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Chiropractic is a health care approach and profession that
emphasizes diagnosis, treatment and prevention of mechanical
disorders of the musculoskeletal system, especially the spine,
under the hypothesis that these disorders affect general health
via the nervous system. It is generally considered to be
complementary and alternative medicine, a characterization many
chiropractors reject. The main treatment involves manual therapy
including manipulation of the spine, and soft
tissue; treatment also includes exercises and health and lifestyle
counseling. Traditionally, chiropractic assumes that a vertebral subluxation
or spinal joint dysfunction interferes with the body's function
and its innate intelligence, a notion that brings ridicule from
mainstream science and medicine. For most of its existence,
chiropractic has battled with mainstream medicine, sustained by
ideas such as subluxation that are not based on solid science.
Vaccination remains controversial among chiropractors. The
American Medical Association called chiropractic an "unscientific
cult" and boycotted it until losing a 1987 antitrust case.
Chiropractic has had a strong political base and sustained demand
for services; in recent decades, it has gained more legitimacy and
greater acceptance among medical physicians and health plans, and
evidence-based medicine has been used to review research studies
and generate practice guidelines. Many studies of treatments used
by chiropractors have been conducted, with conflicting results.
Collectively, systematic reviews of this research |
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have not demonstrated that spinal manipulation is effective,
with the possible exception of back pain. Spinal
manipulation, which chiropractors call "spinal adjustment" or
"chiropractic adjustment", is the most common treatment used in
chiropractic care; in the U.S., chiropractors perform over 90% of
all manipulative treatments. 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. 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; in chiropractic care SMT
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 1/3 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.
Scope of practice
Chiropractors, also known as doctors of chiropractic or
chiropractic physicians in many jurisdictions, emphasize the
conservative management of the neuromusculoskeletal system without
the use of medicines or surgery, with special emphasis on the
spine. Chiropractic combines aspects from mainstream and
alternative medicine: although chiropractors have many attributes
of primary care providers, chiropractic has more of the attributes
of a medical specialty like dentistry or podiatry. It has been
proposed that chiropractors specialize in nonsurgical spine care,
instead of attempting to also treat other problems, but the more
expansive view of chiropractic is still widespread. Mainstream
health care and governmental organizations such as the World
Health Organization consider chiropractic to be complementary and
alternative medicine (CAM); however, a 2008 study reported that
31% of surveyed chiropractors categorized chiropractic as CAM, 27%
as integrated medicine, and 12% as mainstream medicine.
The practice of chiropractic medicine involves a range of
diagnostic methods including skeletal imaging, observational and
tactile assessments, and orthopedic and neurological evaluation. A
chiropractor may also refer a patient to an appropriate
specialist, or co-manage with another health care provider. 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.
Chiropractors cannot write medical prescriptions or perform major
surgery. In the U.S. their scope of practice varies by state in
areas such as conducting laboratory tests or diagnostic
procedures, dispensing dietary supplements, and using other
therapies such as homeopathy and acupuncture; in the state of
Oregon they can become certified to perform minor surgery and to
deliver children via natural childbirth. A 2003 survey of North
American chiropractors found that a slight majority favored
allowing them to write prescriptions for over-the-counter drugs. A
related field, veterinary chiropractic, applies manual therapies
to animals and is recognized in a few U.S. states, but is not
recognized by the American Chiropractic Association as being
chiropractic. |
