The information in this section is a general overview of Chiropractic and is not a direct reflection of Back to Wellness, P.C. We hope this information will help in making the decision on whether to start chiropractic care or not.

• Chiropractic as defined by Dorland's Medical Dictionary:
• So What Is Chiropractic?
• What is conventional medicine?
• What is complementary and alternative medicine (CAM)?
• What Is The History Of The Discovery And Use Of Chiropractic?
• What Kind Of Training Do Chiropractors Receive?
• Chiropractic Training
• Does The Government Regulate Chiropractic?
• Does Chiropractic Treatment Require A Referral From An MD?
• Are Chiropractors Allowed To Practice In Hospitals Or Use Medical Outpatient Facilities?
• What Do Chiropractors Do In Treating Patients?
• Examples of Nonmanual Chiropractic Treatments
• Have Side Effects Or Problems Been Reported From Using Chiropractic To Treat Back Pain?
• Do Health Insurance Plans Pay For Chiropractic Treatment?
• Who Uses Chiropractic And For What Health Problems?
• Are There Scientific Controversies Associated With Chiropractic?
• Is NCCAM Funding Research On Chiropractic?
• Types of Chiropractic
• Types of Chiropractic
• Mixers
• Straights
• Glossary
• References

chiropractic (chi·ro·prac·tic) (ki˝ro-prak’tik) [chiro- + Gr. prassein to do] a nonpharmaceutical, nonsurgical system of health care based on the self-healing capacity of the body and the primary importance of the proper function of the nervous system in the maintenance of health; therapy is aimed at removing irritants to the nervous system and restoring proper function. The most common method of treatment is by spinal manipulation and is primarily done for musculoskeletal complaints; other methods include lifestyle modification, nutritional therapy, and physiotherapy.

Chiropractic ("kye-roh-PRAC-tic") is a form of health care that focuses on the relationship between the body's structure, primarily of the spine, and function. Doctors of chiropractic, who are also called chiropractors or chiropractic physicians, use a type of hands-on therapy called manipulation (or adjustment) as their core clinical procedure.

Note: Most of the information in this section comes from the National Center for Complimentary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH). Other sources are cited at or near the information they refer to.

Doctors of chiropractic practice a hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary, and lifestyle counseling.

The word "chiropractic" combines the Greek words cheir (hand) and praxis (action) and means "done by hand." Chiropractic is an alternative medical system and takes a different approach from conventional medicine in diagnosing, classifying, and treating medical problems. Chiropractic is a profession which provides a set of services that centers mainly around how structure and biomechanics affect function of the body, especially the spine.

The basic concepts of chiropractic can be described as follows:

1. The body has a powerful self-healing ability.
2. The body's structure (primarily that of the spine) and its function are closely related, and this relationship affects health.
3. Chiropractic therapy is given with the goals of normalizing this relationship between structure and function and assisting the body as it heals.

Conventional medicine is medicine as practiced by holders of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine.

Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine.

Chiropractic is a form of spinal manipulation, which is one of the oldest healing practices with writings being found on the use of spinal manipulation as far back as 2700 B.C. Spinal manipulation was described by Hippocrates in ancient Greece.1,2,3 In 1895, Daniel David Palmer founded the modern profession of chiropractic in Davenport, Iowa. Palmer was a self-taught healer and a student of healing philosophies of the day. He observed that the body has a natural healing ability that he believed was controlled by the nervous system. He also believed that subluxations, or misalignments of the spine, interrupt or interfere with this "nerve flow." Palmer suggested that if an organ does not receive its normal supply of impulses from the nerves, it can become diseased. This line of thinking led him to develop a procedure to "adjust" the vertebrae, the bones of the spinal column, with the goal of correcting subluxations.

Some chiropractors continue to view subluxation as central to chiropractic health care.2 However; other chiropractors no longer view the subluxation theory as a unifying theme in health and illness or as a basis for their practice. Other theories as to how chiropractic might work have been developed.

Chiropractic training is a 5 academic year program consisting of both classroom and clinical instruction. The complete curriculum includes a minimum of 4,200 hours of classroom, laboratory, and clinical experience. At least 3 years of preparatory college work are required for admission to chiropractic schools.10,11 Some Chiropractic colleges require a Bachelor's degree before enrollment. Students who graduate receive the degree of Doctor of Chiropractic (D.C.) and are eligible to take national and state licensure board examinations in order to practice. Some schools also offer postgraduate courses, including 2 to 3 year residency programs in specialized fields.12

Chiropractic training typically includes10:

1. Coursework in anatomy, physiology, microbiology, biochemistry, pathology, nutrition, public health, and many other subjects
2. The principles and practice of chiropractic
3. Research methods and procedures
4. Direct experience in caring for patients

The Council on Chiropractic Education, an agency certified by the U.S. Department of Education, is the accrediting body for chiropractic colleges in the United States.12

Government inquiries as well as independent investigations by medical practitioners, have affirmed that today's chiropractic academic training is of equivalent standard to medical training in all pre-clinical subjects. High standards in chiropractic education are maintained by the Council on Chiropractic Education (CCE) and its Commission on Accreditation, as recognized by the U.S. Department of Education.

