are chiropractors doctors

are chiropractors doctors

are chiropractors doctors
are chiropractors doctors

Chiropractors attend graduate-level health colleges to treat disorders of the bones, nerves, muscles, and ligaments. They graduate as doctors of chiropractic degrees, but they are not medical doctors.

While chiropractors are widely known for treating back and neck pain, they also treat bone and soft tissue conditions.

In this article, we explore myths and truths of chiropractic care. We also describe the training that chiropractors undergo, how safe these treatments may be, and the research behind the practice.

A common myth is that chiropractors do not undergo a significant amount of training.

In fact, they typically complete about 8 years of higher education before they are licensed.

are chiropractors doctors

Chiropractors tend to have 4 years of undergraduate education.

They usually graduate with a pre-med major after having taken courses in sciences, such as biology, chemistry, psychology, and physics.

They then attend a chiropractic graduate program. On average, these involve 4 years of education with a total of 4,200 instructional hours in course credits.

Divided by year, a chiropractic graduate program usually involves:

Other studies often accompany those mentioned above.

After completing the educational and training requirements, an aspiring chiropractor in the United States will sit for their state licensing board. Once they have obtained licensure and certification from the board, they will become a doctor of chiropractic.

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  • Chiropractors often receive additional training and certification in a wide variety of specialties, including nutrition, sports medicine, acupuncture, and rehabilitation.

    According to the American Chiropractic Association, the average chiropractic program involves as many classroom hours as a program that trains medical doctors.

    Another common myth is that a chiropractor merely cracks a person’s back or bones.

    Chiropractic care is centered around spinal manipulation. However, practitioners also study how the spine and its structures are related to the body’s function.

    A majority of a chiropractor’s work involves making adjustments to heal:

    They may also provide services such as postural testing and analysis, as well as others designed to promote nutrition and healthful exercise.

    According to the National Center for Complementary and Integrative Health in the U.S., chiropractic therapy is the type most commonly used for back pain. An estimated 74 percent of Americans with pain in this area have used chiropractic care at some point in their treatment.

    Results of a 2010 review cited by the center suggest that spinal manipulation may be useful for treating back pain, migraine headaches, whiplash, and other conditions affecting the upper and lower extremities.

    Like other forms of treatment, chiropractic care will not benefit all injuries. Sessions should be tailored to a person’s needs and performed by a licensed chiropractor.

    Several myths surround this question. One myth is that chiropractors only treat back pain. In fact, chiropractic care can also help to heal pain in the foot, elbow, shoulder, and neck.

    The same review cited by the National Center for Complementary and Integrative Health concluded that chiropractic treatment is not useful in treating:

    Authors of the review failed to find definitive evidence that chiropractic care treated musculoskeletal conditions, such as fibromyalgia, temporomandibular joint disorders, and mid-back pain.

    Chiropractors also do not treat traumatic injuries, such as bone fractures. A chiropractor will usually perform an X-ray to ensure that treatment will not worsen a traumatic injury.

    A 2018 review included 17 years of studies involving spinal manipulation and mobilization, which is a more passive form of manipulation.

    The studies investigated the effects of these treatments on chronic lower back pain, and the authors concluded that the chiropractic methods were “viable” options for pain management.

    A 2017 review examined the effectiveness of spinal manipulation in treating lower back pain.

    The authors concluded that treatment improved both function and pain for up to 6 weeks.

    The American College of Physicians recommend that those with lower back pain use a variety of non-pharmacological treatments, including spinal manipulation.

    Researchers generally agree that more studies are needed to determine the ideal length and frequency of chiropractic sessions and to identify what injuries may benefit from specific treatments.

    One of the most common sources of contention regarding chiropractic treatments concerns safety.

    A person may experience side effects of spinal manipulation, including:

    There have been occasional reports of long-term danger related to chiropractic care.

    The National Center for Complementary and Integrative Health reports that severe complications may include worsening pain and cauda equina syndrome, which involves nerve damage in the lower spinal cord.

    According to the American Chiropractic Association, most discomfort and soreness subsides within 24 hours of spinal manipulation.

    The World Health Organization (WHO) state that it is unsafe for people with certain health conditions to undergo chiropractic manipulation. These conditions include:

    An aspiring chiropractor must spend thousands of hours studying before obtaining a license. In 2016, an estimated 47,400 chiropractors were practicing in the U.S., according to the country’s Bureau of Labor Statistics.

    Chiropractic care is drug-free and non-invasive, and it may treat some musculoskeletal problems. While this form of alternative medicine may not benefit everyone, it is generally considered safe for most people.

    Last medically reviewed on June 6, 2018

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    If you have an aching back or a stiff neck, you might benefit from chiropractic adjustment. Chiropractors are trained medical professionals who use their hands to relieve pain in the spine and other areas of the body.

    Are chiropractors doctors, though? Here’s more information about what these providers do, the training they receive, and what you can expect at your first appointment.

    Chiropractors don’t hold medical degrees, so they aren’t medical doctors. They do have extensive training in chiropractic care and are licensed practitioners.

    Chiropractors begin their education by getting an undergraduate degree with a focus on the sciences. After graduation, they move on to a 4-year chiropractic program with classes and hands-on experience.

    All states in the United States require that chiropractors obtain a doctor of chiropractic degree from a Council on Chiropractic Education (CCE) accredited college.

    are chiropractors doctors

    Some chiropractors choose to specialize in a certain area. They do an additional residency that lasts between 2 and 3 years. There are over 100 different chiropractic methods. No one method is necessarily better than another.

    Some chiropractors choose to specialize in several different areas, which they may describe as using “diversified” or “integrated” techniques.

    Regardless of specialty, all chiropractors must obtain a license to practice by taking an exam. They must also keep current in the field by taking regular continuing education classes.

    There are over 70,000 licensed chiropractors working in the United States today. These practitioners treat various issues and conditions involving the:

    During treatment, your provider performs what are called manipulations using their hands or small instruments. The manipulations to the different parts of the body help with a range of discomforts, including:

    You may be surprised to learn that chiropractors can treat conditions ranging from constipation to infant colic to acid reflux.

  • 21 celsius to fahrenheit
  • Pregnant women may even seek chiropractic care near delivery time. Chiropractors specializing in the Webster technique work to realign the pelvis, which may help baby get into a good position (head down) for vaginal delivery.

    Overall, chiropractors may work to provide holistic treatment, meaning they are treating the whole body and not just the specific ache or pain. Treatment is typically ongoing. You will likely see your chiropractor more than once or twice to manage your condition.

    Your first visit to the chiropractor will likely consist of giving your medical history and having a physical exam. Your provider may even call for additional tests, like an X-ray, to rule out fractures and other conditions.

    From there, your chiropractor may start with the adjustment. You’ll likely sit or lie down on a specially designed, padded table for the treatment.

    You may be directed to move into different positions throughout the appointment, so the chiropractor can treat specific areas of your body. Don’t be surprised if you hear popping or cracking sounds as your chiropractor applies controlled pressure to your joints.

    Wear loose fitting, comfortable clothing to your appointment, and remove jewelry before the practitioner begins. In most cases, a chiropractor can perform all of the necessary adjustments without you needing to change out of your clothing into a hospital gown.

    After your appointment, you may experience headaches or feel tired. The areas your chiropractor manipulated may also feel sore for a while after treatment. These side effects are mild and temporary.

    Sometimes, your chiropractor will prescribe corrective exercises for you to do outside of your appointments.

    Your practitioner may also give you lifestyle advice, like nutrition and exercise suggestions. They may incorporate complementary medicine, like acupuncture or homeopathy, into your treatment plan as well.

    The scope of what a chiropractor’s license allows them to do varies by state. In some states, chiropractors may order diagnostic tests, including imaging and laboratory tests.

    There are very few risks of chiropractic adjustment when it’s performed by a licensed professional. In rare cases, you might experience compression of nerves or disk herniation in the spine. Stroke is another rare but serious complication that can happen after neck manipulation.

    There are also conditions for which you shouldn’t necessarily seek chiropractic care.

    For example, you may want to talk to a primary care doctor before seeing a chiropractor if you’ve experienced numbness or loss of strength in your arm or leg. These symptoms may require a procedure beyond a chiropractor’s scope.

    Other conditions that may require different treatment include:

    If you don’t know if chiropractic treatment is appropriate for your condition, ask your doctor.

    Finding a good chiropractor may be as easy as asking around. Your current primary care physician or even a friend may be able to point you in the right direction.

    You can also use the Find a Doctor tool on the American Chiropractic Association’s website to find licensed chiropractors across the United States.

    Years ago, chiropractic care was included in many health insurance plans. These days, not all medical insurance carriers cover these appointments.

    Before making your first appointment, call your health insurance provider directly to find out your plan’s coverage, as well as copays or deductibles. Your insurance provider may also require a referral from your primary care provider.

    Many health insurers cover chiropractic care for short-term conditions. However, they may not cover this care for long-term conditions or maintenance treatments.

    Over two dozen states also cover chiropractic appointments through Medicare.

    Without coverage, your first appointment may cost around $160, depending on the tests you need. Follow-up appointments may range between $50 and $90 each. The cost will depend on your area and the treatments you receive.

    A licensed chiropractor may be able to help you if you’re experiencing pain in your:

    If your symptoms don’t get better after several weeks, you may want to reevaluate your treatment plan.

    Before you start chiropractic treatment, you may want to ask your practitioner the following questions:

    Be sure to tell your chiropractor about any prescription and over-the-counter medications or supplements you are taking.

    It’s also a good idea to mention any other complementary health treatments you’re using. Giving your chiropractor all this information upfront will make your care safer and more effective.

    Last medically reviewed on June 12, 2020

    Medicare coverers chiropractic care for a specific diagnosis. Medicare Part B covers this care as well as some Advantage and Medigap plans.

    are chiropractors doctors

    Both physical therapy, also known as physiotherapy, and chiropractic care focus on managing pain and other symptoms using noninvasive techniques. Both…

    The Y strap is a specialized chiropractic tool that can be used to decompress the vertebrae of the spine. Learn how it’s used, what the research says…

    Chiropractors use hands-on manipulations to realign your joints and relieve discomfort from a wide range of causes. Learn more about the benefits.

    OUR BRANDS

    If you have an aching back or a stiff neck, you might benefit from chiropractic adjustment. Chiropractors are trained medical professionals who use their hands to relieve pain in the spine and other areas of the body.

    Are chiropractors doctors, though? Here’s more information about what these providers do, the training they receive, and what you can expect at your first appointment.

    Chiropractors don’t hold medical degrees, so they aren’t medical doctors. They do have extensive training in chiropractic care and are licensed practitioners.

    Chiropractors begin their education by getting an undergraduate degree with a focus on the sciences. After graduation, they move on to a 4-year chiropractic program with classes and hands-on experience.

    All states in the United States require that chiropractors obtain a doctor of chiropractic degree from a Council on Chiropractic Education (CCE) accredited college.

    are chiropractors doctors

    Some chiropractors choose to specialize in a certain area. They do an additional residency that lasts between 2 and 3 years. There are over 100 different chiropractic methods. No one method is necessarily better than another.

    Some chiropractors choose to specialize in several different areas, which they may describe as using “diversified” or “integrated” techniques.

    Regardless of specialty, all chiropractors must obtain a license to practice by taking an exam. They must also keep current in the field by taking regular continuing education classes.

    There are over 70,000 licensed chiropractors working in the United States today. These practitioners treat various issues and conditions involving the:

    During treatment, your provider performs what are called manipulations using their hands or small instruments. The manipulations to the different parts of the body help with a range of discomforts, including:

    You may be surprised to learn that chiropractors can treat conditions ranging from constipation to infant colic to acid reflux.

  • bernese mountain dog lifespan
  • Pregnant women may even seek chiropractic care near delivery time. Chiropractors specializing in the Webster technique work to realign the pelvis, which may help baby get into a good position (head down) for vaginal delivery.

    Overall, chiropractors may work to provide holistic treatment, meaning they are treating the whole body and not just the specific ache or pain. Treatment is typically ongoing. You will likely see your chiropractor more than once or twice to manage your condition.

    Your first visit to the chiropractor will likely consist of giving your medical history and having a physical exam. Your provider may even call for additional tests, like an X-ray, to rule out fractures and other conditions.

    From there, your chiropractor may start with the adjustment. You’ll likely sit or lie down on a specially designed, padded table for the treatment.

    You may be directed to move into different positions throughout the appointment, so the chiropractor can treat specific areas of your body. Don’t be surprised if you hear popping or cracking sounds as your chiropractor applies controlled pressure to your joints.

    Wear loose fitting, comfortable clothing to your appointment, and remove jewelry before the practitioner begins. In most cases, a chiropractor can perform all of the necessary adjustments without you needing to change out of your clothing into a hospital gown.

    After your appointment, you may experience headaches or feel tired. The areas your chiropractor manipulated may also feel sore for a while after treatment. These side effects are mild and temporary.

    Sometimes, your chiropractor will prescribe corrective exercises for you to do outside of your appointments.

    Your practitioner may also give you lifestyle advice, like nutrition and exercise suggestions. They may incorporate complementary medicine, like acupuncture or homeopathy, into your treatment plan as well.

    The scope of what a chiropractor’s license allows them to do varies by state. In some states, chiropractors may order diagnostic tests, including imaging and laboratory tests.

    There are very few risks of chiropractic adjustment when it’s performed by a licensed professional. In rare cases, you might experience compression of nerves or disk herniation in the spine. Stroke is another rare but serious complication that can happen after neck manipulation.

    There are also conditions for which you shouldn’t necessarily seek chiropractic care.

    For example, you may want to talk to a primary care doctor before seeing a chiropractor if you’ve experienced numbness or loss of strength in your arm or leg. These symptoms may require a procedure beyond a chiropractor’s scope.

    Other conditions that may require different treatment include:

    If you don’t know if chiropractic treatment is appropriate for your condition, ask your doctor.

    Finding a good chiropractor may be as easy as asking around. Your current primary care physician or even a friend may be able to point you in the right direction.

    You can also use the Find a Doctor tool on the American Chiropractic Association’s website to find licensed chiropractors across the United States.

    Years ago, chiropractic care was included in many health insurance plans. These days, not all medical insurance carriers cover these appointments.

    Before making your first appointment, call your health insurance provider directly to find out your plan’s coverage, as well as copays or deductibles. Your insurance provider may also require a referral from your primary care provider.

    Many health insurers cover chiropractic care for short-term conditions. However, they may not cover this care for long-term conditions or maintenance treatments.

    Over two dozen states also cover chiropractic appointments through Medicare.

    Without coverage, your first appointment may cost around $160, depending on the tests you need. Follow-up appointments may range between $50 and $90 each. The cost will depend on your area and the treatments you receive.

    A licensed chiropractor may be able to help you if you’re experiencing pain in your:

    If your symptoms don’t get better after several weeks, you may want to reevaluate your treatment plan.

    Before you start chiropractic treatment, you may want to ask your practitioner the following questions:

    Be sure to tell your chiropractor about any prescription and over-the-counter medications or supplements you are taking.

    It’s also a good idea to mention any other complementary health treatments you’re using. Giving your chiropractor all this information upfront will make your care safer and more effective.

    Last medically reviewed on June 12, 2020

    Medicare coverers chiropractic care for a specific diagnosis. Medicare Part B covers this care as well as some Advantage and Medigap plans.

    are chiropractors doctors

    Both physical therapy, also known as physiotherapy, and chiropractic care focus on managing pain and other symptoms using noninvasive techniques. Both…

    The Y strap is a specialized chiropractic tool that can be used to decompress the vertebrae of the spine. Learn how it’s used, what the research says…

    Chiropractors use hands-on manipulations to realign your joints and relieve discomfort from a wide range of causes. Learn more about the benefits.

    OUR BRANDS

    If you have an aching back or a stiff neck, you might benefit from chiropractic adjustment. Chiropractors are trained medical professionals who use their hands to relieve pain in the spine and other areas of the body.

    Are chiropractors doctors, though? Here’s more information about what these providers do, the training they receive, and what you can expect at your first appointment.

    Chiropractors don’t hold medical degrees, so they aren’t medical doctors. They do have extensive training in chiropractic care and are licensed practitioners.

    Chiropractors begin their education by getting an undergraduate degree with a focus on the sciences. After graduation, they move on to a 4-year chiropractic program with classes and hands-on experience.

    All states in the United States require that chiropractors obtain a doctor of chiropractic degree from a Council on Chiropractic Education (CCE) accredited college.

    are chiropractors doctors

    Some chiropractors choose to specialize in a certain area. They do an additional residency that lasts between 2 and 3 years. There are over 100 different chiropractic methods. No one method is necessarily better than another.

    Some chiropractors choose to specialize in several different areas, which they may describe as using “diversified” or “integrated” techniques.

    Regardless of specialty, all chiropractors must obtain a license to practice by taking an exam. They must also keep current in the field by taking regular continuing education classes.

    There are over 70,000 licensed chiropractors working in the United States today. These practitioners treat various issues and conditions involving the:

    During treatment, your provider performs what are called manipulations using their hands or small instruments. The manipulations to the different parts of the body help with a range of discomforts, including:

    You may be surprised to learn that chiropractors can treat conditions ranging from constipation to infant colic to acid reflux.

  • 81×9
  • Pregnant women may even seek chiropractic care near delivery time. Chiropractors specializing in the Webster technique work to realign the pelvis, which may help baby get into a good position (head down) for vaginal delivery.

    Overall, chiropractors may work to provide holistic treatment, meaning they are treating the whole body and not just the specific ache or pain. Treatment is typically ongoing. You will likely see your chiropractor more than once or twice to manage your condition.

    Your first visit to the chiropractor will likely consist of giving your medical history and having a physical exam. Your provider may even call for additional tests, like an X-ray, to rule out fractures and other conditions.

    From there, your chiropractor may start with the adjustment. You’ll likely sit or lie down on a specially designed, padded table for the treatment.

    You may be directed to move into different positions throughout the appointment, so the chiropractor can treat specific areas of your body. Don’t be surprised if you hear popping or cracking sounds as your chiropractor applies controlled pressure to your joints.

    Wear loose fitting, comfortable clothing to your appointment, and remove jewelry before the practitioner begins. In most cases, a chiropractor can perform all of the necessary adjustments without you needing to change out of your clothing into a hospital gown.

    After your appointment, you may experience headaches or feel tired. The areas your chiropractor manipulated may also feel sore for a while after treatment. These side effects are mild and temporary.

    Sometimes, your chiropractor will prescribe corrective exercises for you to do outside of your appointments.

    Your practitioner may also give you lifestyle advice, like nutrition and exercise suggestions. They may incorporate complementary medicine, like acupuncture or homeopathy, into your treatment plan as well.

    The scope of what a chiropractor’s license allows them to do varies by state. In some states, chiropractors may order diagnostic tests, including imaging and laboratory tests.

    There are very few risks of chiropractic adjustment when it’s performed by a licensed professional. In rare cases, you might experience compression of nerves or disk herniation in the spine. Stroke is another rare but serious complication that can happen after neck manipulation.

    There are also conditions for which you shouldn’t necessarily seek chiropractic care.

    For example, you may want to talk to a primary care doctor before seeing a chiropractor if you’ve experienced numbness or loss of strength in your arm or leg. These symptoms may require a procedure beyond a chiropractor’s scope.

    Other conditions that may require different treatment include:

    If you don’t know if chiropractic treatment is appropriate for your condition, ask your doctor.

    Finding a good chiropractor may be as easy as asking around. Your current primary care physician or even a friend may be able to point you in the right direction.

    You can also use the Find a Doctor tool on the American Chiropractic Association’s website to find licensed chiropractors across the United States.

    Years ago, chiropractic care was included in many health insurance plans. These days, not all medical insurance carriers cover these appointments.

    Before making your first appointment, call your health insurance provider directly to find out your plan’s coverage, as well as copays or deductibles. Your insurance provider may also require a referral from your primary care provider.

    Many health insurers cover chiropractic care for short-term conditions. However, they may not cover this care for long-term conditions or maintenance treatments.

    Over two dozen states also cover chiropractic appointments through Medicare.

    Without coverage, your first appointment may cost around $160, depending on the tests you need. Follow-up appointments may range between $50 and $90 each. The cost will depend on your area and the treatments you receive.

    A licensed chiropractor may be able to help you if you’re experiencing pain in your:

    If your symptoms don’t get better after several weeks, you may want to reevaluate your treatment plan.

    Before you start chiropractic treatment, you may want to ask your practitioner the following questions:

    Be sure to tell your chiropractor about any prescription and over-the-counter medications or supplements you are taking.

    It’s also a good idea to mention any other complementary health treatments you’re using. Giving your chiropractor all this information upfront will make your care safer and more effective.

    Last medically reviewed on June 12, 2020

    Medicare coverers chiropractic care for a specific diagnosis. Medicare Part B covers this care as well as some Advantage and Medigap plans.

    are chiropractors doctors

    Both physical therapy, also known as physiotherapy, and chiropractic care focus on managing pain and other symptoms using noninvasive techniques. Both…

    The Y strap is a specialized chiropractic tool that can be used to decompress the vertebrae of the spine. Learn how it’s used, what the research says…

    Chiropractors use hands-on manipulations to realign your joints and relieve discomfort from a wide range of causes. Learn more about the benefits.

    OUR BRANDS

    If you have an aching back or a stiff neck, you might benefit from chiropractic adjustment. Chiropractors are trained medical professionals who use their hands to relieve pain in the spine and other areas of the body.

    Are chiropractors doctors, though? Here’s more information about what these providers do, the training they receive, and what you can expect at your first appointment.

    Chiropractors don’t hold medical degrees, so they aren’t medical doctors. They do have extensive training in chiropractic care and are licensed practitioners.

    Chiropractors begin their education by getting an undergraduate degree with a focus on the sciences. After graduation, they move on to a 4-year chiropractic program with classes and hands-on experience.

    All states in the United States require that chiropractors obtain a doctor of chiropractic degree from a Council on Chiropractic Education (CCE) accredited college.

    are chiropractors doctors

    Some chiropractors choose to specialize in a certain area. They do an additional residency that lasts between 2 and 3 years. There are over 100 different chiropractic methods. No one method is necessarily better than another.

    Some chiropractors choose to specialize in several different areas, which they may describe as using “diversified” or “integrated” techniques.

    Regardless of specialty, all chiropractors must obtain a license to practice by taking an exam. They must also keep current in the field by taking regular continuing education classes.

