Chiropractic, Spinal Manipulation, Spinal Manipulation

There's evidence chiropractic may treat back and neck pain, but what about chiropractic treatment of phobias, addiction, ADHD and other psychiatric disorders?

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background

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• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

Chiropractic focuses on the relationship between musculoskeletal structure (primarily the spine) and bodily function (primarily nervous system function) and on how this relationship affects the maintenance or improvement of health. Chiropractors use multiple therapeutic techniques. Chiropractic encompasses spinal manipulative therapy, diet, exercise, X-rays, and other therapeutic techniques such as interferential and electrogalvanic muscle stimulation.

Spinal manipulative therapy (or spinal manipulation) — a method of adjusting the spinal cord using hand pressure, twists and turns — is broad and includes many types of techniques, including those used by chiropractors.

History: Rotation or movement of the spine plays a role in many healing traditions. Records of the use of spinal manipulative therapy date to ancient Chinese and Greek medicine.

The principles of modern chiropractic stem from the work of David Daniel Palmer in the late 1800s. Palmer believed that abnormal nerve function can cause medical disorders. He theorized that adjustment of the spine can improve health. Initially, Palmer's principles were not well received in the medical community, and some early chiropractors were imprisoned (including Palmer himself). A divide between chiropractors and medical doctors culminated in a successful antitrust lawsuit against the American Medical Association for bias against the chiropractic profession (1977-1987). Divisions have also existed in the chiropractic community regarding the extent to which chiropractic should be integrated with other health care fields.

Medicare has reimbursed for chiropractic since 1972. The Council on Chiropractic Education (CCE) adopted national standards in 1974, which are now recognized by the U.S. Department of Education.

Since 1975, the CCE has accredited all U.S. chiropractic colleges. Currently, all 50 U.S. states have statutes recognizing and regulating the practice of chiropractic. There are more than 60,000 licensed chiropractors in the United States, a number expected to reach 100,000 by 2010.

Techniques: Most visits to chiropractors are for musculoskeletal complaints, and almost half are for back pain. Clients usually lie facedown on a Cox table, which is similar to a massage table with an open space in which to place your face. Visits may last 15 minutes to one hour depending on the technique used. Chiropractors may see clients up to three times per week at first, then less frequently over time.

There are more than 100 chiropractic and spinal manipulative adjusting techniques, and practitioners may vary in their approaches. Techniques taught widely in chiropractic schools include:

• Diversified
• Extremity adjusting
• Activator
• Gonstead
• Cox flexion-distraction
• Thompson

Other techniques are taught outside of the established curriculum.

Diagnostic procedures such as X-ray, computed tomography, magnetic resonance imaging and thermography may be used, followed by treatment with ice packs, heat packs, electrical current or ultrasound therapy. Dietary counseling and nutritional support, plus exercise recommendations, may be offered.

Spinal manipulative therapy uses various techniques to apply force to an area of the spine or to a joint. Massage or mobilization of soft tissue is used in techniques such as myofascial trigger point therapy, cross-friction massage, active release therapy, muscle stripping or Rolfing® structural integration. Mechanical traction or the use of external resistance on an area of the spine or on an extremity may be used in certain people.

Theory

There are a number of traditional and scientific theories about the mechanism of action and potential health benefits of chiropractic and spinal manipulative therapy. However, the underlying effects of these therapies on the body are largely unknown.

Traditional hypotheses suggest that changes in normal relationships between the bones of the spine (vertebral bodies) or joints can result in health problems and that manipulation of these areas may correct these changes and improve function. There are more recent theories that nerve damage or compression, muscle spasm, soft-tissue adhesions or release of toxic chemicals from damaged soft tissues can be caused by abnormal spine or joint positioning, which can be improved with manipulation. Scientific research is limited in these areas.

Scientific studies in animals and humans report that abnormal positioning of the spine can alter the function of nerves coming from the spine and may alter heart rate and blood pressure. It is controversial whether spinal manipulative therapy affects the release of chemicals that influence pain and pleasure sensations, such as substance P and endorphins.