What is chiropractic?

Chiropractic (which comes from the Greek word meaning "done by hand") concentrates on manipulating the spine and other joints to treat illnesses. It is based on the belief that because the nervous system controls the body, correcting the spine can treat a variety of illness. Daniel David Palmer founded chiropractic in 1895. Palmer was a self taught healer who was studying spinal structure and manipulative techniques when he reportedly restored the hearing of a deaf man by realigning a displaced vertebra in his back. Palmer believed that most diseases were a result of abnormal nerve signals, caused by "vertebral subluxation" (misalignment of the spine). Although today most chiropractors use other therapies as well, spinal manipulation remains at the center of chiropractic. There are more than 60,000 active chiropractic licenses in the United States. According to a study in 2010, the total number of U.S. adults who visited a chiropractor jumped 57%, from 7.7 million in 2000 to 12.1 million in 2003. This is a higher percentage than yoga, massage, acupuncture, or other diet based therapies.

What happens during a visit to a chiropractor?

The first visit usually lasts about an hour. The chiropractor takes a complete health history, including information on past injuries and illnesses, current conditions and medications, lifestyle, diet, sleep habits, exercise, mental stresses, and use of alcohol, drugs, or tobacco. During a physical exam, the chiropractor evaluates your spine and joints and may perform diagnostic tests, such as blood pressure, x-rays, MRIs, and other tests to make a diagnosis. Treatment usually starts at either the first or second visit. Patients are typically asked to lie on a specially designed table, where the chiropractor does the spinal manipulations. The most common is manual manipulation, where the chiropractor moves a joint to the end of its range, then applies a low force thrust. The chiropractor may also use other treatments, including massage and heat and ice therapies. You should not feel any pain from the manipulation. Some people have minor aches, stiffness, and tiredness for a few days after the manipulation while their body adjusts to the new alignment.

How many treatments will be required?

A typical course of treatment lasts several weeks. The chiropractor may suggest 2 - 3 sessions a week (lasting about 10 - 20 minutes), then weekly sessions once you improve. Together, you and the chiropractor will set goals for your treatment and evaluate how effective treatment is as you go along.

What conditions are treated effectively with chiropractic?

Chiropractic has been shown to be effective for acute and chronic low back pain, neck pain, and headaches. Preliminary evidence suggests it may also help treat frozen shoulder, tennis elbow and other sports injuries, carpal tunnel syndrome, otitis media (ear infection), digestive problems, menstrual and premenstrual pain, attention deficit hyperactivity disorder (ADHD), and asthma. Many people also use chiropractic to treat headaches, fatigue, and other health issues.

Are there conditions that should not be treated with chiropractic?

If you have a broken bone, tumors, an arthritis flare, bone or joint infections, or advanced osteoporosis, you should not have a manipulation in the affected area. Be sure to tell your chiropractor about any physical disabilities you have, or if you experience numbness, tingling, weakness, or other neurological problems. In extremely rare cases, manipulation of the neck has damaged blood vessels or caused strokes. The screening process, however, is designed to detect people at high risk.

How can a qualified practitioner be located?

All 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands recognize chiropractic as a health care profession. A chiropractic degree requires about the same number of classroom hours as a medical degree. The chiropractic program includes clinical experience, basic sciences, and standard, as well as structural (spinal) and functional (nervous system) diagnoses. At least one chiropractic organization serves each state in the U.S. The largest association is the American Chiropractic Association (ACA). The ACA can provide a list of licensed chiropractors in your area.

Does medical insurance cover chiropractic treatments?

Medicare, Medicaid, and worker's compensation cover chiropractic care. Most health care plans offered by employers cover at least part of the cost of chiropractic.

Glossary

• Hard tissue manipulation -- manipulation of bone and cartilage, including joints.
• High velocity thrust -- manual manipulation that involves movement of the selected joint to its end range of voluntary motion, followed by a quick manual thrust.
• Interferential therapy -- a form of electronic stimulation.
• Ischemic compression (Travell-Simons trigger point therapy) -- a technique in which progressively strong pressure is applied to a pressure point, trigger point, or tight muscle.
• Joint mobilization -- slower or gentler manual techniques in which the joint remains within its passive range of movement.
• Low amplitude thrust -- amplitude refers to the depth of, or distance traveled by, the practitioner's thrust. Most adjustment/manipulation is of low amplitude, minimizing total force applied to the patient.
• Manipulation -- manual techniques that move a joint beyond the end point of its passive range of motion.
• Soft tissue manipulation -- manual manipulation of muscle, tendon, and ligament.
• Spinal manipulation -- manipulation of the vertebrae.
• Subluxation -- where alignment, movement integrity, and physiologic function are altered although contact between the joint surfaces remains intact.
• Thrust -- the therapeutic maneuver delivered by the practitioner during high velocity adjustment and manipulation.

