Chiropractic is a form of alternative medicine mostly concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Some proponents, especially those in the field's early history, have claimed that such disorders affect general health via the nervous system, through vertebral subluxation, claims which are demonstrably false. The main chiropractic treatment technique involves manual therapy, especially spinal manipulation therapy (SMT), manipulations of other joints and soft tissues. Its foundation is at odds with mainstream medicine, and chiropractic is sustained by pseudoscientific ideas such as subluxation and "innate intelligence" that reject science. Chiropractors are not medical doctors.
Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results. Systematic reviews of this research have not found evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain. A critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition. Spinal manipulation may be cost-effective for sub-acute or chronic low back pain but the results for acute low back pain were insufficient. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. There is not sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation. Several deaths have been associated with this technique and it has been suggested that the relationship is causative, a claim which is disputed by many chiropractors.
Chiropractic is well established in the United States, Canada, and Australia. It overlaps with other manual-therapy professions such as osteopathy and physical therapy. Most who seek chiropractic care do so for low back pain. Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues. Many chiropractors describe themselves as primary care providers, but the chiropractic clinical training does not support the requirements to be considered primary care providers, so their role on primary care is limited and disputed. Chiropractic has two main groups: "straights", now the minority, emphasize vitalism, "innate intelligence", and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.
D. D. Palmer founded chiropractic in the 1890s, after saying he received it from "the other world", and his son B. J. Palmer helped to expand it in the early 20th century. Throughout its history, chiropractic has been controversial. Despite the overwhelming evidence that vaccination is an effective public health intervention, among chiropractors there are significant disagreements over the subject, which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic. The American Medical Association called chiropractic an "unscientific cult" in 1966 and boycotted it until losing an antitrust case in 1987. Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.
Daniel David Palmer, inventor of chiropractic
|Claims||Vertebral subluxation, spinal adjustment, innate intelligence|
|Risks||Vertebral artery dissection (stroke), compression fracture, death|
|Related fields||Osteopathy, vitalism|
|Year proposed||1895 in Davenport, Iowa, U.S.|
|Original proponents||D. D. Palmer|
|Subsequent proponents||B. J. Palmer|
Chiropractic is generally categorized as complementary and alternative medicine (CAM), which focuses on manipulation of the musculoskeletal system, especially the spine. Its founder, D.D. Palmer, called it "a science of healing without drugs".
Chiropractic's origins lie in the folk medicine of bonesetting, and as it evolved it incorporated vitalism, spiritual inspiration and rationalism. Its early philosophy was based on deduction from irrefutable doctrine, which helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic first principles rather than on the materialism of science. However, most practitioners tend to incorporate scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness. A 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.
|The testable principle||The untestable metaphor|
Restoration of structural integrity
Improvement of health status
|Taken from Mootz & Phillips 1997|
Although a wide diversity of ideas exist among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Some chiropractors claim spinal manipulation can have an effect of a variety of ailments such as irritable bowel syndrome and asthma.
Chiropractic philosophy includes the following perspectives:
Holism assumes that health is affected by everything in an individual's environment; some sources also include a spiritual or existential dimension. In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation. Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis.
A large number of chiropractors fear that if they do not separate themselves from the traditional vitalistic concept of innate intelligence, chiropractic will continue to be seen as a fringe profession. A variant of chiropractic called naprapathy originated in Chicago in the early twentieth century. It holds that manual manipulation of soft tissue can reduce "interference" in the body and thus improve health.
|Perspective attribute||Potential belief endpoints|
|Scope of practice:||narrow ("straight") ←||→ broad ("mixer")|
|Diagnostic approach:||intuitive ←||→ analytical|
|Philosophic orientation:||vitalistic ←||→ materialistic|
|Scientific orientation:||descriptive ←||→ experimental|
|Process orientation:||implicit ←||→ explicit|
|Practice attitude:||doctor/model-centered ←||→ patient/situation-centered|
|Professional integration:||separate and distinct ←||→ integrated into mainstream|
|Taken from Mootz & Phillips 1997|
Straight chiropractors adhere to the philosophical principles set forth by D.D. and B.J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an "innate intelligence" exerted via the human nervous system and is a primary underlying risk factor for many diseases. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for chiropractic treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies into their practice style. Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology (e.g., perform spinal analysis, detect subluxation, correct with adjustment). They prefer to remain separate and distinct from mainstream health care. Although considered the minority group, "they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers."
