The term “chiropractic” combines the Greek words cheir (hand) and praxis (practice) to describe a treatment done by hand. Hands-on therapy—especially adjustment of the spine—is central to chiropractic care, which is based on the notion that the relationship between the body’s structure (primarily that of the spine) and its function (as coordinated by the nervous system) affects health (NIH, 2017).
Spinal adjustment/manipulation is a core treatment in chiropractic care, but it is not synonymous with chiropractic (NIH, 2017). Chiropractors commonly use other treatments in addition to spinal manipulation, and other health care providers (e.g., physical therapists or some osteopathic physicians) may use spinal manipulation (NIH, 2017).
A chiropractor is a health care professional focused on the diagnosis and treatment of neuromuscular disorders, with an emphasis on treatment through manual adjustment and/or manipulation of the spine (Yeomans, 2013). The goal of a chiropractor is to reduce or eliminate pain and help patients improve their functionality and thus their quality of life. A chiropractor also educates their patients on back health, exercise and ergonomics to help them maintain a health back and body.
The back, spine and nervous system are all inter-related, and there are certain views of this relationship a chiropractor bases their practice on, including biomechanical and structural derangement of the spine can affect the nervous system, and for many conditions, chiropractic treatment can restore the structural integrity of the spine, reduce pressure on the sensitive neurological tissue, and consequently improve the health of the individual (Yeomans, 2013).
Chiropractors use non-surgical treatments for lower back pain and/or leg pain (sciatica), neck pain, repetitive strains, headaches, sports injuries, car accident injuries, and arthritic pain (Yeomens, 2013). Although the primary focus of chiropractors is treating neuromusculoskeletal disorders, there are some other conditions a chiropractor may treat or refer the patient to a medical doctor. Chiropractic treatments attempt to re-establish normal spine mobility, which can provide a significant amount of pain relief and irritation, as well as improve reflexes.
What Does a Chiropractor Do?
A chiropractor may perform the following duties, among others (BLS, 2017):
Assess a patient’s medical condition by reviewing the patient’s medical history and concerns, and by performing a physical examination
Analyze the patient’s posture, spine, and reflexes
Conduct tests, including evaluating a patient’s posture and taking x rays
Provide neuromusculoskeletal therapy, which often involves adjusting a patient’s spinal column and other joints
Give additional treatments, such as applying heat or cold to a patient’s injured areas
Advise patients on health and lifestyle issues, such as exercise, nutrition, and sleep habits
Refer patients to other healthcare professionals if needed
The patient’s overall health is the main focus of chiropractic care. Some chiropractors may use massage therapy, rehabilitative exercise and ultrasound in addition to performing spinal adjustments and manipulations. They may also prescribe braces or shoe inserts to help treat certain conditions. Some may choose to specialize in sports, neurology, orthopedics, pediatrics, nutrition, or another chiropractic specialty.
An analysis of the use of complementary health approaches for back pain, based on data from the 2002 NHIS, found that chiropractic was by far the most commonly used therapy - among survey respondents who had used any of these therapies for their back pain, 74 percent (approximately 4 million Americans) had used chiropractic (NIH, 2017). Among those who had used chiropractic for back pain, 66 percent perceived “great benefit” from their treatments (NIH, 2017).
Chiropractic Treatments
During the initial visit, chiropractors typically take a health history and perform a physical examination, with a special emphasis on the spine. Other examinations or tests such as x-rays may also be performed, and when needed, a treatment plan will be developed.
A treatment plan typically involves adjustments, joint mobilization and manual therapies to help increase the range and quality of motion in the affected area. Treatments may also include heat and ice, electrical stimulation, relaxation techniques, rehabilitative and general exercise, counseling about diet, weight loss, and other lifestyle factors, and dietary supplements (NIH, 2017).
Researchers have studied spinal manipulation for a number of conditions ranging from back, neck, and shoulder pain to asthma, carpal tunnel syndrome, fibromyalgia, and headaches, although much of the research has focused on low-back pain, and has shown that spinal manipulation appears to benefit some people with this condition (NIH, 2017).
