Chiropractic treatment uses manipulative therapy to correct subluxation, which has been shown to have some efficacy in treating back and neck pain, headache, and other symptoms of spinal-related conditions.
For its many adherents, chiropractic medicine is a form of alternative medicine which teaches that subluxations are the cause of most disease, a view not generally accepted by the medical community.
- "Chiropractic, which focuses on manipulating the spine to ease back pain and improve overall health, has won wider acceptance over the years. Most health insurance plans now cover it. But in the 110 years since the profession was created, the established medical community largely has boycotted it — challenging its scientific validity in courts and legislative bodies." (Washington Times) (http://www.washtimes.com/national/20050116-115806-6040r.htm)
Usage
The use of manipulative therapy - not necessarily chiropractic - for some purposes enjoys wide acceptance by medical authorities in many nations. It is covered by many health plans such as Medicare in the United States. Although some medical doctors (MDs) and many doctors of osteopathy (DOs) do perform manipulative therapy, more than 90% of the treatment of back pain by manipulative therapy is performed by DCs (Doctors of Chiropractic). [1] (http://www.chiroweb.com/archives/ahcpr/foreword.htm)
A survey released in May 2004 (http://nccam.nih.gov/news/2004/052704.htm) by the National Center for Complementary and Alternative Medicine focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults age 18 years and over during 2002. According to this survey, Chiropractic was the 4th most commonly used CAM therapy (7.5%) in the United States during 2002 ([2] (http://nccam.nih.gov/news/report.pdf) table 1 on page 8) when all use of prayer was excluded. Consistent with previous studies, this study found that the majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine (page 6). "The fact that only 14.8% of adults sought care from a licensed or certified CAM practitioner suggests that most individuals who use CAM self-prescribe and/or self-medicate" (page 6).
Classical chiropractic theory denies otherwise accepted medical facts about the origin of diseases, and instead holds that the correction of subluxation can cure or treat most disease. Although manipulative therapy has been shown to have some efficacy in treating back pain, headache, and other symptoms of spinal-related conditions, few rigorous studies have supported the efficacy of chiropractic medicine outside of this specific area. Many people colloquially use the term chiropractic to refer to manipulative therapy of the spine, even by non-DCs.
History
On September 18, 1895, in Davenport, Iowa, Daniel D. Palmer, inquired about the history of a deaf janitor, named Harvey Lillard. Lillard informed Palmer that while working in a cramp area 17 years ago he felt a pop in his back and had been nearly deaf ever since. Upon examination Daniel D. Palmer found what he described as a lump that was sore to the touch. He concluded that it was possible this lump was a misalignment, that was later to be called a subluxation, was the cause of Harvey Lillards deafness. After correcting this misalignment in the janitor's spine his hearing was restored. Harvey was reported to have noted that he could now hear the wheels of the horse drawn carts in the street below. Danial D. Palmer began further investigation into the phenomena and believed to have discovered that a major source of interference to the nervous system, the vertebral subluxation, interfered with the body's regulatory mechanism, causing what he termed dis-ease or loss of ease
The term chiropractic literally means "done by hand" and originated when chiropractic's founder Daniel D. Palmer asked a patient, Reverend Samuel H. Weed, a Methodist minister and a Greek scholar, to come up with a name from the Greek language to describe his practice. Of the several names submitted to him, Daniel D. Palmer accepted one which combined the words 'chiros' and 'praktikos' (meaning 'done by hand') to describe his adjustment of a vertebra in the spinal column. Palmer had been a bee keeper, school teacher, grocery store owner, and had an interest in the metaphysical health philosophies of his day such as magnetic healing, osteopathy, and spiritualism. He imbued the term "subluxation" with a metaphysical and philosophical meaning, holding that subluxations somehow interfered with the body's "innate intelligence", or life force.
