What is Chiropractic?

The art, science and philosophy of chiropractic emphasizes the nervous system’s interaction with the whole body. Rather than focusing on symptoms, chiropractors have a holistic approach to wellness that utilizes therapeutic techniques and lifestyle changes to correct neuromusculoskeletal disorders and promote the body’s natural healing ability.

The Philosophy of Chiropractic

Before there was a chiropractic profession, there was a question in the mind of the founder of chiropractic, Daniel David Palmer. “I desired to know,” Palmer would say, “why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench, was not.”

Palmer concluded that people get sick when something interferes with their nervous system, primarily when this interference occurs where their spinal nerves exit their vertebrae (through an area called the intervertebral foramen, a tunnel formed between two vertebrae). Palmer called this interference a subluxation, and, as the history of chiropractic now shows, the term stuck.

Chiropractic is deeply rooted in this philosophy, as well as that of Palmer’s son Bartlett Joshua Palmer. This outlook is based on the premise that healthy people have healthy spines and nervous systems. Extrapolating from this, chiropractors believe that subluxations are linked to a weakened nervous system, which can lead to a weakened immune system and can prevent the body from functioning properly and staving off illness. For that reason, many chiropractors believe that subluxations are involved in conditions such as low back pain and possibly even illnesses like colic and asthma.

According to the chiropractic philosophy, there are five components to a subluxation: a spinal component, a nervous component, a muscular component, a soft-tissue component and a disease component. Chiropractors focus on detecting these and removing subluxations, freeing up the body’s natural healing ability, improving function and relieving pain.

Because of this belief in the body’s healing potential, chiropractors have a holistic approach to health and wellness. So, while the philosophy keeps the profession distinct, practitioners often work in multidisciplinary settings, joining medical doctors, massage therapists, nutritionists, reflexologists, naturopaths, acupuncturists and other complementary health-care providers to meet the goal of improving people’s health.

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History of Chiropractic

The story of chiropractic began more than 100 years ago with a man named Harvey Lillard. Lillard was working as a janitor in Davenport, Iowa when he strained his back and lost much of his hearing in the process. Enter Daniel David Palmer, a magnetic healer who worked in the same building. Palmer examined Lillard, saw that his spine was out of alignment and offered to readjust it in hopes of relieving a pinched nerve leading to his ears. Using only his hands, Palmer worked his magic — a few gentle thrusts restored Lillard’s spine and returned much of his hearing.

Palmer didn’t know it, but the treatment for Lillard’s back trouble on that September day in 1895 marked the start of chiropractic. For the Canadian-born Palmer, it was initially just a cue to turn his attention to spinal adjustment. Although he had no formal training, Palmer subscribed to medical journals of the day and was particularly well-read in subjects like anatomy and physiology. Before long, he had conceived of chiropractic as a natural approach to healing, rejecting the use of drugs or surgery. Instead, it would focus on the neuromusculoskeletal system and its effect on general health, with an emphasis on the body’s ability to heal itself. In 1897, he opened the Palmer School of Chiropractic in Davenport with a total of 14 students. Today it is one of more than 30 chiropractic colleges worldwide recognized by the World Federation of Chiropractic (WFC).

One of the first things to distinguish chiropractic from other late 19th-century modes of health care was its ability to survive into the 1900s while other alternative approaches dwindled next to the rise of conventional allopathic medicine. That’s not to say the profession hasn’t had its battles. For years, many chiropractors were accused of practicing medicine without a license. Funding has also been a source of conflict. Following the 1910 “Flexner Report,” the US federal government and, later, corporations, opted to throw most of their financial support behind conventional medical research and practice, making it the de facto authority on bodily healing and treatment.

Such was not the case for chiropractic. Schools of chiropractic remained relatively immature in terms of entrance qualifications, faculty and curriculum through the first half of the century. Money was also a problem; without enough of it, the profession couldn’t afford to carry out proper clinical research. A turning point came in 1944, with the establishment of the Foundation for Chiropractic Education and Research (FCER). With that, the profession had a primary source of funding.

Support for chiropractic accelerated in the 1960s and ’70s. When the federal government recognized the US Council on Chiropractic Education (CCE) as the accrediting agency for schools of chiropractic, it was the first time chiropractic colleges had educational standards for curriculum and admission processes. This boosted their credibility significantly. When several major government inquiries found strong medical evidence to back the effectiveness of chiropractic treatment, the profession edged its way further into the medical mainstream.

In the past 20 years, tensions between medical doctors and chiropractors have waned, largely due to the realization that chiropractic patients — who often rely on both forms of health care — want their chosen providers to cooperate. Furthermore, an increasing number of doctors have recognized chiropractic’s wide range of medical merits. With over 160,000 people in more than 70 countries now making careers as doctors of chiropractic, the profession has a secure, established base on which to work and grow.

And to think it all started with Harvey Lillard’s bad back.

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Chiropractic Treatment by Age Group

Children
Chiropractic care for children can be likened to dental care for kids: just as regular checkups with the dentist can help prevent cavities, regular checkups with the chiropractor can help prevent problems in the spine. It should come as no surprise, then, to learn that doctors of chiropractic are well-trained to examine, diagnose and manage infants and children.

When it comes to treatment, children’s health can be influenced by numerous factors that lend themselves to chiropractic care. Physical injuries, for example, are common in childhood. If not treated properly, these injuries can lead to muscle imbalances, where some muscles become tight while others become weak. In other cases, injuries can cause subluxations and spinal joint dysfunction, which can affect spinal biomechanics and other bodily functions.

Another area for early chiropractic care is posture-related disorders. A growing source of patient visits to chiropractic offices, these are often born out of poor childhood habits. Thus, correcting poor posture and promoting good spinal hygiene in children is of utmost importance to your chiropractor. Your chiropractor will also routinely check for the development of scoliosis; should it be discovered, a plan of management will be introduced and this may warrant a medical referral.

The actual treatment of children is extremely gentle, as chiropractors perform adjustments to children with much less force than they do to adults. Your chiropractor may use his or her hands or, like many chiropractors, choose to adjust children using an activator tool.

Teenagers
As with children, the examination and treatment of teenagers is of critical importance to chiropractors. During puberty, numerous changes taking place in a teen’s body can place significant demands on muscles, joints and bones. During this period, bones tend to grow fast while muscles grow slowly by comparison. These changes can cause muscle imbalances, subluxations and injuries.

