Please forgive the slight inconvenience in creating a new account. Due to juvenile delinquents spamming garbage to the site, we had to install a "Captcha", which can differentiate a spam bot from a human. Once you open your account, confirm it by returning the email, and identifying yourself, we will give you edit privileges. Just request them by leaving a message at click here.

Difference between revisions of "Chiropractic"

From English WikiChiro
Jump to: navigation, search
(Exercise-Rotator Cuff Impingement)
(Effectiveness)
 
(37 intermediate revisions by 3 users not shown)
Line 5: Line 5:
  
  
'Chiropractic'  is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these 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 complimentary 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>
+
'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==
 
==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/>  
 
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, 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>
+
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 ==
 
== 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/>
+
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#Continuing education for professionals|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>
+
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 [[United States|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>
+
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>
 
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>
Line 25: Line 25:
 
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>
 
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 ==
== 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>
 
[[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>
 
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>
+
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>
+
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>
  
==Exercise therapy==
+
{{Navbox
 +
| name  = Chiro. treatment  techniques
 +
| title = [[Chiro. treatment techniques]] > [[Chiro. treatment techniques]]
 +
| state = {{{state<includeonly>|autocollapse</includeonly>}}}
 +
| groupstyle = white-space:nowrap;
  
===Exercise-Neck pain===
+
| group1 =  
 +
| list1 = <div>
 +
[[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]]•
 +
[[Versendaal]]•
 +
</div>
 +
}}
  
Exercise is an integral component of well-rounded treatment protocol utilized by doctors of chiropractic for the recovery of musculoskeletal injury.  This section will review the literature related to neck and low back pain.
+
{{Fringe techniques}}
 +
{{Fringe treatments}}
  
* According to a 2010 systematic review by Miller et al, there is much quality evidence for '''manual therapy and exercise''' in the treatment of whiplash associated disorder (WAD).  The paper states: “Favored over traditional care in reducing pain at short-term follow-up for acute WAD”. <ref name="exercise and neck pain"> {{Cite paper
+
==Physio-therapeutic methods==
| last1 = Miller
+
{{PT modalities}}
| first1 = J et al
+
| title = Manual therapy and exercise for neck pain: a systematic review
+
| journal = Manual therapy
+
| volume = 15
+
| issue = 4
+
| pages = 334-354
+
| year = Aug 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20593537
+
| accessdate = 12-1-2013}}</ref>
+
 
+
* There is a lack of research regarding '''manual therapy and exercise''' in the treatment of '''neck pain with radicular symptoms''' <ref name="exercise and neck pain"/> 
+
 
+
* Manual therapy and exercise improve '''pain and function''' over the long term in comparison to short term relief only with manual therapy alone. Additionally, manual therapy and exercise improve short term pain relief in comparison to exercise alone <ref name="exercise and neck pain"/>
+
 
+
* Manual therapy and exercise improve “'''pain, function, quality of life and patient satisfaction'''” in comparison to manual therapy alone in treatment of chronic neck pain <ref name="exercise and neck pain"/>
+
 
+
* Additional research is needed to determine the best '''manual therapy''' to use in combination with '''exercise''', and vica versa. <ref name="exercise and neck pain"/>
+
 
+
* “Low to moderate quality evidence supports the use of specific '''cervical and scapular stretching and strengthening exercise for chronic neck pain'''immediately post treatment and intermediate term, and cervicogenic headaches in the long term”. <ref name="exercise-scapular stretching"> {{Cite paper
+
| last1 = Kay
+
| first1 = TM et al
+
| title = Exercises for mechanical neck disorders.
+
| journal = Cochrane Database Syst Rev
+
| volume = 15
+
| issue = 8
+
| pages = CD004250
+
| year = 2012 Aug
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/22895940
+
| accessdate = 12-1-2013}}</ref>
+
 