Chiropractic medicine has gained general acceptance in the last 20 years as appropriate treatment for back and neck problems. Until 1983 the American Medical Association made it unethical for M.D.'s to refer patients to chiropractors. In September of 1987, the chiropractic profession achieved a victory when Judge Susan Getzendanner found the AMA and others guilty of an illegal conspiracy against the chiropractic profession (Wilke vs AMA), ordering a permeate injunction against the AMA and forcing them to print the courts findings in the Journal of the American Medical Association. The decision was upheld in the U.S. Court of Appeals in 1990 and again by the U.S. Supreme Court later that same year. The current ethical rules of the American Medical Association now permit M.D.'s to refer patients to D.C.'s for such manipulative therapy if the M.D. believes it is in the best interests of the patients.
A Chiropractor's Education
The educational requirements for chiropractors are similar to that of medical doctors. The Council on Chiropractic Education (CCE) has set minimum guidelines for chiropractic colleges, However additional requirements may be need for a license depending on the state or government a chiropractor chooses to practice in. Many states require a 4 year undergraduate degree, although the minimum for enrollment set forth by the CCE is 90 semester hours as a prerequisite for attending a chiropractic college.The minimum accumulative GPA for a student entering a chiropractic college is 2.50.
48 of the 90 required semester hours much be completed with the courses as follows:
- communication and/or Language skills 6 semester hours
- Psychology 3 semester hours
- Social Science or Humanities 15 semester hours
- Biology with corresponding lab 6 semester hours
- Chemistry with corresponding lab 12 semester hours
- (3 semester hours general/inorganic and 6 semester hours Organic and/or biochemistry)
- Physics with corresponding Lab 6 semester hours
Curriculum for chiropractic college is very intensive and requires slightly more class time than medical school, requiring 2,419 total hours compared to 2,047 a medical student spends in class.
Minimum Required Class Room Hours Chiropractic College / Medical College
- Anatomy/Embryology 456 / 215
- Physiology 243 / 174
- Microbiology 145 /145
- Diagnosis 408 / 113
- Neurology 149 / 171
- X-Ray 271 / 13
- Psychology/Psychiatry 56 / 323
- Obstetrics & Gynecology 66 / 284
- Orthopedics 168 / 2
Chiropractic students require less clinical experience at approximately 1405 hours where their medical counter parts require roughly 5227 hours during their residency.
Two schools of chiropractic medicine
Contemporary chiropractic is divided into two basic schools: The traditional approach is that followed by the faction of the chiropractive movement known as straight chiropractic [3] (http://www.straightchiropractic.com/). The other school known as mixing chiropractic, combines contemporary medical techniques with spinal and other joint manipulation. Mixing chiropractic is itself divided into conservative and liberal factions. [4] (http://www.chiroweb.com/archives/08/21/13.html)
The term straight chiropractic is used to more strictly associate with adherents of Daniel D. Palmer's chiropractic theory, and of those chiropractic schools who believe that subluxations are the cause of most or all diseases. Outside of treatment (not cure) of a limited set of symptoms associated with the spine, there is no medical evidence supporting the efficacy of straight chiropractic, and some techniques in the past have not been safe.
Also note the reformer movement discussed below, The National Association for Chiropractic Medicine (NACM).
Medical risks of spinal manipulation
According to the National Council Against Health Fraud, the conviction held by chiropractic believers that every spine will benefit from an adjustment causes them to manipulate spines inappropriately. Among the concerns about chiropractic manipulation is the widespread use of the explosive "dynamic thrust" which takes the patient by surprise, as opposed to more conservative techniques. This maneuver has a greater potential for inflicting injury.
The practice of greatest concern is the rotary neck movement (sometimes called Vaster cervical or "rotary break"). This type of manipulation has led to trauma, paralysis, strokes, and death among patients. Even chiropractic's legal advisors have warned against its use. Although study results have varied, the actual risk of stroke is typically calculated to be one in 2 to 5 million adjustments. A recent study published in the Canadian Medical Association Journal puts the risk at 'one in 5.85 million adjustments'.
The overuse of x-ray by chiropractors poses potential patient harm. Of primary concern is the 24' x 36' full spine x-ray. This technique exposes patients to a substantial amount of radiation. Exposing the body trunk to x-rays can have serious long-term consequences and should be avoided. Further, according to NCAHF's chiropractic advisors, such radiographs have little or no diagnostic value.