Mixer chiropractors "mix" diagnostic and treatment approaches from chiropractic, medical and/or osteopathic viewpoints and make up the majority of chiropractors. Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine. Many of them incorporate mainstream medical diagnostics and employ conventional treatments including techniques of physical therapy such as exercise, stretching, massage, ice packs, electrical muscle stimulation, therapeutic ultrasound, and moist heat. Some mixers also use techniques from alternative medicine, including nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.
Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1100 North American chiropractors, which found that 88% wanted to retain the term "vertebral subluxation complex", and that when asked to estimate the percent of disorders of internal organs (such as the heart, the lungs, or the stomach) that subluxation significantly contributes to, the mean response was 62%. A 2008 survey of 6,000 American chiropractors demonstrated that most chiropractors seem to believe that a subluxation-based clinical approach may be of limited utility for addressing visceral disorders, and greatly favored non-subluxation-based clinical approaches for such conditions. The same survey showed that most chiropractors generally believed that the majority of their clinical approach for addressing musculoskeletal/biomechanical disorders such as back pain was based on subluxation. Chiropractors often offer conventional therapies such as physical therapy and lifestyle counseling, and it may for the lay person be difficult to distinguish the unscientific from the scientific.
Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn ability to heal itself. D. D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. D. D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic. This concept was later expanded upon by his son, B. J. Palmer, and was instrumental in providing the legal basis of differentiating chiropractic from conventional medicine. In 1910, D. D. Palmer theorized that the nervous system controlled health:
Vertebral subluxation, a core concept of traditional chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades. In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community. This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions.
In 2005, the chiropractic subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity." This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays. This exposes patients to harmful ionizing radiation for no evidentially supported reason. The 2008 book Trick or Treatment states "X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist." Attorney David Chapman-Smith, Secretary-General of the World Federation of Chiropractic, has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on X-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static X-ray than a limp or headache or any other functional problem." The General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, states that the chiropractic vertebral subluxation complex "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease."
As of 2014, the National Board of Chiropractic Examiners states "The specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction. A subluxation is a health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness."
Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery, with special emphasis on the spine. Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues. There is a range of opinions among chiropractors: some believed that treatment should be confined to the spine, or back and neck pain; others disagreed. For example, while one 2009 survey of American chiropractors had found that 73% classified themselves as "back pain/musculoskeletal specialists", the label "back and neck pain specialists" was regarded by 47% of them as a least desirable description in a 2005 international survey. Chiropractic combines aspects from mainstream and alternative medicine, and there is no agreement about how to define the profession: although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry. It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems, but the more expansive view of chiropractic is still widespread.
Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM); and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine. Many chiropractors believe they are primary care providers, including US and UK chiropractors, but the length, breadth, and depth of chiropractic clinical training do not support the requirements to be considered primary care providers, so their role on primary care is limited and disputed.
Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine. Chiropractic is autonomous from and competitive with mainstream medicine, and osteopathy outside the US remains primarily a manual medical system; physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. Practitioners may distinguish these competing approaches through claims that, compared to other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.
Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation. A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle advice.
Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States, (although New Mexico has become the first US state to allow "advanced practice" trained chiropractors to prescribe certain medications.). In the US, their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa, broadly allow treatment of "human ailments"; some, such as Delaware, use vague concepts such as "transition of nerve energy" to define scope of practice; others, such as New Jersey, specify a severely narrowed scope. US states also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements, or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs. A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.
A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in 40 US states, but is not recognized by the American Chiropractic Association as being chiropractic. It remains controversial within certain segments of the veterinary, and chiropractic profession.
No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM, some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.
Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care. Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint. Its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion. High-velocity, low-amplitude spinal manipulation (HVLA-SM) thrusts have physiological effects that signal neural discharge from paraspinal muscle tissues, depending on duration and amplitude of the thrust are factors of the degree in paraspinal muscle spindles activation. Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.
There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools. The following adjustive procedures were received by more than 10% of patients of licensed U.S. chiropractors in a 2003 survey: Diversified technique (full-spine manipulation, employing various techniques), extremity adjusting, Activator technique (which uses a spring-loaded tool to deliver precise adjustments to the spine), Thompson Technique (which relies on a drop table and detailed procedural protocols), Gonstead (which emphasizes evaluating the spine along with specific adjustment that avoids rotational vectors), Cox/flexion-distraction (a gentle, low-force adjusting procedure which mixes chiropractic with osteopathic principles and utilizes specialized adjusting tables with movable parts), adjustive instrument, Sacro-Occipital Technique (which models the spine as a torsion bar), Nimmo Receptor-Tonus Technique, applied kinesiology (which emphasises "muscle testing" as a diagnostic tool), and cranial. Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation. Koren Specific Technique (KST) may use their hands, or they may use an electric device known as an "ArthroStim" for assessment and spinal manipulations. Insurers in the US and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be "experimental and investigational". Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain.