The transition from teen to adult also brings significant changes to actual bone structure and composition. Before the teen years, many bones in the body are soft and flexible. This is because much of the bone is actually made of cartilage. As a teenager, the cartilage hardens into true bone. During this period, the bones and associated ligaments are more vulnerable to fractures, strains and sprains. Therefore, the detection of subluxations and associated muscle imbalances can be helpful in the prevention, restoration and maintenance of health.

Adults
Adults are by far the most frequent consumers of chiropractic health care. This is not surprising. For many, fast-paced lifestyles have led to an alarming increase in stress and stress-related disorders. Muscle, nerve and joint dysfunction are common manifestations that often produce lower back, neck and headache symptoms.

In addition to stress, lack of physical exercise leaves many adults vulnerable to injuries. Injuries are often caused by repetitive movements, either in the workplace or at home. Less frequently, injuries can be caused by sudden falls. In either case, without regular exercise, adult bodies will be less forgiving, yielding to injuries much more easily than children’s. Regardless of the injury, joint dysfunction, subluxation and muscle imbalance can occur.

Lack of exercise also leads to changes in posture. The extent of these changes depends largely on what people do for a living. All activities, though, can lead to imbalances in the neck, back and upper torso that weaken some muscles and tighten others. These imbalances will cause the head to point forward, the upper back to slump and the shoulders to tip lazily forward. Over time, joints are stressed, muscles become tighter and serious symptoms develop.

Seniors
In North America, many chiropractors routinely visit retirement homes with their portable tables and offer chiropractic care. Many hospitals in the US that focus on treating the elderly have also incorporated chiropractic care into their health-care team. It’s easy to see why.

As we get older, wear-and-tear on our joints begins to manifest. This is commonly called osteoarthritis, which is like rust to our joints. It may cause pain and limit one’s range of motion. Chiropractic care has been shown to have an impact in alleviating pain associated with this degenerative process as well as restoring function, mobility and overall health.

But chiropractic treatment for seniors is not limited to arthritis. Chiropractors can also address nutrition, depression, exercise and other health concerns. A chiropractor can help monitor osteoporosis, for example. Or, he or she can rule out more serious causes of low back pain in men, which can be caused by an enlarged prostate. Even where an appropriate referral may be the end result, a chiropractor can be an integral part of any older person’s health-care team.

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What to Expect on Your First Visit

If you’ve never been to a doctor of chiropractic (DC), it’s natural to wonder what to expect on your first visit. To dispel any fears or uncertainties, we’ve prepared the following step-by-step guide.

The office
When you walk into a chiropractor’s office, it may very well look like the office of a medical doctor or a dentist. In some cases, however, your chiropractor may opt for a different look, one that’s warmer and less sterile. It all depends on his or her personal style and philosophy.

Your chiropractor or the office manager will greet you, take your name and ask you to fill out some forms and a questionnaire. That questionnaire will cover your medical background, family history and any previous treatment or surgery.

The examination
When your DC is ready to see you, you will talk together in detail about the history of your complaint. He or she will also ask detailed questions about your health history.

Chiropractors examine patients in much the same way that medical doctors do. Your chiropractor will test your reflexes and muscle strength. He or she may also take your temperature and your pulse. Range of motion is of particular interest to chiropractors, so expect a test to see how far certain joints in your body bend comfortably.

Your chiropractor may also order x-rays or use other techniques to complete or confirm a diagnosis. Be sure to ask questions about any procedures you aren’t familiar with.

The care
If your DC finds a problem with joints in your spine, he or she may use adjustments to care for these joints. An adjustment is a quick but gentle pressure on a joint to loosen it. Chiropractors can perform adjustments either with their hands or with a mechanical device called an activator tool. (Doctors receive years of training to learn about manipulating bones in the back safely.)

Adjustments can produce a popping sound, similar to that of a cracking knuckle, when pressure in the joint is released. The sound is caused by bubbles of carbon dioxide gas escaping from the fluid surrounding the joints. The sound is harmless and the gas will eventually dissolve back into the fluid.

Adjustments shouldn’t be painful, although you may feel some discomfort until the pressure in the joint is relieved.

The follow-up
Depending on your condition, your chiropractor may schedule a series of visits for care. For example, he or she may want to see you three times a week for several weeks, then twice a week for two weeks and so on.

If so many visits seem unusual, consider this: when you see a medical doctor, he or she may prescribe pills to treat your condition. Because you can take the pills yourself, you don’t have to go back to the doctor’s office. Your chiropractor’s care, on the other hand, involves adjustments and tests that must be done in person.

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The Subluxation/Spinal Joint Dysfunction

Whether you just started seeing a chiropractor or are a long-time patient, you’ve probably heard the term “subluxation.” Your chiropractor may have also used the terms vertebral subluxation complex, spinal joint dysfunction or fixation. Generally speaking, these terms are interchangeable. However, subluxation has specific qualities to chiropractors and is a word with historical significance.

By definition, subluxation describes a spinal joint (a joint between two vertebrae) or peripheral joint (a joint other than the vertebral joints, like one in your foot or wrist) that is relatively immobile (has restricted motion) or abnormally positioned. An analogy may be as follows: If you have a steering wheel that is stiff and that does not turn all the way, it is “subluxated” and can lead to an accident. The wheel needs to be oiled so that it is loose and moves to its full capacity, helping you to steer properly.

Subluxations can cause local pain and may interfere with or impede the function of the nervous system, joints and muscles. This may decrease the body’s ability to heal and function optimally. There are generally five components of subluxation, which fall under the broader heading of the vertebral subluxation complex (VSC). These components generally occur sequentially in the following order:

