Chiropractice is a system of complementary medicine based on the diagnosis and manipulative treatment of misalignments of the joints, especially those of the spinal column, which are held to cause other disorders by affecting the nerves, muscles and organs.
The 'hands-on' joint manipulation known as chiropractice is considered particularly valuable for relief of acute (temporary) pain in the lower back. This type of pain usually subsides on its own within three months, but chiropratice treatment can often bring it to an end immediately (see also the entry on osteopathic medicine). In many cases, chiropractice can also ease pain—due either to a temporary condition or aggravation of a chronic problem—in areas such as the mid-back, neck or joints. Additionally, it is sometimes used to relive the pain of headaches, muscle spasms and nerve inflammation. Its effectiveness for relief of sciatica (pain or numbness along the sciatic nerve, generally in the back, buttocks, hips or adjacent parts) remains controversial. After the common cold, low back pain is the most common reason for doctor visits. It is an especially frustrating problem because there's frequently no simple medical explanation for it—and therefore no easy cure.
However, there is now mounting evidence that spinal manipulation can be a genuine source of relief. In 1994, the Agency for Health Care Policy and Research (AHCPR) released its Guidelines on Acute Low Back Problems in Adults. This report identified manipulation (defined as certain specific techniques used to re-align or re-adjust a joint) as the preferred method of treatment for relief of acute back pain. Traction, bed rest, corsets, or drug therapies were not recommended. Similarly, a report from RAND Corporation published in the prestigious Annals of Internal Medicine found manipulation effective for the relief of acute low back pain. (It was not, however, deemed as successful in the treatment of chronic or recurrent low back pain, sciatica, asthma, high blood pressure, or pain caused by neurological conditions.) Chiropractors, Rand pointed out, perform 94 per cent of spinal manipulations (though not necessarily with the same techniques employed in the study).
To date, there is no scientific confirmation of chiropractice's effectiveness for anything other than low back pain. However, in a few years we should know more. In early 1998, the National Institute of Health's Office of Alternative Medicine, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded a research grant to support the first federally funded Centre for Chiropractice Research.
Procedure of Treatment
Although the back is the primary focus of chiropractice the manipulations can be applied to any muscle or joint in the body. Techniques vary among practitioners. Typically, after preparation and proper positioning, the chiropractor creates tension around the offending joint, then applies pressure to return to its proper position. A popping sound is often heard—and sometimes felt—following this manoeuvre. The noise is similar to the one you hear when cracking your knuckles. It results from the sudden release of built-up pressure in the joint and is generally painless. As the joint snaps into place, pain is relieved and proper function is restored.
Other techniques you may encounter include soft tissue manipulation trigger-point manipulation or deep tissue massage. On your first visit to a chiropractor, you will probably be asked to complete a questionnaire about your personal and family medical history. Be sure to discuss any illnesses that run in the family. Although chiropractors are not prepared to diagnose the full gamut of disease, they are trained to perform physical examinations in much the same way as a general medical practitioner. For example, you may be given a blood test to rule out infection and a reflex test to rule out neurological problems. Your blood pressure, pulse and respiration will also be measured. Once these general readings have been taken, the examination will begin to zero in on your musculoskeletal system—the muscles and bones in your body—with particular attention to your spine. The chiropractor will also analyze your posture, and will probably perform some orthopaedic tests as he examines your articulations (a chiropractic term for joints). These tests usually involve moving a particular limb in search of joints that are 'fixated' (not moving) or moving with impaired range. If the chiropractor identifies a fixated joint, he will then attempt to determine whether there is any risk involved to restoring normal movement to the joint and what other parts of the musculoskeletal system have been affected by the joint's dysfunction. It is common for a 'healthy' joint to overcompensate by moving excessively when another joint is not working correctly. The healthy, hyperactive joint might be near the fixated joint or in an entirely different part of the musculoskeletal system. Overcompensation can result in new, incorrect structural configurations that cause discomfort or pain.
To rule out any conditions that would preclude treatment, chiropractors usually take an x-ray of the region causing your pain before beginning the manipulations. Some chiropractors also take x-rays to locate subluxations (partial dislocations). Most chiropractors have basic x-ray equipment on-site and all chiropractors are trained to ready x-ray images. If a specialized view is required, you may be referred to a centre that has advanced technology, such as magnetic resonance imaging (MRI) equipment, or other equipment that provides a comprehensive image. About 90 per cent of chiropractors use x-rays. However, full-spinal x-rays in search of subluxations are considered controversial by many practitioners, and constitute less than 17 per cent of all x-rays performed by chiropractors, according to the American Chiropractice Association. Many practitioners, chiropractice and otherwise, believe that full-spinal x-rays yield little if any useful information, and thus expose patients to radiation needlessly. The chiropractor will also examine your muscles to determine if they are balanced. Just as healthy joints compensate for injuries in other structures, muscles my also exhibit 'compensated distortion'. When one muscle or group of muscles is contracted, for example, those on the other side may be abnormally relaxed. Once the chiropractor has all the information he needs, treatment will proceed.
