Guide To Chiropractic Care and Treatment

Woman lying on side getting adjusted by chiropractor
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What Is Chiropractic?

Chiropractic is a form of health care that focuses on the relationship between the body's structure, primarily of the spine, and function.

Chiropractic is most often used to treat musculoskeletal conditions, problems with the:

The word "chiropractic" combines the Greek words cheir (hand) and praxis (action) and means "done by hand." Chiropractic is an alternative medical system and takes a different approach from conventional medicine in diagnosing, classifying, and treating medical problems.

Doctors of chiropractic, who are also called chiropractors or chiropractic physicians, use a type of hands-on therapy called manipulation (or adjustment) as their core clinical procedure. Manipulation is passive joint movement beyond the normal range of motion. The term adjustment is preferred in chiropractic.

The basic concepts of chiropractic can be described as:

  • the body has a powerful self-healing ability
  • the body's structure (primarily that of 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

What is Conventional Medicine?

Conventional medicine is medicine as practiced by holders of degrees and other allied health professionals such as:

  • M.D. (Doctor of Medicine)
  • D.O. (Doctor of Osteopathic Medicine, a form of conventional medicine)
  • physical therapists
  • psychologists
  • registered nurses

Other terms for conventional medicine include:

  • allopathic medicine
  • Western medicine
  • mainstream medicine
  • orthodox medicine
  • regular medicine
  • biomedicine

What Is Complementary And Alternative Medicine (CAM)?

Health care practices and products that are not presently considered to be part of conventional medicine are called complementary and alternative medicine (CAM).

  • Complementary medicine is used together with conventional medicine.
  • Alternative medicine is used in place of conventional medicine.

For more information see the NCCAM fact sheet "What Is Complementary and Alternative Medicine (CAM)?"

What Is The History Of Chiropractic?

Chiropractic is a form of spinal manipulation, which is one of the oldest healing practices. Spinal manipulation was described by Hippocrates in ancient Greece.

In 1895, Daniel David Palmer founded the modern profession of chiropractic in Davenport, Iowa. Palmer was a self-taught healer and a student of healing philosophies of the day. He observed that the body has a natural healing ability that he believed was controlled by the nervous system. He also believed that subluxations, or misalignments of the spine (a concept that had already existed in the bonesetter and osteopathic traditions), interrupt or interfere with this "nerve flow." Palmer suggested that if an organ does not receive its normal supply of impulses from the nerves, it can become diseased.

This line of thinking led him to develop a procedure to "adjust" the vertebrae, the bones of the spinal column, with the goal of correcting subluxations.

There are differences in beliefs and approaches within the chiropractic profession. Some chiropractors continue to view subluxation as central to chiropractic health care. However, other chiropractors no longer view the subluxation theory as a unifying theme in health and illness or as a basis for their practice. Other theories as to how chiropractic might work have been developed.

Who Uses Chiropractic And For What Health Problems?

In 1997, it was estimated that Americans made nearly 192 million visits a year to chiropractors. Over 88 million of those visits were to treat back or neck pain. In one recent survey, more than 40 percent of patients receiving chiropractic care were being treated for back or low-back problems. More than half of those surveyed said that their symptoms were chronic. Conditions commonly treated by chiropractors include:

  • back pain
  • neck pain
  • headaches
  • sports injuries
  • repetitive strain

Patients also seek treatment of pain associated with other conditions, such as arthritis.

Low-back pain is a common medical problem, occurring in up to one-quarter of the population each year. Most people experience significant back pain at least once during their lifetime.

Several recent reviews on low-back pain have noted that in most cases acute low-back pain gets better in several weeks, no matter what treatment is used. Often, the cause of back pain is unknown, and it varies greatly in terms of how people experience it and how professionals diagnose it. This makes back pain challenging to study.

What Do Chiropractors Do When Treating Patients?

If you become a chiropractic patient, during your initial visit the chiropractor will take your health history. He will perform a physical examination, with special emphasis on the spine, and possibly other examinations or tests such as x-rays. If he determines that you are an appropriate candidate for chiropractic therapy, he will develop a treatment plan.

When the chiropractor treats you, he may perform one or more adjustments. An adjustment (also called a manipulation treatment) is a manual therapy or therapy delivered by the hands. Given mainly to the spine, chiropractic adjustments involve applying a controlled, sudden force to a joint. They are done to increase the range and quality of motion in the area being treated. Other health care professionals also perform various types of manipulation, including:

  • physical therapists
  • sports medicine doctors
  • orthopedists (Doctor of Medicine (M.D.) or Osteopathic Physician (D.O.) who is a surgeon specializing in disorders of the musculoskeletal system)
  • physical medicine specialists
  • doctors of osteopathic medicine
  • doctors of naturopathic medicine (an alternative medical system, also known as naturopathy, in which practitioners work with natural healing forces within the body, with a goal of helping the body heal from disease and attain better health)
  • massage therapists

In the United States, chiropractors perform over 90 percent of manipulative treatments.

It is important to inform all of your health care providers about any treatment that you are using or considering, including chiropractic. This will help each provider make sure that all aspects of your health care are working together.