    There are over 70,000 licensed chiropractors working in the United States today. These practitioners treat various issues and conditions involving the:

    During treatment, your provider performs what are called manipulations using their hands or small instruments. The manipulations to the different parts of the body help with a range of discomforts, including:

    You may be surprised to learn that chiropractors can treat conditions ranging from constipation to infant colic to acid reflux.

  • when was the national guard founded?
  • Pregnant women may even seek chiropractic care near delivery time. Chiropractors specializing in the Webster technique work to realign the pelvis, which may help baby get into a good position (head down) for vaginal delivery.

    Overall, chiropractors may work to provide holistic treatment, meaning they are treating the whole body and not just the specific ache or pain. Treatment is typically ongoing. You will likely see your chiropractor more than once or twice to manage your condition.

    Your first visit to the chiropractor will likely consist of giving your medical history and having a physical exam. Your provider may even call for additional tests, like an X-ray, to rule out fractures and other conditions.

    From there, your chiropractor may start with the adjustment. You’ll likely sit or lie down on a specially designed, padded table for the treatment.

    You may be directed to move into different positions throughout the appointment, so the chiropractor can treat specific areas of your body. Don’t be surprised if you hear popping or cracking sounds as your chiropractor applies controlled pressure to your joints.

    Wear loose fitting, comfortable clothing to your appointment, and remove jewelry before the practitioner begins. In most cases, a chiropractor can perform all of the necessary adjustments without you needing to change out of your clothing into a hospital gown.

    After your appointment, you may experience headaches or feel tired. The areas your chiropractor manipulated may also feel sore for a while after treatment. These side effects are mild and temporary.

    Sometimes, your chiropractor will prescribe corrective exercises for you to do outside of your appointments.

    Your practitioner may also give you lifestyle advice, like nutrition and exercise suggestions. They may incorporate complementary medicine, like acupuncture or homeopathy, into your treatment plan as well.

    The scope of what a chiropractor’s license allows them to do varies by state. In some states, chiropractors may order diagnostic tests, including imaging and laboratory tests.

    There are very few risks of chiropractic adjustment when it’s performed by a licensed professional. In rare cases, you might experience compression of nerves or disk herniation in the spine. Stroke is another rare but serious complication that can happen after neck manipulation.

    There are also conditions for which you shouldn’t necessarily seek chiropractic care.

    For example, you may want to talk to a primary care doctor before seeing a chiropractor if you’ve experienced numbness or loss of strength in your arm or leg. These symptoms may require a procedure beyond a chiropractor’s scope.

    Other conditions that may require different treatment include:

    If you don’t know if chiropractic treatment is appropriate for your condition, ask your doctor.

    Finding a good chiropractor may be as easy as asking around. Your current primary care physician or even a friend may be able to point you in the right direction.

    You can also use the Find a Doctor tool on the American Chiropractic Association’s website to find licensed chiropractors across the United States.

    Years ago, chiropractic care was included in many health insurance plans. These days, not all medical insurance carriers cover these appointments.

    Before making your first appointment, call your health insurance provider directly to find out your plan’s coverage, as well as copays or deductibles. Your insurance provider may also require a referral from your primary care provider.

    Many health insurers cover chiropractic care for short-term conditions. However, they may not cover this care for long-term conditions or maintenance treatments.

    Over two dozen states also cover chiropractic appointments through Medicare.

    Without coverage, your first appointment may cost around $160, depending on the tests you need. Follow-up appointments may range between $50 and $90 each. The cost will depend on your area and the treatments you receive.

    A licensed chiropractor may be able to help you if you’re experiencing pain in your:

    If your symptoms don’t get better after several weeks, you may want to reevaluate your treatment plan.

    Before you start chiropractic treatment, you may want to ask your practitioner the following questions:

    Be sure to tell your chiropractor about any prescription and over-the-counter medications or supplements you are taking.

    It’s also a good idea to mention any other complementary health treatments you’re using. Giving your chiropractor all this information upfront will make your care safer and more effective.

    Last medically reviewed on June 12, 2020

    Medicare coverers chiropractic care for a specific diagnosis. Medicare Part B covers this care as well as some Advantage and Medigap plans.

    are chiropractors doctors

    Both physical therapy, also known as physiotherapy, and chiropractic care focus on managing pain and other symptoms using noninvasive techniques. Both…

    The Y strap is a specialized chiropractic tool that can be used to decompress the vertebrae of the spine. Learn how it’s used, what the research says…

    Chiropractors use hands-on manipulations to realign your joints and relieve discomfort from a wide range of causes. Learn more about the benefits.

    OUR BRANDS

    If you have an aching back or a stiff neck, you might benefit from chiropractic adjustment. Chiropractors are trained medical professionals who use their hands to relieve pain in the spine and other areas of the body.

    Are chiropractors doctors, though? Here’s more information about what these providers do, the training they receive, and what you can expect at your first appointment.

    Chiropractors don’t hold medical degrees, so they aren’t medical doctors. They do have extensive training in chiropractic care and are licensed practitioners.

    Chiropractors begin their education by getting an undergraduate degree with a focus on the sciences. After graduation, they move on to a 4-year chiropractic program with classes and hands-on experience.

    All states in the United States require that chiropractors obtain a doctor of chiropractic degree from a Council on Chiropractic Education (CCE) accredited college.

    are chiropractors doctors

    Some chiropractors choose to specialize in a certain area. They do an additional residency that lasts between 2 and 3 years. There are over 100 different chiropractic methods. No one method is necessarily better than another.

    Some chiropractors choose to specialize in several different areas, which they may describe as using “diversified” or “integrated” techniques.

    Regardless of specialty, all chiropractors must obtain a license to practice by taking an exam. They must also keep current in the field by taking regular continuing education classes.

    There are over 70,000 licensed chiropractors working in the United States today. These practitioners treat various issues and conditions involving the:

    During treatment, your provider performs what are called manipulations using their hands or small instruments. The manipulations to the different parts of the body help with a range of discomforts, including:

    You may be surprised to learn that chiropractors can treat conditions ranging from constipation to infant colic to acid reflux.

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  • Pregnant women may even seek chiropractic care near delivery time. Chiropractors specializing in the Webster technique work to realign the pelvis, which may help baby get into a good position (head down) for vaginal delivery.

    Overall, chiropractors may work to provide holistic treatment, meaning they are treating the whole body and not just the specific ache or pain. Treatment is typically ongoing. You will likely see your chiropractor more than once or twice to manage your condition.

    Your first visit to the chiropractor will likely consist of giving your medical history and having a physical exam. Your provider may even call for additional tests, like an X-ray, to rule out fractures and other conditions.

    From there, your chiropractor may start with the adjustment. You’ll likely sit or lie down on a specially designed, padded table for the treatment.

    You may be directed to move into different positions throughout the appointment, so the chiropractor can treat specific areas of your body. Don’t be surprised if you hear popping or cracking sounds as your chiropractor applies controlled pressure to your joints.

    Wear loose fitting, comfortable clothing to your appointment, and remove jewelry before the practitioner begins. In most cases, a chiropractor can perform all of the necessary adjustments without you needing to change out of your clothing into a hospital gown.

    After your appointment, you may experience headaches or feel tired. The areas your chiropractor manipulated may also feel sore for a while after treatment. These side effects are mild and temporary.

    Sometimes, your chiropractor will prescribe corrective exercises for you to do outside of your appointments.

    Your practitioner may also give you lifestyle advice, like nutrition and exercise suggestions. They may incorporate complementary medicine, like acupuncture or homeopathy, into your treatment plan as well.

    The scope of what a chiropractor’s license allows them to do varies by state. In some states, chiropractors may order diagnostic tests, including imaging and laboratory tests.

    There are very few risks of chiropractic adjustment when it’s performed by a licensed professional. In rare cases, you might experience compression of nerves or disk herniation in the spine. Stroke is another rare but serious complication that can happen after neck manipulation.

    There are also conditions for which you shouldn’t necessarily seek chiropractic care.

    For example, you may want to talk to a primary care doctor before seeing a chiropractor if you’ve experienced numbness or loss of strength in your arm or leg. These symptoms may require a procedure beyond a chiropractor’s scope.

    Other conditions that may require different treatment include:

    If you don’t know if chiropractic treatment is appropriate for your condition, ask your doctor.

    Finding a good chiropractor may be as easy as asking around. Your current primary care physician or even a friend may be able to point you in the right direction.

    You can also use the Find a Doctor tool on the American Chiropractic Association’s website to find licensed chiropractors across the United States.

    Years ago, chiropractic care was included in many health insurance plans. These days, not all medical insurance carriers cover these appointments.

    Before making your first appointment, call your health insurance provider directly to find out your plan’s coverage, as well as copays or deductibles. Your insurance provider may also require a referral from your primary care provider.

    Many health insurers cover chiropractic care for short-term conditions. However, they may not cover this care for long-term conditions or maintenance treatments.

    Over two dozen states also cover chiropractic appointments through Medicare.

    Without coverage, your first appointment may cost around $160, depending on the tests you need. Follow-up appointments may range between $50 and $90 each. The cost will depend on your area and the treatments you receive.

    A licensed chiropractor may be able to help you if you’re experiencing pain in your:

    If your symptoms don’t get better after several weeks, you may want to reevaluate your treatment plan.

    Before you start chiropractic treatment, you may want to ask your practitioner the following questions:

    Be sure to tell your chiropractor about any prescription and over-the-counter medications or supplements you are taking.

    It’s also a good idea to mention any other complementary health treatments you’re using. Giving your chiropractor all this information upfront will make your care safer and more effective.

    Last medically reviewed on June 12, 2020

    Medicare coverers chiropractic care for a specific diagnosis. Medicare Part B covers this care as well as some Advantage and Medigap plans.

    are chiropractors doctors

    Both physical therapy, also known as physiotherapy, and chiropractic care focus on managing pain and other symptoms using noninvasive techniques. Both…

    The Y strap is a specialized chiropractic tool that can be used to decompress the vertebrae of the spine. Learn how it’s used, what the research says…

    Chiropractors use hands-on manipulations to realign your joints and relieve discomfort from a wide range of causes. Learn more about the benefits.

    OUR BRANDS

    When you think of chiropractors, do you think of someone “cracking bones”? That’s not entirely false, yet there is more to our profession than meets the eye.

    Chiropractors are musculoskeletal experts, trained in assessing, diagnosing, and treating disorders relating to muscular, skeletal, and nervous systems.

    Besides that, they have been touted to treat headaches, postural issues, and temporomandibular joint (TMJ) pain.

    In recent years, chiropractic care has gained popularity among those seeking alternative therapy for postural and spinal health and no wonder, when desk jobs are abundant in every sector.

    According to a Singapore General Hospital study, 73 per cent of office workers surveyed experience pain in at least one of the following body parts – the neck, shoulder, and lower back.

    are chiropractors doctors

    Currently, there are about 90 chiropractic clinics operating and at least 150 chiropractors in Singapore, of which a small percentage are registered with The Chiropractic Association Singapore.

    So with many locals opting for chiropractic care these days, the age-old question prevails: Are chiropractors doctors?

    Although chiropractors graduate as doctors of chiropractic degrees and attend a 4-year medical school curriculum, they are not medical doctors.

    Medical doctors tend to focus on acute or immediate symptoms, often prescribing medication in accordance with the ailments of their patients.

    On the other hand, chiropractors utilise manual manipulation and spine adjustment techniques with the aim of lessening or eliminating pain, as well as improving body functions including bone and soft tissue conditions.

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  • This holistic approach means looking at a patient’s physical and emotional wellbeing instead of just focusing on the injury or symptoms at hand.

    This includes the overall look at nutrition, exercises, relaxation techniques, electrical stimulation and acupuncture, which may be useful in managing or preventing a variety of health conditions.

    Spinal manipulation has been proven to significantly reduce lower back pain, as reported in a published study in the Journal of the American Medical Association.

    In fact, Spinal Manipulative Therapy (SMT) is recommended as the initial treatment for back pain in numerous medical guidelines.

    Even with all these accolades, there is still a line drawn when it comes to what chiropractors cannot and should not do in their practice.

    Let’s take a look at 4 things that could address the question: Are Chiropractors Doctors?

    Are chiropractors doctors if they cannot prescribe medication? Yes and no.

    Even though chiropractors carry the title “Dr”, which is legitimate, they cannot advertise or hold themselves out as medical practitioners nor practice medicine as doctors, according to the Ministry of Health (MOH).

    Because chiropractic treatment uses no drugs, chiropractors work on the nervous system’s overall health by aligning the spinal column and allowing the body to heal underlying problems causing pain, restricted movements and other common issues.

    In other words, without the reliance of medication, chiropractors are set to discover the root cause of pain and suggest a treatment plan that will bring about long-term relief rather than prescribing medication to merely alleviate symptoms.

    Take a patient who has high cholesterol for example.

    The most rational solution to lower down the numbers is to prescribe cholesterol-lowering medication, which they will most likely have to take for an inordinate amount of time and lack of explanation on what the root cause of their cholesterol might be in the first place or steps that can be taken for long-term improvement.

    Chiropractic care generally emphasises on getting patients to play an active role in taking care of their health and results, rather than having them be reliant and passive in their long-term recovery.

    So what about surgery? Are chiropractors doctors if they cannot conduct surgery on their patients?

    Chiropractors are not professionally qualified surgeons and they typically use non-invasive treatments such as posture corrections, soft tissues techniques, joint mobilisation, electronic muscle stimulation, and massages.

    Even if chiropractors cannot perform surgery, they can still refer their patients to orthopaedic surgeons who are qualified to perform surgery.

    Both chiropractors and orthopaedic surgeons relieve patients of musculoskeletal discomfort.

    One key difference is chiropractors base their methods on the philosophy of interconnected bodily functions.

    Orthopaedic physicians, on the other hand, use applied medical sciences to diagnose and treat conditions, using X-rays, scans, and physical examinations.

    Although chiropractors are not licensed to use surgical interventions to help their patients restore normal functionality, they play an important part in assisting in rehabilitation and strengthening work post-surgery including helping patients regain mobility and move pain-free in the long term.

    We have been talking about chiropractic care being a hands-on alternative treatment to restore the body’s physiological functions by aligning the spine and improving the flow of nerve transmissions, thereby alleviating back and neck pains, as well as headaches and joint discomfort.

    However, there are certain conditions that are beyond a chiropractor’s scope of practice as they may require medication or surgery, which would be better treated by a medical physician.

    While chiropractic care may be beneficial for muscle-related strains or lower back pain, it is not a suitable treatment for chronic issues such as arthritis.

    It is also important to be sure of your source of pain before deciding on opting for spinal manipulation as it has the potential of making things worse if the application of controlled force is not performed accurately.

    Broken bones and fractures are among the traumatic injuries that chiropractors should not attempt to treat right away until the injury has begun to heal and inflammation is reduced.

    Regardless, a chiropractor can use compression techniques to keep the bone in place so it can heal better on its own.

    In addition, suggesting a variety of stretches and exercises to be performed at regular intervals and intensities will promote a faster recovery rate, strengthen the affected area, and reduce the chances of recurring injuries.

    are chiropractors doctors

    As mentioned, chiropractors cannot and should not practise as medical doctors unless they are registered under the Medical Registration Act (MRA) in Singapore.

    Are chiropractors doctors if they are not able to treat patients the way doctors can? Yes, they are!

    Even if they should not advertise themselves as such, they are still a great complement to medical physicians especially for patients with severe pain.

    Studies have suggested that chiropractic manipulation leads to better results for patients when combined with standard medical care.

    It’s a whole-body approach to living the best of one’s health and well-being.

    It is important for patients to exercise transparency during their doctor visits and to discuss alternative therapies to try, and vice versa.

    However, one thing our chiropractors can do is, to be honest, and upfront about what we can and cannot treat, as well as lay down options for our patients depending on their conditions.

    Singapore Pain Solutions have been aiming to provide authentic and professional chiropractic services for their patients since 2015.

    Set to become one of the best chiropractic providers in the Asia Pacific, our chiropractors are well experienced in sports injury, pediatric chiropractic, pregnancy chiropractic, nutrition for fitness and many other areas.

    Contact us today for a professional consultation and receive the best-specialised treatments for your pains and discomfort.

    116 Lavender Street Pek Chuan Building #01-02 Singapore 338730

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    +65 8606 2861
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    UPDATED NOV. 10, 2021

    Most complex topics defy easy yes and no answers. One such question when considering health care professions is “Are chiropractors doctors?” Of course, the answer is “yes” when you have a solid knowledge of the profession, know the benefits chiropractic patients get, and what research says.

    For many, the term doctor refers to a person who holds a medical doctor (M.D.) degree, which means med school, an internship, a residency, and a license. Because chiropractors do not have an M.D. degree, they aren’t medical doctors. They are doctors of chiropractic care – professionals who care about people and are dedicated to providing non-invasive, personalized care and treatment.

    Chiropractors hold a Doctor of Chiropractic (D.C.) degree from an institution accredited by the Higher Learning Commission, the same organization that issues accreditation for medical schools.

    are chiropractors doctors

    Medical doctors and doctors of chiropractic are also similar because graduates in both M.D. and D.C. schools have:

    A chiropractic degree focuses on diagnosing, caring, and preventing disorders of the spine and other parts of the musculoskeletal system. That’s why chiropractic education is intensive in subjects such as anatomy, physiology, and human biology. Doctors of chiropractic study spinal anatomy in-depth and learn to diagnose neuromusculoskeletal conditions. This depth of study is more evidence that chiropractors are doctors.

    An undergraduate degree, usually in the sciences, is a good start to this career. After acceptance into a chiropractic school, students take on at least 4,200 hours of education, covering classroom and laboratory time and clinical time with patients. In fact, the emphasis on hands-on techniques in chiropractic care demands extensive experience in working with patients.

    Chiropractic students, along with patient care experience through internships or at area treatment facilities, do additional work in labs, independent and group study projects, and research studies.

    Satisfaction: A Chiropractic Degree Delivers Results

    Medical care may be more well-known, but research continues to support the benefit of chiropractic care:

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  • Cleveland University-Kansas City (CUKC) is a national leader in chiropractic and health sciences education. More than one in every 10 chiropractors in the U.S. received a Doctor of Chiropractic (D.C.) degree from the CUKC College of Chiropractic.

    The University offers a B.S. in Human Biology that feeds into the chiropractic program and has a B.S./D.C. degree program that reduces the total time in school.

    CUKC is in Overland Park, Kansas, a suburb of 190,000 within the Kansas City metro area. In 2015, Cleveland Chiropractic College expanded into Cleveland University-Kansas City. Learn more about our doctor of chiropractic degree by contacting an admissions advisor. You’ll get our free eBook: Your Complete Guide to the Chiropractic Profession.

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    © 2008-2021 Cleveland University-Kansas City

    Chiropractic is an alternative health profession[1] concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine.[2] It has esoteric origins[3] and is based on several pseudoscientific ideas.[4]

    Many chiropractors, especially those in the field’s early history, have proposed that mechanical disorders of the joints, especially of the spine, affect general health,[2] and that regular manipulation of the spine (spinal adjustment) improves general health. The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.[5] A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as “doctor” but is not a Doctor of Medicine (M.D.)[6][7] While many chiropractors view themselves as primary care providers,[8][9] chiropractic clinical training does not meet the requirements to be such a provider.[2]

    Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.[8] A 2011 critical evaluation of 45 systematic reviews found that spinal manipulation was ineffective at treating any condition.[10] Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient.[11] No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases.[12]
    There is not sufficient data to establish the safety of chiropractic manipulations.[13] It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[14] There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation.[15] Several deaths have been associated with this technique[14] and it has been suggested that the relationship is causative,[16][17] a claim which is disputed by many chiropractors.[17]

    Chiropractic is well established in the United States, Canada, and Australia.[18] It overlaps with other manual-therapy professions such as osteopathy and physical therapy.[19] Most who seek chiropractic care do so for low back pain.[20] Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues.[8] Chiropractic has two main groups: “straights”, now the minority, emphasize vitalism, “Innate Intelligence”, and consider vertebral subluxations to be the cause of all disease; and “mixers”, the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[21]

    are chiropractors doctors

    D. D. Palmer founded chiropractic in the 1890s,[22] after saying he received it from “the other world”;[23] Palmer maintained that the tenets of chiropractic were passed along to him by a doctor who had died 50 years previously.[24] His son B. J. Palmer helped to expand chiropractic in the early 20th century.[22] Throughout its history, chiropractic has been controversial.[25][26] Its foundation is at odds with evidence-based medicine, and has been sustained by pseudoscientific ideas such as vertebral subluxation and innate intelligence.[27] Despite the overwhelming evidence that vaccination is an effective public health intervention, among chiropractors there are significant disagreements over the subject,[28] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[29] The American Medical Association called chiropractic an “unscientific cult” in 1966[30] and boycotted it until losing an antitrust case in 1987.[9] Chiropractic has had a strong political base and sustained demand for services. In the last decades of the twentieth century, it gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.[9] During the COVID-19 pandemic chiropractic professional associations advised chiropractors to adhere to CDC, WHO, and local health department guidance.[31][32] Despite these recommendations, a small but vocal and influential number of chiropractors spread anti-vaccine disinformation.[33]

    Chiropractic is generally categorized as complementary and alternative medicine (CAM),[1] which focuses on manipulation of the musculoskeletal system, especially the spine.[2] Its founder, D. D. Palmer, called it “a science of healing without drugs”.[8]

    Chiropractic’s origins lie in the folk medicine of bonesetting,[8] and as it evolved it incorporated vitalism, spiritual inspiration and rationalism.[34] 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.[34] This “straight” philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method,[34] and relies on deductions from vitalistic first principles rather than on the materialism of science.[35] However, most practitioners tend to incorporate scientific research into chiropractic,[34] 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.[35] 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.[36]


    Restoration of structural integrity


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  • Improvement of health status


    Innate intelligence


    Body physiology

    Although a wide diversity of ideas exist among chiropractors,[34] 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.[37] Some chiropractors claim spinal manipulation can have an effect on a variety of ailments such as irritable bowel syndrome and asthma.[38]

    Chiropractic philosophy includes the following perspectives:[35]

    Holism assumes that health is affected by everything in an individual’s environment; some sources also include a spiritual or existential dimension.[39] In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.[36] 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.[34]