Misuse of scientific reports
Some doctors who have submitted research backing up the medical benefits of limited forms of spinal manipulation have found their claims incorrectly applied to the entire field of chiropractic manipulation. Perhaps the most well-known case of this occurred in response to The RAND report on The Appropriateness of Spinal Manipulation for Lower-Back Pain. This study was a meta-analysis of 22 controlled experiments; the conclusion was that certain forms of spinal manipulation were successful in treating certain types of lower-back pain. Many chiropractors seized upon these results as proof that chiropractic theory was sound and that chiropractic medicine had reliable results; in fact, the authors of the report had said no such thing. Misuse of this report reached such an extent that the RAND report authors were forced to issue a public statement. In 1993 Dr. Paul Shekelle rebuked some chiropractors for making false claims about RAND's research:
- "...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....RAND's studies were about spinal manipulation, not chiropractic, and dealt with appropriateness, which is a measure of net benefit and harms. Comparative efficacy of chiropractic and other treatments was not explicitly dealt with."
Criticism of chiropractic claims
The National Council Against Health Fraud, an American private, non-profit health care organization issued a report in 1985 critical of chiropractic medicine.
Sixty-two clinical neurologists from across Canada, all certified members of the Royal College of Physicians and Surgeons, have issued a warning to the Canadian public and provincial governments about the dangers of neck manipulation.[5] (http://www.chirobase.org/15News/neurol.html)
Mainstream medical doctors and scientists reject the claims of most chiropractic associations and schools as pseudoscience; many refer to their claims as fraud. Moreover, a chiropractor from the Canadian Memorial Chiropractic College, in Toronto, and two professors at Los Angeles College of Chiropractic have also come to this position; they hold that all chiropractic organizations engage in and promote "quackery."
York University at one point attempted to affiliate with a chiropractic school. The scientists and medical doctors at this school rebelled against the plan, and created their own website explaining why this would be a bad idea. They enlisted the help of Nobel prize winning scientists to explain to the school's administration, and public at large, why chiropractice is unscientific.
There are many investigations and lawsuits underway in Canada for false advertising, deceptive practices and claims, injuries and deaths.
Reformers who reject classical chiropractic theory
A small percent of chiropractors have rejected the metaphysical beliefs of mainstream chiropractors. They view the beliefs of mainstream chiropractic medicine as metaphysical and religious, and having no scientific validity, and as a profession which may be dangerous. In contrast, they hold that there are scientifically defensible uses of spinal manipulation for medical benefits. According to their website:
- The National Association for Chiropractic Medicine (NACM) is a consumer advocacy association of chiropractors who confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery. The NACM offers consumer assistance in finding member practitioners. The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based. The original chiropractic hypothesis, stated simply, is that "subluxation is the cause of dis-ease." Modern day chiropractic associations may have expanded and changed this simple statement for the public, but the reality is that this remains the backbone of chiropractic education and practice to this day. In clarification, the term "subluxation" has never been defined by the profession in a way as to have universal acceptance within the chiropractic profession. Chiropractic "subluxation" is not the same as medical subluxation, which represents a partial dislocation of joint structure and would be a contraindication to "adjusting" or "manipulating" the joint structures. Chiropractic "subluxation," not having universal definition, and, thereby, not having received universal scientific status of existence, has evolved into a metaphysical status. Further, the profession has neither defined nor outlined what disease or "dis-ease" that the correction of the "subluxation" might cure or affect. Because the hypothesis has found no validity in universally accepted, peer-reviewed, published scientific journals, belief in the hypothesis, then, is essentially a theosophy. Science has not found any organ system pathology which "adjustment" or "manipulation" of spinal joint structures has effect; that is, no disease or "dis-ease" process is affected. (Note that the bold-faced terms are in the original document.)
References
Pro-chiropractic references
Chiropractic books, like other medical books, are reviewed by Doody Review Services. This review can be accessed by selecting Barnes & Noble after clicking on the ISBN for the book.