Chiropractic practice is regulated individually by each state and the District of Columbia. Some states require a Bachelor's degree as a prerequisite for licensure. To assist the various regulatory agencies in assessing candidates for licensure, the National Board administers examinations to individuals currently in the chiropractic educational system or who have completed a chiropractic educational program. The National Board also offers an examination designed for previously licensed individuals. Most states require chiropractors to earn continuing education credits to maintain their licenses.1,11 Chiropractors' scope of practice varies by state--including with regard to laboratory tests or diagnostic procedures, the dispensing or selling of dietary supplements, and the use of other CAM therapies such as acupuncture or homeopathy.11,12,17 Chiropractors are not licensed in any state to perform major surgery or prescribe drugs.a

a In Oregon, chiropractors can become certified to perform minor surgery (such as stitching cuts) and to deliver children by natural childbirth.12,17,18

No, a patient does not need referral by an MD before visiting a doctor of chiropractic. Chiropractors are first contact physicians, and are so defined in federal and state regulations. Following a consultation and examination, the doctor of chiropractic will arrive at a diagnosis under chiropractic care, or refer the patient to the appropriate health care provider.

Chiropractors are being recognized to admit and treat patients in hospitals and to use outpatient clinical facilities (such as labs, x-rays, etc.) for their non-hospitalized patients. Hospital privileges were first granted in 1983.

If you become a chiropractic patient, during your initial visit the chiropractor will take your health history. He will perform a physical examination, with special emphasis on the spine, and possibly other examinations or tests such as x-rays.13 If he determines that you are an appropriate candidate for chiropractic therapy, he will develop a treatment plan.

When the chiropractor treats you, he may perform one or more adjustments. An adjustment (also called a manipulation treatment) is a manual therapy, or therapy delivered by the hands. Given mainly to the spine, chiropractic adjustments involve applying a controlled, sudden force to a joint. They are done to increase the range and quality of motion in the area being treated.

Most chiropractors use other treatments in addition to adjustment, such as mobilization, massage, and nonmanual treatments.

• Heat and ice
• Ultrasound
• Electrical stimulation
• Rehabilitative exercise
• Herbal Medicine
• Counseling about diet, weight loss, and other lifestyle factors
• Dietary supplements
• Homeopathy
• Acupuncture

Patients may or may not experience side effects from chiropractic treatment. Effects may include temporary discomfort in parts of the body that were treated, headache, or tiredness. These effects tend to be minor and resolve within 1 to 2 days.7,15

The rate of serious complications from chiropractic has been debated. There have been no organized prospective studies on the number of serious complications. From what is now known, the risk appears to be very low.12,14,15 The rare complication of concern from low-back adjustment is cauda equina syndrome, estimated to occur once per millions of treatments (the number of millions varies; one study placed it at 100 million14).1,16

Compared with CAM therapies as a whole (few of which are reimbursed), coverage of chiropractic by insurance plans is extensive. As of 2002, more than 50 percent of health maintenance organizations (HMOs), more than 75 percent of private health care plans, and all state workers' compensation systems covered chiropractic treatment.1 Chiropractic care is available to members of the armed forces at more than 40 military bases, and is available at nearly 30 veterans' medical facilities. Chiropractors can bill Medicare, and over two dozen states cover chiropractic treatment under Medicaid.17

If you have health insurance, check whether chiropractic care is covered before you seek treatment. Your plan may require care to be approved in advance, limit the number of visits covered, and/or require that you use chiropractors within its network.

In 1997, it was estimated that Americans made nearly 192 million visits a year to chiropractors.4 Over 88 million of those visits were to treat back or neck pain.5 In one recent survey, more than 40 percent of patients receiving chiropractic care were being treated for back or low-back problems.6 More than half of those surveyed said that their symptoms were chronic. A continuing recognition and respect for the chiropractic profession in the United States has led to growing support for chiropractic care all over the world. Conditions commonly treated by chiropractors include back pain, neck pain, headaches, sports injuries, and repetitive strains. Patients also seek treatment of pain associated with other conditions, such as arthritis.7

Low-back pain is a common medical problem, occurring in up to one-quarter of the population each year. Most people experience significant back pain at least once during their lifetime.8 Often, the cause of back pain is unknown, and it varies greatly in terms of how people experience it and how professionals diagnose it.9 This makes back pain challenging to study.

