View source for Chiropractic

{{Quote box |quote= Chiropractic: from [[Greek language|Greek]] ''chiro-'' χειρο- "hand-" <br/> + ''praktikós'' πρακτικός "concerned with action" |source=([[OED]])}}
[[Image:Chiropractic.jpg|alt=Pastiche of man thinking and writing; the ribs, vertebrae, and hip bones of a human skeleton; a hand holding another; and Leonardo's famous drawing of a man in square and circle | right | 250px]]

==Definition==


'Chiropractic'  is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the human body with emphasis on the role of the neuromusculoskeletal system, its specific conditions and their effects on general health.  There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint dysfunction/"[[subluxation]]" <ref name=WHO-guidelines/> <ref name=Nelson>{{cite journal |journal=Chiropr Osteopat |date=2005 |volume=13 |pages=9 |title=Chiropractic as spine care: a model for the profession |author=Nelson CF, Lawrence DJ, Triano JJ ''et al.'' |doi=10.1186/1746-1340-13-9 |pmid=16000175 |url=http://chiroandosteo.com/content/13/1/9 |pmc=1185558 }}</ref>   Chiropractic is the third largest doctoral profession, behind medicine and dentistry<ref name=Smith>{{cite web |url=http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html |title= Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure. |author= Smith M, Morschhauser S |publisher= [[National Library of Medicine]] |accessdate=2008-05-06}}</ref> and, in North America,  are  the largest complementary alternative medical (CAM) profession. <ref name=Kaptchuk-Eisenberg/> In the U.S., chiropractors perform over 90% of all manipulative treatments.<ref>{{cite web |url=http://www.chirobase.org/05RB/AHCPR/12.html  |title=Chiropractic in the United States:Training, Practice, and Research |accessdate=2010-10-01 |year=2010 |publisher=Chirobase}}</ref>

==Scope of Practice==

Chiropractors, (also known as ''doctors of chiropractic'' or ''chiropractic physicians''<ref>[http://www.acatoday.org/pdf/physicianstatus.pdf List of States (and Federal Gov't) Defining DC's as "Physicians"]. Retrieved 2010-05-03.</ref> in all but a handful of jurisdictions),<ref>{{cite journal |journal=JAMA |year=1998 |volume=280 |issue=9 |pages=795–802 |title=Roles of nonphysician clinicians as autonomous providers of patient care |author=Cooper RA, Henderson T, Dietrich CL |pmid=9729991 |doi=10.1001/jama.280.9.795 }}</ref> are primary contact, portal of entry health care practitioners who diagnose and conservatively manage (primarily but not exclusively) the neuromusculoskeletal system without the use of medicines or surgery,<ref name=WHO-guidelines/> 
The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.<ref name=WHO-guidelines/> A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.<ref name=Meeker-Haldeman/> Common patient management involves [[spinal manipulation]] (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, including prescribing natural substances, and lifestyle counseling.<ref name=content-of-practice>{{cite book |chapterurl=http://chiroweb.com/archives/ahcpr/chapter3.htm |chapter= Content of practice |author= Mootz RD, Shekelle PG |year=1997 |title= Chiropractic in the United States: Training, Practice, and Research |pages=67–91 |editor= Cherkin DC, Mootz RD (eds.) |accessdate=2008-10-10 |location= Rockville, MD |publisher= Agency for Health Care Policy and Research |oclc=39856366}} AHCPR Pub No. 98-N002.</ref>

== Education, licensing, and regulation ==
Chiropractors obtain a [[first professional degree]] in the field of chiropractic.<ref>{{cite web |url=http://nces.ed.gov/programs/coe/glossary/f.asp |title= Glossary |publisher= National Center for Education Statistics, [[U.S. Dept. of Education]] |accessdate=2009-06-05}}</ref> The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has been more similar than not, both in the kinds of subjects offered and in the time assigned to each subject.<ref>{{cite journal |author=Johnson C Green B |title=100 Years After the Flexner Report: Reflections on Its Influence on Chiropractic Education |journal=J Chiropr Educ |volume=24 |issue=2 |pages=145–152 |year=2010 |pmc=2967338 |pmid=21048876 }}</ref> Accredited chiropractic programs in the U.S. require that applicants have 90 semester hours of undergraduate education with a grade point average of at least 3.0 on a 4.0 scale; many programs require at least three years of undergraduate education, and more are requiring a bachelor's degree.<ref>{{cite web |url=http://www.chirocolleges.org/prospective_students.html |title=Prospective students |publisher=Association of Chiropractic Colleges |accessdate=2009-07-23}}</ref> Canada requires a minimum three years of undergraduate education for applicants, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program.<ref>{{cite web |url=http://chirofed.ca/english/pdf/Standards_for_Doctor_of_Chiropractic_Programmes.pdf |format=PDF |title=Standards for Doctor of Chiropractic Programmes |date=2008-04-05 |publisher=[[Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards]] |accessdate=2009-04-23}}</ref> Graduates of the [[Canadian Memorial Chiropractic College]] (CMCC) are formally recognized to have at least 7–8 years of university level education.<ref name=CMCCMediaRelations>{{cite web |url=http://www.cmcc.ca/Media_Relations.html |title= Media Relations |publisher= [[Canadian Memorial Chiropractic College]] |accessdate=2010-12-14}}</ref><ref name=GovOntario>{{cite web |url=http://www.edu.gov.on.ca/eng/general/postsec/degreegr.html |title=Degree Authority in Ontario |publisher=Ontario Ministry of Training, Colleges and Universities |accessdate=2010-12-14}}</ref> The [[World Health Organization]] (WHO) guidelines suggest three major full-time educational paths culminating in either a [[Doctor of Chiropractic|DC, DCM, BSc, or MSc]] degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.<ref name=WHO-guidelines/>

Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being [[licensed]] to practice in a particular jurisdiction.<ref>{{cite web |url=http://life.edu/node/94 |title= State chiropractic licensure |accessdate=2009-06-05 |year=2008 |publisher= [[Life University]]}}</ref><ref>{{cite web |url=http://chirofed.ca/english/becoming.html |title= Becoming a chiropractor |publisher=Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards |accessdate=2009-06-05}}</ref> Depending on the location, continuing education may be required to renew these licenses.<ref>{{cite journal |pmc=1839972 |title= Continuing Health Education in Canada |author= Grod JP |journal= [[J Can Chiropr Assoc]] |volume=50 |issue=1 |pages=14–7 |year=2006 |pmid=17549163}}</ref><ref>{{cite journal |journal= Chiropr Osteopat |year=2005 |volume=13 |pages=22 |title= An online survey of chiropractors' opinions of continuing education |author= Stuber KJ, Grod JP, Smith DL, Powers P |url=http://chiroandosteo.com/content/13/1/22 |pmid=16242035 |doi=10.1186/1746-1340-13-22 |pmc= 1282582 |issue=1}}</ref> Specialty training is available through part-time postgraduate education programs such as chiropractic [[orthopedics]] and sports chiropractic, and through full-time residency programs such as [[radiology]] or [[orthopedics]].<ref>{{cite book |chapterurl=http://chiroweb.com/archives/ahcpr/chapter3.htm |chapter= Chiropractic training |author= Coulter ID, Adams AH, Sandefur R |year=1997 |title= Chiropractic in the United States: Training, Practice, and Research |pages=17–28 |editor= Cherkin DC, Mootz RD (eds.) |url=http://curziechiropractic.com/forms/ahcpr/uschiros.pdf |accessdate=2008-05-11 |location= Rockville, MD |publisher= Agency for Health Care Policy and Research |oclc=39856366}} AHCPR Pub No. 98-N002.</ref>

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.<ref name=global-strategy>{{cite web |url=http://chiropracticdiplomatic.com/strategies/global_strategy.pdf |format=PDF |title=Global professional strategy for chiropractic |author=Tetrault M |publisher=Chiropractic Diplomatic Corps |year=2004 |accessdate=2008-04-18 }}</ref> In the U.S., chiropractic schools are accredited through the [[Council on Chiropractic Education]] (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK.<ref>{{cite web |title=The Council on Chiropractic Education (CCE) |url=http://cce-usa.org/ |publisher= The Council on Chiropractic Education |accessdate=2008-07-05 }}</ref><ref>{{cite web |url=http://www.gcc-uk.org/page.cfm |title=The General Chiropractic Council |work= |accessdate=2008-07-26 }}</ref> The U.S. CCE requires a mixing curriculum, which means a straight-educated chiropractor may not be eligible for licensing in states requiring CCE accreditation.<ref name=Morrison>{{cite journal|author=Morrison P|title=Adjusting the role of chiropractors in the United States: why narrowing chiropractor scope of practice statutes will protect patients|journal=Health Matrix Clevel|volume=19|issue=2|pages=493–537|year=2009|pmid=19715143 }}</ref>  CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally.<ref name=CCEI>{{cite web | url = http://www.cceintl.org/About_Us.html | title = About Us | accessdate = 2010-09-30 | publisher = [[Councils on Chiropractic Education International]]}}</ref> Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,<ref>{{cite web |title=Accredited Doctor of Chiropractic programs |url=http://cce-usa.org/adcp.php |publisher=The Council on Chiropractic Education |accessdate=2008-02-22 |archiveurl = http://web.archive.org/web/20080214031937/http://www.cce-usa.org/adcp.php |archivedate = 2008-02-14}}</ref> 2 in Canada,<ref>{{cite web |url=http://chirofed.ca/english/accreditation.html |title=Accreditation of educational programmes |publisher=Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards |accessdate=2009-06-05 }}</ref> 6 in Australasia,<ref name=CCEA>{{cite web | url = http://www.ccea.com.au/Accreditation/Program%20Accreditation%20Status.htm | title = Program Accreditation Status | accessdate = 2010-09-30 | publisher = Council on Chiropractic Education Australasia}}</ref> and 5 in Europe.<ref>{{cite web |url=http://cce-europe.org/institutions.php |title=Institutions holding ''Accredited Status'' with the ECCE |publisher=[[European Council On Chiropractic Education]] |date=2009-07-23 |accessdate=2009-07-25 }}</ref> All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges.<ref name="DeVocht-JW">{{cite journal|journal=Clin Orthop Relat Res|year=2006|volume=444|pages=243–9|title=History and overview of theories and methods of chiropractic: a counterpoint|author=DeVocht JW|doi=10.1097/01.blo.0000203460.89887.8d|pmid=16523145 }}</ref> Of the two chiropractic colleges in Canada, one is publicly funded ([[UQTR]]) and one is privately funded ([[CMCC]]). In 2005, CMCC was granted the privilege of offering a professional health care degree under the Post-secondary Education Choice and Excellence Act, which sets the program within the hierarchy of education in Canada as comparable to that of other primary contact health care professions such as medicine, dentistry and optometry.<ref name=CMCCMediaRelations/><ref name=GovOntario/> Chiropractic curricula in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine.<ref>{{cite journal |author=Marcus DM, McCullough L |title=An evaluation of the evidence in "evidence-based" integrative medicine programs |journal=Acad Med |volume=84 |issue=9 |pages=1229–34 |year=2009 |pmid=19707062 |doi=10.1097/ACM.0b013e3181b185f4 }}</ref>