Many other procedures are used by chiropractors for treating the spine, other joints and tissues, and general health issues. The following procedures were received by more than one-third of patients of licensed U.S. chiropractors in a 2003 survey: Diversified technique (full-spine manipulation; mentioned in previous paragraph), physical fitness/exercise promotion, corrective or therapeutic exercise, ergonomic/postural advice, self-care strategies, activities of daily living, changing risky/unhealthy behaviors, nutritional/dietary recommendations, relaxation/stress reduction recommendations, ice pack/cryotherapy, extremity adjusting (also mentioned in previous paragraph), trigger point therapy, and disease prevention/early screening advice.
A 2010 study describing Belgium chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine. The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%. A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a U.S. chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.
Reviews of research studies within the chiropractic community have been used to generate practice guidelines outlining standards that specify which chiropractic treatments are "legitimate" (i.e. supported by evidence) and conceivably reimbursable under managed care health payment systems. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims. Chiropractic remains at a crossroads, and that in order to progress it would need to embrace science; the promotion by some for it to be a cure-all was both "misguided and irrational". A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.
There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain. Generally, the research carried out into the effectiveness of chiropractic has been of poor quality. Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results. Research published by chiropractors is distinctly biased. For reviews of SM for back pain chiropractic authors tend to have positive conclusions, while others did not show any effectiveness.
There is a wide range of ways to measure treatment outcomes. Chiropractic care, like all medical treatment, benefits from the placebo response. It is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. The efficacy of maintenance care in chiropractic is unknown.
Available evidence covers the following conditions:
The World Health Organization found chiropractic care in general is safe when employed skillfully and appropriately. There is not sufficient data to establish the safety of chiropractic manipulations. Manipulation is regarded as relatively safe but complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis. Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced. Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a chiropractor.
Spinal manipulation is associated with frequent, mild and temporary adverse effects, including new or worsening pain or stiffness in the affected region. They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours; adverse reactions appear to be more common following manipulation than mobilization. The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue. Chiropractic is correlated with a very high incidence of minor adverse effects. Chiropractic are more commonly associated with serious related adverse effects than other professionals following manipulation. Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. There is a case of a three-month-old dying following manipulation of the neck area. Estimates vary widely for the incidence of these complications, and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern. Adverse effects are poorly reported in recent studies investigating chiropractic manipulations. A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable. Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region. Estimates for serious adverse events vary from 5 strokes per 100,000 manipulations to 1.46 serious adverse events per 10 million manipulations and 2.68 deaths per 10 million manipulations, though it was determined that there was inadequate data to be conclusive. Several case reports show temporal associations between interventions and potentially serious complications. The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.
Vertebrobasilar artery stroke (VAS) is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (CMT) and VAS. There is insufficient evidence to support a strong association or no association between cervical manipulation and stroke. While the biomechanical evidence is not sufficient to support the statement that CMT causes cervical artery dissection (CD), clinical reports suggest that mechanical forces have a part in a substantial number of CDs and the majority of population controlled studies found an association between CMT and VAS in young people. It is strongly recommended that practitioners consider the plausibility of CD as a symptom, and people can be informed of the association between CD and CMT before administrating manipulation of the cervical spine. There is controversy regarding the degree of risk of stroke from cervical manipulation. Many chiropractors state that, the association between chiropractic therapy and vertebral arterial dissection is not proven. However, it has been suggested that the causality between chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is probable or definite. There is very low evidence supporting a small association between internal carotid artery dissection and chiropractic neck manipulation. The incidence of internal carotid artery dissection following cervical spine manipulation is unknown. The literature infrequently reports helpful data to better understand the association between cervical manipulative therapy, cervical artery dissection and stroke. The limited evidence is inconclusive that chiropractic spinal manipulation therapy is not a cause of intracranial hypotension. Cervical intradural disc herniation is very rare following spinal manipulation therapy.
Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation. Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year. Practice guidelines aim to reduce unnecessary radiation exposure, which increases cancer risk in proportion to the amount of radiation received. Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based. Although, there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain.
A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation. A 2010 systematic review stated that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggested a precautionary principle in healthcare for chiropractic intervention even if a causality with vertebral artery dissection after neck manipulation were merely a remote possibility. The same review concluded that the risk of death from manipulations to the neck outweighs the benefits. Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation. Edzard Ernst stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors across the world."
A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is routinely associated with considerable harm and no compelling evidence exists to indicate that it adequately prevents symptoms or diseases, thus the risk-benefit is not evidently favorable.
