Chiropractic

Definition

Chiropractic is from Greek words meaning done by hand. It is grounded in the principal that the body can heal itself when the skeletal system is correctly aligned and the nervous system is functioning properly. To achieve this, the practitioner uses his or her hands or an adjusting tool to perform specific manipulations of the vertebrae. When these bones of the spine are not correctly

articulated, resulting in a condition known as subluxation, the theory is that nerve transmission is disrupted and causes pain and illness manifested in the back as well as other areas of the body.

Chiropractic is one of the most popular alternative therapies currently available. Some would say it now qualifies as mainstream treatment as opposed to complementary medicine. Chiropractic treatment is covered by many insurance plans. It has become well-accepted treatment for acute pain and problems of the spine, including lower back pain and whiplash. Applications beyond that scope are not supported by current evidence, although there are ongoing studies into the usefulness of chiropractic for such problems as ear infections, dysmenorrhea , infant colic , migraine headaches, and other conditions. Patients continue to visit chiropractors with complaints of headaches and pain or injury to the neck, middle back, arms, or legs.

Origins

Spinal manipulation has a long history in many cultures but Daniel D. Palmer is the founder of modern chiropractic theory, dating back to the 1890s. A grocer and magnetic healer, he applied his knowledge of the nervous system and manual therapies in an unusual situation. One renowned story concerns Harvey Lillard, a janitor in the office where Palmer worked. The man had been deaf for 17 years, ever since he had sustained an injury to his upper spine. Palmer performed an adjustment on a painful vertebra in the region of the injury and Lillard's hearing was reputedly restored. Palmer theorized that all communication from the brain to the rest of the body passes through the spinal canal, and areas that are poorly aligned or under stress can cause physical symptoms both in the spine and in other areas of the body. Thus the body has the innate intelligence to heal itself when unencumbered by spinal irregularities causing nerve interference. After his success with Lillard, other patients began coming to him for care, and responded well to adjustments. This resulted in Palmer's further study of the relationship between an optimally functional spine and normal health.

Palmer founded the first chiropractic college in 1897. His son, B. J. Palmer, continued to develop chiropractic philosophy and practice after his father's death. B. J. and other faculty members were divided over the role of subluxation in disease. B. J. saw it as the cause of all disease. The others disagreed and sought a more rational way of thinking, thus broadening the base of chiropractic education. From 1910-1920, many other chiropractic colleges were established. Other innovators, including John Howard, Carl Cleveland, Earl Homewood, Joseph Janse, Herbert Lee, and Claude Watkins also helped to advance the profession.

The theories of the Palmers receive somewhat broader interpretation today. Many chiropractors believe that back pain can be relieved and health restored through chiropractic treatment even in patients who do not have demonstrable subluxations. Scientific development and research of chiropractic is gaining momentum. The twenty-first century will likely see the metaphysical concepts such as innate intelligence give way to more scientific proofs and reform.

Many people besides the Palmers have contributed to the development of chiropractic theory and technique. Some have gone on to create a variety of procedures and related types of therapy that have their roots in chiropractic, including McTimoney-Corley chiropractic, craniosacral manipulation, naprapathy, and applied kinesiology . Osteopathy is another related holistic discipline that utilizes spinal and musculoskeletal manipulation as

a part of treatment, but osteopathic training is more similar in scope to that of an M.D.

Benefits

Most people will experience back pain at some time in their lives. A 2002 review reported that lower back region pain accounted for 68 percent of patient visits to chiropractors. Injuries due to overexertion and poor posture are among the most common. Depending on the cause and severity of the condition, options for treatment may include physical therapy, rest, medications, surgery, or chiropractic care. Chiropractic treatment carries none of the risks of surgical or pharmacologic treatment. Practitioners use a holistic approach to health, which is appreciated by most patients. The goal is not merely to relieve the present ailment, but to analyze the cause and recommend appropriate changes of lifestyle to prevent the problem from recurring again. They believe in a risk/benefit analysis before use of any intervention. The odds of an adverse outcome are extremely low. Chiropractic has proven in several studies to be less expensive than many more traditional routes such as outpatient physical therapy. Relief from some neuromuscular problems is immediate, although a series of treatments is likely to be required to maintain the improvement. Spinal manipulation is an excellent option for acute lower back pain, and may also relieve neck pain as well as other musculoskeletal pain. Although most back pain will subside eventually with no treatment at all, chiropractic treatment can significantly shorten the time it takes to get relief. Some types of headache can also be successfully treated by chiropractic.

Description

Initial visit

An initial chiropractic exam will most often include a history and a physical. The patient should be asked about the current complaint, whether there are chronic health problems, family history of disease, dietary habits, medical care received, and any medications currently being taken. Further, the current complaint should be described in terms of how long it has been a problem, how it has progressed, and whether it is the result of an injury or occurred spontaneously. Details of how an injury occurred should be given. The physical exam should evaluate by observation and palpation whether the painful area has evidence of inflammation or poor alignment. Range of motion may also be assessed. In the spine, either hypomobility (fixation) or hypermobility may be a problem. Laboratory analysis is helpful in some cases to rule out serious infection or other health issues that may require referral for another type of treatment. Many practitioners also insist on x rays during the initial evaluation

Manipulation

When spinal manipulation is employed, it is generally done with the hands, although some practitioners may use an adjusting tool. A classic adjustment involves a high velocity, low amplitude thrust that produces a usually painless popping noise, and improves the range of motion of the joint that was treated. The patient may lie on a specially designed, padded table that helps the practitioner to achieve the proper positions for treatment. Some adjustments involve manipulating the entire spine, or large portions of it, as a unit; others are small movements designed to affect a single joint. Stretching, traction, and slow manipulation are other techniques that can be employed to restore structural integrity and relieve nerve interference.

Length of treatment

The number of chiropractic treatments required will vary depending on several factors. Generally longer-term treatment is needed for conditions that are chronic, severe, or occur in conjunction with another health problem. Patients who are not in overall good health may also have longer healing times. Some injuries will inherently require more treatments than others in order to get relief. Care is given in three stages. Initially appointments are more frequent with the goal of relieving immediate pain. Next, the patient moves into a rehabilitative stage to continue the healing process and help to prevent a relapse. Finally, the patient may elect periodic maintenance, or wellness treatments, along with lifestyle changes if needed in order to stay in good health.

