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'''Chiropractic''' is a [[Complementary and alternative medicine|complementary and alternative]] [[health care]] [[profession]] which aims to diagnose, treat, and prevent mechanical disorders of the [[musculoskeletal system]] and their effects on the [[nervous system]] and general [[health]]. Chiropractic care emphasizes manual treatments including [[spinal adjustment]] and [[joint]] and [[soft-tissue]] manipulation. Chiropractic theory emphasizes the body's self-regulation mechanisms. An estimated |
'''Chiropractic''' is a [[Complementary and alternative medicine|complementary and alternative]] [[health care]] [[profession]] which aims to diagnose, treat, and prevent mechanical disorders of the [[musculoskeletal system]] and their effects on the [[nervous system]] and general [[health]]. Chiropractic care emphasizes manual treatments including [[spinal adjustment]] and [[joint]] and [[soft-tissue]] manipulation. Chiropractic theory emphasizes the body's self-regulation mechanisms. An estimated one third of chiropractors believe obstructions to healing can be removed by adjusting [[vertebral subluxation|subluxations]] of the spine and/or extremities. Although disputed research suggests short term pain relief for tension headache and low back pain<ref name="Cooperstein">Cooperstein R, Perle SM, Gatterman MI, Lantz C, Schneider MJ. (2001) Chiropractic technique procedures for specific low back conditions: characterizing the literature ''J Manipulative Physiol Ther'' 24:407-24. PMID 11514818.</ref>, there is no scientific consensus for chiropractic's effectiveness for other conditions. |
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==Introduction== |
==Introduction== |
Revision as of 17:10, 2 June 2006
Chiropractic is a complementary and alternative health care profession which aims to diagnose, treat, and prevent mechanical disorders of the musculoskeletal system and their effects on the nervous system and general health. Chiropractic care emphasizes manual treatments including spinal adjustment and joint and soft-tissue manipulation. Chiropractic theory emphasizes the body's self-regulation mechanisms. An estimated one third of chiropractors believe obstructions to healing can be removed by adjusting subluxations of the spine and/or extremities. Although disputed research suggests short term pain relief for tension headache and low back pain[1], there is no scientific consensus for chiropractic's effectiveness for other conditions.
Introduction
Chiropractic was founded in 1895 by Daniel David Palmer, and was based on the belief that all health problems could be prevented and treated using "adjustments" of the spine, and sometimes other joints, to correct what he termed "subluxations". He, and later his son, BJ Palmer, postulated that these subluxations were misaligned vertebrae which caused nerve compression that "interfered" with the transmission of what he termed "Innate Intelligence". This interference interrupted the proper flow of Innate Intelligence from "above, down, inside, and out" to the organ to which it travelled. As a result, the human body would experience "dis-ease" or disharmony which would result in a loss of health. He compared this process to stepping on a hose that slowed the flow of water to a garden. If you take your foot off the hose, the flow of water returns to normal and the garden will flourish.
While the "pinched hose theory" has mostly been abandoned, it is still used in a modified form by some chiropractors to explain the concept of vertebral subluxation. However, the concept of the subluxation, for which there is disputed scientific evidence, remains an integral part of the typical chiropractic practice. Nevertheless, in 2003 90% of chiropractors believed the vertebral subluxation complex played a significant role in all or most diseases, and practiced accordingly.[2] The remainder limited their practices to the care of musculoskeletal problems.
