What is Chiropractic Care?
Chiropractic care explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Chiropractic care involves providing services that primarily focus on evaluating and treating pain that is the result of nervous system and musculoskeletal conditions. More specifically, chiropractic care takes into consideration the impact that disorders which cause headaches, radiating pain, back pain, joint pain, or neck pain have on patients’ daily lives. This includes the potential effects that these types of conditions may have on a patient’s wellness and overall health.
Practitioners in the chiropractic field generally obtained highly specialized training at the doctoral level although some receive training at the master’s level. During a chiropractic practitioner’s training program, the trainee completes numerous courses and seminars, and receives direct clinical training on assessing, diagnosing, and treating painful conditions that are associated with musculoskeletal health problems. Upon successful completion of the training program, practitioners are poised to provide evidence-based treatment options and therapeutic plans, along with suggestions in terms of rehabilitative exercises. Furthermore, trainees who enroll in chiropractic training programs have the option to participate in courses that focus on nutrition. Therefore, many chiropractic practitioners have an excellent knowledge of nutritional and dietary aspects that allows them to suggest lifestyle changes that are expected to improve patient outcomes.
According to the American Chiropractic Association, the central philosophy of the chiropractic profession is to provide patients with effective, high quality health care through the use of conservative and alternative interventions. Individuals who practice chiropractic care place their utmost concern with the body’s natural ability to heal on its own, in certain cases, after an injury without the use of medication or more invasive techniques such as surgery. Chiropractors generally take a systems approach to each of their cases. More specifically, chiropractic practitioners generally believe that understanding the underlying structure and function of the spine and how it interacts with other systems within the body is necessary to understanding disease and injury.
One of the points that is emphasized is that the biological processes in the body must maintain a natural flow and balance in order for the body to function effectively and efficiently. A classic example of this description has been documented in various studies that illustrate the dynamic interplay between bodily systems, such as the relationship between poor posture and the incidence of low back and neck pain. This particular example highlights the importance of striving for a complete understanding of the complex interaction between systems as well as how they relate to a patient’s pain. A thorough understanding of the body’s anatomy and how certain conditions develop provide the ideal background for achieving a full and complete assessment, arriving at the most accurate diagnosis, and developing an optimal treatment plan. There are several different approaches that chiropractors can choose from for the treatment of chronic pain, but manual therapy is the most frequently performed technique. This form of therapy is also referred to as a chiropractic adjustment, spinal manipulation, or manipulation therapy. In terms of chiropractic care, manual therapy is defined as the use of the hands and direct body contact in which the articulations and soft tissues are treated.Indeed, chiropractic care primarily involves spinal adjustments to correct the internal alignment of the body. Chiropractors then apply targeted and controlled pressure to specific regions of the body or joints. Moreover, they attempt to place the pressure particularly on the areas that are hypomobile, which means it exhibits restricted or limited movement as the result of an injury and associated tissue damage.
Numerous factors have been linked to tissue damage and many injuries occur while performing typical day-to-day tasks. For instance, patients can suffer tissue damage by simply attempting to lift a heavy object, especially if the individual is not following the proper lifting technique. Patients can also sustain tissue damage through repetitive movements that affect the same area. Some patients have even sustained tissue damage from simply sitting in an awkward position for an extended period of time. This is especially the case if the individual has a habit of maintaining poor spinal posture. Each of these types of situations increase the risk of irritating or causing inflamed tissue; both of which may lead to acute or chronic pain. Whether or not the pain associated with a particular condition is acute or chronic, it may be equally debilitating and can have a detrimental impact on an individual’s daily functioning. Therefore, the goal of spinal manipulation is to stimulate the reconstruction of the underlying affected tissue, as well as the surrounding joints in order to restore mobility, reduce and eliminate pain, relieve muscle tightness, and promote tissue healing. Furthermore, spinal manipulation is believed to help improve the overall function of the body, thereby restoring the patient to his or her state of functioning prior to the injury and pain that developed.