A 2012 systematic review suggested that the use of spine manipulation in clinical practice is a cost-effective treatment when used alone or in combination with other treatment approaches. A 2011 systematic review found evidence supporting the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain; the results for acute low back pain were insufficient.
A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of spinal manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain. A 2005 American systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention. The cost-effectiveness of maintenance chiropractic care is unknown.
Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) which looked the chiropractic services utilization found that the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient costs associate with the following use of services by 60% for in-hospital admissions, 59% for hospital days, 62% for outpatient surgeries and procedures, and 85% for pharmaceutical costs when compared with conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame.
Requirements vary between countries. In the U.S. chiropractors obtain a first professional degree in the field of chiropractic. Chiropractic education in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine. The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has been more similar than not, both in the kinds of subjects offered and in the time assigned to each subject. Accredited chiropractic programs in the U.S. require that applicants have 90 semester hours of undergraduate education with a grade point average of at least 3.0 on a 4.0 scale. Many programs require at least three years of undergraduate education, and more are requiring a bachelor's degree. Canada requires a minimum three years of undergraduate education for applicants, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program. Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education. The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.
Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction. Depending on the location, continuing education may be required to renew these licenses. Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics.
In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK. The U.S. CCE requires a mixing curriculum, which means a straight-educated chiropractor may not be eligible for licensing in states requiring CCE accreditation. CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally. Today, there are 18 accredited Doctor of Chiropractic programs in the U.S., 2 in Canada, 6 in Australasia, and 5 in Europe. All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges. Of the two chiropractic colleges in Canada, one is publicly funded (UQTR) and one is privately funded (CMCC). In 2005, CMCC was granted the privilege of offering a professional health care degree under the Post-secondary Education Choice and Excellence Act, which sets the program within the hierarchy of education in Canada as comparable to that of other primary contact health care professions such as medicine, dentistry and optometry.
Regulatory colleges and chiropractic boards in the U.S., Canada, Mexico, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. There are an estimated 49,000 chiropractors in the U.S. (2008), 6,500 in Canada (2010), 2,500 in Australia (2000), and 1,500 in the UK (2000).
Chiropractors often argue that this education is as good as or better than medical physicians', but most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing. The fourth year of chiropractic education persistently showed the highest stress levels. Every student, irrespective of year, experienced different ranges of stress when studying. The chiropractic leaders and colleges have had internal struggles. Rather than cooperation, there has been infighting between different factions. A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.
The chiropractic oath is a modern variation of the classical Hippocratic Oath historically taken by physicians and other healthcare professionals swearing to practice their professions ethically. The American Chiropractic Association (ACA) has an ethical code "based upon the acknowledgement that the social contract dictates the profession's responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the chiropractic doctor's professional services shall be to benefit the patient." The International Chiropractor's Association (ICA) also has a set of professional canons.
A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. According to a 2015 Gallup poll of U.S. adults, the perception of chiropractors is generally favorable; two-thirds of American adults agree that chiropractors have their patient's best interest in mind and more than half also agree that most chiropractors are trustworthy. Less than 10% of US adults disagreed with the statement that chiropractors were trustworthy.
Chiropractors, especially in America, have a reputation for unnecessarily treating patients. In many circumstances the focus seems to be put on economics instead of health care. Sustained chiropractic care is promoted as a preventative tool, but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. A 2010 analysis of chiropractic websites found the majority of chiropractors and their associations made claims of effectiveness not supported by scientific evidence, while 28% of chiropractor websites advocate lower back pain care, which has some sound evidence.
The US Office of the Inspector General (OIG) estimates that for calendar year 2013, 82% of payments to chiropractors under Medicare part B, a total of $359 million, did not comply with Medicare requirements. There have been at least 15 OIG reports about chiropractic billing irregularities since 1986.
In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients." An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights. The libel case ended with the BCA withdrawing its suit in 2010.
Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries. It is viewed as a marginal complementary and alternative medicine health care profession, which has not integrated into mainstream medicine. Billions are spent annually for chiropractic services.
In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.
A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed with patients the serious risk associated with manipulation of the cervical spine and that 46% believed there was possibility of patient would refuse treatment if risk correctly explained. However 80% acknowledged the ethical/moral responsibility to disclose risk to patient.
