Superb Health

Chiropractic

Prepared by: Shane J. Lynch, D.C.

The primary objective of chiropractic is to preserve and restore health by enhancing the “inherent recuperative power of the body to heal itself without the use of drugs or surgery”1. Chiropractors achieve this end by adjusting subluxations (misalignments) throughout the spinal column to relieve any detrimental effects these structural abnormalities may have on the nervous system. The nervous system regulates and controls all functions of the body and for this reason it can be said that it acts as the “innate recuperative power” responsible for maintaining homeostasis, or harmony within the body. A subluxation, therefore, has the ability to alter nervous system function and interfere with homeostatic properties in the body1. The Association of Chiropractic Colleges (ACC) has further described a subluxation as “a complex of functional and or structural and or pathological articular changes that compromise neural integrity and may influence organ system function and overall health”.

The word chiropractic is derived from the Greek words cheir (“hand”) and praktos (“done”) collectively meaning “done by hand”2. This word was chosen by Daniel David Palmer to represent the profession that he began formally developing in 1895 following a miraculous recovery with one of his early patients. A janitor by the name of Harvey Lillard worked in the building that D.D. Palmer practiced and mentioned that he had been deaf for seventeen years after he rose from a stooped position and felt something “give” in his back. Palmer then proceeded to examine Lillard’s spinal column and adjusted a misaligned vertebra at which point the man subsequently regained his hearing2. Prior to this point D.D. Palmer was a magnetic healer, a profession made popular in the nineteenth century by Franz Mesmer, M.D., with the primary objective of “cooling” inflamed areas in the body with touch3,4. This once popular healing modality was also responsible for influencing Andrew Taylor Still, founder of osteopathy3.

The initial hypothesis of chiropractic was that inflammation occurred when “displaced anatomic structures rubbed against one another causing friction and heat”. Palmer’s objective early on, therefore, was to manually reposition parts of the body to remove and prevent inflammation, which he believed “disrupted the healthy tone of cells and tissues in the body”. Not long after this initial hypothesis Palmer narrowed his focus exclusively to the joints of the spinal column stating that subluxations at these joints can lead to nerve impingement, meaning that the nerves become “tense” (irritated/overactive) or “slack” (decreased activity)3,4. It is important to note that impinged nerves and pinched nerves are two separate forms of injury. Pinched nerves, for example, commonly occur when herniated or sequestered disc material physically compresses against nerves. A majority of asymptomatic individuals have some type of minor disc bulge or herniation, but these are generally not severe enough to result in direct nerve pressure4,5,6. Nerve impingement, on the other hand, occurs when nerves are tethered (i.e. stretched) or approximated leading to an increase or decrease in the production of nerve impulses. This increase or decrease of nerve activity, Palmer hypothesized, would cause inflammation or “under functioning in end organs”3,4,5. These early chiropractic definitions closely resemble those put forth today by the ACC and various professional organizations stating that subluxations interfere with nervous system activity, which in turn can have a detrimental effect on overall health1,7,8.

Today doctors of chiropractic (D.C.) act as first contact physicians, meaning that patients can walk into a chiropractor’s office without a referral9. For this reason candidates for the D.C. degree must complete extensive undergraduate studies and complete four years of graduate studies and an internship at an accredited chiropractic college. In addition, candidates must also pass national board exams and become licensed before practicing. This training is essential for providing the D.C. with a comprehensive understanding of the systems of the body and diagnostic information needed to effectively treat a patient or refer to the appropriate health care provider. Currently there are over 60,000 licensed D.C.’s in the U.S. making chiropractic the third largest “doctoral level health care profession after medicine and density”10. Nearly 30 million Americans make chiropractic part of their regular health care program and with approximately 1 million adjustments administered everyday, chiropractic is considered one of the “safest portal of entry health care (professions) available”11.

References:

1 Chiropractic paradigm. The Association of Chiropractic Colleges. [Utilized 2009 Feb. 2]. Available

From: http://www.chirocolleges.org/paradigm_scopet.html

2 Origins and history of chiropractic care. American Chiropractic Association. [Utilized 2009 Feb. 2]

Available from: http://www.acatoday.org/pdf/chiro_history.pdf

3 Keating JC, Cleveland CS, Menke M. Chiropractic History: A Primer. Davenport, Iowa: Association

for the History of Chiropractic; 2004:7-9 & 23-24.

4 Haldeman S. Principles and Practice of Chiropractic. New York: McGraw-Hill; 2005:29, 925 & 30.

5 Leach RA. The Chiropractic Theories: A Textbook of Scientific Research. Philadelphia,

Pennsylvania: Lippincott Williams & Wilkins; 2004: 254-265.

6 Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, et al. Magnetic resonance imaging of

Lumbar spine in people without back pain. N Eng J Med 1994; 331 (2): 69-73.

