How did it begin? Who started it all? The roots of chiropractic care can be traced back to as early as B. The writings mention spinal manipulation and moving the lower extremities in an attempt to alleviate low back pain.
Hippocrates, the Greek physician, who lived from to B. This uneven balance of broad claims and scarce science is undoubtedly a source of friction between the profession and the biomedical community. The scientific value of manipulation needs to be viewed in the context of possible adverse effects.
Of cases of serious complications due to chiropractic, a recent review found more than 8 of 10 were from cervical manipulation.
Serious adverse incidences from neck rotation have included vertebrobasilar accidents with consequences such as brainstem or cerebellar infarction or both , Wallenberg syndrome, locked-in syndrome, and such problems as spinal cord compression, vertebral fracture, tracheal rupture, diaphragm paralysis, and internal carotid hematoma.
The potential for complications with lumbar spine manipulation seems less serious. The chief concern is cauda equina syndrome, and the estimated rate of occurrence has been between "one in many millions of treatments" to less than 1 per million manipulations. It could be argued that additional evidence for chiropractic's effectiveness is still required for it to establish its scientific merits, especially for use beyond treating low back pain.
Regardless of what future research will demonstrate, chiropractic will undoubtedly be an important and prominent feature of US health care. Part of its strength may lie in the domain of the art of healing and how the chiropractic profession negotiates the patient-physician relationship. For people with chronic pain or with other refractory conditions, the chiropractic visit itself can be a source of comfort even without the addition of a demonstrable scientific component.
Treatment by a chiropractor can generate a sense of understanding and meaning, an experience of comfort, an expectation of change, and a feeling of empowerment. Research indicates that for many of the illnesses chiropractic treats, precise diagnosis, assurance of recovery, and physician-patient agreement about the nature of a problem hasten recovery.
Chiropractic finds its voice exactly where biomedicine becomes inarticulate. Too often, biomedicine fails to affirm a patient's chronic pain. Patients think their experience is brushed aside by a physician who treats it as unjustified, unfounded, or annoying, attitudes that heighten a patient's anguish and intensify suffering. By rooting pain in a clear physical cause, chiropractic validates the patient's experience. Even for patients with acute pain, chiropractic's assertiveness, clarity, and precision provide reassurances.
As an anthropologist p83 has noted:. In essence, the chiropractor first manipulates a patient's belief structure before manipulating his or her physical structure.
Chiropractic is in no sense passive; it is, from the start, engaged. Except when contraindicated as in patients with neoplastic disease and those with extreme osteoporosis , some form of therapy is almost always indicated.
For most symptoms, there is a suitable manipulation or a designated mode of redress. Chiropractic adjustment evokes an experience of change so palpable that the patient can often hear it in the characteristic "pop" or "crack," indicating that normal range of motion has been exceeded and a state of greater mobility and ease, however temporary, has been achieved.
A perception of transformation has been audibly triggered. The chiropractic approach to healing relies on the opposite of double-blindedness; it enlists the full participation and awareness of both parties.
From the first encounter on, chiropractors generate different expectations from conventional physicians. Because conventional practitioners assume that back pain, in the absence of systemic signs, is likely to be self-limited, it is not unusual for a patient to wait weeks for an appointment with a specialist or for a radiographic diagnostic assessment. Because a chiropractor believes that back pain is both explicable and amenable to treatment, a patient can usually obtain an appointment within 24 hours of a telephone call.
The message of empathy, urgency, comprehension, and support conveyed by such a rapid response is reassuring and provides a heightened sense of care and compassion. Chiropractic has endured, grown, and thrived in the United States, despite internal contentiousness and external opposition.
Its persistence suggests it will continue to endure as an important component of health care in the United States. In response to the countless requests for the treatment of pain, chiropractors have consistently offered the promise, assurance, and perception of relief. Chiropractic's ultimate lesson may be to reinforce the principle that the patient-physician relationship is fundamentally about words and deeds of connection and compassion.
Chiropractic has managed to embody this message in the gift of the hands. Germeshausen Foundation, Boston, Mass. Reprints: Ted J. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Download PDF Top of Article Abstract Chiropractic's origin Dissension within the movement Spinal manipulation: the core chiropractic act Chiropractic battle for acceptance Chiropractic health care Patient perceptions Scientific evidence for spinal manipulation The art of medicine and chiropractic's effectiveness Conclusions Article Information References.
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More info on this topic. Chiropractic Home. Chiropractic philosophy. How chiropractic helps. History of chiropractic. A typical visit. The residency is a full-time one-year program in integrated clinical practice emphasizing the delivery of chiropractic care in hospitals and other integrated healthcare settings. In recent years, the epidemic of opioid overuse has prompted many respected health organizations to recommend the use of nondrug approaches to pain relief as a first line of defense, potentially helping patients to reduce or avoid the need for prescription pain medications.
Notably, the American College of Physicians ACP updated its guideline for the treatment of acute and chronic low back pain in to recommend first using noninvasive, nondrug treatments—including spinal manipulation—before resorting to drug therapies. The chiropractic profession continues to grow and evolve. There are more than 70, chiropractors licensed today in the United States—practicing in solo practices, multidisciplinary clinics and major hospital systems.
It is estimated that more than 35 million people visit a chiropractor each year. Current Contact ID. Login Contact ID. DNN Id.
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