Complementary and Alternative Medicine (CAM) - Ayurvedic Medicine
Chiropractic medicine is a non-drug, non-surgical approach practiced for over 100 years. Its name comes from the Greek words practikos and cheir, which means done by hand. Chiropractic physicians diagnose, treat, and rehabilitate physical problems or illnesses caused by or related to the neuromusculoskeletal system, especially the spinal column. Chiropractic medicine is a hands-on manipulation technique of joint and soft tissue that corrects imbalances, alleviates pain, and promotes overall health.
Chiropractic medicine is based on the theory that the body possesses an innate self-healing ability and naturally moves toward a state of homeostasis. It views disease as caused by the misalignment of the spinal vertebrae (subluxations) or abnormalities of motion (fixations) that, in turn, lead to dysfunction of nerves, blood vessels, and organs.
Typically, a Chiropractic physician performs a chiropractic adjustment on a patient to maintain proper alignment and movement of the spinal column. This is believed to create proper functioning of the nervous system through the spine, thereby restoring the body to normal function.
History of Chiropractic Medicine
Dr. Daniel Palmer founded chiropractic medicine in 1895 in Davenport, Iowa. Palmer was a grocer, magnetic healer, and dabbler in several spiritual, healing techniques. Even though he was never formally trained in conventional medicine, Palmer studied medical books for many years and treated people with early osteopathic techniques. His first chiropractic success story involved a janitor who had gone partially deaf 17 years earlier while stooping in a mine. After manipulating what Palmer called a subluxed vertebra which had been injured just before the hearing loss, Palmer claimed to have restored this man’s hearing. Palmer also reported to have provided immediate relief to a man with heart trouble by adjusting a displaced vertebra pressed against the nerves that enervate the heart. Two years later, Palmer opened the first chiropractic college and called it the Palmer School of Chiropractic.
The basic premise of Palmer’s teachings was that all living beings are endowed with an innate intelligence flowing throughout their nervous system. He taught that disease results when this flow becomes obstructed by a subluxation of the spine due to impeded blood supply. Palmer believed that the primary task of a chiropractor was to remove nerve interferences caused by subluxations so the innate intelligence could carry out its role of maintaining the health and equilibrium of the body. Based on this theory, Dr. Palmer held that, because the entire body is connected via the nervous system, 95% of all disease is caused by subluxations of the spine.
Removal of subluxations has thus become central to chiropractic treatment protocol. In orthodox medicine a subluxation is used to mean a partial or incomplete dislocation of any two bones at a joint. The American Association of Chiropractic Colleges has broadened Palmer’s definition to a subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health. The cause of this spinal misalignment is due to anything from poor posture, a muscle spasm, an accident, a sports injury, to a birth defect.
Palmer’s only son and student, Barlett Joshua Palmer, known as B.J., was responsible for promoting the chiropractic movement and was later faced with rivals who established their own schools espousing dissenting techniques of spinal manipulation. One such rival was John Howard, a former Palmer College faculty member who started his own college based on more scientific and rational thought—today called the National College of Chiropractic.
This rivalry still exists within today’s chiropractic community, making it difficult to provide one commonly accepted theory about chiropractic care. There are the straights who espouse Palmer’s philosophy of solely using spinal adjustments to resolve subluxations. There are also the mixers who believe diseases can develop from causes other than subluxations, such as bacteria and viruses. The mixers employ techniques in addition to spinal adjustment, such as therapeutic massage, ultrasound, acupuncture, trigger point therapy, physical therapy, nutritional supplementation, and applied kinesiology.
Today, most chiropractors realize the many aspects that cause disease and don’t believe disease is solely caused by subluxations. They do, however, believe that subluxations are a major component that can predispose a patient to disease. According to a 1997 report from the Agency for Health Care Policy and Research, more than two-thirds of chiropractors use techniques other than manipulation, namely exercise, nutritional counseling, and physiotherapy, although 93% retain spinal adjustment as their primary approach to treatment.