It is quite rare for a patient to experience discomfort that is the result of a chiropractic adjustment, but some patients do report that they experience symptoms such as mild soreness and achiness following their treatment sessions. However, these symptoms have been compared to the soreness that would be experienced after engaging in strenuous exercise. The intensity of the symptoms is reported to be generally mild and they typically resolve within 12 to 48 hours. Treatment approaches such as chiropractic manipulation are among the oldest modalities that are still in use today. In actuality, the use of spinal manipulation for therapeutic purposes was documented in ancient Chinese literature and early references to this type of care have even been identified within Egyptian hieroglyphics. Unfortunately, since its early beginnings, chiropractic care has faced numerous harsh criticisms from other professions within the health care field. Nonetheless, the field of chiropractic care is still a critical component of today’s health care system and, nowadays, it is highly regarded as an effective, alternative form of treatment.
Currently, all 50 states offer a licensure in chiropractic care and reports show that this is one of the largest alternative medical professions. It has been estimated that chiropractors perform over 90 million spinal manipulations annually. In terms of patient trends, early estimates suggested that at least one in three individuals who have experienced back pain have seen a chiropractic practitioner for pain management. Indeed, many even regard chiropractic care as one of the leading fields in terms of non-invasive techniques that improve patient outcomes. Moreover, chiropractic practitioners use a variety of manipulation techniques to help alleviate low back pain, neck pain, and headaches, as well as pain in different parts of the body. For certain painful conditions, the first line of intervention methods involves chiropractic care, and when other interventions are available, chiropractic care is regarded as an ideal complementary intervention.
The History Of The Chiropractic Profession
Chiropractic treatment began as early as the 19th century, with its introduction into clinical settings to treat various ailments. Moreover, September 1895 is regarded by most practitioners as the emergence of this healthcare profession. Reports indicate that Daniel David Palmer was the first professional to perform a spinal adjustment during this time period. Since then, empirical evidence as well as anecdotal research related to the effectiveness of chiropractic care and treatment has consistently fluctuated. In actuality, this profession was challenged by many skeptics and even referred to as being a pseudoscientific or mystical field by those involved in mainstream medicine.
|Important Dates in the History of Chiropractic Care|
|1895||Daniel David Palmer performs his first spinal adjustment in Davenport, Iowa|
|1897||Daniel David Palmer founded the Palmer School of Chiropractic|
|1905||Minnesota becomes the first state to issue independent practice license for chiropractic care|
|1910||The Flexner Report is published|
|1933||The U.S. Council of State Chiropractic Examiners is established (now the Federation of Chiropractic Licensing Boards)|
|1944||The Foundation for Chiropractic Education and Research founded|
|1963||The National Board of Chiropractic Examiners founded|
|1974||Louisiana is the last state to issue licensure to chiropractors and the U.S. Department of Education recognizes the U.S. Council on Chiropractic Education as the only accrediting agency for training programs in chiropractic|
|1976||The Journal of Manipulative and Physiological Therapeutics founded|
|1978||In March, the first issue of the Journal of Manipulative and Physiological Therapeutics is published|
|1980||The Association for the History of Chiropractic is established|
|1987||U.S. Supreme Court finds American Medical Association guilty of antitrust violations toward the chiropractic profession|
|2005||World Health Organization publishes training guidelines for chiropractic care|
During the 20th century, when chiropractic care began to emerge as a specialty field of medicine, chiropractic professionals were operating based on the premise that they were practicing a skilled craft rather than an art, especially in the rural parts of America. This was the case because empiricism and evidenced-based practices had not fully permeated the field. It wasn’t until the publication of the Flexner Report in 1910 that health care began to incorporate the practice of science into various treatment methods and training programs. This publication was a culmination of findings from a large study that examined the curricula for 155 medical schools in the U.S. and Canada. The results of the report called for provisions not only for training programs in health care, but also in terms of licensure.
Training For Chiropractic Care Professionals
After the Flexner Report was published in 1910, training programs within health care fields became more selective regarding admissions process, and the curricula became increasingly rigorous. In terms of chiropractic care, two organizations known as the World Health Organization and the American Chiropractic Association oversee the standardization of these training programs.