The percentage of the population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada, with a global high of 20% in Alberta in 2006. In 2008, chiropractors were reported to be the most common CAM providers for children and adolescents, consuming up to 14% of all visits to chiropractors. In 2008, there were around 60,000 chiropractors practicing in North America. In 2002–03, the majority of those who sought chiropractic did so for relief from back and neck pain and other neuromusculoskeletal complaints; most do so specifically for low back pain. The majority of U.S. chiropractors participate in some form of managed care. Although the majority of U.S. chiropractors view themselves as specialists in neuroleptic malignant syndrome conditions, many also consider chiropractic as a type of primary care. In the majority of cases, the care that chiropractors and physicians provide divides the market, however for some, their care is complementary.
In the U.S., chiropractors perform over 90% of all manipulative treatments. Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.
Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient. The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate. As of 2007 7% of the U.S. population is being reached by chiropractic. They were the third largest medical profession in the US in 2002, following physicians and dentists. Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster than the average for all occupations.
Chiropractic was founded in 1895 by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease. The first chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer's office was located. He claimed that he had severely reduced hearing for 17 years, which started soon following a "pop" in his spine. A few days following his adjustment, Lillard claimed his hearing was almost completely restored. Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing and bonesetting; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health. Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic. One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment.
Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence, a vitalistic nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions. D.D. Palmer said he "received chiropractic from the other world". D.D. and B.J. both seriously considered declaring chiropractic a religion, which might have provided legal protection under the U.S. constitution, but decided against it partly to avoid confusion with Christian Science. Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, among which they included the American Medical Association (AMA).
Chiropractic has seen considerable controversy and criticism. Although D.D. and B.J. were "straight" and disdained the use of instruments, some early chiropractors, whom B.J. scornfully called "mixers", advocated the use of instruments. In 1910, B.J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students. The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J.'s invention and promotion of the neurocalometer, a temperature-sensing device, was highly controversial among B.J.'s fellow straights. By the 1930s, chiropractic was the largest alternative healing profession in the U.S.
Chiropractors faced heavy opposition from organized medicine. DD Palmer was jailed in 1907 for practicing medicine without a license. Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed. To defend against medical statutes, B.J. argued that chiropractic was separate and distinct from medicine, asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease. B.J. cofounded the Universal Chiropractors' Association (UCA) to provide legal services to arrested chiropractors. Although the UCA won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974. The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an "unscientific cult" in 1966, and until 1980 advised its members that it was unethical for medical doctors to associate with "unscientific practitioners". This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.
Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. In recent decades chiropractic gained legitimacy and greater acceptance by medical physicians and health plans, and enjoyed a strong political base and sustained demand for services. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.
The word chiropractic comes from Greek χειρο- chiro- (itself from χείρ cheir "hand"), "hand" and πρακτικός praktikos, "practical". Chiropractic is classified as a field of pseudomedicine on account of its esoteric origins.
Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous, ineffective, and unnecessary. Some chiropractors have embraced vaccination, but a significant portion of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing. The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.
Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health. In addition to traditional chiropractic opposition to water fluoridation and vaccination, chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive lifelong chiropractic treatment.
Throughout its history chiropractic has been the subject of internal and external controversy and criticism. According to Daniel D. Palmer, the founder of chiropractic, subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race. A 2003 profession-wide survey found "most chiropractors (whether 'straights' or 'mixers') still hold views of innate Intelligence and of the cause and cure of disease (not just back pain) consistent with those of the Palmers." A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation. Collectively, systematic reviews have not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, is effective for any medical condition, with the possible exception of treatment for back pain. Chiropractic remains controversial, though to a lesser extent than in past years.
The length, breadth, and depth of chiropractic clinical training do not support the claim of broad diagnostic competency required of a PCP. Studies of chiropractic intern clinical experience provides no evidence that chiropractors are trained to a level of a diagnostic generalist for non-musculoskeletal conditions. For chiropractors to describe themselves as PCP diagnosticians is to invite comparisons to other PC diagnosticians, i.e., family practitioners, pediatricians and internists. Such comparisons will not reflect favorably on chiropractic. PCP: primary care providers
A subluxated vertebra ... is the cause of 95 percent of all diseases ... The other five percent is caused by displaced joints other than those of the vertebral column.
A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).CS1 maint: Multiple names: authors list (link)
The AECC University College formally known as the Anglo-European College of Chiropractic. AECC University College is a chiropractic teaching institution. The AECC was a higher education institution offering a Masters in Chiropractic degree validated by Bournemouth University. The AECC offered a BSc in Exercise Science jointly delivered with Bournemouth University and an Access to Higher Education Diploma in Health Sciences.
The first chiropractic college in Europe, founded in 1965 the AECC University College has a unique history and a proud heritage. The continued investment in their on campus facilities has contributed to the awarding of university college status.