+
===Exercise-Low Back Pain===
+
 
+
* '''Walking''': There is inconclusive evidence to support walking and positive effects on LBP.  More research is necessary. <ref name="exercise-LBP"> {{Cite paper
+
| last1 = Hendrick
+
| first1 = P et al
+
| title = The effectiveness of walking as an intervention for low back pain: a systematic review
+
| journal = Eur Spine J.
+
| volume = 19
+
| issue = 10
+
| pages = 1613-1620
+
| year = Oct 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20414688
+
| accessdate = 12-1-2013}}</ref>
+
 
+
* According to a 2010 paper by van Middelkoop, “Evidence from randomised controlled trials demonstrated that '''exercise therapy''' is effective at reducing pain and function in the treatment of chronic low back pain”. However it does not specify one type of exercise being more effect than another. <ref name="exercise-Chronic LBP"> {{Cite paper
+
| last1 = van Middelkoop 
+
| first1 = M et al
+
| title = Exercise therapy for chronic nonspecific low-back pain
+
| journal = Best Pract Res Clin Rheumatol
+
| volume = 24
+
| issue = 2
+
| pages = 193-204
+
| year = Apr 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20227641
+
| accessdate = 12-1-2013}}</ref>
+
 
+
* '''Lumbar stabilization exercises''':  There is moderate evidence that “LSEs are effective in improving pain and function in heterogeneous group of patients with CLBP”. <ref name="exercise-Chronic LBP"> {{Cite paper
+
| last1 = Standaert 
+
| first1 = CJ et al
+
| title = Evidence-informed management of chronic low back pain with lumbar stabilization exercises
+
| journal = Spine J
+
| volume = 8
+
| issue = 1
+
| pages = 114-120
+
| year = Jan-Feb 2008
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Evidence-informed+management+of+chronic+low+back+pain+with+lumbar+stabilization+exercises
+
| accessdate = 12-1-2013}}</ref> There is strong evidence for LSE not being any more effective than a general exercise program. <ref name="exercise-Chronic LBP"/> Additionally, moderate evidence exists suggesting that LSEs are no more effective than manual therapy. <ref name="exercise-Chronic LBP"/>More research is necessary, focusing on types of patients that LSEs are most suited, as well as, “optimal setting for delivering care and training, the most effective exercises, and the optimal dose, duration, frequency, and progression”. <ref name="exercise-Chronic LBP"/>
+
 
+
* '''Lumbar extensor strengthening exercise''': The literature suggests that lumbar extensor strengthening exercise is more effective than no treatment in the short term when used alone or with co-interventions. <ref name="Lumbar extensor strengthening exercise"> {{Cite paper
+
| last1 = Mayer
+
| first1 = J et al
+
| title = Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises
+
| journal = Spine J
+
| volume = 8
+
| issue = 1
+
| pages = 96-113
+
| year = Jan-Feb 2008
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Evidence-informed+management+of+chronic+low+back+pain+with+lumbar+extensor+strengthening+exercises
+
| accessdate = 12-1-2013}}</ref> Additionally it is more effective than most passive modalities in regards to pain, disability and other patient-reported outcomes in CLBP. <ref name="Lumbar extensor strengthening exercise"/> The investigators found no clear benefit over other exercise programs. <ref name="Lumbar extensor strengthening exercise"/> And over the long-term, benefits decline versus other interventions. <ref name="Lumbar extensor strengthening exercise"/>
+
 
+
===Exercise-Rotator Cuff Impingement===
+
 
+
'''Rotator cuff impingement''': Investigators determined that “'''exercise''' has statistically and clinically significant effects on '''pain reduction and improving function''', but not on range of motion or strength. Manual therapy augments the effects of exercise, yet supervised exercise was not different than [[home exercise programs]]”. <ref name="exercise-rotator cuff impingement"> {{Cite paper
+
| last1 = Kuhn
+
| first1 = JE et al
+
| title = Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol
+
| journal = J Shoulder Elbow Surg
+
| volume = 18
+
| issue = 1
+
| pages = 138-160
+
| year = Jan-Feb 2009
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/18835532
+
| accessdate = 12-1-2013}}</ref>
+
  