The chiropractic community has also faced adversity from conventional physicians ever since its inception. At one point, Palmer himself infuriated the orthodoxy so much that he and many of his followers were imprisoned for practicing medicine without a license. This was the beginning of a long history of rivalry between chiropractic and the medical establishment that led to the chiropractic community taking the AMA to court in 1976. The chiropractic community had claimed to be victimized by the medical profession without proper access to medical facilities. The judge presiding over the case decided the AMA had ample evidence for its claims of quackery. Yet, the judge claimed that the AMA had broken the Sherman Antitrust Act because it had caused a restraint of trade by boycotting chiropractors. Subsequently, this ruling prevented the medical establishment from boycotting chiropractors. Relations have been strained between chiropractors and the orthodoxy ever since, but seem to be starting to mend as of late.
Regardless of adversity, chiropractic has continued to prosper and is the most widely used CAM practice in the United States. Today, there are 16 American chiropractic colleges, accredited by the Council of Chiropractic Education, which have more than 2800 graduates per year. Chiropractors are currently the second largest group of health professionals who have primary contact with patients, and their number is supposed to double by 2010. They are licensed in all fifty states, including the District of Columbia, and their services are reimbursed by most health insurance companies, Medicare, and, in many states, Medicaid. It is common to find chiropractors on hospital staffs, workman’s compensation medical examination boards, armed forces health care provider staffs, expert testimony witnesses in lawsuits, and on the team of physicians in sports medicine settings.
Chiropractic Medicine Effectiveness
It has been found that 85% of patients seek chiropractic care for neuro-musculoskeletal problems, particularly neck and back pain. Chiropractic has been used to treat generalized pain, trauma, injuries, and certain internal disorders of the body. It is claimed to help prevent normal breakdown of joints and ligaments by maintaining their proper positioning and to lessen scar tissue accumulation after serious injury, thus preventing possible stiffness and/or weakness of the affected joints.
Chiropractic treatment has been shown to be successful in treating various disturbances of the body, including peripheral joint injuries, sprains, arthritis, bursitis, menstrual difficulties, emotional problems, asthma, bursitis, enuresis, carpal tunnel syndrome, chronic fatigue syndrome, earache, headache, high blood pressure, menstrual problems, muscle cramps, neuralgia, chronic pain, premenstrual syndrome, sprains and strains, tendonitis, and TMJ syndrome.
Chiropractic medicine has also been found to be helpful with addictive behavior. The American College of Addictionology and Compulsive Disorders (ACACD) in Miami, Florida, has chosen chiropractic as the profession of choice in training for board certification in addictionology. Life Chiropractic College in Marietta, Georgia, has also started the first program to deal with chemical dependency in the professional training of chiropractic physicians.
Chiropractic Medicine Education and Licensing Requirements
Chiropractic education requires at least two years of college education with an emphasis in basic science, followed by a five-year chiropractic curriculum. Students usually receive at least 4,000 hours of training, including chiropractic philosophy, basic and clinical science, conventional medical diagnosis, structural and functional diagnosis, chiropractic technique, and clinical care.
A chiropractic license (DC, for doctor of chiropractic) does not usually permit surgery or prescribing drugs, however, some chiropractors have additional training in radiology, orthopedics, neurology, rehabilitation, behavioral health, family practice, nutrition, diagnostic imaging, occupational health, sports injuries, and physical fitness. The American Chiropractic Association describes such training as advanced certification in a chiropractic specialty.
Chiropractic scope of practice varies from state to state. In general, a chiropractic can provide history taking, clinical examination, laboratory tests and results, x-ray findings, evaluation of emotional status, chiropractic manipulations, nutritional counseling, physical therapy, emergency procedures, exercise counseling, and disease prevention. In some states, they can draw blood for testing and deliver babies.
The Experience of Chiropractic Treatment
At the onset of an initial session, the patient fills out a questionnaire about personal and family medical history and the chiropractor takes a case history. Next, the chiropractor does a basic physical and neurological examination where they pay special attention to the spine, joints, muscles, posture, work habits, and body position, especially during time of an injury. Many chiropractors also take spinal x-rays at this point. The chiropractor then discusses their findings, explains the treatment plan, and performs one or several spinal adjustments on the patient.