- Activator Methods Chiropractic Technique, Arlan W. Fuhr (editor), with John R. Green, With Tony S. Keller, Mosby-Year Book, Inc., 1996, hardcover, 460 pages, ISBN 0815136846
- Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS, Gregory D. Cramer, Susan A. Darby, Mosby-Year Book, Inc., 1996, hardcover, 441 pages, ISBN 0801664675
- Best Practices in Clinical Chiropractic, author: Robert D. Mootz, edited by: Howard T. Vernon, Aspen Publishers, 1999 (or 2001), paperback, 200 pages, ISBN 0834213761, papers from the journal Topics on Clinical Chiropractic
- Chiropractic: A Philosophy for Alternative Health Care, Douglass D. Coulter, Science & Technology Books, 1999, paperback 117 pages, ISBN 0750640065
- Chiropractic: History and Evolution of a New Profession, Walter I. Wardwell, Mosby-Year Book, Inc., 1992, hardcover, 358 pages, ISBN 0801668832
- Chiropractic Management of Spine Related Disorders, Meridel I. Gatterman, Lippincott Williams & Wilkins, 1990 (there may be a new edition), hardcover, 437 pages, ISBN 0683034383
- Chiropractic Pediatrics: A Clinical Handbook, Neil J. Davies, Churchill Livingstone, Inc., 2001, hardcover, 475 pages, ISBN 0443062536
- Chiropractic Technique: Principles and Procedures, 2nd edition, Bergmann, Thomas F. Bergmann, David H. Peterson, Mosby-Year Book, Inc., 2002 hardcover, 880 pages, ISBN 032302016X
- Chiropractic Theories, 3rd edition, Robert A. Leach, with contributions by Charles A. Lantz, and Reed B. Phillips, illustrated by Robert S. Fritzius, Lippincott Williams and Wilkins, 1994, hardcover, 426 pages, ISBN 0683049046
- Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms, 2nd edition, Thomas A. Souza, Jones & Bartlett Publishers, Inc., 2001, hardcover, 959 pages, ISBN 0834217287
- Foundations of Chiropractic: Subluxation, Meridel I. Gatterman, Mosby-Year Book, Inc., 1995, hardcover textbook, 487 pages, ISBN 0815135432
- Functional Soft-Tissue Examination and Treatment by Manual Methods: New Perspectives, Revised edition, Warren I. Hammer, Aspen Publishers, Inc., hardcover, 625 pages, ISBN 0834206307
- Guidelines for Chiropractic Quality Assurance and Practice Parameters, editors: Scott Haldeman, David Chapman-Smith and Donald M. Petersen, Aspen Publishers, 1992, paperback, 264 pages ISBN 083420388X
- Positional Release Techniques (Book for Windows and MacIntosh) with Cdrom, Leon Chaitow, Elsevier Science, 2002, paperback, 350 pages, ISBN 0443070814
- Principles and Practices of Chiropractic Techniques, Scott Haldeman, Appleton & Lange, 1992, hardcover, 641 pages, ISBN 0838563600
- Rehabilitation of the Spine: A Practitioner's Manual, editor Craig Liebenson, Lippincott Williams & Wilkins, 1996, hardcover, 432 pages, ISBN 068305032X
- Text-Book of the Science, Art and Philosophy of Chiropractic For Students and Practitioners, D. D. Palmer, Portland Printing House, 1966 reprint of 1910 edition, hardcover, 1007 pages
A chiropractor has assembled a bibliography on amazon.com (http://www.amazon.com/exec/obidos/tg/listmania/list-browse/-/2RPA7OPQ5N8LC/).