    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.[21] A variant of chiropractic called naprapathy originated in Chicago in the early twentieth century.[40][41] It holds that manual manipulation of soft tissue can reduce “interference” in the body and thus improve health.[41]

    Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities.[42] 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.[42] Straights view the medical diagnosis of patient complaints, which they consider to be the “secondary effects” of subluxations, to be unnecessary for chiropractic treatment.[42] 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.[42] Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology such as “perform spinal analysis”, “detect subluxation”, “correct with adjustment”.[21] They prefer to remain separate and distinct from mainstream health care.[21] 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.”[21]

    Mixer chiropractors “mix” diagnostic and treatment approaches from chiropractic, medical or osteopathic viewpoints and make up the majority of chiropractors.[21] Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine.[21] 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.[21] Some mixers also use techniques from alternative medicine, including nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.[21]

    Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1,100 North American chiropractors, which found that 88 percent wanted to retain the term “vertebral subluxation complex”, and that when asked to estimate the percent of disorders of internal organs that subluxation significantly contributes to, the mean response was 62 percent.[43] 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.[44] 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.[44] 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.[45]

    In science-based medicine, the term “subluxation” refers to an incomplete or partial dislocation of a joint, from the Latin luxare for ‘dislocate’.[46][47] While medical doctors use the term exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word subluxation with a metaphysical and philosophical meaning drawn from pseudoscientific traditions such as Vitalism.[48]

    Palmer claimed that vertebral subluxations, interfered with the body’s function and its inborn ability to heal itself.[49] 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.[48]He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.[48] 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.[51] 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.[51] 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.[52][53]

    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.[54] It is essentially a functional entity, which may influence biomechanical and neural integrity.”[54] 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.[54] This exposes patients to harmful ionizing radiation for no evidentially supported reason.[55][56] 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.”[57] 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.”[58] 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.”[59]

    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.”[60][27]

    While some chiropractors limit their practice to short-term treatment of musculoskeletal conditions, many falsely claim to be able treat a myriad of other conditions.[61][62] Some dissuade patients from seeking medical care, others have pretended to be qualified to act as a family doctor.[61]

    Quackwatch, an alternative medicine watchdog, cautions against seeing chiropractors who:[61][63]

    Writing for the Skeptical Inquirer, one physician cautioned against seeing even chiropractors who solely claim to treat musculoskeletal conditions:

    “I think Spinal Manipulation Therapy (SMT) is a reasonable option for patients to try … But I could not in good conscience refer a patient to a chiropractor… When chiropractic is effective, what is effective is not ‘chiropractic’: it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers … If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider.[61]

    Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,[54] with special emphasis on the spine.[2] Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues.[8] 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.[64] 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.[64] 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 attributes of a medical specialty like dentistry or podiatry.[65] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,[36][65] but the more expansive view of chiropractic is still widespread.[66]

    Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);[1] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.[67] Many chiropractors believe they are primary care providers,[8][9] including US[68] and UK chiropractors,[69] but the length, breadth, and depth of chiropractic clinical training do not support the requirements to be considered primary care providers,[2] so their role on primary care is limited and disputed.[2][9]

    Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.[19][70] Chiropractic is autonomous from and competitive with mainstream medicine,[71] and osteopathy outside the US remains primarily a manual medical system;[72] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[71] 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.[19]

    Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.[54] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[65] 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.[5]

    Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States,[73] (although New Mexico has become the first US state to allow “advanced practice” trained chiropractors to prescribe certain medications.[74][75]). 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.[76] 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.[73] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.[43] A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.[77]

    A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in many US states,[78] but is not recognized by the American Chiropractic Association as being chiropractic.[79] It remains controversial within certain segments of the veterinary and chiropractic profession.[80]

    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.[81] 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.[81] Two US states (Washington and Arkansas) prohibit physical therapists from performing SM,[82] 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.[83]

    Spinal manipulation, which chiropractors call “spinal adjustment” or “chiropractic adjustment”, is the most common treatment used in chiropractic care.[84] 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.[85] 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.[85] 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.[86] Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load.[86] 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.[85]

    are chiropractors doctors

    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 US chiropractors in a 2003 survey:[84] 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.[87] Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation.[88] Koren Specific Technique (KST) may use their hands, or they may use an electric device known as an “ArthroStim” for assessment and spinal manipulations.[89] Insurers in the US and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be “experimental and investigational”.[89][90][91][92] 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.[93]

    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 US 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.[84]

    A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine.[94] The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%.[94] A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a United States chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.[95]

    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.[81] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims.[2][27][51][96][97] 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”.[98] 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.[99] Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries.[100]

    Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with varied results.[8] There is no conclusive evidence that chiropractic manipulative treatment is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.[8][10]

    Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.[101][102] Research published by chiropractors is distinctly biased: reviews of SM for back pain tended to find positive conclusions when authored by chiropractors, while reviews by mainstream authors did not.[8]

    There is a wide range of ways to measure treatment outcomes.[103] Chiropractic care benefits from the placebo response,[104] but it is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT).[105] The efficacy of maintenance care in chiropractic is unknown.[106]

    Available evidence covers the following conditions:

    The World Health Organization found chiropractic care in general is safe when employed skillfully and appropriately.[54] There is not sufficient data to establish the safety of chiropractic manipulations.[13] Manipulation is regarded as relatively safe but complications can arise, and it has known adverse effects, risks and contraindications.[54] 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.[54] 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.[54] 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.[148] Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a chiropractor.[8]

    Spinal manipulation is associated with frequent, mild and temporary adverse effects,[14][148] including new or worsening pain or stiffness in the affected region.[149] 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;[13] adverse reactions appear to be more common following manipulation than mobilization.[150] The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue.[151] Chiropractic is correlated with a very high incidence of minor adverse effects.[8] Rarely,[54] 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[14] and children.[152] Estimates vary widely for the incidence of these complications,[13] 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.[14] Adverse effects are poorly reported in recent studies investigating chiropractic manipulations.[153] A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable.[154] Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region.[155] 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.[13] Several case reports show temporal associations between interventions and potentially serious complications.[156] The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.[17]

    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.[156][157] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (CMT) and VAS.[158] There is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.[15] 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.[159] 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.[159] There is controversy regarding the degree of risk of stroke from cervical manipulation.[15] Many chiropractors state that, the association between chiropractic therapy and vertebral arterial dissection is not proven.[17] However, it has been suggested that the causality between chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is probable[17] or definite.[16] There is very low evidence supporting a small association between internal carotid artery dissection and chiropractic neck manipulation.[160] The incidence of internal carotid artery dissection following cervical spine manipulation is unknown.[161] The literature infrequently reports helpful data to better understand the association between cervical manipulative therapy, cervical artery dissection and stroke.[162] The limited evidence is inconclusive that chiropractic spinal manipulation therapy is not a cause of intracranial hypotension.[163] Cervical intradural disc herniation is very rare following spinal manipulation therapy.[164]

    Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation.[165] Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year.[57] Practice guidelines aim to reduce unnecessary radiation exposure,[165] which increases cancer risk in proportion to the amount of radiation received.[166] Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based.[56] 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.[56]

    A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.[15] 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.[17] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.[167] 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.”[167] A 1999 review of 177 previously reported cases published between 1925 and 1997 in which injuries were attributed to manipulation of the cervical spine (MCS) concluded that “The literature does not demonstrate that the benefits of MCS outweigh the risks.” The professions associated with each injury were assessed. Physical therapists (PT) were involved in less than 2% of all cases, with no deaths caused by PTs. Chiropractors were involved in a little more than 60% of all cases, including 32 deaths.[168]

    A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is 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.[12]

    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.[169] 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.[11]

    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 placebo controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[170] 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.[171] The cost-effectiveness of maintenance chiropractic care is unknown.[106][non-primary source needed]

    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.[172]

    Requirements vary between countries. In the U.S. chiropractors obtain a non-medical accredited diploma in the field of chiropractic.[173] Chiropractic education in the U.S. has been criticized for failing to meet generally accepted standards of evidence-based medicine.[174] The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has little similarity, both in the kinds of subjects offered and in the time assigned to each subject.[175] 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.[176] 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.[177] Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education.[178][179] 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.[54]

    Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[180][181] Depending on the location, continuing education may be required to renew these licenses.[182][183] 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.[184]

    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.[185][186] 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.[76] 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.[187] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[188] 2 in Canada,[189] 6 in Australasia,[190] and 5 in Europe.[191] 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.[25] 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.[178][179]

    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.[192][193] There are an estimated 49,000 chiropractors in the U.S. (2008),[194] 6,500 in Canada (2010),[195] 2,500 in Australia (2000),[29] and 1,500 in the UK (2000).[196]

    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.[76] The fourth year of chiropractic education persistently showed the highest stress levels.[197] Every student, irrespective of year, experienced different ranges of stress when studying.[197] The chiropractic leaders and colleges have had internal struggles.[198] Rather than cooperation, there has been infighting between different factions.[198] A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.[198][clarification needed]

    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.[199] 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.”[200] The International Chiropractor’s Association (ICA) also has a set of professional canons.[201]

    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.[36] 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.[202][203]

    Chiropractors, especially in America, have a reputation for unnecessarily treating patients.[57] In many circumstances the focus seems to be put on economics instead of health care.[57] Sustained chiropractic care is promoted as a preventive tool, but unnecessary manipulation could possibly present a risk to patients.[8] Some chiropractors are concerned by the routine unjustified claims chiropractors have made.[8] 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.[206]

    The US Office of the Inspector General (OIG) estimated 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.[207] There have been at least 15 OIG reports about chiropractic billing irregularities since 1986.[207]

    In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,[208][209] 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.”[208] An editorial in Nature suggested that the BCA may have been trying to suppress debate and that this use of English libel law was a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.[210] The libel case ended with the BCA withdrawing its suit in 2010.[211][212]

    Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[18] It is viewed as a marginal and non-clinically–proven attempt at complementary and alternative medicine, which has not integrated into mainstream medicine.[64] Billions are spent annually for chiropractic services.[8]

    In Australia, there are approximately 2488 chiropractors, or one chiropractor for every 7980 people.[213] Most private health insurance funds in Australia cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.[214] In 2014, the chiropractic profession had a registered workforce of 4,684 practitioners in Australia represented by two major organizations — the Chiropractors’ Association of Australia (CAA) and the Chiropractic and Osteopathic College of Australasia (COCA).[215] Annual expenditure on chiropractic care (alone or combined with osteopathy) in Australia is estimated to be between AUD$750–988 million with musculoskeletal complaints such as back and neck pain making up the bulk of consultations; and proportional expenditure is similar to that found in other countries.[215] While Medicare (the Australian publicly funded universal health care system) coverage of chiropractic services is limited to only those directed by a medical referral to assist chronic disease management, most private health insurers in Australia do provide partial reimbursement for a wider range of chiropractic services in addition to limited third party payments for workers compensation and motor vehicle accidents.[215]

    Of the 2,005 chiropractors who participated in a 2015 survey, 62.4% were male and the average age was 42.1 (SD = 12.1) years.[215] Nearly all chiropractors (97.1%) had a bachelor’s degree or higher, with the majority of chiropractor’s highest professional qualification being a bachelor or double bachelor’s degree (34.6%), followed by a master’s degree (32.7%), Doctor of Chiropractic (28.9%) or PhD (0.9%).[215] Only a small number of chiropractor’s highest professional qualification was a diploma (2.1%) or advanced diploma (0.8%).[215]

    In the United Kingdom, there are over 2,000 chiropractors, representing one chiropractor per 29,206 people.[213] Chiropractic is available on the National Health Service in some areas, such as Cornwall, where the treatment is only available for neck or back pain.[216]

    A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed to patients the serious risk associated with manipulation of the cervical spine and that 46% believed there was possibility patients would refuse treatment if the risks were correctly explained. However 80% acknowledged the ethical/moral responsibility to disclose risk to patients.[217]

    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,[218] with a global high of 20% in Alberta in 2006.[219] In 2008, chiropractors were reported to be the most common CAM providers for children and adolescents, these patients representing up to 14% of all visits to chiropractors.[220]

    There were around 50,330 chiropractors practicing in North America in 2000.[213] In 2008, this has increased by almost 20% to around 60,000 chiropractors.[8] In 2002–03, the majority of those who sought chiropractic did so for relief from back and neck pain and other neuromusculoskeletal complaints;[20] most do so specifically for low back pain.[20][218] The majority of U.S. chiropractors participate in some form of managed care.[9] Although the majority of U.S. chiropractors view themselves as specialists in neuromusculoskeletal conditions, many also consider chiropractic as a type of primary care.[9] In the majority of cases, the care that chiropractors and physicians provide divides the market, however for some, their care is complementary.[9]

    In the U.S., chiropractors perform over 90% of all manipulative treatments.[221] 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.[222]

    Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[1] 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.[223] As of 2007 7% of the U.S. population is being reached by chiropractic.[224] They were the third largest medical profession in the US in 2002, following physicians and dentists.[225] Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[194]

    In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services.[220]

    Chiropractic’s origins lie in the folk medicine practice of bonesetting, in which untrained practitioners engaged in joint manipulation or resetting fractured bones.[8]
    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.[226] The first chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer’s office was located.[42] He claimed that he had severely reduced hearing for 17 years, which started soon following a “pop” in his spine.[42] A few days following his adjustment, Lillard claimed his hearing was almost completely restored.[42] Another of Palmer’s patients, Samuel Weed, coined the term chiropractic, from the Greek χειρο- chiro- (itself from χείρ cheir “hand”), “hand” and πρακτικός praktikos, “practical”.[227][228] Chiropractic is classified as a field of pseudomedicine on account of its esoteric origins.[3]

    Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health.[226] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic.[22] 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.[22]

    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.[22] D.D. Palmer said he “received chiropractic from the other world”.[23] 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.[22][23] 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).[22]

    Chiropractic has seen considerable controversy and criticism.[25][26] 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.[22] 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.[22] The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.’s 25,000 chiropractors remained straight.[22] 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.[22]

    Chiropractors faced heavy opposition from organized medicine.[42] DD Palmer was jailed in 1907 for practicing medicine without a license.[229] Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed.[42] 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.[42] B.J. cofounded the Universal Chiropractors’ Association (UCA) to provide legal services to arrested chiropractors.[42] 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.[42] The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an “unscientific cult” in 1966,[30] and until 1980 advised its members that it was unethical for medical doctors to associate with “unscientific practitioners”.[230] 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.[9]

    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.[42] 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.[42] 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.[9] 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.[9] The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.[9]

    Some chiropractors oppose vaccination and water fluoridation, which are common public health practices.[36] Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available.[231] Most chiropractic writings on vaccination focus on its negative aspects,[28] claiming that it is hazardous, ineffective, and unnecessary.[29] 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.[29] The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain.[28] 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.[29] The Canadian Chiropractic Association supports vaccination;[28] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[232] Many even reject the fact that smallpox has been eradicated and they believe it was renamed monkeypox.[232]

    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.[233] 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.[36]

    Throughout its history chiropractic has been the subject of internal and external controversy and criticism.[21][234] 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.[8][50] A 2003 profession-wide survey[43] 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.”[235] A critical evaluation stated “Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.”[8] Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license.[8] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.[42] 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.[8] Chiropractic remains controversial, though to a lesser extent than in past years.[25]


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    [1]Downloads-icon

    Chiropractic is an alternative health profession[1] concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine.[2] It has esoteric origins[3] and is based on several pseudoscientific ideas.[4]

    Many chiropractors, especially those in the field’s early history, have proposed that mechanical disorders of the joints, especially of the spine, affect general health,[2] and that regular manipulation of the spine (spinal adjustment) improves general health. The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.[5] A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as “doctor” but is not a Doctor of Medicine (M.D.)[6][7] While many chiropractors view themselves as primary care providers,[8][9] chiropractic clinical training does not meet the requirements to be such a provider.[2]

    Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.[8] A 2011 critical evaluation of 45 systematic reviews found that spinal manipulation was ineffective at treating any condition.[10] Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient.[11] No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases.[12]
    There is not sufficient data to establish the safety of chiropractic manipulations.[13] It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[14] There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation.[15] Several deaths have been associated with this technique[14] and it has been suggested that the relationship is causative,[16][17] a claim which is disputed by many chiropractors.[17]

    Chiropractic is well established in the United States, Canada, and Australia.[18] It overlaps with other manual-therapy professions such as osteopathy and physical therapy.[19] Most who seek chiropractic care do so for low back pain.[20] Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues.[8] Chiropractic has two main groups: “straights”, now the minority, emphasize vitalism, “Innate Intelligence”, and consider vertebral subluxations to be the cause of all disease; and “mixers”, the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[21]

    are chiropractors doctors

    D. D. Palmer founded chiropractic in the 1890s,[22] after saying he received it from “the other world”;[23] Palmer maintained that the tenets of chiropractic were passed along to him by a doctor who had died 50 years previously.[24] His son B. J. Palmer helped to expand chiropractic in the early 20th century.[22] Throughout its history, chiropractic has been controversial.[25][26] Its foundation is at odds with evidence-based medicine, and has been sustained by pseudoscientific ideas such as vertebral subluxation and innate intelligence.[27] Despite the overwhelming evidence that vaccination is an effective public health intervention, among chiropractors there are significant disagreements over the subject,[28] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[29] The American Medical Association called chiropractic an “unscientific cult” in 1966[30] and boycotted it until losing an antitrust case in 1987.[9] Chiropractic has had a strong political base and sustained demand for services. In the last decades of the twentieth century, it gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.[9] During the COVID-19 pandemic chiropractic professional associations advised chiropractors to adhere to CDC, WHO, and local health department guidance.[31][32] Despite these recommendations, a small but vocal and influential number of chiropractors spread anti-vaccine disinformation.[33]

    Chiropractic is generally categorized as complementary and alternative medicine (CAM),[1] which focuses on manipulation of the musculoskeletal system, especially the spine.[2] Its founder, D. D. Palmer, called it “a science of healing without drugs”.[8]

    Chiropractic’s origins lie in the folk medicine of bonesetting,[8] and as it evolved it incorporated vitalism, spiritual inspiration and rationalism.[34] 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.[34] This “straight” philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method,[34] and relies on deductions from vitalistic first principles rather than on the materialism of science.[35] However, most practitioners tend to incorporate scientific research into chiropractic,[34] 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.[35] 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.[36]


    Restoration of structural integrity


  • 1 cent in rupees
  • Improvement of health status


    Innate intelligence


    Body physiology

    Although a wide diversity of ideas exist among chiropractors,[34] 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.[37] Some chiropractors claim spinal manipulation can have an effect on a variety of ailments such as irritable bowel syndrome and asthma.[38]

    Chiropractic philosophy includes the following perspectives:[35]

    Holism assumes that health is affected by everything in an individual’s environment; some sources also include a spiritual or existential dimension.[39] In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.[36] 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.[34]

    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.[21] A variant of chiropractic called naprapathy originated in Chicago in the early twentieth century.[40][41] It holds that manual manipulation of soft tissue can reduce “interference” in the body and thus improve health.[41]

    Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities.[42] 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.[42] Straights view the medical diagnosis of patient complaints, which they consider to be the “secondary effects” of subluxations, to be unnecessary for chiropractic treatment.[42] 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.[42] Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology such as “perform spinal analysis”, “detect subluxation”, “correct with adjustment”.[21] They prefer to remain separate and distinct from mainstream health care.[21] 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.”[21]

    Mixer chiropractors “mix” diagnostic and treatment approaches from chiropractic, medical or osteopathic viewpoints and make up the majority of chiropractors.[21] Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine.[21] 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.[21] Some mixers also use techniques from alternative medicine, including nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.[21]

    Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1,100 North American chiropractors, which found that 88 percent wanted to retain the term “vertebral subluxation complex”, and that when asked to estimate the percent of disorders of internal organs that subluxation significantly contributes to, the mean response was 62 percent.[43] 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.[44] 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.[44] 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.[45]

    In science-based medicine, the term “subluxation” refers to an incomplete or partial dislocation of a joint, from the Latin luxare for ‘dislocate’.[46][47] While medical doctors use the term exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word subluxation with a metaphysical and philosophical meaning drawn from pseudoscientific traditions such as Vitalism.[48]

    Palmer claimed that vertebral subluxations, interfered with the body’s function and its inborn ability to heal itself.[49] 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.[48]He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.[48] 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.[51] 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.[51] 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.[52][53]

    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.[54] It is essentially a functional entity, which may influence biomechanical and neural integrity.”[54] 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.[54] This exposes patients to harmful ionizing radiation for no evidentially supported reason.[55][56] 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.”[57] 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.”[58] 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.”[59]

    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.”[60][27]

    While some chiropractors limit their practice to short-term treatment of musculoskeletal conditions, many falsely claim to be able treat a myriad of other conditions.[61][62] Some dissuade patients from seeking medical care, others have pretended to be qualified to act as a family doctor.[61]

    Quackwatch, an alternative medicine watchdog, cautions against seeing chiropractors who:[61][63]

    Writing for the Skeptical Inquirer, one physician cautioned against seeing even chiropractors who solely claim to treat musculoskeletal conditions:

    “I think Spinal Manipulation Therapy (SMT) is a reasonable option for patients to try … But I could not in good conscience refer a patient to a chiropractor… When chiropractic is effective, what is effective is not ‘chiropractic’: it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers … If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider.[61]

    Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,[54] with special emphasis on the spine.[2] Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues.[8] 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.[64] 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.[64] 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 attributes of a medical specialty like dentistry or podiatry.[65] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,[36][65] but the more expansive view of chiropractic is still widespread.[66]

    Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);[1] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.[67] Many chiropractors believe they are primary care providers,[8][9] including US[68] and UK chiropractors,[69] but the length, breadth, and depth of chiropractic clinical training do not support the requirements to be considered primary care providers,[2] so their role on primary care is limited and disputed.[2][9]

    Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.[19][70] Chiropractic is autonomous from and competitive with mainstream medicine,[71] and osteopathy outside the US remains primarily a manual medical system;[72] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[71] 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.[19]

    Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.[54] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[65] 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.[5]

    Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States,[73] (although New Mexico has become the first US state to allow “advanced practice” trained chiropractors to prescribe certain medications.[74][75]). 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.[76] 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.[73] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.[43] A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.[77]

    A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in many US states,[78] but is not recognized by the American Chiropractic Association as being chiropractic.[79] It remains controversial within certain segments of the veterinary and chiropractic profession.[80]

