What is chiropractic medicine?

Science and Profession

The major premise of the field of chiropractic states that vertebrae of the spine
can, and frequently do, become misaligned, causing pain and interference in the
normal conduction of nerve impulses from the brain to the organs and tissues of
the body. Although most spinal misalignments are corrected naturally through
normal body movement, some become fixated. As a result, normal nerve transmission
is impaired for long periods of time, and the health of the patient suffers as a
result. Chiropractors perform adjustments aimed at correcting alignment problems
in order to ease pain and improve bodily function.

What distinguishes doctors of chiropractic from other health care professionals is
that they work primarily to identify, analyze, and adjust the vertebrae and
pelvis to their correct positions. Treatment is directed at restoring and
maintaining normal structure and mechanical function of the spine in order to
reduce irritation of the spinal cord and spinal nerves. These irritations lead to
pain and distress of the muscles and joints of the body. Less acknowledged
and still in want of corroborating research is the relationship between the
subluxation (partial dislocation), the neuromusculoskeletal system, and internal
organ dysfunction.

Doctors of chiropractic may examine, diagnose, analyze, and use x-rays for
diagnostic purposes according to generally recognized procedures taught in
accredited chiropractic colleges. Clinical practice generally encompasses
consultation and taking the medical history of the patient; physical,
neurological, orthopedic, and chiropractic examinations; x-ray analysis of the
spine and articulating structures; the administration of adjustments;
physiotherapy; nutritional support; and the use of orthopedic supports. In most
countries, chiropractic practice does not include the prescription or
administration of medicine or drugs, performance of surgery, treatment of
infectious diseases, performance of internal exams, reduction of fractures, or
administration of anesthetics. Historically, chiropractic physicians practiced
either solo or in a group setting with other chiropractors and did not have
hospital privileges. This is changing as some chiropractic physicians are entering
into group practice settings with other health care specialists and gaining
admittance to hospitals in a limited capacity.

Chiropractic history dates back to ancient medical writings dating from 2700 BCE.
Chiropractic was popularized in the United States in 1895, when D. D. Palmer
experimented with a spinal adjustment on Harvey Lillard; Lillard, a janitor, had
experienced a “popping sensation” in his upper spine caused by heavy lifting and
subsequently suffered a loss of hearing. After treatment, Lillard’s hearing
improved and Palmer formulated the early chiropractic scientific premise and
philosophy: that illness is essentially functional in nature and becomes organic
only as an end process. His son, B. J. Palmer, is credited with refining
and promoting the work of his father. The early educational program organized by
D. D. Palmer was admittedly crude, abbreviated, and inadequate. As the profession
grew and matured, however, so did the educational standards, to the current level.
Chiropractic has emerged as a viable alternative health care system.

In the United States, chiropractic colleges are accredited by the Council on
Chiropractic Education, which is in turn approved by the US Office of Education.
The chiropractic curriculum is designed to prepare the chiropractic student to
evaluate and manage conditions from a holistic point of view, in which the various
factors that affect a person’s health are taken into consideration, including
diet, nutritional supplementation, exercise, stress, and lifestyle.

Chiropractors have a full medical curriculum enabling them
to make diagnoses. The education of a chiropractor begins with two years of
preprofessional college study, with concentration in the human sciences. Although
this prerequisite of two years is all that is required, the majority of students
entering chiropractic college possess at least a bachelor’s degree. The student
then begins the doctor of chiropractic (DC) course of study at an accredited
chiropractic college. The DC program is composed of four academic years of study.
The initial phase of study is much like any curriculum in the medical, dental, or
veterinary schools, consisting of courses in the basic sciences: organic
chemistry, biochemistry, anatomy of the musculoskeletal system (including limbs,
trunk, and head), anatomy of the internal structures of the body (including all
the organs, blood vessels, and internal systems), neuroanatomy (the anatomy of the
brain, spinal cord, and entire nervous system), physiology (the study of how these
systems function), neurophysiology, pathology (the study of disease),
bacteriology, histology (the microscopic study of body tissues), and microbiology.
The remainder of the courses are concentrated on the clinical sciences: x-ray
physics, positioning, and interpretation; laboratory diagnosis (blood and urine
studies); physical examination and diagnosis; neurology; orthopedics; cardiology;
pediatrics; geriatrics; dermatology; gastrointestinal and genitourinary systems;
physical
therapy; nutrition; and chiropractic adjustment
techniques.