Follow-up care

Discharge and follow-up therapy are important. If an injury occurred as a result of poor fitness or health, a program of exercise or nutrition should be prescribed. Home therapy may also be recommended, involving such things as anti-inflammatory medication and applications of heat or ice packs. Conscious attention to posture may help some patients avoid sustaining a similar injury in the future, and the chiropractor should be able to discern what poor postural habits require correction. A sedentary lifestyle, particularly with a lot of time spent sitting, is likely to contribute to poor posture and may predispose a person to back pain and injury.

DANIEL PALMER 1845–1913

Chiropractic inventor, Daniel David Palmer, was born on March 7, 1845, in Toronto, Ontario. He was one of five siblings, the children of a shoemaker and his wife, Thomas and Katherine Palmer. Daniel Palmer and his older brother fell victim to wanderlust and left Canada with a tiny cash reserve in April 1865. They immigrated to the United States on foot, walking for 30 days before arriving in Buffalo, New York. They traveled by boat through the St. Lawrence Seaway to Detroit, Michigan. There they survived by working odd jobs and sleeping on the dock. Daniel Palmer settled in What Cheer, Iowa, where he supported himself and his first wife as a grocer and fish peddler in the early 1880s. He later moved to Davenport, Iowa, where he raised three daughters and one son.

Palmer was a man of high curiosity. He investigated a variety of disciplines of medical science during his lifetime, many of which were in their infancy. He was intrigued by phrenology and assorted spiritual cults, and for nine years he investigated the relationship between magnetism and disease. Palmer felt that there was one thing that caused disease. He was intent upon discovering this one thing, or as he called it: the great secret.

In September 1895, Palmer purported to have cured a deaf man by placing pressure on the man's displaced vertebra. Shortly afterward Palmer claimed to cure another patient of heart trouble, again by adjusting a displaced vertebra. The double coincidence led Palmer to theorize that human disease might be the result of dislocated or luxated bones, as Palmer called them. That same year he established the Palmer School of Chiropractic where he taught a three-month course in the simple fundamentals of medicine and spinal adjustment.

Palmer, who was married six times during his life, died in California in 1913; he was destitute. His son, Bartlett Joshua Palmer, successfully commercialized the practice of chiropractic.

Gloria Cooksey

Types of practitioners

Some practitioners use spinal manipulation to the exclusion of all other modalities, and are known as straight chiropractors. Others integrate various types of therapy such as massage, nutritional intervention, or treatment with vitamins, herbs, or homeopathic remedies. They also embrace ideas from other health care traditions. This group is known as mixers. The vast majority of chiropractors, perhaps 85%, fall in this latter category.

Preparations

Patients should enter the chiropractic clinic with an open mind. This will help to achieve maximum results.

Precautions

Chiropractic is not an appropriate therapy for diseases that are severely degenerative and may require medication or surgery. Many conditions of the spine are amenable to manipulative treatment, but that does not include fractures . The practitioner should be informed in advance if the patient is on anticoagulants, or has osteoporosis or any other condition that may weaken the bones. There are other circumstances that would contraindicate chiropractic care, and these should be detected in the history or physical exam. In addition to fractures, Down syndrome, some congenital defects, and some types of cancer are a few of the things that may preclude spinal manipulation. On rare occasions, a fracture or dislocation may occur. There is also a very slim possibility of experiencing a stroke as a result of spinal manipulation, but estimates are that it is no more frequent than 2.5 occurrences per one million treatments.

Be wary of chiropractors who insist on costly x rays and repeated visits with no end in sight. Extensive use is not scientifically justifiable, especially in most cases of lower back pain. There are some circumstances when x rays are indicated, including acute or possibly severe injuries such as those that might result from a car accident.

Side effects

It is not uncommon to have local discomfort in the form of aches, pains, or spasms for a few days following a chiropractic treatment. Some patients may also experience mild headache or fatigue that resolves quickly.

Research & general acceptance

As recently as the 1970s, the American Medical Association (a national group of medical doctors) was quite hostile to chiropractic. AMA members were advised that it was unethical to be associated with chiropractors. Fortunately that has changed, and as of the year 2000, many allopathic or traditionally trained physicians enjoyed cordial referral relationships with chiropractors. The public is certainly strongly in favor of chiropractic treatment. An estimated 15% of people in the United States used chiropractic care in 1997. Chiropractors see the lion's share of all patients who seek medical help for back problems.

Research has also supported the use of spinal manipulation for acute low-back pain. There is some anecdotal evidence recommending chiropractic treatment for ailments unrelated to musculoskeletal problems, but there is not enough research-based data to support this. On the other hand, a chiropractor may be able to treat problems and diseases unrelated to the skeletal structure by employing therapies other than spinal manipulation.

Although many chiropractors limit their practice to spine and joint problems, others claim to treat disorders that are not closely related to the back or musculoskeletal system. These include asthma , bed-wetting, bronchitis , coughs, dizziness , dysmenorrhea, earache , fainting, headache, hyperactivity, indigestion, infertility , migraine, pneumonia , and issues related to pregnancy . There are at least three explanations for possible efficacy for these conditions. One is that the problem could be linked to a nerve impingement, as may be possible with bed-wetting, dizziness, fainting, and headache. In a second group, chiropractic treatment may offer some relief from complicating pain and spasms caused by the disease process, as with asthma, bronchitis, coughs, and pneumonia. The discomforts of pregnancy may also be relieved with gentle chiropractic therapy. A third possibility is that manipulation or use of soft-tissue techniques may directly promote improvement of some conditions. One particular procedure, known as the endonasal technique, is thought to help the eustachian tube to open and thus improve drainage of the middle ear. The tube is sometimes blocked off due to exudates or inflammatory processes. This can offer significant relief from earaches. Some headaches also fall in this category, as skilled use of soft tissue techniques and adjustment may relieve the muscle tension that may initiate some headaches.

