spine in Line -- PBS - Scientific American Frontiers, Web Feature
• National Association for Chiropractic Medicine -- Reform organization
• NCAHF Fact Sheet on Chiropractic (2001) -- William Jarvis, PhD
• NCAHF Position Paper on Chiropractic (1985) -- NCAHF
• Quackery in Chiropractic -- Joseph C. Keating Jr, PhD
• Skeptic's Dictionary: Chiropractic -- Robert Todd Carroll
• Subluxation: dogma or science? -- Keating, Charlton, Grod, Perle, Sikorski, Winterstein

• Chiropractic