What is chiropractic?
Chiropractic is a form of diagnosing and treating illnesses that affect the
nerves, muscles, bones, and joints of the body. Daniel David Palmer founded
chiropractic in 1895. Palmer was a self-taught healer who was studying spinal
structure and manipulative techniques when he cured a man of deafness and acute
back pain by realigning a displaced vertebra in his back. This and other
successes led Palmer to believe that most diseases were a result of abnormal
nerve transmission caused by "vertebral subluxation" (that is, misalignment of
the spine). Although most contemporary chiropractic practices have introduced
other therapies, spinal manipulation remains the essence of chiropractic. Today,
chiropractic is the third largest independent health profession in the Western
world, and the United States alone is home to 52,000 licensed chiropractors who
together see 20 million patients a year.
What happens during a visit to a chiropractor?
The first visit usually lasts about an hour. The chiropractor takes a
complete health history, including information on past injuries and illnesses;
current conditions and medications; lifestyle; diet; sleep habits; exercise;
mental stresses; and use of alcohol, drugs, or tobacco. During a physical exam,
the chiropractor also tests the extent of spinal mobility and may perform
various diagnostic tests, such as blood pressure and x-rays, to rule out other
conditions. Treatment generally begins at either the first or second visit.
Patients are typically asked to lie on a specially designed table, where the
chiropractor performs the spinal manipulations. The most common maneuver is
manual manipulation, which involves movement of the selected joint to the end of
its range, followed by a low-force thrust. The chiropractor may, however, use
other treatments including massage and soft-tissue therapies. Some people
experience minor aches, stiffness, and tiredness for a few days after the
manipulation while their body adjusts to the new alignment.
How many treatments will be required?
More than one session is usually needed to correct a problem; a typical
course of treatment lasts several weeks. The chiropractor may suggest two or
three sessions a week (lasting only about 10 to 20 minutes), then reduce the
frequency to weekly sessions once the condition being treated improves. Patient
and chiropractor together evaluate the effectiveness of treatment based on the
goals discussed in the first session.
What conditions are treated effectively with chiropractic?
Chiropractic has been shown to be effective for acute and chronic low back
pain, neck pain, headaches (including migraines), frozen shoulder, tennis elbow
and other sports injuries, and carpal tunnel syndrome, and may be helpful for
otitis media (ear infection), digestive problems, menstrual and premenstrual
pain, and asthma.
Are there conditions that should not be treated with chiropractic?
Individuals with bone fractures or tumors, acute arthritis, bone or joint
infections, or advanced osteoporosis should avoid chiropractic therapy in areas
affected by any of these conditions. Patients should also tell their
chiropractor about any physical disabilities they have, or if they are
experiencing symptoms of numbness, tingling, weakness, or other neurological
problems. In extremely rare cases, manipulation of the neck has damaged blood
vessels or caused strokes. The screening process, however, is designed to detect
people at high risk.
How can a qualified practitioner be located?
Chiropractors are licensed in all 50 states. A chiropractic degree requires
approximately the same number of educational hours as a medical degree. The
chiropractic program includes clinical experience, basic sciences, and standard
as well as structural (spinal) and functional (nervous system) diagnoses.
Currently, 17 chiropractic colleges exist in the U.S.; the Council of
Chiropractic Education accredits these colleges. At least one chiropractic
organization serves each state in the U.S. The largest association in the
profession of chiropractic is the American Chiropractic Association (ACA). The
ACA can provide a list of licensed chiropractors in your area if you call
800-986-4636, or you can visit the organization's site on the Internet at
Does medical insurance cover chiropractic treatments?
Medicare, Medicaid, and worker's compensation cover chiropractic care.
According to a 1994 federal study, 80% of healthcare plans that employers offer
cover at least part of the cost of chiropractic.