 
==Identity==
 
==Identity==
Line 146: Line 123:
 
==Assimilation into Mainstream==
 
==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="Ernst-adverse">{{cite journal |journal= [[J R Soc Med]] |date=2007 |volume=100 |issue=7 |pages=330–8 |title= Adverse effects of spinal manipulation: a systematic review |author= Ernst E |pmid=17606755 |url=http://www.jrsm.org/cgi/content/full/100/7/330 |doi=10.1258/jrsm.100.7.330 |laysummary=http://www.medicalnewstoday.com/articles/75754.php |laysource= Med News Today |laydate=2007-07-02 |pmc= 1905885}}</ref><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 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.
 
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.
Line 161: Line 138:
 
== Utilization, satisfaction rates, and third party coverage ==
 
== 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>
+
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==
 
==Insurance coverage==
Line 174: Line 151:
 
== Effectiveness ==
 
== 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 rare cases.<ref name=Ernst-adverse/><ref name=CCA-CFCREAB-CPG/>
+
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 ==
 
== 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.<ref>{{cite journal |journal= [[Evid Based Complement Alternat Med]] |date=2006 |volume=3 |issue=4 |pages=425–32 |title= Cost-effectiveness of complementary therapies in the United kingdom—a systematic review |author= Canter PH, Coon JT, Ernst E |doi=10.1093/ecam/nel044 |pmid=17173105 |url=http://ecam.oxfordjournals.org/cgi/content/full/3/4/425 |pmc= 1697737}}</ref> 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>
+
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==
 
==Safety issues==
Line 192: Line 169:
  
 
== References ==
 
== References ==
{{reflist|colwidth=30em}}
+
{{Reflist|3}}
  
 
==External links==
 
==External links==
Line 198: Line 175:
  
 
{{Chiropractic}}
 
{{Chiropractic}}
{{ATTRIB}}
 
[[Category:Chiropractic]]
 
  
 +
==Other languages==
  
[[ar:معالجة يدوية]]<br>
+
 
[[ca:Quiropràctica]]<br>
+
*[[:ar:الكايروبراكتك]]
[[da:Kiropraktik]]<br>
+
*[[:fr:chiropratique]]
[[de:Chiropraktik]]<br>
+
*[[:de:Chiropraktik]]
[[es:Quiropráctica]]<br>
+
*[[:es:quiropráctica]]
[[eo:Kiropraktiko]]<br>
+
*[[:it:chiropractica]]
[[fa:کایروپرکتیک]]<br>
+
*[[:no:Kiropraktor]]
[[fi:Kiropraktiikka]]<br>
+
*[[:ru:Кайропрактик]]
[[fr:Chiropratique]]<br>
+
*[[:ru:Хиропрактик]] (Alternate spelling)
[[he:כירופרקטיקה]]<br>
+
*[[:uk:Кайропрактика]]
[[it:Chiropratica]]<br>
+
 
[[ja:カイロプラクティック]]<br>
+
{{ATTRIB}}
[[ko:카이로프랙틱]]<br>
+
[[Category:Chiropractic]]
[[nl:Chiropraxie]]<br>
+
[[Category:Definitions]]
[[no:Kiropraktor]]<br>
+
[[pl:Kręgarstwo]]<br>
+
[[pt:Quiropraxia]]<br>
+
[[ru:Хиропрактик]]<br>
+
[[ru:Кайропрактик]]  (alternative spelling)<br>
+
[[sv:Kiropraktik]]<br>
+
[[tr:Kiropraktik]]<br>
+
[[ur:معالجہ بالید]]<br>
+

Latest revision as of 15:42, 14 June 2014

Chiropractic: from Greek chiro- χειρο- "hand-"
+ praktikós πρακτικός "concerned with action"
—(OED)
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

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" [1] [2] Chiropractic is the third largest doctoral profession, behind medicine and dentistry[3] and, in North America, are the largest complementary alternative medical (CAM) profession. [4] In the U.S., chiropractors perform over 90% of all manipulative treatments.[5]

