.
Scientific evidence has indicated that spinal manipulation
is safe and effective for treatment for lower back pain, neck pain and
headache, and recent health care guidelines have listed it as a viable
treatment option for symptoms that do not respond to self-care.
Spinal manipulation in chiropractic medicine has evolved
greatly since the first high-velocity adjustment performed by D.D. Palmer in
the late 1800s. In addition, chiropractors have begun to embrace a variety of
other evidence-based approaches to spine problems. Now, techniques include
low-velocity adjustments involving the hands and even instruments and machines,
and various other adjustments incorporating many specialized and individualized
thrusts
Modern chiropractic research has started to focus more on
the efficacy of specific types of spinal manipulation, including when certain
adjustments are performed and how long they are included as part of
chiropractic treatment plans. Besides chiropractors, Doctors of Osteopathic
Medicine (DO) and some Medical Doctors (MD) and Physical Therapists (PT) also
perform spinal manipulation.
Concerns about the safety of manipulating the cervical spine
for neck pain have been raised in relation to strokes. The medical literature
does not substantiate that manipulation increases the risk of or causes
strokes, but rather indicates that the reported stroke cases were patients who
already had signs of impending stroke prior to manipulation. The literature
shows no statistical difference in stroke occurrence among medical specialties,
regardless if someone sees a Medical Doctor or Doctor of Chiropractic, and
reports that chiropractic is generally and equally as safe of a treatment for
neck pain as other nonsurgical care.
Chiropractic health care has also grown beyond spinal manipulation
to include other manual therapy like soft-tissue mobilization and massage,
instrument-assisted soft tissue mobilization, the McKenzie approach to
mechanical diagnosis and therapy, as well as stabilization and strength
training exercise, nutrition and postural programs, and the incorporation of a
cognitive-behavioral context to treatment regimens.
The appropriateness and effectiveness of some newer
treatments (like spinal decompression) used by some chiropractors are a subject
of debate among chiropractors and others, as are some other more recent
developments, including treating children with spinal manipulation and
marketing chiropractic as a holistic treatment of allergies, asthma, acid
reflux, digestive disorders, ear infections, colic and other conditions that
are less commonly treated with spinal manipulation.
Modern Recognition and Use of Chiropractic Medicine
Eighteen years after its founding in America, chiropractic
received its first state licensing in 1913. In the following 18 years,
chiropractic medicine became recognized in 39 states. Chiropractic is now
recognized as a health care profession in not only all 50 states but the
District of Columbia, Puerto Rico, U.S. Virgin Islands and many other
countries. Chiropractic colleges are located in many countries in addition to
the United States and Canada.
Chiropractic licensing is handled on a state-by-state basis
according to specific state laws. There are currently more than 60,000 licensed
chiropractors in the United States, making chiropractic the third largest
doctoral level health care profession behind medicine and dentistry.
Efficacy of Chiropractic Medicine
A 2007 survey estimated that more than 18 million adults (8
percent of the U.S. adult population) and 2 million children (nearly 3 percent
of American children) visited a chiropractor the previous year.15 Chiropractic
may be fully or partially covered by private insurance plans, and Medicare may
cover manual manipulation for subluxation of the spine in certain
circumstances.
A 2009 evidence-based report on population, health and total
health care spending suggested that chiropractic care of back pain and neck
pain provides higher satisfaction, superior outcomes and more
cost-effectiveness than other commonly-utilized back and neck pain treatments,
which can include simple rest, medications, surgery and more.
This report also reviewed the scientific literature on
chiropractic care, which was noted in other findings to be at least as
effective as other widely-used therapies for lower back pain and more effective
(when combined with exercise) than other common treatments for neck pain.
A further review of scientific literature indicated that
patients with chiropractic coverage as part of their insurance benefits had
lower costs and reduced imaging studies, fewer hospitalizations and less
surgeries than patients without chiropractic included in their insurance.
Today, chiropractors enjoy hospital privileges in many
hospitals, practice in multidisciplinary practices, work within the Department
of Defense (DoD) and Veterans Affairs (VA) systems, and treat both Medicare and
Medicaid patients. The profession continues to become more mainstream and
integrated.
References
Spinal Manipulation for Low-Back Pain. National Center for
Complementary and Alternative Medicine (NCAM).
Chiropractor Profession. Medline Plus.
Special thanks to the following individuals for their
contributions to this article:
Dr. Thomas E. Hyde, DC
Dr. Donald R. Murphy, DC, DACAN
Dr. Stephen M. Perle, D.C., M.S.
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