Chiropractic is an alternative form of treatment that is largely concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Proponents claim that the disorder affects general health through the nervous system, a claim that is proven to be false. The main chiropractic treatment technique involves manual therapy, especially spinal manipulation therapy (spine), other joint manipulation and soft tissue. The foundation is contrary to mainstream medicine, and chiropractic is sustained by pseudoscientific ideas such as subluxation and "innate intelligence" that reject science.
A number of controlled clinical studies of the treatments used by chiropractors have been conducted, with conflicting results. A systematic review of this study has not found evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain. Critical evaluation found that spinal manipulation was not collectively effective in treating any condition. Spinal manipulation may be cost-effective for acute or chronic low back pain but results for low acute low back pain are inadequate. The efficacy and cost-effectiveness of treatment chiropractic care is unknown. There is not enough data to establish the safety of chiropractic manipulation. This is often associated with mild to moderate side effects, with serious or fatal complications in rare cases. There is controversy about the risk level of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation. Some deaths have been linked to this technique and it has been argued that the relationship is causative, a claim disputed by many chiropractors.
Chiropractic is well established in the United States, Canada, and Australia. This overlaps with other manual-therapy professions, including massage therapy, osteopathy, and physical therapy. Most who seek chiropractic care do so for lower back pain. Back and neck pain is considered chiropractic specialization, but many chiropractors treat diseases other than musculoskeletal problems. Many chiropractors describe themselves as primary care providers, but chiropractic clinical training does not support the requirements to be considered a primary care provider, so their role in primary care is limited and debatable. Chiropractic has two main groups: "straights", now a minority, emphasizing vitalism, "innate intelligence" and spinal adjustment, and considering vertebral subluxation to be the cause of all illnesses; "mixers", the majority, are more open to common 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 "another world", and his son B. J. Palmer helped expand it in the early 20th century. Throughout its history, chiropractic has become controversial. Despite much evidence that vaccination is an effective public health intervention, among chiropractors there is significant disagreement over the subject, which has caused a negative impact on public vaccination and general chiropractic acceptance. The American Medical Association referred to chiropractic as an "unscientific cult" in 1966 and boycotted it until losing its antitrust case in 1987. Chiropractic has a strong political base and sustained service demand; in the last few decades, it has gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.
Video Chiropractic
Conceptual bases
Philosophy
Chiropractic is generally categorized as complementary and alternative medicine (CAM), which focuses on the manipulation of the musculoskeletal system, especially the spine. Its founder, D.D. Palmer, calling it "the science of healing without drugs".
The origins of Chiropractic lie in the traditional treatment of boneetting, and when it evolves, it incorporates vitalism, spiritual inspiration, and rationalism. Initial philosophy is based on the deduction of an undeniable doctrine, which helps distinguish chiropractic from drugs, provided with legal and political advocacy against the claims of unlicensed medical practice, and allows chiropractors to establish themselves as autonomous professions. This "straight" philosophy, taught to chiropractor generations, rejects the inferential reasoning of the scientific method, and relies on the deduction of the first vitalistic principles rather than on the materialism of science. However, most practitioners tend to incorporate scientific research into chiropractic, and most practitioners are "mixers" who seek to combine the materialistic reductionism of science with their predecessor metaphysics and with a holistic health paradigm. A 2008 commentary states that chiropractic actively broke away from a straight philosophy as part of a campaign to eliminate unobeyed dogma and engage in critical thinking and evidence-based research.
Although various ideas exist among chiropractors, they share the belief that the spine and health are linked in a fundamental way, and that these relationships are mediated through the nervous system. Some chiropractors claim spinal manipulation can have the effect of various diseases such as irritable bowel syndrome and asthma.
The chiropractic philosophy includes the following perspectives:
Holism assumes that health is influenced by everything in one's environment; some sources also include spiritual or existential dimensions. Conversely, reductionism in chiropractic reduces the causes and cures of health problems on one factor, vertebral subluxation. Homeostasis emphasizes the inherent self-healing ability of the body. The initial idea of ​​chiropractic on innate intelligence can be regarded 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 periphery profession. The chiropractic variant called naprapathy originated in Chicago in the early 20th century. He argues that soft-tissue manual manipulation can reduce "disturbance" in the body and thereby improve health.
Straights and mixers
Straight chiropractors adhere to the philosophical principles laid down by D.D. and B.J. Palmer, and maintain the metaphysical definition and vitalistic qualities. Chiropractors immediately believe that spinal subluxation causes a disturbance with "innate intelligence" provided through the human nervous system and is a major underlying risk factor for many diseases. Straights sees a medical diagnosis of a patient's complaint (which they perceive as a "secondary effect" of subluxation) to be unnecessary for chiropractic care. Thus, direct chiropractors are concerned primarily with the detection and correction of vertebral subluxation by adjustment and not "mixing" other types of therapy into their practice style. Their philosophy and explanation are metaphysical and they prefer to use traditional chiropractic lexicon terminology (for example, perform spinal analysis, detect subluxation, correct with adjustments). They prefer to remain separate and different from mainstream health care. Although regarded as a minority group, "they have been able to change their status as pure people and heirs of the lineage to a dramatic influence out of proportion to their numbers."