Dysmenorrhea, hyperactivity, indigestion, and infertility are said to be relieved as a result of improved flow of blood and nerve energy following treatment. Evidence for this is anecdotal at best, but manipulation is unlikely to be harmful if causes treatable by other modalities have been ruled out.

For conditions such as cancer, fractures, infectious diseases, neurologic disease processes, and anything that may cause increase orthopedic fragility, chiropractic treatment alone is not an effective therapy, and may even be harmful in some cases. Those who have known circulatory problems, especially with a history of thrombosis, should not have spinal manipulation.

Training & certification

Chiropractors are licensed by the state in which they practice. Matriculation at a certified school of chiropractic requires at least two years of science-based undergraduate work, and most applicants have completed a bachelor's degree. Chiropractic college is an additional four-year program, and graduates receive a D.C. (doctor of chiropractic) degree. Chiropractic education emphasizes knowledge of anatomy, physiology, diagnostic skills, neurology, and radiology. As of the year 2000, there were 16 chiropractic colleges in the United States. Following graduation, the doctors must pass both national board and state board exams in order to be licensed. A minimum number of continuing education hours per year may be required in some states in order to maintain licensure. Practitioners may also opt for a program to become a diplomate of a more specialized group. Requirements for these groups vary rather vastly, from a program similar to a traditional residency down to some that require a minimal number of hours of continuing education. Some of the specialties offered are radiology, orthopedics, sports injuries, nutrition, neurology, and internal medicine. Most chiropractors do not specialize.

Resources

BOOKS

Cassileth, Barrie. The Alternative Medicine Handbook. New York: W. W. Norton & Co., Inc., 1998.

Dillard, James and Terra Ziporyn. Alternative Medicine for Dummies. Indianapolis: IDG Bks. Worldwide, 1998.

Leach, Robert. The Chiropractic Theories: Principles and Clinical Applications, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1994.

Rondberg, Terry. Chiropractic First. Chandler, AZ: The Chiropractic Journal, 1996.

Woodham, Anne and David Peters. Encyclopedia of Healing Therapies. New York: DK Publishing, Inc., 1997.

PERIODICALS

Hansen, Daniel T. "Applying Technology Assessment to Chiropractic Techniques." Topics in Clinical Chiropractic (September 2002): 1–9.

ORGANIZATIONS

American Chiropractic Association. 1701 Clarendon Blvd., Arlington, VA 22209. (800) 986-4636. http://www.amerchiro.org/.

Judith Turner

Teresa G. Odle

Chiropractic

Definition

Chiropractic is from Greek words meaning done by hand. It is grounded in the principle that the body can heal itself when the skeletal system is correctly aligned and the nervous system is functioning properly. To achieve this, the practitioner uses his or her hands or an adjusting tool to perform specific manipulations of the vertebrae. When these bones of the spine are not correctly articulated, resulting in a condition known as subluxation, the theory is that nerve transmission is disrupted and causes pain in the back, as well as other areas of the body.

Chiropractic is one of the most popular alternative therapies currently available. Some would say it now qualifies as mainstream treatment as opposed to complementary medicine. Chiropractic treatment is covered by many insurance plans and in 2004, the U.S. Department of Veterans Affairs announced full inclusion of chiropractic care for veterans. It has become well-accepted treatment for acute pain and problems of the spine, including lower back pain and whiplash. Applications beyond that scope are not supported by current evidence, although there are ongoing studies into the usefulness of chiropractic for such problems as ear infections, dysmenorrhea, infant colic, migraine headaches, and other conditions.

Purpose

Most people will experience back pain at some time in their lives. Injuries due to overexertion and poor posture are among the most common. Depending on the cause and severity of the condition, options for treatment may include physical therapy, rest, medications, surgery, or chiropractic care. Chiropractic treatment carries none of the risks of surgical or pharmacologic treatment. Practitioners use a holistic approach to health. The goal is not merely to relieve the present ailment, but to analyze the cause and recommend appropriate changes of lifestyle to prevent the problem from occurring again. They believe in a risk/benefit analysis before use of any intervention. The odds of an adverse outcome are extremely low. Chiropractic has proven in several studies to be less expensive than many more traditional routes such as outpatient physical therapy. Relief from some neuromuscular problems is immediate, although a series of treatments is likely to be required to maintain the improvement. Spinal manipulation is an excellent option for acute lower back pain, and may also relieve neck pain as well as other musculoskeletal pain. Although most back pain will subside eventually with no treatment at all, chiropractic treatment can significantly shorten the time it takes to get relief. Some types of headache can also be successfully treated by chiropractic.

Description

Origins

Spinal manipulation has a long history in many cultures but Daniel D. Palmer is the founder of modern chiropractic theory, dating back to the 1890s. A grocer and magnetic healer, he applied his knowledge of the nervous system and manual therapies in an unusual situation. One renowned story concerns Harvey Lillard, a janitor in the office where Palmer worked. The man had been deaf for 17 years, ever since he had sustained an injury to his upper spine. Palmer performed an adjustment on a painful vertebra in the region of the injury and Lillard's hearing was reputedly restored. Palmer theorized that all communication from the brain to the rest of the body passes through the spinal canal, and areas that are poorly aligned or under stress can cause physical symptoms both in the spine and in other areas of the body. Thus the body has the innate intelligence to heal itself when unencumbered by spinal irregularities causing nerve interference. After his success with Lillard, other patients began coming to him for care, and responded well to adjustments. This resulted in Palmer's further study of the relationship between an optimally functional spine and normal health.

Palmer founded the first chiropractic college in 1897. His son, B. J. Palmer, continued to develop chiropractic philosophy and practice after his father's death. B. J. and other faculty members were divided over the role of subluxation in disease. B. J. saw it as the cause of all disease. The others disagreed and sought a more rational way of thinking, thus broadening the base of chiropractic education. From 1910 to 1920, many other chiropractic colleges were established. Other innovators, including John Howard, Carl Cleveland, Earl Homewood, Joseph Janse, Herbert Lee, and Claude Watkins, also helped to advance the profession.

