Though comparatively new to the main stream of medical healthcare, the art of chiropractic has been practiced for thousands of years. Hippocrates and Galen, the famous Greek and Roman physicians, used such hands-on treatments to reposition the spine and to treat a wide range of disorders (Redwood 1996). Chiropractors employ a wide range of spinal adjustments to alleviate stress & inflammation – improving functions of muscles, joints, ligaments, and nerves while decreasing pain, relaxing muscle spasms, and restoring ranges of motion.
Chiropractic is based on the principal that vertebral joint dysfunctions (subluxations), interfere with nerve transmission and disturb normal body function. The definition of the joint dysfunction has been expanded beyond the original concept of vertebral malposition to include mechanical impediments that affect mobility, posture, blood flow, and muscle tone (Kaptchuk and Eisenbert 1998). The broad-scope modernists chiropractor will seek to treat both the cause and the symptom, contending that patient care is in some instances enhanced by such adjuncts such as electrical physical therapy modalities, hands-on muscle therapies, acupuncture, and nutritional regimes including supplementations with vitamins, minerals and herbs (Redwood 1996). These chiropractors employ a wide range of physiotherapy modalities in their treatment course and will often confer and co-treat with many other health professionals including, registered massage therapists, naturopathic doctors, and allopathic medical doctors.
The initial visit to a chiropractor is similar to many respects to a typical doctor’s visit. The chiropractor takes the patient’s complete medical history and checks on vitals signs, height, weight, blood pressure, pulse, temperature, and respiratory rate. A detailed examination of the spine and related structure helps determine the severity of the problem. The initial and subsequent visits are likely to include high velocity, low amplitude thrusts, and continual reevaluation of the presenting problem. If inflammation or muscle spasms are present, the chiropractor may employ ultrasound, electric simulation, vibration, stretching exercises, moist heat, cold packs, or sport massages before or after spinal adjustments. Recommendations for bed rest, corrective exercise, fitness, nutrition, and stress management may also be made.
Ninety-five percent of chiropractic visits are for musculosketal disorders and injuries that result in headaches, and lower back, neck, leg, or arm pain. Such disorders and injuries are the major cause of chronic health problems, long term disability, and healthcare visits, and a major cause of short-term disability and the use of prescription and non-prescription pain-relief drugs (Manga 2000). Numerous studies have shown that spinal manipulations have been especially effective in the treatment of back pain, the second most common ailment for which patients seek alternative therapy (Ofman 1999). Research have also shown that chiropractic care can improve function and provide a faster recovery from back pain than other modalities. In two studies, it was shown that patient satisifaction with treatment provided by chiropractors, orthopedists, and primary car physicians, reported greater satisfaction with chiropractic than the other modalities (Ofman 1999).
In addition, randomized, controlled trials have demonstrated that people with chronic tension headaches and migraines experience longer-term improvement and few side effects with chiropractic care than with pharmaceutical intervention (Boline et. al. 1995; Nelson et al. 1998). Research has also found that shoulder girdle problems are helped by chiropractic manipulation of the neck, upper back, and shoulder (Winters et al. 1997).
There are case reports and anecdotal information that suggest that chiropractic may also be helpful adjunct for arthritis, chronic fatigue syndrome, hypertension, menstrual disorders, periodic leg movement syndrome, pregnancy and childbirth concerns, premenstrual syndrome, rheumatoid arthritis, sprains, tendonitis, tenosynovitis, vision disorders, and temporamandibular joint disorder (Hansen and Triano 2000).
Chiropractic has also been widely used as a preventative therapy, and the profession is widely involved in health promotion and prevention education throughout their community.
Risks, Side Effects, & Adverse Events
Studies have indicated that chiropractic care is generally more safe than medication for the treatment of pain (Gottlieb 1997). Side effects are not common, but some patients may experience minor aches, muscle fatigue, and stiffness for a few days following manipulations. Although extremely rare, reports have suggested the risk of stroke and spinal cord damage from cervical manipulation in 1 in 4 million treatments (in comparison – there is more a likely chance that one is struck by lightning twice in a lifetime) (Terret 2001).
Contraindications to chiropractic care include fractures, bone tumors, bone and joint infections, and acute cauda equina syndrome (Redwood 1996). Those with acute myelopathy, advance osteoporosis, cancer, congenital or acquired deformities, undiagnosed or progressive neurological deficits, and vertebral basilar syndrome, should not receive chiropractic in the affected area (Hansen and Triano 2000). Patients with a history of hypertension and those receiving heparin therapy, should be monitored closely while receiving chiropractic treatments (Plaugher and Bachman 1993).
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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.
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Terrett AG. Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation. Des Moines, IA: NCMIC Group; 2001.
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. BMJ. 1997;314(7090):1320-1325.