What is chiropractic?
Chiropractic (which comes from the Greek word meaning “done by hand”) concentrates on manipulating the spine and other joints to treat illnesses. It is based on the belief that because the nervous system controls the body, correcting the spine can treat a variety of illness. Daniel David Palmer founded chiropractic in 1895. Palmer was a self taught healer who was studying spinal structure and manipulative techniques when he reportedly restored the hearing of a deaf man by realigning a displaced vertebra in his back. Palmer believed that most diseases were a result of abnormal nerve signals, caused by “vertebral subluxation” (misalignment of the spine). Although today most chiropractors use other therapies as well, spinal manipulation remains at the center of chiropractic. There are more than 60,000 active human chiropractic licenses in the United States, and acceptance among the population is increasing. According to a study in 2010, the total number of U.S. adults who visited a chiropractor jumped 57%, from 7.7 million in 2000 to 12.1 million in 2003. This is a higher percentage than yoga, massage, acupuncture, or other diet based therapies.
What conditions are treated effectively with chiropractic?
Chiropractic has been shown to be effective for acute and chronic back pain, neck pain, and join paint. In humans, preliminary evidence suggests it may also help treat frozen shoulder, tennis elbow and other sports injuries, carpal tunnel syndrome, otitis media (ear infection), digestive problems, menstrual and premenstrual pain, attention deficit hyperactivity disorder (ADHD), and asthma. Many people also use chiropractic to treat headaches, fatigue, and other health issues.
Use in the United States
In the United States, chiropractic is considered a complementary health practice. According to the 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of the use of complementary health practices by Americans, about 8 percent of adults (more than 18 million) and nearly 3 percent of children (more than 2 million) had received chiropractic or osteopathic manipulation in the past 12 months.
An analysis of the use of complementary health practices for back pain, based on data from the 2002 NHIS, found that chiropractic was by far the most commonly used therapy. Among survey respondents who had used any of these therapies for their back pain, 74 percent (approximately 4 million Americans) had used chiropractic. Among those who had used chiropractic for back pain, 66 percent perceived “great benefit” from their treatments.
During the initial visit, chiropractors typically take a health history and perform a physical examination, with a special emphasis on the spine. Other examinations or tests such as x-rays may also be performed. If chiropractic treatment is considered appropriate, a treatment plan will be developed.
During followup visits, practitioners may perform one or more of the many different types of adjustments and other manual therapies used in chiropractic care. Given mainly to the spine, a chiropractic adjustment involves using the hands or a device to apply a controlled, rapid force to a joint. The goal is to increase the range and quality of motion in the area being treated and to aid in restoring health. Joint mobilization is another type of manual therapy that may be used.
Chiropractors may combine the use of spinal adjustments and other manual therapies with several other treatments and approaches such as:
- Heat and ice
- Electrical stimulation
- Relaxation techniques
- Rehabilitative and general exercise
- Counseling about diet, weight loss, and other lifestyle factors
- Dietary supplements
What the Science Says
Researchers have studied spinal manipulation for a number of conditions in humans ranging from back, neck, and shoulder pain to asthma, carpal tunnel syndrome, fibromyalgia, and headaches. Much of the research has focused on low-back pain, and has shown that spinal manipulation appears to benefit some people with this condition. (For more information on human use, see the Spinal Manipulation for Low-Back Pain fact sheet.
A 2010 review of scientific evidence on manual therapies in humans for a range of conditions concluded that spinal manipulation/mobilization may be helpful for several conditions in addition to back pain, including migraine and cervicogenic (neck-related) headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders. The review also identified a number of conditions for which spinal manipulation/mobilization appears not to be helpful (including asthma, hypertension, and menstrual pain) or the evidence is inconclusive (e.g., fibromyalgia, mid-back pain, premenstrual syndrome, sciatica, and temporomandibular joint disorders).
- Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated.
- There have been rare reports of serious complications such as stroke, cauda equina syndrome (a condition involving pinched nerves in the lower part of the spinal canal), and worsening of herniated discs, although cause and effect are unclear.
- Safety remains an important focus of ongoing research:
- A 2007 study of treatment outcomes for 19,722 human chiropractic patients in the United Kingdom concluded that minor side effects (such as temporary soreness) after cervical spine manipulation were relatively common, but that the risk of a serious adverse event was “low to very low” immediately or up to 7 days after treatment.
US Government Funded Research
The National Center Complementary and Alternative-Medicine of the National Institutes of Health is supporting research on chiropractic care in humans that includes projects focusing on:
- Spinal manipulation for back pain, neck pain, and headache, as well as for other health conditions such as temporomandibular disorders
- Development of a curriculum to increase the understanding of evidence-informed practice in chiropractic educational institutions
- Influence of patients’ satisfaction with care on their response to treatment, in a study that compared chiropractic and medical care in a group of back-pain patients.
NCCAM also funded establishment of a developmental center for research in chiropractic at the Palmer Center for Chiropractic Research. Investigators at Palmer and at other partnering institutions conduct basic and clinical research on chiropractic treatment approaches, how they might work, and diseases and conditions for which they may be most helpful.
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