Regulatory colleges and chiropractic boards in the U.S., Canada, Mexico, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.<ref>{{cite web | url = http://www.chiropracticcanada.ca/en-us/FactsFAQs.aspx | title = Canadian Chiropractic Association FAQs | accessdate = 2010-10-02 | publisher = [[Canadian Chiropractic Association]]}}</ref><ref>{{cite web | url = http://pacex.fclb.org/Information/FAQ/tabid/364/Default.aspx | title = Federation of Chiropractic Licensing Boards FAQ | accessdate = 2010-10-02 | publisher = [[Federation of Chiropractic Licensing Boards]]}}</ref> There are an estimated 49,000 chiropractors in the U.S. (2008),<ref name=BLS>{{cite web|url=http://www.bls.gov/oco/ocos071.htm|title=Chiropractors|publisher= [[U.S. Bureau of Labor Statistics]]|accessdate=2008-07-05|year=2007}}</ref> 6,500 in Canada (2010),<ref>{{cite web | url = http://www.chiropracticcanada.ca/en-us/AboutUs/ChiropracticInCanada.aspx | title = Canadian Chiropractic Association: Chiropractic in Canada | accessdate = 2010-10-02 | publisher = [[Canadian Chiropractic Association]]}}</ref> 2,500 in Australia (2000),<ref name=Campbell/> and 1,500 in the UK (2000).<ref>{{cite book |title= The Chiropractic Profession: Its Education, Practice, Research and Future Directions |author= Chapman-Smith D |year=2000 |chapter= Current status of the profession |isbn=1-892734-02-8 |publisher=[[NCMIC]] |location= West Des Moines, IA}}</ref>

==Diagnostic and Treatment Procedures==

A core area of focus and expertise of chiropractors is the evaluation of the neuromusculoskeletal (NMS) system with a particular focus on the joints of the spine and extremities. In addition to physical, neurological, orthopedic, radiographic and laboratory tests a core and unique aspect of chiropractic care is the chiropractic examination, or manual palpation of the joint and soft tissues for structural and functional integrity.  Manual therapy/techniques is the most common mode of therapy done in clinical chiropractic practice although adjunctive therapies are also used. Manual therapy consists of procedures by which the hands directly contact the body to treat the articulations or soft tissues.  Spinal manipulative therapy is the defining  procedure performed  in clinical chiropractic practice.  Chiropractic spinal manipulative therapy (CSMT) involves a high-velocity, low amplitude (HVLA) thrust to a dysfunctional (subluxated) joint(s to help improve biomechanical and neurological function.  In the U.S., chiropractors perform over 90% of all manipulative treatments.<ref>{{cite web |url=http://www.chirobase.org/05RB/AHCPR/12.html  |title=Chiropractic in the United States:Training, Practice, and Research |accessdate=2010-10-01 |year=2010 |publisher=Chirobase}}</ref>

== Manipulation/Adjustment Techniques ==
[[Spinal manipulation]], also known as"spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care.<ref name=NBCE_techniques/> 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.<ref name=ACA-SMP/> High-velocity, low-amplitude spinal manipulation (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.<ref>{{cite journal |journal=Spine |year=2007 |volume=7 |issue=5 |pages=583– 95 |title= RESPONSE OF LUMBAR PARASPINAL MUSCLES SPINDLES IS GREATER TO SPINAL MANIPULATIVE LOADING COMPARED WITH SLOWER LOADING UNDER LENGTH CONTROL |author= Pickar JG, Sung PS, Kang YM, Ge W |pmid=17905321 |pmc=2075482 |doi=10.1016/j.spinee.2006.10.006 |url=http://www.thespinejournalonline.com/article/S1529-9430(06)00973-9/abstract }}</ref> More generally, [[spinal manipulative therapy]] (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.<ref name=ACA-SMP>{{cite web |url=http://acatoday.org/pdf/spinal_manipulation_policy.pdf |format=PDF |title= Spinal manipulation policy statement |author= Winkler K, Hegetschweiler-Goertz C, Jackson PS ''et al.'' |accessdate=2008-05-24 |year=2003 |publisher= American Chiropractic Association}}</ref>