Scope of Practice

Chiropractors, (also known as doctors of chiropractic or chiropractic physicians[6] in all but a handful of jurisdictions),[7] 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,[1] The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.[1] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[8] 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.[9]

Education, licensing, and regulation

Chiropractors obtain a first professional degree in the field of chiropractic.[10] 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.[11] 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.[12] 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.[13] Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education.[14][15] The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a 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.[1]

Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[16][17] Depending on the location, continuing education may be required to renew these licenses.[18][19] 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.[20]

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[21] 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.[22][23] 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.[24] 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.[25] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[26] 2 in Canada,[27] 6 in Australasia,[28] and 5 in Europe.[29] 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.[30] 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.[14][15] Chiropractic curricula in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine.[31]

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.[32][33] There are an estimated 49,000 chiropractors in the U.S. (2008),[34] 6,500 in Canada (2010),[35] 2,500 in Australia (2000),[36] and 1,500 in the UK (2000).[37]

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.[38]

Manipulation/Adjustment Techniques

Spinal manipulation, also known as"spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care.[39] 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.[40] 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.[41] 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.[40]

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:[39] 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 emphasises "muscle testing" as a diagnostic tool), and cranial.[42] 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.[43]

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/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.[39]

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%.[44] 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.[45]

Physio-therapeutic methods

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. [8] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,[8][46] but the more expansive view of chiropractic is still widespread.[47] Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);[48] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.[49] 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.[50]

History

(for History, see Chiropractic history)

Assimilation into Mainstream

Chiropractic has gained greater acceptance among medical physicians and health plans in the U.S.,[51] and evidence-based medicine has been used to review research studies and generate practice guidelines.[52] Many studies of treatments used by chiropractors have been conducted. Collectively, systematic reviews of this research has demonstrated that spinal manipulation is effective. Spinal manipulation has been alleged to have serious complications in rare cases (about 1.4/1,000,000),[53] this is clearly less than the risk of taking an aspirin tablet, and thus chiropractic care is generally safe when employed skillfully and appropriately.[1]

Chiropractic is autonomous, and in some ways competitive with mainstream medicine.[54] 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;[55] physical therapists work as a part of mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[54] 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.[56] 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 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.[21]

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,[4] and is the third largest doctoral profession, behind only medicine and dentistry.[57] 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,[58] with a global high of 20% in Alberta.[59] Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors.[60] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[61] most do so specifically for low back pain. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.[58] 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.[62]

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. [52] 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,[2][63][64][65] that have been called ethically suspect when they let practitioners maintain their beliefs to patients' detriment.[2] 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.[66] Continued education enhances the scientific knowledge of the practitioner.[67]

Effectiveness

Manual therapies commonly used by chiropractors are effective for the treatment of low back pain,[68] [69] and might also be effective for the treatment of lumbar disc herniation with radiculopathy,[70][71] neck pain,[72] some forms of headache,[73][74] and some extremity joint conditions.[75][76] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[77] Chiropractic care is generally safe when employed skillfully and appropriately.[1] Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in exceedingly rare cases.[53]

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.[78] 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 effects) 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.[79] The cost-effectiveness of maintenance chiropractic care is unknown.[77]

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,[80][36] one of the most cost-effective public health interventions available.[81] 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.

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. [36] The Canadian Chiropractic Association supports vaccination;[80] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[82]