Most chiropractors use other treatments in addition to adjustment, such as:

  • mobilization (a technique in which a joint is passively moved within its normal range of motion)
  • massage therapy
  • heat and ice
  • ultrasound
  • electrical stimulation
  • rehabilitative exercise
  • magnetic therapy
  • counseling about diet, weight loss, and other lifestyle factors
  • dietary supplements
  • homeopathy
  • acupuncture

What Kind Of Training Do Chiropractors Receive?

Chiropractic training is a 4-year academic program consisting of both classroom and clinical instruction. At least 3 years of preparatory college work are required for admission to chiropractic schools. Students who graduate receive the degree of Doctor of Chiropractic (D.C.) and are eligible to take state licensure board examinations in order to practice. Some schools also offer postgraduate courses, including 2- to 3-year residency programs in specialized fields.

Chiropractic training typically includes:

  • Coursework in anatomy, physiology, microbiology, biochemistry, pathology, nutrition, public health, and many other subjects
  • The principles and practice of chiropractic
  • Research methods and procedures
  • Direct experience in caring for patients

The Council on Chiropractic Education, an agency certified by the U.S. Department of Education, is the accrediting body for chiropractic colleges in the United States.

Does The Government Regulate Chiropractic?

Chiropractic practice is regulated individually by each state and the District of Columbia. Most states require chiropractors to earn continuing education credits to maintain their licenses. Chiropractors' scope of practice varies by state--including with regard to laboratory tests or diagnostic procedures, the dispensing or selling of dietary supplements, and the use of other CAM therapies such as acupuncture or homeopathy. Chiropractors are not licensed in any state to perform major surgery or prescribe drugs.

Do Health Insurance Plans Pay For Chiropractic Treatment?

Compared with CAM therapies as a whole (few of which are reimbursed), coverage of chiropractic by insurance plans is extensive. As of 2002, more than 50 percent of health maintenance organizations (HMOs), more than 75 percent of private health care plans, and all state workers' compensation systems covered chiropractic treatment. Chiropractors can bill Medicare, and over two dozen states cover chiropractic treatment under Medicaid.

If you have health insurance, check whether chiropractic care is covered before you seek treatment. Your plan may require care to be approved in advance, limit the number of visits covered, and/or require that you use chiropractors within its network.

Have Side Effects Or Problems Been Reported From Using Chiropractic To Treat Back Pain?

Patients may or may not experience side effects from chiropractic treatment. Effects may include temporary discomfort in parts of the body that were treated, headache, or tiredness. These effects tend to be minor and to resolve within 1 to 2 days.

The rate of serious complications from chiropractic has been debated.

There have been no organized prospective studies on the number of serious complications. From what is now known, the risk appears to be very low. It appears to be higher for cervical-spine, or neck, manipulation (e.g., cases of stroke have been reported. The rare complication of concern from low-back adjustment is cauda equina syndrome that occurs when the nerves of the cauda equina (a bundle of spinal nerves extending beyond the end of the spinal cord) are compressed and damaged. Symptoms include:

  • leg weakness
  • loss of bowel, bladder, and/or sexual functions
  • changes in sensation around the rectum or genitalia

Cauda equina syndrome is estimated to occur once per millions of treatments (the number of millions varies; one study placed it at 100 million).

For your safety, it is important to inform all of your health care providers about any care or treatments that you are using or considering, including chiropractic.

This is to help ensure a coordinated course of care (to find out more, see the NCCAM fact sheet "Selecting a Complementary and Alternative Medicine Practitioner").

What Has Scientific Research Found Out About Whether Chiropractic Works For Low-Back Pain?

So far, the scientific research on chiropractic and low-back pain has focused on if, and how well, chiropractic care helps in relieving pain and other symptoms that people have with low-back pain.

This research often compares chiropractic to other treatments.

Overall, research evidence has been seen as weak and less than convincing for the effectiveness of chiropractic for back pain.

Several key points are helpful to keep in mind about research findings.

  • Many clinical trials of chiropractic analyze the effects of chiropractic manipulation alone, but chiropractic practice includes more than manipulation.
  • Results of a trial performed in one setting (such as a managed care organization or a chiropractic college) may not completely apply in other settings.
  • Researchers have observed that the placebo effect may be at work in chiropractic care as in other forms of health care.
  • What Is The Placebo Effect?

Even though research studies of chiropractic treatment for low-back pain have been of uneven quality and insufficient to allow firm conclusions. Nonetheless, the overall sense of the data is that for low-back pain, chiropractic treatment and conventional medical treatments are about equally helpful.

It is harder to draw conclusions about the relative value of chiropractic for other clinical conditions.

There are also scientific controversies about chiropractic, both inside and outside the profession. For example, within the profession, there have been disagreements about:

  • the use of physical therapy techniques
  • which techniques are most appropriate for certain conditions
  • the concept of subluxations (misalignments of the spine)

Outside views of chiropractic treatment have questioned:

  • the effectiveness of chiropractic treatments
  • their scientific basis
  • the potential risks in subsets of patients (for example, the risks of certain types of adjustments to patients with osteoporosis or risk factors for osteoporosis, compared to patients with healthier bone structures).

Chiropractic Research: The Bottom Line

Research studies on chiropractic are ongoing. The results are expected to expand scientific understanding of chiropractic. A key area of research is the basic science of what happens in the body (including its cells and nerves) when specific chiropractic treatments are given.

Source: NCCAM Publication No. D196

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