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:<ref name=NBCE_techniques/> [[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), [[Clarence Gonstead#Gonstead Technique|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), [[Neuromuscular therapy|Nimmo Receptor-Tonus Technique]], [[Applied Kinesiology]] (which emphasises "muscle testing" as a diagnostic tool), and cranial.<ref>{{cite book |title=Technique Systems in Chiropractic |author=Cooperstein R, Gleberzon BJ |publisher=Churchill Livingstone |year=2004 |isbn=0-443-07413-5 |ref=TSC }}</ref> 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.<ref>{{cite journal |author=Dagenais S, Mayer J, Wooley JR, Haldeman S |title=Evidence-informed management of chronic low back pain with medicine-assisted manipulation |journal=Spine J |volume=8 |issue=1 |pages=142–9 |year=2008 |pmid=18164462 |doi=10.1016/j.spinee.2007.09.010 }}</ref>

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 U.S. chiropractors in a 2003 survey: [[Diversified technique]] (full-spine manipulation; mentioned in previous paragraph), [[physical fitness]]/[[exercise]] promotion, corrective or therapeutic exercise, [[ergonomic]]/[[Neutral spine|postural]] advice, self-care strategies, [[activities of daily living]], changing risky/unhealthy behaviors, [[Diet (nutrition)|nutritional/dietary]] recommendations, [[Relaxation technique|relaxation]]/[[stress reduction]] recommendations, [[Cryotherapy|ice pack/cryotherapy]], extremity adjusting (also mentioned in previous paragraph), [[Neuromuscular therapy|Trigger point therapy]], and [[disease prevention]]/early [[Screening (medicine)|screening]] advice.<ref name=NBCE_techniques>{{cite book |title= Job Analysis of Chiropractic |chapter= Professional functions and treatment procedures |year=2005 |pages=121–38 |author= Christensen MG, Kollasch MW |location= Greeley, CO |publisher= [[National Board of Chiropractic Examiners]] |chapterurl=http://nbce.org/pdfs/job-analysis/chapter_10.pdf |format=PDF |accessdate=2008-08-25 |isbn=1-884457-05-3}}</ref>

A 2010 study describing Belgium 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%.<ref>{{Cite pmid|21036284}}</ref> A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a U.S. chiropractic college found [[Diversified]], [[Gonstead]], and upper cervical manipulations are frequently used methods.<ref>{{cite journal |journal=J Manipulative Physiol Ther |year=2009 |volume=32 |issue=2 |pages=140–8 |title= Prevalence of musculoskeletal injuries sustained by students while attending a chiropractic college |author= Ndetan HT, Rupert RL, Bae S, Singh KP |doi=10.1016/j.jmpt.2008.12.012 |pmid=19243726}}</ref>

{{Navbox
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[[Active Release Technique]]•
[[Activator technique]]•
[[Applied kinesiology]] •
[[Atlas Orthogonal]]• 
[[Auricular]]•
[[Auriculotherapy]]•
[[Barge analysis]]•
[[Bio-Geometric integration]]•
[[Biomechanics]]•
[[Blair]]•
[[Carver technique]]•
[[Cervical care]]•
[[Cervical drop]]•
[[Chiropractic biophysics]]•
[[Chiropractic Cranial Technique]]•
[[Clinical kinesiology]]•
[[Chiropractic Manipulative Reflex Technique]]•
[[Contact reflex analysis]]•
[[Cox]]•
[[Directional non-Force]]•
[[Diversified technique]]•
[[FAKTR-PM]] •
[[Flexion-distraction]]•
[[Gonstead]]•
[[Graston]]•
[[Grostic]]•
[[Hole in one (HIO)]]•
[[Koren Specific]]•
[[Leander]]•
[[Logan basic]]•
[[Manipulation under anesthesia]]•
[[Manual adjusting]]•
[[Meric]]•
[[Motion palpation]]•
[[Network]]•
[[Neural organization technique]]•
[[Neuro muscular technique]]•
[[Neuro Vascular technique]]•
[[Nimmo]]•
[[NUCCA]]•
[[Palmer package]]•
[[Pettibon]]•
[[Pierce]]•
[[Pierce Stillwagon]]•
[[Pro-adjuster]]•
[[Receptor tonus]]•
[[Sacro Occipital Technique]]•
[[Soft tissue orthopedics]]•
[[Spinal adjustment]]•
[[Spinal biomechanics]]•
[[Spinal biomedical engineering]]•
[[Spinal biophysics]]•
[[Spinal column stressology]]•
[[Thompson]]•
[[Thompson terminal point]]•
[[Toggle recoil]]•
[[Torque release]]•
[[Total body modification]]•
[[Traction]]•
[[Trigger point therapy]]•
[[Upper cervical specific chiropractic|Upper Cervical]]•
[[Vector point therapy]]•
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{{Fringe techniques}}
{{Fringe treatments}}