Trainees must have completed a minimum 90 credit hours of science courses at the undergraduate level prior to entering into a training program with a chiropractic focus. Trainees can then complete one of three different training paths in chiropractic care:
- One to four years of prerequisite training in undergraduate-level basic sciences followed by a four year, full-time doctorate program in order to obtain a Doctorate of Chiropractic or DC
- Two to three years of master-level training following the completion of a bachelor degree in order to obtain a Master of Science in Chiropractic
- Five years in a dual bachelor- and master-level program in order to obtain a Bachelor of Science in Chiropractic
Overall, the training programs for chiropractic care require a minimum of 4,200 credit hours. This includes time spent in the classroom, as well as in the laboratory or engaged in supervised clinical service. Chiropractic trainees are also required to complete 1,000 hours of supervised clinical training that counts towards the total credit hours. For trainees completing a doctorate of chiropractic, additional requirements include passing all national and state boards as well as the licensure exam. Once they complete the training requirements, individuals with a doctorate of chiropractic are regarded as physicians in various states across the U.S.
Chiropractic trainees generally receive rigorous instruction in the basic and clinical sciences. This includes anatomy, physiology, and biochemistry. Students are also required to receive comprehensive education and training on differential diagnoses, radiology, and various therapeutic techniques. These training programs specifically focus on exposing students to a rich learning environment in which they can gain a better understanding of the human body structure and biological functions under healthy conditions and diseased states.
The Scope Of Chiropractic Practice
The scope of chiropractic care is vast as chiropractors have the ability to provide beneficial treatment for various conditions. For instance, it is widely recognized that individuals who practice chiropractic care can recommend therapeutic intervention plans for many conditions that are not necessarily neuromusculoskeletal in nature. In actuality, chiropractic practitioners who train at the doctorate level are equipped with a knowledge base and skill set that allows them to treat numerous non-neuromusculoskeletal issues.
In terms of neuromusculoskeletal conditions, chiropractic practitioners typically treat patients who have spinal disc diseases, osteoarthritis, tendonitis, carpal tunnel syndrome, strains, and sprains. In terms of the non-neuromusculoskeletal conditions, chiropractic doctors can suggest treatments that provide relief to individuals who suffer from digestive disorders, otitis media, asthma, and allergies. Moreover, novel research is being conducted on additional conditions that chiropractic medicine may be able to provide substantial benefits for.
Conditions Treated By Chiropractic Care
Various reports have indicated that approximately 84% of adults will experience some form of back pain over the course of their lifetime. Of even greater concern, however, is the fact that relapse rates for individuals with back pain are exceedingly high. Some evidence has even suggested that approximately 78% of adults who have experienced an episode of back pain are expected to experience another episode of pain at some point in their lifetime. The Center for Disease Control (CDC) has reported that back pain is linked to significant physical disabilities and may be the source of various detrimental deficits in terms of a patient’s ability to function at home and at the workplace.
According to the National Institutes of Health, back pain costs people in the U.S. an estimated $50 billion every year. Moreover, back pain has been described as the leading cause of work-related disabilities and absenteeism from work. Furthermore, back pain is often responsible for a decrease in work performance and productivity as well as significant increases in health insurance claims. During the last 10 years, the clinical community has increased the number of trials that have been performed in an attempt to identify the prognostic factors of back pain. In particular, randomized control trials are being conducted to test the effectiveness of various treatment options that are currently available.
To be able to treat a variety of conditions, chiropractors must possess an in-depth understanding of all the components of the spine, how pain originates, how it progresses, and the complexity of different types of pain. Having a good grasp of this fundamental knowledge provides a framework for developing an individualized treatment plan for patients. However, conditions that are typically treated by chiropractors are those that involve the spine, which is a complex system that includes neurological components that may be implicated as the source of either acute or chronic pain.
More specifically, the spine or backbone is the structure that actually refers to the vertebral column. This structure runs down the back side of the torso. Twenty-four individual vertebrae and nine vertebrae that are fused together make up the spine. The vertebrae consist of boney tissue and several arches that protrude out of the center of the vertebrae. The spine is divided into different regions. The first section is the lowest region of the spine called the sacral curve, which consists of a sacrum and tailbone that are made up of four coccygeal vertebrae. The lumbar curve is directly above this region and it consists of five vertebrae. Next is the thoracic curve and this region contains 12 individual vertebrae that form the mid- and upper parts of the back. The top of the spine contains the cervical curve or the neck.
