Chiropractic is from Greek words meaning
done by hand. It is grounded in the principle that
the body can heal itself when the skeletal system
is correctly aligned and the nervous system is functioning
properly. To achieve this, the practitioner uses his
or her hands or an adjusting tool to perform specific
manipulations of the vertebrae. When these bones of
the spine are not correctly articulated, resulting
in a condition known as subluxation, the theory is
that nerve transmission is disrupted and causes pain
and illness manifested in the back as well as other
areas of the 
body.
Chiropractic is one of the most popular
alternative therapies currently available. Some would
say it now qualifies as mainstream treatment as opposed
to complementary medicine. Chiropractic treatment
is covered by many insurance plans. It has become
well-accepted treatment for acute pain and problems
of the spine, including lower back pain and whiplash.
Applications beyond that scope are not supported by
current evidence, although there are ongoing studies
into the usefulness of chiropractic for such problems
as ear infections, dysmenorrhea, infant colic, migraine
headaches, and other conditions.
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Purpose
Most people will experience back pain
at some time in their lives. Injuries due to overexertion
and poor posture are among the most common. Depending
on the cause and severity of the condition, options
for treatment may include physical therapy, rest,
medications, surgery, or chiropractic care. Chiropractic
treatment carries none of the risks of surgical or
pharmacologic treatment. Practitioners use a holistic
approach to health, which is appreciated by most patients.
The goal is not merely to relieve the present ailment,
but to analyze the cause and recommend appropriate
changes of lifestyle to prevent the problem from recurring
again. They believe in a risk/benefit analysis before
use of any intervention. The odds of an adverse outcome
are extremely low. Chiropractic has proven in several
studies to be less expensive than many more traditional
routes such as outpatient physical therapy. Relief
from some neuromuscular problems is immediate, although
a series of treatments is likely to be required to
maintain the improvement. Spinal manipulation is an
excellent option for acute lower back pain, and may
also relieve neck pain as well as other musculoskeletal
pain. Although most back pain will subside eventually
with no treatment at all, chiropractic treatment can
significantly shorten the time it takes to get relief.
Some types of headache can also be successfully treated
by chiropractic.
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Description
Origins
Spinal manipulation has a long history
in many cultures but Daniel D. Palmer is the founder
of modern chiropractic theory, dating back to the
1890s. A grocer and magnetic healer, he applied his
knowledge of the nervous system and manual therapies
in an unusual situation. One renowned story concerns
Harvey Lillard, a janitor in the office where Palmer
worked. The man had 
been
deaf for 17 years, ever since he had sustained an
injury to his upper spine. Palmer performed an adjustment
on a painful vertebra in the region of the injury
and Lillard's hearing was reputedly restored. Palmer
theorized that all communication from the brain to
the rest of the body passes through the spinal canal,
and areas that are poorly aligned or under stress
can cause physical symptoms both in the spine and
in other areas of the body. Thus the body has the
innate intelligence to heal itself when unencumbered
by spinal irregularities causing nerve interference.
After his success with Lillard, other patients began
coming to him for care, and responded well to adjustments.
This resulted in Palmer's further study of the relationship
between an optimally functional spine and normal health.
Palmer founded the first chiropractic
college in 1897. His son, B. J. Palmer, continued
to develop chiropractic philosophy and practice after
his father's death.B. J. and other faculty members
were divided over the role of subluxation in disease.
B. J. saw it as the cause of all disease. The others
disagreed and sought a more rational way of thinking,
thus broadening the base of chiropractic education.
From 1910–1920, many other chiropractic colleges
were established. Other innovators, including John
Howard, Carl Cleveland, Earl Home-wood, Joseph Janse,
Herbert Lee, and Claude Watkins, also helped to advance
the profession.
The theories of the Palmers receive
somewhat broader interpretation today. Many chiropractors
believe that back pain can be relieved and health
restored through chiropractic treatment even in patients
who do not have demonstrable subluxations. Scientific
development and research of chiropractic is gaining
momentum. The twenty-first century will likely see
the metaphysical concepts such as innate intelligence
give way to more scientific proofs and reform.
Many people besides the Palmers have
contributed to the development of chiropractic theory
and technique. Some have gone on to create a variety
of procedures and related types of therapy that have
their roots in chiropractic, including McTimoney-Corley
chiropractic, craniosacral manipulation, naprapathy,
and applied kinesiology. Osteopathy is another related
holistic discipline that utilizes spinal and musculoskeletal
manipulation as a part of treatment, but osteopathic
training is more similar in scope to that of an M.D.
Initial visit
An initial chiropractic exam will
most often include a history and a physical. The patient
should be asked about what the current complaint is,
whether there are chronic health problems, family
history of disease, dietary habits, medical care received,
and any medications currently being taken. Further,
the current complaint should be described in terms
of how long it has been a problem, how it has progressed,
and whether it is the result of an injury or occurred
spontaneously. Details of how an injury occurred should
be given. The physical exam should evaluate by observation
and palpation whether the painful area has evidence
of inflammation or poor alignment. Range of motion
may also be assessed. In the spine, either hypomobility
(fixation) or hypermobility may be a problem. Laboratory
analysis is helpful in some cases to rule out serious
infection or other health issues that may require
referral for another type of treatment. Many practitioners
also insist on x rays during the initial evaluation
Manipulation
When spinal manipulation is employed,
it is generally done with the hands, although some
practitioners may use an adjusting tool. A classic
adjustment involves a high velocity, low amplitude
thrust that produces a usually painless popping noise,
and improves the range of motion of the joint that
was treated. The patient may lie on a specially designed,
padded table that helps the practitioner to achieve
the proper positions for treatment. Some adjustments
involve manipulating the entire 
spine,
or large portions of it, as a unit; others are small
movements designed to affect a single joint. Stretching,
traction, and slow manipulation are other techniques
that can be employed to restore structural integrity
and relieve nerve interference.
