Chiropractic
|
|
Chiropractic, also known as chiropractic care, is a health discipline that seeks to prevent and treat health problems by using spinal adjustments in order to correct misalignments, or subluxations. The brain and nervous system control and coordinate all the body's functions in part through nerve branches that exit from the spinal cord between the vertebrae. Slight spinal misalignments are said to interfere with the function of the nerve as it exits the verterbral foramina. Chiropractors were the first to infer a causal relationship between nerve interference or compression at the spine and subsequent problems in more distant parts or organ systems regulated by the nerve.
Practitioners of chiropractic are called chiropractors. They receive the degree Doctor of Chiropractic, (D.C.) and are commonly called doctor in the same way that a dentist is called a doctor. The term chiropractic physician is allowed in some parts of the United States, but this term is not in general use.
Adherents claim that the practice of chiropractic can be effective in treating back and neck pain, headaches, and other symptoms of spine-related conditions; however, most medical doctors and scientists assert that chiropractic treatment is pseudoscience.
| Contents |
History
Chiropractic was founded by Daniel David Palmer of Davenport, Iowa, USA. Palmer is referred to by some historians as a "fish monger" because he sold goldfish commercially. It is more interesting to know that he practiced magnetic healing beginning in the mid-1880s in Burlington, Iowa. Palmer tried to find a single cause for all disease. In 1895, Palmer was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years prior, he felt a pop in his back and had been nearly deaf ever since. Upon examination, Palmer found what he described as a lump that was sore to the touch. He concluded that this lump was a misalignment in the spine and a possible cause of Lillard's deafness. After the doctor corrected this misalignment, Lillard could reportedly hear the wheels of the horse-drawn carts in the street below. Palmer's version of this event has always been disputed by Lillard's daughter, Valdeenia Lillard Simons. She says that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."
The term chiropractic originated when Palmer asked a patient to come up with a name from the Greek language to describe his practice. Of the several names submitted to him, Palmer accepted one which combined the words chiros and praktikos (meaning "done by hand") to describe his adjustment of a vertebra in the spinal column. Palmer had been a beekeeper, school teacher, and grocery store owner, and had an interest in the various health philosophies of his day such as magnetic healing, osteopathy, and spiritualism.
Chiropractic subluxation
Palmer imbued the term "subluxation" with a metaphysical and philosophical meaning. He held that certain dislocations of bones interfered with the "innate intelligence", a kind of spiritual energy or life force dependent upon God that connects the brain to the rest of the body. Palmer claimed that subluxations interfered with the proper communication of this innate intelligence with the rest of the body, and that by fixing them 95% of diseases could be treated.
In the mid-1990s the US Association of Chiropractic Colleges redefined a subluxation as follows: "A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health." In 1997 the Foundation for Chiropractic Education and Research defined a subluxation as "a joint problem (whether a problem with the way the joint is functioning, a physical problem with the joint, or a combination of any of these) that affects the function of nerves and therefore affects the body's organs and general health."
In recent years a number of chiropractic associations have developed new definitions of "subluxation" that have no connection with Palmer's ideas, yet are not the same as medical subluxations.
Usage
The use of manipulative therapy — not necessarily chiropractic — enjoys wide acceptance by medical authorities in many nations. It is covered by many health plans such as Medicare in the United States. Although some medical doctors (MDs) and many doctors of osteopathy (DOs) do perform manipulative therapy, more than 90 percent of the treatment of back pain by manipulative therapy is performed by DCs (Doctors of Chiropractic). [1] (http://www.chiroweb.com/archives/ahcpr/foreword.htm)
According to a survey released in 2004 by the National Center for Complementary and Alternative Medicine, chiropractic was the fourth most commonly used complementary and alternative medicine therapy among adults in the United States (7.5%).[2] (http://nccam.nih.gov/news/2004/052704.htm) [3] (http://nccam.nih.gov/news/report.pdf)
Chiropractic has gained general acceptance in the last 40 years as an appropriate treatment for certain back and neck problems. This was partly a result of the prolonged litigation between the powerful American Medical Association (AMA) and various chiropractors over the legitimacy of the field (see Wilk v. American Medical Association). The AMA is politically opposed to chiropractic as a healing discipline and disputes the concept of subluxation.
According to Harrison's Principles of Internal Medicine, a meta-analysis of nine studies found spinal manipulation to be effective in improving uncomplicated, acute back pain. The studies found no benefit to treating chronic pain or sciatic nerve irritation.
Requirements for credentials
The admissions requirements for chiropractic colleges in the United States are the lowest among health care professional schools in terms of the minimum number of undergraduate semester hours (toward a bachelor's degree) that are required on entrance, the actual percentage of applicants with a four year bachelor's degree on entrance, the minimum GPA required on entrance, and the actual average GPA of applicants on entrance. [4] (http://www.google.com/url?sa=U&start=1&q=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi%3Fcmd%3DRetrieve%26db%3DPubMed%26list_uids%3D9046456%26dopt%3DAbstract&e=10431) The American Council on Chiropractic Education (CCE) is in charge of setting minimum guidelines for chiropractic colleges; however, additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice. Many states require a four-year undergraduate degree, although the minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours. The minimum cumulative grade point average for a student entering a chiropractic college is 2.50. Commonly required classes include communication or language skills, psychology, social science or humanities, biology, organic and inorganic chemistry, and physics, as well as the common medical classes in anatomy or embryology, physiology, microbiology, diagnosis, neurology, x-ray, orthopedics, obstetrics, and gynecology. However, the process of credentialing varies widely by country.
Political schools of chiropractic
Contemporary chiropractic is divided into two basic schools:
- The traditional approach, followed by the faction of the chiropractive movement known as straight chiropractic [5] (http://www.straightchiropractic.com/).
