I walk in a commercial area I have not been in before. It is a long strip mall of offices. Chiropractors have been on the edge of traditional medicine for centuries. I have friends who go to chiropractors regularly and are very satisfied with the results. My parents were friends with a family whose father was a chiropractor. They were lovely people, but the father would not let his children drink milk. Am not sure why. Perhaps he was one of the first vegans? Or maybe he felt his children should get their calcium in some other form. Regardless, I believe they grew up to be happy and healthy adults. I did go to a female chiropractor once when my right knee was giving me pain. She performed an adjustment and also acupuncture. I can’t really say that it made much difference. I ended up having knee replacement surgery. But, I still believe that chiropractors are valuable and deserve an honored place in our society. Let’s learn more about them.
History
According to Wikipedia, the history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer — who was also involved in many other natural healing philosophies — had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samuel Weed coined the word "chiropractic" from Greek roots. Chiropractic's early philosophy was rooted in vitalism, naturalism, magnetism, spiritualism and other constructs that are not amenable to the scientific method, although Palmer tried to merge science and metaphysics. In 1896, Palmer's first descriptions and underlying philosophy of chiropractic echoed Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improved health. Palmer distinguished his work by noting that he was the first to use short-lever, high-velocity, low-amplitude manipulative techniques using the spinous process and transverse processes as mechanical levers. He described the effects of chiropractic spinal manipulation as being mediated primarily by the nervous system.
Despite the similarities between chiropractic and osteopathy, the latter's practitioners sought to differentiate themselves by seeking licensure to regulate the profession, calling chiropractic a "bastardized form of osteopathy." In 1907 in a test of the new osteopathy law, a Wisconsin-based chiropractor was charged with practicing osteopathic medicine without a license. Practicing medicine without a license led to many chiropractors — including D.D. Palmer — being jailed. Ironically, Palmer's legal defense of chiropractic consisted of the first chiropractic textbook “Modernized Chiropractic” published in 1906, written by "mixer" chiropractors Longworthy, Smith, et al., who Palmer despised. Although the chiropractors won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common, and in many cases, they were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all 50 states from Kansas in 1913 through Louisiana in 1974.
Division within the profession has been intense with "mixers" combining spinal adjustments with other treatments and "straights" relying solely on spinal adjustments. A conference sponsored by the National Institutes of Health in 1975 spurred the development of chiropractic research. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 antitrust case. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation. By the mid-1990s there was a growing scholarly interest in chiropractic.
1890s
In 1895, the world was in the Second Industrial Revolution, marked by innovation and creativity. Health care had emerged from the practice of heroic medicine. All varieties of treatments and cures including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines were competing to be the new method for the century. Neither consumers nor many practitioners had much knowledge of either the causes of — or cures for — illnesses. The theory of modern medicine, fueled by Louis Pasteur's refutation of the centuries-old spontaneous generation theory in 1859, was growing as Charles Darwin published his book on natural selection. The German bacteriologist Robert Koch formulated his postulates, bringing scientific clarity to what was a new field. Drugs, medicines and quack cures were becoming more prevalent and were unregulated. Concerned about what he saw as the abusive nature of drugging, MD Andrew Taylor Still ventured into magnetic healing — meaning hypnotism — and bonesetting in 1875. He opened the American School of Osteopathy in Kirksville, Missouri in 1892.
Early growth
After the case of Harvey Lillard, D.D. Palmer stated: "I had a case of heart trouble which was not improving. I examined the spine and found a displaced vertebra pressing against the nerves which innervate the heart. I adjusted the vertebra and gave immediate relief — nothing ‘accidental’ or ‘crude’ about this. Then I began to reason if two diseases, so dissimilar as deafness and heart trouble, came from impingement — a pressure on nerves — were not other diseases due to a similar cause? Thus, the science (knowledge) and art (adjusting) of chiropractic were formed at that time.”
