Chiropractic sources

Chiropractic(Note: Some Links will take you FROM Ourmed, to our Sister Site, WikiChiro.org.)

(This page is a highly edited version of a page originally from Wikipedia, which comes to Ourmed from our sister site, WIKICHIRO.ORG where you are also welcome to edit articles freely. NB: The chapter heading/links below will take you directly to those pages at Wikichiro.org)

Definition
Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. Though frequently categorized as a complementary or alternative form of medicine, the World Federation of Chiropractic considers that, as a result of the acceptance of chiropractic as a valid treatment option for various musculoskeletal conditions, the discipline is now in the realm of mainstream. and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.

The primary modality of treatment involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes adjunctive physio-therapeutic modalities, nutritional supplementation, exercises, and health and lifestyle counseling. Modern Chiropractic Doctors explain the basis of a Chiropractic adjustment by scientifically acceptable terms.

The profession is currently dominated by modern progressive Doctors who are attuned to the results of scientific studies, and are more open to other mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture. Chiropractic is well established in the U.S., Canada and Australia. , although, like any profession, there remains a small faction which refuses to give up a concept based in vitalism, called "Innate intelligence". To these people, the mainstream of the profession are considered "mixers", because we include all natural modalities into the "mix".

History
(for History, see Chiropractic history AT WIKICHIRO)

Assimilation into Mainstream
Chiropractic has gained greater acceptance among medical physicians and health plans in the U.S., and evidence-based medicine has been used to review research studies and generate practice guidelines. Many studies of treatments used by chiropractors have been conducted. Collectively, systematic reviews of this research has demonstrated that spinal manipulation is effective. Spinal manipulation has been alleged to have serious complications in rare cases (about 1.4/1,000,000), this is clearly less than the risk of taking an aspirin tablet, and thus chiropractic care is generally safe when employed skillfully and appropriately.

Chiropractic is autonomous, and in some ways competitive with mainstream medicine. Osteopathy enjoys medical licensing only in the US. Outside the U.S. it remains primarily a manual medical system, with mostly less recognition than Chiropractic; physical therapists work as a part of mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise. Chiropractors, uniquely use a high velocity, low intensity form of manipulation which requires a far higher degree of training and experience to effectively utilize. This may account for the difference in effectiveness of treatment, when one compares these approaches. In a landmark study in 1990 published in the British medical journal involving 741 patients, Chiropractic manipulation was found to be significantly superior to ANY other method of treating low back pain. The same group was followed and in 1995 the BMJ published the follow-up study showing that those results were still demonstrable in that patient population. Later studies showing lesser results apparently did NOT include Chiropractic methods of manipulation and this may be the reason for the significant difference.

WorldWide presence
Chiropractic is established in the U.S., Canada, and Australia, Switzerland, Mexico, Panama, Japan, the UK, Scandinavia, and much of the rest of Western Europe, and is present to a lesser extent in as many as 90 countries.

United States
In the late 1970's the Federal government, through the then Department of Health, Education and Welfare, formally recognized the CCE (and subsequently the New York Board of Regents) as a national accrediting agency for the profession. Then the mostly proprietary colleges scrambled to rid themselves of legacy faculty who were providing an "inbred" education, and replaced them with professors holding PhD's in each of the various disciplines which were also taught in medical colleges. From that period on, the education in Chiropractic changed forever. Consisting of five (5) academic years (10 semesters), after college, like medical school, the modern Doctor of Chiropractic studies all the various medical specialties, as well as a thorough grounding in all the basic and clinical sciences, and diagnosis. The key difference between Chiropractic and medical education is merely the philosophy of therapy, in that the DC is not opposed to drugs or surgery where appropriate or necessary, but prefers to take an approach which uses natural, or "conservative" therapies as a first  line of attack on a condition, before resorting to chemicals or invasive procedures.

Accreditation
For Accreditation see: Educational accreditation AT WIKICHIRO

Regulatory boards
For Regulatory boards see: Regulatory boards AT WIKICHIRO

Utilization, satisfaction rates, and third party coverage
In the U.S., chiropractic is the third largest healing arts profession, and is the third largest doctoral profession, behind only medicine and dentistry. The percentage of population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada, with a global high of 20% in Alberta. Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors. The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints; most do so specifically for low back pain. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention. Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.

Insurance coverage
For Insurance coverage see Insurance coverage AT WIKICHIRO

Evidence basis
The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be antiscientific reasoning and unsubstantiated claims, Continuing education enhances the scientific knowledge of the practitioner.

Effectiveness
Many controlled clinical studies of Spinal manipulation (SM) are available, but their results dont always agree,. Health claims made by chiropractors about using manipulation for pediatric health conditions are supported by some studies. A study critical of Chiropractic was refuted when a 2008 supportive review found serious flaws in the critical approach and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments. Most research has focused on Spinal manipulation (SM) in general, rather than solely on chiropractic SM. A 2002 review of randomized clinical trials of SM was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular; however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it.

There is a wide range of ways to measure treatment outcomes. Chiropractic care, like all medical treatment, benefits from the placebo response. It is hard to construct a trustworthy placebo for clinical trials of Spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. The efficacy of maintenance care in chiropractic is unknown.

Cost-effectiveness
A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings. A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to Non-specific effect) remains uncertain. A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention. The cost-effectiveness of maintenance chiropractic care is unknown.

Safety issues
For Safety, see Chiropractic safety at WIKICHIRO

Public health
Most chiropractors do NOT oppose reasonable vaccination or water fluoridation, which are common public health practices. Although within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available. Most chiropractors have embraced a reasonable approach to vaccination, but some of the profession, as in any large group, like, e.g. Medicine, rejects it, as Chiropractic philosophy says that the power that created the body heals the body.

The American Chiropractic Association and the |Int'l Chiropractor's Ass'n support individual exemptions to compulsory vaccination laws. A 1995 survey of U.S. chiropractors found that a minority still believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.

One needs to keep in perspective that a fully accredited educational process in the USA did not really commence until about 1975, and thus those DC's in practice prior to that time, received what is called an "inbred" education. From the onset of CCE accreditation, the FIVE academic years of graduate education drastically changed the attitudes of the majority of DC's in such matters.

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.