What is Chiropractic?

According to The American Chiropractic Association,

http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=61

Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.  Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.

Doctors of Chiropractic – often referred to as chiropractors or chiropractic physicians – practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.

The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,” also called “chiropractic adjustment.”   The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile – or restricted in their movement – as a result of a tissue injury. Tissue injury can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses, such as sitting in an awkward position with poor spinal posture for an extended period of time. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for the sufferer. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, and allowing tissues to heal.

Chiropractic adjustment rarely causes discomfort. However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) that usually resolves within 12 to 48 hours.

In many cases, such as lower back pain, chiropractic care may be the primary method of treatment. When other medical conditions exist, chiropractic care may complement or support medical treatment by relieving the musculoskeletal aspects associated with the condition.

Doctors of chiropractic may assess patients through clinical examination, laboratory testing, diagnostic imaging and other diagnostic interventionsto determine when chiropractic treatment is appropriate or when it is not appropriate.  Chiropractors will readily refer patients to the appropriate health care provider when chiropractic care is not suitable for the patient’s condition, or the condition warrants co-management in conjunction with other members of the health care team.

History of Chiropractic Care

According to The American Chiropractic Association,

http://www.acatoday.org/level3_css.cfm?T1ID=13&T2ID=61&T3ID=149 

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. Hippocrates, the Greek physician, who lived from 460 to 357 B.C., also published texts detailing the importance of chiropractic care. In one of his writings he declares, “Get knowledge of the spine, for this is the requisite for many diseases”.

In the United States, the practice of spinal manipulation began gaining momentum in the late nineteenth century. In 1895, Daniel David Palmer founded the Chiropractic profession in Davenport, 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. In 1897, Daniel David Palmer went on to begin the Palmer School of Chiropractic, which has continued to be one of the most prominent chiropractic colleges in the nation.

Throughout the twentieth century, doctors of chiropractic gained legal recognition in all fifty states. A continuing recognition and respect for the chiropractic profession in the United States has led to growing support for chiropractic care all over the world. The research that has emerged from ” around the world” has yielded incredibly influential results, which have changed, shaped and molded perceptions of chiropractic care. The report, Chiropractic in New Zealand published in 1979 strongly supported the efficacy of chiropractic care and elicited medical cooperation in conjunction with chiropractic care. The 1993 Manga study published in Canada investigated the cost effectiveness of chiropractic care. The results of this study concluded that chiropractic care would save hundreds of millions of dollars annually with regard to work disability payments and direct health care costs.

Doctors of chiropractic have become pioneers in the field of non-invasive care promoting science-based approaches to a variety of ailments. A continuing dedication to chiropractic research could lead to even more discoveries in preventing and combating maladies in future years.

Education of Doctors of Chiropractic

Doctors of chiropractic must complete four to five years at an accredited chiropractic college. The complete curriculum includes a minimum of 4,200 hours of classroom, laboratory and clinical experience. Approximately 555 hours are devoted to learning about adjustive techniques and spinal analysis in colleges of chiropractic. In medical schools, training to become proficient in manipulation is generally not required of, or offered to, students. The Council on Chiropractic Education requires that students have 90 hours of undergraduate courses with science as the focus.

Those intending to become doctors of chiropractic must also pass the national board exam and all exams required by the state in which the individual wishes to practice. The individual must also meet all individual state licensing requirements in order to become a doctor of chiropractic.

An individual studying to become a doctor of chiropractic receives an education in both the basic and clinical sciences and in related health subjects. The intention of the basic chiropractic curriculum is to provide an in-depth understanding of the structure and function of the human body in health and disease. The educational program includes training in the basic medical sciences, including anatomy with human dissection, physiology, and biochemistry. Thorough training is also obtained in differential diagnosis, radiology and therapeutic techniques. This means, a doctor of chiropractic can both diagnose and treat patients, which separates them from non-physician status providers, like physical therapists. According to the Council on Chiropractic Education DCs are trained as Primary care Providers.

What is a Doctor of Chiropractic?

The proper title for a doctor of chiropractic is “doctor” as they are considered physicians under Medicare and in the overwhelming majority of states. The professional credentials abbreviation ” D.C.” means doctor of chiropractic. ACA also advocates in its Policies on Public Health that DCs may be referred to as (chiropractic) physicians as well.

Chiropractic Philosophy

As a profession, the primary belief is in natural and conservative methods of health care. Doctors of chiropractic have a deep respect for the human body’s ability to heal itself without the use of surgery or medication. These doctors devote careful attention to the biomechanics, structure and function of the spine, its effects on the musculoskeletal and neurological systems, and the role played by the proper function of these systems in the preservation and restoration of health. A Doctor of chiropractic is one who is involved in the treatment and prevention of disease, as well as the promotion of public health, and a wellness approach to patient healthcare.