Yes, there are scientific controversies about chiropractic, both inside and outside the profession. For example, within the profession, there have been disagreements about the use of physical therapy techniques, which techniques are most appropriate for certain conditions, and the concept of subluxations. Outside views have questioned the effectiveness of chiropractic treatments, their scientific basis, (for more information see our Why Chiropractic section) and the potential risks in subsets of patients (for example, the risks of certain types of adjustments to patients with osteoporosis or risk factors for osteoporosis, compared to patients with healthier bone structures19,20).

Research studies on chiropractic are ongoing. The results are expected to expand scientific understanding of chiropractic. A key area of research is the basic science of what happens in the body (including its cells and nerves) when specific chiropractic treatments are given. The report, Chiropractic in New Zealand published in 1979 strongly supported the efficacy of chiropractic care and elicited medical cooperation in conjunction with chiropractic care. The 1993 Manga study published in Canada investigated the cost effectiveness of chiropractic care. The results of this study concluded that chiropractic care would save hundreds of millions of dollars annually with regard to work disability payments and direct health care costs. But despite such evidence, the case for the profession is confounded by inaccurate use of the term chiropractic. In 1995, Alan Terrett, an Australian professor of health science, reviewed the published research on the complications of chiropractic neck manipulation. On contacting the original authors and patients, he found that many reported incidents were not severe at all and that many of the "chiropractic manipulations" were not performed by chiropractors.

Yes. Recent projects supported by NCCAM include:

• Comparing conventional medical care for acute back pain with an "expanded benefits" package (consisting of conventional care plus a choice of chiropractic, massage, or acupuncture)
• Finding out what happens (through measurement) in the lumbar portion of the spine after chiropractic positioning and adjustment
• Evaluating the effects of the speed of spinal adjustment on muscles and nerves
• Studying the effectiveness of chiropractic adjustment for a variety of conditions, including neck pain, chronic pelvic pain, and temporomandibular disorders (TMD) in the jaw

Finally in this section we will discuss the types of chiropractic. There are many types of chiropractic services and within each type there are subgroups.

Below you will find a list of chiropractic techniques. It is not a comprehensive list but only a few of the more common techniques being used in the USA today. There are currently almost 50 chiropractic colleges and over 150 named techniques being used world wide. Why so many? Every person is unique and different, including identical twins, and depending on how they respond to a treatment that technique may or may not be the right one for them. Other reasons that there are so many can simply be attributed to personal preference. Stop and think for a moment, how many different brands of bottled water are there, how many brands and sizes of tires, how many prescription and over the counter pain medications? Because of this not every chiropractor you go to will be the same. When selecting a new chiropractor do some research and if you find one you are not happy with there are other ways to be adjusted and other people to do the adjusting. Find what works best for you. The techniques are listed in alphabetical order with partial definitions taken from the website of each technique. No endorsement of the following techniques is intended or implied. This is for informational purposes only:

Activator Methods Chiropractic Technique (AMCT) uses the Activator Adjusting Instrument to give consistent low-force, high-speed chiropractic adjustments.

Applied Kinesiology (AK) is a system that evaluates structural, chemical and mental aspects of health using manual muscle testing with other standard methods of diagnosis.

The Atlas Orthogonist is a doctor in the field of Chiropractic, with training in the structure, function and bio-mechanics of the upper cervical spine.

B.E.S.T. is a physical yet non-forceful, energy-balancing procedure used by the hands to reestablish the full healing potential of the body using its natural healing abilities.

The Blair chiropractic technique is a specific system of analyzing and adjusting the upper cervical vertebrae of the spinal column.

CBP Technique can best be characterized as full spine and pelvis corrective/rehabilitative procedures having a firm foundation in the sciences of biomechanics and physics.

Cox Technic is non-surgical, non-hospital, gentle, well-researched, well-referenced chiropractic spinal adjusting manipulation which, research shows, drops intradiscal pressures and increases the foraminal area. Further, Cox® Technic realigns and restores ranges of motion inherent to the spine while reducing low back pain, especially in radiculopathy (extremity pain) patients.

The Gonstead technique is one of the most comprehensive, well researched techniques available today. It is a full spine and extremities technique that utilizes many checks and balances (palpation, instrumentation, x-rays) regarding what, when and when not to adjust. The Gonstead practitioner gives a very comfortable, specific, low force, high velocity hands-on adjustment with quick, lasting results in most patients.

The technique is based on light, sustained force exerted against a specific contact point on the sacrum at the base of the spine. Auxiliary contacts at various points in the spine, or along specific muscles such as the piriformus, also can be used.

The Pettibon System is a comprehensive rehabilitation program for the spine's hard and soft tissues. It uses x-rays for diagnosis, assessing progress, and proof of treatment effectiveness. It tests each patient's ability to respond to care, and trains patients in home care for faster correction.

The Thompson Technique utilizes a "Segmental Drop Table" to enhance the motion force imparted towards the segment or area to be adjusted.

