Chiropractic is from Greek words meaning done by hand. It is grounded in the principle that the body can heal itself when the skeletal system is correctly aligned and the nervous system is functioning properly. To achieve this, the practitioner uses his or her hands or an adjusting tool to perform specific manipulations of the vertebrae. When these bones of the spine are not correctly articulated, resulting in a condition known as subluxation, the theory is that nerve transmission is disrupted and causes pain in the back, as well as other areas of the body.Chiropractic is one of the most popular alternative therapies currently available. Some would say it now qualifies as mainstream treatment as opposed to complementary medicine. Chiropractic treatment is covered by many insurance plans and in 2004, the U.S. Department of Veterans Affairs announced full inclusion of chiropractic care for veterans. It has become well-accepted treatment for acute pain and problems of the spine, including lower back pain and whiplash. Applications beyond that scope are not supported by current evidence, although there are ongoing studies into the usefulness of chiropractic for such problems as ear infections, dysmenorrhea, infant colic, migraine headaches, and other conditions.
Most people will experience back pain at some time in their lives. Injuries due to overexertion and poor posture are among the most common. Depending on the cause and severity of the condition, options for treatment may include physical therapy, rest, medications, surgery, or chiropractic care. Chiropractic treatment carries none of the risks of surgical or pharmacologic treatment. Practitioners use a holistic approach to health. The goal is not merely to relieve the present ailment, but to analyze the cause and recommend appropriate changes of lifestyle to prevent the problem from occurring again. They believe in a risk/benefit analysis before use of any intervention. The odds of an adverse outcome are extremely low. Chiropractic has proven in several studies to be less expensive than many more traditional routes such as outpatient physical therapy. Relief from some neuromuscular problems is immediate, although a series of treatments is likely to be required to maintain the improvement. Spinal manipulation is an excellent option for acute lower back pain, and may also relieve neck pain as well as other musculoskeletal pain. Although most back pain will subside eventually with no treatment at all, chiropractic treatment can significantly shorten the time it takes to get relief. Some types of headache can also be successfully treated by chiropractic.
Spinal manipulation has a long history in many cultures but Daniel D. Palmer is the founder of modern chiropractic theory, dating back to the 1890s. A grocer and magnetic healer, he applied his knowledge of the nervous system and manual therapies in an unusual situation. One renowned story concerns Harvey Lillard, a janitor in the office where Palmer worked. The man had been deaf for 17 years, ever since he had sustained an injury to his upper spine. Palmer performed an adjustment on a painful vertebra in the region of the injury and Lillard’s hearing was reputedly restored. Palmer theorized that all communication from the brain to the rest of the body passes through the spinal canal, and areas that are poorly aligned or under stress can cause physical symptoms both in the spine and in other areas of the body. Thus the body has the innate intelligence to heal itself when unencumbered by spinal irregularities causing nerve interference. After his success with Lillard, other patients began coming to him for care, and responded well to adjustments. This resulted in Palmer’s further study of the relationship between an optimally functional spine and normal health.Palmer founded the first chiropractic college in 1897. His son, B. J. Palmer, continued to develop chiropractic philosophy and practice after his father’s death. B. J. and other faculty members were divided over the role of subluxation in disease. B. J. saw it as the cause of all disease. The others disagreed and sought a more rational way of thinking, thus broadening the base of chiropractic education. From 1910 to 1920, many other chiropractic colleges were established. Other innovators, including John Howard, Carl Cleveland, Earl Homewood, Joseph Janse, Herbert Lee, and Claude Watkins, also helped to advance the profession.
The theories of the Palmers receive somewhat broader interpretation today. Many chiropractors believe that back pain can be relieved and health restored through chiropractic treatment even in patients who do not have demonstrable subluxations. Scientific development and research of chiropractic is gaining momentum. The twenty-first century will likely see the metaphysical concepts such as innate intelligence give way to more scientific proofs and reform.
Many people besides the Palmers have contributed to the development of chiropractic theory and technique. Some have gone on to create a variety of procedures and related types of therapy that have their roots in chiropractic, including McTimoney-Corley chiropractic, craniosacral manipulation, naprapathy, and applied kinesiology. Osteopathy is another related holistic discipline that utilizes spinal and musculoskeletal manipulation as a part of treatment, but osteopathic training is more similar in scope to that of an M.D.
An initial chiropractic exam will most often include a history and a physical. The patient should be asked about the current complaint, whether there are chronic health problems, family history of disease, dietary habits, medical care received, and any medications currently being taken. Further, the current complaint should be described in terms of how long it has been a problem, how it has progressed, and whether it is the result of an injury or occurred spontaneously. Details of how an injury occurred should be given. The physical exam should evaluate by observation and palpation whether the painful area has evidence of inflammation or poor alignment. Range of motion may also be assessed. In the spine, either hypomobility (fixation) or hypermobility may be a problem. Laboratory analysis is helpful in some cases to rule out serious infection or other health issues that may require referral for another type of treatment. Many practitioners also insist on x rays during the initial evaluation
When spinal manipulation is employed, it is generally done with the hands, although some practitioners may use an adjusting tool. A classic adjustment involves a high velocity, low amplitude thrust that produces a usually painless popping noise, and improves the range of motion of the joint that was treated. The patient may lie on a specially designed, padded table that helps the practitioner to achieve the proper positions for treatment. Some adjustments involve manipulating the entire spine, or large portions of it, as a unit; others are small movements designed to affect a single joint. Stretching, traction, and slow manipulation are other techniques that can be employed to restore structural integrity and relieve nerve interference.
A new use of technology with traditional chiropractic care has been introduced. Using a hand-held device that is pressed to the spine or joints, a chiropractor may soon be able to detect and manipulate the skeleton not only with his or her hands but with the computer-linked device that uses harmonic frequencies to detect a misalignment in the spine. The new technology was not widely accepted in 2004, however.