1. Abnormal spinal mechanics
   Your chiropractor will use his or her hands to assess the movement of your spine or peripheral joints. When a joint is not moving well relative to the joint above or below it, it is said to have abnormal spinal mechanics. This may result from trauma, like a fall, or from chronic mistreatment, like poor posture. If you have abnormal mechanics, you may notice a lack of mobility, such as difficulty moving your head to check your rearview mirror. If not cared for, this can lead to abnormal nerve function. Your chiropractor will use adjustments to restore the restricted motion.
2. Abnormal nerve function
   Whenever a subluxation does not heal properly there will be a pinched or irritated spinal nerve. That’s because the spinal facet joint is located adjacent to the spinal nerve roots, and sprained spinal joints irritate the roots either by direct pressure (only about 10% to 15% of the time) or by irritation with inflammatory chemicals (85% to 90% of the time). In addition, when the joint is sprained or subluxated the tiny nerve endings in the joint’s cartilage may become damaged. If this happens, it can alter the messages nerves send to the brain and affect the brain’s ability to control the spinal muscles.
3. Abnormal muscle function
   Whenever there are pinched or irritated spinal nerves there will usually be muscle problems. Pinched (impinged) nerves will cause muscle weakness, whereas irritated nerves may cause muscle strain or spasm. This can lead to muscle inflammation and eventually scar tissue formation or gristle in the muscle. To patients, this feels like tight or rope-like muscles, which are tender to touch. In addition, patients may notice that their muscles burn and tire easily. Left unchecked, this inflammation can spread throughout the spine.
4. Abnormal function of soft tissues around the spine
   Inflammation that occurs in muscles and joints can cause further complications by spreading to all areas around the spine. With long-term swelling of structures, such as ligaments, disks and other soft tissues, calcium and fibrous materials are laid down. With repeated episodes of subluxation, the spine accumulates an increasingly larger number of abnormal sites. In fact, some MRI studies have shown areas of soft-tissue fibrosis and calcification up to one inch thick around the spine. At the same time, long-term swelling can increase due to improper vascular supply and drainage. From here, full-blown spinal disease is the likely outcome.
5. Disease at the spinal level and of the whole body
   At this stage, irreversible disease or pathology can occur. This may manifest in the spinal area as bony spurs on the vertebrae, decreased disk height and roughened joint surfaces. Known as osteoarthritis or subluxation degeneration, it can occur at any age, but is increasingly common as people get older. In addition, it can lead to disease or pathology away from the spine, in all body tissues, organs and systems.

If you have any questions about subluxation or the problems it causes, please speak with your chiropractor.

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The Adjustment/Manipulation

There are many professions around the world today that use spinal manipulation in the treatment of patients. But chiropractic is the only profession in which manipulation, known as adjustment to chiropractors, serves as the main focus of care and education.

That said, there is a great deal of controversy among chiropractors today about whether to use the word manipulation or adjustment to describe what is, in essence, spinal or peripheral joint manipulation. Many chiropractors prefer the word adjustment, which has historical, anatomical, scientific and philosophical relevance. They believe that it differentiates chiropractors from other health-care providers utilizing spinal manipulation, whereas manipulation is a term more widely accepted by allopathic medicine.

So what is an adjustment? The chiropractic adjustment involves the utilization of specific, short-lever, high-velocity and controlled forceful thrusts by hand or instrument (such as an activator tool) that are directed at subluxations. The goal of this corrective pressure is to return joints to their proper position, remove subluxations and restore health to the nervous system.

References: Leach, R. The Chiropractic Theories: A Synopsis of Chiropractic Theories. Philadelphia: Lippincott Williams and Wilkins, 1986. 15.

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Preventive/Maintenance Care

Chiropractors don’t just treat biomechanical and neuromusckuloskeletal disorders, but also help prevent them. The latter is commonly referred to as either preventive or maintenance care.

While your chiropractor will explain his or her particular philosophy regarding chiropractic’s role in preventing pain and maintaining health, formal definitions have also been established.

In the US, the definition is determined by the “Guidelines for Chiropractic Quality Assurance and Practice Parameters” (known as the “Mercy Conference Guidelines”) and is as follows: Any management plan that seeks to prevent disease, prolong life, promote health and enhance the quality of life. A specific regimen is designed to provide for the patient’s well-being or for maintaining the optimum state of health.

It is important to recognize that the guidelines state, “preventive/maintenance care is elective; must include periodic reassessment; may include treatment, education and counseling; and generally should be delivered at a frequency of not more than once a month.” Still, while the guidelines recommend once a month, many patients elect to have preventive/maintenance care more often and many chiropractors feel this is reasonable and important in promoting wellness.

In Canada, the “Clinical Guidelines for Chiropractic Practice in Canada” (known as the “Glenerin Guidelines”) define preventive/maintenance care as: Elective care given at regular intervals designed to maintain maximum health and promote optimal function. It may incorporate screening procedures designed to identify developing risk problems pertaining to the patient’s health status and give advice on same.

In all cases, it is up to the chiropractor and the patient to determine whether or not an individual is a candidate for this type of care.

References: Mootz, R. and H. Vernon. Best Practices in Clinical Chiropractic. Maryland: Aspen Publishers, 1999. 184-186.

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Chiropractic Safety

How safe is chiropractic?
Chiropractic is recognized as one of the safest types of health care in the world. Numerous studies, including those funded by governments, universities and nonprofit research institutions, have proven it to be a successful primary therapy for neuromusculoskeletal conditions — a therapy that is safer, in fact, than most medical procedures used to treat the same conditions. Chiropractic is also widely used as a complementary mode of care for a variety of other conditions and diseases and to promote overall health and well-being.

Is there a connection between stroke and chiropractic treatment?
Would you think twice about cradling the phone on your shoulder, checking your blind spot while backing into a parking space or getting your hair shampooed at a salon? The risk of stroke from chiropractic care is no greater than it is from any of these everyday activities.

The source of public concern in this regard is a condition known as vertebral artery syndrome (VAS), which occurs when sudden head movements disrupt the blood flow in the vertebral artery, possibly leading to stroke. As the above examples illustrate, the risk of this complication arising from upper cervical (or neck) manipulation by a chiropractor is extremely remote. According to the 1996 RAND report, “The Appropriateness of Manipulation and Mobilization of the Cervical Spine,” only one out of every one million chiropractic patients experiences VAS. To put it another way, you are five times more likely to get hit by lightning than to suffer VAS at the hands of a chiropractor.

Up to 75% of chiropractic patients receive cervical manipulation as part of their individual chiropractic care. It may be performed as part of your care for total spinal health and wellness, or for specific causes such as muscle tension and stiffness, headache or injury. After a detailed history and examination, if there is any indication that you would be at risk, your chiropractor will not include a neck adjustment in your treatment.

How does the safety of chiropractic compare to other medical procedures?
In comparison to allopathic medicine, which uses drugs and surgery as an integral part of treatment, chiropractic presents far less risk. Consider, for example, that in the United States an estimated 140,000 people die each year from drug-related reactions. And the risk of death due to gastrointestinal complications from taking nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen is 400 times greater that the complication rate for people who receive cervical manipulation, while the mortality rate for people who undergo cervical spine surgery is 7,000 times higher.

