Chiropractic offers the foremost contemporary example of a healing art that bridges the gap between complementary and conventional healthcare. The chiropractic profession has many characteristics of a mainstream health discipline that provides essential services, with licensure throughout North America and several dozen other nations, an increasingly strong scientific research base supporting its central treatment methods, widespread insurance coverage and 20 million patients per year in the United States. At the same time, the health worldview of chiropractic practitioners and educators places them firmly in the camp of the natural healing arts, emphasizing the inherent capacity of the human body to heal without drugs and surgery in most cases.
Chiropractors are independent primary contact practitioners, licensed for both diagnosis and treatment with no requirement of referral from a medical physician. Chiropractic practice is limited not by anatomical region but according to the procedures it includes and excludes, unlike dentistry, podiatry, and optometry. The chiropractor’s legal scope of practice under state law generally excludes surgery and the prescription of pharmaceuticals; its core component is the manual adjustment or manipulation of the spine and other muscular and skeletal structures.
The United States is home to approximately 65,000 of the world’s 90,000 chiropractors. Rigorous educational standards are supervised by government-recognized accrediting agencies, including the Council on Chiropractic Education (CCE) in the United States. After fulfilling college science prerequisites similar to those required to enter medical or osteopathic schools, chiropractic students must complete a chiropractic college program lasting four academic years, which includes a wide range of basic science courses in anatomy, physiology, pathology, taught by faculty members who hold doctorates or masters degrees in their fields of specialty. In addition, chiropractic clinical training includes extensive coursework in radiology, orthopedics, diagnosis, manual adjusting and manipulation procedures for the spine and other joints, physiotherapy, rehabilitation, public health and nutrition.
The final year of the chiropractic college curriculum is largely devoted to intensive work as clinical interns, treating patients under the supervision of experienced clinical faculty. At many chiropractic colleges, clinical training includes rotations in the chiropractic departments at Veterans Administration hospitals (where chiropractors serve on the medical staff), free clinics serving the poor, and other interdisciplinary settings where they work alongside medical physicians and other health practitioners.
Approximately 90% of chiropractic patients present as cases with problems of the muscular, skeletal or nervous systems – principally back pain, neck pain, and headaches, the conditions for which spinal adjustment (also known as spinal manipulation) is most effective.
Since the dawn of the modern of era of chiropractic research, which began in 1975 when the U.S. federal government convened a National Institutes of Health conference on the research status of spinal manipulation, research on chiropractic has steadily expanded. There are now over 100 randomized trials on spinal manipulation. The majority address various aspects of low back pain, which reflects the fact that more than half of all chiropractic patients present with low back pain as a primary symptom.
In a substantial majority of these research studies, spinal manipulation has outperformed comparison therapies or placebo. None of the dozens of trials on low back pain found that a comparison therapy or a placebo delivered results superior to spinal manipulation. And significantly, not a single patient in any of the studies related to chiropractic – for low back pain or any other condition – experienced a major adverse side-effect.
Research on spinal manipulation for low back pain is broad and deep. This has led national medical practice guidelines in the United States and other nations to recognize spinal manipulation as a nonpharmacologic treatment method “with proven benefit” for both acute and chronic low back pain. The most influential recent set of guidelines was published by a joint panel representing the American Pain Society and American College of Physicians (Annals of Internal Medicine, 2007).
A current summary of research supporting chiropractic care for low back pain and many other conditions can be found in the peer-reviewed booklet, Chiropractic Research and Practice State of the Art. Written to be understandable by the general public and available at no charge, it can be read or downloaded here.
Daniel Redwood, DC, is a Professor at Cleveland Chiropractic College – Kansas City. He is editor-in-chief of Health Insights Today (www.healthinsightstoday.com) and serves on the editorial boards of the Journal of the American Chiropractic Association, Journal of Alternative and Complementary Medicine, and Topics in Integrative Healthcare.