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.[83]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 World Health Organization (2005) (PDF). WHO guidelines on basic training and safety in chiropractic. ISBN 92-4-159371-7. http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf. Retrieved 2008-02-29. 
  2. 2.0 2.1 2.2 Nelson CF, Lawrence DJ, Triano JJ et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat 13: 9. doi:10.1186/1746-1340-13-9. PMID 16000175. PMC 1185558. http://chiroandosteo.com/content/13/1/9. 
  3. Smith M, Morschhauser S. "Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure.". National Library of Medicine. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html. Retrieved 2008-05-06. 
  4. 4.0 4.1 Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med 158 (20): 2215–24. doi:10.1001/archinte.158.20.2215. PMID 9818801. http://archinte.ama-assn.org/cgi/content/full/158/20/2215. 
  5. "Chiropractic in the United States:Training, Practice, and Research". Chirobase. 2010. http://www.chirobase.org/05RB/AHCPR/12.html. Retrieved 2010-10-01. 
  6. List of States (and Federal Gov't) Defining DC's as "Physicians". Retrieved 2010-05-03.
  7. Cooper RA, Henderson T, Dietrich CL (1998). "Roles of nonphysician clinicians as autonomous providers of patient care". JAMA 280 (9): 795–802. doi:10.1001/jama.280.9.795. PMID 9729991. 
  8. 8.0 8.1 8.2 Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med 136 (3): 216–27. PMID 11827498. http://www.annals.org/cgi/reprint/136/3/216.pdf. 
  9. Mootz RD, Shekelle PG (1997). "Content of practice". in Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366. http://chiroweb.com/archives/ahcpr/chapter3.htm. Retrieved 2008-10-10.  AHCPR Pub No. 98-N002.
  10. "Glossary". National Center for Education Statistics, U.S. Dept. of Education. http://nces.ed.gov/programs/coe/glossary/f.asp. Retrieved 2009-06-05. 
  11. Johnson C Green B (2010). "100 Years After the Flexner Report: Reflections on Its Influence on Chiropractic Education". J Chiropr Educ 24 (2): 145–152. PMID 21048876. 
  12. "Prospective students". Association of Chiropractic Colleges. http://www.chirocolleges.org/prospective_students.html. Retrieved 2009-07-23. 
  13. "Standards for Doctor of Chiropractic Programmes" (PDF). Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. 2008-04-05. http://chirofed.ca/english/pdf/Standards_for_Doctor_of_Chiropractic_Programmes.pdf. Retrieved 2009-04-23. 
  14. 14.0 14.1 "Media Relations". Canadian Memorial Chiropractic College. http://www.cmcc.ca/Media_Relations.html. Retrieved 2010-12-14. 
  15. 15.0 15.1 "Degree Authority in Ontario". Ontario Ministry of Training, Colleges and Universities. http://www.edu.gov.on.ca/eng/general/postsec/degreegr.html. Retrieved 2010-12-14. 
  16. "State chiropractic licensure". Life University. 2008. http://life.edu/node/94. Retrieved 2009-06-05. 
  17. "Becoming a chiropractor". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. http://chirofed.ca/english/becoming.html. Retrieved 2009-06-05. 
  18. Grod JP (2006). "Continuing Health Education in Canada". J Can Chiropr Assoc 50 (1): 14–7. PMID 17549163. 
  19. Stuber KJ, Grod JP, Smith DL, Powers P (2005). "An online survey of chiropractors' opinions of continuing education". Chiropr Osteopat 13 (1): 22. doi:10.1186/1746-1340-13-22. PMID 16242035. PMC 1282582. http://chiroandosteo.com/content/13/1/22. 
  20. Coulter ID, Adams AH, Sandefur R (1997). "Chiropractic training". in Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 17–28. OCLC 39856366. http://chiroweb.com/archives/ahcpr/chapter3.htm. Retrieved 2008-05-11.  AHCPR Pub No. 98-N002.
  21. 21.0 21.1 Tetrault M (2004). "Global professional strategy for chiropractic" (PDF). Chiropractic Diplomatic Corps. http://chiropracticdiplomatic.com/strategies/global_strategy.pdf. Retrieved 2008-04-18. 