During the later part of the student chiropractor’s education, he or she will see
patients in a college-affiliated clinic as an “extern,” which prepares the future
doctor for patient care and management. In addition to the basic chiropractic
curriculum, there are residencies available in both radiology and orthopedics. A
chiropractic graduate may apply to study an additional three years in order to
become either a chiropractic radiologist or a chiropractic orthopedist. The
training received in these programs is highly specialized, and both of these
chiropractic specialists are the equal of their medical counterparts in terms of
diagnostic abilities. In addition, comprehensive 360-hour programs of study in
orthopedics, neurology, radiology, and sports medicine exist; doctors
completing such programs are eligible to sit for an examination to be awarded
diplomate status by chiropractic boards in the corresponding specialties.
Postgraduate education for the practicing chiropractor includes seminars and
workshops in soft tissue injuries, disk syndromes, lower back pain,
and other common and difficult conditions. Interdisciplinary seminars and
conferences in nutrition, fitness, biochemical imbalances, and numerous other
areas of common interest allow physicians from every discipline the opportunity to
exchange views and perspectives. The licensing procedure for the graduate
chiropractic doctor varies from state to state and country to country.

Diagnostic and Treatment Techniques

To understand fully how chiropractic health care works, it is necessary to
understand the spine and the role that it plays in overall body function. The
nervous system—consisting of the brain, cranial nerves (nerves that originate in
the head), the spinal cord, and thirty-one pairs of spinal nerves that branch out
much as the limbs of a tree do—generates and regulates all activities in the body.
Signals, or impulses, travel along the nerve fibers conveying information between
the brain and the rest of the body. Since every tissue and organ of the body is
connected to and controlled by nerves from the spinal cord and brain, removal of
nerve interference can bring dramatic results. Interference with the transmission
of these impulses results in alteration of normal body function. The cranium
(skull) and spinal column, composed of twenty-four bones called vertebrae, house
the brain and spinal cord. In addition to protecting the spinal cord, the spine is
the core of the skeletal framework that supports upright posture, provides for
organ and muscle attachment, and allows for the dynamics of human movement. Given
this monumental job, the spine and its connecting framework are subject to much
activity and abuse.

For the mechanics of body motion to occur properly, there must be full, free, and
harmonious movement in every one of the spinal joints. The working unit of the
spine is referred to as the motor unit. The motor unit is composed of two
vertebrae joined by cartilage cushions called disks and four posterior joints
called facet joints, two located to attach the superior vertebra and two to attach
the inferior vertebra. The disks separate the vertebrae while allowing flexibility
and shock absorption for the spine. They also maintain openings between the
vertebrae that are necessary for the passage of the spinal nerves. The facet
joints provide additional movement and are limited in their range of motion by
ligaments. Restriction in any of them can be compensated for only by the other
joints and adjoining structures (such as ribs, muscles, or tendons), thus
producing strain in the compensating structures.

It is at the location of the facet joints of the spine where subluxation occurs—an
alteration of the alignment and proper movement of the spinal joint resulting in
irritation of the exiting spinal nerve via compression, stretch, or chronic
(constant) irritation—and leads to alteration of normal body functions.
Subluxations can result from various factors, including trauma, toxic irritation,
muscular imbalance caused by disuse or repetitive tasks, ligamental weakening,
organic dysfunction, and stress. The altered nerve impulse transmission, left
uncorrected, results in accumulative dysfunction in the tissue cells of the
body.

Spinal biomechanics, the basis of the chiropractor’s evaluation, refers to the
manner in which the spine works in movement. Restoration of spinal motion is the
primary treatment on which chiropractors depend to alleviate patients’ symptoms.
The single most distinguishing element of chiropractic procedures is the spinal
adjustment. This chiropractic adjustment is a technique of physically moving the
spine by hand or by instrument with the objective of mobilizing a fixated joint.
It is a gentle but dynamic thrust applied to a specific joint in a way that
generates joint movement in a specific direction. Basically, it is a way to “coax”
a restricted joint into moving. Applied repeatedly over a period of time, spinal
adjustments are capable of restoring mobility to even the most chronic spinal
subluxations. Deep-rooted subluxations that have existed for several years
typically require months of care. Fixations of lesser duration and severity
respond in less time, often the mildest in one treatment. The procedure works
because the restoration of the proper mechanics of spinal motion via the spinal
adjustment improves joint function, corrects specific joint problems, and helps
prevent injury through increased spinal strength brought about by spinal joints
that function properly.