D.D. Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos cheiros and praktikos — meaning "done by hand" — to describe Palmer's treatment method, creating the term "chiropractic." Palmer initially hoped to keep his discovery a family secret, but in 1896 he added a school to his magnetic healing infirmary and began to teach others his method. It would become known as Palmer School of Chiropractic, now Palmer College of Chiropractic. Among the first graduates were Andrew P. Davis MD, DO; William A. Seally, MD; B.J. Palmer, D.D.'s son; Solon M. Langworthy; John Howard; and Shegataro Morikubo. Langworthy moved to Cedar Rapids, Iowa and opened the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure, combining it with what would become naturopathic cures and osteopathy. D.D. Palmer — who was not interested in mixing chiropractic with other cures — turned down an offer to be a partner.
D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself “doctor.” Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack."
Changing political and health care environment
The early 19th century had seen the rise of patent medicine and the nostrum remedium trade. Although some remedies were sold through doctors of medicine, most were sold directly to consumers by lay people, some of whom used questionable advertising claims. The addictive, and sometimes toxic, effects of some remedies — especially morphine and mercury-based cures known as quicksilver or quacksilber in German — prompted the popular rise of less dangerous alternatives, such as homeopathy and eclectic medicine. In the mid-19th century, as the germ theory began to replace the metaphysical causes of disease, the search for invisible microbes required the world to embrace the scientific method as a way to discover the cause of disease.
In the U.S., licensing for health care professionals had all but vanished around the time of the Civil War, leaving the profession open to anyone who felt inclined to become a physician; the market alone determined who would prove successful and who would not. Medical schools were plentiful, inexpensive and mostly privately owned. With free entry into the profession and education in medicine cheap and available, many men entered practice, leading to an overabundance of practitioners which drove down the individual physician's income. In 1847, the American Medical Association was formed and established higher standards for preliminary medical education and for the M.D. At the time, most medical practitioners were unable to meet the stringent standards, so a "grandfather clause" was included. The effect was to limit the number of new practitioners.
In 1849, the AMA established a board to analyze quack remedies and nostrums and to enlighten the public about their nature and their dangers. Relationships were developed with pharmaceutical companies in an effort to curb the patent medicine crisis and consolidate the patient base around the medical doctor. By the turn of the 20th century, the AMA had created a Committee on National Legislation to represent the AMA in Washington and re-organized as the national organization of state and local associations. Intense political pressure by the AMA resulted in unlimited and unrestricted licensing only for medical physicians that were trained in AMA-endorsed colleges. By 1901, state medical boards were created in almost every state, requiring licentiates to provide a diploma from an AMA-approved medical college. By 1910, the AMA was a powerful force; this was the beginning of organized medicine.
In 1880, the teaching profession had begun significant changes as well. Advances in chemistry and science in Germany created strong incentives to create markets for their new products. By 1895, the new "Kulturopolitik" ideology of "First teach them; then sell them" had begun creating the political pressure necessary to improve teaching in science and math in schools and colleges in the U.S. The medical schools were the first to suffer the attack; they were ridiculed as obsolete — inadequate — and inefficient. The crisis attracted the attention of some of the world's richest men. In 1901, John D. Rockefeller created the Rockefeller Institute for Medical Research. By 1906, the AMA's Council on Medical Education had created a list of unacceptable schools. In 1910, the Flexner Report — financed by the Carnegie Foundation — closed hundreds of private medical and homeopathic schools and named Johns Hopkins as the model school. The AMA had created the nonprofit, federally subsidized university hospital setting as the new teaching facility of the medical profession, effectively gaining control of all federal health care research and student aid.