Today there are 17 [17] accredited chiropractic colleges in the US and two in Canada, and an estimated 70,000 chiropractors in the United States, 5000 in Canada, 2500 in Australia, 1300 in the United Kingdom, and smaller numbers in about 50 other countries. In the U.S. and Canada, licensed individuals who practice chiropractic are commonly referred to as "chiropractors," "doctors of chiropractic," (DC) or "chiropractic physicians." Most patients who visit a chiropractor do so initially because of symptoms arising from musculoskeletal problems, especially low back and neck pain, although most chiropractors say they concern themselves with the overall health of the patient.[citation needed]
The initial chiropractic technique was manipulation of the spine (called "adjustment") and remains the primary technique[citation needed]. The chiropractic adjustment differs from other manipulative techniques in its precision and accuracy in correcting vertebral subluxations. Today's chiropractor may continue to adhere to the strict tenets of Palmer and use only spinal adjustments or he/she may also include a broad range of methods, short of drugs and surgery, that are directed at "correcting" subluxations and/or relieving musculoskeletal pain. Some doctors of chiropractic employ chiropractic assistants to work as office staff and perform therapeutic activities and may also employ massage and physiotherapists as adjuncts to chiropractic care. According to a 2002 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%)[3][4]. It is now practiced in hundreds of different ways.[5] The U.S. Department of Labor's Occupational Outlook Handbook said:
- Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices. [18]
Spinal adjustments, chiropractic's primary technique, may provide short-term relief of certain forms of back and neck pain, headaches, and other spine-related conditions, but studies show conflicting results. For example, a systematic review (1997) noted "Strong evidence was found for the effectiveness of spinal manipulation, back schools and exercise therapy, especially for short-term effects."[6] However, a more recent (2006) systematic review concluded "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment."[7]
Chiropractic may be able to show it can be a partner in today's cost-conscious healthcare environment. A 2005 study stated that "the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs."[8]
Chiropractic is also used by some professional athletes. The U.S. Olympic Medical Services Staff includes doctors of chiropractic who work with medical doctors for the benefit of the athletes. [19]
There are two main groups of chiropractors, known within the field as "mixers" and "straights". Both groups treat patients using a subluxation based treatment system-with differences arising based on the reasons for getting subluxations adjusted, claims made and various treatments or sub-specialities provided.
Straight chiropractors are the oldest movement, operating half of the accredited schools and graduating 75% of practicing chiropractors. They largely follow the writings of chiropractic founder DD Palmer and his son BJ Palmer, but have expanded the earlier theories by suggesting alternative mechanisms. Straight chiropractors fully accept Palmer's hypothesis that spinal adjustments remove interference to the human nervous system and improve communication between the brain and target tissues. Treatments are assumed to remove a primary underlying risk factor for disease rather than treat a patient's diseases per se. As a result, straight chiropractors view the diagnosis of patient complaints as unnecessary and avoid it if possible. Instead they rely on a collection of tests, many being proprietary to chiropractic while some are shared among the health professions (i.e. motion palpation which is used by some physical therapists). The objective of chiropractic testing is to identify vertebral subluxations and determine a plan of treatment. This stance against diagnosing patient complaints has been a source of contention within the profession because accreditation standards mandate that differential diagnosis be taught in all chiropractic programs so that the care provided to patients is safe and relevant to their complaints. Moreover, several state chiropractic licensing boards mandate that patient complaints be diagnosed prior to receiving care. Most straight chiropractors limit treatment to spinal adjustments.