==Physio-therapeutic methods==
{{PT modalities}}

==Identity==

Although there is inter and intraprofessional disagreement about the role of chiropractors as primary care providers in the mainstream health care system, contemporary chiropractic practice resembles more a medical specialty like dentistry or podiatry with a specialized focus. <ref name=Meeker-Haldeman>{{cite journal |journal=[[Ann Intern Med]] |year=2002 |volume=136 |issue=3 |pages=216–27 |title=Chiropractic: a profession at the crossroads of mainstream and alternative medicine |author=Meeker WC, Haldeman S |pmid=11827498 |url=http://www.annals.org/cgi/reprint/136/3/216.pdf |format=PDF }}</ref> It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,<ref name=Meeker-Haldeman/><ref name=Murphy-pod>{{cite journal |author= Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF |title= How can chiropractic become a respected mainstream profession? the example of podiatry |journal= Chiropr Osteopat |volume=16 |pages=10 |year=2008 |pmid=18759966 |doi=10.1186/1746-1340-16-10 |url=http://chiroandosteo.com/content/pdf/1746-1340-16-10.pdf |format=PDF |pmc= 2538524}}</ref> but the more expansive view of chiropractic is still widespread.<ref>{{cite journal |author=Gleberzon BJ, Cooperstein R, Perle SM |title=Can chiropractic survive its chimerical nature? |journal=J Can Chiropr Assoc |volume=49 |issue=2 |pages=69–73 |year=2005 |pmid=17549192 |pmc=1840015 }}</ref> Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be [[Alternative medicine|complementary and alternative medicine]] (CAM);<ref name=Chapman-Smith>{{cite book |author= Chapman-Smith DA, Cleveland CS III |chapter= International status, standards, and education of the chiropractic profession |pages=111–34 |title= Principles and Practice of Chiropractic |edition=3rd |editor= Haldeman S, Dagenais S, Budgell B ''et al.'' (eds.) |publisher=McGraw-Hill |year=2005 |isbn=0-07-137534-1}}</ref> and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.<ref name=Redwood-CAM>{{cite journal |journal=[[J Altern Complement Med]] |year=2008 |volume=14 |issue=4 |pages=361–8 |title=Do chiropractors identify with complementary and alternative medicine? results of a survey |doi=10.1089/acm.2007.0766 |pmid=18435599 |author=Redwood D, Hawk C, Cambron J, Vinjamury SP, Bedard J }}</ref> Aligning with conventional medicine could give chiropractors more university affiliation and access to hospitals and long-term facilities; aligning with the CAM movement could bring more patients looking for nonmedical approaches.<ref>{{cite book |author=[[#TSC|Cooperstein & Gleberzon]] |chapter=Current and future utilization rates and trends |pages=297–305 }}</ref>

==History==
(for History, see [[Chiropractic history]])

==Assimilation into Mainstream==

Chiropractic has gained greater acceptance among medical [[Physician|physicians]] and [[Health plan|health plans]] in the U.S.,<ref name="Cooper">{{cite journal |journal= [[Milbank Q]] |date=2003 |volume=81 |issue=1 |pages=107–38 |title= Chiropractic in the United States: trends and issues |author= Cooper RA, McKee HJ |doi=10.1111/1468-0009.00040 |pmid=12669653}}</ref> and [[Evidence-based medicine|evidence-based medicine]] has been used to review research studies and generate [[Medical guideline|practice guidelines]].<ref name="Villanueva-Russell" /> Many studies of treatments used by chiropractors have been conducted. Collectively, [[Systematic review|systematic reviews]] of this research has demonstrated that spinal manipulation is [[Efficacy#Healthcare|effective]]. Spinal manipulation has been alleged to have serious [[Complication (medicine)|complications]] in rare cases (about 1.4/1,000,000),<ref name="CCA-CFCREAB-CPG">{{cite journal |journal= J Can Chiropr Assoc |date=2005 |volume=49 |issue=3 |pages=158–209 |title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash |author= Anderson-Peacock E, Blouin JS, Bryans R ''et al.'' |url=http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf |format=PDF}} {{cite journal |journal= J Can Chiropr Assoc |date=2008 |volume=52 |issue=1 |pages=7–8 |title= A clinical practice guideline update from The CCA•CFCREAB-CPG |author= Anderson-Peacock E, Bryans B, Descarreaux M ''et al.'' |url=http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf |format=PDF}}</ref> this is clearly less than the risk of taking an aspirin tablet, and thus chiropractic care is generally safe when employed skillfully and appropriately.<ref name="WHO-guidelines">{{cite paper |author= World Health Organization |date=2005 |title= WHO guidelines on basic training and safety in chiropractic |url=http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |format=PDF |id= ISBN 92-4-159371-7 |accessdate=2008-02-29}}</ref> 