The spinal cord is actually located inside of the spinal column. It begins at the base of the head in a structure called the occipital bone and extends down the torso. It also contains long nerve bundles that transmit sensory information to various parts of the body, but especially the brain. The primary function of the spinal cord is to transmit information regarding fine and gross motor control movements, different types of reflexes, and conduit sensory signals. Accordingly, it is one of the most crucial components of the human anatomy and is therefore, well-protected by several layers of tissue called spinal meninges and the spinal column. The brain is also protected by a thick layer of meninges. These layers are referred to as the dura, arachnoid, and pia mater. Duramater means “tough mother” in Latin and this name is appropriate because it is the membrane that is primarily responsibility for protecting the brain and the spinal cord from injuries. Furthermore, it is composed of tough, thick, and somewhat inflexible tissue that prevents cerebrospinal fluid leakage.
In addition, there is an area in the outermost region of the spinal column called the epidural space. This region is also referred to as the lymphatic system and it is often the target for different pain management techniques because it contains numerous blood vessels, spinal nerve roots, and fatty tissues. Anti-inflammatory medication and steroids are often delivered directly to spinal nerve roots in the epidural space. Furthermore, spinal nerves extend to various regions and organs throughout the entire body and this allows medication to be widely distributed to different locations that may be causing pain due to inflammation, irritation, or swelling.
Spinal nerve roots, which are embedded within the spinal cord, may also be targeted in order to completely hinder signal transmission and reduce severe pain. Damaged or inflamed nerve roots can lead to paresis, characterized as muscle weakness and partial immobility, or paralysis, characterized by complete immobility. Any particular component of the spinal system may be responsible for an acute or chronic condition that is causing persistent pain.
In order to diagnose the cause of the pain, chiropractors conduct clinical investigations through in-depth patient assessments and X-ray imaging that helps identify the cause of back or neck pain. After the source is identified, chiropractors generally rely on the manipulation of the affected joint in order to help the patient regain function, restore mobility, and accelerate the healing process. Additional treatment modalities that are utilized include massage therapy, stretching techniques, ice and heat compression, nutrition and exercise counseling, and electrical stimulation. The following sections describe common conditions that are treated by chiropractic practitioners.
A variety of musculoskeletal conditions and sports injuries that have become a chronic issue can be treated through chiropractic care. The misalignment of vertebrae, known as subluxation, is also commonly identified as the source of pain for many patients. Misaligned vertebrae put spinal nerves under pressure and this leads to intense pain. While this condition may be caused by a single traumatic event, more often than not, it is caused by years of poor posture. In today’s modern work environment, a large percentage of the population sits in front of a computer all day and then returns home and sits in front of the television. Over time, this type of sedentary lifestyle can place quite a bit of pressure on the spine, thereby increasing the risk of developing irritation, inflammation, and pain in the back.
A physician examines each patient’s painful condition in order to provide an accurate diagnosis. The following musculoskeletal conditions can be successfully treated with chiropractic care:
- Migraines and sinus or cluster headaches
- Stiffness and pain in the upper, mid, and lower back
- Stiffness and pain in the neck
- Muscle spasms or pinched nerves
- Pain, numbness, or weakness in the legs or arms
- Pain and dysfunction in the legs or arms
- Tarsal or carpal tunnel syndrome
Additional Diseases And Conditions
Various medical conditions that afflict individuals of all ages can be the focus of chiropractic care in addition to conditions that affect the musculoskeletal system. This means that even infants and older individuals may be appropriate candidates for chiropractic care with regard to the management of their chronic condition.
Indeed, chiropractic care physicians are trained to provide full or partial relief for the following conditions:
- Chronic fatigue syndrome
- Fertility issues
- Ear infection
- Frequently occurring colds or the flu
- Gastrointestinal syndromes
- Multiple sclerosis
- Thoraic outlet syndrome
- Loss of equilibrium
- Intervertebral disc syndrome
- Temporomandibular joint disorders
- Respiratory infection
- Menstrual disorders (e.g., pre-menstrual syndrome)
Some of the most common types of injuries that are reported can be treated with chiropractic care. Automobile accidents continue to constitute the majority of injuries that are sustained annually within the U.S. After the occurrence of these types of injuries, symptoms may not surface until several weeks and sometimes months following the initial injury.