References critical of chiropractic medicine
-
- Assendelft WJJ, Bouter LM, Knipschild PG. Complications of spinal manipulation - a comprehensive review of the literature. J Fam Pract 1996; 42: 475-480
- Beatty, R. "Dissecting hematoma of the internal carotid artery following chiropractic cervical manipulation" J Trauma, 17:248-249, 1977
- Benassy, J. and Wolinetz, E., "Quadraplegia after chiropractic manipulation," RHUM, 24:555- 556, 1957
- A. Breen, E. Leerberg, M. D Pedigo, G. Waddell, L. G F Giles, E Ernst, and W J J Assendelft Chiropractic for low back pain BMJ, January 23, 1999; 318(7178): 261a - 261.
- Chiropractic for low back pain: We don't know whether it does more good than harm, The British Medical Journal, 1998; 317:160-160 (18 July)
- Davidson, K., et al, "Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation" NEURORADIOLOGY, 115:651-652, 1975
- Ernst E. Chiropractors use of X-rays Br J Radiol
- E. Ernst Spinal manipulation: Its safety is uncertain Can. Med. Assoc. J., January 1, 2002; 166(1): 40 - 41
- Harrison, J. Strokes ICA Malpractice Alert, 2:1-2, 1981
- Krueger, B. and Okazakl, H. "Vertebral-basilar distribuation infarction following chiropractic cervical manipulation", Mayo Clin Pros. 55:322-332, 1980
- Levine, J., Howe, J., and Rolofson, J., "Radiation exposure to a phantom patient during simulated chiropractic spinal radiography", Radiol Health Data Reports, 12:245-251, 1971
- Miller, R. and Bunon, R. "Stroke following chiropractic manipulation of the spine" JAMA, 229:189-190, 1974
- Modde, P. "Malpractice as an inevitable result of chiropractic philosophy and training" Legal Aspects of Med Practice, Feb:20-23, 1979
- Rinsky. L, et al, "A cervical spinal cord injury following chiropractic manipulation" Paraplegia, 13:223-22, 1976
- Schelihas, K., et al, "Vertebrobasilar injuries following cervical manipulation" Am Med Assoc, 244:1450-1453, 1980
- Smith, P and Doll, R., "Mortality among patients with ankylosing spondylitis after a single treatment course with x-rays", Brit Med J, 284:449-460, 1982 Abrams, H., "The overutilization of x-rays", New England J MED, 300:1213-1216, 1979
- Stano M, Smith M. Chiropractic and medical costs of low back care. Medical Care 1996; 34: 191-204
- Zak, S. and Carmody, R . "Cerebellar infarction from chiropractic neck manipulation" Ariz Med, 41:333-337, 1984
- Zauel, D., and Carlow, T., "Internuclear Ophthalmalegia following cervical manipulation" Annals of Neurol, l:308, 1977
External links
Mixing chiropractic
Straight chiropractic
Critical of chiropractic
- The American Medical Association issued a report (http://www.ama-assn.org/ama/pub/article/2036-2523.html) in 1997 that discusses various alternative or complementary medicines, including chiropractic.
- Nobel prize winners denounce plan for university to affiliate with a chiropractic college (http://www.csicop.org/articles/19990203-chiropractic/index.html)
- Chirobase (http://www.chirobase.org/) A skeptical guide to chiropractic history, theories, and current practices, operated by Stephen Barrett, MD; William T. Jarvis, PhD; and Samuel Homola, DC.
- Chirowatch (http://www.chirowatch.com/chiropractic-watch.html/) - Terry Polevoy, MD
- ChiroLinks (http://chirolinks.quackfiles.com/) Chiropractic resources, articles & links from a skeptical angle - Paul Lee, PT
- Chirotalk(SM) (http://chirotalk.proboards3.com/index.cgi/) The Skeptical Chiropractic Discussion Forum - Allen Botnick, DC, PharmD
- National Association for Chiropractic Medicine (NACM) (http://www.chiromed.org/)
- The Canadian Orthopractic Manual Therapy Association (http://orthopractic.org/)
- Spin Doctors I: The Interactive Investigation (http://www.canoe.ca/ChiroYork/) - Paul Benedetti, Wayne MacPhail
- Spin Doctors II: Manipulating Children (http://www.canoe.ca/PedChiro/home.html/) - Paul Benedetti, Wayne MacPhail
- Neck911@sprint.ca (http://www.neck911.com/)
- Keeping Your Spine In Line (http://www.pbs.org/saf/1210/features/spine.htm/) - PBS
- Adjusting the Joints (http://www.pbs.org/saf/1210/segments/1210-3.htm/) - PBS
- Adjusting the Joints: Video (http://www.pbs.org/saf/1210/video/watchonline.htm/) - PBS Go to the "Adjusting the Joints" section. Then turn on your speakers and watch the video.