Mixer chiropractors are an early offshoot of the straight movement. Their chiropractic schools comprise 50% of the ones in operation but produce only 25% of graduating chiropractors. This branch of chiropractic originated from naturopathic, osteopathic, medical, and even chiropractic doctors who attended the Palmer College of Chiropractic and then re-organized the treatment system to include a wider number of diagnostic and treatment approaches. They eventually split and formed various other chiropractic schools including the National College of Chiropractic. Their treatments may include naturopathy and physical therapy devices. While still subluxation based, mixer chiropractors also administer therapeutic techniques to treat problems associated with both the spine and extremities, including musculoskeletal issues such as pain and decreased range of motion. Mixer chiropractors use a modified form of medical diagnosis which considers vertebral subluxations to be a form of osteoarthritis. Diagnosis is made through a process of elimination after ruling out other known disorders, noting general signs of mechanical dysfunction in the spine, and through straight chiropractic analysis procedures as described above.[9]
Although chiropractic has gained more acceptance in the last 40 years as an appropriate treatment for certain back, neck and other spine-related problems, resulting in increased usage, [citation needed] statistics in the later years have shown some variations from these trends: student enrollments fell 39.9% between 1996 and 2002, [10] and the percentage of the adult population that uses chiropractic fell by 25% from 1997 to 2002. [11] The statistics for student enrollments seem to be rising again, while patient use statistics are still uncertain.[citation needed]
History
In 1885, the world was well into the second industrial revolution, marked by innovation and creativity. Health care was no exception consisting of competing treatments including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines. Neither consumers nor many practitioners had much knowledge of either the causes of, or cures for, illnesses.[12] Allopathy, fueled by Louis Pasteur's refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. German bacteriologist, Robert Koch formulated his postulates bringing some much-needed scientific clarity to what was then a very confused field.[20] Drugs, medicines and quack cures were becoming more prevalent and were mostly unregulated. MD Andrew Taylor Still [21], ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.[22] Daniel David Palmer (DD Palmer), a teacher, grocer turned magnetic healer opened his office of magnetic healing in Davenport, Iowa in 1886. After nine successful years,[13] DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18,1895.
Conflicting accounts of the first Chiropractic adjustment
Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which indicated spinal misalignment and a possible cause of Lillard's deafness. Palmer corrected the misalignment, and Lillard could then hear the wheels of the horse-drawn carts in the street below. [14] Palmer said there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude" about this adjustment; it was specific so much so that no chiropractor has equalled it.[23]
Palmer's version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said 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 [something of] it, then they both would share. But, it didn't happen." [15]
Early growth
After the case of Harvey Lillard, Palmer stated: "I had a case of heart trouble which was not improving. I examined the spine and found a displaced vertebra pressing against the nerves which innervate the heart. I adjusted the vertebra and gave immediate relief -- nothing "accidental" or "crude" about this. Then I began to reason if two diseases, so dissimilar as deafness and heart trouble, came from impingement, a pressure on nerves, were not other disease due to a similar cause? Thus the science (knowledge) and art (adjusting) of Chiropractic were formed at that time." [14]
DD Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term chiropractic. In 1896, DD added a school to his magnetic healing infirmary and began to teach others his method. It would be become known as Palmer School of Chiropractic (PSC, now Palmer College of Chiropractic). Among the first graduates were Andrew P. Davis MD,DO, William A. Seally,MD, BJ Palmer (DD's son), Solon M. Langworthy, John Howard, and Shegataro Morikubo.
Langworthy would move to Cedar Rapids, Iowa and open the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure (ASC & NC) combining it with naturapathy cures and Osteopathy.[16] DD Palmer, who disliked the mixing of chiropractic with other cures, turned down an offer to be a partner.
In a controversial move, DD Palmer would abruptly turn the Palmer School over to BJ Palmer. DD would move on to help open several schools in several states. At the request of some of Palmer's students, and with DD's blessing, John Howard opened the National School of Chiropractic in 1906 in the same building where Harvey Lillard had received the first adjustment, several blocks from PSC.[24].[25]
Changing political and healthcare environment
The early 19th century had seen the rise of patent medicine and the nostrum trade. Although some remedies were marketed through doctors of medicine, most were sold directly to consumers by lay people with the use of questionable advertising claims. The addictive, and sometimes toxic, effects of some remedies, especially morphine and mercury-based folk cures, prompted the early laws that defined the practice of medicine. In the mid 1800's, as the germ theory began to take hold, medicine began to embrace the scientific method as a way to battle disease. In 1847, the American Medical Association formed to establish standards for the preliminary medical education and for the degree of MD. In 1849, a board was established to analyze quack remedies and nostrums and to enlighten the public in regard to the nature and danger of such remedies.[17] Relationships were developed with pharmaceutical companies in an effort to curb the patent medicine crisis and consolidate the patient base around the medical doctor. By the turn of the century, the AMA had created a Committee on National Legislation to represent the Association's interest in Washington[17] and re-organized as the national organization of state and local associations. By 1910, the AMA was a powerful national force; this was the beginning of organized medicine.[26].
