A Chiropractor (from Greek chiros and praktikos meaning “done by hand”) is a health care professional who diagnoses and treats mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health. Chiropractic is based on the premise that a spinal joint dysfunction can interfere with the nervous system and result in many different conditions of diminished health. While some chiropractors use the term vertebral subluxation to describe what they treat, others have dropped this concept and concentrate mostly on the musculoskeletal components of spinal injury and rehabilitation of the spine. In contrast, the term subluxation as used in conventional medicine is usually associated with specific conditions which are a direct consequence of injury to joints or associated nerves.
Chiropractic was founded in 1895 by D. D. Palmer, and it is now practiced in more than 100 countries. Chiropractic treatments vary depending on the patient’s condition and the type of approach taken by the particular chiropractor. They commonly include spinal adjustments, although other interventions may be used as well.
There are four main groups of chiropractors: “traditional straights”, “objective straights”, “mixers”, and “reform”. All groups, except reform, treat patients using a subluxation-based system. Differences are based on the philosophy for adjusting, claims made about the effects of those adjustments, and various additional treatments provided along with the adjustment.
Traditional Straight Chiropractors are the original practice. Traditional straight chiropractors follow the philosophical principles set forth by founder DD Palmer and son BJ Palmer; that vertebral subluxation leads to interference of the human nervous system and is a primary underlying risk factor for almost any disease. Straights adhere to the chiropractic diagnosis of subluxations, and view the medical diagnosis of patient complaints (which they consider to be the “secondary effects” of subluxations) to be unnecessary for treatment. Instead, patients are typically screened for “red flags” of serious disease, and treated based on a practitioner’s preferred chiropractic technique. This stance against medical diagnosing has been a source of contention between mixers and straights, because accreditation standards mandate that differential diagnosis be taught in all chiropractic programs so that patient care is safe and relevant to their complaints. Additionally, several state chiropractic licensing boards mandate that patient complaints be diagnosed before receiving care. The most popular national association for traditional straights is the International Chiropractors Association (ICA), as well as the Federation of Straight Chiropractors and Organizations (FSCO) and the World Chiropractic Alliance (WCA).
Objective Straight Chiropractors have one purpose in practice — to correct vertebral subluxations because they interfere with the full expression of life by reducing the ability of the innate intelligence of the body (a controversial concept referring to an inborn organizing and healing force in the human body) to coordinate function through the nervous system. Objective Straight chiropractors are a minority group and a recent off-shoot of the traditional straights. This group is differentiated from traditional straights mainly by the claims made. While traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases, objective straights only focus on the correction of chiropractic vertebral subluxations. Like traditional straights, objective straights typically do not diagnose patient complaints. Their guiding principles are summed up as: “We do not want to diagnose and treat diseases, even diseases of the spine.” and “We do not want chiropractic to be practiced as an alternative to medicine.” They also don’t refer to other professionals, but do encourage their patients “to see a medical physician if they indicate that they want to be treated for the symptoms they are experiencing or if they would like a medical diagnosis to determine the cause of their symptoms.”Most objective straights limit treatment to spinal adjustments. Objective straights tend to share the viewpoints found in the Foundation for the Advancement of Chiropractic Education (F.A.C.E.).
Mixer Chiropractors are an early offshoot of the straight movement. The mixer branch originated from naturopathic, osteopathic, medical, and even chiropractic doctors who attended the Palmer College of Chiropractic and then re-organized the treatment system to include more diagnostic and treatment approaches. They eventually split from the traditional straight group and formed various other chiropractic schools including the National College of Chiropractic. Their treatments may include naturopathic remedies, physical therapy devices, or other Complementary and Alternative Medicine (CAM) methods. While still subluxation based, mixers also treat problems associated with both the spine and extremities, including musculoskeletal issues such as pain and decreased range of motion. Mixers describe vertebral subluxations as a form of joint dysfunction or osteoarthritis. Diagnosis is made after ruling out other known disorders and noting general signs of mechanical dysfunction in the spine. They tend to be members of the American Academy of Chiropractic Physicians, The American Academy of Spine Physicians, and/or the American Chiropractic Association (ACA), and all the major groups in Europe are also in membership of the European Chiropractors Union. Most chiropractors are of the mixer category.