- PBS's Scientific American Frontiers Resources (http://www.pbs.org/saf/1210/resources/resources-3.htm/)
- NCAHF Position Paper on Chiropractic (http://www.ncahf.org/pp/chirop.html/)
- HCRC FAQ Sheet: Chiropractic (http://web.archive.org/web/20030224123231/http://hcrc.org/faqs/chiro.html/) - Steven Novella, MD
- Chiropractic (http://web.archive.org/web/20030301160423/http://www.hcrc.org/contrib/novella/chirop.html/) - Steven Novella, MD
- Chiropractic: A Skeptical View (http://www.chirobase.org/01General/skeptic.html/) - William T. Jarvis, Ph.D.
- Bonesetting, Chiropractic, and Cultism (http://www.chirobase.org/05RB/BCC/00c.html/) - Samuel Homola, DC
- Inside Chiropractic: A Patient's Guide (http://www.prometheusbooks.com/site/catalog/book_277.html/) - Samuel Homola, DC
- Skeptic's Dictionary: Chiropractic (http://www.skepdic.com/chiro.html/) - Robert Todd Carroll
- Chiropractic - ebm-first (http://www.ebm-first.com/?cat=5/)
- ChiroMod Wiki (Chiropractic Modernized) (http://chiromod.com/chiro.pl?Home_Page/)
Schools of chiropractic United States
- Doctor of Chiropractic degree Compared to Doctor of Medicine Degree (http://www.drgrisanti.com/mddc.htm)
- Alphabetical list by country with links to Chiropractic Colleges (http://www.fcer.org/html/Links/educ.htm)
- Cleveland Chiropractic College (http://www.clevelandchiropractic.edu/), Kansas City, Missouri and Los Angeles, California
- Life Chiropractic College West (http://www.lifewest.edu/) in Hayward, California (Bay area)
- Life Chiropractic College (http://www.life.edu/newlife/admissions/programs/collegechiro.html) in Marietta, Georgia
- Logan College of Chiropractic (http://www.logan.edu/) in Chesterfield, Missouri
- National University of Health Sciences (http://www.nuhs.edu/) in Lombard, Illinois near Chicago
- New York Chiropractic College (http://www.nycc.edu/) in Seneca Falls, New York
- Northwestern Health Sciences University in Bloomington, Minnesota (http://www.nwhealth.edu/)
- Palmer College of Chiropractic (http://www.palmer.edu/PCC/PCCmain.htm) in Davenport, Iowa
- Palmer College of Chiropactic Florida (http://www.palmer.edu/pccf/default.htm) in Port Orange, Florida
- Palmer College of Chiropractic West (http://www.palmer.edu/PCCW/PCWmain.htm) in San Jose, California
- Parker College of Chiropractic (http://www.parkercc.edu/) in Dallas, Texas
- Sherman College of Straight Chiropractic in Spartanburg, South Carolina (http://www.sherman.edu/)
- Los Angeles College of Chiropractic of the Southern California University of Health Sciences (http://www.lacc.edu/lacc/index.php)
- Texas Chiropractic College (http://www.txchiro.edu/) in Pasadena, Texas near Houston
- University of Bridgeport College of Chiropractic (http://www.bridgeport.edu//pages/38.asp) in Bridgeport, Connecticut near New York City
- Western States Chiropractic College (http://www.wschiro.edu/) in Portland, Oregon
Schools of chiropractic outside the United States
- Australia
- Canada
- England
- France
- New Zealand
- Sweden
Skeptic
Other
de:Chiropraktik
ja:カイロプラクティック
|