Medicine vs. chiropractic
Since its inception, chiropractic was controversial among the established medical orthodoxy. Chiropractors were jailed for "practicing medicine without a license" which the profession designed a legal and political defense against prosecution, arguing that chiropractic was "separate and distinct from medicine," asserting that chiropractors "analyzed" rather than "diagnosed" and "adjusted" subluxations rather than "treated" disease. In 1963 the American Medical Association formed a "Committee on Quackery" designed to "contain and eliminate" the chiropractic profession. In 1966, the AMA referred to chiropractic as an "unscientific cult," and until 1980, held that it was unethical for medical doctors to associate themselves with "unscientific practitioners." Then in 1987, the AMA was found to have engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession." In the 1980s, spinal manipulation gained mainstream recognition and has spurred ongoing collaboration into research of manipulative therapies and models of delivery of chiropractic care for musculoskeletal conditions in the mainstream health care sector.
In September 1899, a medical doctor in Davenport named Heinrich Matthey started a campaign against drugless healers in Iowa, demanding a change in the statute to prevent drugless healers from practicing in the state and claiming that health education could no longer be entrusted to anyone but doctors of medicine. Osteopathic schools across the country responded by developing a program of college inspection and accreditation. D.D. Palmer, whose school had just graduated its seventh student, insisted that his techniques did not need the same courses or license as medicine, as his graduates did not prescribe drugs or evaluate blood or urine. In 1901, D.D. was charged with misrepresenting a course in chiropractic which was not a real science. He persisted in his strong stance against licensure, citing freedom of choice as his cause. He was arrested twice more by 1906, and although he contended that he was not practicing medicine, he was convicted for professing he could cure disease without a license in medicine or osteopathy. Dr. Solon Langworthy — who continued to mix chiropractic at the American School of Chiropractic & Nature Cure — took a different route for chiropractic. He improved classrooms and provided a curriculum of study instead of the single course. He narrowed the scope of chiropractic to the treatment of the spine and nervous system, leaving blood work to the osteopath and began to refer to the brain as the "life force." He was the first to use the word subluxation to describe the misalignment that narrowed the "spinal windows" or intervertebral foramina and interrupted the nerve energy. In 1906, Langworthy published the first book on chiropractic, “Modernized Chiropractic ‒ Special Philosophy ‒ A Distinct System.” He brought chiropractic into the scientific arena.
B.J. Palmer re-develops chiropractic
D.D. Palmer's student and son, B.J. Palmer, assumed control of the Palmer School in 1906 and promoted professionalism and formal training in chiropractic, expanding enrollment to a peak of above 1,000 students in the early 1920s. Chiropractic leaders of the time often invoked religious imagery, and B.J. seriously considered declaring chiropractic a religion, deciding against this partly to avoid confusion with Christian Science. He also worked to overcome chiropractic's initial resistance to the use of medical technology, by accepting diagnostic technology such as spinal-rays — which he called spinography — in 1910.
Prosecution of doctors of chiropractic or DCs for unlicensed practice after the conviction of D.D. Palmer and a previous charge against B.J. Palmer resulted in B.J. and several Palmer graduates creating the Universal Chiropractic Association. Its initial purpose was to protect its members by covering their legal expenses should they get arrested. Its first case came in 1907, when Shegataro Morikubo DC of Wisconsin was charged with unlicensed practice of osteopathy. It was a test of the new osteopathic law. In an ironic twist, using mixer Langworthy's book “Modernized Chiropractic,” attorney Tom Morris legally differentiated chiropractic from osteopathy by the differences in the philosophy of chiropractic's "supremacy of the nerve" and osteopathy's "supremacy of the artery." Morikubo was freed, and the victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art and a philosophy, and B.J. Palmer became the "Philosopher of Chiropractic."
