Chiropractic is a health care profession that focuses on the
relationship between the body's structure-mainly the spine-and
its functioning. Although practitioners may use a variety
of treatment approaches, they primarily perform adjustments (manipulations)
to the spine or other parts of the body with the goal of correcting
alignment problems, alleviating pain, improving function, and
supporting the body's natural ability to heal itself.
Key Points
- People seek chiropractic care primarily for pain conditions
such as back pain, neck pain, headache, and extremity (e.g.,
hand or foot) problems.
- In the United States, chiropractic practitioners must meet
the licensing and continuing education requirements of the state
in which they practice. All states require practitioners to
complete a Doctor of Chiropractic degree program at a properly
accredited college.
- Most chiropractic-related research has focused on the efficacy
of spinal manipulation, especially for low-back pain. Researchers
are also gathering evidence on the safety of spinal manipulation.
- Tell all your health care providers about any complementary
and alternative practices you use. Give them a full picture
of what you do to manage your health. This will help ensure
coordinated and safe care.
Overview and History
The term "chiropractic" combines the Greek words cheir (hand)
and praxis (practice) to describe a treatment done by hand. Hands-on
therapy-especially adjustment of the spine-is central to chiropractic
care. Chiropractic is based on the notion that the relationship
between the body's structure (primarily that of the spine) and
its function (as coordinated by the nervous system) affects health.
While some procedures associated with chiropractic care can be
traced back to ancient times, the modern profession of chiropractic
was founded by Daniel David Palmer in 1895 in Davenport, Iowa.
Palmer, a self-taught healer, believed that the body has "innate
intelligence" or a natural healing ability. He theorized that
"subluxations" (misalignments of the spine) can interfere with
this ability, and that manipulation of the spine can help to restore
or maintain health. Evidence-based explanations for the effects
of chiropractic manipulations are the subject of ongoing scientific
investigation, including studies supported by the National Center
for Complementary and Alternative Medicine (NCCAM).
Spinal adjustment/manipulation is a core treatment in chiropractic
care, but it is not synonymous with chiropractic. Chiropractors
commonly use other treatments in addition to spinal manipulation,
and other health care providers (e.g., physical therapists or
some osteopathic physicians) may use spinal manipulation.
Use in the United States
In the United States, chiropractic is often considered part of
complementary and alternative medicine (CAM). According to the
2007 National Health Interview Survey (NHIS), which included a
comprehensive survey of CAM use by Americans, about 8 percent
of American adults (more than 18 million) and nearly 3 percent
of children (more than 2 million) had received chiropractic or
osteopathic manipulation in the past 12 months. Additionally,
an analysis of NHIS cost data found that adults in the United
States spent approximately $11.9 billion out-of-pocket on CAM
practitioner visits-$3.9 billion of which was spent on visits
to chiropractic or osteopathic practitioners.
Many people who seek chiropractic care have low-back pain. People
also commonly seek chiropractic care for other kinds of musculoskeletal
pain (e.g., neck, shoulder), headaches, and extremity (e.g., hand
or foot) problems.
An analysis of CAM use for back pain, based on data from the 2002
NHIS, found that chiropractic was by far the most commonly used
CAM therapy for back pain. Among survey respondents who had used
CAM for their back pain, 74 percent (corresponding to 4 million
Americans) had used chiropractic. Among those who had used chiropractic
for back pain, 66 percent perceived "great benefit" from their
treatments.
Treatment
During the initial visit, chiropractors typically take a health
history and perform a physical examination, with a special emphasis
on the spine. Other examinations or tests such as x-rays may also
be performed. If chiropractic treatment is considered appropriate,
a treatment plan will be developed.
During followup visits, practitioners may perform one or more
of the many different types of adjustments and other manual therapies
used in chiropractic care. Given mainly to the spine, a chiropractic
adjustment involves using the hands or a device to apply a controlled,
rapid force to a joint. The goal is to increase the range and
quality of motion in the area being treated and to aid in restoring
health. Joint mobilization is another type of manual therapy that
may be used.
Chiropractors may combine the use of spinal adjustments and
other manual therapies with several other treatments and approaches
such as:
- Heat and ice
- Electrical stimulation
- Relaxation techniques
- Rehabilitative and general exercise
- Counseling about diet, weight loss, and other lifestyle factors
- Dietary supplements.
Practitioners: Education and Licensure
Chiropractic colleges accredited by the Council on Chiropractic
Education (CCE) offer Doctor of Chiropractic (D.C.) degree programs.
(CCE is the agency certified by the U.S. Department of Education
to accredit chiropractic colleges in the United States.) Admission
to a chiropractic college requires a minimum of 90 semester hour
credits of undergraduate study, mostly in the sciences.
Chiropractic training is a 4-year academic program that includes
both classroom work and direct experience caring for patients.
Coursework typically includes instruction in the biomedical sciences,
as well as in public health and research methods. Some chiropractors
pursue a 2- to 3-year residency for training in specialized fields.
Chiropractic is regulated individually by each state and the District
of Columbia. All states require completion of a Doctor of Chiropractic
degree program from a CCE-accredited college. Examinations administered
by the National Board of Chiropractic Examiners are required for
licensing and include a mock patient encounter. Most states require
chiropractors to earn annual continuing education credits to maintain
their licenses. Chiropractors' scope of practice varies by state
in areas such as the dispensing or selling of dietary supplements
and the use of other CAM therapies such as acupuncture or homeopathy.
If You Are Thinking About Seeking Chiropractic Care
