Chiropractic

Definition
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 and illness manifested 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 some insurance plans. See the separate article regarding insurance cover
for chiropractic consultations in New Zealand.

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.

Purpose
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, which is appreciated by most patients. 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 recurring 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 option for acute lower back pain,
and may also relieve neck pain as well as other musculoskeletal pain. Some types of headache can
also be successfully treated by chiropractic.

Description
Origins
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 1910–1920, many other chiropractic colleges were established. Other innovators, including
John Howard, Carl Cleveland, Earl Home-wood, 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.

Initial visit
An initial chiropractic exam will most often include a history and a physical. The patient should be
asked about what the current complaint is, 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.

Manipulation
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.
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 in order to stay in good health.

Follow-up care
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.

Preparations
Patients should enter the chiropractic clinic with an open mind. This will help to achieve maximum
results.

Precautions
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 that 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.

There are other circumstances that would contraindicate chiropractic care, and 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.

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.

Side effects
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 (AMA) was quite hostile to chiropractic,
which it deemed a cult. AMA members were advised that it was unethical to be associated with
chiropractors. However since 2000, many allopathic or traditionally trained physicians enjoy cordial
referral relationships with chiropractors. An estimated 15% of people in the United States used
chiropractic care in 1997. Chiropractors see the lion's share of all patients who seek medical help
for back problems.

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,
bed-wetting, bronchitis, coughs, dizziness, dysmenorrhea, earache, fainting, headache,
hyperactivity, indigestion, infertility, migraine, pneumonia, and issues related to pregnancy.

There are at least three explanations for possible efficacy 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 orthopaedic 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.

Resources for the unedited article

Books
Cassileth, Barrie. The Alternative Medicine Handbook. New York: W. W. Norton & Co., Inc., 1998.
Dillard, James, and Terra Ziporyn. Alternative Medicine for Dummies. Indianapolis: IDG Bks.
Worldwide, 1998.
Leach, Robert. The Chiropractic Theories: Principles and Clinical Applications. 3rd ed. Philadelphia:
Lippincott Williams & Wilkins, 1994.
Rondberg, Terry. Chiropractic First. Chandler, AZ: The Chiropractic Journal, 1996.
Woodham, Anne, and David Peters. Encyclopedia of Healing Therapies. New York: DK Publishing,
Inc., 1997.
Organisations
American Chiropractic Association. 1701 Clarendon Blvd., Arlington, VA 22209. (800) 986-4636.
www.amerchiro.org

[Article by: Judith Turner - Encyclopedia of Medicine, by an Answers Corp. partner]