Straights and Mixers
Many of the initial students at PSC and ASC & NC had previous experience in healthcare as naturopaths, osteopaths, and medical physicians. As the profession grew, it inevitably became more common to mix chiropractic with those and other techniques. While some techniques were not unusual, others were questionable in their design and application. With the new AMA definitions for the practice of medicine becoming the new law of the land, DD continued to refine chiropractic as a unique form of practice seperate from that of medicine. He often denounced the mixing of his drugless discovery with any other form of cure, and refused to defend those who did.pg4 However, as a result of his own extravagant claims of cure being touted in his new periodical, The Chiropractor, DD, too, was convicted of practicing medicine without a license. Refusing to pay the fine, he would spend 105 days in jail before eventually paying the $389.50.[13] Thereafter, DD would relinquish all rights to PSC to BJ and see his influence significantly diminish. BJ Palmer was now in charge of the Fountainhead of Chiropractic (PSC).
The next 15 years would see the opening of no less than 30 additional chiropractic schools, including John Howard's National School of Chiropractic (now the National University of Health Sciences) that would move to Chicago, Illinois. Each school would attempt to develop its own identity while BJ Palmer continued to develop his father's discovery. Chiropractic was to face several obstacles in the coming years that would both divide and unify its members. BJ would lead the subsequent struggle to legally practice chiropractic as a seperate and unique health care profession. His influence over the next several years would further define the Mixers of chiropractic and those who practiced it Straight.[16].
Association battles
Imediately following the conviction of his father, BJ along with many of his colleagues would create the Universal Chiropractic Association (UCA). Its original purpose was to provide a safety net for those who would later be arrested by the AMA's medical trust. Its first success was in the aquittal of Shegetaro Morikubo, DC in 1907 where BJ would later note:
- "We are always mindful of those early days when UCA...used various expedients to defeat medical court prosecutions. We legally squirmed this way and that, here and there. We did not diagnose, treat, or cure disease. We analyzed, adjusted cause, and Innate in patient cured. All were professional matters of fact in science, therefore justifiable in legal use to defeat medical trials and convictions."pg5
With each susequent case, BJ's direction for chiropractic was more evident.
DD Palmer said he "received chiropractic from the other world" [18] during a seance, from a deceased physician named Dr Jim Atkinson. [19]
He regarded chiropractic as partly religious in nature, and in a letter of May 4, 1911 he said: "we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase." [18]
Keating et al., writing for the Association for the History of Chiropractic, said D.D. Palmer
- "introduced the concept of Innate Intelligence circa 1904. Innate, he believed, was an intelligent entity which directed all the functions of the body, and used the nervous system to exert its influence. (Donahue 1986, 1987)."
Palmer’s son B. J. Palmer initiated research, development and promotion of chiropractic.
DD Palmer's effort to find a single cause for all disease led him to say:
- A subluxated vertebra . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column. (From: Palmer D.D. The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.)
Wilk et al. vs the American Medical Association
Before 1980, Principle 3 of the American Medical Association Principles of Medical Ethics stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult."
As a result of this policy, an antitrust suit was brought against the AMA and other medical associations in 1976 - Wilk et al vs American Medical Association et al. - by Wilk and other chiropractors. The landmark lawsuit ended in 1987 when the Federal Appeals Court found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this objective could not have been satisfied in a manner less restrictive of competition, for instance by public education campaigns. The AMA then lost its appeal to the Supreme Court and had to allow its members to collaborate with chiropractors. PDF of key transcripts
The judge in the Wilk case said that the AMA had covered up research on the effectiveness of chiropractic for back pain. She then said that chiropractors clearly wanted "a judicial pronouncement that chiropractic is a valid. efficacious, even scientific health care service." She said no "well designed, controlled, scientific study" had been done, and concluded "I decline to pronounce chiropractic valid or invalid on anecdotal evidence." PDF of key transcripts
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 a Universal Intelligence that connects the brain to the rest of the body. Palmer claimed that subluxations interfered with the proper communication of this innate intelligence with the rest of the body, and that, by fixing them, 100% of all diseases could be treated.
