Chiropractic: new respect for an ancient treatment

What is chiropractic?

According to a definition created by delegates at the recent World Chiropractic Congress in New Zealand, chiropractic is "concerned with the diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health."

According to chiropractic principles, abnormal functioning, or disease, is believed to be the result of interference with transmission of nerve impulses throughout the body. Chiropractors believe that pain and dysfunction in muscle, lymphatic and other organs and tissues are caused by the misalignment of vertebrae (the interlocking bones of the spinal column), referred to as subluxations.

These subluxations which place pressure, strain, or tension on the spinal cord, spinal nerves or peripheral nerves can result from:

• Injuries
• Improper sleeping positions
• Poor posture
• Poor lifting/bending habits
• Obesity
• Lack of exercise
• Psychological stress
• Inherited spinal weakness

Loss of mobility within a motion segment comprised of neighboring pairs of vertebrae and their surrounding tissues is referred to as a fixation, and can also cause pain and dysfunction.

Chiropractors are trained to restore misaligned vertebrae to their proper position in the spinal cord using a procedure called "spinal adjustment" or "manipulation." (The word "chiropractic" is derived from the Greek words "cheir" and "praktkos" meaning "done by hand.") According to the Wholistic Health Center in Syosset, New York, "Chiropractic seeks to analyze and correct misalignments through spinal adjustments, thereby reestablishing proper circulation of bio-energy, blood and lymph, normalizing nerve impulses and balancing muscle tension. Regular chiropractic adjustments help to maintain postural alignment, restore normal function and prevent many potential problems."

History of chiropractic

Hippocrates, "the Father of Modern Medicine," and an early proponent of spinal manipulation, believed that it was the physician's job to remove any obstruction that would prevent the body from healing. He recommended that healers "Get knowledge of the spine, for this is the requisite for many diseases."

Prehistoric cave paintings in southwestern France dating back to 17,500 B.C. were the first known depictions of spinal manipulation, a technique also utilized by the Chinese, Greek, Egyptians and other ancient peoples. Primitive American Indian hieroglyphics showed back walking (walking on the back of a patient) as a method of curing the sick.

Chiropractic today

Chiropractic is a holistic, drug-free, non-surgical method of healing, whose primary goals include the relief of musculoskeletal pain and the restoration of mobility. Although the majority of people seeking chiropractic care are suffering from low back pain, most chiropractors will also treat back, neck and shoulder pain, headaches, sports injuries, and disorders such as carpal tunnel syndrome and certain jaw conditions. A small percentage of chiropractors still claim they can cure any disease from allergies to heart disease to cancer but such claims are not supported by scientific evidence. However, the first federally funded Center for Chiropractic Research, established in 1998, is studying numerous possibilities.

The principal treatments used by chiropractors are spinal adjustments, which are specific applications of force, often using high-velocity, low-amplitude thrusts, intended to move the misaligned spinal vertebrae back to their normal position to correct or reduce nerve interference. Historically, chiropractors have adhered to one of two philosophical orientations:

Straights - adhere strictly to the philosophy of adjustments for locating and eliminating subluxations as the only necessary treatment

Mixers - combine spinal manipulation with adjunct therapies such as physiotherapy, ultrasound, massage and nutrition counseling

A 1997 report from the Agency for Health Care Policy and Research found that more than two-thirds of chiropractors practicing today incorporate at least some of these techniques into their practice.

Chiropractic exams and treatments

A Doctor of Chiropractic (DC) begins his or her examination by taking the patient's history, including family history, diet, work and lifestyle-related factors. A physical exam, using techniques such as palpation of the spinal column, focuses on possible subluxations, muscle strength and postural and structural problems. The majority of chiropractors today use x-rays to locate subluxations and to rule out any conditions that would preclude treatment. (Chiropractic is not recommended for fractures, osteoporosis, bone or joint infections, bone cancer, acute rheumatoid arthritis and diseases of the spinal cord or bone marrow.) Once treatment commences, adjustments are done with the patient lying on a specially constructed table that conforms to body contours. Serious side effects from spinal manipulations are rare.

Is chiropractic effective?

Today, more than 20 million adults use chiropractic services each year, making it the most frequently used alternative health care in the country. There are approximately 60,000 doctors of chiropractic in active practice throughout the United States. Chiropractors are licensed in all fifty states after completing a rigorous course of study, and their practice is regulated by state chiropractic boards. Chiropractic services are covered by Medicare, Medicaid, workers compensation programs and many other insurance providers.

In 1994, the Federal Agency for Health Policy and Research, which formulated guidelines for the care of persons with nonspecific low back pain (related to minor musculoskeletal strain or no known cause), concluded that spinal manipulation chiropractic's primary treatment technique was one of only three treatments whose effectiveness was substantiated by research. A September 1998 survey by the Stanford Center for Research in Disease Prevention found that 81% of patients surveyed said that chiropractic cured or reduced their symptoms considerably. Several recent studies suggest that spinal manipulations may be beneficial for headaches, particularly those related to muscle tension.

Many insurance companies now pay a portion of chiropractic costs. Check with your plan to find out about your coverage. When choosing a chiropractor, ask about training and treatment philosophies. And make sure that you let your medical doctor know that you are working with a chiropractor.