    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.[81] 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.[81] Two US states (Washington and Arkansas) prohibit physical therapists from performing SM,[82] 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.[83]

    Spinal manipulation, which chiropractors call “spinal adjustment” or “chiropractic adjustment”, is the most common treatment used in chiropractic care.[84] 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.[85] 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.[85] 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.[86] Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load.[86] 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.[85]

    are chiropractors doctors

    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 US chiropractors in a 2003 survey:[84] 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.[87] Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation.[88] Koren Specific Technique (KST) may use their hands, or they may use an electric device known as an “ArthroStim” for assessment and spinal manipulations.[89] Insurers in the US and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be “experimental and investigational”.[89][90][91][92] 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.[93]

    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 US 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.[84]

    A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine.[94] The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%.[94] A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a United States chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.[95]

    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.[81] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims.[2][27][51][96][97] 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”.[98] 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.[99] Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries.[100]

    Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with varied results.[8] There is no conclusive evidence that chiropractic manipulative treatment is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.[8][10]

    Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.[101][102] Research published by chiropractors is distinctly biased: reviews of SM for back pain tended to find positive conclusions when authored by chiropractors, while reviews by mainstream authors did not.[8]

    There is a wide range of ways to measure treatment outcomes.[103] Chiropractic care benefits from the placebo response,[104] but it is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT).[105] The efficacy of maintenance care in chiropractic is unknown.[106]

    Available evidence covers the following conditions:

    The World Health Organization found chiropractic care in general is safe when employed skillfully and appropriately.[54] There is not sufficient data to establish the safety of chiropractic manipulations.[13] Manipulation is regarded as relatively safe but complications can arise, and it has known adverse effects, risks and contraindications.[54] 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.[54] 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.[54] 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.[148] Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a chiropractor.[8]

    Spinal manipulation is associated with frequent, mild and temporary adverse effects,[14][148] including new or worsening pain or stiffness in the affected region.[149] 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;[13] adverse reactions appear to be more common following manipulation than mobilization.[150] The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue.[151] Chiropractic is correlated with a very high incidence of minor adverse effects.[8] Rarely,[54] 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[14] and children.[152] Estimates vary widely for the incidence of these complications,[13] 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.[14] Adverse effects are poorly reported in recent studies investigating chiropractic manipulations.[153] A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable.[154] Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region.[155] 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.[13] Several case reports show temporal associations between interventions and potentially serious complications.[156] The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.[17]

    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.[156][157] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (CMT) and VAS.[158] There is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.[15] 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.[159] 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.[159] There is controversy regarding the degree of risk of stroke from cervical manipulation.[15] Many chiropractors state that, the association between chiropractic therapy and vertebral arterial dissection is not proven.[17] However, it has been suggested that the causality between chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is probable[17] or definite.[16] There is very low evidence supporting a small association between internal carotid artery dissection and chiropractic neck manipulation.[160] The incidence of internal carotid artery dissection following cervical spine manipulation is unknown.[161] The literature infrequently reports helpful data to better understand the association between cervical manipulative therapy, cervical artery dissection and stroke.[162] The limited evidence is inconclusive that chiropractic spinal manipulation therapy is not a cause of intracranial hypotension.[163] Cervical intradural disc herniation is very rare following spinal manipulation therapy.[164]

    Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation.[165] Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year.[57] Practice guidelines aim to reduce unnecessary radiation exposure,[165] which increases cancer risk in proportion to the amount of radiation received.[166] Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based.[56] 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.[56]

    A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.[15] 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.[17] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.[167] 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.”[167] A 1999 review of 177 previously reported cases published between 1925 and 1997 in which injuries were attributed to manipulation of the cervical spine (MCS) concluded that “The literature does not demonstrate that the benefits of MCS outweigh the risks.” The professions associated with each injury were assessed. Physical therapists (PT) were involved in less than 2% of all cases, with no deaths caused by PTs. Chiropractors were involved in a little more than 60% of all cases, including 32 deaths.[168]

    A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is 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.[12]

    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.[169] 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.[11]

    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 placebo controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[170] 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.[171] The cost-effectiveness of maintenance chiropractic care is unknown.[106][non-primary source needed]

    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.[172]

    Requirements vary between countries. In the U.S. chiropractors obtain a non-medical accredited diploma in the field of chiropractic.[173] Chiropractic education in the U.S. has been criticized for failing to meet generally accepted standards of evidence-based medicine.[174] The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has little similarity, both in the kinds of subjects offered and in the time assigned to each subject.[175] 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.[176] 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.[177] Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education.[178][179] 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.[54]

    Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[180][181] Depending on the location, continuing education may be required to renew these licenses.[182][183] 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.[184]

    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.[185][186] 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.[76] 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.[187] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[188] 2 in Canada,[189] 6 in Australasia,[190] and 5 in Europe.[191] 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.[25] 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.[178][179]

    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.[192][193] There are an estimated 49,000 chiropractors in the U.S. (2008),[194] 6,500 in Canada (2010),[195] 2,500 in Australia (2000),[29] and 1,500 in the UK (2000).[196]

    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.[76] The fourth year of chiropractic education persistently showed the highest stress levels.[197] Every student, irrespective of year, experienced different ranges of stress when studying.[197] The chiropractic leaders and colleges have had internal struggles.[198] Rather than cooperation, there has been infighting between different factions.[198] A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.[198][clarification needed]

    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.[199] 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.”[200] The International Chiropractor’s Association (ICA) also has a set of professional canons.[201]

    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.[36] 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.[202][203]

    Chiropractors, especially in America, have a reputation for unnecessarily treating patients.[57] In many circumstances the focus seems to be put on economics instead of health care.[57] Sustained chiropractic care is promoted as a preventive tool, but unnecessary manipulation could possibly present a risk to patients.[8] Some chiropractors are concerned by the routine unjustified claims chiropractors have made.[8] 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.[206]

    The US Office of the Inspector General (OIG) estimated 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.[207] There have been at least 15 OIG reports about chiropractic billing irregularities since 1986.[207]

    In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,[208][209] 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.”[208] An editorial in Nature suggested that the BCA may have been trying to suppress debate and that this use of English libel law was a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.[210] The libel case ended with the BCA withdrawing its suit in 2010.[211][212]

    Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[18] It is viewed as a marginal and non-clinically–proven attempt at complementary and alternative medicine, which has not integrated into mainstream medicine.[64] Billions are spent annually for chiropractic services.[8]

    In Australia, there are approximately 2488 chiropractors, or one chiropractor for every 7980 people.[213] Most private health insurance funds in Australia cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.[214] In 2014, the chiropractic profession had a registered workforce of 4,684 practitioners in Australia represented by two major organizations — the Chiropractors’ Association of Australia (CAA) and the Chiropractic and Osteopathic College of Australasia (COCA).[215] Annual expenditure on chiropractic care (alone or combined with osteopathy) in Australia is estimated to be between AUD$750–988 million with musculoskeletal complaints such as back and neck pain making up the bulk of consultations; and proportional expenditure is similar to that found in other countries.[215] While Medicare (the Australian publicly funded universal health care system) coverage of chiropractic services is limited to only those directed by a medical referral to assist chronic disease management, most private health insurers in Australia do provide partial reimbursement for a wider range of chiropractic services in addition to limited third party payments for workers compensation and motor vehicle accidents.[215]

    Of the 2,005 chiropractors who participated in a 2015 survey, 62.4% were male and the average age was 42.1 (SD = 12.1) years.[215] Nearly all chiropractors (97.1%) had a bachelor’s degree or higher, with the majority of chiropractor’s highest professional qualification being a bachelor or double bachelor’s degree (34.6%), followed by a master’s degree (32.7%), Doctor of Chiropractic (28.9%) or PhD (0.9%).[215] Only a small number of chiropractor’s highest professional qualification was a diploma (2.1%) or advanced diploma (0.8%).[215]

    In the United Kingdom, there are over 2,000 chiropractors, representing one chiropractor per 29,206 people.[213] Chiropractic is available on the National Health Service in some areas, such as Cornwall, where the treatment is only available for neck or back pain.[216]

    A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed to patients the serious risk associated with manipulation of the cervical spine and that 46% believed there was possibility patients would refuse treatment if the risks were correctly explained. However 80% acknowledged the ethical/moral responsibility to disclose risk to patients.[217]

    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,[218] with a global high of 20% in Alberta in 2006.[219] In 2008, chiropractors were reported to be the most common CAM providers for children and adolescents, these patients representing up to 14% of all visits to chiropractors.[220]

    There were around 50,330 chiropractors practicing in North America in 2000.[213] In 2008, this has increased by almost 20% to around 60,000 chiropractors.[8] In 2002–03, the majority of those who sought chiropractic did so for relief from back and neck pain and other neuromusculoskeletal complaints;[20] most do so specifically for low back pain.[20][218] The majority of U.S. chiropractors participate in some form of managed care.[9] Although the majority of U.S. chiropractors view themselves as specialists in neuromusculoskeletal conditions, many also consider chiropractic as a type of primary care.[9] In the majority of cases, the care that chiropractors and physicians provide divides the market, however for some, their care is complementary.[9]

    In the U.S., chiropractors perform over 90% of all manipulative treatments.[221] 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.[222]

    Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[1] 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.[223] As of 2007 7% of the U.S. population is being reached by chiropractic.[224] They were the third largest medical profession in the US in 2002, following physicians and dentists.[225] Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[194]

    In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services.[220]

    Chiropractic’s origins lie in the folk medicine practice of bonesetting, in which untrained practitioners engaged in joint manipulation or resetting fractured bones.[8]
    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.[226] The first chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer’s office was located.[42] He claimed that he had severely reduced hearing for 17 years, which started soon following a “pop” in his spine.[42] A few days following his adjustment, Lillard claimed his hearing was almost completely restored.[42] Another of Palmer’s patients, Samuel Weed, coined the term chiropractic, from the Greek χειρο- chiro- (itself from χείρ cheir “hand”), “hand” and πρακτικός praktikos, “practical”.[227][228] Chiropractic is classified as a field of pseudomedicine on account of its esoteric origins.[3]

    Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health.[226] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic.[22] 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.[22]

    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.[22] D.D. Palmer said he “received chiropractic from the other world”.[23] 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.[22][23] 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).[22]

    Chiropractic has seen considerable controversy and criticism.[25][26] 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.[22] 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.[22] The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.’s 25,000 chiropractors remained straight.[22] 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.[22]

    Chiropractors faced heavy opposition from organized medicine.[42] DD Palmer was jailed in 1907 for practicing medicine without a license.[229] Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed.[42] 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.[42] B.J. cofounded the Universal Chiropractors’ Association (UCA) to provide legal services to arrested chiropractors.[42] 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.[42] The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an “unscientific cult” in 1966,[30] and until 1980 advised its members that it was unethical for medical doctors to associate with “unscientific practitioners”.[230] 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.[9]

    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.[42] 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.[42] 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.[9] 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.[9] The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.[9]

    Some chiropractors oppose vaccination and water fluoridation, which are common public health practices.[36] Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available.[231] Most chiropractic writings on vaccination focus on its negative aspects,[28] claiming that it is hazardous, ineffective, and unnecessary.[29] 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.[29] The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain.[28] 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.[29] The Canadian Chiropractic Association supports vaccination;[28] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[232] Many even reject the fact that smallpox has been eradicated and they believe it was renamed monkeypox.[232]

    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.[233] 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.[36]

    Throughout its history chiropractic has been the subject of internal and external controversy and criticism.[21][234] 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.[8][50] A 2003 profession-wide survey[43] 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.”[235] A critical evaluation stated “Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.”[8] Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license.[8] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.[42] 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.[8] Chiropractic remains controversial, though to a lesser extent than in past years.[25]


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    [1]Downloads-icon

    Chiropractic is an alternative health profession[1] concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine.[2] It has esoteric origins[3] and is based on several pseudoscientific ideas.[4]

    Many chiropractors, especially those in the field’s early history, have proposed that mechanical disorders of the joints, especially of the spine, affect general health,[2] and that regular manipulation of the spine (spinal adjustment) improves general health. The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.[5] A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as “doctor” but is not a Doctor of Medicine (M.D.)[6][7] While many chiropractors view themselves as primary care providers,[8][9] chiropractic clinical training does not meet the requirements to be such a provider.[2]

    Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.[8] A 2011 critical evaluation of 45 systematic reviews found that spinal manipulation was ineffective at treating any condition.[10] Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient.[11] No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases.[12]
    There is not sufficient data to establish the safety of chiropractic manipulations.[13] It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[14] There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation.[15] Several deaths have been associated with this technique[14] and it has been suggested that the relationship is causative,[16][17] a claim which is disputed by many chiropractors.[17]

    Chiropractic is well established in the United States, Canada, and Australia.[18] It overlaps with other manual-therapy professions such as osteopathy and physical therapy.[19] Most who seek chiropractic care do so for low back pain.[20] Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues.[8] Chiropractic has two main groups: “straights”, now the minority, emphasize vitalism, “Innate Intelligence”, and consider vertebral subluxations to be the cause of all disease; and “mixers”, the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[21]

    are chiropractors doctors

    D. D. Palmer founded chiropractic in the 1890s,[22] after saying he received it from “the other world”;[23] Palmer maintained that the tenets of chiropractic were passed along to him by a doctor who had died 50 years previously.[24] His son B. J. Palmer helped to expand chiropractic in the early 20th century.[22] Throughout its history, chiropractic has been controversial.[25][26] Its foundation is at odds with evidence-based medicine, and has been sustained by pseudoscientific ideas such as vertebral subluxation and innate intelligence.[27] Despite the overwhelming evidence that vaccination is an effective public health intervention, among chiropractors there are significant disagreements over the subject,[28] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[29] The American Medical Association called chiropractic an “unscientific cult” in 1966[30] and boycotted it until losing an antitrust case in 1987.[9] Chiropractic has had a strong political base and sustained demand for services. In the last decades of the twentieth century, it gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.[9] During the COVID-19 pandemic chiropractic professional associations advised chiropractors to adhere to CDC, WHO, and local health department guidance.[31][32] Despite these recommendations, a small but vocal and influential number of chiropractors spread anti-vaccine disinformation.[33]

    Chiropractic is generally categorized as complementary and alternative medicine (CAM),[1] which focuses on manipulation of the musculoskeletal system, especially the spine.[2] Its founder, D. D. Palmer, called it “a science of healing without drugs”.[8]

    Chiropractic’s origins lie in the folk medicine of bonesetting,[8] and as it evolved it incorporated vitalism, spiritual inspiration and rationalism.[34] 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.[34] This “straight” philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method,[34] and relies on deductions from vitalistic first principles rather than on the materialism of science.[35] However, most practitioners tend to incorporate scientific research into chiropractic,[34] 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.[35] 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.[36]


    Restoration of structural integrity


  • character stuffing program in c
  • Improvement of health status


    Innate intelligence


    Body physiology

    Although a wide diversity of ideas exist among chiropractors,[34] 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.[37] Some chiropractors claim spinal manipulation can have an effect on a variety of ailments such as irritable bowel syndrome and asthma.[38]

    Chiropractic philosophy includes the following perspectives:[35]

    Holism assumes that health is affected by everything in an individual’s environment; some sources also include a spiritual or existential dimension.[39] In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.[36] 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.[34]

    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.[21] A variant of chiropractic called naprapathy originated in Chicago in the early twentieth century.[40][41] It holds that manual manipulation of soft tissue can reduce “interference” in the body and thus improve health.[41]

    Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities.[42] 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.[42] Straights view the medical diagnosis of patient complaints, which they consider to be the “secondary effects” of subluxations, to be unnecessary for chiropractic treatment.[42] 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.[42] Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology such as “perform spinal analysis”, “detect subluxation”, “correct with adjustment”.[21] They prefer to remain separate and distinct from mainstream health care.[21] 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.”[21]

    Mixer chiropractors “mix” diagnostic and treatment approaches from chiropractic, medical or osteopathic viewpoints and make up the majority of chiropractors.[21] Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine.[21] 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.[21] Some mixers also use techniques from alternative medicine, including nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.[21]

    Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1,100 North American chiropractors, which found that 88 percent wanted to retain the term “vertebral subluxation complex”, and that when asked to estimate the percent of disorders of internal organs that subluxation significantly contributes to, the mean response was 62 percent.[43] 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.[44] 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.[44] 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.[45]

    In science-based medicine, the term “subluxation” refers to an incomplete or partial dislocation of a joint, from the Latin luxare for ‘dislocate’.[46][47] While medical doctors use the term exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word subluxation with a metaphysical and philosophical meaning drawn from pseudoscientific traditions such as Vitalism.[48]

    Palmer claimed that vertebral subluxations, interfered with the body’s function and its inborn ability to heal itself.[49] 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.[48]He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.[48] 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.[51] 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.[51] 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.[52][53]

    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.[54] It is essentially a functional entity, which may influence biomechanical and neural integrity.”[54] 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.[54] This exposes patients to harmful ionizing radiation for no evidentially supported reason.[55][56] 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.”[57] 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.”[58] 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.”[59]

    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.”[60][27]

    While some chiropractors limit their practice to short-term treatment of musculoskeletal conditions, many falsely claim to be able treat a myriad of other conditions.[61][62] Some dissuade patients from seeking medical care, others have pretended to be qualified to act as a family doctor.[61]

    Quackwatch, an alternative medicine watchdog, cautions against seeing chiropractors who:[61][63]

    Writing for the Skeptical Inquirer, one physician cautioned against seeing even chiropractors who solely claim to treat musculoskeletal conditions:

    “I think Spinal Manipulation Therapy (SMT) is a reasonable option for patients to try … But I could not in good conscience refer a patient to a chiropractor… When chiropractic is effective, what is effective is not ‘chiropractic’: it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers … If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider.[61]

    Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,[54] with special emphasis on the spine.[2] Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues.[8] 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.[64] 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.[64] 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 attributes of a medical specialty like dentistry or podiatry.[65] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,[36][65] but the more expansive view of chiropractic is still widespread.[66]

    Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);[1] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.[67] Many chiropractors believe they are primary care providers,[8][9] including US[68] and UK chiropractors,[69] but the length, breadth, and depth of chiropractic clinical training do not support the requirements to be considered primary care providers,[2] so their role on primary care is limited and disputed.[2][9]

    Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.[19][70] Chiropractic is autonomous from and competitive with mainstream medicine,[71] and osteopathy outside the US remains primarily a manual medical system;[72] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[71] 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.[19]

    Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.[54] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[65] 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.[5]

    Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States,[73] (although New Mexico has become the first US state to allow “advanced practice” trained chiropractors to prescribe certain medications.[74][75]). 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.[76] 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.[73] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.[43] A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.[77]

    A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in many US states,[78] but is not recognized by the American Chiropractic Association as being chiropractic.[79] It remains controversial within certain segments of the veterinary and chiropractic profession.[80]

    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.[81] 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.[81] Two US states (Washington and Arkansas) prohibit physical therapists from performing SM,[82] 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.[83]

    Spinal manipulation, which chiropractors call “spinal adjustment” or “chiropractic adjustment”, is the most common treatment used in chiropractic care.[84] 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.[85] 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.[85] 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.[86] Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load.[86] 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.[85]

    are chiropractors doctors

    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 US chiropractors in a 2003 survey:[84] 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.[87] Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation.[88] Koren Specific Technique (KST) may use their hands, or they may use an electric device known as an “ArthroStim” for assessment and spinal manipulations.[89] Insurers in the US and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be “experimental and investigational”.[89][90][91][92] 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.[93]

    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 US 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.[84]

    A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine.[94] The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%.[94] A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a United States chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.[95]

    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.[81] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims.[2][27][51][96][97] 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”.[98] 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.[99] Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries.[100]

    Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with varied results.[8] There is no conclusive evidence that chiropractic manipulative treatment is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.[8][10]

    Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.[101][102] Research published by chiropractors is distinctly biased: reviews of SM for back pain tended to find positive conclusions when authored by chiropractors, while reviews by mainstream authors did not.[8]

    There is a wide range of ways to measure treatment outcomes.[103] Chiropractic care benefits from the placebo response,[104] but it is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT).[105] The efficacy of maintenance care in chiropractic is unknown.[106]

    Available evidence covers the following conditions:

    The World Health Organization found chiropractic care in general is safe when employed skillfully and appropriately.[54] There is not sufficient data to establish the safety of chiropractic manipulations.[13] Manipulation is regarded as relatively safe but complications can arise, and it has known adverse effects, risks and contraindications.[54] 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.[54] 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.[54] 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.[148] Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a chiropractor.[8]

    Spinal manipulation is associated with frequent, mild and temporary adverse effects,[14][148] including new or worsening pain or stiffness in the affected region.[149] 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;[13] adverse reactions appear to be more common following manipulation than mobilization.[150] The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue.[151] Chiropractic is correlated with a very high incidence of minor adverse effects.[8] Rarely,[54] 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[14] and children.[152] Estimates vary widely for the incidence of these complications,[13] 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.[14] Adverse effects are poorly reported in recent studies investigating chiropractic manipulations.[153] A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable.[154] Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region.[155] 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.[13] Several case reports show temporal associations between interventions and potentially serious complications.[156] The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.[17]

    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.[156][157] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (CMT) and VAS.[158] There is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.[15] 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.[159] 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.[159] There is controversy regarding the degree of risk of stroke from cervical manipulation.[15] Many chiropractors state that, the association between chiropractic therapy and vertebral arterial dissection is not proven.[17] However, it has been suggested that the causality between chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is probable[17] or definite.[16] There is very low evidence supporting a small association between internal carotid artery dissection and chiropractic neck manipulation.[160] The incidence of internal carotid artery dissection following cervical spine manipulation is unknown.[161] The literature infrequently reports helpful data to better understand the association between cervical manipulative therapy, cervical artery dissection and stroke.[162] The limited evidence is inconclusive that chiropractic spinal manipulation therapy is not a cause of intracranial hypotension.[163] Cervical intradural disc herniation is very rare following spinal manipulation therapy.[164]

    Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation.[165] Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year.[57] Practice guidelines aim to reduce unnecessary radiation exposure,[165] which increases cancer risk in proportion to the amount of radiation received.[166] Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based.[56] 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.[56]

    A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.[15] 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.[17] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.[167] 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.”[167] A 1999 review of 177 previously reported cases published between 1925 and 1997 in which injuries were attributed to manipulation of the cervical spine (MCS) concluded that “The literature does not demonstrate that the benefits of MCS outweigh the risks.” The professions associated with each injury were assessed. Physical therapists (PT) were involved in less than 2% of all cases, with no deaths caused by PTs. Chiropractors were involved in a little more than 60% of all cases, including 32 deaths.[168]

