chiropractic

chiropractic is a profession that specializes in the diagnosis, treatment, and overall management of conditions that are due to mechanical dysfunction of the joints and muscles and its effects on the nervous system.

The philosophy behind chiropractic is that the body has the capability of healing itself. If factors of accident or lifestyle lead to poor, inadequate, or incorrect function in the spine or the joints, irritation of nerves and muscles can occur, causing direct or referred pain or discomfort, or even disease. Chiropractors use their skills and techniques to detect signs of restriction of movement, and to restore normal function and allow self-healing.

The term ‘chiropractic’ is derived from two Greek words, ‘cheir’ and ‘praktikos’, denoting treatment by hand, or manipulation. Chiropractic manipulation uses gentle hand movements known as ‘adjustments’. The first chiropractic treatment was given by the Canadian Daniel David Palmer in 1895. One hundred years later the chiropractic profession is now established throughout the world, with national associations of chiropractors in over 70 countries.

A chiropractor will always begin a first consultation with a discussion of the patient's symptoms, medical history, lifestyle, and posture. The patient will then be examined, using standard neurological and orthopaedic tests and chiropractic manual tests, before the chiropractor begins treatment. Practitioners use many different techniques to adjust the body, and frequently offer self-help advice and exercise programmes to patients. They may also take X-rays when necessary to aid diagnosis. If the examination identifies underlying disease or a condition for which chiropractic is inappropriate they will immediately refer the patient to a general practitioner or consultant. Chiropractors do not prescribe drugs or use surgical procedures.

Restrictions in the movement of joints can often be detected before the onset of pain. For this reason, chiropractors advise people to have regular spinal check-ups, in the same way that they go for dental check-ups, to avoid pain in the future. This is believed to be particularly important for babies and young children, whose constant knocks and tumbles could lead to later joint problems, and for those young people whose developing bodies are liable to imbalance from carrying heavy bags, wearing fashionable footwear, sitting at computers, and an increasingly sedentary lifestyle.

Chiropractic treatment is suitable for people of any age, including babies, pregnant women, and the elderly, and for a wide range of conditions, including back pain; sciatica; tension headaches; migraine; neck, shoulder, and arm pains; sports injuries; repetitive strain injury; and many other joint and muscle disorders.

Treatment consists of rapid, highly specific adjustments to the affected joint, and sometimes soft tissue massage. Although normally painless, treatment may result in a ‘popping’ noise, which is due to pressure changes within the joint and has no significance. A treatment programme is tailored for each individual, and appropriate techniques are selected to suit that patient's age and overall condition. Manipulation of the spine is aimed at reducing the effects of stress on the particular spinal nerves that are associated with the patient's symptoms; thus, for example, a nerve affected in the cervical part of the vertebral column may be causing headache or neck pain, or in the lumbar part, low back pain. Chiropractors also treat pain in the limbs or the chest.

Manipulation for low back pain has attracted most attention and research. In 1995 the British Medical Journal reported on the follow-up of a Medical Research Council trial, which concluded that patients with low back pain treated by chiropractic derive more benefit and long-term satisfaction than those treated in hospital out-patient clinics. In September 1996 the Royal College of General Practitioners issued Guidelines for the Management of Acute Low Back Pain; these were reviewed and reissued in 1999, recommending manipulative treatment within the first weeks and confirming that the risks are very low in skilled hands.

Apart from these examples, research into the effectiveness of chiropractic has been relatively sparse. This is due largely to the problems of obtaining finance when drug companies are not involved. However, recent trials have been carried out in the UK, Denmark, Canada, and the Netherlands, with positive results, and an increasing number of UK chiropractors are undertaking comprehensive practice-based research projects.

Patients may also be treated for a range of other conditions such as asthma, indigestion and the irritable bowel syndrome, palpitations, high blood pressure, period pains, infantile colic, and other conditions which may not be directly related to the spine or joints. In cases where these less usual problems are treated, the patient's own doctor is generally contacted and a trial period of treatments agreed upon. Chiropractors believe that if they can reduce, by manipulation, the stress on a spinal nerve within the spinal column, this can affect dysfunctions stemming from the same vertebral level. They regularly report success with such treatment. Researchers world-wide are now investigating such claims. One example is a planned collaborative cardiology–chiropractor study of unexplained chest pain.

In the UK it takes 5 years to become a chiropractor: a full-time, 4-year BSc course, followed by a postgraduate year working in a clinic under supervision. Those who have trained at an accredited college can become members of the British Chiropractic Association; this was established in 1925 and now represents the majority of the 1200 UK practitioners. In North America there is a minimum of 6 years' university-level training: 2 years of qualifying sciences and 4 years of chiropractic college. The practice of chiropractic is licensed by law in all US states and Canadian provinces.

In the UK, the Chiropractors Act received Royal Assent in 1994. The General Chiropractic Council was established in 1997, and its statutory register opened in 1999; it is responsible for setting standards of both education and conduct, and since June 2001 all chiropractors are required to be registered if they are to practise legally in the UK.

Many health insurance companies will now pay for chiropractic treatment, and chiropractors are generally recognized as primary health care professionals by the medical establishment. The Clinical Standards Advisory Group recommended, in 1994, that there should be earlier access to the manipulative therapies and a redistribution of resources within the NHS to make this possible.

Manya McMahon

Bibliography

Copland-Griffiths, M. (1991). Dynamic chiropractic today. Thorsons Publishers Ltd, Wellinborough.