A chiropractic adjustment involves being properly positioned on a chiropractic table, followed by pressure applied to the relevant joint(s) to return it to proper alignment. An audible, painless click or popping sound is often a result of the structural adjustment, said to be due to the release of gases from the joint fluid. The patient may notice an increased range of motion and reduction of soreness following an adjustment.
Some chiropractors prefer to employ non-force techniques as they apply gentle touch along the spine, skull, and pelvis. With this method, no popping sound or click is heard when the subluxations are corrected. A chiropractic adjustment can also be accomplished with a small hand-held device called an activator. Oftentimes activators are used with children or the elderly because they provide a more gentle adjustment of the joint than hand manipulations.
An initial chiropractic visit lasts anywhere from thirty to sixty minutes and subsequent visits last between ten and thirty minutes. A typical course of chiropractic treatment is three to five visits a week for two weeks. One may experience relief immediately or within nine to twelve visits. If there is no relief or it gets much worse the treatments may need to be stopped. Some chiropractors believe one should have their spine aligned on a regular basis, such as monthly or every six weeks as a preventive measure to keep the spine free of subluxations.
Precautions for Chiropractic Treatment
The vast majority of chiropractic manipulations are safe. Serious side effects from spinal manipulations appear to be rare, although there have been reports of strokes following a neck adjustment. Chiropractic adjustment can cause severe damage if a patient presents neurological involvement, bone disease, spinal chord disease, recent fracture, serious circulatory problems, aneurysms, tumor, acute rheumatoid arthritis, or history of thrombosis. It should also be avoided in an area that has been operated on such as spinal fusion, acute and healed fractures and dislocations with signs of ligament damage, and idiopathic scoliosis. Of course, a chiropractor should always carefully screen patients for these conditions prior to providing treatment. Any manipulation of the body carries a potential risk factor; therefore, proceeding with caution is of utmost importance.
The Agency for Health Care Policy and Research has estimated that the incidence of adverse events as a result of a manipulation to the neck area is one in one million procedures. Furthermore, it has estimated the risk of a serious side effect from lower back adjustments to be one case in one hundred million. Manipulation of the spine, and especially the cervical area, could be dangerous and even fatal. If the neck were to be twisted too far, the walls of the vulnerable vertebral arteries could tear where they pass up to the neck. This could result in an aneurysm or blood clots, which could lead to a stroke or other neurological symptoms, such as vertigo and slurring, or even death.
Cases of neurological damage as a result of chiropractic manipulations of the neck have been reported. In 1992, researchers at Stanford Stroke Center in California found fifty five people with permanent nerve damage following manipulation. One of these people even died.
Some people have chiropractors act as their gate keepers, but it is important that not all chiropractors have sufficient training to diagnose all medical conditions.
Chiropractic Published Studies, Reports and Guidelines
There are several research studies done in the early 1990s by organizations such as the Workman’s Compensation Fund, Britain’s Medical Research Council, Rand Corporation, Florida Department of Labor, and the Oregon Workman’s Compensation Board. These studies have been published in well known journals such as the Journal of Manipulative and Physiological Therapeutics, Annals of Internal Medicine, and Medical Hypotheses. The results of the studies found chiropractic treatment to be an effective treatment for the following: low back pain, impaired speech, reversing the stress response and bolstering immune performance, sciatica, asthma, high blood pressure, or pain caused by neurological conditions and osteoarthritis.
A set of federal guidelines on Acute Low Back Problems in Adults was released in 1994 by the Florida Department of Labor and the Oregon Workman’s Compensation Board from the Agency for Health Care Policy and Research (AHCPR) to further inform the public about the efficacy of chiropractic treatment. These guidelines recommended spinal manipulations as the preferred treatment for acute back pain as compared to traction, bed rest, and drug therapy.