Human error is another factor that tilts the safety balance in chiropractic’s favor. In the United States, it is estimated that up to 98,000 Americans die yearly from medical errors — a doctor accidentally making the wrong incision, a nurse administering the wrong medication, and so on.

But with all forms of treatment, whether allopathic or alternative, any risks, however slight, should not be ignored. While the methods used by chiropractors have proven to be safe in almost all cases, it is a constant concern for chiropractors to evaluate their patients to determine if treatment will cause an adverse reaction.

Can chiropractic adjustment damage your joints?
The answer is no. What’s more, most chiropractic adjustments are painless. Often, the adjustment may feel good and can provide immediate relief from stiffness or tension.

While some people may get nervous about the “pop” that an adjustment can produce, the sound is not coming from the bones themselves. It’s coming from a lubricant called synovial fluid that’s found in every joint. That fluid contains dissolved gases. Separating joints creates pressure, which forces the gases to rapidly escape, creating the “pop.”

You may have some discomfort during an adjustment, however, if you’ve had a recent injury, as adjustments can irritate inflamed tissue. As your body heals this should stop. Some people also experience odd sensations in their extremities after adjustments. This is a normal reaction to the relieving of pressure on nerves and is usually no cause for concern.

Can chiropractic adjustment lead to arthritis?
There is no evidence to suggest that chiropractic care and manipulation of the spine can lead to arthritis. On the contrary, chiropractors often care for people with arthritis by maintaining joint health. However, concern has been raised over the safety of people who try to adjust themselves, by cracking their own knuckles, for example. While people might have the right idea by trying to relieve pressure on the joints, only chiropractors can ensure an adjustment is performed safely, without possibly weakening or causing harmful friction to surrounding joint structures. The best advice: Don’t try to do it yourself. Seek the expertise of your chiropractor.

Do chiropractors refer patients to other specialists?
Like other doctors, chiropractors belong to a large and growing network of health-care professionals and make referrals for patients when necessary. Chiropractors are well educated to recognize risk factors and signs of disease and will not hesitate to make a referral when it’s in a patient’s best interest.

References:

1. Zuber, M., J. Meder and J. Moss. “Cartoid Artery Dissection due to Elongated Styloid Process.” Neurology (Nov. 1999).
2. U.S. Department of Health and Human Services. “Chiropractic in the United States: Training, Practice and Research,” Dec. 1997.
3. Coulter, I., E. Hurwitz, A. Adams, W. Meeker, D. Hansen, R. Mootz, P. Aker, B. Genovese and P. Shekelle. “The Appropriateness of Manipulation and Mobilization of the Cervical Spine.” Santa Monica: RAND, 1996.
4. Shekelle, P. G., E. Hurwitz, I. Coulter, A. Adams, B. Genovese and R. Brook. “The Appropriateness of Chiropractic Spinal Manipulation for Low-Back Pain.” Santa Monica: RAND, 1996.
5. Dabbs, V. and W. Lauretti. “A Risk Assessment of Cervical Manipulation v. NSAIDs for the Treatment of Neck Pain.” Journal of Manipulative and Physiological Therapeutics, Vol. 18 (1995): 530-36.
6. Carson, J.L. and L.R. Willett. “Toxicity of Nonsteroidal Anti-inflammatory drugs: An Overview of the Epidemiological Evidence.” Drugs, Vol. 46 (1993): 243-248.
7. Weintrob, M. “Beauty Parlor Stroke Syndrome: Report of Five Cases.” Journal of the American Medical Association (1993): 2085-86.
8. Manga, Pran, D. Angus, et al. “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain.” Ottawa: University of Ottawa, 1993.
9. Gabriel, S.E., L. Jaakkimainen and C. Bombardier. “Risk for Serious Gastrointestinal Gomplications Related to the Use of Nonsteroidal Anti-inflammatory Drugs: A Meta Analysis.” Annals of Internal Medicine, Vol. 115 (1991): 787-796.
10. Hasselberg, P.D., Report of the Commission of Inquiry. “Chiropractic in New Zealand.” Wellington, 1979.

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Today, millions of dollars are spent each year on chiropractic research in North America, with solid medical studies covering basic science, health and education. But this hasn’t always been the case. For most of the last century, the field of chiropractic — which began in 1895 — has been criticized for its lack of clinical research. Insufficient funds were the main reason research was neglected. For chiropractors, there were more pressing concerns: obtaining the legal right to practice and overcoming immense skepticism from the medical community.

That’s not to say there wasn’t an effort to conduct formal research. In 1944, the National Chiropractic Association (NCA) was established, spawning the Chiropractic Research Foundation (CRF). CRF’s original purpose was to promote the funding needed to develop sound chiropractic research. However, with the 1960s came the realization that developing educational standards in chiropractic schools was the profession’s top priority. With that, the CRF was renamed the Foundation for Accredited Chiropractic Education (FACE), and a new emphasis was placed on gaining nationally recognized accreditation. While this was good news for chiropractic colleges, it also meant that advancements in research were put on hold.

During the next decade, the profession tried again. This time, FACE was reorganized to form the Foundation of Chiropractic Education and Research (FCER), which remains the profession’s primary source of funding even today. But without a standard accreditation system in chiropractic schools, the focus remained largely on education for the next several years.

The real turnaround began in the last 25 years. In 1974, the Council on Chiropractic Education (CCE) was finally recognized as the accrediting agency for chiropractic schools, making way for more time and effort to be directed to research. In 1975, the first US federally funded research conference on chiropractic and spinal manipulation took place in Maryland, which was a major step in uniting researchers across the country. Later in the ’70s, publications such as the Journal of Manipulative and Physiological Therapeutics and Modern Developments in the Principles and Practices of Chiropractic provided a platform for important clinical research. The latter was the first major interdisciplinary text written by both chiropractors and medical doctors.