Some of the above techniques focus on the upper cervical spine, some on the pelvis, and others address the whole spine. Some of these techniques use a hands-on approach while others use instruments to deliver the adjustment. Several different forms of locating or diagnosing the problem are used, including but not limited to, leg length checks, muscle testing, palpation, posture analysis, surface thermography, and x-ray.

Within each of the above types of chiropractic techniques you will find subgroups. The two main subgroups are explained below. Once again they are listed in alphabetical order and no endorsement is intended or implied. The definitions are taken from a website but we were unable to relocate this information. We do not claim these definitions as our own but cannot at this time give credit to the original creators. This is for informational purposes only:

Mixers believe that diseases can develop from other causes, like bacteria and viruses. But they believe that subluxations affect the body's health by lowering resistance to disease. The deviation of a spinal vertebra may cause a neurological imbalance within the body, setting the stage for a lowered resistance. Mixers comprise the majority of practitioners. Their practice extends beyond the narrow focus on vertebral subluxation. They use a wider range of modalities as well as concepts from diverse health care traditions in their practice. Many integrate methods from other traditions. The most common are: nutritional supplementation, vitamins, homeopathic drugs, and nutritional advice. Some integrate Chinese medicine, naturopathy, homeopathy, massage or bodywork, mind/body approaches, or other healing methods into their offerings. Individual chiropractors often develop their own unique reputation and synthesis of different traditions.

The straights follow D.D. Palmer's doctrine that subluxations of the vertebrae can cause or contribute to most disorders, but they do not claim to be able to diagnose or treat diseases -only to detect and cure subluxations. Only about 15 percent of all chiropractors can be called "straight" chiropractors. Straight chiropractors consider their scope of practice limited to:

• The anatomy of the spine and immediate articulations
• The condition of vertebral subluxation
• Addressing vertebral subluxations
• Educating patients and advising them about subluxations

straight c. the practice of chiropractic in strict accordance with the principles of its founder, D.D. Palmer, without additions made by later practitioners. The original definition of subluxation as a vertebral displacement is adhered to, and chiropractic is considered to be non-therapeutic, its purpose being solely to contribute to health by the correction of vertebral subluxations.

1. Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine. 2002;136(3):216-227.
2. Kaptchuk TJ, Eisenberg DM. Chiropractic: origins, controversies, and contributions. Archives of Internal Medicine. 1998;158(20):2215-2224.
3. Bronfort G. Spinal manipulation: current state of research and its indications. Neurologic Clinics. 1999;17(1):91-111.
4. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. Journal of the American Medical Association. 1998;280(18):1569-1575.
5. Wolsko PM, Eisenberg DM, Davis RB, et al. Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine. 2003;28(3):292-297.
6. Coulter ID, Hurwitz EL, Adams AH, et al. Patients using chiropractors in North America: who are they, and why are they in chiropractic care? Spine. 2002;27(3):291-296.
7. Vickers A, Zollman C. ABC of complementary medicine. The manipulative therapies: osteopathy and chiropractic. BMJ. 1999;319(7218):1176-1179.
8. Atlas SJ, Nardin RA. Evaluation and treatment of low back pain: an evidence-based approach to clinical care. Muscle and Nerve. 2003;27(3):265-284.
9. Complementary medicine: fact and fiction about chiropractic. Harvard Health Letter. 1999;24(3):1-3.
10. The Council on Chiropractic Education. Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status January 2003. Council on Chiropractic Education Web site. Accessed at www.cce-usa.org on June 16, 2003.
11. Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965-973.
12. Agency for Health Care Policy and Research. Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research; 1998. AHCPR publication no. 98-N002.
13. Dagenais S, Haldeman S. Chiropractic. Primary Care. 2002;29(2):419-437.
14. Shekelle PG, Adams AH, Chassin MR, et al. Spinal manipulation for low-back pain. Annals of Internal Medicine. 1992;117(7):590-598.
15. Senstad O, Leboeuf-Yde C, Borchgrevink C. Frequency and characteristics of side effects of spinal manipulative therapy. Spine. 1997;22(4):435-440.
16. Haldeman S, Rubinstein SM. Cauda equina syndrome in patients undergoing manipulation of the lumbar spine. Spine. 1992;17(12):1469-1473.
17. Cooper RA, Henderson T, Dietrich CL. Roles of nonphysician clinicians as autonomous providers of patient care. Journal of the American Medical Association. 1998;280(9):795-802.
18. Chiropractic regulatory boards. Federation of Chiropractic Licensing Boards Web site. Accessed at www.fclb.org/boards.htm on June 16, 2003.
19. Ernst E. Chiropractic spinal manipulation for back pain. British Journal of Sports Medicine. 2003;37(3):195-196.
20. Sran MM. Commentary on "Chiropractic spinal manipulation for back pain." British Journal of Sports Medicine. 2003;37:196.