A 2010 review of scientific evidence on manual therapies for a range of conditions concluded that spinal manipulation/mobilization may be helpful for several conditions in addition to back pain, including migraine and cervicogenic (neck-related) headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders (NIH, 2017).
Chiropractic Safety
There may be some side effects to spinal manipulation, including headaches, tiredness or discomfort in the treated area. There have also been reports of stroke and pinched nerves due to chiropractic care, although the direct cause or link to the chiropractor is not clear. According to the National Institutes of Health (2017), the two following studies are important to note:
A 2007 study of treatment outcomes for 19,722 chiropractic patients in the United Kingdom concluded that minor side effects (such as temporary soreness) after cervical spine manipulation were relatively common, but that the risk of a serious adverse event was “low to very low” immediately or up to 7 days after treatment.
A 2009 study that drew on 9 years of hospitalization records for the population of Ontario, Canada analyzed 818 cases of vertebrobasilar artery (VBA) stroke (involving the arteries that supply blood to the back of the brain). The study found an association between visits to a health care practitioner and subsequent VBA stroke, but there was no evidence that visiting a chiropractor put people at greater risk than visiting a primary care physician. The researchers attributed the association between health care visits and VBA stroke to the likelihood that people with VBA dissection (torn arteries) seek care for related headache and neck pain before their stroke.
Lower Back Pain
Millions of Americans experience low back pain every day. The lumbar spine, or low back, is a remarkably well-engineered structure of interconnecting bones, joints, nerves, ligaments, and muscles all working together to provide support, strength, and flexibility (Peloza, 2017). Because of its complex structure and inter-connections, the lower back is susceptible to injury and pain.
The lower back supports the weight of the entire upper body and is involved in primary mobility functions such as bending and twisting, flexing and rotating the hips, and supporting the spinal column. Nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet (Peloza, 2017). The majority of acute lower back pain is due to injury to the muscles, ligaments, joints or discs in this area, although the specific cause can be difficult to identify.
Symptoms of lower back pain include the following (Peloza, 2017):
Pain that is dull or achy, contained to the low back
Stinging, burning pain that moves from the low back to the backs of the thighs, sometimes into the lower legs or feet; can include numbness or tingling (sciatica)
Muscle spasms and tightness in the low back, pelvis, and hips
Pain that worsens after prolonged sitting or standing
Difficulty standing up straight, walking, or going from standing to sitting
Acute back pain has a sudden onset and may last for several days or weeks. Subacute lower back pain lasts between 6 weeks and 3 months.
Types of Lower Back Pain
There are multiple categorizations of back pain, and some issues do not readily fall into one specific category. Some lower back pain does not have an identifiable cause, so the chiropractor focuses on treating the symptoms. There are two common types of back pain: mechanical and radicular.
Mechanical pain is the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine (Peloza, 2017). This pain is typically located in the lower back, buttocks and the hips.
Radicular pain occurs if a nerve or nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg (Peloza, 2017). This pain is typically experienced by sharp, electric, burning pain resulting in numbness or weakness. Sciatica is radicular pain.
There are many additional sources of pain, including claudication pain (from stenosis) myelopathic pain, neuropathic pain, deformity, tumors, infections, pain from inflammatory conditions (such as rheumatoid arthritis or ankylosing spondylitis), and pain that originates from another part of the body and presents in the lower back (such as kidney stones, or ulcerative colitis) (Peloza, 2017).
What is Chiropractic Medicine?
Chiropractic is the field of medicine and health care profession that uses a variety of treatment approaches, including adjustments and manipulations of the spine or other parts of the body to correct alignment, alleviate pain, improve function and support the body’s natural ability to heal itself (NIH, 2017).
Most research on chiropractic has focused on spinal manipulation, which appears to benefit some people with low-back pain and may also be helpful for headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders (NIH, 2017). Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated. There have been rare reports of serious complications such as stroke, but whether spinal manipulation actually causes these complications is unclear, although safety remains an important focus of ongoing research (NIH, 2017).
According to the 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of the use of complementary health approaches by Americans, about 8 percent of adults (more than 18 million) and nearly 3 percent of children (more than 2 million) had received chiropractic or osteopathic manipulation in the past 12 months (NIH, 2017). In addition, billions of dollars are spent in out-of-pocket costs to chiropractors.
