Evolution of Chiropractic Medicine in Health Care
The scientific merit of spinal dysfunction and therapeutic benefits of spinal manipulation for neuromusculoskeletal conditions were challenged in the early days of chiropractic. Manipulation has been generally accepted for back pain, neck pain, sciatica, joint problems, sprains, strains, osteoarthritis, herniated discs and other musculoskeletal (MSK) conditions.
Scientific evidence has indicated that spinal manipulation is a safe, mild-to-moderate pain reliever for lower back pain, neck pain and headache, and recent health care guidelines have listed it as a viable treatment option for symptoms that do not respond to self-care.1
Spinal manipulation in chiropractic medicine has evolved greatly since the first high-velocity adjustment performed by D.D. Palmer in the late 1800s. In addition, chiropractors have begun to embrace a variety of other evidence-based approaches to spine problems. Now, techniques include low-velocity adjustments involving the hands and even instruments and machines, and various other adjustments incorporating many specialized and individualized thrusts.2
Spinal Manipulation: High-Velocity Low-Amplitude (HVLA)
Modern chiropractic research has started to focus more on the efficacy of specific types of spinal manipulation, including when certain adjustments are performed and how long they are included as part of chiropractic treatment plans.1 Besides chiropractors, Doctors of Osteopathic Medicine (DO) and some Medical Doctors (MD) and Physical Therapists (PT) also perform spinal manipulation.
Concerns about the safety of manipulating the cervical spine for neck pain have been raised in relation to strokes. The medical literature does not substantiate that manipulation increases the risk of or causes strokes, but rather indicates that the reported stroke cases were patients who already had signs of impending stroke prior to manipulation. The literature shows no statistical difference in stroke occurrence among medical specialties, regardless if someone sees a Medical Doctor or Doctor of Chiropractic, and reports that chiropractic is generally and equally as safe of a treatment for neck pain as other nonsurgical care.3,4
Other Chiropractic Treatments besides Manipulation
Chiropractic health care has also grown beyond spinal manipulation to include other manual therapy like soft-tissue mobilization and massage, instrument-assisted soft tissue mobilization, the McKenzie approach to mechanical diagnosis and therapy, as well as stabilization and strength training exercise, nutrition and postural programs, and the incorporation of a cognitive-behavioral context to treatment regimens.
The appropriateness and effectiveness of some newer treatments (like spinal decompression) used by some chiropractors are a subject of debate among chiropractors and others, as are some other more recent developments, including treating children with spinal manipulation and marketing chiropractic as a holistic treatment of allergies, asthma, acid reflux, digestive disorders, ear infections, colic and other conditions that are less commonly treated with spinal manipulation.
Modern Recognition and Use of Chiropractic Medicine
Eighteen years after its founding in America, chiropractic received its first state licensing in 1913. In the following 18 years, chiropractic medicine became recognized in 39 states. Chiropractic is now recognized as a health care profession in not only all 50 states but the District of Columbia, Puerto Rico, U.S. Virgin Islands and many other countries. Chiropractic colleges are located in many countries in addition to the United States and Canada.5
Chiropractic licensing is handled on a state-by-state basis according to specific state laws. There are currently more than 60,000 licensed chiropractors in the United States, making chiropractic the third largest doctoral level health care profession behind medicine and dentistry.6
Efficacy of Chiropractic Medicine
A 2007 survey estimated that more than 18 million adults (8 percent of the U.S. adult population) and 2 million children (nearly 3 percent of American children) visited a chiropractor the previous year.7 Chiropractic may be fully or partially covered by private insurance plans, and Medicare may cover manual manipulation for subluxation of the spine in certain circumstances.8
A 2009 evidence-based report on population, health and total health care spending suggested that chiropractic care of back pain and neck pain provides higher satisfaction, superior outcomes and more cost-effectiveness than other commonly-utilized back and neck pain treatments, which can include simple rest, medications, surgery and more.9
This report also reviewed the scientific literature on chiropractic care, which was noted in other findings to be at least as effective as other widely-used therapies for lower back pain and more effective (when combined with exercise) than other common treatments for neck pain.10-12
A further review of scientific literature indicated that patients with chiropractic coverage as part of their insurance benefits had lower costs and reduced imaging studies, fewer hospitalizations and less surgeries than patients without chiropractic included in their insurance.13,14
Today, chiropractors enjoy hospital privileges in many hospitals, practice in multidisciplinary practices, work within the Department of Defense (DoD) and Veterans Affairs (VA) systems, and treat both Medicare and Medicaid patients. The profession continues to become more mainstream and integrated.
Special thanks to the following individuals for their contributions to this article:
Dr. Thomas E. Hyde, DC
Dr. Donald R. Murphy, DC, DACAN
Dr. Stephen M. Perle, D.C., M.S.
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14.Nelson CF, Metz RD, LaBrot T. Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. J Manipulative Physiol Ther 2005; 28: 564-9.