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Chiropractic care is an Integrative Healthcare modality that deals with the relationship between the body’s structure and function. The goal of chiropractic care is to correct alignment problems, ease pain, improve function, and support the human body’s ability to heal itself. Generally, this is carried out by a series of manual adjustments to the patient’s musculoskeletal system, namely the spine, joints, and bones. Chiropractic care has been shown to improve back pain, nerve interference, headaches, and physical injuries.
The term “chiropractic” combines the Greek words cheir (hand) and praxis (practice) which literally means hands on therapy. Chiropractic care is based on the notion that the relationship between the body’s structure (primarily that of the spine) and its function (as coordinated by the nervous system) affects health. Dr. David Palmer developed chiropractic care in the late 19th century while researching the origin of disease. His original theory was that most ailments could be traced to vertebrae related issues as well as an imbalance of tension in the spinal nervous system. Dr. Palmer demonstrated some success with his therapies but struggled to gain acceptance by the established medical industry at the time.
Both Dr. palmer and his son were arrested in the early 20th century for practicing medicine without a license. B.J. Palmer, David’s son, was able to establish chiropractic as a successful integrative modality. This trend towards acceptance and professionalism was continued and expanded upon by Willard Carver who established one of the first chiropractic schools in the United States. By the late 20th century chiropractic care enjoyed acceptance by the established medical profession commonly referred to as allopathic Medicine. Since its inception, chiropractic care has evolved and now includes the diagnosis and treatment of structural abnormalities in the spinal column and the relationship between the vertebrae and the enhancement of the flow of electrical impulses between the brain and the nervous system. There are many techniques that have been developed in chiropractic care that are used in other forms of treatment throughout many different modalities such as physical therapy.
In the United States, chiropractic care is often considered an integrative health approach. Many people who seek chiropractic care have low-back pain. People also commonly seek chiropractic care for other kinds of musculoskeletal pain, headaches, and hand or foot problems. During the initial visit, chiropractors typically take a health history and perform a physical examination, with a special emphasis on the spine. Other examinations or tests such as x-rays may also be performed. If chiropractic treatment is considered appropriate, a treatment plan will be developed.
During follow up visits, practitioners may perform one or more of the many different types of adjustments and other manual therapies used in chiropractic care. Given mainly to the spine, a chiropractic adjustment involves using the hands or a device to apply a controlled, rapid force to a joint. The goal is to increase the range and quality of motion in the area being treated and to aid in restoring health. Joint mobilization is another type of manual therapy that may be used. Chiropractors may combine the use of spinal adjustments and other manual therapies with several other treatments and approaches such as heat and ice, electrical stimulation, relaxation techniques, rehabilitative and general exercise, counseling about diet, weight loss, and other lifestyle factors, and dietary supplements.
Chiropractic colleges accredited by the Council on Chiropractic Education (CCE) offer Doctor of Chiropractic (D.C.) degree programs. (CCE is the agency certified by the U.S. Department of Education to accredit chiropractic colleges in the United States.) Admission to a chiropractic college requires a minimum of 90 semester hour credits of undergraduate study, mostly in the sciences. Chiropractic training is a 4-year academic program that includes both classroom work and direct experience caring for patients. Coursework typically includes instruction in the biomedical sciences, as well as in public health and research methods. Some chiropractors pursue a 2- to 3-year residency for training in specialized fields.
Chiropractic is regulated individually by each state and the District of Columbia. All states require completion of a Doctor of Chiropractic degree program from a CCE-accredited college. Examinations administered by the National Board of Chiropractic Examiners are required for licensing and include a mock patient encounter. Most states require chiropractors to earn annual continuing education credits to maintain their licenses. Chiropractors’ scope of practice varies by state in areas such as the dispensing or selling of dietary supplements and the use of other complementary health approaches such as acupuncture or homeopathy.
Researchers have studied spinal manipulation for a number of conditions ranging from back, neck, and shoulder pain to asthma, carpal tunnel syndrome, fibromyalgia, and headaches. Much of the research has focused on low-back pain, and has shown that spinal manipulation appears to benefit some people with this condition. A 2010 review of scientific evidence on manual therapies for a range of conditions concluded that spinal manipulation/mobilization may be helpful for several conditions in addition to back pain, including migraine and neck-related headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders. The review also identified several conditions for which spinal manipulation/mobilization appears not to be helpful including asthma, hypertension, and menstrual pain or the evidence is inconclusive fibromyalgia, mid-back pain, premenstrual syndrome, sciatica, and temporomandibular joint disorders.
Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated. There have been rare reports of serious complications such as stroke, cauda equina syndrome a condition involving pinched nerves in the lower part of the spinal canal, and worsening of herniated discs, although cause and effect are unclear. Safety remains an important focus of ongoing research. A 2007 study of treatment outcomes for 19,722 chiropractic patients in the United Kingdom concluded that minor side effects, such as temporary soreness, after cervical spine manipulation were relatively common, but that the risk of a serious adverse event was “low to very low” immediately or up to 7 days after treatment. Ask about typical out-of-pocket costs and insurance coverage. Chiropractic is covered by many health maintenance organizations and private health plans, Medicare, and state workers’ compensation systems.