  22. "The Council on Chiropractic Education (CCE)". The Council on Chiropractic Education. http://cce-usa.org/. Retrieved 2008-07-05. 
  23. "The General Chiropractic Council". http://www.gcc-uk.org/page.cfm. Retrieved 2008-07-26. 
  24. Morrison P (2009). "Adjusting the role of chiropractors in the United States: why narrowing chiropractor scope of practice statutes will protect patients". Health Matrix Clevel 19 (2): 493–537. PMID 19715143. 
  25. "About Us". Councils on Chiropractic Education International. http://www.cceintl.org/About_Us.html. Retrieved 2010-09-30. 
  26. "Accredited Doctor of Chiropractic programs". The Council on Chiropractic Education. Archived from the original on 2008-02-14. http://web.archive.org/web/20080214031937/http://www.cce-usa.org/adcp.php. Retrieved 2008-02-22. 
  27. "Accreditation of educational programmes". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. http://chirofed.ca/english/accreditation.html. Retrieved 2009-06-05. 
  28. "Program Accreditation Status". Council on Chiropractic Education Australasia. http://www.ccea.com.au/Accreditation/Program%20Accreditation%20Status.htm. Retrieved 2010-09-30. 
  29. "Institutions holding Accredited Status with the ECCE". European Council On Chiropractic Education. 2009-07-23. http://cce-europe.org/institutions.php. Retrieved 2009-07-25. 
  30. DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145. 
  31. Marcus DM, McCullough L (2009). "An evaluation of the evidence in "evidence-based" integrative medicine programs". Acad Med 84 (9): 1229–34. doi:10.1097/ACM.0b013e3181b185f4. PMID 19707062. 
  32. "Canadian Chiropractic Association FAQs". Canadian Chiropractic Association. http://www.chiropracticcanada.ca/en-us/FactsFAQs.aspx. Retrieved 2010-10-02. 
  33. "Federation of Chiropractic Licensing Boards FAQ". Federation of Chiropractic Licensing Boards. http://pacex.fclb.org/Information/FAQ/tabid/364/Default.aspx. Retrieved 2010-10-02. 
  34. "Chiropractors". U.S. Bureau of Labor Statistics. 2007. http://www.bls.gov/oco/ocos071.htm. Retrieved 2008-07-05. 
  35. "Canadian Chiropractic Association: Chiropractic in Canada". Canadian Chiropractic Association. http://www.chiropracticcanada.ca/en-us/AboutUs/ChiropracticInCanada.aspx. Retrieved 2010-10-02. 
  36. 36.0 36.1 36.2 Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics 105 (4): e43. doi:10.1542/peds.105.4.e43. PMID 10742364. http://pediatrics.aappublications.org/cgi/content/full/105/4/e43. 
  37. Chapman-Smith D (2000). "Current status of the profession". The Chiropractic Profession: Its Education, Practice, Research and Future Directions. West Des Moines, IA: NCMIC. ISBN 1-892734-02-8. 
  38. "Chiropractic in the United States:Training, Practice, and Research". Chirobase. 2010. http://www.chirobase.org/05RB/AHCPR/12.html. Retrieved 2010-10-01. 
  39. 39.0 39.1 39.2 Christensen MG, Kollasch MW (2005). "Professional functions and treatment procedures" (PDF). Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners. pp. 121–38. ISBN 1-884457-05-3. http://nbce.org/pdfs/job-analysis/chapter_10.pdf. Retrieved 2008-08-25. 
  40. 40.0 40.1 Winkler K, Hegetschweiler-Goertz C, Jackson PS et al. (2003). "Spinal manipulation policy statement" (PDF). American Chiropractic Association. http://acatoday.org/pdf/spinal_manipulation_policy.pdf. Retrieved 2008-05-24. 
  41. Pickar JG, Sung PS, Kang YM, Ge W (2007). "RESPONSE OF LUMBAR PARASPINAL MUSCLES SPINDLES IS GREATER TO SPINAL MANIPULATIVE LOADING COMPARED WITH SLOWER LOADING UNDER LENGTH CONTROL". Spine 7 (5): 583– 95. doi:10.1016/j.spinee.2006.10.006. PMID 17905321. PMC 2075482. http://www.thespinejournalonline.com/article/S1529-9430(06)00973-9/abstract. 
  42. Cooperstein R, Gleberzon BJ (2004). Technique Systems in Chiropractic. Churchill Livingstone. ISBN 0-443-07413-5. 
  43. Dagenais S, Mayer J, Wooley JR, Haldeman S (2008). "Evidence-informed management of chronic low back pain with medicine-assisted manipulation". Spine J 8 (1): 142–9. doi:10.1016/j.spinee.2007.09.010. PMID 18164462. 