In 1998, Lon Morgan, D.C., wrote, in the Journal of the Canadian Chiropractic Association,
- "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity." [27]
In the mid-1990's, the Association of Chiropractic Colleges redefined a subluxation as 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.
Today, chiropractors use the concept of Innate Intelligence to describe the body's self-healing physiology; accordingly, they hold that healthcare interventions should consider the person as a whole and that conservative (non-invasive) treatment approaches should be used where possible.
Philosophy of the subluxation
Both chiropractic and mainstream medicine hold that much of the body is controlled by nerve impulses sent to and from the brain along the spinal cord. Whether the brain commanding the foot to move, the foot signaling the brain that it is in pain, or even a simple patellar reflex, the spinal cord is involved. Outgoing impulses from the brain pass down the spinal cord and exit 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), chiropractic doctors 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.
Science and chiropractic
Chiropractic is controversial because of the lack of scientific evidence for some of the claims made by chiropractors (see [28]). There is scientific agreement that, wherever applicable, an evidence based medicine framework should be used to assess health outcomes, and that systematic reviews with strict protocols are an important part of objectively evaluating the efficacy of treatments. Where evidence from such reviews is lacking, this does not necessarily mean that the treatment is ineffective, only that the case for a benefit of treatment may not have been rigorously established. Organisations such as the Cochrane Collaboration and Bandolier publish such reviews. An editorial in The Journal of Manipulative and Physiological Therapeutics in 2005, The Cochrane Collaboration: is it relevant for doctors of chiropractic?, proposed that involvement in Cochrane collaboration would be a way for chiropractic to gain greater acceptance within medicine. The collaboration has 11,500 contributors from more than 90 countries organised in 50 review groups. For chiropractic, relevant review groups include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular Disease Group. The editorial states:
- "For example, a chiropractor may provide conservative care supported by a Cochrane review to a patient with carpal tunnel syndrome. If the patient's symptoms become progressive, the doctor may consider referring the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open surgery for the said condition.”"
The Cochrane Collaboration found insufficient evidence that chiropractic is beneficial for asthma, carpal tunnel syndrome, and painful menstrual periods. Bandolier found insufficient evidence that chiropractic is beneficial for migraine, chronic low back pain and menopausal symptoms .
University of Saskatchewan sociologist Leslie Biggs interviewed 600 Canadian chiropractors in 1997, and found that 74.3% of them did not believe that controlled clinical trials were the best way to evaluate chiropractic, and 68.1% believed that most diseases are caused by spinal malalignment. [29]
There is much conflict in the results of chiropractic research. For instance, many chiropractors [30] claim to treat infantile colic. According to a 1999 survey of the Ontario Chiropractic Association (representing 83% of chiropractors in Ontario), 46% treated children for colic. [20] In 1999 a randomized controlled clinical trial with a blinded observer suggested that there is evidence that spinal manipulation may help infantile colic. [21] However, in 2001, a Norwegian double-blind study said “Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic.” [22]
American Medical Association
In 1997, the following statement was adopted as policy of the American Medical Association (AMA) after a report on a number of alternative therapies:[31]
- "There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies."
Safety
As with all interventions, risks may be associated with spinal manipulation. These risks, although rare, include vertebrobasilar accidents, strokes, disc herniations, vertebral fracture, and cauda equina syndrome, according to Harrison's. Most serious complications occur after cervical (the 7 bones in the upper third of the spine) manipulation. The practice of greatest concern is the rotary neck movement, sometimes called "master cervical" or "rotary break", which may be linked to trauma, paralysis, strokes, and death.
Nothing more than a temporal relationship has ever been established in relation to severe complications and chiropractic intervention. Chiropractic continues to be one of the safest health care professions[32] and Chiropractors benefit from some of the lowest malpractice insurance premiums among the health care industry[33].