Several organizations have also contributed to advances in research. In 1996, Iowa’s Consortial Center for Chiropractic Research began to hold annual workshops to establish a research agenda and attract private and public research funds. In 1997, the workshop led to a grant of over $4 million from US federal agencies. Although this amount pales in comparison to that given to medical research (with grants totaling over $13 billion in 1997), it is more than the total federal funding ever previously granted to chiropractic research. It is also sure to help the profession build on a body of research that already includes comprehensive studies supporting chiropractic care in the following areas:

Low back pain
Low back pain is the most commonly treated condition in the chiropractic profession, accounting for over 65% of patient complaints. Numerous studies confirm that chiropractic care is an effective form of low back pain management.

In 1995, a study published in the British Medical Journal compared the ongoing chiropractic and hospital outpatient management for over 700 patients with low back pain. After three years, those treated by a chiropractor showed an improvement rate nearly 30% higher than those treated in a hospital. Similarly, in 1993 the Government of Ontario commissioned a report into the safety and effectiveness of chiropractic treatment of lower back pain that concluded overwhelmingly in its favor. The following year, that report was endorsed by government-sponsored practice guidelines in the US and the UK.

References:

1. Hurwitz, E., et al. “Use of chiropractic services from 1985 through 1991 in the United States and Canada.” American Journal of Public Health, Vol. 8 (1998): 771-776.
2. Meade, T., et al. “Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up.” British Medical Journal, Vol. 311 (1995): 349-351.
3. Manga, P., et al. “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain.” Ottawa, Ontario: Pran Manga and Associates, 1993. Books
4. Chapman-Smith, D. The Chiropractic Profession. West Des Moines: NCMIC Group Inc., 2000.

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Neck pain
In recent years, chiropractic treatment of the neck has received a lot of negative attention. However, in the past five years, three major studies have concluded that neck manipulation and mobilization are safe and effective methods of treatment for patients with neck pain. The “Quebec Task Force Report”, the “RAND Corporation Report” and the “Cochrane Collaboration Systematic Review” have all produced evidence that neck pain is more effectively managed by chiropractic manipulation than treatments commonly administered by medical professionals.

References:

1. Coulter, I., et al. “The appropriateness of manipulation and mobilization of the cervical spine.” Santa Monica, California: RAND, 1996.
2. Aker, P., et al. “Conservative management of mechanical neck pain: systematic overview and meta- analysis.” British Medical Journal, Vol. 313 (1996): 1291-1296.
3. Spitzer, W., et al. “Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining whiplash and its management.” Spine, Vol. 20 (1995): 85.

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Headaches
There are several types of headaches, including migraine, tension and cervicogenic (arising from the cervical spine). Numerous controlled trials now support the effectiveness of chiropractic treatment for all three. In a controlled trial conducted by Macquarie University in Australia, for example, 172 migraine sufferers were treated with spinal manipulation therapy (SMT) for a six-month period. Results showed that over 20% of participants reported a dramatic reduction in the number of migraines experienced after only two months of therapy. Likewise, the majority of participants reported a marked improvement in the severity of their migraine episodes.

References:

1. Bonello, R., et al. “A Randomized Controlled Trial of Chiropractic Spinal Manipulation Therapy for Migraine.” Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic (1999): 183- 184.
2. Bronfort, G., et al. “The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache.” The Journal of Manipulative and Physiological Therapeutics, Vol. 21 (1998): 511-519.
3. Christensen, H.W., et al. “The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache.” The Journal of Manipulative and Physiological Therapeutics, Vol. 20 (1997): 326-330.
4. Boline, P., et al. “Spinal Manipulation vs Amitriptyline for the Treatment of Chronic Tension-Type Headaches.” The Journal of Manipulative and Physiological Therapeutics, Vol. 18 (1995): 148-154.
5. Parker G.B., et al. “Why Does Migraine Improve during a Clinical Trial? Further Results from a Trial of Cervical Manipulation for Migraine.” Australian and New Zealand Journal of Medicine, Vol. 10 (1980): 192-198.
6. Parker G., et al. “A Controlled Trial of Cervical Manipulation for Migraine.” Australian and New Zealand Journal of Medicine, Vol. 8 (1978): 589-593.

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Colic
Studies suggest that infantile colic, a persistent crying in otherwise healthy babies, may be attributed to problems in the spine. In a study conducted in Denmark of 316 infants with both colic and some form of spinal disturbance (i.e. limited movement of the back), chiropractic treatment over the course of two weeks resulted in a 94% success rate. In 60% of the infants, the symptoms stopped completely; 34% of infants showed significant improvement. In a more recent study, researchers compared the treatment results of two groups of colicky babies, with one group being treated by spinal manipulation and the other by the drug dimethicone. Outcomes were measured in the number of hours the babies cried, as recorded in a diary. During trial days four to seven, babies being treated with spinal manipulation cried 1.4 hours less than those being treated by dimethicone. On days eight through 11, this number increased to 1.7 hours. The study concluded that spinal manipulation can be an effective treatment in relieving infantile colic.

References:

1. Wiberg, J.M.M., et al. “The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer.” Journal of Manipulative and Physiological Therapeutics, Vol. 22, No. 8 (1999).
2. Klougar, N., et al. “Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases.” Journal of Manipulative and Physiological Therapeutics, Vol. 12 (1989): 281-288.

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Asthma
The 1979 New Zealand Commission of Inquiry into Chiropractic found that chiropractic treatment, paired with medical care, can be an effective way of managing asthma. The inquiry cites the case of a two-year-old asthmatic whose condition had not been improving under the care of a medical specialist. Upon examination by a chiropractor, it was suggested that the child may have fallen and injured his neck. The chiropractor adjusted the patient’s back and his symptoms diminished significantly. Since then, studies have shown mixed results in the effectiveness of chiropractic treatment in asthmatic children with some form of spinal dysfunction. While patients have reported relief from symptoms and decreased dependency on medication, rates of peak airflow have shown less improvement.

References:

1. Balon, J., et al. “A Comparision of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma.” New England Journal of Medicine, Vol. 339 (1998): 1013-1020.
2. Bronfort, G. “Asthma and Chiropractic.” European Journal of Chiropractic, Vol. 44 (1996): 1-7.
3. Hviid, C. “A Comparison of the Effect of Chiropractic Treatment on Respiratory Function in Patients with Respiratory Distress Symptoms and Patients without.” Bulletin of the European Chiropractic Union, Vol. 26 (1978): 17-34.