DANIEL PALMER (1845–1913)

Chiropractic inventor, Daniel David Palmer, was born on March 7, 1845, in Toronto, Ontario. He was one of five siblings, the children of a shoemaker and his wife, Thomas and Katherine Palmer. Daniel Palmer and his older brother fell victim to wanderlust and left Canada with a tiny cash reserve in April 1865. They immigrated to the United States on foot, walking for 30 days before arriving in Buffalo, New York. They traveled by boat through the St. Lawrence Seaway to Detroit, Michigan. There they survived by working odd jobs and sleeping on the dock. Daniel Palmer settled in What Cheer, Iowa, where he supported himself and his first wife as a grocer and fish peddler in the early 1880s. He later moved to Davenport, Iowa, where he raised three daughters and one son.

Palmer was a man of high curiosity. He investigated a variety of disciplines of medical science during his lifetime, many of which were in their infancy. He was intrigued by phrenology and assorted spiritual cults, and for nine years he investigated the relationship between magnetism and disease. Palmer felt that there was one thing that caused disease. He was intent upon discovering this one thing, or as he called it: the great secret.

In September 1895, Palmer purported to have cured a deaf man by placing pressure on the man's displaced vertebra. Shortly afterward Palmer claimed to cure another patient of heart trouble, again by adjusting a displaced vertebra. The double coincidence led Palmer to theorize that human disease might be the result of dislocated or luxated bones, as Palmer called them. That same year he established the Palmer School of Chiropractic where he taught a three-month course in the simple fundamentals of medicine and spinal adjustment.

Palmer, who was married six times during his life, died in California in 1913; he was destitute. His son, Bartlett Joshua Palmer, successfully commercialized the practice of chiropractic.

The theories of the Palmers receive somewhat broader interpretation today. Many chiropractors believe that back pain can be relieved and health restored through chiropractic treatment even in patients who do not have demonstrable subluxations. Scientific development and research of chiropractic is gaining momentum. The twenty-first century will likely see the metaphysical concepts such as innate intelligence give way to more scientific proofs and reform.

Many people besides the Palmers have contributed to the development of chiropractic theory and technique. Some have gone on to create a variety of procedures and related types of therapy that have their roots in chiropractic, including McTimoney-Corley chiropractic, craniosacral manipulation, naprapathy, and applied kinesiology. Osteopathy is another related holistic discipline that utilizes spinal and musculoskeletal manipulation as a part of treatment, but osteopathic training is more similar in scope to that of an M.D.

Initial visit

An initial chiropractic exam will most often include a history and a physical. The patient should be asked about the current complaint, whether there are chronic health problems, family history of disease, dietary habits, medical care received, and any medications currently being taken. Further, the current complaint should be described in terms of how long it has been a problem, how it has progressed, and whether it is the result of an injury or occurred spontaneously. Details of how an injury occurred should be given. The physical exam should evaluate by observation and palpation whether the painful area has evidence of inflammation or poor alignment. Range of motion may also be assessed. In the spine, either hypomobility (fixation) or hypermobility may be a problem. Laboratory analysis is helpful in some cases to rule out serious infection or other health issues that may require referral for another type of treatment. Many practitioners also insist on x rays during the initial evaluation

Manipulation

When spinal manipulation is employed, it is generally done with the hands, although some practitioners may use an adjusting tool. A classic adjustment involves a high velocity, low amplitude thrust that produces a usually painless popping noise, and improves the range of motion of the joint that was treated. The patient may lie on a specially designed, padded table that helps the practitioner to achieve the proper positions for treatment. Some adjustments involve manipulating the entire spine, or large portions of it, as a unit; others are small movements designed to affect a single joint. Stretching, traction, and slow manipulation are other techniques that can be employed to restore structural integrity and relieve nerve interference.

A new use of technology with traditional chiropractic care has been introduced. Using a hand-held device that is pressed to the spine or joints, a chiropractor may soon be able to detect and manipulate the skeleton not only with his or her hands but with the computer-linked device that uses harmonic frequencies to detect a misalignment in the spine. The new technology was not widely accepted in 2004, however.

Length of treatment

The number of chiropractic treatments required will vary depending on several factors. Generally longer-term treatment is needed for conditions that are chronic, severe, or occur in conjunction with another health problem. Patients who are not in overall good health may also have longer healing times. Some injuries will inherently require more treatments than others in order to get relief. Care is given in three stages. Initially appointments are more frequent with the goal of relieving immediate pain. Next, the patient moves into a rehabilitative stage to continue the healing process and help to prevent a relapse. Finally, the patient may elect periodic maintenance, or wellness treatments, along with lifestyle changes if needed to stay in good health.

Follow-up care

Discharge and follow-up therapy are important. If an injury occurred as a result of poor fitness or health, a program of exercise or nutrition should be prescribed. Home therapy may also be recommended, involving such things as anti-inflammatory medication and applications of heat or ice packs. Conscious attention to posture may help some patients avoid sustaining a similar injury in the future, and the chiropractor should be able to discern what poor postural habits require correction. A sedentary lifestyle, particularly with a lot of time spent sitting, is likely to contribute to poor posture and may predispose a person to back pain and injury.

Types of practitioners

Some practitioners use spinal manipulation to the exclusion of all other modalities, and are known as straight chiropractors. Others integrate various types of therapy such as massage, nutritional intervention, or treatment with vitamins, herbs, or homeopathic remedies. They also embrace ideas from other health care traditions. This group is known as mixers. The vast majority of chiropractors, perhaps 85%, fall in this latter category.

Preparations

Patients should enter the chiropractic clinic with an open mind. This will help to achieve maximum results.

Precautions

Chiropractic is not an appropriate therapy for diseases that are severely degenerative and may require medication or surgery. Many conditions of the spine are amenable to manipulative treatment, but this does not include fractures. The practitioner should be informed in advance if the patient is on anticoagulants, or has osteoporosis or any other condition that may weaken the bones. Other circumstances might suggest the patient should not have chiropractic care. These should be detected in the history or physical exam. In addition to fractures, Down syndrome, some congenital defects, and some types of cancer are a few of the things that may preclude spinal manipulation. On rare occasions, a fracture or dislocation may occur. There is also a very slim possibility of experiencing a stroke as a result of spinal manipulation, but estimates are that it is no more frequent than 2.5 occurrences per one million treatments.

