The chiropractic profession has faught many good fights in the time since it’s inception in 1892. In 1991, after well over a decade of litigation, the United States Supreme Court affirmed a lower court ruling declaring the American Medical Association et. al. guilty of anti-trust violations that were part of an ongoing conspiracy to “contain and eliminate” (the AMA’s own words) the chiropractic profession. As a result of the Wilk v. AMA suit, the medical profession reversed its longstanding ban on interprofessional cooperation between medical doctors and chiropractors, agreed to publish the full findings of the court in the Journal of the American Medical Association, and paid a large sum of money which is now being used for chiropractic research. This has not undone the effects of a well-organized anti-chiropractic campaign by organized medicine (which at one point even included attempting to rig in advance a federally mandated study on chiropractic!), but it certainly points to the dawning of a new day.

In December of 1994, the Agency for Health Care Policy and Research published guidelines for the management of acute adult low back pain. Spinal manipulation, was considered front line treatment for lower back pain and was essentially chiropractors rochester nysynonymous with the chiropractic profession. Despite this publication, and over forty randomized control trials that support spinal manipulation as an effective treatment for low back pain, the attitude, understanding and willingness to refer patients to chiropractors has not changed much at all. Many scientific papers supporting the efficacy of chiropractic treatment for other musculoskeletal disorders such as whiplash, neck pain and headaches, etc were ignored and overlooked.

As with any profession, chiropractic has its’ own problems of identity and understanding. To the medical profession, there seems to be too much ambiquity about the treatment itself. Consider the following 7 reasons for clarification.

1.Which patients should I consider for chiropractic care?

The best outcomes for chiropractic treamt are for patients with acute/subacute mechanical/myofascial cervical, thoracic or lumbosacral spinal pain.Diagnostic classifications include whiplash, stable radiculopathy, lumbar stenosis, facet syndrome, costotransverse capsulitis, sacroiliac joint pain, spinal strain/sprain, non-specific spinal pain, discogenic low back pain, myofascial pain syndromes and cervical headaches.Patients with cervical or lumbar intervertebral disc herniations commonly respond positively to chiropractic management. Treatments are likely to include forms of traction (e.g., flexion-distraction), Mackenzie (extension) therapy and other positional release techniques.

Our patients with repetitive strain injuries, carpal tunnel syndrome, thoracic outlet syndrome, temporomandibular joint pain and other musculoskeletal disorders also appreciate excellent outcomes.

2.How much care is necessary for a patient to improve with chiropractic treatment?

Patients with spinal pain often experience improvement and pain relief within a few treatments, while others require more extensive care. Some patients feel better after the first treatment. Acute, uncomplicated pain is often relieved within 2-4 weeks. Chronic or complicated acute patients may require four to five weeks of treatment. Patients with chronic or permanent conditions may be treated under a ódisease managementó model. Once the patient has reached a point of maximum therapeutic benefit in a comprehensive treatment program, manipulation and adjunctive therapies may be provided on a periodic basis to maintain functional and symptom gains. The real goal should be to encourage non reliance on constant treatment.

3.Is chiropractic manipulation safe?

When chiropractic manipulation is indicated for a specific condition, it is a very safe procedure. The most common side effect experienced by patients receiving spinal manipulation is short-tem soreness in the area of the treatment; commonly 1in 5.

The most concerning potential complications from spinal manipulation are cauda equina syndrome (CES) and vertebral basilar artery injury (VBAI). The likelihood of these complications is approximately 1: 4.5 million (VBAI) to 1: 100 million (CES).

A history of spinal surgery, osteoporosis, healed fracture, disc herniation without significant or progressive neurologic deficit, scoliosis, chronic arthopathies, degenerative changes, some acute injuries and joint instability are not absolute contraindications to treatment.

Absolute contraindications: severe or progressive neurologic deficit, infections or malignancies, acute bone demineralization, acute fracture/dislocation and acute arthropathies. A contraindication to spinal manipulation in one region of the spine rarely precludes treatment in another region. If techniques cannot be modified to accommodate the patient’s condition, manipulation is withheld.

4.How does manipulation work?

Spinal manipulation has shown to result in an immediate post treatment increase in range of motion, decreased adjacent soft tissue tenderness, improved function and decreased pain. Although the exact mechanism is not clear, current models that explain the treatment benefits appreciated following spinal manipulative therapy (SMT) include: motion segment unbuckling, meniscoid inclusion release, intra-articular adhesion / fringe release, stimulation of joint mechanoreceptors and/or relaxation of hypertonic muscle. Centrally mediated reflexes are being investigated.

5.Why is there such variation in treatment among chiropractors?

The chiropractic profession is philosophically divided into two primary groups;
1.those who adhere to many of the traditional chiropractic theories that promote lifelong care, and
2.those who work on an integrated, evidence based care model.

Philosophically based chiropractors advocate that spinal manipulation (referred to an óadjustmentó) improves health through reducing sub-clinical neurologic impairment by correcting intervertebral joint dysfunction (referred to as a ‘subluxationó). Theoretically, spinal adjustments are directed at restoring neural homeostasis, rather than administered to treat a clinical disorder. Also, regular adjustments are administered as a means of preventive healthcare. Most of these chiropractors do not seek a clinical diagnosis other than ‘subluxationó, and do not exercise standard examination and treatment procedures.

Evidence based chiropractors commonly work on a physical medicine model to diagnose and treat their patients. Spinal manipulation is one component of the management strategy, which also draws from those therapies that are shared with physical therapists and physiatrists. These chiropractic physicians administer therapeutic treatment modalities such as ultrasound, electrical muscle stimulation, hot/cold therapies and instruct their patients in rehabilitative exercises, stretches, lifestyle changes and proper diet. Many evidence based chiropractors work cooperatively within hospitals and integrated care centers.

6.With all of the variation in chiropractic, how does one identify a qualified chiropractor?

The Journal of Family Practice (1992) published the following guidelines to consider when selecting a chiropractor:
ïTreats mainly musculoskeletal disorders
ïDoes not radiograph every patient
ïWilling to be clinically observed
ïPositive feedback from patients
ïCommunicates with the referring physician
ïAdministers reasonable treatment programs
ïDoes not charge a global, up front fee

7.How well educated are chiropractors?

In 2009, 16 chiropractic programs in the United States were accredited by the Council on Chiropractic Education. Applicants must have at least 90 semester hours of undergraduate study leading toward a bachelor’s degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor’s degree, which may eventually become the minimum entry requirement. Several chiropractic colleges offer prechiropractic study, as well as a bachelor’s degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the States.
Chiropractic programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience. During the first 2 years, most chiropractic programs emphasize classroom and laboratory work in sciences such as anatomy, physiology, public health, microbiology, pathology, and biochemistry. The last 2 years focus on courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. Chiropractic programs and institutions grant the degree of Doctor of Chiropractic (D.C.).

Chiropractic colleges also offer postdoctoral training in orthopedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practice, pediatrics, and applied chiropractic sciences. Once such training is complete, chiropractors may take specialty exams leading to ìdiplomateî status in a given specialty. Exams are administered by chiropractic specialty boards.

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Filed under: Chiropractic Medicine

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