Learning Objectives

Name the founder of the modern

profession of chiropractic.

Describe the basic concepts of

chiropractic.

What is the purpose of an adjustment?

Chiropractic
By
Emily Greenough

Learning Objectives

What is Chiropractic?

Identify some of the common

conditions treated by chiropractors.

Manipulative and BodyBody-Based practice

of CAM interventions and therapies.

What are some of the controversies or

criticisms of chiropractic?

Profession which focuses on dx, tx, and

preventing mechanical disorders of the
musculoskeletal system, their effects on
the nervous system and general health.

History of Chiropractic

Chiropractic- means done by hand,

Chiropracticreferring to manipulation of the spine.

The Founder of the Modern

Profession of Chiropractic

Greek words cheir (hand) and praxis

(action)

Healing
philosophies
Spiritualism
Magnetic therapy
Background in
osteopathic
training

Chiropractic is a form of spinal

manipulation, one of the oldest healing
practices.
Spinal manipulation was described by
Hippocrates in ancient Greece.

DD Palmer

Observed the body had a natural healing

ability controlled by the nervous system.
Coined the term subluxationssubluxationsmisalignments of the spine.
Misalignments cause nerve compression
that interferes with proper flow of Innate
Intelligence (God) to body organs, results
in disease or disharmony.
A.k.a. Innate Life Force, Universal Intelligence

Daniel David
Palmer

The First Experiment with

Chiropractic

1895--Palmers story
1895
examination found a sore lump on Lillards back,
misalignment caused deafness

Lillards storystory- daughter reports book to back

Lillards deafness was told to be improved,
w/out any other explanation.
1896-- added treatment to school
1896
Now known as Palmer College of Chiropractic
90% of chiropractors believe the vertebral
subluxation plays significant role in all or most
diseases

Basic Concepts of Chiropractic

The body has a powerful selfself-healing

ability.
The bodys structure (primarily the spine)
and its function are closely related, and
this relationship affects health.
Chiropractic therapy is given with the
goals of normalizing this relationship
between structure and function and
assisting the body as it heals.

The Chiropractor

In the U.S. chiropractors perform over

90% of manipulative treatments.

Adjustments (special emphasis on spine)

Treatment that seeks to eliminate pain
Involve applying a controlled, sudden force
to a joint
Increases the range and quality of motion
in the area being treated

Conditions Commonly Treated

by Chiropractors
Back pain including lowlow-back pain
Neck pain
Headaches including migraines
Sports Injuries
Repetitive strains
Others

Asthma, Arthritis, Bursitis, Cerebral Palsy,

Flu symptoms, DM, Infertility, etc

Prevalence

NCCAM
Estimated Americans (1997) made
nearly 192 million visits a year to
chiropractors.
Over 88 million of those visits were to
treat back or neck pain.
18
18--38 million annually reported for relief
of head and neck pain.

Cervical Spine Manipulation

Before
and
After

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Objective
Acquire information for designing a large
clinical trial and determine its feasibility
and to make preliminary estimates of the
relationship between headache outcomes
and the number of visits to a chiropractor

Study Design
Randomized, control trial

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Subjects
24 adults with chronic cervicogenic
headache

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Outcomes Measured
Modified Von Korff Scales (MVK)

Methods
Randomly allocated to 1, 3, or 4 visits per
week for 3 weeks.
Chiropractors allowed 2 physical modalities
each visit. (heat and soft tissue therapy)

MVK pain scale rating: HA pain today, worst HA

pain in last 4 weeks, average HA pain in last 4
weeks.
MVK disability scale measures interference
with: daily activities, social and recreational
activities, ability to work outside or around
house.

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Feasibility of a larger study was

determined by:

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Sociodemographics
General health status

Completion rates for the f/u questionnaires

had to be 90%
Participants had to attend at least 2/3 of
scheduled visits
Participants reported number of visits
sought outside the study.