The AECC were granted their own taught degree-awarding powers in May 2016 and from September 2017 following a rebrand all new students entering the institution will enrol on courses that will be validated by AECC University College. This means that all the qualifications students receive at the end of their studies will in the future be made in the name of AECC University College. Courses that are run as of 17 October 2017 include: Masters in Chiropractic- MChiro (Hons), BSc (Hons) Clinical Exercise and Rehabilitation Science, Access to Higher Education Diploma (Health Sciences) and a number of Postgraduate opportunities and short courses in Ultrasound and CPD Seminars for healthcare professionals.
At the AECC the emphasis was on the teaching of chiropractic. Alongside the University of South Wales and the McTimoney College of Chiropractic, the former Anglo-European College of Chiropractic is one of only three institutions in the United Kingdom to offer chiropractic degrees recognised by the General Chiropractic Council.Applied kinesiology
Applied kinesiology (AK) is a technique in alternative medicine claimed to be able to diagnose illness or choose treatment by testing muscles for strength and weakness.According to their guidelines on allergy diagnostic testing, the American College of Allergy, Asthma and Immunology stated there is "no evidence of diagnostic validity" of applied kinesiology. Another study has shown that, as an evaluative method, AK "is no more useful than random guessing", and the American Cancer Society has said that "scientific evidence does not support the claim that applied kinesiology can diagnose or treat cancer or other illness".Canadian Memorial Chiropractic College
The Canadian Memorial Chiropractic College (CMCC) is a non-profit, private higher education institution in Toronto, Ontario, Canada.
Founded in 1945, CMCC is a not-for-profit corporation and is a registered charity. It receives no direct government funding and relies on tuition and membership fees, and community and alumni donations to fund its operations.Chiropractic controversy and criticism
Throughout its history chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all diseases of the human race. A 2003 profession-wide survey found "most chiropractors (whether 'straights' or 'mixers') still hold views of Innate Intelligence and of the cause and cure of disease (not just back pain) consistent with those of the Palmers." A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D. D. Palmer, were jailed for practicing medicine without a license. D. D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.Chiropractic researchers have documented that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science. Collectively, systematic reviews have not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, was effective for any medical condition, with the possible exception of treatment for back pain. Although rare, spinal manipulation, particularly of the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children.In 2008, Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian. A preliminary hearing took place at the Royal Courts of Justice in front of judge David Eady. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question. An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights. The libel case ended with the BCA withdrawing its suit in 2010.Chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines. Some chiropractors continue to be opposed to vaccination. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors opposed water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.Chiropractic education
Chiropractic education trains students in chiropractic. The entry criteria, structure, teaching methodology and nature of chiropractic programs offered at chiropractic schools vary considerably around the world. Students are trained in academic areas including scopes of practice, neurology radiology, microbiology, psychology, ethics, biology, gross anatomy, chemistry/biochemistry, spinal anatomy, phlebotomy, neurology and more. Prospective students are also usually trained in clinical nutrition, public health, pediatrics and other health or wellness related areas.
The entry criteria, structure, teaching methodology and nature of chiropractic programs offered at chiropractic schools vary considerably around the world, although in the United States programs are required to teach specific areas for accreditation purposes.
A 2005 World Health Organization (WHO) guideline states regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Students must pass boards administered by the National Board of Chiropractic Examiners (NBCE) to be licensed to practice in a U.S state or territory. The boards consists of parts I, II, III, and IV, as well as other additional tests required by state or if desired by students such as the physiotherapy exam.Chiropractic treatment techniques
Chiropractors primarily use manipulation of the spine as a treatment. It was founded in North America by DD Palmer in the 19th century.Spinal manipulation became more popular in the 1980s. There are about 200 chiropractic techniques, but there is a significant amount of overlap between them, and many techniques involve slight changes of other techniques.According to the American Chiropractic Association the most frequently used techniques by chiropractors are Diversified technique 95.9%, Extremity manipulating/adjusting 95.5%, Activator Methods 62.8%, Gonstead technique 58.5%, Cox Flexion/Distraction 58.0%, Thompson 55.9%, Sacro Occipital Technique [SOT] 41.3%, Applied Kinesiology 43.2%, NIMMO/Receptor Tonus 40.0%, Cranial 37.3%, Manipulative/Adjustive Instruments 34.5%, Palmer upper cervical [HIO] 28.8%, Logan Basic 28.7%, Meric 19.9%, and Pierce-Stillwagon 17.1%.There is no evidence that chiropractic manipulation is effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.Council on Chiropractic Education – USA
The Council on Chiropractic Education (CCE) is an American agency recognized by the United States Department of Education for accreditation of programs and institutions offering the Doctor of Chiropractic degree. The CCE seeks to ensure the quality of chiropractic education in the United States by means of accreditation, educational improvement, and public information. The CCE develops accreditation criteria to assess how effectively programs or institutions plan, implement, and evaluate their mission and goals, program objectives, inputs, resources, and outcomes of their chiropractic programs. The CCE is also recognized by the Council for Higher Education Accreditation (CHEA) and is a member of the Association of Specialized and Professional Accreditors (ASPA).Councils on Chiropractic Education International
The Councils on Chiropractic Education International (CCEI) is an organization of chiropractic accrediting bodies worldwide. Organized in Brussels during 2001, the CCEI maintains its International Chiropractic Accreditation Standards, and aids in the development and recognition of new accrediting bodies in geographic regions where such agencies are not currently recognized.