Other injuries that may be seen at a chiropractic office may be the result of work-related injuries such as falls and injuries that are sustained while lifting. Furthermore, sports injuries are frequently treated with chiropractic care.
Injuries that can be treated with chiropractic care include:
- Chronic injuries
- Injuries resulting from automobile accidents
- Injuries due to a fall
- Iliotibial band syndrome (ITBS)
- Lifting injuries
- Plantar fasciitis injury
- Rotator cuff injury
- Sports injuries
It is widely accepted that chiropractors primarily focus on the treatment of chronic pain, but they can also provide expertise and guidance in preventing the onset of pain.
At the initial consultation with a chiropractor, a patient can expect the meeting to be focused primarily on gathering a detailed history of previous and current health. More specifically, the chiropractor will ask a series of questions regarding the patient’s immediate family history and personal history. Furthermore, the chiropractor will gather specific information regarding the pain. For example, the patient will be asked to discuss the approximate onset of the current episode of pain, a detailed description of the pain, and any other relevant details. This initial assessment will help the chiropractor evaluate whether any potential underlying conditions may be the source of the painful symptoms. In addition, during the initial visit, the chiropractor will more than likely conduct a physical exam. During this examination, the chiropractor will carefully examine the alignment of the body and look for any other structural abnormalities. The practitioner may also manipulate several joints while assessing the pain. This can help confirm the diagnosis prior to establishing a treatment plan. If needed, the chiropractor may order X-rays to help identify musculoskeletal abnormalities.
Once the chiropractor has determined the source of the pain through the initial assessment and physical exam, the next course of the chiropractic care typically involves a spinal adjustment. During the adjustment, rapid force is applied manually to the affected area, which pushes that part of the body beyond its normal range of motion. Patients generally do not report a significant amount of discomfort during the procedure, although patients may expect to hear a cracking or popping sound during the manipulation procedure.
Chiropractors are trained to utilize several different manipulation techniques, which include some of the following:
- Articulatory: Many injuries can include impairments in articular or joint motion. The goal of the articulatory technique is to restore the injured joint to its full range of motion by counteracting joint stiffness through manual manipulation. For this technique, the chiropractor applies force at a low velocity with moderate to high frequency, guiding the joint through its full range of motion.
- Direct thrust technique: The direct thrust technique is probably the most commonly recognized approach that is utilized by chiropractors. This technique involves the use of high velocity force, typically with the hands, that is applied directly to the spine. Patients are expected to hear a crackling sound during the manipulation of the vertebral segments. The goal of the direct thrust technique is to release injured joints that are causing restricted motion by applying short, sharp force to the area.
- Functional technique: The functional technique applies gentle force to the joint in order to release it from restriction. During the procedure, should even the slightest restriction be detected, the joint is held in the position where the restriction was detected until its releases.
- Indirect positional technique: The indirect positional technique is a passive technique that is utilized to release hypertonic muscles and restore a full range of motion within joints. During this procedure, the joint is held in a neutral position, meaning that tension is not experienced within the surrounding tissue or joint, and then force is applied. This technique can also involve the use of specific pressure with the intent of lengthening the muscle tissue.
- Myofascial release: The myofascial release technique involves stretching fascia tissue (a covering over the muscles of the body) that has been experiencing excess tension and rigidity. Chiropractors are experts at locating areas of uneven tension and pain that is often believed to be caused by stress. Therefore, the myofascial technique involves identifying regions of high tension and then applying light pressure until the area relaxes.
- Muscle energy: The muscle energy techniqueis a non-thrusting method that involves isometric movements with the goal of restoring a full range of motion. This technique is referred to as an active method because patients must participate in the application of force against a restrictive barrier. This force is applied consistently for a brief period of time (usually several seconds) that is then followed by a period of relaxation. The procedure is then repeated in a slightly different position until no additional improvements in range of motion are detected within the joint.