Patients should be wary of chiropractors who insist on costly x rays and repeated visits with no end in sight. Extensive use is not scientifically justifiable, especially in most cases of lower back pain. There are some circumstances when x rays are indicated, including acute or possibly severe injuries such as those that might result from a car accident.

Side effects

It is not uncommon to have local discomfort in the form of aches, pains, or spasms for a few days following a chiropractic treatment. Some patients may also experience mild headache or fatigue that resolves quickly.

Research and general acceptance

As recently as the 1970s, the American Medical Association (a national group of medical doctors) was quite hostile to chiropractic. AMA members were advised that it was unethical to be associated with chiropractors. Fortunately that has changed, and as of 2000, many allopathic or traditionally trained physicians enjoy cordial referral relationships with chiropractors. The public is strongly in favor of chiropractic treatment. Chiropractors see the lion's share of all patients who seek medical help for back problems. And chiropractic treatment is the most widely used of all alternative medical treatments.

Research has also supported the use of spinal manipulation for acute low back pain. There is some anecdotal evidence recommending chiropractic treatment for ailments unrelated to musculoskeletal problems, but there is not enough research-based data to support this. On the other hand, a chiropractor may be able to treat problems and diseases unrelated to the skeletal structure by employing therapies other than spinal manipulation.

Although many chiropractors limit their practice to spine and joint problems, others claim to treat disorders that are not closely related to the back or musculoskeletal system. These include asthma, bedwetting, bronchitis, coughs, dizziness, dysmenorrhea, earache, fainting, headache, hyperactivity, indigestion, infertility, migraine, pneumonia, and issues related to pregnancy. There are at least three explanations for the possible effectiveness for these conditions. One is that the problem could be linked to a nerve impingement, as may be possible with bed-wetting, dizziness, fainting, and headache. In a second group, chiropractic treatment may offer some relief from complicating pain and spasms caused by the disease process, as with asthma, bronchitis, coughs, and pneumonia. The discomforts of pregnancy may also be relieved with gentle chiropractic therapy. A third possibility is that manipulation or use of soft-tissue techniques may directly promote improvement of some conditions. One particular procedure, known as the endonasal technique, is thought to help the eustachian tube to open and thus improve drainage of the middle ear. The tube is sometimes blocked off due to exudates or inflammatory processes. This can offer significant relief from earaches. Some headaches also fall in this category, as skilled use of soft tissue techniques and adjustment may relieve the muscle tension that may initiate some headaches.

Dysmenorrhea, hyperactivity, indigestion, and infertility are said to be relieved as a result of improved flow of blood and nerve energy following treatment. Evidence for this is anecdotal at best, but manipulation is unlikely to be harmful if causes treatable by other modalities have been ruled out.

For conditions such as cancer, fractures, infectious diseases, neurologic disease processes, and anything that may cause increased orthopedic fragility, chiropractic treatment alone is not an effective therapy, and may even be harmful in some cases. Those who have known circulatory problems, especially with a history of thrombosis, should not have spinal manipulation.

Resources

PERIODICALS

"Technology Takes Tiny Steps in Hands-on Chiropractic Industry." Medical Letter on the CDC & FDA June 20, 2004: 17.

"VA Includes Chiropractic Care for Veterans." Managed Care Weekly May 3, 2004: 23.

ORGANIZATIONS

American Chiropractic Association. 1701 Clarendon Blvd., Arlington, VA 22209. (800) 986-4636. 〈http://www.amerchiro.org〉.

KEY TERMS

Adjustment— A specific type of manipulation of the spine designed to return it to proper structural and functional form.

Allopathic— Conventional practice of medicine generally associated with M.D. physicians.

Dysmenorrhea— Painful menstruation.

Osteoporosis— A condition of decreased bone density, causing increased bone fragility, that is most common in elderly women.

Subluxation— Misalignment between vertebrae that structurally and functionally impairs nerve function.

Chiropractic

Definition

Deriving its meaning from the Greek words for hand cheir, and praktikos, or praxis, meaning practical, the basis for Chiropractic care is the musculoskeletal system of the human body—particularly the spine. The theory and focus at the core of this medical treatment is that if the body is aligned properly, its natural ability to heal itself will be enhanced.

Description

The history of chiropractic provides an insight to the practice itself. Chiropractic is, in fact, an ancient medical art, with roots that can be traced to China and Greece as far back as 2700 B.C.E. Hippocrates, the ancient Greek physician for whom the Hippocratic oath was named, wrote about chiropractic care and the importance of understanding and being able to manipulate the spine for bodily alignment. Daniel David Palmer (1845–1913) founded the profession as it came to be known in North America, in Davenport, Iowa, in 1895. The Palmer School of Chiropractic remained one of the most prestigious chiropractic schools even into the twenty-first century. The methods of chiropractic care emphasize a natural, non-surgical, and drug-free approach to healing the human body. As a result of Palmer's influence and a gradual promotion of its benefits, chiropractic care grew throughout the twentieth century.

When people seek the assistance of a chiropractor, they are usually seeking freedom from pain or seeking to maintain optimum health by allowing the body's proper alignment to assist in the interactive functioning of the entire body. The medical profession places chiropractic care in the category of complementary or alternative medical treatment, but tends to view it as a valid and useful component in a complete medical care plan.

Chiropractors approach patient care in much the same manner as medical doctors. The medical history of clients is assessed. Chiropractors observe their clients' muscle strength and weakness, their postures in various positions, the spinal range of motion, and any structural abnormalities. Diagnostic medical tests may be administered in order to make these determinations, including laboratory tests. X rays and imaging are particularly useful tools to the chiropractor in order to analyze the physical, neurological, and orthopedic issues to be addressed.

Hand manipulation, also referred to as chiropractic adjustment, of the spine is the main line of treatment for the chiropractor, using two common techniques. One is the recoil thrust, with the patient lying face down on a special table designed to move only slightly downward. The chiropractor makes thrusts in order to adjust the spine. The other method is the rotational thrust, in which patients lie on the table, the upper body turned into the direction opposite that of the pelvis. For that, the chiropractor

then uses rapid repeated, and hard or strong thrusts to the spine.