B.J. Palmer believed that their chiropractic school was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea, and then we show them how to sell it". The next 15 years saw the opening of 30 more chiropractic schools, including John Howard's National School of Chiropractic — now the National University of Health Sciences — that moved to Chicago, Illinois. Each school attempted to develop its own identity, while B.J. Palmer continued to develop the philosophy behind his father's discovery. Fueled by the persistent and provocative advertising of recent chiropractic graduates, local medical communities — who had the power of the state at their disposal — immediately had them arrested. There were only 12,000 practicing chiropractors with more than 15,000 prosecutions for practicing medicine without a license in the first 30 years. D.D. Palmer was also jailed for practicing medicine without a license. Tom Morris and his partner, Fred Hartwell, were able to successfully defend 80% through the UCA. B.J. would later note about those battles:
"We are always mindful of those early days when UCA...used various expedients to defeat medical court prosecutions. We legally squirmed this way and that, here and there. We did not diagnose, treat or cure disease. We analyzed, adjusted cause and Innate in patient cured. All were professional matters of fact in science, therefore justifiable in legal use to defeat medical trials and convictions."
His influence over the next several years further divided the “mixers” — or those who mixed chiropractic with other cures — from the “straights” who practiced chiropractic by itself.
D. D. Palmer’s last years
While B.J. worked to protect and develop chiropractic around the Palmer school, D.D. Palmer continued to develop his techniques from Oregon. In 1910, he theorized that nerves control health.
Before his sudden and controversial death in 1913, D.D. Palmer often voiced concern for B.J. Palmer's management of chiropractic. He challenged B.J.'s methods and philosophy and made every effort to regain control of chiropractic. He repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration — either too tense or too slack — affecting the tone or health of the end organ and noted, "A subluxated vertebra . . . is the cause of 95 percent of all diseases … The other five percent is caused by displaced joints other than those of the vertebral column."
During the long-fought battle for licensure in California, in 1911 he wrote of his philosophy for chiropractic, and hinted at his plan for the legal defense of chiropractic.
In "The Chiropractor" — published posthumously in 1914 — D.D. Palmer revisits the topic of chiropractic as religion, quoting F.W. Carlin as saying "The religion of chiropractic is absurd.” He continued: "I fully agree with Dr. Carlin. To say or think that the science, art and philosophy of chiropractic, or that chiropractic, the three combined, has a religion, is really absurd and ridiculous.”
The 2008 book “Trick or Treatment” states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, at a homecoming parade for the Palmer School of Chiropractic. Weeks later D.D. Palmer died. The official cause of death was recorded as typhoid. The book “Trick or Treatment” indicated "it seems more likely that his death was a direct result of injuries caused by his son." There was speculation that it was not an accident, but instead a case of patricide. Chiropractic historian Joseph C. Keating, Jr. has described the attempted patricide of D.D. Palmer as a "myth" and "absurd on its face," citing an eyewitness who recalled that D.D. was not struck by B.J.'s car, but rather, had stumbled. He also says that "Joy Loban, DC, executor of D.D.'s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son." They had become bitter rivals over the leadership of chiropractic. B.J. Palmer resented his father for the way he treated his family, stating that his father beat three of his children with straps and was so much involved in chiropractic that he hardly knew his children. D. D. claimed that his son B. J. struck him with his car.
Straights vs. mixers
State laws to regulate and protect chiropractic practice were introduced in all 50 states in the U.S. Medical examining boards worked to keep all health care practices under their legal control, but an internal struggle among doctors of chiropractic on how to structure the laws complicated the process. Initially, the UCA, led by B.J. Palmer, opposed state licensure altogether. Palmer feared that such regulation would lead to M.D. physician control of the profession. The UCA eventually caved in, but B.J. remained strong in the opinion that examining boards should be composed exclusively of chiropractors — not mixers, and the educational standards to be adhered to were the same as the Palmer School. A "Model Bill" was drafted in 1922 to present to all states that did not yet have a law. They warned state associations to purge their mixing members or face competition by the formation of a new "straight" association in their state.
Although D.D. and B.J. were "straight" and disdained the use of instruments, some early chiropractors — who B.J. scornfully called "mixers" — advocated the use of instruments. In 1910 B.J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students.
The mixer camp grew until by 1924, B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J.'s invention and promotion of the neurocalometer, a temperature-sensing device, was highly controversial among B.J.'s fellow straights. By the 1930s chiropractic was the largest alternative healing profession in the U.S.
