Chiropractic, which loosely means “to treat by hand,” is a type of manipulative
therapy that has been practiced in the U.S. for over 100 years. This discipline is based on
the premise that function of the joints and muscles of the spine can have a profound effect
upon health. Through a complex relationship with the nervous system, problems with vertebral
(spinal) joints can result in local neck and back
pain and even cause pain to be felt in the head, arms, and legs (“referred”
pain). Chiropractors identify these problems in specific joints as chiropractic
“subluxations” or “joint dysfunctions.” (Note: Medical
doctors use the word “subluxation” in a different way, denoting a bone that has
nearly dislocated.) Instead of pain, patients may sometimes experience a feeling of numbness,
a “pins and needles” sensation, dizziness, or a host of other unusual
manifestations. More controversial is the premise proposed by chiropractors and other manual
therapists that symptoms usually associated with internal organs, such as stomach aches, digestive problems, infant colic, and asthma, for example, may sometimes improve with
manipulative care.1 2 3 4 5
Chiropractic manipulation or adjustments seek to restore normal function to the spine and
other joints. Typically, this entails the chiropractor applying a specific, highly-controlled
treatment directly to a joint or muscle with his or her hands. When successful, this often
reduces or eliminates both local and referred pain, allows muscle spasms to relax, and is
thought to remove irritation from the nervous system, which may result in other health
Chiropractors (referred to as chiropractic physicians in some areas) serve as portals of
entry into the healthcare system. This means that a patient may choose to see a chiropractor
before seeing any other practitioner.6 Consequently, chiropractors are trained to
perform the same standard orthopedic, neurologic, and physical examination procedures as those
performed in traditional allopathic medicine. This enables them to screen their patients for
fractures, cancers, and other serious diseases
requiring medical treatment.
In addition, chiropractors do a further evaluation of the motion and positioning of spinal
and extremity joints, the functions of muscles, and an overall evaluation of posture and
movement. Chiropractors usually identify subluxations by carefully evaluating a number of
factors. This approach may include assessing points of tenderness, subtle movements of
individual joints, the amount of joint “springiness” in response to gentle
pressure, altered muscle tone (such as a spasm), and any asymmetry in the feel of the bone or
other tissue beneath their fingertips.
Most chiropractors share a philosophy that medications and surgery should be saved as
treatments of last resort for many conditions. Chiropractic care also has a history of
blending nutritional and other alternative therapies with a natural approach to promoting
health through lifestyle modification and exercise. Many modern chiropractors receive
additional training in physical rehabilitation and specific exercise therapy that can be
useful when treating patients with whiplash injuries, shoulder or knee injuries, or stubborn
low back pain. Others make nutritional
analysis, botanical therapy, and in some states even acupuncture a significant part of their practices.
Other treatment options that chiropractors may employ include traction, supports and braces,
and electrotherapies, such as ultrasound, muscle stimulation, and TENS (transcutaneous
electrical nerve stimulation).
When necessary, a chiropractor may order x-rays, blood tests, or advanced studies, such as
an MRI or CT scan, before deciding on a course of treatment or referral.
Even outside the chiropractic profession, joint manipulation has generally been accepted as
an appropriate treatment for low back pain.7 8 9 Medical
doctors are even being encouraged to “offer spinal manipulation as a therapeutic option
of accepted efficacy,” acknowledging that “in many settings referral to a
chiropractor is the most practical way of doing this.”10 In practice,
however, chiropractors treat a much wider range of problems including ankle sprains, rotator cuff injuries, a variety of
headaches, and joint pain throughout the body, as well as offer general supportive care for
conditions ranging from rheumatoid arthritis
to the conservative management of high blood
pressure. The effectiveness of chiropractic care in these areas has yet to be thoroughly
1. Haldeman S. Principles and Practice of Chiropractic. Norwalk,
Connecticut: Appleton & Lange, 1992.
2. Maigne, R. Thoracolumbar junction syndrome, a source of diagnostic
error. Journal of Orthopaedic Medicine, 1995;17(3):84–9.
3. Lewit K. Manipulative Therapy in Rehabilitation of the Motor
System. London: Butterworths, 1985.
4. Grieve GP. Common Vertebral Joint Problems. Edinburgh:
Churchill Livingstone, 1981.
5. Travell J, Simmons D. Myofascial Pain and Dysfunction.
Baltimore: Williams & Wilkins, 983.
6. Vear HJ. Chiropractic Standards of Practice and Quality Care.
Gaithersburg, MD: Aspen, 1992.
7. Acute Low Back Problems in Adults, Clinical Practice
Guidelines. U.S. Department of Health and Human Services, December 1994.
8. Waddell G, Feder G, McIntosh A, et al. Low Back Pain Evidence
Review. London: Royal College of General Practitioners, 1996.
9. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and
chronic nonspecific low back pain. Spine 1997;22(18):2128–58.
10. Shekelle PG, Coulter I, Hurwitz EL, et al. Congruence between
decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness
criteria in North America. Ann Intern Med 1998;129(1):9–7.