    A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is 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.[12]

    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.[169] 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.[11]

    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 placebo controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[170] 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.[171] The cost-effectiveness of maintenance chiropractic care is unknown.[106][non-primary source needed]

    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.[172]

    Requirements vary between countries. In the U.S. chiropractors obtain a non-medical accredited diploma in the field of chiropractic.[173] Chiropractic education in the U.S. has been criticized for failing to meet generally accepted standards of evidence-based medicine.[174] The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has little similarity, both in the kinds of subjects offered and in the time assigned to each subject.[175] 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.[176] 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.[177] Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education.[178][179] 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.[54]

    Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[180][181] Depending on the location, continuing education may be required to renew these licenses.[182][183] 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.[184]

    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.[185][186] 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.[76] 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.[187] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[188] 2 in Canada,[189] 6 in Australasia,[190] and 5 in Europe.[191] 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.[25] 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.[178][179]

    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.[192][193] There are an estimated 49,000 chiropractors in the U.S. (2008),[194] 6,500 in Canada (2010),[195] 2,500 in Australia (2000),[29] and 1,500 in the UK (2000).[196]

    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.[76] The fourth year of chiropractic education persistently showed the highest stress levels.[197] Every student, irrespective of year, experienced different ranges of stress when studying.[197] The chiropractic leaders and colleges have had internal struggles.[198] Rather than cooperation, there has been infighting between different factions.[198] A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.[198][clarification needed]

    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.[199] 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.”[200] The International Chiropractor’s Association (ICA) also has a set of professional canons.[201]

    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.[36] 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.[202][203]

    Chiropractors, especially in America, have a reputation for unnecessarily treating patients.[57] In many circumstances the focus seems to be put on economics instead of health care.[57] Sustained chiropractic care is promoted as a preventive tool, but unnecessary manipulation could possibly present a risk to patients.[8] Some chiropractors are concerned by the routine unjustified claims chiropractors have made.[8] 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.[206]

    The US Office of the Inspector General (OIG) estimated 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.[207] There have been at least 15 OIG reports about chiropractic billing irregularities since 1986.[207]

    In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,[208][209] 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.”[208] An editorial in Nature suggested that the BCA may have been trying to suppress debate and that this use of English libel law was a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.[210] The libel case ended with the BCA withdrawing its suit in 2010.[211][212]

    Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[18] It is viewed as a marginal and non-clinically–proven attempt at complementary and alternative medicine, which has not integrated into mainstream medicine.[64] Billions are spent annually for chiropractic services.[8]

    In Australia, there are approximately 2488 chiropractors, or one chiropractor for every 7980 people.[213] Most private health insurance funds in Australia cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.[214] In 2014, the chiropractic profession had a registered workforce of 4,684 practitioners in Australia represented by two major organizations — the Chiropractors’ Association of Australia (CAA) and the Chiropractic and Osteopathic College of Australasia (COCA).[215] Annual expenditure on chiropractic care (alone or combined with osteopathy) in Australia is estimated to be between AUD$750–988 million with musculoskeletal complaints such as back and neck pain making up the bulk of consultations; and proportional expenditure is similar to that found in other countries.[215] While Medicare (the Australian publicly funded universal health care system) coverage of chiropractic services is limited to only those directed by a medical referral to assist chronic disease management, most private health insurers in Australia do provide partial reimbursement for a wider range of chiropractic services in addition to limited third party payments for workers compensation and motor vehicle accidents.[215]

    Of the 2,005 chiropractors who participated in a 2015 survey, 62.4% were male and the average age was 42.1 (SD = 12.1) years.[215] Nearly all chiropractors (97.1%) had a bachelor’s degree or higher, with the majority of chiropractor’s highest professional qualification being a bachelor or double bachelor’s degree (34.6%), followed by a master’s degree (32.7%), Doctor of Chiropractic (28.9%) or PhD (0.9%).[215] Only a small number of chiropractor’s highest professional qualification was a diploma (2.1%) or advanced diploma (0.8%).[215]

    In the United Kingdom, there are over 2,000 chiropractors, representing one chiropractor per 29,206 people.[213] Chiropractic is available on the National Health Service in some areas, such as Cornwall, where the treatment is only available for neck or back pain.[216]

    A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed to patients the serious risk associated with manipulation of the cervical spine and that 46% believed there was possibility patients would refuse treatment if the risks were correctly explained. However 80% acknowledged the ethical/moral responsibility to disclose risk to patients.[217]

    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,[218] with a global high of 20% in Alberta in 2006.[219] In 2008, chiropractors were reported to be the most common CAM providers for children and adolescents, these patients representing up to 14% of all visits to chiropractors.[220]

    There were around 50,330 chiropractors practicing in North America in 2000.[213] In 2008, this has increased by almost 20% to around 60,000 chiropractors.[8] In 2002–03, the majority of those who sought chiropractic did so for relief from back and neck pain and other neuromusculoskeletal complaints;[20] most do so specifically for low back pain.[20][218] The majority of U.S. chiropractors participate in some form of managed care.[9] Although the majority of U.S. chiropractors view themselves as specialists in neuromusculoskeletal conditions, many also consider chiropractic as a type of primary care.[9] In the majority of cases, the care that chiropractors and physicians provide divides the market, however for some, their care is complementary.[9]

    In the U.S., chiropractors perform over 90% of all manipulative treatments.[221] 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.[222]

    Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[1] 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.[223] As of 2007 7% of the U.S. population is being reached by chiropractic.[224] They were the third largest medical profession in the US in 2002, following physicians and dentists.[225] Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[194]

    In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services.[220]

    Chiropractic’s origins lie in the folk medicine practice of bonesetting, in which untrained practitioners engaged in joint manipulation or resetting fractured bones.[8]
    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.[226] The first chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer’s office was located.[42] He claimed that he had severely reduced hearing for 17 years, which started soon following a “pop” in his spine.[42] A few days following his adjustment, Lillard claimed his hearing was almost completely restored.[42] Another of Palmer’s patients, Samuel Weed, coined the term chiropractic, from the Greek χειρο- chiro- (itself from χείρ cheir “hand”), “hand” and πρακτικός praktikos, “practical”.[227][228] Chiropractic is classified as a field of pseudomedicine on account of its esoteric origins.[3]

    Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health.[226] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic.[22] 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.[22]

    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.[22] D.D. Palmer said he “received chiropractic from the other world”.[23] 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.[22][23] 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).[22]

    Chiropractic has seen considerable controversy and criticism.[25][26] 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.[22] 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.[22] The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.’s 25,000 chiropractors remained straight.[22] 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.[22]

    Chiropractors faced heavy opposition from organized medicine.[42] DD Palmer was jailed in 1907 for practicing medicine without a license.[229] Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed.[42] 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.[42] B.J. cofounded the Universal Chiropractors’ Association (UCA) to provide legal services to arrested chiropractors.[42] 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.[42] The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an “unscientific cult” in 1966,[30] and until 1980 advised its members that it was unethical for medical doctors to associate with “unscientific practitioners”.[230] 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.[9]

    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.[42] 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.[42] 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.[9] 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.[9] The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.[9]

    Some chiropractors oppose vaccination and water fluoridation, which are common public health practices.[36] Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available.[231] Most chiropractic writings on vaccination focus on its negative aspects,[28] claiming that it is hazardous, ineffective, and unnecessary.[29] 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.[29] The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain.[28] 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.[29] The Canadian Chiropractic Association supports vaccination;[28] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[232] Many even reject the fact that smallpox has been eradicated and they believe it was renamed monkeypox.[232]

    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.[233] 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.[36]

    Throughout its history chiropractic has been the subject of internal and external controversy and criticism.[21][234] 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.[8][50] A 2003 profession-wide survey[43] 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.”[235] A critical evaluation stated “Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.”[8] Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license.[8] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.[42] 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.[8] Chiropractic remains controversial, though to a lesser extent than in past years.[25]


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    [1]Downloads-icon

    Chiropractic is an alternative health profession[1] concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine.[2] It has esoteric origins[3] and is based on several pseudoscientific ideas.[4]

    Many chiropractors, especially those in the field’s early history, have proposed that mechanical disorders of the joints, especially of the spine, affect general health,[2] and that regular manipulation of the spine (spinal adjustment) improves general health. The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.[5] A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as “doctor” but is not a Doctor of Medicine (M.D.)[6][7] While many chiropractors view themselves as primary care providers,[8][9] chiropractic clinical training does not meet the requirements to be such a provider.[2]

    Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.[8] A 2011 critical evaluation of 45 systematic reviews found that spinal manipulation was ineffective at treating any condition.[10] Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient.[11] No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases.[12]
    There is not sufficient data to establish the safety of chiropractic manipulations.[13] It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[14] There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation.[15] Several deaths have been associated with this technique[14] and it has been suggested that the relationship is causative,[16][17] a claim which is disputed by many chiropractors.[17]

    Chiropractic is well established in the United States, Canada, and Australia.[18] It overlaps with other manual-therapy professions such as osteopathy and physical therapy.[19] Most who seek chiropractic care do so for low back pain.[20] Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues.[8] Chiropractic has two main groups: “straights”, now the minority, emphasize vitalism, “Innate Intelligence”, and consider vertebral subluxations to be the cause of all disease; and “mixers”, the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[21]

    are chiropractors doctors

    D. D. Palmer founded chiropractic in the 1890s,[22] after saying he received it from “the other world”;[23] Palmer maintained that the tenets of chiropractic were passed along to him by a doctor who had died 50 years previously.[24] His son B. J. Palmer helped to expand chiropractic in the early 20th century.[22] Throughout its history, chiropractic has been controversial.[25][26] Its foundation is at odds with evidence-based medicine, and has been sustained by pseudoscientific ideas such as vertebral subluxation and innate intelligence.[27] Despite the overwhelming evidence that vaccination is an effective public health intervention, among chiropractors there are significant disagreements over the subject,[28] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[29] The American Medical Association called chiropractic an “unscientific cult” in 1966[30] and boycotted it until losing an antitrust case in 1987.[9] Chiropractic has had a strong political base and sustained demand for services. In the last decades of the twentieth century, it gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.[9] During the COVID-19 pandemic chiropractic professional associations advised chiropractors to adhere to CDC, WHO, and local health department guidance.[31][32] Despite these recommendations, a small but vocal and influential number of chiropractors spread anti-vaccine disinformation.[33]

    Chiropractic is generally categorized as complementary and alternative medicine (CAM),[1] which focuses on manipulation of the musculoskeletal system, especially the spine.[2] Its founder, D. D. Palmer, called it “a science of healing without drugs”.[8]

    Chiropractic’s origins lie in the folk medicine of bonesetting,[8] and as it evolved it incorporated vitalism, spiritual inspiration and rationalism.[34] 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.[34] This “straight” philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method,[34] and relies on deductions from vitalistic first principles rather than on the materialism of science.[35] However, most practitioners tend to incorporate scientific research into chiropractic,[34] 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.[35] 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.[36]


    Restoration of structural integrity


  • how tall is a 20 story building
  • Improvement of health status


    Innate intelligence


    Body physiology

    Although a wide diversity of ideas exist among chiropractors,[34] 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.[37] Some chiropractors claim spinal manipulation can have an effect on a variety of ailments such as irritable bowel syndrome and asthma.[38]

    Chiropractic philosophy includes the following perspectives:[35]

    Holism assumes that health is affected by everything in an individual’s environment; some sources also include a spiritual or existential dimension.[39] In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.[36] 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.[34]

    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.[21] A variant of chiropractic called naprapathy originated in Chicago in the early twentieth century.[40][41] It holds that manual manipulation of soft tissue can reduce “interference” in the body and thus improve health.[41]

    Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities.[42] 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.[42] Straights view the medical diagnosis of patient complaints, which they consider to be the “secondary effects” of subluxations, to be unnecessary for chiropractic treatment.[42] 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.[42] Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology such as “perform spinal analysis”, “detect subluxation”, “correct with adjustment”.[21] They prefer to remain separate and distinct from mainstream health care.[21] 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.”[21]

    Mixer chiropractors “mix” diagnostic and treatment approaches from chiropractic, medical or osteopathic viewpoints and make up the majority of chiropractors.[21] Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine.[21] 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.[21] Some mixers also use techniques from alternative medicine, including nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.[21]

    Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1,100 North American chiropractors, which found that 88 percent wanted to retain the term “vertebral subluxation complex”, and that when asked to estimate the percent of disorders of internal organs that subluxation significantly contributes to, the mean response was 62 percent.[43] 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.[44] 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.[44] 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.[45]

    In science-based medicine, the term “subluxation” refers to an incomplete or partial dislocation of a joint, from the Latin luxare for ‘dislocate’.[46][47] While medical doctors use the term exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word subluxation with a metaphysical and philosophical meaning drawn from pseudoscientific traditions such as Vitalism.[48]

    Palmer claimed that vertebral subluxations, interfered with the body’s function and its inborn ability to heal itself.[49] 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.[48]He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.[48] 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.[51] 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.[51] 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.[52][53]

    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.[54] It is essentially a functional entity, which may influence biomechanical and neural integrity.”[54] 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.[54] This exposes patients to harmful ionizing radiation for no evidentially supported reason.[55][56] 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.”[57] 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.”[58] 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.”[59]

    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.”[60][27]

    While some chiropractors limit their practice to short-term treatment of musculoskeletal conditions, many falsely claim to be able treat a myriad of other conditions.[61][62] Some dissuade patients from seeking medical care, others have pretended to be qualified to act as a family doctor.[61]

    Quackwatch, an alternative medicine watchdog, cautions against seeing chiropractors who:[61][63]

    Writing for the Skeptical Inquirer, one physician cautioned against seeing even chiropractors who solely claim to treat musculoskeletal conditions:

    “I think Spinal Manipulation Therapy (SMT) is a reasonable option for patients to try … But I could not in good conscience refer a patient to a chiropractor… When chiropractic is effective, what is effective is not ‘chiropractic’: it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers … If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider.[61]

    Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,[54] with special emphasis on the spine.[2] Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues.[8] 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.[64] 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.[64] 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 attributes of a medical specialty like dentistry or podiatry.[65] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,[36][65] but the more expansive view of chiropractic is still widespread.[66]

    Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);[1] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.[67] Many chiropractors believe they are primary care providers,[8][9] including US[68] and UK chiropractors,[69] but the length, breadth, and depth of chiropractic clinical training do not support the requirements to be considered primary care providers,[2] so their role on primary care is limited and disputed.[2][9]

    Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.[19][70] Chiropractic is autonomous from and competitive with mainstream medicine,[71] and osteopathy outside the US remains primarily a manual medical system;[72] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[71] 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.[19]

    Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.[54] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[65] 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.[5]

    Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States,[73] (although New Mexico has become the first US state to allow “advanced practice” trained chiropractors to prescribe certain medications.[74][75]). 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.[76] 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.[73] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.[43] A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.[77]

    A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in many US states,[78] but is not recognized by the American Chiropractic Association as being chiropractic.[79] It remains controversial within certain segments of the veterinary and chiropractic profession.[80]

    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.[81] 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.[81] Two US states (Washington and Arkansas) prohibit physical therapists from performing SM,[82] 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.[83]

    Spinal manipulation, which chiropractors call “spinal adjustment” or “chiropractic adjustment”, is the most common treatment used in chiropractic care.[84] 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.[85] 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.[85] 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.[86] Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load.[86] 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.[85]

    are chiropractors doctors

    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 US chiropractors in a 2003 survey:[84] 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.[87] Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation.[88] Koren Specific Technique (KST) may use their hands, or they may use an electric device known as an “ArthroStim” for assessment and spinal manipulations.[89] Insurers in the US and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be “experimental and investigational”.[89][90][91][92] 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.[93]

    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 US 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.[84]

    A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine.[94] The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%.[94] A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a United States chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.[95]

    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.[81] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims.[2][27][51][96][97] 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”.[98] 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.[99] Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries.[100]

    Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with varied results.[8] There is no conclusive evidence that chiropractic manipulative treatment is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.[8][10]

    Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.[101][102] Research published by chiropractors is distinctly biased: reviews of SM for back pain tended to find positive conclusions when authored by chiropractors, while reviews by mainstream authors did not.[8]

    There is a wide range of ways to measure treatment outcomes.[103] Chiropractic care benefits from the placebo response,[104] but it is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT).[105] The efficacy of maintenance care in chiropractic is unknown.[106]

    Available evidence covers the following conditions:

    The World Health Organization found chiropractic care in general is safe when employed skillfully and appropriately.[54] There is not sufficient data to establish the safety of chiropractic manipulations.[13] Manipulation is regarded as relatively safe but complications can arise, and it has known adverse effects, risks and contraindications.[54] 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.[54] 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.[54] 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.[148] Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a chiropractor.[8]

    Spinal manipulation is associated with frequent, mild and temporary adverse effects,[14][148] including new or worsening pain or stiffness in the affected region.[149] 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;[13] adverse reactions appear to be more common following manipulation than mobilization.[150] The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue.[151] Chiropractic is correlated with a very high incidence of minor adverse effects.[8] Rarely,[54] 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[14] and children.[152] Estimates vary widely for the incidence of these complications,[13] 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.[14] Adverse effects are poorly reported in recent studies investigating chiropractic manipulations.[153] A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable.[154] Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region.[155] 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.[13] Several case reports show temporal associations between interventions and potentially serious complications.[156] The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.[17]

    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.[156][157] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (CMT) and VAS.[158] There is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.[15] 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.[159] 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.[159] There is controversy regarding the degree of risk of stroke from cervical manipulation.[15] Many chiropractors state that, the association between chiropractic therapy and vertebral arterial dissection is not proven.[17] However, it has been suggested that the causality between chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is probable[17] or definite.[16] There is very low evidence supporting a small association between internal carotid artery dissection and chiropractic neck manipulation.[160] The incidence of internal carotid artery dissection following cervical spine manipulation is unknown.[161] The literature infrequently reports helpful data to better understand the association between cervical manipulative therapy, cervical artery dissection and stroke.[162] The limited evidence is inconclusive that chiropractic spinal manipulation therapy is not a cause of intracranial hypotension.[163] Cervical intradural disc herniation is very rare following spinal manipulation therapy.[164]

    Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation.[165] Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year.[57] Practice guidelines aim to reduce unnecessary radiation exposure,[165] which increases cancer risk in proportion to the amount of radiation received.[166] Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based.[56] 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.[56]

    A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.[15] 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.[17] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.[167] 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.”[167] A 1999 review of 177 previously reported cases published between 1925 and 1997 in which injuries were attributed to manipulation of the cervical spine (MCS) concluded that “The literature does not demonstrate that the benefits of MCS outweigh the risks.” The professions associated with each injury were assessed. Physical therapists (PT) were involved in less than 2% of all cases, with no deaths caused by PTs. Chiropractors were involved in a little more than 60% of all cases, including 32 deaths.[168]

    A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is 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.[12]

    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.[169] 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.[11]

    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 placebo controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[170] 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.[171] The cost-effectiveness of maintenance chiropractic care is unknown.[106][non-primary source needed]

    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.[172]

    Requirements vary between countries. In the U.S. chiropractors obtain a non-medical accredited diploma in the field of chiropractic.[173] Chiropractic education in the U.S. has been criticized for failing to meet generally accepted standards of evidence-based medicine.[174] The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has little similarity, both in the kinds of subjects offered and in the time assigned to each subject.[175] 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.[176] 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.[177] Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education.[178][179] 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.[54]

    Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[180][181] Depending on the location, continuing education may be required to renew these licenses.[182][183] 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.[184]

    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.[185][186] 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.[76] 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.[187] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[188] 2 in Canada,[189] 6 in Australasia,[190] and 5 in Europe.[191] 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.[25] 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.[178][179]

    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.[192][193] There are an estimated 49,000 chiropractors in the U.S. (2008),[194] 6,500 in Canada (2010),[195] 2,500 in Australia (2000),[29] and 1,500 in the UK (2000).[196]

    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.[76] The fourth year of chiropractic education persistently showed the highest stress levels.[197] Every student, irrespective of year, experienced different ranges of stress when studying.[197] The chiropractic leaders and colleges have had internal struggles.[198] Rather than cooperation, there has been infighting between different factions.[198] A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.[198][clarification needed]

    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.[199] 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.”[200] The International Chiropractor’s Association (ICA) also has a set of professional canons.[201]

    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.[36] 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.[202][203]

    Chiropractors, especially in America, have a reputation for unnecessarily treating patients.[57] In many circumstances the focus seems to be put on economics instead of health care.[57] Sustained chiropractic care is promoted as a preventive tool, but unnecessary manipulation could possibly present a risk to patients.[8] Some chiropractors are concerned by the routine unjustified claims chiropractors have made.[8] 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.[206]

    The US Office of the Inspector General (OIG) estimated 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.[207] There have been at least 15 OIG reports about chiropractic billing irregularities since 1986.[207]

    In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,[208][209] 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.”[208] An editorial in Nature suggested that the BCA may have been trying to suppress debate and that this use of English libel law was a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.[210] The libel case ended with the BCA withdrawing its suit in 2010.[211][212]

    Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[18] It is viewed as a marginal and non-clinically–proven attempt at complementary and alternative medicine, which has not integrated into mainstream medicine.[64] Billions are spent annually for chiropractic services.[8]

    In Australia, there are approximately 2488 chiropractors, or one chiropractor for every 7980 people.[213] Most private health insurance funds in Australia cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.[214] In 2014, the chiropractic profession had a registered workforce of 4,684 practitioners in Australia represented by two major organizations — the Chiropractors’ Association of Australia (CAA) and the Chiropractic and Osteopathic College of Australasia (COCA).[215] Annual expenditure on chiropractic care (alone or combined with osteopathy) in Australia is estimated to be between AUD$750–988 million with musculoskeletal complaints such as back and neck pain making up the bulk of consultations; and proportional expenditure is similar to that found in other countries.[215] While Medicare (the Australian publicly funded universal health care system) coverage of chiropractic services is limited to only those directed by a medical referral to assist chronic disease management, most private health insurers in Australia do provide partial reimbursement for a wider range of chiropractic services in addition to limited third party payments for workers compensation and motor vehicle accidents.[215]