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Compliance
Contacted by phone during weeks 1, 2, 3,
4, 6, 8, 10 and 12 to keep them engaged
and remind them to fill out questionnaires
Reminder calls for appointments
Allowed to seek care outside the study

Baseline Variables

energy/fatigue
emotional well being
self rated health
depression

2 visits to establish baseline

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Findings
For HA pain, substantial differences were
found between participants receiving 1
treatment/week and those receiving either
3 or 4 treatments/week.
Comparable differences between groups
were found for HA disability at 12 weeks.
Neck pain and associated disability
appeared to parallel HA outcomes.

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Findings

Dose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Study
Journal of Manipulative and Physiologic Therapies
(2004) vol. 27 issue 9

Participants willing to be randomized,

follow tx protocol, and complete f/u
questionnaires.
Data suggests support for a dosedose-response
relationship between cervicogenic HA
pain/disability and number of chiropractic
treatments.
Larger number of visits produces greater
benefits.

Outside care

3 sought unscheduled treatment or outside

care

Noncompliance

Only 1 participant missed a treatment schedule

A Controlled Trial of Cervical Manipulation of Migraine

Australian and New Zealand Journal of Medicine
(1978) vol. 8

Objective
Evaluate the efficacy of cervical manipulation for
migraines

Study Design
Controlled trial of 6 months

Subjects
85 volunteers (males 33, females 52)
Suffering from migraines (mean 19 years)
Under the age of 55 years

Conclusion

A Controlled Trial of Cervical Manipulation of Migraine

Australian and New Zealand Journal of Medicine
(1978) vol. 8

Treatment GroupsGroups- no more than 2 x/week

Chiropractic Manipulation
Required to manipulate the spinespine- movement of
joints beyond normal limitations
Manipulation
Required medical practitioner and physiotherapist
to manipulate the spinespine-movement of joints
beyond normal limitations
Control
Require medical practitioner and physiotherapist to
perform cervical mobilizationmobilization- movement of joints
within normal limitations

A Controlled Trial of Cervical Manipulation of Migraine

Australian and New Zealand Journal of Medicine
(1978) vol. 8

Hypothesis
Post
Post--treatment scores for the whole
sample would be less than prepre-treatment
scores
Cervical manipulation (performed by any
therapist) would be more effective than the
control treatment
Chiropractic treatment would be more
effective than the other 2 treatments

A Controlled Trial of Cervical Manipulation of Migraine

Australian and New Zealand Journal of Medicine
(1978) vol. 8

Results
Whole sample, migraine symptoms were
significantly reduced.
No difference in outcome found between
therapists, or by those who received the
control treatment.
Chiropractic was no more effective at
reducing duration, disability, or frequency,
but greater reduction in pain variant.

A Controlled Trial of Cervical Manipulation of Migraine

Australian and New Zealand Journal of Medicine
(1978) vol. 8

Compliance
required migraine form at the end of
each migraine.

duration of attack (duration hr/attack)

pain (visual analogue scale intensity)
disability (5 point scalescale-1=usual activities,
5=had to remain in bed)

Outcome MeasuresMeasures-phone
migraine frequency was compared to
migraine form to compare data.

Controversies and Criticism

Inside the profession
The Mixers, Straights, and Reformers

Concept of subluxations
Use of appropriate physical therapy
techniques for conditions

Controversies and Criticism

Controversies and Criticism

Outside the profession

Effectiveness of treatments

Non
Non--manual treatments

heat and ice, magnetic therapy, nutrition

counseling and dietary supplements

Potential risks
Presumed to be safe from what is known
Osteoporosis compared to healthier bone

Conclusions?

Research finding had missing or poorpoorquality data.

Overall research findings, unable to provide
enough evidence to support effectiveness
of treatment.
Maybe more effective than sham therapy,
but no more or less than other treatments.

Thank You

Research studies are ongoing

Key area of research is the basic science of
what happens in the body such as the cells
and nerves when specific treatments are
given.

Scientific basis

Any

Questions?

Risk of complications from adjustments

of lowlow-back pain appear very low, but
risks increase for adjustments of the
neck.