Mixer chiropractors "mix" diagnostic and treatment approaches from a chiropractic, medical and/or osteopathic perspective and form the majority of chiropractors. Unlike direct chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine. Many of them combine major medical diagnoses and use conventional treatments including physical therapy techniques such as exercise, stretching, massage, ice packs, electrical muscle stimulation, therapeutic ultrasound, and damp heat. Some mixers also use techniques from alternative medicine, including nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.
Although mixers are the majority, many retain confidence in vertebral subluxation as shown in the 2003 survey of 1100 North American chiropractors, who found that 88% wanted to retain the term "vertebral complex subluxation", and when asked to estimate the percent of internal organ disorders (such as heart, lungs, or stomach) that subluxation significantly contributes, the average response is 62%. A 2008 survey of 6,000 American chiropractors suggests that most chiropractors seem to believe that a subluxation-based clinical approach may be of limited utility to address visceral disorders, and it is well-liked that non-subluxation-based clinical approaches to such conditions. The same survey shows that most chiropractors generally believe that most of their clinical approaches to overcoming musculoskeletal/biomechanical disorders such as back pain are based on subluxation. Chiropractors often offer conventional therapies such as physical therapy and lifestyle counseling, and perhaps for the layman it is difficult to distinguish the unscientific from the scientific.
Vertebral subluxation
Palmer hypothesizes that the vertebral joint misalignment, which he calls vertebral subluxation, impairs the functioning of the body and its innate ability to heal itself. D. D. Palmer rejects his earlier theory that vertebral subluxation causes the nerve to be wedged in an intervertebral space in favor of subluxation causing a change of nerve vibration, too tense or too loose, affecting the tone (health) of the final organ. D. D. Palmer, using a vitalistic approach, is imbued with the term subluxation with metaphysical and philosophical meanings. He qualifies this by noting that knowledge of innate intelligence is not essential to the practice of competent chiropractic. This concept was later expanded by his son, B. J. Palmer, and was instrumental in providing a legal basis for distinguishing chiropractic from conventional medicines. In 1910, D. D. Palmer theorized that the health of the nervous system was controlled:
- "Physiologists divide the nerve fibers, which form the nerves, into two classes, afferent and efferent." Impressions are made at the ends of peripheral afferent fibers, creating a sensation transmitted to the central nervous system. "The efferent nerve fibers carry an outlet impulse from center to end Most of them get into the muscles and hence are called motor impulses, some of which are secretions and enter the gland, some are inhibition, their function is to withstand secretions, bring out impulses and sensations into this neural activity, or more precisely their fibers, can become excited or healed by impingement, the result is a modification of functionality - too much or not enough action - which is a disease. "
Vertebral subluxation, the traditional chiropractic core concept, remains unfounded and largely untested, and the debate over whether to defend it in the chiropractic paradigm has been going on for decades. In general, traditional chiropractic-based chiropractic criticism (including chiropractors) is skeptical of its clinical value, dogmatic beliefs and metaphysical approaches. While direct chiropractic still retains the traditional vitalistic constructs held by the founders, evidence-based chiropractic demonstrates that a mechanistic view will allow chiropractic care to be integrated into the broader health care community. It is still a source of ongoing debate in the chiropractic profession as well, with some chiropractic schools still teaching traditional/direct based subluxation chiropractic, while others have moved towards an evidence-based chiropractic that rejects metaphysical standpoints and limits itself to particularly neuromusculoskeletal conditions.