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Enuresis (bed-wetting)
Twenty percent of children between the ages of four and five suffer from bed-wetting. While the causes are not entirely known, chiropractors have reported successful treatment in bed wetters with some form of spinal dysfunction. In an Australian study of 171 children between the ages of four and 15, chiropractic treatment alone was found to be more effective than psychotherapy, but less effective than dry bed training methods. Chiropractors believe that combining chiropractic care with other treatment methods, such as fluid restriction, would improve these results significantly.

References:

1. LeBoeuf-Yde, C., et al. “Chiropractic Care of Children with Nocturnal Enuresis: A Prospective Outcome Study.” The Journal of Manipulative and Physiological Therapeutics, Vol. 14 (1991): 110- 115.

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Otitis media (middle ear infection)
Otitis media (OM) is an inflammation of the middle ear caused by complications of colds, sore throats and sinusitis. While chiropractic treatment is not advised for the treatment of OM, in some cases it has been known to prevent chronic cases. A 1992 US study examined a two-year-old girl suffering from chronic OM in both ears, despite several routine treatments with antibiotics. After six months without results, her parents consulted a chiropractor. The first chiropractic examination found that the girl’s spine was out of alignment and after an initial treatment to restore the normal range of motion, there was a significant reduction in pain and ear discharge; further treatment brought total relief. Any recurrences over the next six months were alleviated after chiropractic care and today the girl is free of symptoms. The likely explanation for these results is that chiropractic manipulation restores motion in the spine, which alters the nervous system and therefore improves the drainage of the ear’s eustachian tubes. Further studies are now underway to determine whether medical treatment, chiropractic treatment or a combination of both is the most effective method of treatment for patients with OM.

References:

1. Fallon, J.M. “The Role of Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media.” Journal of Clinical Chiropractic Pediatrics, Vol. 2 (1997): 167-183.
2. Froehle, R.M. “Ear Infection: A Retrospective Study Examining Improvement from Chiropractic Care and Analyzing for Influencing Factors.” Journal of Manipulative and Physiology Therapeutics, Vol. 19, No. 3 (March-April 1996): 169-177.
3. Phillips, N.J. “Vertebral Subluxation and Otitis Media: A Case Study, Chiropractic.” Journal Chiropractic Research and Clinical Investigation, Vol. 8 (1992): 38-39.

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Pelvic disorders and dysmenorrhea (Painful Menstruation)
In a study published in The Journal of Manipulative and Physiological Therapeutics, it was found that a variety of gynecological, sexual and bowel disorders may be successfully managed under chiropractic care. The most detailed report cited the case of a 41-year-old woman who had experienced several years of low back and pelvic disorders, including difficulty in urination. After chiropractic examination, it was determined that the woman had a disk herniation in the low back. Adjustment by a chiropractor brought relief from the pain and an end to her urinary problems. Likewise, a study done by the National College of Chiropractic found that chiropractic care has provided relief in patients suffering from dysmenorrhea (painful menstruation). Further research on this subject is underway.

References:

1. Browning, J.E. “Chiropractic Distractive Decompression in the Treatment of Pelvic Pain and Organic Dysfunction in Patients with Evidence of Lower Sacral Nerve Root Compression.” The Journal of Manipulative and Physiological Therapeutics, Vol. 11 (1998): 436-442.
2. Kokjohn, K., et al. “The Effect of Spinal Manipulation on Pain and Prostaglandin Levels in Primary Dysmenorrhea.” The Journal of Manipulative and Physiological Therapeutics, Vol. 15 (1992): 279-285.

Cost-effectiveness
A 1997 study conducted by Miron Stano at Michigan’s Oakland University compared the costs of health care for patients of medicine and patients of chiropractic. By reviewing the insurance claims paid by patients, Stano found that those receiving chiropractic treatment, either by itself or with medical care, had health- care costs averaging $1,000 less than those receiving medical care alone. Furthermore, patients receiving only chiropractic care paid 30% less in total insurance costs than those under the care of a medical doctor. Similarly, numerous studies show that patients with low back pain who are treated by a chiropractor often avoid thousands of dollars in medical expenses, such as surgery and medication.

References:

1. Smith, M. and M. Stano. “Costs and Recurrences of Chiropractic and Medical Episodes of Low-Back Care.” The Journal of Manipulative and Physiological Therapeutics, Vol. 20, No. 1 (1997): 5-12.
2. Chapman-Smith, D. The Chiropractic Profession. West Des Moines: NCMIC Group Inc., 2000.

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Patient Satisfaction
A 1989 survey conducted by Dr. Daniel Cherkin and Dr. Frederick MacCornack found that patients receiving care from health maintenance organizations (HMOs) in the state of Washington were three times as likely to report satisfaction with chiropractic care than they were from other health-care providers. Early in the 1990s, a similar study conducted by the Gallup Organization found that 90% of chiropractic patients felt their care was effective. Over 80% were satisfied with their care, and close to 75% felt that their expectations had been met.

References:

1. Cherkin, D.C. and F.A. MacCornack. “Patient Evaluations of Low Back Pain from Family Physicians and Chiropractors.” Western Journal of Medicine, Vol. 151, No. 1 (July 1989): 83-84.

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Over the past century, chiropractic education has developed to the point where government studies in the US, Sweden and New Zealand consider it equivalent in the basic sciences to a medical education.

Much of this development stems from the establishment of the Council on Chiropractic Education (CCE) in 1974, which the US Department of Education recognizes as the accrediting agency for chiropractic schools. The CCE, a nonprofit organization located in Scottsdale, Ariz., sets standards for schools’ curriculum, faculty, facilities, patient care and research.

Chiropractic college programs are rigorous and thorough. To attend, applicants must have at least 90 semester hours worth of study toward a bachelor’s degree. Their chiropractic college education then lasts four years, and in the fourth year involves a clinical internship of approximately 1,000 hours.

When that’s done, graduates face one more trial. To practice in the US or Canada, they must pass comprehensive national and state or provincial licensing exams, similar to those for other professionals like lawyers and doctors.