Chiropractic health care can be useful for the detection and correction of
existing health problems and for preventive purposes. Chiropractors look for the
reason that a patient’s symptom developed, including such contributing factors as
environmental conditions, lifestyle, systemic stress, and malfunction.

Perspective and Prospects

Chiropractic history dates back to 2700 BCE. Modern chiropractic originated in the
second half of the nineteenth century during a time when many theories of healing
were being promulgated. Chiropractic and osteopathy
shared their early beginnings amid the emergence of several alternatives to the
regular school of healing (medicine), including the Thomsonian system (the use of
botanicals), the Hygienic movement (the use of fresh fruits and vegetables, fresh
air, exercise, and better food preparation), and homeopathy. Daniel David Palmer,
born in 1845 in Canada, was involved in making and losing several small mercantile
fortunes when he made his way to Iowa in 1886 to become a magnetic healer. Over
the next decade, he attracted patients from throughout the Midwest until one day
in September 1895, a janitor named Harvey Lillard came into his office, received
an “adjustment,” and regained his lost hearing. Soon afterward, the term
“chiropractic” (Greek meaning “done by hand”) was coined by Samuel Weed, a Palmer
patient. D. D. Palmer began giving instruction at Dr. Palmer’s School and Cure,
later becoming Palmer Institute and Chiropractic Infirmary and finally Palmer
Chiropractic College.

Brian Inglis, a distinguished British historian, commentator, and author of the
two-volume work The History of Medicine (1965), wrote: “The rise
of chiropractic . . . has been one of the most remarkable social phenomena in
American history . . . yet it has gone virtually unexplored.” In spite of its
humble origins and formulative years, chiropractic has had a decided impact on the
evolution of health care attitudes. For more than a century, it fought for its
very survival, overcoming a strong medical lobby in 1977 when the American Medical
Association (AMA) reversed its long-standing policy against
professional interrelationships between medical doctors and chiropractors. In
March 1977, the AMA’s Judicial Council announced:
A physician may refer a patient for diagnostic or therapeutic services to
another physician, a limited practitioner, or any other provider of health
care services permitted by law to furnish such services, whenever he
believes that this may benefit the patient. As in the case of referrals to
physician-specialists, referrals to limited practitioners should be based on
their individual competence and ability to perform the services needed by
the patient.

Despite the AMA’s policy change toward chiropractic, however, complete acceptance by the medical profession has not occurred. This reluctance has not been attributable solely to the attitudes of the medical profession. Rather, it is the result of a combination of the continued opposition of the medical profession and the resistance of chiropractors to subordinate themselves to medical prescription, as with physical therapists who practice under medical supervision. Chiropractors have been independent practitioners for too long, functioning at a high level in the diagnosis and treatment of illness, for them to be willing to regress in status.

It is likely that the chiropractic profession will continue on its present course
of becoming a health profession with parallels to general medicine. Emphasizing
the uniqueness of chiropractic treatment and the contrasting philosophical
approaches of health maintenance and therapy, chiropractic has not only survived
but also flourished. Whether used as a preventive means to ensure good health or
as a way to help the body cure itself of disease, chiropractic has sometimes
succeeded where other health care measures have failed.

Bibliography

Bergmann, Thomas F.,
and David H. Peterson. Chiropractic Technique: Principles and
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Coulter, Ian Douglass.
Chiropractic: A Philosophy for Alternative Health Care.
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Haldeman, Scott, ed.
Principles and Practice of Chiropractic. 3d ed. New
York: McGraw-Hill, 2005. Print.

Lenarz, Michael, and
Victoria St. George. The Chiropractic Way. New York:
Bantam, 2003. Print.

Tousley, Dirk, and
David M. Lees. The Chiropractic Handbook for Patients. 3rd
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