In 2005, chiropractic subluxation was defined by the World Health Organization as a "lesion or dysfunction in a joint or motion segment in which alignment, integrity of movement and/or physiological functions are altered, even though the contact between the joint surfaces remains intact.This is essentially a functional entity, affects 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 the patient to harmful ionizing radiation for no supported reason. Book 2008 Trick or Treatment states "X-rays can reveal both the subluxation and the innate intelligence associated with chiropractic philosophy, because they do not exist." Lawyer David Chapman-Smith, General Secretary of the World Chiropractic Federation, has stated that "Medical critics have asked how subluxation might be if not seen on X-rays.The answer is that chiropractic subluxation is essentially a functional entity, not a structural one, it is no more visible on static X-rays than limp or headaches or other functional problems. "The General Chiropractic Council, the legal watchdog for chiropractors in the UK, states that the complex subluxation of the chiropractic spine" is not supported by clinical research evidence that would allow claims which made it the cause of the disease. "
In 2014, the National Council of Chiropractic Examiners states: "The specific focus of chiropractic practice is known as chiropractic subluxation or joint dysfunction." Subluxation is a health problem manifested in bone joints, and, through complex anatomical and physiological relationships, affects the nervous system and can lead to reduced function, disability or disease. "
Maps Chiropractic
Scope of practice
Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of drugs or surgery, with special emphasis on the spine. Back and neck pain is a chiropractic specialty but many chiropractors treat diseases other than musculoskeletal problems. There are various opinions among chiropractors: some believe that treatment should be limited to the spine, or back and neck pain; others disagree. For example, while a 2009 survey of American chiropractors has found that 73% classified themselves as "back pain/musculoskeletal specialists", the label "back and neck pain specialists" was considered by 47% of them as the lowest > desirable description in international surveys 2005. Chiropractic combines aspects of mainstream and alternative medicine, and there is no agreement on how to define the profession: although chiropractors have many attributes of primary care providers, chiropractic has more attributes than medical specialties such as dentistry or podiatry. It has been proposed that chiropractor specialists specialize in nonsurgical spinal treatments, rather than trying to treat other problems, but the wider chiropractic view is still widespread.
Major health care and government organizations such as the World Health Organization consider chiropractic as complementary and alternative medicine (CAM); and a 2008 study reported that 31% of investigated chiropractic were categorized chiropractic as CAM, 27% as an integrated drug, and 12% as the main drug. Many chiropractors believe that they are the primary care providers, including US and UK chiropractors, but the length, breadth, and depth of chiropractic clinical training do not support the requirement to be considered primary care providers, so their role in primary care is limited and debatable.
Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine. Chiropractic is autonomous from and competes with mainstream drugs, and osteopathy outside the US remains primarily a manual medical system; Physical therapists work together and work closely with mainstream medicine, and osteopathic drugs in the US have joined the medical profession. Practitioners can differentiate this competitive approach through claims that, compared to other therapists, chiropractors greatly emphasize spinal manipulation, tend to use stronger manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machines and sports.
The diagnosis of chiropractic may involve a variety of methods including skeletal imaging, observational and tactile assessment, and orthopedic and neurologic evaluation. A chiropractor may also refer patients to a suitable specialist, or cooperate with other health care providers. General patient management involves spinal manipulation (SM) and other manual therapies for joints and soft tissues, rehabilitation exercises, health promotion, electrical modalities, complementary procedures, and lifestyle suggestions.
Chiropractors are typically not licensed to write medical prescriptions or conduct major operations in the United States, (though New Mexico has become the first US state to allow "practice trained" to train chiropractors to prescribe certain drugs.) In the US, the scope of their practice varies by country, based on the inconsistent view of chiropractic care: some countries, such as Iowa, extensively allow treatment of "human disease"; some, such as Delaware, use unclear concepts such as "nerve energy transition" to determine the scope of practice; others, such as New Jersey, determine a very narrow scope. US states are also different whether chiropractors can perform laboratory tests or diagnostic procedures, issue dietary supplements, or use other therapies such as homeopathy and acupuncture; in Oregon they can get certified for small operations and to give birth to children through natural childbirth. A 2003 survey of North American chiropractic experts found that a small percentage benefited to allow them to write prescriptions for over-the-counter medicines. A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription drugs as an advantage for chiropractic care.
Related fields, chiropractic animals, apply manual therapies to animals and are recognized in 40 US states, but are not recognized by the American Chiropractic Association as chiropractic. It's still controversial in certain segments of the veterinarian, and chiropractic profession.
There is no single profession that "has" spinal manipulation and there is little consensus as to which profession should manage SM, raising concerns by chiropractors that other medical doctors can "steal" SM procedures from chiropractors. The focus on evidence-based SM research has also raised concerns that the resulting practice guidelines may limit the scope of chiropractic practice for treating back and neck. Two US states (Washington and Arkansas) prohibit physical therapists from doing SM, some countries allow them to do so only if they have completed advanced training in BC, and some countries allow only chiropractors to do SM, or just chiropractors and doctors. Bills to ban non-chiropractors more than do BC are regularly introduced to the state legislature and are opposed by the organization of physical therapists.
Treatment
Spinal manipulation, called chiropractors as "spinal adjustment" or "chiropractic adjustment", is the most commonly used treatment in chiropractic care. Spinal manipulation is a passive manual maneuver in which a complex of three joints is taken over the normal range of movement, but not too far away to cause dislocation or damage to joints. The decisive factor is the dynamic impulse, which is a sudden force that causes audible release and attempts to increase range of motion of the joints. High speed, low-amplitude spinal manipulation (HVLA-SM) thrust has physiological effects that signal the release of nerves from paraspinal muscle tissue, depending on the duration and amplitude of the thrust is a degree factor in the activation of paraspinal muscle spindles. Clinical skills in using HVLA-SM encouragement depend on the practitioner's ability to handle the duration and magnitude of the load. More generally, spinal manipulative therapy (TTS) describes techniques in which the hand is used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise affect the spine and related tissues.