    Of the 2,005 chiropractors who participated in a 2015 survey, 62.4% were male and the average age was 42.1 (SD = 12.1) years.[215] Nearly all chiropractors (97.1%) had a bachelor’s degree or higher, with the majority of chiropractor’s highest professional qualification being a bachelor or double bachelor’s degree (34.6%), followed by a master’s degree (32.7%), Doctor of Chiropractic (28.9%) or PhD (0.9%).[215] Only a small number of chiropractor’s highest professional qualification was a diploma (2.1%) or advanced diploma (0.8%).[215]

    In the United Kingdom, there are over 2,000 chiropractors, representing one chiropractor per 29,206 people.[213] Chiropractic is available on the National Health Service in some areas, such as Cornwall, where the treatment is only available for neck or back pain.[216]

    A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed to patients the serious risk associated with manipulation of the cervical spine and that 46% believed there was possibility patients would refuse treatment if the risks were correctly explained. However 80% acknowledged the ethical/moral responsibility to disclose risk to patients.[217]

    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,[218] with a global high of 20% in Alberta in 2006.[219] In 2008, chiropractors were reported to be the most common CAM providers for children and adolescents, these patients representing up to 14% of all visits to chiropractors.[220]

    There were around 50,330 chiropractors practicing in North America in 2000.[213] In 2008, this has increased by almost 20% to around 60,000 chiropractors.[8] In 2002–03, the majority of those who sought chiropractic did so for relief from back and neck pain and other neuromusculoskeletal complaints;[20] most do so specifically for low back pain.[20][218] The majority of U.S. chiropractors participate in some form of managed care.[9] Although the majority of U.S. chiropractors view themselves as specialists in neuromusculoskeletal conditions, many also consider chiropractic as a type of primary care.[9] In the majority of cases, the care that chiropractors and physicians provide divides the market, however for some, their care is complementary.[9]

    In the U.S., chiropractors perform over 90% of all manipulative treatments.[221] 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.[222]

    Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[1] 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.[223] As of 2007 7% of the U.S. population is being reached by chiropractic.[224] They were the third largest medical profession in the US in 2002, following physicians and dentists.[225] Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[194]

    In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services.[220]

    Chiropractic’s origins lie in the folk medicine practice of bonesetting, in which untrained practitioners engaged in joint manipulation or resetting fractured bones.[8]
    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.[226] The first chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer’s office was located.[42] He claimed that he had severely reduced hearing for 17 years, which started soon following a “pop” in his spine.[42] A few days following his adjustment, Lillard claimed his hearing was almost completely restored.[42] Another of Palmer’s patients, Samuel Weed, coined the term chiropractic, from the Greek χειρο- chiro- (itself from χείρ cheir “hand”), “hand” and πρακτικός praktikos, “practical”.[227][228] Chiropractic is classified as a field of pseudomedicine on account of its esoteric origins.[3]

    Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health.[226] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic.[22] 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.[22]

    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.[22] D.D. Palmer said he “received chiropractic from the other world”.[23] 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.[22][23] 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).[22]

    Chiropractic has seen considerable controversy and criticism.[25][26] 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.[22] 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.[22] The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.’s 25,000 chiropractors remained straight.[22] 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.[22]

    Chiropractors faced heavy opposition from organized medicine.[42] DD Palmer was jailed in 1907 for practicing medicine without a license.[229] Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed.[42] 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.[42] B.J. cofounded the Universal Chiropractors’ Association (UCA) to provide legal services to arrested chiropractors.[42] 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.[42] The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an “unscientific cult” in 1966,[30] and until 1980 advised its members that it was unethical for medical doctors to associate with “unscientific practitioners”.[230] 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.[9]

    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.[42] 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.[42] 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.[9] 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.[9] The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.[9]

    Some chiropractors oppose vaccination and water fluoridation, which are common public health practices.[36] Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available.[231] Most chiropractic writings on vaccination focus on its negative aspects,[28] claiming that it is hazardous, ineffective, and unnecessary.[29] 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.[29] The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain.[28] 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.[29] The Canadian Chiropractic Association supports vaccination;[28] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[232] Many even reject the fact that smallpox has been eradicated and they believe it was renamed monkeypox.[232]

    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.[233] 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.[36]

    Throughout its history chiropractic has been the subject of internal and external controversy and criticism.[21][234] 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.[8][50] A 2003 profession-wide survey[43] 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.”[235] A critical evaluation stated “Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.”[8] Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license.[8] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.[42] 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.[8] Chiropractic remains controversial, though to a lesser extent than in past years.[25]


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    [1]Downloads-icon


    Osteopathy is a type of alternative medicine that emphasizes physical manipulation of the body’s muscle tissue and bones.[1][2] Practitioners of osteopathy are referred to as osteopaths.[3][4][5] Its name derives from Ancient Greek “bone” (ὀστέον) and “pain, suffering” (πάθος).

    Osteopathic manipulation is the core set of techniques in osteopathy.[6] Parts of osteopathy, such as craniosacral therapy, have no therapeutic value and have been labeled as pseudoscience and quackery.[7][8] The techniques are based on an ideology created by Andrew Taylor Still (1828–1917) which posits the existence of a “myofascial continuity”—a tissue layer that “links every part of the body with every other part”. Osteopaths attempt to diagnose and treat what was originally called “the osteopathic lesion”, but which is now named “somatic dysfunction”,[6] by manipulating a person’s bones and muscles. Osteopathic Manipulative Treatment (OMT) techniques are most commonly used to treat back pain and other musculoskeletal issues.[6][9]

    In the United States, the education and training of Doctor of Osteopathic Medicine (DO) osteopathic physicians is equivalent to that of Doctor of Medicine (MD) physicians.[10][11] Osteopathic manipulation is still included in the curricula of osteopathic physicians and is considered a unique aspect of Doctor of Osteopathic Medicine (DO) training. The “Doctor of Osteopathic Medicine” degree, however, became a medical degree and is no longer a degree of non-medical osteopathy. Because DOs in the United States attend accredited medical schools that teach allopathic medicine and surgery, graduates of osteopathic medical schools have the option to sit for both the osteopathic physician-specific COMLEX medical licensing exam and the allopathic USMLE licensing exam; DOs must attend ACGME accredited residencies like their MD peers to practice medicine and surgery in any specialty of medicine.

    The practice of osteopathy began in the United States in 1874. Osteopathy was founded by Andrew Taylor Still, a 19th-century American physician (MD), Civil War surgeon, and Kansas state and territorial legislator.[12][13][14][15] He lived near Baldwin City, Kansas, during the American Civil War and it was there that he founded the practice of osteopathy.[16] Still claimed that human illness was rooted in problems with the musculoskeletal system, and that osteopathic manipulations could solve these problems by harnessing the body’s own self-repairing potential.[17] Still’s patients were forbidden from treatment by conventional medicine, as well as from other practices such as drinking alcohol.[6] These practices derive from the belief, common in the early 19th century among proponents of alternative medicine, that the body’s natural state tends toward health and inherently contains the capacity to battle any illness.[18] This was opposed to orthodox practitioners, who held that intervention by a physician was necessary to restore health in the patient. Still established the basis for osteopathy, and the division between alternative medicine and traditional medicine had already been a major conflict for decades.[19]

    are chiropractors doctors

    The foundations of this divergence may be traced back to the mid-18th century when advances in physiology began to localize the causes and nature of diseases to specific organs and tissues. Doctors began shifting their focus from the patient to the internal state of the body, resulting in an issue labeled as the problem of the “vanishing patient”.[20] A stronger movement towards experimental and scientific medicine was then developed. In the perspective of the DO physicians, the sympathy and holism that were integral to medicine in the past were left behind. Heroic medicine became the convention for treating patients, with aggressive practices like bloodletting and prescribing chemicals such as mercury, becoming the forefront in therapeutics.[21] Alternative medicine had its beginnings in the early 19th century, when gentler practices in comparison to heroic medicine began to emerge. As each side sought to defend its practice, a schism began to present itself in the medical marketplace, with both practitioners attempting to discredit the other. The osteopathic physicians—those who are now referred to as DO’s—argued that the allopathic physicians had an overly mechanistic approach to treating patients, treated the symptoms of disease instead of the original causes, and were blind to the harm they were causing their patients. Allopathic practitioners had a similar argument, labeling osteopathic medicine as unfounded, passive, and dangerous to a disease-afflicted patient.[22] This is the medical environment that pervaded throughout the 19th century, and the setting Still entered when he began developing his idea of osteopathy.

    After experiencing the loss of his wife and three daughters to spinal meningitis and noting that the current orthodox medical system could not save them, Still may have been prompted to shape his reformist attitudes towards conventional medicine.[23] Still set out to reform the orthodox medical scene and establish a practice that did not so readily resort to drugs, purgatives, and harshly invasive therapeutics to treat a person suffering from ailment,[18] similar to the mindset of the irregulars in the early 19th century. Thought to have been influenced by spiritualist figures such as Andrew Jackson Davis and ideas of magnetic and electrical healing, Still began practicing manipulative procedures that intended to restore harmony in the body.[23] Over the course of the next twenty five years, Still attracted support for his medical philosophy that disapproved of orthodox medicine, and shaped his philosophy for osteopathy. Components included the idea that structure and function are interrelated and the importance of each piece of the body in the harmonious function of its whole.

    Still sought to establish a new medical school that could produce physicians trained under this philosophy, and be prepared to compete against the orthodox physicians. He established the American School of Osteopathy on 20 May 1892, in Kirksville, Missouri, with twenty-one students in the first class.[24] Still described the foundations of osteopathy in his book “The Philosophy and Mechanical Principles of Osteopathy” in 1892.[25] He named his new school of medicine “osteopathy”, reasoning that “the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions”.[26] He would eventually claim that he could “shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck.”[27]

    When the state of Missouri granted the right to award the MD degree,[28] he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.[29] In the early 20th century, osteopaths across the United States sought to establish law that would legitimize their medical degree to the standard of the modern medic.[30] The processes were arduous, and not without conflict. In some states, it took years for the bills to be passed. Osteopaths were often ridiculed and in some cases arrested,[30] but in each state, osteopaths managed to achieve the legal acknowledgement and action they set out to pursue. In 1898 the American Institute of Osteopathy started the Journal of Osteopathy and by that time four states recognized osteopathy as a profession.[31]

    According to the American Osteopathic Association (AOA), osteopathic manipulative treatment (OMT) is considered to be only one component of osteopathic medicine and may be used alone or in combination with pharmacotherapy, rehabilitation, surgery, patient education, diet, and exercise. OMT techniques are not necessarily unique to osteopathic medicine; other disciplines, such as physical therapy or chiropractic, use similar techniques.[32] In reality many DOs do not practice OMT at all and over time DOs in general practice less and less OMT and instead apply the common medical treatments.[33]

    One integral tenet of osteopathy is that problems in the body’s anatomy can affect its proper functioning. Another tenet is the body’s innate ability to heal itself. Many of osteopathic medicine’s manipulative techniques are aimed at reducing or eliminating the impediments to proper structure and function so the self-healing mechanism can assume its role in restoring a person to health.[34] Osteopathic medicine defines a concept of health care that embraces the concept of the unity of the living organism’s structure (anatomy) and function (physiology). The AOA states that the four major principles of osteopathic medicine are the following:[35]

  • how many confederates died in the civil war
  • These principles are not held by Doctors of Osteopathic Medicine to be empirical laws; they serve, rather, as the underpinnings of the osteopathic approach to health and disease.[citation needed]

    Muscle energy techniques address somatic dysfunction through stretching and muscle contraction. For example, if a person is unable to fully abduct her arm, the treating physician raises the patient’s arm near the end of the patient’s range of motion, also called the edge of the restrictive barrier. The patient then tries to lower her arm, while the physician provides resistance. This resistance against the patient’s motion allows for isotonic contraction of the patient’s muscle. Once the patient relaxes, her range of motion increases slightly. The repetition of alternating cycles of contraction and subsequent relaxation help the treated muscle improve its range of motion.[36] Muscle energy techniques are contraindicated in patients with fractures, crush injuries, joint dislocations, joint instability, severe muscle spasms or strains, severe osteoporosis, severe whiplash injury, vertebrobasilar insufficiency, severe illness, and recent surgery.

    Counterstrain is a system of diagnosis and treatment that considers the physical dysfunction to be a continuing, inappropriate strain reflex, which is inhibited during treatment by applying a position of mild strain in the direction exactly opposite to that of the reflex.[37] After a counterstrain point tender to palpation has been diagnosed,[38] the identified tender point is treated by the osteopathic physician who, while monitoring the tender point, positions the patient such that the point is no longer tender to palpation.[39] This position is held for ninety seconds and the patient is subsequently returned to her normal posture.[38] Most often this position of ease is usually achieved by shortening the muscle of interest.[39] Improvement or resolution of the tenderness at the identified counterstrain point is the desired outcome.[38] The use of counterstrain technique is contraindicated in patients with severe osteoporosis, pathology of the vertebral arteries, and in patients who are very ill or cannot voluntarily relax during the procedure.

    High velocity, low amplitude (HVLA) is a technique which employs a rapid, targeted, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and engages the restrictive barrier in one or more places of motion to elicit release of restriction.[40] The use of HVLA is contraindicated in patients with Down syndrome due to instability of the atlantoaxial joint which may stem from ligamentous laxity, and in pathologic bone conditions such as fracture, history of a pathologic fracture, osteomyelitis, osteoporosis, and severe cases of rheumatoid arthritis.[41][42] HVLA is also contraindicated in patients with vascular disease such as aneurysms, or disease of the carotid arteries or vertebral arteries.[41] People taking ciprofloxacin or anticoagulants, or who have local metastases should not receive HVLA.[41]

    Myofascial release is a form of alternative treatment. The practitioners claim to treat skeletal muscle immobility and pain by relaxing contracted muscles. Palpatory feedback by the practitioner is said to be an integral part to achieving a release of myofascial tissues,[40] accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the stretch reflex of muscles and overlying fascia.[43]

    Practitioners who perform myofascial release consider the fascia and its corresponding muscle to be the main targets of their procedure, but assert that other tissue may be affected as well, including other connective tissue.[43] Fascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the human body, including muscle. This soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow.[44]

    Some osteopaths search for small lumps of tissue, called “Chapman release points” as part of their diagnostic procedure.[45]

    Lymphatic pump treatment (LPT) is a manual technique intended to encourage lymph flow in a person’s lymphatic system.[46] The first modern lymphatic pump technique was developed in 1920, although osteopathic physicians used various forms of lymphatic techniques as early as the late 19th century.[47]

    Relative contraindications for the use of lymphatic pump treatments include fractures, abscesses or localized infections, and severe bacterial infections with body temperature elevated higher than 102 °F (39 °C).[48]

    A 2005 Cochrane review of OMT in asthma treatment concluded that there was insufficient evidence that OMT can be used to treat asthma.[49]

    In 2013, a Cochrane review reviewed six randomized controlled trials which investigated the effect of four types of chest physiotherapy (including OMT) as adjunctive treatments for pneumonia in adults and concluded that “based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults.” Techniques investigated in the study included paraspinal inhibition, rib raising, and myofascial release. The review found that OMT did not reduce mortality and did not increase cure rate, but that OMT slightly reduced the duration of hospital stay and antibiotic use.[50] A 2013 systematic review of the use of OMT for treating pediatric conditions concluded that its effectiveness was unproven.[51]

    In 2014, a systematic review and meta-analysis of 15 randomized controlled trials found moderate-quality evidence that OMT reduces pain and improves functional status in acute and chronic nonspecific low back pain.[52] The same analysis also found moderate-quality evidence for pain reduction for nonspecific low back pain in postpartum women and low-quality evidence for pain reduction in nonspecific low back pain in pregnant women.[52] A 2013 systematic review found insufficient evidence to rate osteopathic manipulation for chronic nonspecific low back pain.[53] In 2011, a systematic review found no compelling evidence that osteopathic manipulation was effective for the treatment of musculoskeletal pain.[54]

    A 2018 systematic review found that there is no evidence for the reliability or specific efficacy of the techniques used in visceral osteopathy.[55]

    The New England Journal of Medicine’s 4 November 1999 issue concluded that patients with chronic low back pain can be treated effectively with manipulation.[56] The United Kingdom’s National Health Service says there is “limited evidence” that osteopathy “may be effective for some types of neck, shoulder or lower limb pain and recovery after hip or knee operations”, but that there is no evidence that osteopathy is effective as a treatment for health conditions unrelated to the bones and muscles.[57] Others have concluded that there is insufficient evidence to suggest efficacy for osteopathic style manipulation in treating musculoskeletal pain.[58]

    The American Medical Association listed DOs as “cultists” and deemed MD consultation of DOs unethical from 1923 until 1962.[59] MDs regarded that osteopathic treatments were rooted in “pseudoscientific dogma”, and although physicians from both branches of medicine have been able to meet on common ground, tensions between the two continue.[17]

    In 1988, Petr Skrabanek classified osteopathy as one of the “paranormal” forms of alternative medicine, commenting that it has a view of disease which had no meaning outside its own closed system.[60]

    In a 1995 conference address, the president of the Association of American Medical Colleges, Jordan J. Cohen, pinpointed OMT as a defining difference between MDs and DOs; while he saw there was no quarrel in the appropriateness of manipulation for musculoskeletal treatment, the difficulty centered on “applying manipulative therapy to treat other systemic diseases” – at that point, Cohen maintained, “we enter the realm of skepticism on the part of the allopathic world.”[17]

    In 1998, Stephen Barrett of Quackwatch said that the worth of manipulative therapy had been exaggerated and that the American Osteopathic Association (AOA) was acting unethically by failing to condemn craniosacral therapy. The article attracted a letter from the law firm representing the AOA accusing Barrett of libel and demanding an apology to avert legal action.[17] In response, Barrett made some slight modifications to his text, while maintaining its overall stance; he queried the AOA’s reference to “the body’s natural tendency toward good health”, and challenged them to “provide [him] with adequate scientific evidence showing how this belief has been tested and demonstrated to be true.”[17] Barrett has been quoted as saying, “the pseudoscience within osteopathy can’t compete with the science”.[17]

    In 1999, Joel D. Howell noted that osteopathy and medicine as practiced by MDs were becoming increasingly convergent. He suggested that this raised a paradox: “if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic – that is, based on osteopathic manipulation or other techniques – why should its use be limited to osteopaths?”[6]

    In 2004, the osteopathic physician Bryan E. Bledsoe, a professor of emergency medicine, wrote disparagingly of the “pseudoscience” at the foundation of OMT. In his view, “OMT will and should follow homeopathy, magnetic healing, chiropractic, and other outdated practices into the pages of medical history.”[61]

    In 2010, Steven Salzberg wrote that OMT was promoted as a special distinguishing element of DO training, but that it amounted to no more than “‘extra’ training in pseudoscientific practices.”[62] It has been suggested that osteopathic physicians may be more likely than MDs to be involved in questionable practices such as orthomolecular therapy and homeopathy.[63][64]

    Retired MD and U.S. Air Force flight surgeon Harriet Hall stated that DOs trained in the U.S. are Doctors of Osteopathic Medicine and are legally equivalent to MDs. “They must be distinguished from ‘osteopaths’, members of a less regulated or unregulated profession that is practiced in many countries. Osteopaths get inferior training that can’t be compared to that of DOs.”[65]

    The osteopathic profession has evolved into two branches, non-physician manual medicine osteopaths and full scope of medical practice osteopathic physicians. These groups are so distinct that in practice they function as separate professions. The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions. In Australia, Denmark, New Zealand, Switzerland, UAE and UK the non-physician manual medicine osteopaths are regulated by statute and practice requires registration with the relevant regulatory authority. The Osteopathic International Alliance has a country guide with details of registration and practice rights and the International Osteopathic Association has a list of all accredited osteopathic colleges.[66]

    Several international and national organizations exist relating to osteopathic education and political advocacy. Similarly, there is also an international organization of organizations for national osteopathic and osteopathic medical associations, statutory regulators, and universities/medical schools offering osteopathic and osteopathic medical education, known as the Osteopathic International Alliance (OIA).[67]

    The following sections describe the legal status of osteopathy and osteopathic medicine in each country listed.

    A majority of osteopaths work in private practice, with osteopaths working within aged care, traffic and workers compensation schemes or co-located with medical practitioners. The majority of private health insurance providers cover treatment performed by osteopaths, as do many government based schemes such as veteran’s affairs[68] or workers compensations schemes[69][70] In addition, treatment performed by osteopaths is covered by the public healthcare system in Australia (Medicare)[71] under the Chronic Disease Management plan.