  44. PMID 21036284 (PubMed)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  45. Ndetan HT, Rupert RL, Bae S, Singh KP (2009). "Prevalence of musculoskeletal injuries sustained by students while attending a chiropractic college". J Manipulative Physiol Ther 32 (2): 140–8. doi:10.1016/j.jmpt.2008.12.012. PMID 19243726. 
  46. Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF (2008). "How can chiropractic become a respected mainstream profession? the example of podiatry" (PDF). Chiropr Osteopat 16: 10. doi:10.1186/1746-1340-16-10. PMID 18759966. PMC 2538524. http://chiroandosteo.com/content/pdf/1746-1340-16-10.pdf. 
  47. Gleberzon BJ, Cooperstein R, Perle SM (2005). "Can chiropractic survive its chimerical nature?". J Can Chiropr Assoc 49 (2): 69–73. PMID 17549192. 
  48. Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". in Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1. 
  49. Redwood D, Hawk C, Cambron J, Vinjamury SP, Bedard J (2008). "Do chiropractors identify with complementary and alternative medicine? results of a survey". J Altern Complement Med 14 (4): 361–8. doi:10.1089/acm.2007.0766. PMID 18435599. 
  50. Cooperstein & Gleberzon. "Current and future utilization rates and trends". pp. 297–305. 
  51. Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues". Milbank Q 81 (1): 107–38. doi:10.1111/1468-0009.00040. PMID 12669653. 
  52. 52.0 52.1 Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303. 
  53. 53.0 53.1 Anderson-Peacock E, Blouin JS, Bryans R et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc 49 (3): 158–209. http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf.  Anderson-Peacock E, Bryans B, Descarreaux M et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc 52 (1): 7–8. http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf. 
  54. 54.0 54.1 Pettman E (2007). "A history of manipulative therapy". J Man Manip Ther 15 (3): 165–74. PMID 19066664. 
  55. Baer HA (2006). "The drive for legitimization by osteopathy and chiropractic in Australia: between heterodoxy and orthodoxy". Complement Health Pract Rev 11 (2): 77–94. doi:10.1177/1533210106292467. 
  56. Norris P (2001). "How 'we' are different from 'them': occupational boundary maintenance in the treatment of musculo-skeletal problems". Sociol Health Illn 23 (1): 24–43. doi:10.1111/1467-9566.00239. 
  57. "Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure.". National Library of Medicine. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html. Retrieved 2008-05-06. 
  58. 58.0 58.1 Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review". Chiropr Osteopat 15: 2. doi:10.1186/1746-1340-15-2. PMID 17241465. PMC 1784103. http://chiroandosteo.com/content/15/1/2. 
  59. Crownfield PW (2007). "Chiropractic in Alberta: a model of consumer utilization and satisfaction". Dyn Chiropr 25 (6). http://chiroweb.com/archives/25/06/02.html. 
  60. Kemper KJ, Vohra S, Walls R; Task Force on Complementary and Alternative Medicine; the Provisional Section on Complementary, Holistic, and Integrative Medicine (2008). "The use of complementary and alternative medicine in pediatrics". Pediatrics 122 (6): 1374–86. doi:10.1542/peds.2008-2173. PMID 19047261. 
  61. Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03". BMC Health Serv Res 6 (49): 49. doi:10.1186/1472-6963-6-49. PMID 16600038. PMC 1458338. http://www.biomedcentral.com/1472-6963/6/49. 
  62. Gaumer G (2006). "Factors associated with patient satisfaction with chiropractic care: survey and review of the literature". J Manipulative Physiol Ther 29 (6): 455–62. doi:10.1016/j.jmpt.2006.06.013. PMID 16904491. 
  63. Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat 13: 17. doi:10.1186/1746-1340-13-17. PMID 16092955. PMC 1208927. http://chiroandosteo.com/content/13/1/17. 