Therapeutic equipment common to virtually all chiropractors is a specialized table designed to conform to a patient's body. The table has mechanized parts that can be adjusted in accordance with the patient's size and region of the body that requires treatment. For example, the surfaces where the face, pelvis, and other body structures lie will yield independently as the chiropractor applies controlled force to these areas during treatment. According to the American Chiropractice Association, more than 90 per cent of chiropractors use techniques common to physical therapy, especially in preparation for manipulation. Your practitioner may use a broad, pad-like vibrator to relax your back muscles. He may apply hot or cold compress to increase circulation and relax painful muscle spasms, or use traction to ease pressure. Ultrasound is often used as a 'micro massage' to stimulate circulation and remove fluid from the area around a damaged joint and nearby tissues. Some chiropractors also recommend and teach relaxation techniques as a way to prevent future strain, and prescribe rehabilitative exercises as part of an extended treatment plan. Some also prescribe and sell dietary supplements and herbs, although such products fall outside the realm of chiropractice.
Treatment Time: The initial visit typically lasts at least one hour. Subsequent visits usually take between 10 and 30 minutes.
Treatment Frequency: On an average, a course of treatment involves three to five visits per week for two weeks. Several studies have noted that consumers using chiropractice care are more satisfied with treatment than patients who receive medical care. Chiropractice are perceived as spending more time face-to-face with the patient, although no studies have been done to verify this.
The primary goals of chiropractic therapy are relief of musculoskeletal pain and restoration of mobility. However, many consumers use (or misuse) chiropractors for a wide variety of unrelated ailments. In a 1993 survey of more than 5,000 chiropractors, musculoskeletal complaints did in fact dominate the list of conditions they treated, but respondents also reported 'routinely' seeing patients with headaches and 'often' seeing patients with high blood pressure problems, allergies or obesity. Seen less frequently were patients with nutritional disorder, menstrual irregularities, asthma and diabetes. Chiropractice has long drawn criticism from the medical world for its failure to provide valid proof of its effectiveness and for the exaggerated claims of some practitioners who have touted spinal adjustment as a cure for everything form chronic pain to sinus infections.
Indeed, until 1980 the American Medical Association (AMA) labelled as unethical the referral of patients to chiropractors, only lifting the prohibition when challenged in a successful antitrust suit. Lately, with growing proof of spinal manipulation's effectiveness for low back pain, chiropractice has gained new-found respectability. Collaboration between medical specialists and chiropractors is on the increase, and some managed care plans have begun covering chiropractice treatments. Still, critics say there is little evidence that chiropractice relieves studies support chiropractice for the treatment of chronic musculoskeletal disorders, although some studies of chiropractic treatment for headache show promising results. The version of chiropractice currently gaining medical favour is far different from the original discipline.
Developed by Daniel David Palmer in Davenport, Iowa, in 1985, chiropractice started out as a natural healing method freighted with a variety of spiritual and metaphysical concepts. Palmer's theory suggested that an innate intelligence flows through the nervous system and can be obstructed by a 'subluxation' – or misalignment—of one or more of the 24 joints in the vertebral column, thus interfering with the blood supply and the body's full expression of healthy functioning. Palmer believed that, because all parts of the body are connected through the nervous system, all diseases were caused by one or more subluxations. Thus, any disease could be cured by manipulating ore realigning the vertebrae in order to allow the body to heal itself. A significant misalignment of the vertebrae is rare—and, as in scoliosis, is usually quite noticeable. Conversely, many people have asymmetrical spines with slight imperfections in alignment, yet suffer no adverse effects on their health. Many contemporary chiropractors therefore have begun to discuss subluxations less in terms of misalignment and more in terms of loss of function, since even a joint in perfect alignment may fail to work properly and tend to cause pain.
Over the years, different branches of chiropractic developed that emphasized one or more principles of Palmer's original theories to greater or lesser degrees. Historically, chiropractors categorized themselves as 'straights' or 'mixers' to describe how closely they adhered to Palmer's philosophy. 'Straights' were purists, using only manipulation and focusing exclusively on the spine; 'mixers' supplemented manipulation with other forms of treatment, such as nutritional counselling and physiotherapy, and acknowledged that diseases were caused by problems other than subluxations. Chiropractice schools and professional associations developed along these lines. Today, these distinctions are breaking down. According to a 1997 report from the Agency for Health Care Policy and Research, more than two-thirds of chiropractors use techniques other than manipulation, such as exercise, nutritional counselling, and physiotherapy, although 93 per cent retain spinal adjustment as their primary approach to treatment.
Who Should Avoid This Therapy?
Chiropractice is not recommended for disorders of other than musculoskeletal origin, and should be avoided for certain musculoskeletal problems as well. For instance, it is not recommended for osteoporosis, bone or joint infections, bone cancer, acute rheumatoid arthritis and diseases of the spinal cord or bone marrow. It should also be avoided in an area that has been operated on, such as a spinal fusion, and near acute fractures and dislocations or healed fractures and dislocations with signs of ligament damage. Chiropractors do not treat fractures. Scoliosis, a condition in which the spine curves to the side, is generally considered a target for chiropractice therapy. However,idiopathic scoliosis, which develops over time instead of being present at birth (congenital scoliosis), is not appropriate for treatment by a chiropractor.
Serious side-effects from spinal manipulation appear to be rear. Strokes have been reported following manipulation of the neck, presumably as a result of damage to one of the arteries supplying blood to the brain. However, the incidence of adverse events from manipulation of the neck region is estimated to be one in one million procedures, according to the Agency for Health Care Policy and Research. Likewise, the agency pegs the risk of a serious side-effect from manipulation of the lower back at once case in 100 million manipulations. Minor side-effects of spinal manipulation have not been systematically analyzed. The adverse reactions reported by one study, such as headache, radiating discomfort and fatigue following manipulation, were not clearly shown to be a result of the treatment.