Chiropractic in 2003:
Chiropractic medicine is becoming an integrated part of mainstream healthcare. There are approximately 190 million visits to chiropractic physicians each year.1 Orthopedists, neurologists and primary care physicians are becoming increasingly aware of the many benefits of chiropractic care for their patients. One recent survey of family physicians found that two thirds of medical physicians felt "moderately" or "very" informed about chiropractic medicine. Furthermore, 65% admitted referring patients to chiropractors and 98% of chiropractors made routine referrals to medical physicians.2 More and more chiropractors are joining the staffs at area hospitals. They are communicating with medical doctors via patient reports and phone calls, incorporating outcome assessment and designing treatment plans with a clear beginning, middle and end. The chiropractic Center at Winchester Hospital is one of many hospitals now leading this front.
Studies confirm that most patients go to the chiropractor for musculoskeletal problems: about 60% with LBP and the remainder with head, neck and extremity symptoms.2 The Manga Report, a report to the Ontario Ministry of Health in 1998 concluded that "...for the management of low back pain, chiropractic care is the most effective treatment, and should be fully integrated into the healthcare system." For those individuals with headaches, cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.3 Duke University just released a ground breaking study demonstrating chiropractic's effectiveness for headaches.
Seniors have long touted the many benefits of chiropractic care. One study showed that "[Elderly] chiropractic users were less likely to have been hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. In addition, they were less likely to use prescription drugs." 4
The British Medical Journal stated that spinal manipulation provider greater improvement of symptoms in those suffering from persistent neck and back complaints compared with physical therapy. The patients receiving spinal manipulation also had greater improvements of physical functioning in fewer visits.6
A prominent orthopedic surgeon and researcher Kirkaldy-Willis claims that ninety percent (90%) of patients with low back pain have "dysfunction," indicating that changes exhibited are mainly those of abnormal function with slight anatomic changes to the three joint complex, the intervertebral disc and zygapophyseal joints. Of the remaining ten percent (10%) he claims that fifty percent (50%) of those have lateral nerve root entrapment. With dynamic recurrent lateral entrapment there is a laxity of the posterior joints and of the annulus causing abnormal movement of the vertebrae resulting in a narrowing of the lateral nerve canal and tapping on the main spinal nerve as this passes along the canal. Dr. Kirkaldy-Willis indicates that manipulation is an effective method of treatment for both patients with dysfunction and lateral nerve root entrapment.5
Chiropractors use a variety of diagnostic procedures to characterize the patient's condition and identify an appropriate management plan. Most of these are identical to those used by medical physicians. Chiropractors are trained in customary physical and laboratory diagnostic procedures, including history-taking; physical examination including blood pressure, orthopedic, neurological examination; x-ray examination and laboratory testing and evaluation (Coulter et. al., 1997; Mootz & Shakelle, 1997). What differentiates the chiropractic physician from their medical counterparts may be the use of other procedures to assess the patient's musculoskeletal system, including a biomechanical examination to assess joint function and mobility, postural assessment and palpation to locate joint dysfunction, muscle tension and trigger points.5
1. Eisenberg DM, Davis RB, Ettner SL, Appel S., Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-upnational survey. JAMA. 1998; 280:1569-75. [PMID: 9820257].
2. Meeker W and Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine, Annals of Internal Medicine. 2002; 136:216-227.
3. McCrory DC, Penzlan DB, Hasselbald V, Gray RN. Evidence Report: Behavioral and Physical Treatments for Tension Type and Cervicogenic Headache. Des Moines, IA: Foundation for Chiropractic Education and Research, 2001.
4. Coulter I, Hurwitz E, Aronow H. Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and health promotion. Topics in Clinical Chiropractic 1996; 3 (2): 46-55.
5. Coulter, I.D., Adams, A.H., & Sandefur R. (1997). Chiropractic training. In D.C. Cherkin and R.D. Mootz (Eds.), Chiropractic in the United States: Training practice, and research (pp. 17-27). Washing, D.C.: Agency for Healthcare Policy and Research.
6. Randomized Clinical Trial of Manipulative Therapy and Physiotherapy for persistent Back and Neck Complaints: Results of One Year Follow-Up. Koes, B.W. et al. British Medical Journal 1992; 304: 601-605.