Benefits of Chiropractic Care
The amount of empirical evidence that demonstrates favorable results with regard to chiropractic care is continuously being published. These studies and clinical trials have described findings regarding the safety and effectiveness of the interventions that are generally performed by chiropractors in comparison to invasive surgical procedures or the use of prescription pain medication. Indeed, the primary goal of chiropractic care is to improve patient outcome by providing safe and cost-effective relief from the debilitating symptoms of pain.
Furthermore, research has shown that chiropractic manipulation has yielded the following health benefits to patients when compared to more conventional treatment methods:
- A decrease in the need for pain medication
- Faster recovery periods
- Lower rates of patient disability
- Greater improvements in pain symptoms
- Greater improvements in activity tolerance
In terms of chiropractic treatment for cervical spine pain, which can include neck pain, headaches, or upper back pain, chiropractors usually adjust the neck by applying pressure to the cervical joints. There are several risks and side effects that are involved with this procedure which are discussed in the next section. However, studies report that these side effects tend to emerge on the same day of the procedure and were no longer reported by the patient after 24 to 48 hours. The results of these studies also suggest that chiropractic procedures for the treatment of cervical spine pain is associated with a 75% reduction in reported symptoms of pain at 12 weeks when compared to patients who took medication.
Moreover, the pain relieving benefits of chiropractic care were maintained during the one-year follow up visit. A similar year-long, randomized, controlled trial that examined the effectiveness of spinal mobilization in patients with chronic neck pain, compared to either physiotherapy or conventional care from a general practitioner (which typically involved education, medication, and supportive counseling), indicated that spinal mobilization was linked to faster recovery periods and less reported pain at 26 weeks. Patients with chronic low back pain have also been shown to benefit greatly from chiropractic care. In one particular study, patients who were treated by chiropractors for symptoms of low back pain exhibited greater improvements in pain after four weeks than patients who received conventional care from their primary care physicians.
In terms of cost effectiveness, chiropractic care has received ample support for its benefits in comparison to surgery or medication. More specifically, spinal mobilization that is performed by a chiropractor costs about one-third less than physiotherapy or conventional care.
Risks Associated With Chiropractic Care
Chiropractic care is described as a safe alternative to invasive surgery or prescription medication for the treatment of many types of pain conditions, particularly those which originate in the musculoskeletal system. There are very few risks associated with chiropractic care and serious complications associated with the commonly utilized procedures are quite rare. Patients should, however, ensure that their practitioner is highly trained and appropriately licensed to provide chiropractic care, prior to their initial visit.
Risks that are associated with undergoing chiropractic care include:
- Disc herniation
- Nerve compression within the lower spinal column that typically results in pain, weakness, numbness of the legs, and the loss of bowel and bladder control
Patients should also tell their chiropractor if they have a history of osteoporosis, spinal instability, cancer in the spine, tingling or numbness in their extremities, or an increased risk of stroke.
Chiropractic care is among the oldest treatment modalities still in practice today. This field primarily focuses on accurately assessing and effectively treating painful symptoms that are associated with nervous system and musculoskeletal conditions. However, chiropractic care also aims at understanding the impact that disorders within these systems have on patients (e.g., back pain, neck pain, joint pain, radiating pain, and headaches) as well as the potential repercussions to the patient’s overall health and wellness.
Practicing chiropractors can receive either a masters or doctorate level of training that equips them with highly-specialized skills in spinal and joint manipulation in order to provide pain relief. Manipulation, which is also known as a chiropractic adjustment, emphasizes key goals such as increasing mobility in the musculoskeletal system, thereby decreasing chronic pain without the use of prescription medication.
The scope of chiropractic care is quite vast and this medical field is beneficial for the treatment of a wide range of conditions, from headaches to carpal tunnel syndrome to fertility problems to respiratory infections.
Patients who receive chiropractic care are likely to experience significant relief from debilitating pain, along with improvements in their overall day-to-day functioning. Research has actually shown that chiropractic manipulation can allow patients to decrease the use of medication, achieve faster recovery from their painful condition, while reducing patient disability. When chiropractic care is utilized as a complimentary intervention, patients generally experience greater improvements of their painful symptoms, as well as their activity tolerance.
It is essential that pain is properly diagnosed before a treatment plan is established. In addition, it is important to speak with a practitioner that is trained and licensed to practice chiropractic care about the appropriateness of the treatment approach that is recommended.
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