Documented serious complications after manipulation of the cervical spine are very rare (1 in 3-4 million manipulations or fewer). This estimate is based on international studies of millions of chiropractic cervical adjustments from 1965 to the present day. The "one in a million" estimate is echoed in an extensive review of spinal manipulation performed by the RAND corporation.[34] However, in another study, Dvorak cites figures of 1 in 400,000, while Jaskoviak reported approximately 5 million cervical manipulations from 1965 to 1980 at The National College of Chiropractic Clinic in Chicago, without a single case of vertebral artery stroke or serious injury [35]. Less conservative treatments such as neck surgery are also often used for conditions similar to the conditions chiropractors treat using spinal adjustments. Cervical spine surgery has a 3-4% rate of complication and 4,000-10,000 deaths per million neck surgeries.
With studies of this nature it is difficult to determine what percentage of incidents are reported. The RAND study, for example, assumed that only 1 in 10 cases would have been reported. Dr Edzard Ernst surveyed neurologists in Britain for cases of serious neurological complication occurring within 24 hours of cervical spinal manipulation during the past year. 35 cases had been seen by the 24 who responded, and none of those had been reported. His survey led him to conclude that underreporting was closer to 100%, rendering estimates "nonsensical." [36]
A 2001 study in the medical journal Stroke found that vertebrobasilar accidents (VBAs) are five times more likely in those aged <45 years who had visited a chiropractor in the week before the VBA, compared to controls who had not visited a chiropractor. [37]
Chiropractors cite a New Zealand Commission report as supporting the safety of chiropractic. The report said "We are satisfied that chiropractic treatment in New Zealand is remarkably safe." (Report of the Commission of Inquiry Into Chiropractic 1979:p 77). But this was disputed by the judge in the Wilk v. American Medical Association case; on safety, this report was found to be "unsatisfactory", and a review of the New Zealand report by the United States Congress' Office of Technology Assessment found 'serious problems' in the report's treatment of safety and efficacy issues. It concluded that the New Zealand report's review of the safety issue was 'unsatisfactory.' [38]
It should be noted that most studies performed that deal with the stroke issue and cervical manipulation do not take into account the difference between "manipulation" and the "Chiropractic adjustment". According to "a research report in the Journal of Manipulative and Physiological Therapeutics, "manipulations" administered by a Kung Fu practitioner, GPs, osteopaths, physiotherapists, a wife, a blind masseur, and an Indian barber had been incorrectly attributed to chiropractors." The report goes on to say, "The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a non-chiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader's opinion of chiropractic and chiropractors." (Terrett AGJ: Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. JMPT 1995;18:203.) Chiropractic adjustments are set apart from manipulation due to their precision and specificity [39]. It should also be noted that there are nearly 200 different chiropractic techniques, which vary considerably in their application; such differences have never been taken into account in relation to safety issues.
Chiropractic education, licensing, and regulation
United States
In the United States, graduates of chiropractic school receive the degree Doctor of Chiropractic (D.C.), are referred to as "doctor", and are eligible to seek licensure in all jurisdictions. The Council on Chiropractic Education [40] (CCE) sets minimum guidelines for chiropractic colleges, but additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice. Currently all 19 chiropractic institutions in the USA are accredited by the CCE.
Students often enter chiropractic school with a Bachelor's degree, or with three years of post-secondary education in the sciences and other appropriate coursework. However, in 2005 only one chiropractic college required a baccalaureate degree as an admission requirement. [41] The minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours, and the minimum cumulative GPA for a student entering is 2.50. Commonly required classes include: psychology, biology, organic and inorganic chemistry, and physics. Other common medical classes are: anatomy or embryology, physiology, microbiology, diagnosis, neurology, x-ray, orthopedics, obstetrics/gynecology, histology, and pathology.