There are several schools of chiropractic adjustment techniques, although most chiropractic mix techniques are from some schools. The following adjustment procedures are accepted by more than 10% of US spinal expert licensed in the 2003 survey: Diversification Techniques (full spine manipulation, using various techniques), limb adjustments, Activator techniques (which use springs to convey proper adjustment for bone rear), Thompson Techniques (which rely on drop tables and detailed procedural protocols), Gonstead (which emphasizes evaluation of the spine along with special adjustments that avoid rotational vectors), Cox/flexion-interference (soft, low- force adjustment procedures that mix chiropractic with osteopathic principle and utilizing special adjustment tables with movable parts), adjustment instruments, Sacro-Occipital Techniques (which model the spine as a torque rod), Nimmo Receptor-Tonus Technique, applied kinesiology (which emphasizes "testing muscle" as a tool diagnostic), and cranial. Biophysical techniques Chiropractic uses inverse rotation function during spinal manipulation. Special Techniques Koren (KST) can use their hands, or they can use an electrical device known as "ArthroStim" for spinal assessment and manipulation. Insurers in the US and UK who include other chiropractic techniques exclude KST from coverage because they consider it to be "experimental and investigative". Drug-assisted manipulations, such as manipulation under anesthesia, involve sedation or local anesthesia and performed by a team that includes an anesthesiologist; a systematic review of 2008 found no sufficient evidence to make recommendations about its use for chronic back pain.
Many other procedures are used by chiropractors to treat spine, joints and other tissues, and general health problems. The following procedure is accepted by more than one-third of US bone pediatricians licensed in the 2003 survey: Diversification Techniques (full spine manipulation mentioned in previous paragraphs), physical fitness/exercise promotion, corrective or therapeutic exercises, ergonomic/postural suggestions, self-care strategies , daily life activities, changing risky/unhealthy behaviors, nutrition/dietary recommendations, relaxation/stress reduction recommendations, ice packs/cryotherapy, limb adjustments (also mentioned in the preceding paragraph), trigger point therapy, and disease prevention/suggestion suggestions early.
A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focused on neuromusculoskeletal complaints in adult patients, with emphasis on the spine. The diversification technique is the most commonly applied technique at 93%, followed by the Activator mechanical aid technique at 41%. A 2009 study assessing chiropractic students giving or receiving spinal manipulation while attending US chiropractic colleges found Diversified, Gonstead, and top cervical manipulations is a frequently used method.
Practice guide
Research research reviews in chiropractic communities have been used to produce practice guidelines that outline standards that define "legitimate" chiropractic care (ie supported by evidence) and may be substituted under managed health care payment systems. The evidence-based guidance is supported by one end of the ideological continuum between chiropractors; the other end uses antiscientific reasoning and makes unwarranted claims. Chiropractic stays at the crossroads, and for its advancement needs to embrace science; promotion by some to be medicine-all are "misdirected and irrational". A 2007 survey of Alberta chiropractic experts found that they did not consistently apply research in practice, which may be due to lack of education and research skills.
Effectiveness
There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for some types of back pain. Generally, research done into chiropractic effectiveness has poor quality. A number of controlled clinical studies of the treatments used by chiropractors have been conducted, with conflicting results. The research published by the chiropractors is clearly biased. For a review of chiropractic writers for back pain it tends to have a positive conclusion, while others do not show effectiveness.
There are various ways to measure treatment outcomes. Chiropractic care, like all medical treatments, benefits from a placebo response. It is difficult to establish a reliable placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether the proposed placebo actually has no effect. The efficacy of maintenance care in chiropractic is unknown.
The World Health Organization finds chiropractic care generally safe when used with skill and precision. There is not enough data to establish the safety of chiropractic manipulation. Manipulation is considered relatively safe but complications can arise, and have been known to be 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 that are known to cause unstable joints. Relative contraindications are conditions in which an increased risk is acceptable in some situations and where low-force and soft-tissue techniques are the treatment of choice; These contraindications include osteoporosis. Although most contraindications apply only to the manipulation of affected areas, some neurological signs indicate referral to emergency medical services; this includes sudden and severe headaches or severe neck pain not as experienced before. Chiropractic risk does not directly involve a delayed or wrong diagnosis through chiropractor consultation.