Chiropractic is autonomous, and in some ways competitive with mainstream medicine.<ref name="Pettman" /> Osteopathy enjoys medical licensing only in the US. Outside the U.S. it remains primarily a manual medical system, with mostly less recognition than Chiropractic;<ref>{{cite journal |journal= Complement Health Pract Rev |year=2006 |volume=11 |issue=2 |pages=77–94 |doi=10.1177/1533210106292467 |title= The drive for legitimization by osteopathy and chiropractic in Australia: between heterodoxy and orthodoxy |author= Baer HA}}</ref> physical therapists work as a part of mainstream medicine, and [[Osteopathic medicine in the U.S.|osteopathic medicine in the U.S.]] has merged with the medical profession.<ref name="Pettman">{{cite journal |author=Pettman E |title=A history of manipulative therapy |journal=J Man Manip Ther |volume=15 |issue=3 |pages=165–74 |year=2007 |pmid=19066664 |pmc=2565620}}</ref> Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.<ref name="Norris">{{cite journal |author= Norris P |year=2001 |title= How 'we' are different from 'them': occupational boundary maintenance in the treatment of musculo-skeletal problems |journal= Sociol Health Illn |volume=23 |issue=1 |pages=24–43 |doi=10.1111/1467-9566.00239}}</ref> Chirorpactors, uniquely use a high velocity, low intensity form of manipulation which requires a far higher degree of training and experience to effectively utilize. This may account for the difference in effectiveness of treatment, when one compares these approaches. In a landmark study in 1990 published in the [[British medical journal|British medical journal]] involving 741 patients, Chiropractic manipulation was found to be significantly superior to ANY other method of treating low back pain. The same group was followed and in 1995 the BMJ published the follow-up study showing that those results were still demonstrable in that patient population. Later studies showing lesser results apparently did NOT include Chiropractic methods of manipulation and this may be the reason for the significant difference.

==WorldWide presence==

Chiropractic is established in the [[U.S.]], [[Canada]], and [[Australia]], and is present to a lesser extent in as many as 90 other countries.<ref name=global-strategy>{{cite web |url=http://chiropracticdiplomatic.com/strategies/global_strategy.pdf |format=PDF |title= Global professional strategy for chiropractic |author= Tetrault M |publisher= [[Chiropractic Diplomatic Corps]] |date=2004 |accessdate=2008-04-18}}</ref> 

==Accreditation==
For Accreditation see: [[Educational accreditation]]
==Regulatory boards==
For Regulatory boards see:  [[Regulatory boards]]

== Utilization, satisfaction rates, and third party coverage ==

In the U.S., chiropractic is the third largest healing arts profession,<ref name=Kaptchuk-Eisenberg>{{cite journal |journal= [[Arch Intern Med]] |date=1998 |volume=158 |issue=20 |pages=2215–24 |title= Chiropractic: origins, controversies, and contributions |author= Kaptchuk TJ, Eisenberg DM |pmid=9818801 |url=http://archinte.ama-assn.org/cgi/content/full/158/20/2215 |doi= 10.1001/archinte.158.20.2215}}</ref> and is the third largest doctoral profession, behind  only medicine and dentistry.<ref>{{cite web |url=http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html |title= Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure.|coauthors= Smith M, Morschhauser S |publisher= [[National Library of Medicine]] |accessdate=2008-05-06}}</ref> The percentage of population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada,<ref name=Lawrence-Meeker/> with a global high of 20% in [[Alberta]].<ref>{{cite journal |url=http://chiroweb.com/archives/25/06/02.html |title= Chiropractic in Alberta: a model of consumer utilization and satisfaction |journal= Dyn Chiropr |volume=25 |issue=6 |author= Crownfield PW |date=2007}}</ref> Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors.<ref name=Kemper>{{cite journal |author= Kemper KJ, Vohra S, Walls R; Task Force on Complementary and Alternative Medicine; the Provisional Section on Complementary, Holistic, and Integrative Medicine |title= The use of complementary and alternative medicine in pediatrics |journal=Pediatrics |volume=122 |issue=6 |pages=1374–86 |year=2008 |pmid=19047261 |doi=10.1542/peds.2008-2173}}</ref> The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;<ref>{{cite journal |journal= [[BMC Health Serv Res]] |date=2006 |volume=6 |issue=49 |title= A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03 |author= Hurwitz EL, Chiang LM |doi=10.1186/1472-6963-6-49 |pmid=16600038 |url=http://www.biomedcentral.com/1472-6963/6/49 |pages=49 |pmc= 1458338}}</ref> most do so specifically for low back pain.<!-- <ref name=Lawrence-Meeker/> --> Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.<ref name=Lawrence-Meeker>{{cite journal |journal= Chiropr Osteopat |date=2007 |volume=15 |title= Chiropractic and CAM utilization: a descriptive review |author= Lawrence DJ, Meeker WC |doi=10.1186/1746-1340-15-2 |pmid=17241465 |url=http://chiroandosteo.com/content/15/1/2 |pages=2 |pmc= 1784103}}</ref> Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.<ref>{{cite journal |journal= J Manipulative Physiol Ther |date=2006 |volume=29 |issue=6 |pages=455–62 |title= Factors associated with patient satisfaction with chiropractic care: survey and review of the literature |author= Gaumer G |doi=10.1016/j.jmpt.2006.06.013 |pmid=16904491}}</ref>

==Insurance coverage==
For Insurance coverage see [[Insurance coverage]]