    Osteopathy Australia[72] (formerly the Australian Osteopathic Association) is a national organization representing the interests of Australian osteopaths, osteopathy as a profession in Australia, and consumers’ right to access osteopathic services. Founded in 1955 in Victoria, the Australian Osteopathic Association became a national body in 1991 and became Osteopathy Australia in 2014.[73] and is a member of the Osteopathic International Alliance.[74]

    The Osteopathy Board of Australia[75] is part of the Australian Health Practitioner Regulation Agency which is the regulatory body for all recognized health care professions in Australia.[76] The Osteopathic Board of Australia is separate from the Medical Board of Australia which is the governing body that regulates medical practitioners. Osteopaths trained internationally may be eligible for registration in Australia, dependent on their level of training and following relevant competency assessment.[76]

    Students training to be an osteopath in Australia must study in an approved program in an accredited university.[77] Current accredited courses are either four or five years in length.[78] To achieve accreditation universities courses must demonstrate the capabilities of graduates.[79] The capabilities are based on the CanMEDS competency framework that was developed by the Royal College of Physicians and Surgeons of Canada.

    are chiropractors doctors

    A 2018 large scale study, representing a response rate of 49.1% of the profession indicated the average age of the participants was 38.0 years, with 58.1% being female and the majority holding a Bachelor or higher degree qualification for osteopathy. The study also estimated a total of 3.9 million patients consulted osteopaths every year in Australia. Most osteopaths work in referral relationships with a range of other health services, managing patients primarily with musculoskeletal disorders.[80]

    In Canada, the titles “osteopath” and “osteopathic physician” are protected in some provinces by the medical regulatory college for physicians and surgeons.[81][82][83] As of 2011, there were approximately 20 U.S.-trained osteopathic physicians, all of which held a Doctor of Osteopathic Medicine degree, practicing in all of Canada.[84] As of 2014, no training programs have been established for osteopathic physicians in Canada.[85]

    The non-physician manual practice of osteopathy is practiced in most Canadian provinces.[86] As of 2014, manual osteopathic practice is not a government-regulated health profession in any province,[87] and those interested in pursuing osteopathic studies must register in private osteopathy schools.[88] It is estimated that there are over 1,300 osteopathic manual practitioners in Canada, most of whom practice in Quebec and Ontario.[85] Some sources indicate that there are between 1,000 and 1,200 osteopaths practicing in the province of Quebec, and although this number might seem quite elevated, many osteopathy clinics are adding patients on waiting lists due to a shortage of osteopaths in the province.[88]

    Beginning in 2009, Université Laval in Quebec City was working with the Collège d’études ostéopathiques in Montreal on a project to implement a professional osteopathy program consisting of a bachelor’s degree followed by a professional master’s degree in osteopathy as manual therapy.[88] However, due to the many doubts concerning the scientific credibility of osteopathy from the university’s faculty of medicine, the program developers decided to abandon the project in 2011, after .mw-parser-output .frac{white-space:nowrap}.mw-parser-output .frac .num,.mw-parser-output .frac .den{font-size:80%;line-height:0;vertical-align:super}.mw-parser-output .frac .den{vertical-align:sub}.mw-parser-output .sr-only{border:0;clip:rect(0,0,0,0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px}2+1⁄2 years of discussion, planning, and preparation for the program implementation.[88] There was some controversy with the final decision of the university’s committee regarding the continuous undergraduate and professional graduate program in osteopathy because the Commission of studies, which is in charge of evaluating new training programs offered by the university, had judged that the program had its place at Université Laval before receiving the unfavourable support decision from the faculty of medicine.[88] Had the program been implemented, Université Laval would have been the first university institution in Quebec to offer a professional program in osteopathy as a manual therapy.[88]

    Hesham Khalil introduced osteopathy in the Middle East at a local physical therapy conference in Cairo, Egypt in 2005 with a lecture titled “The global Osteopathic Concept / Holistic approach in Somatic Dysfunction”. Since then he has toured the Middle East to introduce osteopathy in other Middle Eastern and North African countries, including Sudan, Jordan, Saudi Arabia, Qatar, UAE, Kuwait and Oman.
    In December 2007 the first Workshop on Global osteopathic approach was held at the Nasser Institute Hospital for Research and Treatment, sponsored by the Faculty of Physical Therapy, University of Cairo, Egypt.[89] On 6 August 2010, the Egyptian Osteopathic Society (OsteoEgypt) was founded. OsteoEgypt promotes a two-tier model of osteopathy in Egypt and the Middle East. The event was timed to coincide with the birthday of A.T. Still.[90][91][non-primary source needed]

    There is no European regulatory authority for the practice of osteopathy or osteopathic medicine within the European Union; each country has its own rules. The UK’s General Osteopathic Council, a regulatory body set up under the country’s Osteopaths Act 1993, issued a position paper on European regulation of osteopathy in 2005.[92]

    Since the early 1970s, osteopaths have been practicing in Belgium, during which time several attempts have been made to obtain an official status of health care profession.[citation needed] In 1999, a law was voted (the ‘Colla-Law'[93]) providing a legal framework for osteopathy, amongst three other non-conventional medical professions.
    In 2011, the former Belgian Minister Onkelinx set up the Chambers for Non-Conventional Medicines and the Joint Commission provided for in the “Colla-law” (1999). Their goal was to discuss and reach an agreement between the various medical professions to rule on these practices. In February 2014, only one practice, homeopathy, received its recognition. The others, including osteopathy, remain unresolved.[94]
    Since 2014, the majority of the professional osteopathic associations have joined together under the name of UPOB – BVBO (Union Professionelle des Osteopathes de Belgique – Belgische Vereniging van Belgische Osteopaten – Professional Union of Belgian Osteopaths) in order to strengthen the image and vision of osteopathy (± 900 osteopaths). This unification also led in the creation of a website[95] which represents all aspects of osteopathy in Belgium. Its aim is to offer Belgians a base of information about osteopathy, to provide access to a national on-call emergency service as well as to osteopathic care facilities for the less fortunates. The site has also a search engine giving access to all osteopaths who exclusively practice osteopathy. Lastly, the website serves as a platform to support actions working towards the recognition of osteopathy. In 2020, they changed their name to osteopathie.be

    Osteopathy is a governmentally recognized profession and has title protection, autorisation d’utiliser le titre d’ostéopathe.[96] The most recent decree regarding osteopathy was enacted in 2014.[97][98][99][100][101][102]

    Germany has both osteopathy and osteopathic medicine. There is a difference in the osteopathic education between non-physician osteopaths, physiotherapists, and medical physicians.

    Physiotherapists are a recognized health profession and can achieve a degree of “Diploma in Osteopathic Therapy (D.O.T.)”. Non-physician osteopaths are not medically licensed. They have an average total of 1200 hours of training, roughly half being in manual therapy and osteopathy, with no medical specialization before they attain their degree. Non-physician osteopaths in Germany officially work under the “Heilpraktiker” law. Heilpraktiker is a separate profession within the health care system. There are many schools of osteopathy in Germany; most are moving toward national recognition although such recognition does not currently exist.[103] In Germany, there are state level rules governing which persons (non-physicians) may call themselves osteopaths.[104]

    Osteopathy is a governmentally recognized health profession and the title of Osteopath is protected by Law (Act 45/2003, of 22 October, and Act 71/2013, of 2 September). Currently there are eight faculties that teach the four-year degree course of osteopathy (BSc Hon in Osteopathy).[105]

    Sri Sri University offers BSc and MSc Osteopathy programmes.[106]

    The practice of osteopathy is regulated by law, under the terms of the Health Practitioners Competence Assurance Act 2003[107] which came into effect on 18 September 2004. Under the Act, it is a legal requirement to be registered with the Osteopathic Council of New Zealand (OCNZ),[108] and to hold an annual practicing certificate issued by them, in order to practice as an osteopath. Each of the fifteen health professions regulated by the HPCA Act work within the “Scope of Practice” determined and published by its professional Board or Council. Osteopaths in New Zealand are not fully licensed physicians. In New Zealand, in addition to the general scope of practice, osteopaths may also hold the Scope of Practice for Osteopaths using Western Medical Acupuncture and Related Needling Techniques.[109]

    In New Zealand a course is offered at Unitec.[110] Australasian courses consist of a bachelor’s degree in clinical science (osteopathy) followed by a master’s degree. The Unitec double degree programme is the OCNZ prescribed qualification for registration in the scope of practice: Osteopath, Australian qualifications accredited by the Australian and New Zealand Osteopathic Council are also prescribed qualifications.

    Osteopaths registered and in good standing with the Australian Health Practitioner Regulation Agency – Osteopathy Board of Australian are eligible to register in New Zealand under the mutual recognition system operating between the two countries. Graduates from programs in every other country are required to complete an assessment procedure.[111]

    The scope of practice for US-trained osteopathic physicians is unlimited on an exceptions basis. Full licensure to practice medicine is awarded on an exceptions basis following a hearing before the licensing authorities in New Zealand. Both the Medical Council of New Zealand[112] and the OCNZ[113] regulate osteopathic physicians in New Zealand. Currently, the country has no recognized osteopathic medical schools.[114]

    The first school of osteopathy was established in London in 1917 by John Martin Littlejohn, a pupil of A.T. Still, who had been Dean of the Chicago College of Osteopathic Medicine. After many years of existing outside the mainstream of health care provision, the osteopathic profession in the UK was accorded formal recognition by Parliament in 1993 by the Osteopaths Act.[115] This legislation now provides the profession of osteopathy the same legal framework of statutory self-regulation as other healthcare professions such as medicine and dentistry. This Act provides for “protection of title”. A person who expressly or implicitly describes themself as an osteopath, osteopathic practitioner, osteopathic physician, osteopathist, osteotherapist, or any kind of osteopath is guilty of an offence unless they are registered as an osteopath.

    The General Osteopathic Council (GOsC) regulates the practice of osteopathy under the terms of the Act. Under British law, an osteopath must be registered with the GOsC to practice in the United Kingdom.[116] More than 5,300 osteopaths were registered in the UK as of 2021.[117] The General Osteopathic Council has a statutory duty to promote, develop and regulate the profession of osteopathy in the UK. Its duty is to protect the interests of the public by ensuring that all osteopaths maintain high standards of safety, competence and professional conduct throughout their professional lives. In order to be registered with the General Osteopathic Council an osteopath must hold a recognized qualification that meets the standards as set out by law in the GOsC’s Standard of Practice.[118]

    Osteopathic medicine is regulated by the General Osteopathic Council, (GOsC) under the terms of the Osteopaths Act 1993 and statement from the GMC. Practising osteopaths will usually have a B.S. or MSc in osteopathy. Accelerated courses leading to accreditation are available for those with a medical degree and physiotherapists.[119] The London College of Osteopathic Medicine[120] teaches osteopathy only to those who are already physicians.

    An osteopathic physician in the United States is a physician trained in the full scope of medical practice, with a degree of Doctor of Osteopathic Medicine (DO).[121][11][122][123]. With the increased internationalization of osteopathy, the American Osteopathic Association (AOA) recommended in 2010 that the older terms osteopathy and osteopath be reserved for “informal or historical discussions and for referring to previously named entities in the profession and foreign-trained osteopaths”, and replaced in the US by osteopathic medicine and osteopathic physician.[124][125] The American Association of Colleges of Osteopathic Medicine made a similar recommendation.[126]

    Those trained only in manual osteopathic treatment, generally to relieve muscular and skeletal conditions, are referred to as osteopaths,[127] and are not permitted to use the title DO in the United States[citation needed] to avoid confusion with osteopathic physicians.[1]


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    Vitalism is the belief that “living organisms are fundamentally different from non-living entities because they contain some non-physical element or are governed by different principles than are inanimate things.”[1][a] Where vitalism explicitly invokes a vital principle, that element is often referred to as the “vital spark,” “energy,” or “élan vital,” which some equate with the soul. In the 18th and 19th centuries vitalism was discussed among biologists, between those who felt that the known mechanics of physics would eventually explain the difference between life and non-life and vitalists who argued that the processes of life could not be reduced to a mechanistic process. Some vitalist biologists proposed testable hypotheses meant to show inadequacies with mechanistic explanations, but these experiments failed to provide support for vitalism. Biologists now consider vitalism in this sense to have been refuted by empirical evidence, and hence regard it either as a superseded scientific theory,[4] or, since the mid-20th century, as a pseudoscience.[5][6]

    Vitalism has a long history in medical philosophies: many traditional healing practices posited that disease results from some imbalance in vital forces.

    The notion that bodily functions are due to a vitalistic principle existing in all living creatures has roots going back at least to ancient Egypt.[7] In Greek philosophy, the Milesian school proposed natural explanations deduced from materialism and mechanism. However, by the time of Lucretius, this account was supplemented, (for example, by the unpredictable clinamen of Epicurus), and in Stoic physics, the pneuma assumed the role of logos. Galen believed the lungs draw pneuma from the air, which the blood communicates throughout the body.[8]

    In Europe, medieval physics was influenced by the idea of pneuma, helping to shape later aether theories.

    Vitalists included English anatomist Francis Glisson (1597–1677) and the Italian doctor Marcello Malpighi (1628–1694).[9] Caspar Friedrich Wolff (1733–1794) is considered to be the father of epigenesis in embryology, that is, he marks the point when embryonic development began to be described in terms of the proliferation of cells rather than the incarnation of a preformed soul. However, this degree of empirical observation was not matched by a mechanistic philosophy: in his Theoria Generationis (1759), he tried to explain the emergence of the organism by the actions of a vis essentialis (an organizing, formative force), stating “All believers in epigenesis are vitalists.” Carl Reichenbach (1788–1869) later developed the theory of Odic force, a form of life-energy that permeates living things.

    are chiropractors doctors

    In the 17th century, modern science responded to Newton’s action at a distance and the mechanism of Cartesian dualism with vitalist theories: that whereas the chemical transformations undergone by non-living substances are reversible, so-called “organic” matter is permanently altered by chemical transformations (such as cooking).[10]

    As worded by Charles Birch and John B. Cobb, “the claims of the vitalists came to the fore again” in the 18th century:[9] “Georg Ernst Stahl’s followers were active as were others, such as the physician genius Francis Xavier Bichat of the Hotel Dieu.”[9] However, “Bichat moved from the tendency typical of the French vitalistic tradition to progressively free himself from metaphysics in order to combine with hypotheses and theories which accorded to the scientific criteria of physics and chemistry.”[11] John Hunter recognised “a ‘living principle’ in addition to mechanics.”[9]

    Johann Friedrich Blumenbach also was influential in establishing epigenesis in the life sciences in 1781 with his publication of Über den Bildungstrieb und das Zeugungsgeschäfte. Blumenbach cut up freshwater Hydra and established that the removed parts would regenerate. He inferred the presence of a “formative drive” (Bildungstrieb) in living matter. But he pointed out that this name,

    like names applied to every other kind of vital power, of itself, explains nothing: it serves merely to designate a peculiar power formed by the combination of the mechanical principle with that which is susceptible of modification.

    Jöns Jakob Berzelius, one of the early 19th century fathers of modern chemistry, argued that a regulative force must exist within living matter to maintain its functions.[10] Vitalist chemists predicted that organic materials could not be synthesized from inorganic components, but Friedrich Wöhler synthesised urea from inorganic components in 1828.[12] However, contemporary accounts do not support the common belief that vitalism died when Wöhler made urea. This Wöhler Myth, as historian Peter Ramberg called it, originated from a popular history of chemistry published in 1931, which, “ignoring all pretense of historical accuracy, turned Wöhler into a crusader who made attempt after attempt to synthesize a natural product that would refute vitalism and lift the veil of ignorance, until ‘one afternoon the miracle happened'”.[13][14][15]

    Between 1833 and 1844, Johannes Peter Müller wrote a book on physiology called Handbuch der Physiologie, which became the leading textbook in the field for much of the nineteenth century. The book showed Müller’s commitments to vitalism; he questioned why organic matter differs from inorganic, then proceeded to chemical analyses of the blood and lymph. He describes in detail the circulatory, lymphatic, respiratory, digestive, endocrine, nervous, and sensory systems in a wide variety of animals but explains that the presence of a soul makes each organism an indivisible whole. He also claimed the behavior of light and sound waves showed that living organisms possessed a life-energy for which physical laws could never fully account.[16]

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  • Louis Pasteur (1822–1895) after his famous rebuttal of spontaneous generation, performed several experiments that he felt supported vitalism. According to Bechtel, Pasteur “fitted fermentation into a more general programme describing special reactions that only occur in living organisms. These are irreducibly vital phenomena.” Rejecting the claims of Berzelius, Liebig, Traube and others that fermentation resulted from chemical agents or catalysts within cells, Pasteur concluded that fermentation was a “vital action”.[1]

    Hans Driesch (1867–1941) interpreted his experiments as showing that life is not run by physicochemical laws.[5] His main argument was that when one cuts up an embryo after its first division or two, each part grows into a complete adult. Driesch’s reputation as an experimental biologist deteriorated as a result of his vitalistic theories, which scientists have seen since his time as pseudoscience.[5][6] Vitalism is a superseded scientific hypothesis, and the term is sometimes used as a pejorative epithet.[17] Ernst Mayr (1904–2005) wrote:

    It would be ahistorical to ridicule vitalists. When one reads the writings of one of the leading vitalists like Driesch one is forced to agree with him that many of the basic problems of biology simply cannot be solved by a philosophy as that of Descartes, in which the organism is simply considered a machine… The logic of the critique of the vitalists was impeccable.[18]

    Vitalism has become so disreputable a belief in the last fifty years that no biologist alive today would want to be classified as a vitalist. Still, the remnants of vitalist thinking can be found in the work of Alistair Hardy, Sewall Wright, and Charles Birch, who seem to believe in some sort of nonmaterial principle in organisms.[19]

    Other vitalists included Johannes Reinke and Oscar Hertwig. Reinke used the word neovitalism to describe his work, claiming that it would eventually be verified through experimentation, and that it was an improvement over the other vitalistic theories. The work of Reinke influenced Carl Jung.[20]

    John Scott Haldane adopted an anti-mechanist approach to biology and an idealist philosophy early on in his career. Haldane saw his work as a vindication of his belief that teleology was an essential concept in biology. His views became widely known with his first book Mechanism, life and personality in 1913.[21] Haldane borrowed arguments from the vitalists to use against mechanism; however, he was not a vitalist. Haldane treated the organism as fundamental to biology: “we perceive the organism as a self-regulating entity”, “every effort to analyze it into components that can be reduced to a mechanical explanation violates this central experience”.[21] The work of Haldane was an influence on organicism.

    Haldane also stated that a purely mechanist interpretation can not account for the characteristics of life. Haldane wrote a number of books in which he attempted to show the invalidity of both vitalism and mechanist approaches to science. Haldane explained:

    We must find a different theoretical basis of biology, based on the observation that all the phenomena concerned tend towards being so coordinated that they express what is normal for an adult organism.

    By 1931, biologists had “almost unanimously abandoned vitalism as an acknowledged belief.”[22]

    Contemporary science and engineering sometimes describe emergent processes, in which the properties of a system cannot be fully described in terms of the properties of the constituents.[23][24] This may be because the properties of the constituents are not fully understood, or because the interactions between the individual constituents are also important for the behavior of the system.

    Whether emergence should be grouped with traditional vitalist concepts is a matter of semantic controversy.[25] According to Emmeche et al. (1997):

    On the one hand, many scientists and philosophers regard emergence as having only a pseudo-scientific status. On the other hand, new developments in physics, biology, psychology, and cross-disciplinary fields such as cognitive science, artificial life, and the study of non-linear dynamical systems have focused strongly on the high level ‘collective behaviour’ of complex systems, which is often said to be truly emergent, and the term is increasingly used to characterize such systems.

    A popular vitalist theory of the 18th century was “animal magnetism”, in the theories of Franz Mesmer (1734–1815). However, the use of the (conventional) English term animal magnetism to translate Mesmer’s magnétisme animal can be misleading for three reasons:

    Mesmer’s ideas became so influential that King Louis XVI of France appointed two commissions to investigate mesmerism; one was led by Joseph-Ignace Guillotin, the other, led by Benjamin Franklin, included Bailly and Lavoisier. The commissioners learned about Mesmeric theory, and saw its patients fall into fits and trances. In Franklin’s garden, a patient was led to each of five trees, one of which had been “mesmerized”; he hugged each in turn to receive the “vital fluid,” but fainted at the foot of a ‘wrong’ one. At Lavoisier’s house, four normal cups of water were held before a “sensitive” woman; the fourth produced convulsions, but she calmly swallowed the mesmerized contents of a fifth, believing it to be plain water. The commissioners concluded that “the fluid without imagination is powerless, whereas imagination without the fluid can produce the effects of the fluid.”[27]

    Vitalism has a long history in medical philosophies: many traditional healing practices posited that disease results from some imbalance in vital forces. In the Western tradition founded by Hippocrates, these vital forces were associated with the four temperaments and humours; Eastern traditions posited an imbalance or blocking of qi or prana. One example of a similar notion in Africa is the Yoruba concept of ase. Today forms of vitalism continue to exist as philosophical positions or as tenets in some religious traditions.[citation needed]

    Complementary and alternative medicine therapies include energy therapies,[28] associated with vitalism, especially biofield therapies such as therapeutic touch, Reiki, external qi, chakra healing and SHEN therapy.[29] In these therapies, the “subtle energy” field of a patient is manipulated by a practitioner. The subtle energy is held to exist beyond the electromagnetic energy produced by the heart and brain. Beverly Rubik describes the biofield as a “complex, dynamic, extremely weak EM field within and around the human body….”[29]

    The founder of homeopathy, Samuel Hahnemann, promoted an immaterial, vitalistic view of disease: “…they are solely spirit-like (dynamic) derangements of the spirit-like power (the vital principle) that animates the human body.” The view of disease as a dynamic disturbance of the immaterial and dynamic vital force is taught in many homeopathic colleges and constitutes a fundamental principle for many contemporary practising homeopaths.[citation needed]

    Vitalism has sometimes been criticized as begging the question by inventing a name. Molière had famously parodied this fallacy in Le Malade imaginaire, where a quack “answers” the question of “Why does opium cause sleep?” with “Because of its dormitive virtue (i.e., soporific power).”[30] Thomas Henry Huxley compared vitalism to stating that water is the way it is because of its “aquosity”.[31] His grandson Julian Huxley in 1926 compared “vital force” or élan vital to explaining a railroad locomotive’s operation by its élan locomotif (“locomotive force”).