Spinal manipulation is associated with frequent, mild and transient side effects, including new or worsening pain or stiffness in the affected area. They have been estimated to occur in 33% to 61% of patients, and often occur within one hour of treatment and disappear within 24 to 48 hours; adverse reactions seem to be more common following manipulation rather than mobilization. The most common side effects are mild headache, pain, and increased pain. Chiropractic correlates with a very high incidence of minor side effects. Chiropractic is more often associated with serious side effects than other professionals after manipulation. Rarely, spinal manipulation, especially in the upper spine, can also lead to complications that can cause permanent disability or death; this can occur in adults and children. There is the case of a three-month-old man dying of manipulation of the neck area. Estimates vary widely for the occurrence of these complications, and actual events are unknown, due to high levels of unreported reporting and difficulty linking manipulations with adverse effects such as stroke, which is of particular concern. Adverse reactions are reportedly poor in a recent study investigating chiropractic manipulation. The 2016 systematic review concludes that reporting rates are inappropriate and unacceptable. Serious side effects reports have occurred, resulting from spinal manipulation 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, although it is determined that there is insufficient data to be conclusive. Several case reports suggest a temporal association between potentially serious interventions and complications. The published medical literature contains reports of 26 deaths since 1934 after chiropractic manipulation and many more that seem to remain unpublished.
Vertebrobasilar artery stroke (VAS) is statistically associated with chiropractic services in people under the age of 45, but it is also related to general practitioner services, suggesting that this association may be explained by pre-existing conditions. The evidence is weak and strong enough to support the cause (as compared to statistical relationship) between cervical manipulation therapy (CMT) and VAS. There is not sufficient evidence to support a strong relationship or no relationship between cervical manipulation and stroke. While biomechanical evidence is insufficient to support the assertion that CMT causes cervical artery dissection (CD), clinical reports indicate that mechanical strength has a share in a large number of CDs and the majority of population-controlled studies have found an association between CMT and VAS. in young people. It is strongly recommended that practitioners consider CD logic as a symptom, and people can be informed about the relationship between CD and CMT before administering the cervical spine. There is controversy regarding the risk of stroke from cervical manipulation. Many chiropractors claim that, the relationship between chiropractic therapy and vertebral artery dissection is not proven. However, it has been argued that the causality between chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is possible or definite. There is very low evidence that supports a small relationship between internal carotid artery dissection and chiropractic neck manipulation. The incidence of internal carotid artery dissection after cervical spine manipulation is unknown. Literature rarely reports useful data to better understand the relationship between cervical manipulation therapy, cervical artery dissection and stroke. Limited evidence can not be concluded that chiropractic spinal manipulation therapy is not a cause of intracranial hypotension. Intradural cervical herniation is very rare after spinal manipulation therapy.
Chiropractors, like other primary care providers, sometimes use diagnostic imaging techniques such as X-rays and CT scans that depend on ionizing radiation. Although there is no clear evidence for this practice, some chiropractors may still perform X-rays in patients several times a year. The practice guide aims to reduce unnecessary radiation exposure, which increases the risk of cancer in proportion to the amount of radiation received. Research shows that the radiological instructions given at chiropractic schools around the world seem to be evidence-based. Although, there seems to be a difference between some schools and available evidence regarding radiographic aspects for patients with acute lower back pain without any serious disease indication, which may contribute to chiropractic overuse of radiographs for lower back pain.
Benefits
A systematic review of 2012 concludes that there is no accurate assessment of the risk benefits for cervical manipulation. The systematic review 2010 states that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggests the precautionary principle in health care for chiropractic intervention even if causality with vertebral artery dissection after neck manipulation is only a remote possibility.. The same study concluded that the risk of death from manipulation to the neck outweighs its benefits. Chiropractors have criticized this conclusion, claiming that the authors did not evaluate the potential benefits of spinal manipulation. Edzard Ernst stated, "This detail is not the subject of my review, but I am referring to that evaluation and should add that the recent report commissioned by the General Cooprictics Council does not support many of the strange claims made by many chiropractors around the world."
A review of 2009 evaluating the care of chiropractic treatments found that spinal manipulation was routinely associated with considerable damage and there was no strong evidence to suggest that it was enough to prevent symptoms or illness, so the benefits of the risk did not prove beneficial.
Cost effectiveness
A 2012 systematic review suggests that the use of spinal manipulation in clinical practice is a cost-effective treatment when used alone or in combination with other treatment approaches. A systematic review of 2011 found evidence supporting the cost effectiveness of the use of spinal manipulation for the treatment of acute or chronic low back pain; the results for acute lower back pain are not sufficient.
A review of systematic cost-effectiveness in 2006 found that the cost effectiveness of reported spinal manipulation in the UK compared with other treatments for back pain, but the report was based on data from clinical trials without false control and specific cost effectiveness. treatment (compared with non-specific effects) remains uncertain. A 2005 systematic review of the economic evaluation of conservative care for low back pain finds that significant quality problems in available studies mean a definite uncorrelated conclusion about the most cost-effective interventions. The cost-effectiveness of chiropractic care treatment is unknown.
