Introduction

Chiropractic (Greek: done by hand). A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation and restoring function.

Chiropractic arose as a separate profession in the United States in the 1890s. Until the 1950s the profession was concentrated in North America and was largely isolated from the mainstream of health care. In the 1960s and 1970s the foundations were laid for broader acceptance of the profession – improved educational and licensing standards, significant research, research texts and scientific journals, and legal recognition and regulation in all US states and various other countries.

Today, more than 100 years after its birth, chiropractic is taught and practised throughout the world and the profession has earned broad acceptance from the public and in national health care systems for its services. It is widely regarded as the leading example of a complementary health care discipline reaching maturity and mainstream acceptance, and WHO has now published guidelines recommending minimal educational standards for the regulation of chiropractic services within national health care systems.

Practice

The relationship between structure, especially of the spine and musculoskeletal system and function, especially as coordinated by the nervous system, is central to the profession’s approach to treatment, health and well being. Philosophically there is an emphasis on the mind/body relationship in health and the natural healing powers of the body. This represents a biopsychosocial philosophy of health rather than a biomedical one.

Research demonstrates that the primary reasons patients consult chiropractors are back pain (approximately 60%), other musculoskeletal pain such as pain in the neck, shoulder, extremities and arthritic pain (20%) and headaches including migraine (10%). About 1 in 10 (10%) present with a wide variety of conditions caused, aggravated or mimicked by neuromusculoskeletal disorders (e.g. pseudo angina, dysmennorhea, respiratory and digestive dysfunctions).

Management includes manual techniques with particular competency in joint adjustment/manipulation, and rehabilitation exercises, patient education and lifestyle modification, and the use of physical therapy modalities and orthotics and other supports. The profession makes no use of prescription drugs or surgery, and patients requiring these interventions are referred for medical care.

Interdisciplinary practice is now common, with chiropractic doctors/chiropractors, medical doctors, physical therapists and others working as partners in private practices, occupational health, automobile accident and other rehabilitation centres and national sports medicine teams. While most chiropractic services are community based in private offices, hospital based services are today available in many countries.

Law

The practice of chiropractic is recognized and regulated by law in approximately 40 countries, and in many other countries where the profession is established practice is recognized and legal under general law. Common features of legislation and practice in all jurisdictions are:

The unqualified practice of chiropractic by persons without formal training, but claiming to be ‘chiropractors’, remains a significant problem in some countries without regulatory legislation (e.g. Brazil, Germany, Korea, Japan).

Education

Common international standards of education have been achieved through a network of accrediting agencies that began with the US Council on Chiropractic Education (CCE), recognized by the US Office of Education since 1974. These agencies are now represented by the Councils on Chiropractic Education International (CCEI).

Entrance requirements vary according to country, but in North America are a minimum of three years university credits in qualifying subjects. The chiropractic college professional program has a minimum of 4 full-time academic years, and results in a masters degree or equivalent in many countries. It is followed by postgraduate clinical training and/or licensing exams in many countries. Postgraduate specialties include chiropractic sciences, orthopedics, pediatrics, neurology, radiology, rehabilitation and sports chiropractic.

In former times most chiropractors graduated from North American colleges. There are now colleges in Australia, Brazil, Canada, Denmark, France, Japan, Korea, Mexico, New Zealand, South Africa, Spain and the UK as well as the United States. Depending upon the country chiropractic education is either within the university system (most countries) or in private colleges. Several other countries have plans to open colleges soon  (e.g. Argentina, China, Italy, Jordan, Norway and Thailand).

Research

There is substantial evidence supporting the safety and effectiveness of chiropractic treatment for patients with the conditions most frequently seen in chiropractic practice and highly prevalent in the population, namely:

Back Pain: Evidence-based practice guidelines from international and multidisciplinary expert panels endorse chiropractic management for both acute and chronic non-specific low-back pain by recommending spinal manipulation, over-the-counter pain medication, exercise and early return to activities as the most effective and cost-effective management for most patients. Rest beyond a few days, passive machine therapies, prescription drugs and steroid injections are not recommended on account of ineffectiveness and/or side effects. Management should be on a biopsychosocial model e.g. European Back Pain Guidelines - www.backpainEurope.org.

Neck Pain: Evidence-based practice guidelines from similar expert panels (e.g. Quebec Task Force on Whiplash, 1995, Bone and Joint Decade Neck Pain Task Force 2008) support similar management for non-specific neck pain, the second largest cause of musculoskeletal disability after back pain in developed countries.

Headache: Chiropractic, medical and dental research during the 1990s identified the structures in the cervical spine that cause much headache previously diagnosed as tension headache or migraine, and now identified as cervicogenic headache by the International Headache Society. Clinical trials have now reported that chiropractic management is effective for patients with cervicogenic headache.

Integration

Chiropractic services are now largely or fully integrated with medical and other mainstream health care services in a number of countries. At the University of Southern Denmark, chiropractic and medical students complete their first three years of study of basic sciences together before branching into their separate clinical training. In the US chiropractic services are now available in the military and veterans’ administration hospital and health care systems, and through Harvard University’s health care network. In the words of Wayne Jonas, MD, Founding Director, Office of Alternative Medicine, US National Institutes of Health:

(The Chiropractic Profession, NCMIC Group, 2000)