CCEI provides accreditation services through its assigned member organizations to chiropractic educational entities situated in areas not currently served by a CCEI member agency. Accreditation agency actions and status designations for chiropractic educational entities that award equivalent degrees are mutually endorsed on the basis of membership in CCEI.Daniel David Palmer
Daniel David Palmer or D.D. Palmer (March 7, 1845 – October 20, 1913) was the founder of chiropractic. He was an avid proponent of various forms of pseudoscientific alternative medicine such as magnetic healing. He was an opponent of vaccination. Palmer was born in Ontario but emigrated to United States. He died under mysterious circumstances.
Palmer believed that the human body had an ample supply of natural healing power transmitted through the nervous system. He suggested that if any one organ was affected by an illness, it merely must not be receiving its normal "nerve supply" which he dubbed a "spinal misalignment", or subluxation. He saw chiropractic as a form of realigning to reestablish the supply.History of chiropractic
The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. While Lillard was working without his shirt on in Palmers office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samel Weed coined the word "chiropractic" from Greek roots. Chiropractic's early philosophy was rooted in vitalism, naturalism, magnetism, spiritualism and other constructs that are not amenable to the scientific method, although Palmer tried to merge science and metaphysics. In 1896, Palmer's first descriptions and underlying philosophy of chiropractic echoed Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improved health. Palmer distinguished his work by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. He described the effects of chiropractic spinal manipulation as being mediated primarily by the nervous system.Despite the similarities between chiropractic and osteopathy, the latter's practitioners sought to differentiate themselves by seeking licensure to regulate the profession, calling chiropractic a "bastardized form of osteopathy". In 1907 in a test of the new osteopathy law, a Wisconsin based chiropractor was charged with practicing osteopathic medicine without a license. Practicing medicine without a license led to many chiropractors, including D.D. Palmer, being jailed. Ironically the Palmers legal defence of chiropractic consisted of the first chiropractic textbook 'Modernized Chiropractic' published in 1906, written by "mixer" chiropractors Longworthy, Smith, et al., whom the Palmers despised. Although the chiropractors won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases they were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974.
Division within the profession has been intense, with "mixers" combining spinal adjustments with other treatments, and "straights" relying solely on spinal adjustments. A conference sponsored by the National Institutes of Health in 1975 spurred the development of chiropractic research. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 antitrust case. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation. By the mid 1990s there was a growing scholarly interest in chiropractic.Life University
Life University is a private university in Marietta, Georgia. It was established in 1974 by chiropractor Sid E. Williams. In addition to undergraduate and graduate programs in health and wellness-oriented fields, Life University is best known for its Doctor of Chiropractic degree program. It is the largest single campus chiropractic college in the world and claims that vitalism is its guiding philosophy. Life University centers their philosophy, including clinical training, around the vertebral subluxation complex.List of chiropractic schools
This list of chiropractic schools is organized alphabetically by country. In those countries with functioning, specialized, accrediting agencies, the colleges holding "recognized", or "accredited" status are delineated. Other countries and regions are in the process of developing similar programs of accreditation; and, in Switzerland, chiropractic is so fully integrated into the health care system that the existence of a separate accrediting agency is thus obviated. The course is taught in university, on the same basis as human medicine.
In 2015, nine internationally accredited chiropractic colleges: AECC, WIOC, IFEC-Paris, IFEC-Toulouse, SDU-Odense, UZ-Zurich, UJ-Johannesburg, Durbin University of Technology and Macquarie University, Australia, made an open statement which included: "The teaching of the vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historic context is therefore inappropriate and unnecessary".