Analysis of clinical and cost-benefit data from 2003 to 2005 by independent medical doctors association (IPA) associations who looked at the use of chiropractic services found that clinical use and chiropractic service fees based on 70,274 month members over the 7- year period of patient cost reduction were associated with the use of the following services 60% for hospitalization, 59% for hospital days, 62% for surgery and outpatient procedures, and 85% for pharmaceutical costs when compared to conventional medicine (visit to primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame.
Education, licensing and regulation
Terms vary from country to country. In US chiropractors, get the first professional degree in chiropractic. Chiropractic education in the US has been criticized for failing to meet generally accepted standards for evidence-based medicine. The curriculum contents of chiropractic and North American medical academies related to fundamental and clinical sciences are more similar than not, both in the types of subjects offered and within the time set for each subject. The accredited chiropractic program in the US requires 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 many more require a bachelor's degree. Canada requires a minimum of three years of education for applicants, and at least 4200 hours of learning (or equivalent) of full-time chiropractic education for matriculation through an accredited chiropractic program. Graduates of the Canadian Memorial Chiropractic College (CMCC) are officially recognized to have at least 7-8 years of university-level education. The World Health Organization (WHO) guidelines recommend three full-time primary education paths culminating in a DC, DCM, BSc, or MSc degree. In addition to the full-time line, they also suggest a conversion program for people with other health care education and limited training programs for areas where there is no legislation governing chiropractic.
After graduation, there may be a requirement to pass national, state or provincial board exams before being licensed to practice in certain jurisdictions. Depending on location, continuing education may be required to renew this license. Specialized 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 US, chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the official government agency responsible for chiropractic regulation in the UK. CCE AS requires a mixing curriculum, which means a well-educated chiropractor may not be eligible for a license in a state requiring CCE accreditation. CCE in the US, Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a standard model of accreditation with the aim of having international portable credentials. Currently, there are 18 Accredited Chopsticks Doctors programs in the US, 2 in Canada, 6 in Australasia, and 5 in Europe. All but one of the chiropractic colleges in the US are privately funded, but in some 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, the CMCC was granted the privilege of offering a professional health care degree under the Preferences and Excellence Act of Post-Secondary Education, which sets programs in the hierarchy of education in Canada comparable to other major contact care professions such as medicine, dentistry and optometry.
Educational institutions and chiropractic councils in the US, Canada, Mexico and Australia are responsible for protecting the public, practice standards, discipline issues, quality assurance and competency maintenance. There are approximately 49,000 chiropractors in the US (2008), 6,500 in Canada (2010), 2,500 in Australia (2000), and 1,500 in the UK (2000).
Chiropractors often argue that education is as good or better than medical doctors, but most chiropractic training is limited to the classroom with much time spent learning theory, adjustment, and marketing. The fourth year of chiropractic education constantly shows the highest levels of stress. Every student, regardless of the year, experiences different stress ranges when learning. Chiropractic leaders and academics have experienced internal struggles. Instead of working together, there is a different dispute between factions. A number of acts bounce off due to the secret nature of the chiropractic college in an attempt to enroll students.
Ethics
The chiropractic vows are a modern variation of the classic Hippocratic Oath that historically was taken by doctors and other health care professionals who vowed to practice their profession ethically. The American Chiropractic Association (ACA) has a code of ethics "based on the recognition that social contracts dictate professional responsibilities to patients, the public, and the profession, and uphold the basic principles that the main goal of professional service of chiropractic physicians will benefit patients." International Chiropractor Association (ICA) also has a professional canon set.
A 2008 commentary proposed that the chiropractic profession actively organize itself to combat abuse, fraud, and shamanism, which is more prevalent in chiropractic than other health care professions, breaking social contracts between patients and doctors. According to a Gallup poll of 2015 for US adults, chiropractor perception is generally advantageous; two thirds of American adults agree that chiropractors have the best interests of their patients in mind and more than half also agree that most chiropractors can be trusted. Fewer than 10% of US adults disagree with the claim that chiropractors can be trusted.
Chiropractors, especially in America, have a reputation for caring for unnecessary patients. In many circumstances, the focus seems to be on economic rather than health care. Ongoing chiropractic care is promoted as a prevention tool, but unnecessary manipulation may pose a risk to the patient. Some chiropractors are concerned with the routines of the chiropractors who have been justified. Analysis of chiropractic sites in 2010 found that the majority of chiropractors and their associates make claims of effectiveness unsupported by scientific evidence, while 28% of chiropractor websites advocate the treatment of low back pain, which has some strong evidence.
The Office of the US Inspector General (OIG) estimates that for the calendar year 2013, 82% of payments to chiropractors under Medicare part B, total $ 359 million, do not comply with Medicare requirements. There are at least 15 OIG reports about chiropractic billing aberrations since 1986.
