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Chiropractic, also known as chiropractic care, is a health care discipline that claims to prevent and treat health problems by using spinal adjustments in order to correct spinal dysfunction, or subluxations. Chiropractic asserts 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 commonly refer to themselves 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 some limited objective clinical data or peer-reviewed research that demonstrates efficacy to certain chiropractic therapies. Chiropractic claims to be effective in the treatment of back and neck pain, headaches, and other symptoms that chiropractic views as spine-related conditions (although some medical science often disagrees with these assumptions).

History

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 tried to find a single cause for all disease.

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.

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. Both father and son had strong personalities and developed a very strained relationship, culminating in an incident where the father accused his son of attempting to murder him by deliberately driving his car into him.

Spiritistic origins

Palmer's interest in spiritualism had a major role in his claims regarding the spiritual origins of chiropractic.

He claimed to have received the principles of chiropractic "from the other world" (during spiritistic seances), from a "supernatural source", the long dead medical physician, Dr. Jim Atkinson.

He also claimed divine inspiration:

Chiropractic science, its art and philosophy, deal with human and spiritual phenomena. The conscientious reverent acknowledgement of the phenomena, in sentiment and act, connects the spiritual with the physical, and constitutes in its fullest and highest sense a religion.

The knowledge and philosophy given me by Dr. Jim Atkinson, an intelligent spiritual being, together with explanations of phenomena, principles resolved from causes, effects, powers, laws and utility, appealed to my reason.

The method by which I obtained an explanation of certain physical phenomena, from an intelligence in the spiritual world, is known in biblical language as inspiration. In a great measure The Chiropractor’s Adjuster was written under such spiritual promptings.

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 95% of 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."

Despite differing definitions of "subluxation" 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.

To date there is limited scientific evidence of the existence of "subluxations", in terms of quantifiable measures. Nerve conduction studies of human spinal nerves identified as being subluxed by chiropractors were shown to be normal by conventional scientific measures. Studies involving X-ray and CT scanning of the human spine before and after chiropractic manipulation show no changes in joint position as identified by radiologists. This lack of a clear definition of "subluxation", supported by scientific evidence, is one of the major sources of chiropractic's struggle for acceptance within the traditional medical community.

Philosophy of the Subluxation

Chiropractic philosophy holds that so 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 — not necessarily chiropractic — 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. It is covered by many health plans such as Medicare in the United States. Although some medical doctors (MDs) and many doctors of osteopathy (DOs) 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.

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.

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.

The admissions requirements for chiropractic colleges in the United States are not as stringent as schools for other health care professions. This can be seen from:

• the minimum number of undergraduate semester hours (toward a bachelor's degree);
• the minimum grade point average (GPA) required.

Also relevant are:

• the percentage of applicants with a four year bachelor's degree;
• the average GPA of applicants.

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 two basic schools, straight and mixer, which differ in their approaches to patient care. However, all chiropractic approaches are heavily based on the use of manipulation as a panacea for mechanical musculoskeletal dysfunction of the spine and extremities.

1. In the traditional approach, known as straight chiropractic, which is the application of different manipulative techniques for the expressed intention of removing any of a large number of problems that are all grouped under the catchall name of subluxation, from misaligned bones to posture correction. Straight chiropractors believe that medicine is flawed because it fails to accept subluxations as a primary cause of disease; instead seeing them as effects from other underlying problems that may or may not need to be treated. Believing they are unimportant, straight chiropractors refuse to use the proven diagnostic algorithms of traditional diagnosis and instead use often debunked or at best questionable proprietary chiropractic methods on patients. Straight chiropractic is supported by the fact that health insurance companies often refuse to reimburse chiropractors for diagnostic testing and many states do not allow chiropractors enough scope to perform the procedures necessary to do it. The patients of straight chiropractic can generally expect to have undiagnosed systems monitored for two weeks for improvement before being referred to a medical doctor. Gonstead Technique: one of the benchmark techniques in chiropractic. It is a highly specific, full-body approach to the restoration of functionality of the spine.
2. Mixing chiropractic, which combines contemporary medical diagnosis and treatment with manipulation. In this model, patient complains are diagnosed accurately but subluxation is asserted to be a mechanical joint pain sydrome while the underlying cause of patient complaints is often ignored. Mixing style practioners utilize both 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 kinesiology. Mixing chiropractic is itself divided into conservative and liberal groupsTemplate:Fn.
3. 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 disease, NACM members claim to receive mainstream approvalTemplate:Fn more so than practitioners of straight or traditional 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" .

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 1985, The National Council Against Health Fraud (NCAHF), a non-profit healthcare watch-dog group, issued a position statement critical of chiropractic.

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, spinal cord compression, 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.

Although serious, these complications due to spinal manipulation remain very rare having been estimated at 1 in 3 or 4 million manipulations or less. In comparison, between one in eight and one in fifteen patients admitted to hospital can be expected to contract a hospital sourced infection or suffer other significant medical complication.

Highly specific treatment procedures have also been developed to address subluxation or misalignment 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 manipulative procedures. Development of this upper cervical treatment 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.

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 medicine 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)

External links

Descriptions of chiropractic procedures

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

Chiropractic organizations and promotion

• American Chiropractic Association
• World Federation of Chiropractic
• Dynamic Chiropractic Online
• General Chiropractic Council (UK)
• British Chiropractic Association

Chiropractic Colleges

• New York Chiropractic College
• Association of Chiropractic Colleges
• Anglo-European College of Chiropractic
• McTimoney Chiropractic College (UK)

Skeptical and anti-chiropractic

• Chirobase — Skeptical Guide to Chiropractic History, Theories, and Practices
• Skeptic's Dictionary: chiropractic
• Chirotalk: A Skeptical Discussion Forum About Chiropractic

• Alternative medicine
• Chiropractic