VICUS.COM (8 April 2000) -- As the largest of the
alternative/complementary health professions in North America, and the
third largest health-care profession in the United States,
used by more than 50 million Americans each year (Horstman, 1998).
Patients visit their chiropractor primarily for relief from back and
neck pain following an injury or accident.
Is chiropractic the correct alternative medicine for what ails you?
Here are answers to frequently asked questions about this profession,
whose roots are in antiquity, but whose principles in today's practice
are only about 100 years old.
Question: What conditions are most responsive to chiropractic
Answer: Chiropractic is considered to have efficacy in the
treatment of the following conditions (Bratman, 1999):
- Back pain (acute)
- Back pain (chronic)
- Esophageal reflux
- Headache due to tension
- Headache related to muscular tension
- Neck pain (acute)
- Neck pain (chronic)
- Pinched nerves (sciatica, disc disease, etc.)
- Shoulder pain
- Tailbone pain
Q: For which conditions is chiropractic most effective?
A: In clinical practice, chiropractic is a reasonable treatment
choice for acute neck and back pain, according to Steven Bratman,
M.D., in The Alternative Medicine Rating Guide. The
strongest scientific support for chiropractic is in the treatment of
acute back pain, chronic neck pain and tension headaches.
Q: How does chiropractic work to treat these conditions?
A: The Arthritis Foundation's alternative therapies data cites that
historically, chiropractic manipulation therapy was thought to work by
correcting misalignment (subluxation)
of vertebrae in the spine. The "pinched nerve" theory behind
chiropractic is that the nervous system, which runs through the spinal
column, can have far-reaching effects if it is blocked or injured.
Although controversy still swirls about its definition, even among
chiropractors, subluxation is thought to cause pain and weaken the
body's defenses. By adjusting the spinal joints to address subluxation,
chiropractors believe normal nerve function and health may be able to
be restored (Horstman, 1999).
Q: Is this theory supported by scientific evidence?
A: Support for the effectiveness of chiropractic manipulation is
based more on clinical response than laboratory experiments. For
example, in 1973, Yale anatomy professor Edmund Crelin subjected the
spines of six human cadavers to a series of mechanical forces and
measured the effects of these forces on the sizes and shapes of the
intervertebral foramina. These are the openings through which spinal
nerves pass and where, according to chiropractic theory, vertebral
subluxation induces pinching of nerves. Crelin found that no force
short of that which broke the spine deformed the openings so their
walls contacted the nerves (Nelson, 1999).
Despite this, the results of clinical studies suggest that
chiropractic manipulation is at least as effective for the treatment
of low back pain as most standard therapies. Furthermore, several
regulatory agencies in the U.S., Canada and England recommend
chiropractic manipulation for neck and back pain.
Q: How does chiropractic differ from osteopathic medicine?
A: Doctors of osteopathy (DOs) were actually the first to make use of manipulation to treat
disease. Today, the practice of osteopathic medicine is very similar
to that of medical doctors (MDs). However, the techniques started by
osteopaths have been adopted by physical and massage therapists, as
well as chiropractors. For those
osteopaths who continue to make use of manipulation, their focus is on
soft tissues and joints outside the spine, while chiropractors focus
most of their efforts on the spine. In addition, the manipulation
technique is different. Osteopaths concentrate on gentle, large
movements (low velocity, high amplitude technique), while
chiropractors make use of rapid short movements (high velocity, low
amplitude technique; Bratman, 1999).
Q: What kind of training do chiropractors receive?
A: Chiropractors are trained in four-year chiropractic colleges,
and are licensed in all 50 states, as well as the District of Columbia
and Puerto Rico. Licensed chiropractors have the letters
"DC" after their name, which stand for doctor of
Q: How does chiropractic training compare to medical
A: There are many similarities between chiropractic and medical
education. In the basic and clinical sciences, there are more
similarities than differences in terms of studies offered and time
allotted to each subject. Chiropractic and allopathic
medicine differ most in diagnostic evaluation and clinical
practice, which in medical schools far exceeds that provided by
chiropractic schools. The therapies that chiropractic and medical
students learn are also distinct from each other, and the settings in
which students receive clinical training are different and isolated
from each other (Coulter et al., 1998).
Q: How can I find a good chiropractor?
A: You can start by consulting a known source for reliable health
information, including allopaths (doctors, nurses), other health-care
practitioners and reputable online professional directories. Other
sources of information about chiropractic and referrals to
chiropractic physicians can be obtained by contacting the
organizations listed in the table in the related article below.
Russo, Jr., PharmD, is senior vice president of medical
communications at Vicus.com. He is a pharmacist and medical writer
with more than 20 years of experience in medical education.
Bratman S. The
Alternative Medicine Ratings Guide: An Expert Panel Ranks the Best
Treatments for Over 80 Conditions. Rocklin (CA): Prima
Coulter ID, Adams AH, Coggan P, Wilkes M, Gonyea M. A Comparative
Study of Chiropractic and Medical Education. Alternative
Therapies in Health and Medicine 1998; 4(5):64-75.
Horstman J. The
Arthritis Foundation's Guide to Alternative Therapies. Atlanta
(GA): Arthritis Foundation; 1999.
Nelson CF. Spinal manipulation and chiropractic: Views of a
reformist chiropractor. Priorities 1999;
The Burton Goldberg Group. Alternative
Medicine: The Definitive Guide. Fife (WA): Future Medicine