In 2009, the reaction to the defamation lawsuit filed by the British Chiropractic Association (BCA) against Simon Singh, has inspired the filing of official false advertising complaints against more than 500 individual chiropractors in a 24-hour period, prompting the McTimoney Chiropractic Association to write to its members advise them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and questions by phone, and notify its members: "If you have a website, stop now NOW." and "Finally, we strongly recommend that you NOT discuss this with others, especially patients." An editorial in Nature has suggested that BCA might try to suppress the debate and that the use of the defamation laws of Britain is a burden on the right to freedom of expression, protected by the European Convention on Human Rights. The case of defamation ended with BCA revoking its lawsuit in 2010.
Reception
Chiropractic is established in the US, Canada, and Australia, and is present at lower levels in many other countries. It is seen as an alternative health care complementary and marginal treatment, which has not yet been integrated into the mainstream treatment. They are the third largest medical profession, following doctors and dentists. Billions are spent annually for chiropractic services.
Australia
In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when patients are referred by medical practitioners.
United Kingdom
In the UK chiropractic is available at the National Health Service in some areas, such as Cornwall where treatments are only available for neck or back pain.
A 2010 study by a questionnaire presented to British chiropractors showed only 45% of chiropractors were disclosed with patients at serious risk associated with cervical spine manipulation and that 46% believed there was a possibility that patients would refuse treatment if the risks were properly defined. Yet 80% recognize ethical/moral responsibility to disclose risks to patients.
United States and Canada
The percentage of population utilizing chiropractic care at a given time generally falls into the range from 6% to 12% in the US and Canada, with a global high of 20% in Alberta in 2006. In 2008, chiropractors reportedly became the most common CAM provider for children. children and adolescents, spending up to 14% of all visits to chiropractors. In 2008, there were about 60,000 chiropractic practitioners practicing in North America. In 2002-03, the majority of those seeking chiropractic did so to relieve back and neck pain and other neuromusculoskeletal complaints; mostly done specifically for lower back pain. The majority of US chiropractors participate in some form of managed care. Although the majority of US chiropractors view themselves as specialists in conditions of malignant neuroleptic syndrome, many also consider chiropractic as a primary treatment type. In most cases, the care provided by chiropractors and doctors to divide the market, but for some people, their care is complementary.
In the US, chiropractors perform more than 90% of all manipulative treatments. The level of satisfaction is usually higher for chiropractic care than with medical care, with a 1998 US survey reporting 83% of respondents satisfied or very satisfied with their care; the quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.
The utilization of chiropractic care is sensitive to the costs incurred by co-payments by patients. The use of chiropractic decreased from 9.9% of US adults in 1997 to 7.4% in 2002; this is the largest relative decline among CAM professions, which overall has a stable level of usage. In 2007 7% of the US population was being reached by chiropractic. The work of the US chiropractor is expected to increase by 14% between 2006 and 2016, faster than the average for all jobs.
In the US, most countries require insurance companies to cover chiropractic care, and most HMOs cover this service.
History
Chiropractic was founded in 1895 by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesizes that manual manipulation of the spine can cure disease. The first chiropractic patient D.D. Palmer is Harvey Lillard, a worker in the building where Palmer's office is located. He claims that he has greatly reduced his hearing for 17 years, which begins soon after "pop" in his spine. A few days after his adjustment, Lillard claimed his hearing almost completely recovered. Chiropractic competes with its predecessor osteopathy, another medical system based on magnetic healing and bone repeater; both systems were established by charismatic midwesterners opposed to conventional treatment that day, and both postulated that manipulation improves health. Although originally preserved chiropractic as a family secret, in 1898 Palmer began teaching it to several students at the new Palmer School of Chiropractic. A student, his son Bartlett Joshua (B.J.) Palmer, committed to promoting chiropractic, took over the Palmer School in 1906, and quickly expanded its enrollment.
Initial chiropractors believe that all illnesses are caused by a disturbance in the inborn intelligence flow, vital nerve energy or life force that represents God's presence in humans; Chiropractic leaders often bring up religious images and moral traditions. DD. Palmer said he "received chiropractic from another world". DD. and B.J. both seriously consider expressing chiropractic as a religion, which may have provided legal protection under the US constitution, but decided not to do so in part to avoid confusion with Christian Science. The early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertising, aligning themselves with ordinary people against intellectuals and beliefs, including the American Medical Association (AMA).
Chiropractic has seen a lot of controversy and criticism. Although D.D. and B.J. "straight" and underestimated the use of instruments, some early chiropractors, roughly called BLE "mixers", advocated the use of instruments. In 1910, B.J. altering the course and supporting X-rays necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students. Camp mixers grew until 1924 B. J. estimated that only 3,000 of 25,000 US chiropractors remained aligned. That year, the discovery and promotion of BBJ from neurocalometers, temperature sensing devices, was highly controversial among B.J. In the 1930s, chiropractic was the largest alternative healing profession in the United States.