Length of treatment
The number of chiropractic treatments
required will vary depending on several factors. Generally
longer-term treatment is needed for conditions that
are chronic, severe, or occur in conjunction with
another health problem. Patients who are not in overall
good health may also have longer healing times. Some
injuries will inherently require more treatments than
others in order to get relief. Care is given in three
stages. Initially appointments are more frequent with
the goal of relieving immediate pain. Next, the patient
moves into a rehabilitative stage to continue the
healing process and help to prevent a relapse. Finally,
the patient may elect periodic maintenance, or wellness
treatments, along with lifestyle changes if needed
in order to stay in good health.
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Follow-up care
Discharge and follow-up therapy are
important. If an injury occurred as a result of poor
fitness or health, a program of exercise or nutrition
should be prescribed. Home therapy may also be recommended,
involving such things as anti-inflammatory medication
and applications of heat or ice packs. Conscious attention
to posture may help some patients avoid sustaining
a similar injury in the future, and the chiropractor
should be able to discern what poor postural habits
require correction. A sedentary lifestyle, particularly
with a lot of time spent sitting, is likely to contribute
to poor posture and may predispose a person to back
pain and injury.
Types of practitioners
Some practitioners use spinal manipulation
to the exclusion of all other modalities, and are
known as straight chiropractors. Others integrate
various types of therapy such as massage, nutritional
intervention, or treatment with vitamins, herbs, or
homeopathic remedies. They also embrace ideas from
other health care traditions. This group is known
as mixers. The vast majority of chiropractors, perhaps
85%, fall in this latter category.
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Preparations
Patients should enter the chiropractic
clinic with an open mind. This will help to achieve
maximum results.
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Precautions
Chiropractic is not an appropriate
therapy for diseases that are severely degenerative
and may require medication or surgery. Many conditions
of the spine are amenable to manipulative treatment,
but that does not include fractures. The practitioner
should be informed in advance if the patient is on
anticoagulants, or has osteoporosis or any other condition
that may weaken the bones. There are other circumstances
that would contraindicate chiropractic care, and these
should be detected in the history or physical 
exam.
In addition to fractures, Down syndrome, some congenital
defects, and some types of cancer are a few of the
things that may preclude spinal manipulation. On rare
occasions, a fracture or dislocation may occur. There
is also a very slim possibility of experiencing a
stroke as a result of spinal manipulation, but estimates
are that it is no more frequent than 2.5 occurrences
per one million treatments.
Be wary of chiropractors who insist
on costly x rays and repeated visits with no end in
sight. Extensive use is not scientifically justifiable,
especially in most cases of lower back pain. There
are some circumstances when x rays are indicated,
including acute or possibly severe injuries such as
those that might result from a car accident.
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Side effects
It is not uncommon to have local discomfort
in the form of aches, pains, or spasms for a few days
following a chiropractic treatment. Some patients
may also experience mild headache or fatigue that
resolves quickly.
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Research and general acceptance
As recently as the 1970s, the American
Medical Association (a national group of medical doctors)
was quite hostile to chiropractic, which it deemed
a cult. AMA members were advised that it was unethical
to be associated with chiropractors. Fortunately that
has changed, and as of 2000, many allopathic or traditionally
trained physicians enjoy cordial referral relationships
with chiropractors. The public is certainly strongly
in favor of chiropractic treatment. An estimated 15%
of people in the United States used chiropractic care
in 1997. Chiropractors see the lion's share of all
patients who seek medical help for back problems.
Research has also supported the use
of spinal manipulation for acute low back pain. There
is some anecdotal evidence recommending chiropractic
treatment for ailments unrelated to musculoskeletal
problems, but there is not enough research-based data
to support this. On the other hand, a chiropractor
may be able to treat problems and diseases unrelated
to the skeletal structure by employing therapies other
than spinal manipulation.
Although many chiropractors limit
their practice to spine and joint problems, others
claim to treat disorders that are not closely related
to the back or musculoskeletal system. These include
asthma, bed-wetting, bronchitis, coughs, dizziness,
dysmenorrhea, earache, fainting, headache, hyperactivity,
indigestion, infertility, migraine, pneumonia, and
issues related to pregnancy. 
There
are at least three explanations for possible efficacy
for these conditions. One is that the problem could
be linked to a nerve impingement, as may be possible
with bed-wetting, dizziness, fainting, and headache.
In a second group, chiropractic treatment may offer
some relief from complicating pain and spasms caused
by the disease process, as with asthma, bronchitis,
coughs, and pneumonia. The discomforts of pregnancy
may also be relieved with gentle chiropractic therapy.
A third possibility is that manipulation or use of
soft-tissue techniques may directly promote improvement
of some conditions. One particular procedure, known
as the endonasal technique, is thought to help the
eustachian tube to open and thus improve drainage
of the middle ear. The tube is sometimes blocked off
due to exudates or inflammatory processes. This can
offer significant relief from earaches. Some headaches
also fall in this category, as skilled use of soft
tissue techniques and adjustment may relieve the muscle
tension that may initiate some headaches.
Dysmenorrhea, hyperactivity, indigestion,
and infertility are said to be relieved as a result
of improved flow of blood and nerve energy following
treatment. Evidence for this is anecdotal at best,
but manipulation is unlikely to be harmful if causes
treatable by other modalities have been ruled out.
For conditions such as cancer, fractures,
infectious diseases, neurologic disease processes,
and anything that may cause increased orthopedic fragility,
chiropractic treatment alone is not an effective therapy,
and may even be harmful in some cases. Those who have
known circulatory problems, especially with a history
of thrombosis, should not have spinal manipulation.
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