This document is based upon and supports the theme of the World Federation of Chiropractic Educational Statement formulated in November 2014 at the Miami Education Conference.Logan University
Logan University, is a private special focus university providing college education in chiropractic and the health sciences in Chesterfield, Missouri.National University of Health Sciences
National University of Health Sciences (NUHS) is a private university in Lombard, Illinois that focuses on the health sciences. The university offers professional degrees in chiropractic and naturopathic medicine, master's degrees in acupuncture and Oriental medicine, a bachelor's degree in biomedical science, and a certificate or associate degree in massage therapy.Palmer College of Chiropractic
Palmer College of Chiropractic is the founding college of chiropractic and is located in Davenport, Iowa. It was established in 1897 by Daniel David Palmer and is considered "The Fountainhead," as it was the first school of chiropractic in the world. The college's name was originally the Palmer School and Cure and later became the Palmer School of Chiropractic. Most early chiropractic schools were founded by Palmer alumni.Spinal adjustment
Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment.
Spinal adjustments were among many chiropractic techniques invented in the 19th century by Daniel David Palmer, the founder of Chiropractic. Claims made for the benefits of spinal adjustments range from temporary, palliative (pain relieving) effects to long term wellness and preventive care. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease.Sports chiropractic
Sports chiropractic is a specialty of chiropractic. It generally requires post-graduate coursework and a certification or diplomate status granted by a credentialing agency recognized in a practitioner's region. Assessment and diagnosis of sports-related injuries by a sports chiropractor involves a physical exam and sometimes imaging studies. Treatment is described as noninvasive and can include joint manipulations as well as recommendations for exercises designed to improve strength, flexibility and range of motion.Vertebral subluxation
In chiropractic, a vertebral subluxation is a purported misalignment of the spinal column, not necessarily visible on X-rays, leading to a set of signs and symptoms sometimes termed vertebral subluxation complex. It has no biomedical basis, lacks clinical meaningfulness, and is categorized as pseudoscientific by leading chiropractic authorities. Traditionally, the "specific focus of chiropractic practice" is the chiropractic subluxation and historical chiropractic practice assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its Innate Intelligence, as promulgated by D. D. Palmer, the inventor of chiropractic.
The chiropractic subluxation is the heart of the split between "straight" and "mixer" chiropractors. Straight chiropractors continue to follow Palmer's vitalistic tradition, claiming that subluxation has considerable health effects and also adding a visceral component to the definition, while mixers, as exemplified by the United Kingdom's General Chiropractic Council, consider it a historical concept with no evidence identifying it as the cause of disease.Within the chiropractic tradition, a vertebral subluxation complex is believed to be a dysfunctional biomechanical spinal segment which actively alters neurological function, which in turn, is believed to lead to neuromusculoskeletal and visceral disorders. The WHO acknowledges this difference between the medical and chiropractic definitions of a subluxation: medical doctors only refer to "significant structural displacements" as subluxations, whereas chiropractors suggest that a dysfunctional segment, whether displaced significantly or not, should be referred to as a subluxation. This difference has been noted in the proceedings of the chiropractic profession's Mercy Center Consensus Conference: "The chiropractic profession refers to this concept as a 'subluxation'. This use of the word subluxation should not be confused with the term's precise anatomic usage, which considers only the anatomical relationships."The chiropractic vertebral subluxation complex has been a source of controversy since its inception in 1895 due to the lack of empirical evidence for its existence, its metaphysical origins, and claims of its far reaching effects on health and disease. Although some chiropractic associations and colleges support the concept of subluxation, many in the chiropractic profession reject it and shun the use of this term as a diagnosis. In the United States and in Canada the term nonallopathic lesion may be used in place of subluxation.In 2015, internationally accredited chiropractic colleges from Bournemouth University, University of South Wales, University of Southern Denmark, University of Zürich, Institut Franco-Européen de Chiropraxie, and University of Johannesburg made an open statement which included: "The teaching of the vertebral subluxation complex as a vitalistic2 construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historic context is therefore inappropriate and unnecessary."Veterinary chiropractic
Veterinary chiropractic, also known as animal chiropractic, is the practice of spinal manipulation or manual therapy for animals. Veterinary chiropractors typically treat horses, racing greyhounds, and pets. It has become a fast developing field in animal alternative medicine.It remains controversial within certain segments of the veterinary and chiropractic profession. There is some degree of risk associated with even skilled manipulation in animals as the potential for injury exists with any technique used.The founder of chiropractic, Daniel David Palmer, used the method on animals, partly to challenge claims that the placebo effect was responsible for favorable results in humans. Chiropractic treatment of large animals dates back to the early 1900s. As of 2016, 40 states in the US provide statutory or regulatory guidelines for the practice of chiropractic and related treatments on animals, generally requiring some form of veterinary involvement.