Chiropractors face severe opposition from organized drugs. DD Palmer was jailed in 1907 for practicing medicine without a license. Thousands of chiropractors are prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed. To defend against medical laws, B.J. argues that chiropractic is separate and distinct from medicine, affirming that chiropractors "are analyzed" rather than "diagnosed", and "adapted" subluxation rather than "treated" diseases. B.J. founded the Universal Chiropractic Association (UCA) to provide legal services to the captured chiropractors. Although UCA won their first trial in Wisconsin in 1907, prosecutions triggered by the state medical board became increasingly common and in many cases successful. In response, the chiropractors conducted political campaigns to obtain separate licensing laws, eventually succeeding in all fifty states, from Kansas in 1913 to Louisiana in 1974. The old dispute between chiropractors and doctors has continued for decades. The AMA labeled chiropractic as an "unscientific cult" in 1966, and until 1980 advised its members that it was unethical for physicians to associate with "unscientific practitioners". This culminated in an important decision of 1987, Wilk v. AMA , in which the court found that the AMA has engaged in unreasonable trade and conspiracy controls, and which ended the de facto AMA boycott of chiropractic.
Serious research to test chiropractic theory did not begin until the 1970s, and continues to be hampered by scientific and pseudoscientific ideas that retain the profession in long combat with organized drugs. In the mid-1990s there was an increasing scientific interest in chiropractic, which aided efforts to improve the quality of care and established clinical guidelines recommending manual therapy for acute lower back pain. In recent decades chiropractic has gained greater legitimacy and acceptance by medical doctors and health plans, and enjoys a strong political base and sustained service demand. However, his future looks uncertain: as the number of practitioners increases, evidence-based medicine insists on care with the values ​​shown, managed care payments are limited, and competition grows from massage therapists and other healthcare professionals. This profession responds by marketing products and devices more naturally aggressively, and by reaching further into alternative medicine and primary care.
The word chiropractic comes from the Greek ????? - chiro - (own from "cheir " hand ")," hand "and" praktos , "practical". Chiropractic is classified as a pseudomedicine field because of its esoteric origin.
Public health
Some chiropractors oppose vaccinations and water fluoridation, which is a public health practice. In the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available. Most chiropractic writing on vaccination focuses on its negative aspect, claiming that it is dangerous, ineffective, and unnecessary. Some chiropractors have received vaccinations, but most professions reject them, because the original chiropractic philosophy traces the spinal cord disease and states that the vaccine interferes 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 exceptions to mandatory vaccination laws, and a 1995 US chiropractic expert survey found that about a third believe there is no scientific evidence that immunization prevents disease. Canadian Chiropractic Association supports vaccination; a survey in Alberta in 2002 found that 25% of chiropractors advised patients to, and 27% resist, vaccinate themselves or their children.
Initial opposition to water fluoridation includes chiropractors, some of whom continue to oppose it as incompatible with chiropractic philosophy and violation of personal freedom. Other chiropracticians have actively promoted fluoridation, and some chiropractic organizations have endorsed the scientific principles of public health. In addition to traditional chiropractic opposition to water fluoridation and vaccination, the efforts of chiropractors to build a positive reputation for their public health role are also compromised by their reputation for recommending repeated chiropractic lifetime treatment.
Controversy
Throughout the history of chiropractic has been the subject of controversy and internal and external criticism. According to Daniel D. Palmer, founder of chiropractic, subluxation is the only cause of disease and manipulation is a cure for all human diseases. A 2003 professional survey found "most chiropractors (whether 'straight' or 'mixers') still have a congenital Intelligence view and the causes and cures of disease (not just back pain) that are consistent with those of the Palmers." A critical evaluation says "Chiropractic is rooted in a mystical concept, causing internal conflict in the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, jailed for practicing medicine without a license. For the most part, chiropractic has struggled with mainstream medicine, underpinned by antifientific and pseudoscientific ideas such as subluxation. Collectively, a systematic review has not shown that spinal manipulation, the main treatment method used 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 previous years.
See also
- List of topics that are characterized as pseudoscience
- Chiropractic education
- School chiropractic
- The Chiropractic International Education Council
- Tool toftness
- World Chiropractic Federation
References
Further reading
- Long PH (2013). Barrett S, ed. Chiropractic Abuse: An Insider's Lament . American Council on Science & amp; Health. ISBN 978-0-9727094-9-1.
- Homola S (2002). Shermer M, ed. Chiropractic: Conventional or Alternative Healing? . The Skeptic Encyclopedia of Pseudoscience . 1 . ABC-CLIO. pp.Ã, 308-. ISBN: 978-1-57607-653-8.
- Menke JM (January 2014). "Does Manual Therapy Help Low Back Pain?: An Analysis of Comparative Effectiveness". Spine (Meta-analysis). 39 (7): E463-72. doi: 10.1097/BRS.0000000000000230. PMID 24480940.
External links
- Chiropractic in Curlie (based on DMOZ)
Source of the article : Wikipedia
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