The chiropractic curriculum
A typical four-year chiropractic college program may consist of the following:

First year

• Chiropractic procedures
• Clinical applied chiropractic
• Functional anatomy and biomechanics
• Fundamentals of nutrition
• General anatomy
• Histology
• Human biomechanics
• Human physiology
• Introduction to physical examination skills
• Neuroscience
• Normal radiological anatomy
• Palpation

Second year

• Chiropractic principles
• Chiropractic procedures
• Clinical applied chiropractic
• Clinical microbiology
• Clinical nutrition
• Clinical orthopedics and neurology
• Community health
• Differential diagnosis
• Imaging interpretation
• Jurisprudence
• Nutritional assessment
• Pathology
• Pharmacotoxicology
• Physics and clinical imaging
• Physiological therapeutics
• Practice management
• Research methods

Third year

• Chiropractic principles
• Clinical application of manual procedures
• Clinical internship
• Clinical laboratory clerkship
• Clinical psychology
• Dermatology
• Differential diagnosis
• Geriatrics
• Imaging interpretation
• Integrated chiropractic clinical application
• Jurisprudence
• Obstetrics and gynecology
• Pediatrics
• Physiological therapeutics
• Practice management
• Radiological position and technique

Fourth year

• Clinical internship of approximately 1,000 hours

References:

1. Chapman-Smith, D. The Chiropractic Profession. West Des Moines: NCMIC Group Inc., 2000.

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What is a subluxation?
subluxation refers to a spinal or peripheral joint that is relatively immobile or out of place. Subluxations create an imbalance in the spine, affecting the way our body and brain communicate with one another, irritating nerves and blood vessels and possibly causing pain and dysfunction in muscles and organs.

What causes a subluxation?
Accidents, injuries and inherited spinal weaknesses are common causes of subluxations. Other causes include poor sleeping habits, poor posture, obesity, stress, a sedentary lifestyle and too little rest.

How is a subluxation corrected?
Chiropractors treat subluxations with a healing technique called spinal adjustment, a procedure that involves applying specific, short, quick thrusts to return vertebrae (the bones that compose the spine and protect the spinal cord) to their proper position. They may also use other tools and techniques, and will explain these to you at the time.

Does the adjustment hurt?
Most chiropractic adjustments are painless; in fact, the adjustment may feel good and can be relieving. If you’ve had a recent injury, however, adjustments can irritate inflamed tissue and cause some discomfort. Some people also experience odd sensations in their extremities after adjustments. This is a normal reaction to the relieving of pressure on nerves and is usually no cause for concern.

How old should a person be before receiving chiropractic care?
While every chiropractor has his or her own preference, people of all ages are candidates for chiropractic treatment. Even babies can have subluxations, due to the rigors of birth. In general, it’s best to treat children’s subluxations early, as they interfere with nerves that control developing muscles and organs. With an early checkup, your chiropractor can detect these problems while they’re easy to correct.

Should I go to a chiropractor if I feel fine?
Your chiropractor can recognize and detect problem areas in your spine before they develop into problem conditions. Chiropractic adjustments may help to maintain or support a healthy spine, and maintenance spinal care programs, which may include advice on posture, nutrition and exercise, can effectively prevent pain. Regular checkups will also ensure that small stresses on the spine don’t become major misalignments.

How will the adjustment help me?
Chiropractic adjustments help eliminate interference that prevents your body from healing itself. Misaligned vertebrae interfere with your nervous system, which affects organs and muscles throughout your body. Your chiropractor treats the underlying problem, which can alleviate painful symptoms.

Does an adjustment have to make a noise to be effective?
No. While it’s true that patients often hear a “pop” during an adjustment, similar to the sound you’d hear cracking your knuckles, it’s not related to the treatment’s effectiveness. Instead, the explanation lies in a lubricant called synovial fluid that’s found in every joint. That fluid contains dissolved gases. Separating joints creates pressure, which forces the gases to rapidly escape, creating a “pop.”

How does chiropractic care help pregnant women?
Pregnancy places additional weight and stress on women’s bodies. Chiropractic treatment can help relieve pregnancy-related low back, leg and shoulder blade pain. It may also reduce incidences of headache and nausea. Ask your chiropractor how much experience he or she has in treating pregnant women.

Is it true that chiropractors do not prescribe medication or perform surgery?
Yes. Chiropractors don’t prescribe medication or perform invasive procedures. They believe the body has the ability to heal itself, and therefore focus on providing it with the right elements for self-restoration. This makes chiropractic one of the safest of all treatments.

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Glossary

Anatomy

Articulation: A joint formed where two or more bones in the body meet. Your foot bone, for example, forms an articulation with your leg bone. You call that articulation an ankle.

Atlas: Another name for the first cervical vertebra, which is located at the top of your spine and supports your head. Misalignment of the atlas can place stress on your neuromusculoskeletal system.

Axis: Another name for the second cervical vertebra, which is located in your neck. This is an important joint that contributes significantly to your neck’s range of motion.

Biomechanics: The body’s mechanics, such as how muscles, bones, tendons and ligaments work to produce movement.

Coccyx: Commonly called the tailbone, the coccyx is composed of four separate but fused vertebrae that make up the bottom of your spine.

Cervical spine: The area of your spine containing the seven vertebrae that compose the neck.

Joint: A meeting point of two or more bones in your body that functions like a door hinge. Joints, like hinges, sometimes get stuck, or subluxated. Your chiropractor can adjust them to help improve your health.

Kyphosis: Refers to the shape of your mid-back and sacral regions of your spine, which are shaped like a backward letter C.

Ligament: Tissue that bonds bone to bone. Ligaments are strong and provide excellent support, which is especially important in joints like your ankle.

Lordosis: Refers to the shape of the cervical and lumbar regions of your spine, which are shaped like the letter C. You aren’t born with this curve, but develop it as an infant when you start to sit, crawl and stand.

Lumbar: The area of your spine containing the five vertebrae that compose the lower back.

Muscle: Contractile tissue that allows body parts to move. While most people don’t realize it, muscles are considered bodily organs.

Muscle tone: A slight, continuous contraction of muscle fibers that is necessary to maintain posture, keep muscles healthy and squeeze blood in your veins back to your heart. Without muscle tone, your muscles would get weak and be susceptible to injury.

Neuromusculoskeletal system: A broad term referring to the neurological system, including the brain, spinal cord and nerves, the muscle system, which includes muscles, ligaments, tendons and connective tissues, and the skeletal system, which includes bones of the skull, spine and limbs.

Sacroiliac joint: The joint between the sacrum and the ilium, which is a flat bone that helps compose your pelvis. You have two sacroiliac joints, which allow for proper pelvic movement. When they get irritated or inflamed it causes significant pain.

Sacrum: A triangular-shaped bone between your pelvic bones that is the foundation for your spine. The sacrum helps transfer weight, allows for small pelvic movements and meets with the pelvic bones to form the sacroiliac joints.