== Evidence basis ==

The principles of [[evidence-based medicine]] have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under [[managed care]]. <ref name=Villanueva-Russell>{{cite journal |journal= [[Soc Sci Med]] |date=2005 |volume=60 |issue=3 |pages=545–61 |title= Evidence-based medicine and its implications for the profession of chiropractic |author= Villanueva-Russell Y |doi=10.1016/j.socscimed.2004.05.017 |pmid=15550303}}</ref> Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be [[antiscientific]] reasoning and unsubstantiated claims,<ref name=Nelson/><ref name=Keating-subluxation>{{cite journal |journal=[[Chiropr Osteopat]] |date=2005 |volume=13 |pages=17 |title=Subluxation: dogma or science? |author=Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF |doi=10.1186/1746-1340-13-17 |pmid=16092955 |url=http://chiroandosteo.com/content/13/1/17 |pmc=1208927 }}</ref><ref name=History-Primer2>{{cite web |title= Chiropractic history: a primer |author= Keating JC Jr, Cleveland CS III, Menke M |url=http://data.memberclicks.com/site/ahc/ChiroHistoryPrimer.pdf |format=PDF |date=2005 |accessdate=2008-06-16 |publisher= Association for the History of Chiropractic |quote= A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).}}</ref><ref>Science, antiscience, materialism and vitalism:
*{{cite journal |author= Keating JC Jr |journal= [[Skept Inq]] |volume=21 |issue=4 |pages=37–43 |title= Chiropractic: science and antiscience and pseudoscience side by side |date=1997}}
*{{cite book |author= Phillips RB |chapter= The evolution of vitalism and materialism and its impact on philosophy |pages=65–76 |title= Principles and Practice of Chiropractic |edition=3rd |editor= Haldeman S, Dagenais S, Budgell B ''et al.'' (eds.) |publisher=[[McGraw-Hill]] |date=2005 |isbn=0-07-137534-1}}</ref> that have been called ethically suspect when they let practitioners maintain their beliefs to patients' detriment.<ref name=Nelson/> A 2007 survey of [[Alberta]] chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.<ref>{{cite journal |journal= J Manipulative Physiol Ther |year=2007 |volume=30 |issue=2 |pages=109–15 |title= How important is research-based practice to chiropractors and massage therapists? |author= Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD |doi=10.1016/j.jmpt.2006.12.013 |pmid=17320731}}</ref> Continued education enhances the scientific knowledge of the practitioner.<ref>{{cite journal |journal= Chiropr Osteopat |year=2006 |volume=14 |pages=18 |title= Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care |author= Feise RJ, Grod JP, Taylor-Vaisey A |pmid=16930482 |url=http://chiroandosteo.com/content/14/1/18 |doi=10.1186/1746-1340-14-18 |pmc= 1560147}}</ref>

== Effectiveness ==

Manual therapies commonly used by chiropractors are effective for the treatment of low back pain,<ref name=Cochrane-2011>{{cite journal|journal= [[Cochrane Database Syst Rev]]|year=2011|issue=2|pages=CD008112|title= Spinal manipulative therapy for chronic low-back pain|author= Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW|doi=10.1002/14651858.CD008112.pub2|pmid=21328304|volume=|editor1-last= Rubinstein|editor1-first= Sidney M}}</ref> <ref name=Dagenais-2010>{{cite journal|journal= [[Spine J]]|year=2010|volume=10|issue=10|pages=918–940|title= NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain|author= Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM|doi=10.1016/j.spinee.2010.07.389|pmid=20869008}}</ref> and might also be effective for the treatment of lumbar disc herniation with radiculopathy,<ref name="Leininger B, Bronfort G, Evans R, Reiter T 2011 105–25">{{cite journal |journal= Phys Med Rehabil Clin N Am |year=2011 |volume=22 |issue=1 |pages=105–25 |title= Spinal manipulation or mobilization for radiculopathy: a systematic review |author= Leininger B, Bronfort G, Evans R, Reiter T |pmid=21292148 |doi=10.1016/j.pmr.2010.11.002}}</ref><ref name="Hahne AJ, Ford JJ, McMeeken JM 2010 E488–504">{{cite journal |journal= Spine |year=2010 |volume=35 |issue=11 |pages=E488–504 |title= Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review |author= Hahne AJ, Ford JJ, McMeeken JM |pmid=20421859 |doi=10.1097/BRS.0b013e3181cc3f56}}</ref> neck pain,<ref name="Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL 2010 315–333">{{cite journal |journal= Manual Therapy |year= 2010 |volume=15 |issue=4 |pages=315–333 |title= Manipulation or mobilisation for neck pain: a Cochrane Review |author= Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL |pmid=20510644 |doi= 10.1016/j.math.2010.04.002 }}</ref> some forms of headache,<ref name="Chaibi A, Tuchin PJ, Russell MB 2011">{{cite journal |journal= J Headache Pain |year=2011 |volume= 12|issue= 2|pages= 127–33|title= Manual therapies for migraine: a systematic review |author= Chaibi A, Tuchin PJ, Russell MB |pmid=21298314 |doi=10.1007/s10194-011-0296-6 |pmc=3072494}}</ref><ref name="Bronfort G, Nilsson N, Haas M et al. 2004 CD001878">{{cite journal |journal= Cochrane Database Syst Rev |year=2004 |issue=3 |pages=CD001878 |title= Non-invasive physical treatments for chronic/recurrent headache |author= Bronfort G, Nilsson N, Haas M ''et al.'' |doi=10.1002/14651858.CD001878.pub2 |pmid=15266458 |editor1-last= Brønfort |editor1-first= Gert}}</ref> and some extremity joint conditions.<ref name="Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W 2009 53–71">{{cite journal |author= Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W |title= Manipulative therapy for lower extremity conditions: expansion of literature review |journal= J Manipulative Physiol Ther |volume=32 |issue=1 |pages=53–71 |year=2009 |pmid=19121464 |doi=10.1016/j.jmpt.2008.09.013}}</ref><ref name="pmid21109059">{{Cite pmid|21109059}}</ref> The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.<ref name=Leboeuf-Yde-C/> Chiropractic care is generally safe when employed skillfully and appropriately.<ref name=WHO-guidelines/> Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal [[Complication (medicine)|complications]] in exceedingly rare cases.<ref name=CCA-CFCREAB-CPG/>