In 1995, a report from the General Medical Council in Britain showed that patients receiving chiropractic treatment for low back pain had a higher incidence of recovery than those treated at a hospital physiotherapy out-patient clinic.
The quest for more substantial research on Chiropractic medicine continues today with studies being done at NCCAM funded by the Consortial Center for Chiropractic Research in Iowa. These studies are analyzing the effectiveness of chiropractic care for neck pain, sciatica, chronic pelvic pain in women, as well as other conditions. These studies are a result of a recently augmented $2.7 million grant from the NCCAM.
For more information about chiropractic medicine contact the International Chiropractors Association, 703-528-5000 (straight chiropractic), the American Chiropractic Association (ACA), 800-986-4636. (mixer chiropractic). The ACA also has a web site at http://www.amerchiro.org/, or the World Chiropractic Alliance, 800-347-1011.
Techniques Practiced by Mixer Chiropractors
APPLIED KINESIOLOGY (AK)
AK refers to a group of holistic, interdisciplinary therapies based on the belief that a pattern of weakness in specific muscles indicates a specific diagnosis. The process of examining the patient for this weakness to obtain an overall view of the patient’s neurological system is called muscle testing. The information gathered from the patient’s muscle tests is then analyzed along with information gathered from clinical history, physical examination, and laboratory tests to reach a diagnosis.
AK was developed by an American chiropractor Dr. George Goodheart, Jr. during the late 1960s. Dr. Goodheart founded the International College of Applied Kinesiology, which prides itself as a rigorous, disciplined approach to kinesiology. The aim of AK is to restore health and overall balance of the body and to improve muscle and nerve performance. This is accomplished by addressing problems such as inadequate diet, chemical toxicity, structural damage, or postural misalignment through spinal manipulation and training with acupuncture, acupressure, or massage.
Contact: Visit the website of the International College of Applied Kinesiology at http://www.icak.com
McTimoney Chiropractic is a more gentle form of chiropractic adjustment founded in 1951 by John McTimoney in Britain. This system uses a technique pioneered by B.J. Palmer known as the toggle-recoil thrust whereby the practitioner pushes the joint in the desired direction with one rapid movement and subsequently releases it. The rapid push is thought to stretch the joint ligaments and tendons, and upon their release the body’s natural elasticity realigns the bones. The gentleness of this technique makes it ideal for babies and the elderly.
Contact: Visit the website for McTimoney Chiropractic at http://www.mctimoney-chiropractic.org
NAMBUDRIPAD ALLERGY ELIMINATION TECHNIQUE (NAET)
NAET is named for its innovator, Dr. Devi Nambudripad. It is a simple, gentle, and non-invasive method which locates and removes blockages in electromagnetic pathways that are related to allergens. This method is based on the theory that an allergic reaction is a result of a conflict between the energy fields of the allergy sufferer and the allergen. The aim is to create a permanent, drug free elimination of all types of allergies.
The practitioner utilizes AK to determine what substance a client is allergic to by muscle testing while the client holds a sample of a suspected allergen. Acupressure, acupuncture, or chiropractic is then performed with the client continuing to hold the allergen. Stimulation of the acupuncture points balances the electromagnetic fields of the body with those of the allergen, reprogramming the nervous system to stop identifying the substance as an allergen. The client then avoids contact with the allergen, certain foods, and substances associated with that allergen for 25 hours after which they are retested.
Contact: Visit a NAET website at http://www.naet.com
This is a technique employed by chiropractors who use Network Spinal Analysis developed by Dr. Donald Epstein. Epstein observed from clinical experience that not all subluxations are the same. This very gentle method utilizes twelve techniques to deliver a low force adjustment through contact with the tissues overlying the spine, resulting in full spine ramifications including both bony and soft tissues components. This is different from attempting to match the vertebra being adjusted to a specific technique, states Dr. Epstein. The difference lies in the sequence of adjustments and the networking of the various methods. Network chiropractors focus on releasing emotional as well as physical blockages.
Contact: Visit the website of the Association for Network Care at http://www.associationfornetworkcare.com