Soft tissue: Non-bony tissue, like muscles, disks, tendons and ligaments.

Spine: Your spine supports your body and protects the delicate spinal cord and nerves. It comprises 33 vertebrae, grouped into different categories based on location and anatomy. These locations are the cervical, thoracic, lumbar, sacral and coccygeal regions.

Tender point: One of several pea-size, focal and hypersensitive sites found most commonly in muscle and connective tissue that, unlike a trigger point, doesn’t cause pain in other regions when stimulated.

Tendon: An extension of muscle that functions as an attachment between muscle and bone. Tendons are extremely strong, but not very capable of contracting.

Thoracic: The area of your spine containing the 12 vertebrae that compose the upper back.

Trigger point: One of several pea-size, focal and hypersensitive sites found most commonly in muscle and connective tissue that, when stimulated, can cause pain in a specific region. A stimulated trigger point in the back of your neck, for example, can cause a dull pain that radiates to the area around your eyes.

Vertebrae: Bony segments that form your spinal column. Humans normally have 33 of these stacked on top of each other. There are seven in your neck, 12 in your mid back, five in your low back, five in your sacrum and four in your tailbone.

Conditions

Acute: Symptoms or conditions that have developed recently, which are usually sharp or severe.

Chronic: Symptoms or conditions that have persisted for weeks, months or even years, which can range from mild to severe.

Degeneration: A breaking down of bodily tissue, such as that in the spine. Poor spinal mechanics, trauma and aging can cause a thinning or degeneration of spinal disks, the same way driving a car wears out tires.

Health: To chiropractors, health isn’t just an absence of disease, but a state of positive mental, physical and spiritual functioning.

Misalignment: Improperly aligned joints in the body. These are usually associated with subluxations, and can stress your neuromusculoskeletal system.

Spasm: Involuntary shortening of muscle fiber. Spasm often occurs after an injury, but many things can cause it. During spasm, muscles cannot be relaxed and the associated joints have a decreased range of motion.

Strain: An injury to muscles or ligaments caused by overstretching, overuse, tearing, tension or torsion. Poor posture can also strain these tissues, as it places increased demands on them.

Subluxation: An area in the spine that moves improperly. It occurs when spinal bones become misaligned or lose their normal range of motion. A subluxation can stress the entire nervous system.

Vertebral subluxation complex: A number of conditions associated with a subluxation that includes abnormal joint motion, abnormal nerve expression, abnormal muscle function, abnormal soft tissue and abnormal function of internal organs and systems.

Whiplash: An injury that occurs when the head is suddenly accelerated and decelerated, in a whip-like motion, forward to backward or side to side. While many people associate whiplash with motor vehicle accidents, the injury can also occur during sports or falls. Exercise

Active exercise: An exercise performed without assistance. A sit-up, for example, is an active exercise.

Passive exercise: An exercise performed with assistance, usually from a therapist, that requires the exerciser to exert little physical energy. Passive exercises are important during the acute, or early, phase of recovery from an injury.

Resisted exercise: An exercise performed against resistance. All weight-training exercises, for example, are resisted exercises. Bodily Movements

Extension: Movement of two body parts away from each other, such as when you look up and move your chin away from your chest.

Flexion: Movement of two body parts toward each other, such as when you flex your bicep and move your hand and wrist to your shoulder.

Pronation: Inward or medial movement of a body part. If one arm is stretched out palm up, for example, and then rotated so that the palm is facing down, the movement is called pronation.

Range of motion: The arc through which a joint or joints can move. Chiropractors often use the term when discussing dysfunctional joints. A normal neck, for example, can move about 70 to 90 degrees to the right. Chiropractors would say a neck that only rotated 50 degrees had a restricted range of motion.

Supination: Outward or lateral movement of a body part. If one arm is stretched out palm down, for example, and then rotated so that the palm is facing up, the movement is called supination. Chiropractic Care

Acute care: Treatment directed at relieving painful symptoms, which have usually developed recently.

Activator tool: Also known as an activator adjusting instrument, the T-shaped, handheld activator tool allows chiropractors to give precise, low-force and high-speed adjustments.

Adjustment: The application of thrust to a joint in the body, using a specific speed, depth and force. Chiropractors deliver this adjustment by hand or with a small handheld device called an activator tool. Adjustments are the primary method of removing joint misalignments or subluxations.

Maintenance or preventive care: Chiropractic care that focuses on maintaining patients’ optimal health. This includes regular chiropractic checkups, which allow chiropractors to detect and correct subluxations or spinal misalignments.

Manual treatment: Treatment by hand, which may consist of adjustments, mobilizations, traction, massage and other techniques, all aimed at influencing the spine and its related components.

Mobilization: A form of physical therapy in which chiropractors apply gentle, often repetitive movements to stuck joints in the body without the use of thrust.

Palpation: Examination by touch. Palpation is one of several methods chiropractors use to assess tissue beneath the skin, like muscle, ligament, tendon, bone and fat. Using their hands, chiropractors can palpate tissue to determine its size, consistency, mobility and general health.

Soft tissue therapy: Therapy directed at the muscles, tendons and ligaments of the body. This therapy can include massage, which your chiropractor or a massage therapist can administer. Massage helps to relax tight muscles, increase circulation and promote healing.

Thrust: A force applied during a chiropractic adjustment.

Types of Health Care

Allopathic medicine: A method of treatment that focuses on producing effects that are the opposite of those associated with an illness. If someone had an illness that caused dry skin, for example, allopathic doctors would prescribe moisturizing remedies. The word comes from combining the Greek allos, meaning other, and patheia, meaning suffering.

Chiropractic: Chiropractic is a health-care profession based on diagnosing, treating and preventing neuromusculoskeletal disorders, and a health-care philosophy centered on the effects those disorders and other lifestyle factors have on a patient’s nervous system and overall health.

The word chiropractic means to practice with the hands, as it comes from combining the Greek words cheir, meaning hand, and praktikos, meaning practical or operative. The term refers to chiropractors’ hands-on techniques, especially adjustments, which some call manipulations or spinal manipulative therapy. But it could also refer to chiropractors’ guiding hands, as they help patients adopt lifestyle habits that promote health and well-being.

Holistic medicine: A method of treatment that focuses on the entire person and his or her environment, rather than partitioned illnesses or body parts.

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