Evolution of Chiropractic Medicine in Health Care

The scientific merit of spinal dysfunction and therapeutic benefits of spinal manipulation for neuromusculoskeletal conditions were challenged in the early days of chiropractic. Manipulation has been generally accepted for back pain, neck pain, sciatica, joint problems, sprains, strains, osteoarthritis, herniated discs and other musculoskeletal (MSK) conditions

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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

See Spinal Manipulation: High-Velocity Low-Amplitude (HVLA)

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.

Chiropractic Adjustment

A chiropractic adjustment - also known as chiropractic manipulation, manual manipulation, or spinal manipulation - is a common therapeutic treatment for lower back pain.

A chiropractic adjustment refers to a chiropractor applying manipulation to the vertebrae that have abnormal movement patterns or fail to function normally.

The objective of this chiropractic treatment is to reduce the subluxation, with the goals of increasing range of motion, reducing nerve irritability and improving function.

Chiropractic adjustment typically involves:

A high velocity, short lever arm thrust applied to a vertebra. An accompanying, audible release of gas (joint cavitation) that is caused by the release of oxygen, nitrogen, and carbon dioxide, which releases joint pressure (cavitation)

This gives the patient a relieving sensation, although just going to the gym muscles will get a bit sore, this is normal. In our office we use several therapies to avoid the side effects of the stiffness and tenderness that can occur, Including muscle stimulation with an interferential current on the effected muscles. We also will use ultrasound and Ice if needed. Massage therapy is also an option.

See Spinal Manipulation: High-Velocity Low-Amplitude (HVLA)

Chiropractic Adjustment Techniques

There are many different manipulative techniques that can be utilized in our office, and there is a certain skill level and "art" involved with high velocity, low amplitude adjustment or manipulation. It is perhaps more important for the chiropractor to determine when not to apply the adjustment. After almost 30 years adjusting patents, I feel my skill level is very good.

The most common reaction to a chiropractic adjustment is aching or soreness in the spinal joints or muscles. If this aching or soreness occurs, it is usually within the first few hours post-treatment and does not last longer than 24 hours after the chiropractic adjustment. Application of an ice pack often reduces the symptoms relatively quickly.

References:

The American Chiropractic Association: Facts & Statistics about Chiropractic.

Unsworth A, Dowson D, Wright V. "Cracking joints".

Related Articles:

Understanding Spinal Manipulation

Conservative vs Surgical Care for Lower Back Pain

Chiropractic Procedures for the Sacroiliac Joint

The Graston Technique: An Instrument Assisted Soft Tissue Manual Therapy for Back Pain

Article written by: Steven G. Yeomans, DC

Chiropractic Adjustments and the Immune System

It’s started, many of my patients are coughing, sneezing and more thanks to any number of seasonal illnesses.  If you’d like to avoid it altogether, and frankly who wouldn’t, you’ll need an immune system that’s in top shape.  But how do you shape up your immune system?  A healthy diet is a great way to contribute to this. And while many people are aware of that—regardless of how well they comply-- fewer know how the body’s immune system is impacted by another biological network: the nervous system.  The primary nexus point of your nervous system is found at your spine.  It’s the foundation of the traditional chiropractic care I provide, but what does it have to do with getting sick or being able to fight off illness?

The alignment of your spine can play a big role in the way your body communicates across systems, including your immune system.  If your spine is misaligned, or if subluxations are present, the result can be a lack of immune defense, like when you become susceptible to the flu, or an improper immune response, as is the case with many allergies.  While it’s not very hard to tell if you’re coming down with a bad cold or if hay fever is taking its toll, you can’t always tell if the root cause is a subluxation. While fundamental to health, misalignments and subluxations may not be something you may be able to feel directly.  If you’re masking your symptoms with medicine, you’re only silencing your body’s immune response.  To alleviate your symptoms, you must correct your immune response by realigning your body so it can function at its best.

This is accomplished through tried and true, natural chiropractic adjustments. When the spine is in proper alignment the complex communication that occurs throughout your body’s networks is restored, and when that happens, your body can heal innately and defend against illness.  So before you consider a flu shot or restock your medicine cabinet in preparation for cold, flu and allergy season, try a spinal adjustment as your best line of defense, as well as the most efficient, non-invasive and natural method for enabling your body to do what it should do best: heal and thrive.        

-          Dr. David B. Thomson B.Sc. D.C.