7 ICA policy statements. International Chiropractors Association. [Utilized 2009 Feb. 2]. Available

from: http://www.chiropractic.org/index.php?p=ica/policies

8 Purpose & overview. World Chiropractic Alliance. [Utilized 2009 Feb. 2]. Available from:

http://worldchiropracticalliance.org/about/wca.htm

9 Frequently asked questions. American Chiropractic Association. [Utilized 2009 Feb. 2]. Available

from: http://acatoday.org/level2_css.cfm?T1ID=13&T2ID=70

10 General information about chiropractic care. American Chiropractic Association. [Utilized 2009 Feb. 2]. Available from: http://www.acatoday.org/pdf/Gen_Info.pdf

11 Chiropractic quick facts. International Chiropractors Association. [Utilized 2009 Feb. 2]. Available

from: http://www.chiropractic.org/index.php?p=chiroinfo/main

Research:

If a topic of interest is not located in this section I recommend trying the search features on the peer-reviewed journal sites or at the Index to Chiropractic Literature (ICL) referenced under the resource section of this paper.

Musculoskeletal related issues

* Lawrence DJ, Meeker W, Branson R, Bronfort G, et al. Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis. J Manipulative Physiol Ther 2008; 31 (9):659-74.

o “As much or more evidence exist for the use of spinal manipulation to reduce symptoms and improve function in patients with chronic LBP (low back pain) as for use in acute and subacute LBP.”

* Giles LG, Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003; 28(14): 1502-3.

o “…in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication.”

* Carey TS, Garrett J, Jackman A, McLaughlin C, et al. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. N Eng J Med 1995; 333 (14):913-917.

o “Patients who saw chiropractors reported a significantly higher degree of satisfaction than those who saw practitioners in the other four strata (primary care physician, orthopedic or HMO provider)”.

* Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ 1995;311:349-351.

o “…improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear… At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals. “

General health and wellness:

* Welch A, Boone R. Sympathetic and parasympathetic responses to specific diversified adjustments to chiropractic vertebral subluxations of the cervical and thoracic spine. J Chiro Med 2008; 7(3): 86-93.

o “Diastolic pressure (indicating a sympathetic response) dropped significantly postadjustment among those receiving cervical adjustments, accompanied by a moderate clinical effect (0.50). It is preliminarily suggested that cervical adjustments may result in parasympathetic responses, whereas thoracic adjustments result in sympathetic responses. Furthermore, it appears that these responses may demonstrate the relationship of autonomic responses in association to the particular segment(s) adjusted.”

* Cohn A. Chiropractic and the neuroimmune connection. J Vert Sublux Res 2008; Sep (30):1-5.

o “There appear to be numerous modes of communication between the nervous system and the immune system. It also appears, not only in theory but in practice, that chiropractic adjustments may have a beneficial effect on the functioning of both the nervous and the immune system.”

* Bakris G, Dickholtz M, Meyer PM, Kravitz G, et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Human Hyperten 2007; 21: 347-352.

o “We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP (blood pressure) similar to the use of two-drug combination therapy”.

* Cramer G, Bugdell B, Henderson C, Khalsa P, et al. Basic science research related to chiropractic spinal adjusting: the state of the art and recommended revisited. J Manipulative Physiol Ther 2006; 29: 726-761.

o “The summaries of the literature for the 6 topic sections (anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system) indicated that a significant body of basic science research evaluating chiropractic spinal adjusting has been completed and published since the 1997 basic science white paper.”

* Budgell B, Polus B. The effects of thoracic manipulation on heart rate variability: a controlled crossover trial. J Manipulative Physiol Ther 2006; 29: 603-610.

o “High-velocity and low-amplitude manipulation of the thoracic spine appears to be able to influence autonomic output to the heart in ways that are not duplicated by a sham procedure or by other forms of somatic/physical therapies.”

* Haldeman S. Neurological effects of the adjustment. J Manipulative Physiol Ther 2000; 23(2): 112-114.

o “The discussion of the neurological effects of the adjustment is no longer a debate between believers and skeptics of any specific theory. There is now sufficient scientific investigation to develop working models to explain the effects of the adjustment.”

* Budgell B. Reflex effects of subluxation: the autonomic nervous system. J Manipulative Physiol Ther 2000; 23 (2): 104-106.

o “Recent neuroscience research supports neurophysiological rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function”.

* Bolton PS. Relex effects of vertebral subluxations: the peripheral nervous system. an update. J Manipulative Physiol Ther 2000; 23 (2): 101-103.

o “There is good evidence that displacement of vertebrae modulate nerve activity in afferent nerves innervating muscle spindles and other low (mechanical) threshold receptors, such as Golgi tendon organs in the intervertebral muscles. It is also clear that some types of vertebral displacements can modulate heart rate, blood pressure, and electrical activity in renal and adrenal nerves and in gastrointestinal muscles”.

Resourses:

* Index to Chiropractic Literature (ICL): www.chiroindex.org
* Journal of Manipulative and Physiological Therapeutics: www.jmptonline.org
* Journal of Chiropractic Medicine: www.journalchiromed.com
* Journal of Vertebral Subluxation Research: www.jvsr.com
* The American Journal of Clinical Chiropractic: www.idealspine.com/pages/AJCC_INDEX.htm
* Pubmed (key words: chiropractic, spinal manipulation): www.pubmed.gov
* The Association of Chiropractic Colleges (ACC): www.chirocolleges.org
* The American Chiropractic Association (ACA): www.amerchiro.org
* International Chiropractic Association (ICA): www.chiropractic.org
* The World Chiropractic Alliance (WCA): www.worldchiopracticalliance.org
* Chiropractic is Safe: www.chiropracticissafe.org