What is chiropractic?

Chiropractic is a form of diagnosing and treating illnesses that affect the nerves, muscles, bones, and joints of the body. Daniel David Palmer founded chiropractic in 1895. Palmer was a self-taught healer who was studying spinal structure and manipulative techniques when he cured a man of deafness and acute back pain by realigning a displaced vertebra in his back. This and other successes led Palmer to believe that most diseases were a result of abnormal nerve transmission caused by "vertebral subluxation" (that is, misalignment of the spine). Although most contemporary chiropractic practices have introduced other therapies, spinal manipulation remains the essence of chiropractic. Today, chiropractic is the third largest independent health profession in the Western world, and the United States alone is home to 52,000 licensed chiropractors who together see 20 million patients a year.

What happens during a visit to a chiropractor?

The first visit usually lasts about an hour. The chiropractor takes a complete health history, including information on past injuries and illnesses; current conditions and medications; lifestyle; diet; sleep habits; exercise; mental stresses; and use of alcohol, drugs, or tobacco. During a physical exam, the chiropractor also tests the extent of spinal mobility and may perform various diagnostic tests, such as blood pressure and x-rays, to rule out other conditions. Treatment generally begins at either the first or second visit. Patients are typically asked to lie on a specially designed table, where the chiropractor performs the spinal manipulations. The most common maneuver is manual manipulation, which involves movement of the selected joint to the end of its range, followed by a low-force thrust. The chiropractor may, however, use other treatments including massage and soft-tissue therapies. Some people experience minor aches, stiffness, and tiredness for a few days after the manipulation while their body adjusts to the new alignment.

How many treatments will be required?

More than one session is usually needed to correct a problem; a typical course of treatment lasts several weeks. The chiropractor may suggest two or three sessions a week (lasting only about 10 to 20 minutes), then reduce the frequency to weekly sessions once the condition being treated improves. Patient and chiropractor together evaluate the effectiveness of treatment based on the goals discussed in the first session.

What conditions are treated effectively with chiropractic?

Chiropractic has been shown to be effective for acute and chronic low back pain, neck pain, headaches (including migraines), frozen shoulder, tennis elbow and other sports injuries, and carpal tunnel syndrome, and may be helpful for otitis media (ear infection), digestive problems, menstrual and premenstrual pain, and asthma.

Are there conditions that should not be treated with chiropractic?

Individuals with bone fractures or tumors, acute arthritis, bone or joint infections, or advanced osteoporosis should avoid chiropractic therapy in areas affected by any of these conditions. Patients should also tell their chiropractor about any physical disabilities they have, or if they are experiencing symptoms of numbness, tingling, weakness, or other neurological problems. In extremely rare cases, manipulation of the neck has damaged blood vessels or caused strokes. The screening process, however, is designed to detect people at high risk.

How can a qualified practitioner be located?

Chiropractors are licensed in all 50 states. A chiropractic degree requires approximately the same number of educational hours as a medical degree. The chiropractic program includes clinical experience, basic sciences, and standard as well as structural (spinal) and functional (nervous system) diagnoses. Currently, 17 chiropractic colleges exist in the U.S.; the Council of Chiropractic Education accredits these colleges. At least one chiropractic organization serves each state in the U.S. The largest association in the profession of chiropractic is the American Chiropractic Association (ACA). The ACA can provide a list of licensed chiropractors in your area if you call 800-986-4636, or you can visit the organization's site on the Internet at www.amerchiro.org.

Does medical insurance cover chiropractic treatments?

Medicare, Medicaid, and worker's compensation cover chiropractic care. According to a 1994 federal study, 80% of healthcare plans that employers offer cover at least part of the cost of chiropractic.

Glossary

• Hard tissue manipulation– manipulation of bone and/or cartilage, including joints
• High velocity thrust– manual manipulation that involves movement of the selected joint to its end range of voluntary motion, followed by a quick manual thrust
• Interferential therapy– a form of electronic stimulation
• Ischemic compression (Travell-Simons trigger point therapy)– a technique in which progressively strong pressure is applied to a pressure point, trigger point, or tight muscle
• Joint mobilization– slower or gentler manual techniques in which the joint remains within its passive range of movement.
• Low amplitude thrust– amplitude refers to the depth of, or distance traveled by, the practitioner's thrust. Most adjustment/manipulation is of low amplitude, minimizing total force applied to the patient.
• Manipulation–manual techniques that move a joint beyond the end point of its passive range of motion.
• Soft tissue manipulation– manual manipulation of muscle, tendon, and ligament.
• Spinal manipulation– manipulation of the vertebrae
• Subluxation– where alignment, movement integrity, and/or physiologic function are altered although contact between the joint surfaces remains intact.
• Thrust– the therapeutic maneuver delivered by the practitioner during high-velocity adjustment and manipulation.

Supporting Research

Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18(3):148-154.

Fallon J. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. J Clin Chiropractic Pediatr. 1997;2(2):167-183.

Gottlieb MS. Conservative management of spinal osteoarthritis with glucosamine sulfate and chiropractic treatment. J Manipulative Physiol Ther. 1997;20(6):400-414.

Hansen DT, Triano JJ. Chiropractic. In: Novey DW, ed. Clinician's Complete Reference to Complementary/Alternative Medicine. St. Louis, MO: Mosby; 2000:310-324.

Hertzman-Miller RP, Morgenstern H, Hurwitz EL, et al. Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low back pain study. Am J Public Health. 2002;92(10):1628-1633.

Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6 month follow-up outcomes from the UCLA low back pain study. Spine. 2002;27(20):2193-2204.

Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health. 2002;92(10):1634-1641.

Kaptchuk TJ, Eisenberg DM. Chiropractic origins, controversies, and contributions. Arch Intern Med. 1998;158(20):2215-2224.

Lauretti WJ. The comparative safety of chiropractic. In: Redwood D, ed. Contemporary Chiropractic. New York, NY: Churchill Livingstone; 1997:229-244.

Manga P. Economic case for the integration of chiropractic services into the health care system. J Manipulative Physiol Ther. 2000;23(2):118-122.

Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Ann Intern Med. 2002;136(3):216-227.

Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther. 1998;21(8):511-519.

Ofman JJ. Chiropractic spinal manipulation for treatment of acute low back pain. In: Saltmarsh N, ed. The Physician's Guide to Alternative Medicine. Atlanta, GA: American Health Consultants; 1999:265-266.

Plaugher G, Bachman TR. Chiropractic management of a hypertensive patient. J Manipulative Physiol Ther. 1993;16(8):544-9.

Redwood D. Chiropractic. In: Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone Inc.; 1996:91-110.

Rupert RL. A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I. J Manipulative Physiol Ther. 2000;23(1):1-9.

Terrett AG. Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation. Des Moines, IA: NCMIC Group; 2001.

Wiberg JM, 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(8):517-522.

Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboom-de Jong B. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomized, single blind study. BMJ. 1997;314(7090):1320-1325.