In the U.S., chiropractic programs require at least 4,200 hours of combined classroom, laboratory, and clinical experience. The last 2 years stress courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, orthopedics, neurology, geriatrics, physiotherapy, and nutrition. Graduates must complete 5 years of schooling and pass 4 national board exams to complete their education. To qualify for licensure, graduates must sit for State examination; most State boards require at least 2 years of undergraduate education, and an increasing number require a 4-year bachelor’s degree. All boards require the completion of a 4-year program at an accredited college leading to the Doctor of Chiropractic degree. Once licensed, most States require chiropractors to attend 12-48 hours of continuing education annually.
Chiropractic colleges also offer Postdoctoral training in neurology, orthopedics, sports injuries, nutrition, rehabilitation, industrial consulting, radiology, family practice, pediatrics, and applied chiropractic sciences. After such training, chiropractors may take exams leading to "diplomate" status in a given specialty including orthopedics, neurology and radiology.
Australia
In Australia, chiropractic is taught at three universities: RMIT in Melbourne, Murdoch University in Perth and Macquarie University in Sydney. To be registered by various state Chiropractic Registration Boards, a Bachelor of Chiropractic Science, a Bachelor of Science or health-related degree, plus the successful completion of a full-fee paying postgraduate qualifying program for the Master of Chiropractic is required.
Practice styles and schools of thought
Contemporary chiropractic is divided into three schools of thought - straight, mixer, and reform - which differ in their approaches to patient care. All chiropractic approaches are based on non-invasive, non-medication approaches, with many based on the use of manipulation as a treatment for mechanical musculoskeletal dysfunction of the spine and extremities. The three schools of thought do not correspond exactly to existing membership organizations, but adherents tend to favor certain organizations.
- Straight chiropractors primarily concern themselves with vertebral subluxation correction. Practitioners primarily limit their practice to adjusting vertebral subluxations. Straight chiropractors hold that only the body can cure the body. By aligning the vertebrae, straight chiropractors believe that they are clearing nerve impulse restrictions and therefore providing a more efficient dialogue between the brain and the rest of the body's systems, thus putting the body in a better position to cure (or heal) itself. Straight chiropractors are a minority, and tend to be members of the Federation of Straight Chiropractic Organization (FSCO), International Chiropractors Association (ICA), and the World Chiropractic Alliance (WCA).
- Mixing chiropractors combine contemporary medical diagnosis and treatment with chiropractic adjustments. Mixing style practitioners use adjustments to treat chiropractic subluxations, as well as nutrition and naturopathic style remedies for other disorders. Methods used include ultrasound, TENS, rehabilitation or the use of other diagnostic methods such as Applied Kinesiology (AK). Mixing chiropractic is itself divided into conservative and liberal groupsTemplate:Fn. Many mixers are members of the American Chiropractic Association (ACA), but there are also many exceptions.
- Reform chiropractors are oriented at mainstream medicine, advocating a very limited use of chiropractic primarily for treatment of musculoskeletal conditions.
Most universities teaching chiropractic, including Palmer in Davenport Iowa, use rehabilitation methods, exercise, physiological therapeutics and nutrition. The National College (now University) incorporated physical therapy in 1912, even before there was a profession bearing its name. The profession in the U.S. continues to be divided only into specialities. Some do spine-only, others prefer to do sports and rehabilitation. There are musculoskeletal foci and those who co-manage people with organic problems, MS or cancer along with their regular medical approaches.
References
- ^ Cooperstein R, Perle SM, Gatterman MI, Lantz C, Schneider MJ. (2001) Chiropractic technique procedures for specific low back conditions: characterizing the literature J Manipulative Physiol Ther 24:407-24. PMID 11514818.
- ^ McDonald W (2003) How Chiropractors Think and Practice: The Survey of North American Chiropractors. Institute for Social Research, Ohio Northern University
- ^ More Than One-Third of U.S. Adults Use Complementary and Alternative Medicine, According to New Government Survey (Press Release), May 27 2004, available online
- ^ Complementary and Alternative Medicine Use Among Adults: United States, 2002 (Report), May 27 2004, available online (PDF format)
- ^ Burton, Bernard. "Chiropractic Management of Low Back Pain." Cleveland Clinic: Spinal Care 2000 Symposium. March 30, 2000.