The History of Chiropractic
Ancient Beginnings
The true beginnings of chiropractic date back over 4000 years to ancient Chinese etchings and the ancient Indian practice of Yoga, which focused on keeping flexibility in the spine. In ancient Greece, Hippocrates (the father of medicine) wrote many ties about the importance of spine health and the nervous system. Another Greek physician known as Galen, was known for adjusting a Roman scholar’s neck and curing the scholar’s paralysis.
The Year: 1895
Chiropractic, the medical profession that specializes in manual therapy and especially spinal manipulation, is the most important example of alternative medicine in the United States and alternative medicine's greatest anomaly (Kaptchuk and Eisenberg, 2017). This medical field dates back to 1895, when D.D. Palmer performed the first spinal manipulation, in which he adjusted a janitor’s neck and cured his deafness. Palmer combined bonesetting, magnetic healing, orthodox science and popular health reform into what is now known as chiropractic.
Bonesetters were prevalent in 19th century health care, and was grouped along with midwifery, tooth-pulling, and other issues that were considered inconsequential to medically-trained physicians at the time. Bonesetters also put out-of-place joints back into place, a practice that is known today as subluxation; thus, bonesetting provide the method for chiropractic.
Magnetic Healing provided the theory for chiropractic, and Palmer specifically wrote about the contributions of magnetic healing. Practitioners of magnetic healing identified the unimpeded flow of energy with health and defined illness as obstruction (Kaptchuk and Eisenberg, 2017). Palmer was the first to combine magnetic healing with bonesetting to re-align spinal vertebrae.
Palmer saw himself as a scientist and wasted no time in adopting prevailing scientific notions of the spinal cord to chiropractic theory (Kaptchuk and Eisenberg, 2017). He applied orthodox science to subluxation and manipulations in order to understand the root cause of chiropractic issues.
Daniel David (D.D.) Palmer
Palmer began his practice of magnetic healing in Iowa, and referred to himself as a doctor. After nine years of clinical experience and theorizing, D.D. had decided that inflammation was the essential characteristic of all disease (Keating et al, 2004). He would attempt to locate the inflammation of his patient’s using his fingers, although he soon realized inflammation was also due to the displacement of anatomical structures.
The following was published in regards to Dr. Palmer in 1896 (Keating et al, 2004): He heals the sick, the halt, the lame, and those paralyzed, through the medium of his potent magnetic fingers placed upon the organ or organs diseased and not by rubbing or stroking, as other ‘magnetic curers’do… Dr. Palmer seeks out the cause, the diseased organ upon which the disease depends, and treats that organ. Magnetics generally treat all cases alike, by general stroking, passes or rubbing. I think Dr. Palmer’s plan is much more rational, and should be the most successful” (Livezey, cited in Palmer 1896).
Palmer would establish the first chiropractic school, known as Palmer’s School of Chiropractic, and his son, B.J., was one of his students. B.J. engaged in some of the earliest research in the profession and greatly expanded the osteological collection his father had established (Keating et al, 2004). He grew the Palmer School of Chiropractic (PSC), and expanded its enrollment, and he was considered the leader of the chiropractic profession.
Chiropractic in Organized Medicine
By the mid-1930s an educational reform campaign, launched by the National Chiropractic Association (NCA, predecessor of today’s ACA), had begun in earnest (Keating et al, 2004). Out of this arose a feud within the profession, between those who wanted to establish non-profit schools, a 4-year curriculum and improvements in diagnostic science, and those who though medicalizing the profession would lead to its demise. In 1947, the NCA established the NCA Council on Education, which is now known as the Council on Chiropractic Education.
The Prosecution of Chiropractors
Not only was D.D. Palmer tried for practicing medicine without a license, but many other chiropractors were prosecuted for practicing medicine, surgery and osteopathy. In 1906, B.J. Palmer and several other chiropractors organized the Universal Chiropractors Association (UCA) to provide legal services to chiropractors when they were arrested (Keating et al, 2017).