Hand manipulation is not the only tool a chiropractor might use. Therapies that include water, light, massage, ultrasound, electric stimulus, acupuncture , and heat are all within the scope of chiropractic treatment. In addition to those, physical supports might also be applied, such as straps, braces, or tapes, that serve the spine with a manual adjustment.

Chiropractors are not authorized to write prescriptions for medications or to perform surgery. They might offer services regarding other aspects of health maintenance such as nutrition with recommendations of dietary supplements , massage, and other relaxation measures, or they might recommend acupuncture.

For patients who have a medical history that raises concerns for safety or effectiveness of chiropractic care, the chiropractor might recommend consultation with a conventional medical doctor or specialist. In some cases, chiropractic might not be recommended or desirable. It is also the case that some chiropractors distinguish themselves from others in their field.

The National Association for Chiropractic Medicine (NACM) describes itself as a “consumer advocacy association of chiropractors who confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery.” Members of this association limit their procedures to treating joint dysfunctional disorders, those that include the “biomechanics of the human frame, posture, weight bearing and gait, and the pain or discomfort concomitant with this dysfunction which may result in excessive ‘wearz of these joint structures,” according the NACM Web site. Chiropractors in this association are not viewed as alternative healthcare providers. According to their guidelines, they do not consider themselves to be primary care physicians but the first step in conventional medical care, working in concert with medical and osteopathic professionals.

The American Chiropractic Association (ACA) emphasizes on its Web site that chiropractic care treats “neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the arms or legs, and headaches.” The organization emphasizes that chiropractic can address tissue injury that has emerged due to specific trauma or through repetitive stress . The chiropractic professionals state that “chiropractic adjustment rarely causes discomfort.” Nonetheless, as with any medical or alternative medical procedure, checking with one's primary care physician or other medical professional is always advised in determining whether a proposed treatment might be beneficial.

The question of how senior adults might benefit from chiropractic has remained an interesting one into the twenty-first century. Theories differ. In fact, according to ACA and other affiliated groups studying ideal practice locations, as of 2008, people most likely to seek chiropractic care are between the ages of 25 and 54. Gary Pirnat, a chiropractor affiliated with the University Health Centers in Whittier and Pasadena, California, indicated in a 2008 article that “While many seniors may feel they are too old to be treated by a doctor of chiropractic in most cases nothing could be further from the truth.” Seniors might benefit from chiropractic manipulation of joints and muscles that are in pain and stiff from arthritis. Even massage techniques when properly applied can benefit individuals following hip surgery or other surgeries that might temporarily limit a patient's mobility.

As reported in Chiropractic and Osteopathy, in 2007, a team of medical and other health service professionals determined that 4.6% of older adults seek chiropractic care. While not conclusive, this comprehensive research study with a nationally representative sampling of U.S. Medicare clients indicated that older adults are probably less likely than those in younger demographic groups to seek chiropractic. Influential factors could include financial status or healthcare concerns that might be contraindicated by pursuit of chiropractic. As of 2008, no definitive research had reached conclusive evidence regarding the frequency of chiropractic care among senior adults.

Work settings

Chiropractors work in their own offices or in group practices with other chiropractors and perhaps other alternate and complementary healthcare professionals such as massage therapists, acupuncturists, and nutritionists. By the late twentieth century, holistic healthcare centers became popular alternatives to traditional medical practices. The environment is clean, safe, and often complements a chiropractor's approach to health through a reduction of stress.

Care team role

Chiropractors might differ in their view of the profession or their role in a care team. While some see themselves as primary care physicians, others see themselves and their profession as complementary and a first step in the line of physicians and other healthcare professionals. When addressing the needs of senior adults, chiropractors of both mindsets assess individual patients by scrutinizing their physical, emotional, and mental condition. Chiropractors seek to determine the most effective treatment by using medical history and available laboratory tests, x rays, or other imaging techniques. The effective chiropractor, like the effective primary care physician, caregiver , and family member, follows a care plan that is considerate of the overall condition of the patient, one that is sensitive to the emotional and mental wellbeing of the individual as well as the person's physical strengths and limitations. No chiropractor is licensed to prescribe medication. The determination of prescription medicine must be left to a licensed medical or osteopathic physician.

Education/Training

Chiropractors in the United States are licensed by each state according to its specific requirements and board certified by the National Board of Chiropractor Examiners that creates the national standards for chiropractic care. Often the course of educational study begins with an undergraduate degree usually similar to that of a pre-med program, with an emphasis on biology, anatomy, and physiology, and other medical and scientific disciplines. As of 2007, 16 chiropractic programs and two chiropractic institutions were accredited by the Council on Chiropractic Education. Some individuals might enter a program before receiving a bachelor&s degree. According to the U.S. Department of Labor, in those instances, applicants must have 90 semester hours of undergraduate study that are leading to a bachelor&s degree. Those courses might include the basic liberal arts courses such as English, social sciences and the humanities as well as science courses. Though not yet considered the minimal requirement for all programs, as of 2008, the Labor Department reported that eventually a bachelor&s degree might be required by all chiropractic schools.

Once admitted to a program, students pursuing a chiropractic career are required to fulfill a combined 4,200 hours of classroom, laboratory, and clinical experience. The first two years of study include primarily classroom and laboratory work, with an emphasis on anatomy, physiology, public health, microbiology, pathology, and biochemistry. The final years of a four to five year program focus on the practical courses of manipulation and spinal adjustment, as well as clinical experience in physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. This course of study results in the granting of the degree of Doctor of Chiropractic. At graduation, individuals will have completed an internship at an outpatient clinic that is owned or run by the chiropractic college.

Postdoctoral study is possible at chiropractic colleges in the fields of orthopaedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practices, pediatrics, and applied chiropractic sciences. Following such training, chiropractors take examinations that result in diplomate status in a particular specialty. These examinations are administered by the chiropractic associations that include those particular specialties.