- Hard tissue manipulation- manipulation
of bone and/or cartilage, including joints
- High velocity thrust- manual
manipulation that involves movement of the selected joint to its end range of
voluntary motion, followed by a quick manual thrust
- Interferential therapy- a form of
- Ischemic compression (Travell-Simons trigger point
therapy)- a technique in which progressively strong
pressure is applied to a pressure point, trigger point, or tight muscle
- Joint mobilization- slower or gentler
manual techniques in which the joint remains within its passive range of
- Low amplitude thrust- amplitude refers
to the depth of, or distance traveled by, the practitioner's thrust. Most
adjustment/manipulation is of low amplitude, minimizing total force applied to
- Manipulation-manual techniques that
move a joint beyond the end point of its passive range of motion.
- Soft tissue manipulation- manual
manipulation of muscle, tendon, and ligament.
- Spinal manipulation- manipulation of
- Subluxation- where alignment, movement
integrity, and/or physiologic function are altered although contact between the
joint surfaces remains intact.
- Thrust- the therapeutic maneuver
delivered by the practitioner during high-velocity adjustment and manipulation.
Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation
vs. amitriptyline for the treatment of chronic tension-type headaches: a
randomized clinical trial. J Manipulative Physiol Ther.
Fallon J. The role of the chiropractic adjustment in the care and treatment
of 332 children with otitis media. J Clin Chiropractic Pediatr.
Gottlieb MS. Conservative management of spinal osteoarthritis with
glucosamine sulfate and chiropractic treatment. J Manipulative Physiol
Hansen DT, Triano JJ. Chiropractic. In: Novey DW, ed. Clinician's Complete
Reference to Complementary/Alternative Medicine. St. Louis, MO: Mosby;
Hertzman-Miller RP, Morgenstern H, Hurwitz EL, et al. Comparing the
satisfaction of low back pain patients randomized to receive medical or
chiropractic care: results from the UCLA low back pain study. Am J Public
Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical
care with and without physical therapy and chiropractic care with and without
physical modalities for patients with low back pain: 6 month follow-up outcomes
from the UCLA low back pain study. Spine. 2002;27(20):2193-2204.
Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A
randomized trial of chiropractic manipulation and mobilization for patients with
neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public
Kaptchuk TJ, Eisenberg DM. Chiropractic origins, controversies, and
contributions. Arch Intern Med. 1998;158(20):2215-2224.
Lauretti WJ. The comparative safety of chiropractic. In: Redwood D, ed.
Contemporary Chiropractic. New York, NY: Churchill Livingstone;
Manga P. Economic case for the integration of chiropractic services into the
health care system. J Manipulative Physiol Ther.
Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of
mainstream and alternative medicine. Ann Intern Med. 2002;136(3):216-227.
Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV. The
efficacy of spinal manipulation, amitriptyline and the combination of both
therapies for the prophylaxis of migraine headache. J Manipulative Physiol
Ofman JJ. Chiropractic spinal manipulation for treatment of acute low back
pain. In: Saltmarsh N, ed. The Physician's Guide to Alternative Medicine.
Atlanta, GA: American Health Consultants; 1999:265-266.
Plaugher G, Bachman TR. Chiropractic management of a hypertensive patient.
J Manipulative Physiol Ther. 1993;16(8):544-9.
Redwood D. Chiropractic. In: Micozzi MS, ed. Fundamentals of Complementary
and Alternative Medicine. New York, NY: Churchill Livingstone Inc.;
Rupert RL. A survey of practice patterns and the health promotion and
prevention attitudes of US chiropractors. Maintenance care: part I. J
Manipulative Physiol Ther. 2000;23(1):1-9.
Terrett AG. Current Concepts in Vertebrobasilar Complications Following
Spinal Manipulation. Des Moines, IA: NCMIC Group; 2001.
Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal
manipulation in the treatment of infantile colic: a randomized controlled
clinical trial with a blinded observer. J Manipulative Physiol
Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboom-de Jong B. Comparison
of physiotherapy, manipulation, and corticosteroid injection for treating
shoulder complaints in general practice: randomized, single blind study.