Scope of Practice

Doctors of chiropractic frequently treat individuals with neuromusculoskeletal complaints, such as headaches, joint pain, neck pain, low back pain and sciatica. Chiropractors also treat patients with osteoarthritis, spinal disk conditions, carpal tunnel syndrome, tendonitis, sprains, and strains. However, the scope of conditions that Doctors of chiropractic manage or provide care for is not limited to neuromusculoskeletal disorders. Chiropractors have the training to treat a variety of non-neuromusculoskeletal conditions such as: allergies, asthma, digestive disorders, otitis media (non-suppurative) and other disorders as new research is developed.

A variety of techniques, treatment and procedure are used to restore healing which will be the topic of future education releases.

Works Cited

1. Chapman-Smith, David: The Chiropractic Profession. West Des Moines, Iowa, NCMIC Group Inc., 2000: 11-17, 70-71.
2. Chiropractic: State of Art. Arlington, Virginia, American Chiropractic Association, 1998: 2-3, 12-14.
3. Spinal Manipulation Policy Statement. Arlington, Virginia: American Chiropractic Association, 1999: 6.

Chiropractic Research

According to The American Chiropractic Association,

http://www.acatoday.org/level3_css.cfm?T1ID=13&T2ID=61&T3ID=150

Numerous studies have shown that chiropractic treatment is both safe and effective.  The following are excerpts from a few of the more recent studies.  By examining the research supporting chiropractic care, you will find that chiropractic offers tremendous potential in meeting today’s health care challenges.

For Acute and Chronic Pain

“Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”

– Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics

In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.

 — Korthals-de Bos et al (2003), British Medical Journal

In Comparison to Other Treatment Alternatives

“Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”

– Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

“In our randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.”

– Hoving et al (2002), Annals of Internal Medicine

For Headaches

“Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.”

— Duke Evidence Report, McCrory, Penzlen, Hasselblad, Gray (2001)

“The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values.” ‘

— Journal of Manipulative and Physiological Therapeutics, Boline et al. (1995)

Cost Effectiveness

Low back pain initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD), according to a study that analyzed data from 85,000 Blue Cross Blue Shield (BCBS) beneficiaries in Tennessee over a two-year span. The study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays. Researchers estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee. They also concluded that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.

– Liliedahl et al (2010), Journal of Manipulative and Physiological Therapeutics

“Chiropractic care appeared relatively cost-effective for the treatment of chronic low-back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulative efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis.”

– Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

Patient Satisfaction

“Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks.”

— Hertzman-Miller et al (2002), American Journal of Public Health

Popularity of Chiropractic

“Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades.”

– Meeker, Haldeman (2002), Annals of Internal Medicine

Chiropractic Education

According to The American Chiropractic Association,

Educational requirements for doctors of chiropractic are among the most stringent of any of the health care professions.

The typical applicant at a chiropractic college has already acquired nearly four years of pre-medical undergraduate college education, including courses in biology, inorganic and organic chemistry, physics, psychology and related lab work. Once accepted into an accredited chiropractic college, the requirements become even more demanding — four to five academic years of professional study are the standard. Because of the hands-on nature of chiropractic, and the intricate adjusting techniques, a significant portion of time is spent in clinical training.

Doctors of chiropractic — who are licensed to practice in all 50 states, the District of Columbia, and in many nations around the world — undergo a rigorous education in the healing sciences, similar to that of medical doctors. In some areas, such as anatomy, physiology, and rehabilitation, they receive more intensive education than most medical doctors or physical therapists.

Like other primary health care doctors, chiropractic students spend a significant portion of their curriculum studying clinical subjects related to evaluating and caring for patients. Typically, as part of their professional training, they must complete a minimum of a one-year clinical-based program dealing with actual patient care. In total, the curriculum includes a minimum of 4,200 hours of classroom, laboratory and clinical experience. The course of study is approved by an accrediting agency which is fully recognized by the U.S. Department of Education. This has been the case for more than 25 years.

Before they are allowed to practice, doctors of chiropractic must pass national board examinations and become state-licensed. Chiropractic colleges also offer post-graduate continuing education programs in specialty fields ranging from sports injuries and occupational health to orthopedics and neurology. These programs allow chiropractors to specialize in a healthcare discipline or meet state re-licensure requirements.

This extensive education prepares doctors of chiropractic to diagnose health care problems, treat the problems when they are within their scope of practice and refer patients to other health care practitioners when appropriate.