Every state and the District of Columbia require that chiropractic practice be regulated and license chiropractors according to that state's individual requirements. In order to practice in any given state or in the District of Columbia, individuals must obtain a license for the chosen jurisdiction. Some states have reciprocal agreements for licensure, meaning that the participating states mutually accept the licensing of an individual without further examination. As of 2008, some state licensing boards required at least two years of undergraduate education. An increasing number of them, however, required a four-year bachelor&s degree in order to begin chiropractic study leading to a degree and licensing. All states except New Jersey required continuing education credits each year in order to maintain licensure.

Family teaching

Chiropractors often approach their treatment as part of a larger medical therapy. Senior adults and their families who might be caring for them can expect a number of approaches by the caring chiropractor. Such a professional will want patients to understand fully the procedures used and how they might affect the overall health and wellbeing of individuals being treated. Whatever treatment or dietary supplements are recommended, sufficient literature or other information and counseling should be provided to patients and their family members. Any potential side effects or contraindications with other current medications and medical treatments and conditions will be addressed by any competent chiropractic professional. If such information is not forthcoming, caution should be taken to address concerns with a primary care physician. Chiropractic treatment might be suspended or abandoned altogether should other concerns proscribe such a course.

As of 2008, many insurance programs, including Medicare, covered chiropractic care. Individuals should determine if their insurance policy covers chiropractic care before seeking it. The chiropractor and office staff should be able to provide assistance in regard to medical billing , and whatever limits might be imposed by Medicare or other healthcare plans and insurance companies.

KEY TERMS

Alternative or complementary medicine —Those healthcare practices that are not considered part of traditional medicine, sometimes used separately and sometimes used in coordination with traditional medicine.

Dietary supplements —A product ingested orally that might contain vitamins, minerals, herbs, or other botanicals, amino acids, enzymes, or other ingredients that are provided to supplement the regular diet. Such supplements require special labeling by the U.S. Food and Drug Administration that considers them food rather than drugs.

Traditional or conventional medicine —Medical practice by licensed medical or osteopathic doctors in coordination with other healthcare professionals such as registered nurses, physical therapists, and psychologists. Traditional medical doctors are licensed to prescribe and distribute medication.

Chiropractic treatment methods

• Spinal manipulations or adjustments
• Heat or ice
• Rest
• Rehabilitative exercise
• Nutritional and lifestyle counseling
• Dietary supplements

Resources

BOOKS

Palmer, D. D. Chiropractic: A Science, An Art, and the Philosophy Thereof. Kila, MT: Kessinger, 2006.

PERIODICALS

“How Often Are Physicians and Chiropractors Provided with Patient Information When Accepting Referrals?”Journal of Ambulatory Care Management (October/December 2007): 344.

“The Use of Chiropractors by Older Adults in the United States.” Chiropractic & Osteopathy (September 6, 2007).

OTHER

“Chiropractic.” MedlinePlus.com March 31, 2008 [cited April 8, 2008]. http://www.nlm.nih.gov/medlineplus/chiropractic.html.

“An Introduction to Chiropractic.”National Center for Complementary and Alternative Medicine November 2007 [cited April 8, 2008]. http://nccam.nih.gov/health/chiropractic/.

ORGANIZATIONS

American Chiropractic Association, 1701 Clarendon Blvd., Arlington, VA, 22209, (703) 276-8800, (703) 243-2593, [email protected], www.americhiro.org.

Canadian Chiropractic Examining Board, Suite 238, 2116 Twenty-seventh Avenue NE, Calgary, Alberta, Canada, T2E 7A6, (403) 230-5997, (403) 230-3321, [email protected], www.cceb.ca.

Council on Chiropractic Education, 8049 N. Eighty-fifth Way, Scottsdale, AZ, 85258-4321, (480) 443-8877, (480) 483-7333, [email protected], www.cce-usa.org.

National Association for Chiropractic Medicine, 15427 Baybrook Drive, Houston, TX, 77062, www.chiromed.org.

National Center for Complementary Medicine, National Institutes of Health, Rockville Pike, Bethesda, MD, 20892, [email protected], www.nccam.nih.gov.

Jane Elizabeth Spear

chiropractic is a profession that specializes in the diagnosis, treatment, and overall management of conditions that are due to mechanical dysfunction of the joints and muscles and its effects on the nervous system.

The philosophy behind chiropractic is that the body has the capability of healing itself. If factors of accident or lifestyle lead to poor, inadequate, or incorrect function in the spine or the joints, irritation of nerves and muscles can occur, causing direct or referred pain or discomfort, or even disease. Chiropractors use their skills and techniques to detect signs of restriction of movement, and to restore normal function and allow self-healing.

The term ‘chiropractic’ is derived from two Greek words, ‘cheir’ and ‘praktikos’, denoting treatment by hand, or manipulation. Chiropractic manipulation uses gentle hand movements known as ‘adjustments’. The first chiropractic treatment was given by the Canadian Daniel David Palmer in 1895. One hundred years later the chiropractic profession is now established throughout the world, with national associations of chiropractors in over 70 countries.

A chiropractor will always begin a first consultation with a discussion of the patient's symptoms, medical history, lifestyle, and posture. The patient will then be examined, using standard neurological and orthopaedic tests and chiropractic manual tests, before the chiropractor begins treatment. Practitioners use many different techniques to adjust the body, and frequently offer self-help advice and exercise programmes to patients. They may also take X-rays when necessary to aid diagnosis. If the examination identifies underlying disease or a condition for which chiropractic is inappropriate they will immediately refer the patient to a general practitioner or consultant. Chiropractors do not prescribe drugs or use surgical procedures.

Restrictions in the movement of joints can often be detected before the onset of pain. For this reason, chiropractors advise people to have regular spinal check-ups, in the same way that they go for dental check-ups, to avoid pain in the future. This is believed to be particularly important for babies and young children, whose constant knocks and tumbles could lead to later joint problems, and for those young people whose developing bodies are liable to imbalance from carrying heavy bags, wearing fashionable footwear, sitting at computers, and an increasingly sedentary lifestyle.

Chiropractic treatment is suitable for people of any age, including babies, pregnant women, and the elderly, and for a wide range of conditions, including back pain; sciatica; tension headaches; migraine; neck, shoulder, and arm pains; sports injuries; repetitive strain injury; and many other joint and muscle disorders.