Length of treatment
The number of chiropractic treatments required will vary depending on several factors. Generally longer-term treatment is needed for conditions that are chronic, severe, or occur in conjunction with another health problem. Patients who are not in overall good health may also have longer healing times. Some injuries will inherently require more treatments than others in order to get relief. Care is given in three stages. Initially appointments are more frequent with the goal of relieving immediate pain. Next, the patient moves into a rehabilitative stage to continue the healing process and help to prevent a relapse. Finally, the patient may elect periodic maintenance, or wellness treatments, along with lifestyle changes if needed to stay in good health.
Discharge and follow-up therapy are important. If an injury occurred as a result of poor fitness or health, a program of exercise or nutrition should be prescribed. Home therapy may also be recommended, involving such things as anti-inflammatory medication and applications of heat or ice packs. Conscious attention to posture may help some patients avoid sustaining a similar injury in the future, and the chiropractor should be able to discern what poor postural habits require correction. A sedentary lifestyle, particularly with a lot of time spent sitting, is likely to contribute to poor posture and may predispose a person to back pain and injury.
Types of practitioners
Some practitioners use spinal manipulation to the exclusion of all other modalities, and are known as straight chiropractors. Others integrate various types of therapy such as massage, nutritional intervention, or treatment with vitamins, herbs, or homeopathic remedies. They also embrace ideas from other health care traditions. This group is known as mixers. The vast majority of chiropractors, perhaps 85%, fall in this latter category.
Patients should enter the chiropractic clinic with an open mind. This will help to achieve maximum results.
Chiropractic is not an appropriate therapy for diseases that are severely degenerative and may require medication or surgery. Many conditions of the spine are amenable to manipulative treatment, but this does not include fractures. The practitioner should be informed in advance if the patient is on anticoagulants, or has osteoporosis or any other condition that may weaken the bones. Other circumstances might suggest the patient should not have chiropractic care. These should be detected in the history or physical exam. In addition to fractures, Down syndrome, some congenital defects, and some types of cancer are a few of the things that may preclude spinal manipulation. On rare occasions, a fracture or dislocation may occur. There is also a very slim possibility of experiencing a stroke as a result of spinal manipulation, but estimates are that it is no more frequent than 2.5 occurrences per one million treatments.
Patients should be wary of chiropractors who insist on costly x rays and repeated visits with no end in sight. Extensive use is not scientifically justifiable, especially in most cases of lower back pain. There are some circumstances when x rays are indicated, including acute or possibly severe injuries such as those that might result from a car accident.
It is not uncommon to have local discomfort in the form of aches, pains, or spasms for a few days following a chiropractic treatment. Some patients may also experience mild headache or fatigue that resolves quickly.
Research and general acceptance
As recently as the 1970s, the American Medical Association (a national group of medical doctors) was quite hostile to chiropractic. AMA members were advised that it was unethical to be associated with chiropractors. Fortunately that has changed, and as of 2000, many allopathic or traditionally trained physicians enjoy cordial referral relationships with chiropractors. The public is strongly in favor of chiropractic treatment. Chiropractors see the lion’s share of all patients who seek medical help for back problems. And chiropractic treatment is the most widely used of all alternative medical treatments.
Research has also supported the use of spinal manipulation for acute low back pain. There is some anecdotal evidence recommending chiropractic treatment for ailments unrelated to musculoskeletal problems, but there is not enough research-based data to support this. On the other hand, a chiropractor may be able to treat problems and diseases unrelated to the skeletal structure by employing therapies other than spinal manipulation.Although many chiropractors limit their practice to spine and joint problems, others claim to treat disorders that are not closely related to the back or musculoskeletal system. These include asthma, bedwetting, bronchitis, coughs, dizziness, dysmenorrhea, earache, fainting, headache, hyperactivity, indigestion, infertility, migraine, pneumonia, and issues related to pregnancy. There are at least three explanations for the possible effectiveness for these conditions. One is that the problem could be linked to a nerve impingement, as may be possible with bed-wetting, dizziness, fainting, and headache. In a second group, chiropractic treatment may offer some relief from complicating pain and spasms caused by the disease process, as with asthma, bronchitis, coughs, and pneumonia. The discomforts of pregnancy may also be relieved with gentle chiropractic therapy. A third possibility is that manipulation or use of soft-tissue techniques may directly promote improvement of some conditions. One particular procedure, known as the endonasal technique, is thought to help the eustachian tube to open and thus improve drainage of the middle ear. The tube is sometimes blocked off due to exudates or inflammatory processes. This can offer significant relief from earaches. Some headaches also fall in this category, as skilled use of soft tissue techniques and adjustment may relieve the muscle tension that may initiate some headaches.
Dysmenorrhea, hyperactivity, indigestion, and infertility are said to be relieved as a result of improved flow of blood and nerve energy following treatment. Evidence for this is anecdotal at best, but manipulation is unlikely to be harmful if causes treatable by other modalities have been ruled out.
For conditions such as cancer, fractures, infectious diseases, neurologic disease processes, and anything that may cause increased orthopedic fragility, chiropractic treatment alone is not an effective therapy, and may even be harmful in some cases. Those who have known circulatory problems, especially with a history of thrombosis, should not have spinal manipulation.
“Technology Takes Tiny Steps in Hands-on Chiropractic Industry.” Medical Letter on the CDC & FDA June 20, 2004: 17.
“VA Includes Chiropractic Care for Veterans.” Managed Care Weekly May 3, 2004: 23.
American Chiropractic Association. 1701 Clarendon Blvd., Arlington, VA 22209. (800) 986-4636. http://www.amerchiro.org.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.