Prosecutions of chiropractors grew increasingly common, often instigated by state medical boards that were determined to crush all challengers to their authority (Keating et al, 2004). During this time, police officers would wear plain clothes and disguise themselves as patients to gather evidence.
North Dakota was the first state to officially recognize chiropractic as a legitimate medical field in 1915. By 1924, more than 24 states had followed.
The Foundation of Modern Chiropractic
According to Keating et al (2004) the core of traditional chiropractic includes the following:
The body is a self-regulating and self-healing organism.
The nervous system is the master system that regulates and controls all other organs and tissues and relates the individual to his/her environment.
Spinal biomechanical dysfunction in the form of vertebral subluxation complex may adversely affect the nervous system’s ability to regulate function.
The central focus of the doctor of chiropractic is to correct, manage or minimize vertebral subluxation through the chiropractic spinal adjustment.
There are over 35 chiropractic academic institutions throughout the world today. In fact, Chiropractic is now the world's third largest healthcare profession, the largest holistic approach, and one of the fastest growing. The field of chiropractic is continuously evolving as new techniques are discovered.
Current research being done in this field includes spinal manipulation for back pain, neck pain, and headache, as well as for other health conditions such as temporomandibular disorder, development of a curriculum to increase the understanding of evidence-informed practice in chiropractic educational institutions, and influence of patients’ satisfaction with care on their response to treatment, in a study that compared chiropractic and medical care in a group of back-pain patients (NIH, 2017).
The National Center for Complementary and Integrative Health (NCCIH) also funded establishment of a developmental center for research in chiropractic at the Palmer Center for Chiropractic Research. Investigators at Palmer and at other partnering institutions conduct basic and clinical research on chiropractic treatment approaches, how they might work, and diseases and conditions for which they may be most helpful (NIH, 2017).
How to Become a Chiropractor
It takes several years of education and training to become a licensed chiropractor. To practice chiropractic, you will need to complete an undergraduate degree, earn a Doctor of Chiropractic (D.C.) degree, obtain a license, and, in some cases, receive further training in a specialty field.
Undergraduate Degree
Although most D.C. programs do not require a particular undergraduate major, most future chiropractors choose a major in a science, such as biology, chemistry or physics. Other majors may include a social science such as sociology or psychology, or communications or interpersonal relations. Acceptance into an accredited D.C. program is extremely competitive, as there are a limited number of accredited programs in the United States.
Doctor of Chiropractic Degree
Chiropractic colleges accredited by the Council on Chiropractic Education (CCE) offer Doctor of Chiropractic (D.C.) degree programs (NIH, 2017). During this 4-year program, students will take courses in anatomy, biomedical sciences, public health, research methods, chiropractic physiology and diagnosis, and many others. They will also receive hands-on training in chiropractic techniques, biophysics, spinal biomechanics and extremity adjustment techniques (Study, 2017). Most programs involve an internship, so the student can interact directly with chiropractic patients under the direct supervision of a licensed chiropractor.
Licensing
Each state has its own chiropractic licensing requirements, although most states require passing of the National Board of Chiropractic Examiners exam. Some states do have their own examination requirement. To maintain a state license, most chiropractors are required to earn continuing education credits on an annual basis.
Chiropractic Job Prospects
Most chiropractors work in individual or group private practices, and a large number of them are self-employed. The median annual income for chiropractors is $67,520, with a projected growth of 10 percent by the year 2026, which is faster than the average for all occupations. Many students are attracted to this health care field because it is non-invasive and does not involve prescribing medications.
Ted J. Kaptchuk, OMD; David M. Eisenberg, MD. Chiropractic- Origins, Controversies and Contributions. Center for Alternative Medicine Research, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Retrieved November 11, 2017 from: https://www.brianesty.com/bodywork/PDF/Chiropractic%20History.pdf
Joseph C. Keating, Jr., Ph.D., Carl S. Cleveland III, D.C., Michael Menke, M.A. Chiropractic History: A Primer. Association for the History of Chiropractic. 2004. Retrieved November 3, 2017 from: https://www.brianesty.com/bodywork/PDF/Chiropractic%20History.pdf
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