  64. Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. http://data.memberclicks.com/site/ahc/ChiroHistoryPrimer.pdf. Retrieved 2008-06-16. "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)." 
  65. Science, antiscience, materialism and vitalism:
    • Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq 21 (4): 37–43. 
    • Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". in Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1. 
  66. Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731. 
  67. Feise RJ, Grod JP, Taylor-Vaisey A (2006). "Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care". Chiropr Osteopat 14: 18. doi:10.1186/1746-1340-14-18. PMID 16930482. PMC 1560147. http://chiroandosteo.com/content/14/1/18. 
  68. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (2011). Rubinstein, Sidney M. ed. "Spinal manipulative therapy for chronic low-back pain". Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304. 
  69. Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010). "NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain". Spine J 10 (10): 918–940. doi:10.1016/j.spinee.2010.07.389. PMID 20869008. 
  70. Leininger B, Bronfort G, Evans R, Reiter T (2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review". Phys Med Rehabil Clin N Am 22 (1): 105–25. doi:10.1016/j.pmr.2010.11.002. PMID 21292148. 
  71. Hahne AJ, Ford JJ, McMeeken JM (2010). "Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review". Spine 35 (11): E488–504. doi:10.1097/BRS.0b013e3181cc3f56. PMID 20421859. 
  72. Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL (2010). "Manipulation or mobilisation for neck pain: a Cochrane Review". Manual Therapy 15 (4): 315–333. doi:10.1016/j.math.2010.04.002. PMID 20510644. 
  73. Chaibi A, Tuchin PJ, Russell MB (2011). "Manual therapies for migraine: a systematic review". J Headache Pain 12 (2): 127–33. doi:10.1007/s10194-011-0296-6. PMID 21298314. 
  74. Bronfort G, Nilsson N, Haas M et al. (2004). Brønfort, Gert. ed. "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. 
  75. Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W (2009). "Manipulative therapy for lower extremity conditions: expansion of literature review". J Manipulative Physiol Ther 32 (1): 53–71. doi:10.1016/j.jmpt.2008.09.013. PMID 19121464. 
  76. PMID 21109059 (PubMed)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  77. 77.0 77.1 Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic – what do we know?". Chiropr Osteopat 16 (1): 3. doi:10.1186/1746-1340-16-3. PMID 18466623. PMC 2396648. http://chiroandosteo.com/content/16/1/3. 
  78. Mootz RD, Hansen DT, Breen A, Killinger LZ, Nelson C (2006). "Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession". J Manipulative Physiol Ther 29 (9): 707–25. doi:10.1016/j.jmpt.2006.09.001. PMID 17142165. 
  79. van der Roer N, Goossens MEJB, Evers SMAA, van Tulder MW (2005). "What is the most cost-effective treatment for patients with low back pain? a systematic review". Best Pract Res Clin Rheumatol 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007. PMID 15949783. 
  80. 80.0 80.1 Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". J Manipulative Physiol Ther 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414. http://jmptonline.org/article/S0161-4754(05)00111-9/fulltext. 
  81. Ehreth J (2003). "The global value of vaccination". Vaccine 21 (7–8): 596–600. doi:10.1016/S0264-410X(02)00623-0. PMID 12531324. 
  82. Russell ML, Injeyan HS, Verhoef MJ, Eliasziw M (2004). "Beliefs and behaviours: understanding chiropractors and immunization". Vaccine 23 (3): 372–9. doi:10.1016/j.vaccine.2004.05.027. PMID 15530683. 
  83. Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success" (PDF). Am J Public Health 79 (10): 1405–8. doi:10.2105/AJPH.79.10.1405. PMID 2782512. PMC 1350185. http://www.ajph.org/cgi/reprint/79/10/1405.pdf. 

External links

Other languages