Chiropractic
By
Emily Greenough
Learning Objectives
Name the founder of the modern
profession of chiropractic.
Describe the basic concepts of
chiropractic.
What is the purpose of an adjustment?
Learning Objectives
Identify some of the common
conditions treated by chiropractors.
What are some of the controversies or
criticisms of chiropractic?
What is Chiropractic?
Manipulative and Body-Based practice
of CAM interventions and therapies.
Profession which focuses on dx, tx, and
preventing mechanical disorders of the
musculoskeletal system, their effects on
the nervous system and general health.
History of Chiropractic
Chiropractic- means “done by hand”,
referring to manipulation of the spine.
– Greek words cheir (hand) and praxis
(action)
Chiropractic is a form of spinal
manipulation, one of the oldest healing
practices.
– Spinal manipulation was described by
Hippocrates in ancient Greece.
The Founder of the Modern
Profession of Chiropractic
Daniel David
Palmer
– Healing
philosophies
– Spiritualism
– Magnetic therapy
– Background in
osteopathic
training
DD Palmer
Observed the body had a natural healing
ability controlled by the nervous system.
Coined the term “subluxations”-
misalignments of the spine.
Misalignments cause nerve compression
that interferes with proper flow of “Innate
Intelligence” (God) to body organs, results
in disease or disharmony.
– A.k.a. Innate Life Force, Universal Intelligence
The First Experiment with
Chiropractic
1895-Palmer’s story
– examination found a sore lump on Lillard’s back,
misalignment caused deafness
Lillard’s story- daughter reports book to back
Lillard’s deafness was told to be improved,
w/out any other explanation.
1896- added treatment to school
– Now known as Palmer College of Chiropractic
– 90% of chiropractors believe the vertebral
subluxation plays significant role in all or most
diseases
Basic Concepts of Chiropractic
The body has a powerful self-healing
ability.
The body’s structure (primarily the spine)
and its function are closely related, and
this relationship affects health.
Chiropractic therapy is given with the
goals of normalizing this relationship
between structure and function and
assisting the body as it heals.
The Chiropractor
In the U.S. chiropractors perform over
90% of manipulative treatments.
Adjustments (special emphasis on spine)
– Treatment that seeks to eliminate pain
– Involve applying a controlled, sudden force
to a joint
– Increases the range and quality of motion
in the area being treated
Conditions Commonly Treated
by Chiropractors
Back pain including low-back pain
Neck pain
Headaches including migraines
Sports Injuries
Repetitive strains
Others
– Asthma, Arthritis, Bursitis, Cerebral Palsy,
Flu symptoms, DM, Infertility, etc
Prevalence
NCCAM
– Estimated Americans (1997) made
nearly 192 million visits a year to
chiropractors.
– Over 88 million of those visits were to
treat back or neck pain.
– 18-38 million annually reported for relief
of head and neck pain.
Cervical Spine Manipulation
Before and After
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Objective
– Acquire information for designing a large
clinical trial and determine its feasibility
and to make preliminary estimates of the
relationship between headache outcomes
and the number of visits to a chiropractor
Study Design
– Randomized, control trial
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Subjects
– 24 adults with chronic cervicogenic
headache
Methods
– Randomly allocated to 1, 3, or 4 visits per
week for 3 weeks.
– Chiropractors allowed 2 physical modalities
each visit. (heat and soft tissue therapy)
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Outcomes Measured
– Modified Von Korff Scales (MVK)
MVK pain scale rating: HA pain today, worst HA
pain in last 4 weeks, average HA pain in last 4
weeks.
MVK disability scale measures interference
with: daily activities, social and recreational
activities, ability to work outside or around
house.
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Feasibility of a larger study was
determined by:
– Completion rates for the f/u questionnaires
had to be 90%
– Participants had to attend at least 2/3 of
scheduled visits
– Participants reported number of visits
sought outside the study.