== Cost-effectiveness ==

A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings.<ref>{{cite journal |journal= J Manipulative Physiol Ther |date=2006 |volume=29 |issue=9 |pages=707–25 |title= Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession |author= Mootz RD, Hansen DT, Breen A, Killinger LZ, Nelson C |doi=10.1016/j.jmpt.2006.09.001 |pmid=17142165}}</ref> A 2006 systematic [[cost-effectiveness]] review found that the reported cost-effectiveness of chiropractic manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to [[non-specific effect]]s) remains uncertain.A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.<ref>{{cite journal |journal= [[Best Pract Res Clin Rheumatol]] |date=2005 |volume=19 |issue=4 |pages=671–84 |title= What is the most cost-effective treatment for patients with low back pain? a systematic review |author= van der Roer N, Goossens MEJB, Evers SMAA, van Tulder MW |doi=10.1016/j.berh.2005.03.007 |pmid=15949783}}</ref> The cost-effectiveness of maintenance chiropractic care is unknown.<ref name=Leboeuf-Yde-C>{{cite journal|journal=Chiropr Osteopat|year=2008|volume=16|page=3|title=Maintenance care in chiropractic – what do we know?|author=Leboeuf-Yde C, Hestbæk L|doi=10.1186/1746-1340-16-3|pmid=18466623|url=http://chiroandosteo.com/content/16/1/3|pmc=2396648|issue=1}}</ref>

==Safety issues==
For Safety, see  [[Chiropractic safety]]

== Public health ==

Most chiropractors do NOT oppose reasonable [[vaccination]] or [[water fluoridation]], which are common [[public health]] practices. Although within the chiropractic community there are significant disagreements about vaccination,<ref name=Busse/><ref name=Campbell/> one of the most cost-effective public health interventions available.<ref>{{cite journal |author= Ehreth J |title= The global value of vaccination |journal=Vaccine |volume=21 |issue=7–8 |pages=596–600 |year=2003 |pmid=12531324 |doi=10.1016/S0264-410X(02)00623-0}}</ref> Most chiropractors have embraced  a reasonable approach to vaccination, but some of the profession, as in any large group rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing.<!-- <ref name=Campbell/> --> 

The [[American Chiropractic Association]] and the International Chiropractors Association support individual exemptions to compulsory vaccination laws. A 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. <ref name=Campbell>{{cite journal |journal=Pediatrics |date=2000 |volume=105 |issue=4 |pages=e43 |title= Chiropractors and vaccination: a historical perspective |author= Campbell JB, Busse JW, Injeyan HS |pmid=10742364 |url=http://pediatrics.aappublications.org/cgi/content/full/105/4/e43 |doi= 10.1542/peds.105.4.e43}}</ref> The [[Canadian Chiropractic Association]] supports vaccination;<ref name=Busse>{{cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=5 |pages=367–73 |title= Chiropractic antivaccination arguments |author= Busse JW, Morgan L, Campbell JB |doi=10.1016/j.jmpt.2005.04.011 |pmid=15965414 |url= http://jmptonline.org/article/S0161-4754(05)00111-9/fulltext}}</ref> a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.<ref>{{cite journal |author= Russell ML, Injeyan HS, Verhoef MJ, Eliasziw M |title= Beliefs and behaviours: understanding chiropractors and immunization |journal=Vaccine |volume=23 |issue=3 |pages=372–9 |year=2004 |pmid=15530683 |doi=10.1016/j.vaccine.2004.05.027}}</ref>

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.<ref>{{cite journal |journal= Am J Public Health |date=1989 |volume=79 |issue=10 |pages=1405–8 |title= Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success |author= Jones RB, Mormann DN, Durtsche TB |pmid=2782512 |pmc=1350185 |url=http://www.ajph.org/cgi/reprint/79/10/1405.pdf |format=PDF |doi= 10.2105/AJPH.79.10.1405}}</ref>

== References ==
{{Reflist|3}}

==External links==
* {{dmoz|Health/Alternative/Chiropractic}}

{{Chiropractic}}

==Other languages==


*[[:ar:الكايروبراكتك]]
*[[:fr:chiropratique]]
*[[:de:Chiropraktik]]
*[[:es:quiropráctica]]
*[[:it:chiropractica]]
*[[:no:Kiropraktor]]
*[[:ru:Кайропрактик]]
*[[:ru:Хиропрактик]] (Alternate spelling)
*[[:uk:Кайропрактика]]

{{ATTRIB}}
[[Category:Chiropractic]]
[[Category:Definitions]]