- Mixing chiropractic, which combines contemporary medical techniques with spinal and other joint manipulation. Methods used might include ultrasound, TENS, rehabilitation or the use of other diagnostic methods such as kinesiology. Mixing chiropractic is itself divided into conservative and liberal factions. [6] (http://www.chiroweb.com/archives/08/21/13.html)
Medical risks of spinal manipulation
The major risks of spinal manipulation include vertebrobasilar accidents, disc herniations, vertebral fracture, spinal cord compression, and cauda equina syndrome, according to Harrison's. Most serious complications occur after cervical (neck) manipulation.
According to the National Council Against Health Fraud (NCAHF), the conviction held by chiropractic believers that every spine will benefit from an adjustment causes them to manipulate spines inappropriately. Among the concerns about chiropractic manipulation is the widespread use of the explosive "dynamic thrust", which takes the patient by surprise, as opposed to more conservative techniques. This maneuver has a greater potential for inflicting injury.
The practice of greatest concern is the rotary neck movement (sometimes called "Vaster cervical" or "rotary break"). This type of manipulation has led to trauma, paralysis, strokes, and death among patients.
The overuse of x-ray photography by chiropractors poses potential patient harm. Of primary concern is the 24' x 36' full spine x-ray. This technique exposes patients to a substantial amount of radiation. Exposing the body trunk to x-rays can have serious long-range consequences and should be avoided. Further, according to NCAHF's chiropractic advisors, such radiographs have little or no diagnostic value.
Misuse of science reports
Some doctors who have submitted research backing up the medical benefits of limited forms of spinal manipulation have found their claims incorrectly applied to the entire field of chiropractic manipulation. Perhaps the most well-known case of this occurred in response to The RAND report on The Appropriateness of Spinal Manipulation for Lower-Back Pain. This study was a meta-analysis of 22 controlled experiments; the conclusion was that certain forms of spinal manipulation were successful in treating certain types of lower back pain. Many chiropractors seized upon these results as proof that chiropractic theory was sound and that chiropractic medicine had reliable results; in fact, the authors of the report said no such thing. Misuse of this report reached such an extent that the RAND report authors were forced to issue a public statement. In 1993 Dr. Paul Shekelle rebuked the chiropractic industry for making false claims about RAND's research:
- "...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....RAND's studies were about spinal manipulation, not chiropractic, and dealt with appropriateness, which is a measure of net benefit and harms. Comparative efficacy of chiropractic and other treatments was not explicitly dealt with."
Criticism of chiropractic claims
The National Council Against Health Fraud, an American private, non-profit healthcare organization, issued a report in 1985 critical of chiropractic medicine.
Sixty-two clinical neurologists from across Canada, all certified members of the Royal College of Physicians and Surgeons of Canada, have issued a warning to the Canadian public and provincial governments about the dangers of neck manipulation.[7] (http://www.chirobase.org/15News/neurol.html)
Mainstream medical doctors and scientists reject the claims of most chiropractic associations and schools as pseudoscience; many refer to their claims as fraud. Most recently, a chiropractor from the Canadian Memorial Chiropractic College in Toronto and two professors at the Los Angeles College of Chiropractic also agreed on this position by stating that all chiropractic organizations engage in and promote "quackery."
York University once attempted to affiliate with a chiropractic school. The scientists and medical doctors at this school rebelled against this plan and created their own website explaining why this would be a bad idea. They enlisted the help of Nobel Prize-winning scientists to explain to the school's administration, and the public, why chiropractic is unscientific.
There are many investigations and lawsuits underway in Canada for false advertising, deceptive practices and claims, injuries and deaths related to chiropractic.
Reformers who reject classical chiropractic theory
A small percent of chiropractors have rejected the metaphysical beliefs of mainstream chiropractors. They view the beliefs of mainstream chiropractic medicine as metaphysical and religious, having no scientific validity, and as a profession which may be dangerous. In contrast, they hold that there are scientifically defensible uses of spinal manipulation for medical benefits. According to their website:
- The National Association for Chiropractic Medicine (NACM) is a consumer advocacy association of chiropractors who confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery. The NACM offers consumer assistance in finding member practitioners. The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based. The original chiropractic hypothesis, stated simply, is that "subluxation is the cause of dis-ease." Modern day chiropractic associations may have expanded and changed this simple statement for the public, but the reality is that this remains the backbone of chiropractic education and practice to this day. In clarification, the term "subluxation" has never been defined by the profession in a way as to have universal acceptance within the chiropractic profession. Chiropractic "subluxation" is not the same as medical subluxation, which represents a partial dislocation of joint structure and would be a contraindication to "adjusting" or "manipulating" the joint structures. Chiropractic "subluxation," not having universal definition, and, thereby, not having received universal scientific status of existence, has evolved into a metaphysical status. Further, the profession has neither defined nor outlined what disease or "dis-ease" that the correction of the "subluxation" might cure or affect. Because the hypothesis has found no validity in universally accepted, peer-reviewed, published scientific journals, belief in the hypothesis, then, is essentially a theosophy. Science has not found any organ system pathology which "adjustment" or "manipulation" of spinal joint structures has effect; that is, no disease or "dis-ease" process is affected.
While the stated ideals of the NACM seem valid, and are well-regarded by many reform-minded chiropractors, the organization itself has come under scrutiny. It seems that the organization requires two things for membership: agreement with its ideals, and a check that clears. Its stated ideas can be recognized as valid, but membership in the organization itself should not be regarded as a sign of competency. Chiropractors can join simply by making payment to its founder, who then promotes its members as the only "legitimate" chiropractors. Membership in the NACM signifies only that the member has made adequate payment to the organization.
External links
- The National Association for Chiropractic Medicine (http://www.chiromed.org/)