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Baseline Variables
– Sociodemographics
– General health status
energy/fatigue
emotional well being
self rated health
depression
– 2 visits to establish baseline
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Compliance
– Contacted by phone during weeks 1, 2, 3,
4, 6, 8, 10 and 12 to keep them engaged
and remind them to fill out questionnaires
– Reminder calls for appointments
– Allowed to seek care outside the study
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Findings
– For HA pain, substantial differences were
found between participants receiving 1
treatment/week and those receiving either
3 or 4 treatments/week.
– Comparable differences between groups
were found for HA disability at 12 weeks.
– Neck pain and associated disability
appeared to parallel HA outcomes.
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Findings
– Outside care
3 sought unscheduled treatment or outside
care
– Noncompliance
Only 1 participant missed a treatment schedule
Dose Response For Chiropractic Care of Chronic Cervicogenic Headache
and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9
Conclusion
– Participants willing to be randomized,
follow tx protocol, and complete f/u
questionnaires.
– Data suggests support for a dose-response
relationship between cervicogenic HA
pain/disability and number of chiropractic
treatments.
– Larger number of visits produces greater
benefits.
A Controlled Trial of Cervical Manipulation of Migraine
Australian and New Zealand Journal of Medicine
(1978) vol. 8
Objective
– Evaluate the efficacy of cervical manipulation for
migraines
Study Design
– Controlled trial of 6 months
Subjects
– 85 volunteers (males 33, females 52)
– Suffering from migraines (mean 19 years)
– Under the age of 55 years
A Controlled Trial of Cervical Manipulation of Migraine
Australian and New Zealand Journal of Medicine
(1978) vol. 8
Treatment Groups- no more than 2 x/week
– Chiropractic Manipulation
Required to manipulate the spine- “movement of
joints beyond normal limitations”
– Manipulation
Required medical practitioner and physiotherapist
to manipulate the spine-”movement of joints
beyond normal limitations”
– Control
Require medical practitioner and physiotherapist to
perform cervical mobilization- “movement of joints
within normal limitations”
A Controlled Trial of Cervical Manipulation of Migraine
Australian and New Zealand Journal of Medicine
(1978) vol. 8
Hypothesis
– Post-treatment scores for the whole
sample would be less than pre-treatment
scores
– Cervical manipulation (performed by any
therapist) would be more effective than the
control treatment
– Chiropractic treatment would be more
effective than the other 2 treatments
A Controlled Trial of Cervical Manipulation of Migraine
Australian and New Zealand Journal of Medicine
(1978) vol. 8
Compliance
– required “migraine form” at the end of
each migraine.
duration of attack (duration hr/attack)
pain (visual analogue scale “intensity”)
disability (5 point scale-1=usual activities,
5=had to remain in bed)
Outcome Measures-phone
– migraine frequency was compared to
“migraine form” to compare data.
A Controlled Trial of Cervical Manipulation of Migraine
Australian and New Zealand Journal of Medicine
(1978) vol. 8
Results
– Whole sample, migraine symptoms were
significantly reduced.
– No difference in outcome found between
therapists, or by those who received the
control treatment.
– Chiropractic was no more effective at
reducing duration, disability, or frequency,
but greater reduction in pain variant.
Controversies and Criticism
Inside the profession
The Mixers, Straights, and Reformers
– Concept of subluxations
– Use of appropriate physical therapy
techniques for conditions
Controversies and Criticism
Outside the profession
Effectiveness of treatments
– Non-manual treatments
heat and ice, magnetic therapy, nutrition
counseling and dietary supplements
Potential risks
– Presumed to be safe from what is known
– Osteoporosis compared to healthier bone
Controversies and Criticism
Scientific basis
– Research finding had missing or poor-
quality data.
– Overall research findings, unable to provide
enough evidence to support effectiveness
of treatment.
– Maybe more effective than sham therapy,
but no more or less than other treatments.
Conclusions?
Research studies are ongoing
– Key area of research is the basic science of
what happens in the body such as the cells
and nerves when specific treatments are
given.
Risk of complications from adjustments
of low-back pain appear very low, but
risks increase for adjustments of the
neck.
Thank You
Any Questions?