Alcantara J, Davis J. The chiropractic care of children with attention-deficit/hyperactivity disorder: a retrospective case series. Explore (NY). 2010;6(3):173-82.

Alcantara J, Cossette M. Intractable migraine headaches during pregnancy under chiropractic care. Complement Ther Clin Pract. 2009;15(4):192-7.

Bakris G, Dickholtz M Sr, Meyer PM, et al., Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens. 2007;21(5):347-52.

Balon JW, Mior SA. Chiropractic care in asthma and allergy. Ann Allergy Asthma Immunol. 2004;93(2 Suppl 1):S55-60.

Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. J Manipulative Physiol Ther. 2006;29(2):107-14.

Davis MA, Sirovich BE, Weeks WB. Utilization and expenditures on chiropractice care in the United States from 1997 to 2006. Health Serv Res. 2010;45(3):748-61.

DeVocht JW. History and overview of theories and methods of chiropractic: a counterpoint. Clin Orthop Relat Res. 2006;444:243-9.

Erfanian P, Tenzif S, Guerriero RC. Assessing effects of a semi-customized experimental cervical pillow on symptomatic adults with chronic neck pain with and without headache. JCCA J Can Chiropr Assoc. 2004;48(1):20-8.

Ernst E. Chiropractic manipulation for non-spinal pain--a systematic review. N Z Med J. 2003;116(1179):U539.

Ernst E. Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials. Int J Clin Pract. 2009 Sep;63(9):1351-3.

Ernst E. Chiropractic treatment for fibromyalgia: a systematic review. Clin Rheumatol. 2009 Oct;28(10):1175-8.

Fernandez-de-las-Penas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC. Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache. J Orthop Sports Phys Ther. 2006;36(3):160-9.

Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol. 2007;118(2):391-402.

Haneline MT. Chiropractic manipulation and acute neck pain: a review of the evidence. J Manipulative Physiol Ther. 2005;28(7):520-5.

Hawk C, Cambron J. Chiropractic care for older adults: effects on balance, dizziness, and chronic pain. J Manipulative Physiol Ther. 2009 Jul-Aug;32(6):431-7.

Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW. Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med. 2007;13(5):491-512.

Hawk C, Rupert RL, Colonvega M, Boyd J, Hall S. Comparison of bioenergetic synchronization technique and customary chiropractic care for older adults with chronic musculoskeletal pain. J Manipulative PhysiolTher. 2006;29(7):540-9.

Hertzman-Miller RP, Morgenstern H, Hurwitz EL, et al. Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low back pain study. Am J Public Health. 2002;92(10):1628-1633.

Hoskins W, McHardy A, Pollard H, Windsham R, Onley R. Chiropractic treatment of lower extremity conditions: a literature review. J Manipulative Physiol Ther. 2006;29(8):658-71.

Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6 month follow-up outcomes from the UCLA low back pain study. Spine. 2002;27(20):2193-2204.

Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health. 2002;92(10):1634-1641.

Hurwitz EL, Morgenstern H, Kominski GF, Yu F, Chiang LM. A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study.Spine. 2006;31(6):611-21; discussion 622.

Leaver AM, Refshauge KM, Maher CG, Latimer J, Herbert RD, Jull G, McAuley JH. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial. BMC Musculoskelet Disord. 2007;8:18.

Lenssinck ML, Damen L, Verhagen AP, et al., The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain. 2004;112(3):381-8.

Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Ann Intern Med. 2002;136(3):216-227.

Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal manipulation for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2006;3:CD002119.

Radpasand M, Owens E. Combined multimodal therapies for chronic tennis elbow: pilot study to test protocols for a randomized clinical trial. J Manipulative Physiol Ther. 2009 Sep;32(7):571-85.

Ricotti V, Delanty N. Use of complementary and alternative medicine in epilepsy. Curr Neurol Neurosci Rep. 2006;6(4):347-53.

Rowe DE, Feise RJ, Crowther ER, et al., Chiropractic manipulation in adolescent idiopathic scoliosis: a pilot study. Chiropr Osteopat. 2006;14:15.

Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6(2):131-7.

Shearar KA, Colloca CJ, White HL. A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. J Manipulative Physiol Ther. 2005;28(7):493-501.

Smith DL, Dainoff MJ, Smith JP. The effect of chiropractic adjustments on movement time: a pilot study using Fitts Law. J Manipulative Physiol Ther. 2006;29(4):257-66.

Stuber KJ. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. JCCA J Can Chiropr Assoc. 2007;51(1):30-41.

Stuber K, Sajko S, Kristmanson K. Chiropractic treatment of lumbar spinal stenosis: a review of the literature. J Chiropr Med. 2009 Jun;8(2):77-85.

Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005;11(1):42-9.

Verhagen AP, Karels C, Bierma-Zeinstra SM, et al., Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database Syst Rev. 2006;3:CD003471.

Vohra S, Johnston BC, Cramer K, Humphreys K. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007;119(1):e275-83.