Mixers, disturbed by the edicts of the PSC having so much influence in their daily practice, created the American Chiropractic Association — one of the early precursors to today's ACA. Though born out of necessity to defend against the UCA attacks, the ACA's stated purposes were to advance education and research for chiropractic. Its growth was initially stunted by its resolution to recognize physiotherapy and other modalities as pertaining to chiropractic. What growth did occur was credited to its second president, Frank R. Margetts, DC with support from his alma mater, National Chiropractic College. He insisted that no college administrator could hold an official position in the association, giving doctors in the field a collective voice. But a disagreement within the UCA in 1924 turned the tide for the ACA. B.J. was still working to purge mixers from practicing chiropractic, and he saw a new invention by Dossa D. Evans, the "Neurocalometer" or NCM, as the answer to all of straight chiropractic's legal and financial problems. As the owner of the patent on the NCM, he planned to limit the number of NCMs to 5,000 and lease them only to graduates of the Palmer-related schools who were members of the UCA. He then claimed that the NCM was the only way to accurately locate subluxations, preventing over 20,000 mixers from being able to defend their method of practice.
There was an immediate uproar among practicing DCs. Even Tom Moore, B.J.'s long-time ally and president of the UCA, displayed his dismay by resigning, though he was later reinstated. B.J. reluctantly resigned as treasurer, ending his relationship with the UCA. B.J. moved on to form the Chiropractic Health Bureau which is today's ICA, along with his staunchest supporters and Fred Hartwell — Tom Moore's partner — acting as council. Membership in the UCA dropped while the ACA membership rose. In 1930, the ACA and UCA joined to form the National Chiropractic Association. The NCA developed a Committee on Educational Standards, making John J. Nugent DC responsible for raising educational standards for the profession. The years of consolidation or closing of unacceptable schools while developing the new standards earned Nugent the nickname "Chiropractic's Abraham Flexner" from his admirers and "Chiropractic's Anti-Christ" from his adversaries. The CES evolved into today's Council on Chiropractic Education and was granted the status of chiropractic's accrediting body by the U.S. Department of Education. Nugent was also instrumental in the Chiropractic Research Foundation, today's Foundation for Chiropractic Education and Research. The differences in state laws that exist today can be traced back to these early legal struggles.
Chiropractic struggled with survival and identity during its formative years, including internal struggles between its leaders and colleges. Chiropractic is rooted in mystical concepts, leading to internal conflicts between straights and mixers which continue to this day. Objective straight chiropractors — who are an offshoot of straights — only focus on the correction of chiropractic vertebral subluxations while traditional straights claim that chiropractic adjustments are a plausible treatment for a wide range of diseases. Reform chiropractors are an evidence-based offshoot of mixers who reject traditional Palmer philosophy and tend not to use alternative medicine methods. From 1984 to about 2008, some of them were organized as the National Association for Chiropractic Medicine, an organization which met strong opposition from the profession and finally ceased to exist.
Debate
There is continued disagreement over what "innate" and "subluxation" mean to chiropractic. Some chiropractors believe in Innate Intelligence, a faith-based, unscientific belief which has been a source of derision for chiropractors. Chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; D.D. Palmer wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison." There is significant disagreement within the chiropractic community concerning vaccination, one of the most cost-effective public health interventions available. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. Although most chiropractic writings on vaccination focus on its negative aspects, antivaccination sentiment is espoused by what appears to be a minority of chiropractors. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
Scope and practice
Chiropractors emphasize the conservative management of the neuro-musculoskeletal system without the use of medicines or surgery, with special emphasis on the spine. Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues. There is a range of opinions among chiropractors: some believed that treatment should be confined to the spine, or back and neck pain; others disagreed. For example, while one 2009 survey of American chiropractors had found that 73% classified themselves as "back pain/musculoskeletal specialists", the label "back and neck pain specialists" was regarded by 47% of them as a least desirable description in a 2005 international survey. Chiropractic combines aspects from mainstream and alternative medicine, and there is no agreement about how to define the profession: although chiropractors have many attributes of primary care providers, chiropractic has more attributes of a medical specialty like dentistry or podiatry. It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems, but the more expansive view of chiropractic is still widespread.
Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine or CAM; and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine and 12% as mainstream medicine. Many chiropractors believe they are primary care providers — including U.S. and UK chiropractors — but the length, breadth and depth of chiropractic clinical training do not support the requirements to be considered primary care providers, so their role on primary care is limited and disputed.
Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy and sports medicine. Chiropractic is autonomous from and competitive with mainstream medicine, and osteopathy outside the U.S. remains primarily a manual medical system; physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. Practitioners may distinguish these competing approaches through claims that compared to other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.
Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments and orthopedic and neurological evaluation. A chiropractor may also refer a patient to an appropriate specialist or co-manage with another health care provider. Common patient management involves spinal manipulation and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures and lifestyle advice.
Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States, although New Mexico has become the first U.S. state to allow "advanced practice" trained chiropractors to prescribe certain medications. In the U.S., their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa, broadly allow treatment of "human ailments;" some, such as Delaware, use vague concepts such as "transition of nerve energy" to define scope of practice; others, such as New Jersey, specify a severely narrowed scope. U.S. states also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs. A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.
A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in 40 U.S. states, but is not recognized by the American Chiropractic Association as being chiropractic. It remains controversial within certain segments of the veterinary and chiropractic profession.
No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Washington and Arkansas prohibit physical therapists from performing SM; some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.
Treatments
Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment" is the most common treatment used in chiropractic care. Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint. Its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion. High-velocity, low-amplitude spinal manipulation or HVLA-SM thrusts have physiological effects that signal neural discharge from paraspinal muscle tissues, depending on duration and amplitude of the thrust are factors of the degree in paraspinal muscle spindles activation. Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load. More generally, spinal manipulative therapy or SMT describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to or otherwise influence the spine and related tissues.
There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools. The following adjustive procedures were received by more than 10% of patients of licensed U..S chiropractors in a 2003 survey: Diversified technique (full-spine manipulation, employing various techniques), extremity adjusting, Activator technique (which uses a spring-loaded tool to deliver precise adjustments to the spine), Thompson technique (which relies on a drop table and detailed procedural protocols), Gonstead (which emphasizes evaluating the spine along with specific adjustment that avoids rotational vectors), Cox/flexion-distraction (a gentle, low-force adjusting procedure which mixes chiropractic with osteopathic principles and utilizes specialized adjusting tables with movable parts), adjustive instrument, Sacro-occipital technique (which models the spine as a torsion bar), Nimmo Receptor-Tonus technique, applied kinesiology (which emphasizes "muscle testing" as a diagnostic tool) and cranial. Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation. Koren Specific Technique or KST may use their hands, or they may use an electric device known as an "ArthroStim" for assessment and spinal manipulations. Insurers in the U.S. and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be "experimental and investigational". Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain.
Many other procedures are used by chiropractors for treating the spine, other joints and tissues, and general health issues. The following procedures were received by more than one-third of patients of licensed US chiropractors in a 2003 survey: Diversified technique (full-spine manipulation; mentioned in previous paragraph), physical fitness/exercise promotion, corrective or therapeutic exercise, ergonomic/postural advice, self-care strategies, activities of daily living, changing risky/unhealthy behaviors, nutritional/dietary recommendations, relaxation/stress reduction recommendations, ice pack/cryotherapy, extremity adjusting (also mentioned in previous paragraph), trigger point therapy and disease prevention/early screening advice.
A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine. The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%. A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a United States chiropractic college found Diversified, Gonstead and upper cervical manipulations are frequently used methods.
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