Reform Chiropractors are a minority group who advocate the use of palpation and manipulation to identify and treat osteoarthritis, painful joints, and other musculoskeletal problems. They do not subscribe to the Palmer philosophy of Innate Intelligence and vertebral subluxations, do not believe that spinal joint dysfunction causes organic or systemic disease, and tend not to use alternative medicine methods. They prefer to align themselves more with medical and osteopathic physicians in their views of disease causes, processes and responses to manipulative therapy. Reformers tend to share the viewpoints found in the National Association for Chiropractic Medicine.
Since its inception, Chiropractic has been the subject of controversy, criticism, and outright attacks. It has come from critics within the profession, critics outside the profession, and from researchers in the scientific community. Historically, these have indirectly led to the scientific investigation of chiropractic and an antitrust suit against the American Medical Association. In May 2006, a nationwide phone survey study published in the Journal of Manipulative Physiological Therapeutics reported that 83% of individuals are satisfied or very satisfied with chiropractic care.
Chiropractic’s Approach to Healthcare
According to Robert Mootz D.C. and Reed Phillips D.C., Ph.D., although chiropractic has much in common with other health professions, its philosophical approach distinguishes it from modern medicine. Chiropractic philosophy involves what has been described as a “contextual, naturopathic approach” to health care. The traditional, “allopathic” or “medical” model considers disease as generally the result of some external influence, such as a toxin, a parasite, an allergen, or an infectious agent: the solution is to counter the perceived environmental factor (e.g., using an antibiotic for a bacterial infection). By contrast, the naturopathic approach considers that lowered “host resistance” is necessary for disease to occur, so the appropriate solution is to direct treatment to strength
en the host, regardless of the environment. In contemporary clinical practice, one can find elements of both naturopathic and allopathic philosophy among all types of providers. The degree to which a practitioner emphasizes different tenets of these philosophies is one factor that determines the manner in which they practice.
Chiropractic Perspectives That Reflect a Holistic Approach to Patient Care
recognizes dynamics between lifestyle, environment, and health
emphasizes understanding the cause of illness in an effort to eradicate, rather than palliate, associated symptoms
recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body
appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system
balances the benefits against the risks of clinical interventions
recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures
prevents unnecessary barriers in the doctor-patient encounter
emphasizes a patient-centered, hands-on approach intent on influencing function through structure
strives toward early intervention, emphasizing timely diagnosis and treatment of functional, reversible conditions
While the Chiropractic approach to healthcare stresses the importance of prevention, most patients initially visit a chiropractor complaining of a musculoskeletal problem (especially low back and neck pain).
Most chiropractors concern themselves with the overall health of the patient. Therefore, chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery. Chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices.
Most chiropractors work in private practice or work in small groups, employing chiropractic assistants as office staff and to perform therapeutic activities. They may also employ massage and physiotherapists as adjuncts to chiropractic care.
Gaumer G. Factors associated with patient satisfaction with chiropractic care: survey and review of the literature. J Manipulative Physiol Ther. 2006 Jul-Aug;29(6):455-62.
AHCPR Publication No. 98-N002 Agency for Health Care Policy and Research – AHCPR Chapter 2 (Table 1) Chiropractic Belief Systems, Robert D. Mootz DC; Reed B. Phillips DC, PhD.
More information …
American Chiropractic Association — amerchiro.org
Journal of Manipulative and Physiological Therapeutics (JMPT) is dedicated to the advancement of chiropractic health care. It provides the latest information on current developments in therapeutics, as well as reviews of clinically oriented research and practical information for use in clinical settings. The Journal’s editorial board includes some of the world’s leading clinical low-back and spine researchers from medicine, osteopathy, chiropractic, and post-secondary education. JMPT, the premier biomedical publication in the chiropractic profession, publishes peer-reviewed original articles, case reports, journal abstracts, commentary, and new media reviews. Readers include chiropractors, osteopaths, physical therapists, physiatrists, radiologists, and sports medicine specialists. The Journal of Manipulative and Physiological Therapeutics is the official journal of the American Chiropractic Association