Chiropractic, which loosely means “to treat by hand,” is a type of manipulative therapy that has been practiced in the U.S. for over 100 years. This discipline is based on the premise that function of the joints and muscles of the spine can have a profound effect upon health. Through a complex relationship with the nervous system, problems with vertebral (spinal) joints can result in local neck and back pain and even cause pain to be felt in the head, arms, and legs (“referred” pain). Chiropractors identify these problems in specific joints as chiropractic “subluxations” or “joint dysfunctions.” (Note: Medical doctors use the word “subluxation” in a different way, denoting a bone that has nearly dislocated.) Instead of pain, patients may sometimes experience a feeling of numbness, a “pins and needles” sensation, dizziness, or a host of other unusual manifestations. More controversial is the premise proposed by chiropractors and other manual therapists that symptoms usually associated with internal organs, such as stomach aches, digestive problems, infant colic, and asthma, for example, may sometimes improve with manipulative care.1, 2, 3, 4, 5
Chiropractic manipulation or adjustments seek to restore normal function to the spine and other joints. Typically, this entails the chiropractor applying a specific, highly-controlled treatment directly to a joint or muscle with his or her hands. When successful, this often reduces or eliminates both local and referred pain, allows muscle spasms to relax, and is thought to remove irritation from the nervous system, which may result in other health benefits.
Chiropractors (referred to as chiropractic physicians in some areas) serve as portals of entry into the healthcare system. This means that a patient may choose to see a chiropractor before seeing any other practitioner.6 Consequently, chiropractors are trained to perform the same standard orthopedic, neurologic, and physical examination procedures as those performed in traditional allopathic medicine. This enables them to screen their patients for fractures, cancers, and other serious diseases requiring medical treatment.
In addition, chiropractors do a further evaluation of the motion and positioning of spinal and extremity joints, the functions of muscles, and an overall evaluation of posture and movement. Chiropractors usually identify subluxations by carefully evaluating a number of factors. This approach may include assessing points of tenderness, subtle movements of individual joints, the amount of joint “springiness” in response to gentle pressure, altered muscle tone (such as a spasm), and any asymmetry in the feel of the bone or other tissue beneath their fingertips.
Most chiropractors share a philosophy that medications and surgery should be saved as treatments of last resort for many conditions. Chiropractic care also has a history of blending nutritional and other alternative therapies with a natural approach to promoting health through lifestyle modification and exercise. Many modern chiropractors receive additional training in physical rehabilitation and specific exercise therapy that can be useful when treating patients with whiplash injuries, shoulder or knee injuries, or stubborn low back pain. Others make nutritional analysis, botanical therapy, and in some states even acupuncture a significant part of their practices. Other treatment options that chiropractors may employ include traction, supports and braces, and electrotherapies, such as ultrasound, muscle stimulation, and TENS (transcutaneous electrical nerve stimulation).
When necessary, a chiropractor may order x-rays, blood tests, or advanced studies, such as an MRI or CT scan, before deciding on a course of treatment or referral.
Even outside the chiropractic profession, joint manipulation has generally been accepted as an appropriate treatment for low back pain.7, 8, 9 Medical doctors are even being encouraged to “offer spinal manipulation as a therapeutic option of accepted efficacy,” acknowledging that “in many settings referral to a chiropractor is the most practical way of doing this.”10 In practice, however, chiropractors treat a much wider range of problems including ankle sprains, rotator cuff injuries, a variety of headaches, and joint pain throughout the body, as well as offer general supportive care for conditions ranging from rheumatoid arthritis to the conservative management of high blood pressure. The effectiveness of chiropractic care in these areas has yet to be thoroughly researched.
1. Haldeman S. Principles and Practice of Chiropractic. Norwalk, Connecticut: Appleton & Lange, 1992.
2. Maigne, R. Thoracolumbar junction syndrome, a source of diagnostic error. Journal of Orthopaedic Medicine, 1995;17(3):84–9.
3. Lewit K. Manipulative Therapy in Rehabilitation of the Motor System. London: Butterworths, 1985.
5. Travell J, Simmons D. Myofascial Pain and Dysfunction. Baltimore: Williams & Wilkins, 983.
6. Vear HJ. Chiropractic Standards of Practice and Quality Care. Gaithersburg, MD: Aspen, 1992.
7. Acute Low Back Problems in Adults, Clinical Practice Guidelines. U.S. Department of Health and Human Services, December 1994.
8. Waddell G, Feder G, McIntosh A, et al. Low Back Pain Evidence Review. London: Royal College of General Practitioners, 1996.
9. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. Spine 1997;22(18):2128–58.
10. Shekelle PG, Coulter I, Hurwitz EL, et al. Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America. Ann Intern Med 1998;129(1):9–7.
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