- ^ van Tulder M (1997) Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine 22:2128-56. [1]
- ^ Ernst E (2006) A systematic review of systematic reviews of spinal manipulation J R Soc Med 99:192-6 [2]
- ^ Nelson CF, Metz RD, LaBrot T (2005) Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain J Man Phys Ther 28:564-9 Abstract
- ^ Souza T (2005) Differential Diagnosis and Management for the Chiropractor, Third Edition : Protocols and Algorithms Jones and Bartlett Publishers Inc. 3rd edition
- ^ National Center for Education Statistics, Integrated Postsecondary Education Data System, Retrieved online 8/15/2004 at [3] Quoted here: [4]
- ^ Tindle HA. (2005) Trends in use of complementary and alternative medicine by US adults: 1997-2002 Altern Ther Health Med 11:42-9 [5]
- ^ "The Chiropractic Profession and Its Research and Education Programs", Final Report, pg 41, Florida State University, MGT of America, December 2000 [6]
- ^ a b Keating J. D.D. Palmer's Lifeline [7]
- ^ a b Palmer DD (1910) The Science, Art and Philosophy of Chiropractic Portland, Oregon: Portland Printing House Company [8] Cite error: The named reference "SciArtPhi" was defined multiple times with different content (see the help page).
- ^ Westbrooks B (1982) The troubled legacy of Harvey Lillard: the black experience in chiropractic. Chiropractic History 2:4653 [9]
- ^ a b Keating J. Chiropractic History: A Primer,Sutherland Companies [10]
- ^ a b AMA Web site,AMA History 1847 - 1899,Retrieved May 27,2006[11]
- ^ a b Palmer D.D. (1911) D.D. Palmer's Religion of Chiropractic [12] Cite error: The named reference "chiroreligion" was defined multiple times with different content (see the help page).
- ^ Keating J. Faulty Logic & Non-skeptical Arguments in Chiropractic [13]
- ^ Verhoef MJ,Costa Papadopoulos C. Survey of Canadian chiropractors’involvement in the treatment of patients under the age of 18. [14]
- ^ Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.[15]
- ^ Olafsdottir E, Forshei S, Fluge G, Markestad T. Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child 2001;84:138-141. [16]
See also
External links
Advocacy
- Chiropractic organizations
- American Chiropractic Association (ACA)
- British Chiropractic Association (BCA)
- Canadian Chiropractic Association (CCA)
- Japanese Association of Chiropractors (JAC)
- International Chiropractors Association (ICA)
- National Association for Chiropractic Medicine
- World Chiropractic Alliance (WCA)
- World Federation of Chiropractic (WFC)
- Foundation for Chiropractic Education and Research (FCER)
- Descriptions of chiropractic procedures
- Other resources
- Chiropractic Resource Organization
- Dynamic Chiropractic Online (ChiroWeb)
- Directory of Chiropractors in the United States
- The Chiropractic Profession and Its Research and Education Programs
- The Future of Chiropractic Revisited: 2005 to 2015
- Other
- Cherkin, Daniel C.; Mootz, Robert D. (1997) Chiropractic in the United States: Training, Practice, and Research, available online
- Healey, James W. (1990) "It's Where You Put the Period", Dynamic Chiropractic, Volume 08, Issue 21 (October 10, 1990) available online
Critiques
- A Different Way To Heal? -- PBS - Scientific American Frontiers, Web Feature
- Chiropractic: science and antiscience and pseudoscience side by side -- Joseph C. Keating, Jr, PhD
- Commentary: The Specter of Dogma -- Joseph C. Keating, Jr., PhD
- Faulty Logic and Non-skeptical Arguments in Chiropractic -- Joseph C. Keating Jr, PhD