Treatment consists of rapid, highly specific adjustments to the affected joint, and sometimes soft tissue massage. Although normally painless, treatment may result in a ‘popping’ noise, which is due to pressure changes within the joint and has no significance. A treatment programme is tailored for each individual, and appropriate techniques are selected to suit that patient's age and overall condition. Manipulation of the spine is aimed at reducing the effects of stress on the particular spinal nerves that are associated with the patient's symptoms; thus, for example, a nerve affected in the cervical part of the vertebral column may be causing headache or neck pain, or in the lumbar part, low back pain. Chiropractors also treat pain in the limbs or the chest.

Manipulation for low back pain has attracted most attention and research. In 1995 the British Medical Journal reported on the follow-up of a Medical Research Council trial, which concluded that patients with low back pain treated by chiropractic derive more benefit and long-term satisfaction than those treated in hospital out-patient clinics. In September 1996 the Royal College of General Practitioners issued Guidelines for the Management of Acute Low Back Pain; these were reviewed and reissued in 1999, recommending manipulative treatment within the first weeks and confirming that the risks are very low in skilled hands.

Apart from these examples, research into the effectiveness of chiropractic has been relatively sparse. This is due largely to the problems of obtaining finance when drug companies are not involved. However, recent trials have been carried out in the UK, Denmark, Canada, and the Netherlands, with positive results, and an increasing number of UK chiropractors are undertaking comprehensive practice-based research projects.

Patients may also be treated for a range of other conditions such as asthma, indigestion and the irritable bowel syndrome, palpitations, high blood pressure, period pains, infantile colic, and other conditions which may not be directly related to the spine or joints. In cases where these less usual problems are treated, the patient's own doctor is generally contacted and a trial period of treatments agreed upon. Chiropractors believe that if they can reduce, by manipulation, the stress on a spinal nerve within the spinal column, this can affect dysfunctions stemming from the same vertebral level. They regularly report success with such treatment. Researchers world-wide are now investigating such claims. One example is a planned collaborative cardiology–chiropractor study of unexplained chest pain.

In the UK it takes 5 years to become a chiropractor: a full-time, 4-year BSc course, followed by a postgraduate year working in a clinic under supervision. Those who have trained at an accredited college can become members of the British Chiropractic Association; this was established in 1925 and now represents the majority of the 1200 UK practitioners. In North America there is a minimum of 6 years' university-level training: 2 years of qualifying sciences and 4 years of chiropractic college. The practice of chiropractic is licensed by law in all US states and Canadian provinces.

In the UK, the Chiropractors Act received Royal Assent in 1994. The General Chiropractic Council was established in 1997, and its statutory register opened in 1999; it is responsible for setting standards of both education and conduct, and since June 2001 all chiropractors are required to be registered if they are to practise legally in the UK.

Many health insurance companies will now pay for chiropractic treatment, and chiropractors are generally recognized as primary health care professionals by the medical establishment. The Clinical Standards Advisory Group recommended, in 1994, that there should be earlier access to the manipulative therapies and a redistribution of resources within the NHS to make this possible.

Manya McMahon

Bibliography

Copland-Griffiths, M. (1991). Dynamic chiropractic today. Thorsons Publishers Ltd, Wellinborough.

Chiropractic

2762 ■ AMERICAN COLLEGE OF CHIROPRACTIC ORTHOPEDISTS

c/o Bill Fisher, Scholarship Committee Chair
P.O. Box 424
Delmont, PA 15626
Tel: (724)523-5505
Fax: (724)523-6875
Web Site: http://www.accoweb.org
To provide financial assistance to college students enrolled in their fifth term or later of chiropractic college.
Title of Award: F. Maynard Lipe Scholarship Award Area, Field, or Subject: Medicine, Chiropractic; Medicine, Orthopedic Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: The award is $1,000. Funds are sent to the recipient's school and may be used to pay for tuition (not for books, lab fees, or other ancillary expenses). Duration: The award is granted annually.
Eligibility Requirements: This program is open to students who have completed at least 4 terms in an approved college of chiropractic. Applicants must have a GPA of 3.0 or higher and a career objective to specialize in chiropractic orthopedics. Along with their application, they must submit an article from 1,000 to 2,500 words in length on a subject related to chiropractic orthopedics. Selection is based on the excellence of the article. Deadline for Receipt: January of each year. Additional Information: When possible, the student is a guest at the association's convention.

2763 ■ INTERNATIONAL CHIROPRACTORS ASSOCIATION

1110 North Glebe Road, Suite 1000 Arlington, VA 22201
Tel: (703)528-5000
Free: 800-423-4690
Fax: (703)528-5023
E-mail: [email protected]
Web Site: http://www.chiropractic.org
To provide financial assistance to student members of the International Chiropractors Association (SICA).
Title of Award: Alma Neilsen Perpetual Scholarship Area, Field, or Subject: Medicine, Chiropractic Level of Education for which Award is Granted: Four Year College Number Awarded: Varies each year. Funds Available: A stipend is awarded (amount not specified). Duration: 1 year.
Eligibility Requirements: This program is open to members of the SICA organization on the campus of a college approved by the International Chiropractors Association (ICA). Applicants must be sophomores, juniors, or seniors and able to demonstrate financial need. They must submit a short statement (100 to 120 words) on their commitment to chiropractic and why this scholarship should be awarded to them. Deadline for Receipt: April of each year. Additional Information: Approved ICA chiropractic colleges include Cleveland Chiropractic College of Kansas City, Cleveland Chiropractic College of Los Angeles, Life Chiropractic College (Marietta, Georgia), Life Chiropractic College-West (Hayward, California), Logan College of Chiropractic, (Chesterfield, Missouri), Los Angeles College of Chiropractic, New York Chiropractic College (Seneca Falls, New York), Palmer College of Chiropractic (Davenport, Iowa), Palmer College of Chiropractic-West (San Jose, California), and Palmer College of Chiropractic-Florida (Port Orange, Florida). Information is also available from Jackie Ballard, ICAA Scholarship Chair, 815 Jefferson Avenue, Huntington, WV 25704.