    Another criticism is that vitalists have failed to rule out mechanistic explanations. This is rather obvious in retrospect for organic chemistry and developmental biology, but the criticism goes back at least a century. In 1912, Jacques Loeb published The Mechanistic Conception of Life, in which he described experiments on how a sea urchin could have a pin for its father, as Bertrand Russell put it (Religion and Science). He offered this challenge:

    Loeb addressed vitalism more explicitly:

    Bechtel states that vitalism “is often viewed as unfalsifiable, and therefore a pernicious metaphysical doctrine.”[1] For many scientists, “vitalist” theories were unsatisfactory “holding positions” on the pathway to mechanistic understanding. In 1967, Francis Crick, the co-discoverer of the structure of DNA, stated “And so to those of you who may be vitalists I would make this prophecy: what everyone believed yesterday, and you believe today, only cranks will believe tomorrow.”[32]

    While many vitalistic theories have in fact been falsified, notably Mesmerism, the pseudoscientific retention of untested and untestable theories continues to this day. Alan Sokal published an analysis of the wide acceptance among professional nurses of “scientific theories” of spiritual healing. (Pseudoscience and Postmodernism: Antagonists or Fellow-Travelers?).[33] Use of a technique called therapeutic touch was especially reviewed by Sokal, who concluded, “nearly all the pseudoscientific systems to be examined in this essay are based philosophically on vitalism” and added that “Mainstream science has rejected vitalism since at least the 1930s, for a plethora of good reasons that have only become stronger with time.”[33]

    Joseph C. Keating, Jr.[34] discusses vitalism’s past and present roles in chiropractic and calls vitalism “a form of bio-theology.” He further explains that:

    Keating views vitalism as incompatible with scientific thinking:

    Keating also mentions Skinner’s viewpoint:

    According to Williams, “[t]oday, vitalism is one of the ideas that form the basis for many pseudoscientific health systems that claim that illnesses are caused by a disturbance or imbalance of the body’s vital force.”[36] “Vitalists claim to be scientific, but in fact they reject the scientific method with its basic postulates of cause and effect and of provability. They often regard subjective experience to be more valid than objective material reality.”[36]

    Victor Stenger[37] states that the term “bioenergetics” “is applied in biochemistry to refer to the readily measurable exchanges of energy within organisms, and between organisms and the environment, which occur by normal physical and chemical processes. This is not, however, what the new vitalists have in mind. They imagine the bioenergetic field as a holistic living force that goes beyond reductionist physics and chemistry.”[38]

    Such a field is sometimes explained as electromagnetic, though some advocates also make confused appeals to quantum physics.[29] Joanne Stefanatos states that “The principles of energy medicine originate in quantum physics.”[39] Stenger[38] offers several explanations as to why this line of reasoning may be misplaced. He explains that energy exists in discrete packets called quanta. Energy fields are composed of their component parts and so only exist when quanta are present. Therefore, energy fields are not holistic, but are rather a system of discrete parts that must obey the laws of physics. This also means that energy fields are not instantaneous. These facts of quantum physics place limitations on the infinite, continuous field that is used by some theorists to describe so-called “human energy fields”.[40] Stenger continues, explaining that the effects of EM forces have been measured by physicists as accurately as one part in a billion and there is yet to be any evidence that living organisms emit a unique field.[38]

    Vitalistic thinking has also been identified in the naive biological theories of children: “Recent experimental results show that a majority of preschoolers tend to choose vitalistic explanations as most plausible. Vitalism, together with other forms of intermediate causality, constitute unique causal devices for naive biology as a core domain of thought.”[41]


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    Daniel David Palmer or D.D. Palmer (March 7, 1845 – October 20, 1913) was a Canadian American chiropractor who was the founder of chiropractic.[2] Palmer was born in Port Perry, Ontario, but emigrated to the United States.[3] He was also an avid proponent of various other forms of pseudoscientific alternative medicine such as magnetic healing. Palmer opposed anything he thought to be associated with mainstream medicine such as vaccination.[4]

    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.

    Palmer was born in Port Perry, Ontario, Canada to Thomas Palmer and his wife Katherine McVay.[5] At age twenty he moved to the United States with his family. Palmer held various jobs such as a beekeeper, school teacher, and grocery store owner, and had an interest in the various health philosophies of his day, including magnetic healing, and spiritualism. In 1870 Palmer was probably a student of metaphysics.[6] Palmer practiced magnetic healing beginning in the mid-1880s in Burlington and Davenport, Iowa.

    In 1895, Palmer was practicing magnetic healing from an office in Davenport when he encountered the building’s janitor, Harvey Lillard. Lillard’s hearing was severely impaired, and Palmer theorized that a palpable lump in his back that Palmer had noticed was related to Lillard’s hearing deficits.[7] Palmer then treated Lillard’s back and claimed to have successfully restored his hearing,[8] a claim which was influential in chiropractic history.

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    This account of how the first adjustment came to be would later be countered by Harvey’s daughter who recounts a different interaction between the two men, as told to her by her father. She claims that Palmer overheard Harvey telling a joke just outside his office, and joined the group to catch the end of it. Upon hearing the punchline, Palmer heartily slapped Lillard on the back. A few days later Lillard remarked that his hearing had improved since the incident, inspiring Palmer to pursue vertebral treatment as a means to cure disease.[9]

    In 1896, D.D. Palmer’s first descriptions and underlying philosophy of chiropractic was strikingly similar to Andrew Still’s principles of osteopathy established a decade earlier.[10] 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 to improve health; chiropractors dubbed this manipulable lesion “subluxation” which interfered with the nervous system whereas osteopaths dubbed the spinal lesion “somatic dysfunction” which affected the circulatory system. Palmer drew further distinctions by noting that he was the first to use short-lever manipulative techniques using the spinous process and transverse processes as mechanical levers to spinal dysfunction/subluxation.[7] Soon after, osteopaths began an American wide campaign proclaimed that chiropractic was a bastardized form of osteopathy and sought licensure to differentiate the two groups.[10] Although Palmer initially denied being trained by osteopathic medicine founder A.T. Still, in 1899 he wrote:

    Some years ago I took an expensive course in Electropathy, Cranial Diagnosis, Hydrotherapy, Facial Diagnosis. Later I took Osteopathy [which] gave me such a measure of confidence as to almost feel it unnecessary to seek other sciences for the mastery of curable disease. Having been assured that the underlying philosophy of chiropractic is the same as that of osteopathy…Chiropractic is osteopathy gone to seed.[6]

    His theories revolved around the concept that altered nerve flow was the cause of all disease, and that misaligned spinal vertebrae had an effect on the nerve flow. He postulated that restoring these vertebrae to their proper alignment would restore health.

    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.[8]

    Palmer began teaching others his new treatment methods. In 1897, he founded the Palmer School and Cure in Davenport, later renamed Palmer College of Chiropractic. Among Palmer’s early students was his son B.J. Palmer.[11]

  • 1.60 meters to feet
  • In 1906, Palmer was prosecuted under the new medical arts law in Iowa for practicing medicine without a license, and chose to go to jail instead of paying the fine. As a result, he spent 17 days in jail, but then elected to pay the fine. Shortly thereafter, he sold the school of chiropractic to B.J. Palmer. After the sale of the school was finalized, D.D. Palmer went to the west coast of the United States, where he helped to found chiropractic schools in Oklahoma, California, and Oregon.

    As an active spiritist, D.D. Palmer said he “received chiropractic from the other world”[12] from a deceased medical physician named Dr. James Atkinson.[13]

    According to his son, B.J. Palmer, “Father often attended the annual Mississippi Valley Spiritualists Camp Meeting where he first claimed to receive messages from Dr. James Atkinson on the principles of chiropractic.”[14][15]

    The knowledge and philosophy given me by Dr. James Atkinson, an intelligent spiritual being, together with explanations of phenomena, principles resolved from causes, effects, powers, laws and utility, appealed to my reason. The method by which I obtained an explanation of certain physical phenomena, from an intelligence in the spiritual world, is known in biblical language as inspiration. In a great measure The Chiropractor’s Adjuster was written under such spiritual promptings. (p. 5)[15]

    He regarded chiropractic as partly religious in nature. At various times he wrote:

    … we must have a religious head, one who is the founder, as did Christ, Muhammad, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase.[12]

    … nor interfere with the religious duty of chiropractors, a privilege already conferred upon them. It now becomes us as chiropractors to assert our religious rights. (p. 1)[15]

    The practice of chiropractic involves a moral obligation and a religious duty. (p. 2)[15]

    By correcting these displacements of osseous tissue, the tension frame of the nervous system, I claim that I am rendering obedience, adoration and honor to the All-Wise Spiritual Intelligence, as well as a service to the segmented, individual portions thereof – a duty I owe to both God and mankind. In accordance with this aim and end, the Constitution of the United States and the statutes personal of California confer upon me and all persons of chiropractic faith the inalienable right to practice our religion without restraint or interference.[15](p. 12)

    He distanced himself from actually renaming the profession to the “religion of chiropractic” and discussed the differences between a formal, objective religion and a personal, subjective ethical religious belief. [15](p. 6)

    Like other drugless healers of the era, Palmer practised as a magnetic healer prior to founding chiropractic. Palmer sought to combine magnetic, scientific and vitalistic viewpoints as a drugless healer.

    In 1886 I began as a business. Although I practiced under the name of magnetic, I did not slap or rub, as others. I questioned many M.D.s as to the cause of disease. I desired to know why such a person had asthma, rheumatism, or other afflictions. I wished to know what differences there were in two persons that caused one to have certain symptoms called disease which his neighbor living under the same conditions did not have…In my practice of the first 10 years which I named magnetic, I treated nerves, followed and relieved them of inflammation. I made many good cures, as many are doing today under a similar method.[15]

    He met opposition throughout his life, including locally, and was accused of being a crank and a quack. An 1894 edition of the local paper, the Davenport Leader, wrote:

    A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method … he has certainly profited by the ignorance of his victims … His increase in business shows what can be done in Davenport, even by a quack.[16]

    Like his son, Palmer was against vaccines:

    It is the very height of absurdity to strive to ‘protect’ any person from smallpox or any other malady by inoculating them with a filthy animal poison. – D.D. Palmer[4]

    The Palmers espoused anti-vaccination opinions in the early part of the 20th century, rejecting the germ theory of disease in favor of a worldview that a subluxation-free spine, achieved by spinal adjustments, would result in an unfettered innate intelligence;….[17]

    The relationship with his son, B. J. Palmer, was tenuous and often bitter, especially after the sale of his school. Their subsequent disagreements regarding the direction of the emerging field of chiropractic were evident in D. D. Palmer’s writings. B.J. Palmer resented his father for the way he treated his family, stating that his father beat three of his children with straps and was so much involved in chiropractic that “he hardly knew he had any children”.[18] Even the circumstances surrounding his death were postulated to be attributable to B. J.

    Court records reflect that during a parade in Davenport in August 1913, D. D. was marching on foot when he was struck from behind by a car driven by B. J. He died in Los Angeles, California on October 20, 1913. The official cause of death was typhoid fever, though some believe it was the consequence of his injuries.[18] The courts exonerated B.J. of any responsibility for his father’s death.

    Chiropractic historian Joseph C. Keating, Jr. has described the attempted patricide of D. D. Palmer as a “myth” and “absurd on its face” and cites an eyewitness who recalled that D.D. was not struck by B. J.’s car, but rather had stumbled. He also says that “Joy Loban, DC, executor of D.D.’s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son.”[19][20]



    “D.D. Palmer’s Lifeline”Downloads-icon


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    Davenport is a city in and the county seat of Scott County, Iowa, United States. It is located along the Mississippi River on the eastern border of the state, and is the largest of the Quad Cities, a metropolitan area with a population estimate of 382,630 and a CSA population of 474,226; it is the 90th largest CSA in the nation.[3][4] Davenport was founded on May 14, 1836 by Antoine Le Claire and was named for his friend George Davenport, a former English sailor who served in the U.S. Army during the War of 1812, served as a supplier Fort Armstrong, worked as a fur trader with the American Fur Company, and was appointed a quartermaster with the rank of colonel during the Black Hawk War. According to the 2010 census, the city had a population of 99,685 (making it Iowa’s third-largest city). The city appealed this figure, arguing that the Census Bureau missed a section of residents, and that its total population was more than 100,000.[5][6] The Census Bureau estimated Davenport’s 2019 population to be 101,590.[7]

    Located approximately halfway between Chicago and Des Moines, Davenport is on the border of Iowa across the river from Illinois. The city is prone to frequent flooding due to its location on the Mississippi River. There are two main universities: St. Ambrose University and Palmer College of Chiropractic, where the first chiropractic adjustment took place. Several annual music festivals take place in Davenport, including the Mississippi Valley Blues Festival, the Mississippi Valley Fair, and the Bix Beiderbecke Memorial Jazz Festival. An internationally known 7-mile (11 km) foot race, called the Bix 7, is run during the festival. The city has a Class A minor-league baseball team, the Quad Cities River Bandits. Davenport has 50 plus parks and facilities, as well as more than 20 miles (32 km) of recreational paths for biking or walking.

    Three interstates, 80, 74 and 280, and two major United States Highways serve the city. Davenport has seen steady population growth since its incorporation. National economic difficulties in the 1980s resulted in job and population losses. The Quad Cities was ranked as the most affordable metropolitan area in 2010 by Forbes magazine. In 2007, Davenport, along with neighboring Rock Island, won the City Livability Award in the small-city category from the U.S. Conference of Mayors. In 2012, Davenport, and the Quad Cities Metropolitan Area, was ranked among the fastest-growing areas in the nation in the growth of high-tech jobs.[8] Notable natives of the city have included jazz legend Bix Beiderbecke, Pulitzer Prize-winning playwright Susan Glaspell, former National Football League running back Roger Craig, UFC Welterweight Champion Pat Miletich, IBF Middleweight and WBA Super Middleweight boxing champion Michael Nunn, and former two time WWE Champion and WWE Universal Champion Seth Rollins.

    The land was originally owned by the historic Sauk people, Meskwaki (Fox), and Ho-Chunk (Winnebago) Native American tribes. France laid claim to this territory as part of its New France and Illinois Country in the 18th century. Its traders and missionaries came to the area from Canada (Quebec), but it did not have many settlers here. After losing to Great Britain in the Seven Years’ War, France ceded its territory east of the Mississippi River to the victor, but retained lands to the west.

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    In 1803 France sold its holdings in North America west of the Mississippi River to the United States under the Louisiana Purchase. Lieutenant Zebulon Pike was the first United States representative to officially visit the Upper Mississippi River area. On August 27, 1805, Pike camped on the present-day site of Davenport.[9]

    In 1832, a group of Sauk, Meskwaki, and Kickapoo people were defeated by the United States in the Black Hawk War. The United States government concluded the Black Hawk Purchase, sometimes called the Forty-Mile Strip or Scott’s Purchase, by which the US acquired lands in what is now eastern Iowa. The purchase was made for $640,000 on September 21, 1832 and contained an area of some 6 million acres (24,000 km2), at a price equivalent to 11 cents/acre (26 $/km2). Although named after the defeated chief Black Hawk, he was being held prisoner by the US. Sauk chief Keokuk, who had remained neutral in the war, signed off on the purchase. It was made on the site of present-day Davenport. Army General Winfield Scott and Governor of Illinois, John Reynolds, acted on behalf of the United States, with Antoine Le Claire, a mixed-race (Métis) man, serving as translator. He later was credited with founding Davenport.

    Chief Keokuk gave a generous portion of land to Antoine Le Claire’s wife, Marguerite, the granddaughter of a Sauk chief. Le Claire built their home on the exact spot where the agreement was signed, as stipulated by Keokuk, or he would have forfeited the land. Le Claire finished the ‘Treaty House’ in the spring of 1833. He founded Davenport on May 14, 1836, naming it for his friend Colonel George Davenport, who was stationed at Fort Armstrong during the war. The city was incorporated on January 25, 1839.[10] The area was successively governed by the legislatures of the Michigan Territory, the Wisconsin Territory, Iowa Territory and finally Iowa.

    Scott County was formed by an act of the Wisconsin Territorial legislature in 1837.[11] Both Davenport and its neighbor Rockingham campaigned to become the county seat. The city with the most votes from Scott County citizens in the February 1838 election would become the county seat. On the eve of the election, Davenport citizens acquired the temporary service of Dubuque laborers so they could vote in the election. Davenport won the election with the help of the laborers. Rockingham supporters protested the elections to the territorial governor, on the grounds the laborers from Dubuque were not Scott County residents. The governor refused to certify the results of the election. A second election was held the following August. To avoid another import of voters, the governor set a 60-day residency requirement for all voters. Davenport won by two votes. Because the margin of victory was so close, a third election was held in the summer of 1840. As the August election drew nearer, Rockingham residents grew tired of the county seat cause. Davenport easily won the third election. Consequently, to avoid questions about the county seat, Davenport quickly built the first county courthouse.[12]

    The Rock Island Railroad built the first railroad bridge across the Mississippi River in 1856. It connected Davenport to Rock Island, Illinois.[13] This railway connection resulted in significant improvements to transportation and commerce with Chicago, a booming 19th-century city. The addition of new railroad lines to Muscatine and Iowa City, and the acquisition of other lines by the Rock Island Railroad, resulted in Davenport becoming a commercial railroad hub.[9]

    Steamboat companies rightly saw nationwide railroads as a threat to their business. On May 6, 1856, just weeks after the bridge was completed, a steamboat captain deliberately crashed the Effie Afton into the bridge. The owner of the Effie Afton, John Hurd, filed a lawsuit against the Rock Island Railroad Company. Abraham Lincoln was the lead defense lawyer for the railroad company.[13] The decision of the United States Supreme Court upheld the right to bridge navigable streams, therefore the bridge was allowed to remain.[14]

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  • Prior to the start of the Civil War, Governor Samuel J. Kirkwood declared Davenport to be Iowa’s first military headquarters; five military camps were set up in the city to aid the Union.[16]

    The Davenport City Hall was built in 1895 for price of $100,000 ($3.11 million in 2020 dollars). [17] Architectural journals of the time poked fun at the project due to the small amount of money budgeted.[18] The skyline began forming in the 1920s with the construction of the Kahl Building, the Parker Building, and the Capitol Theatre during a period of economic and building expansion.

    By 1932, thousands of Davenport residents were on public relief, due to the Great Depression. A shantytown of the poor developed in the west end of the city, along the Mississippi River. Sickness, hunger, and unsanitary living conditions plagued the area.

    The situation would soon change, as many citizens went to work for the Works Progress Administration. Davenport had an economic boom during and after World War II, driven by wartime industry and peacetime demand. As Davenport grew, it absorbed smaller surrounding communities, annexing Rockingham, Nahant, Probstei, East Davenport, Oakdale, Cawiezeel, Blackhawk, Mt. Joy, Green Tree, and others. Oscar Mayer, Ralston Purina, and other companies built plants in west Davenport. The Interstate highway network reached Davenport in 1956, improving transportation in the area. By 1959, more than 1,000 homes a year were being constructed.

    By the late 1970s, the good times were over for both downtown and local businesses and industries. Railroad restructuring in the mid-20th century had caused a loss of jobs in the industry. The farm crisis of the 1980s negatively affected Davenport and the rest of the Quad Cities, where a total of 35,000 workers lost their jobs throughout the entire Quad Cities area.[19] Restructuring of heavy industry also continued: the Caterpillar plant on the city’s north side closed, causing another wave of job loss.[19]

    With the 1990s, the city finally showed the beginnings of a resurgence.[19] In the early 21st century, many renovations and building additions have occurred to revitalize the downtown area, including repairing Modern Woodmen Park, the building of the Skybridge and the Figge Art Museum. In 2011, the Gold Coast and Hamburg Historic District was named as a 2011 “America’s Great Place” by the American Planning Association.[20]

    Davenport’s longitude and latitude coordinates in decimal form are 41.542982, −90.590745.[21] According to the United States Census Bureau, the city has a total area of 65.08 square miles (168.56 km2), of which 62.95 square miles (163.04 km2) is land and 2.13 square miles (5.52 km2) is water.[22] Davenport is located approximately 170 miles (270 km) west of Chicago and 170 miles (270 km) east of the Iowa state capital of Des Moines. The city is located about 200 miles (320 km) north of St. Louis, Missouri, and 265 miles (426 km) southeast of Minneapolis, Minnesota. Farmland surrounds Davenport, outside the Quad Cities area.

    Davenport is located on the banks of the Mississippi River. At this point the river has a maximum depth of around 30 to 40 feet (9.1 to 12.2 m) and is 2,217 feet (676 m) wide where the Centennial Bridge crosses it. The river flows from east to west in this area, as opposed to its usual north to south direction.[23] From the river the city starts to slope north up a hill, which is steep at some points. The streets of the city, especially downtown and in the central part of the town, follow a grid design.

    Davenport often makes national headlines when it suffers seasonal flooding by the Mississippi River.[24] It is the largest city bordering the Mississippi that has no permanent flood wall or levee.[25] Davenport residents prefer to maintain open access to the river for parks and vistas rather than have it cut off by dikes and levees. Davenport has adopted ordinances requiring any new construction in the floodplain to be elevated above the 100-year-flood level, or protected with walls. As a result, former mayor Phil Yerington said that if they “let Mother Nature take her course, we’ll all be better off”.[24] An example of a Davenport building that is elevated or flood-proofed is the Figge Art Museum.[26]

    Under the Köppen climate classification, Davenport is considered to have a humid continental climate (Dfa). Summers are very warm to hot with high levels of humidity. Winters have cold temperatures and often high winds, with snow likely from November through February. Average snowfall in Davenport is 30.7 inches (780 mm) per year.[27] January is on average the coldest month, while July is the warmest.[28] The highest temperature recorded in Davenport was 111 °F (44 °C) on July 12, 1936.[29] The lowest temperature, −29 °F (−34 °C), was recorded on January 18, 2009.[30] Substantial weather changes frequently occur at three- to four-day intervals as a result of mid-latitude storm tracks, which is where low and high pressure extratropical disturbances occur.[31][32]

    Although several minor tornadoes have occurred, no devastating tornado has ever touched down in Davenport.[33] Flooding, however, is often a problem in Davenport due to the lack of a flood wall. During the Great Flood of 1993, the water crested at 22.63 feet (6.90 m) on July 9.[34] This is nearly 8 feet (2.4 m) above the 14.9-foot (4.5 m) flood stage. Major flooding in Davenport causes many problems. Roads in and around the downtown area, including U.S. Route 67, are closed and cause increased traffic on other city roads. The effects of major flooding can be long-lasting. For example, during the 2008 flooding, Credit Island in the city’s southwest corner remained closed for 5½ months while crews worked on cleaning up damage and removing river debris.[35] Duck Creek, a stream situated in Bettendorf and Davenport, is also vulnerable to flash flooding. Severe thunderstorms on June 16, 1990, created heavy flash flooding in Bettendorf and Davenport that killed four people.[36] Another major flood happened on June 12, 2008, when severe thunderstorms caused Duck Creek to overflow its banks and flood properties and nearby streets (see Iowa flood of 2008).[37]

    Davenport has several neighborhoods dating back to the 1840s.[41] The original city plot was around current day Ripley and 5th Streets, where Antoine Le Claire had built his house. The city can be divided into five areas: downtown, central, east end, near north and northwest, and west end. Many architectural designs are found throughout the city including Victorian, Queen Anne, Tudor Revival, and others.[42] Many of the original neighborhoods were inhabited by German settlers.[41]

    The east side of the city dates back to 1850 and has always contained higher end housing. The proximity and commanding view of the river kept these neighborhoods a fashionable address, long after the original families departed.[43] Lindsay Park, in The Village of East Davenport, was used as parade grounds for Civil War soldiers from Camp McClellan.[16]

    In contrast to the east side, the central and west neighborhoods originally contained many of the working class Germans who settled the town. Development on the west side started in the 1850s, with extensive construction occurring in the 1870s.[44] Housing was mostly one and a half to two-story front gable American Foursquare and simplified Queen Anne style. The central Hamburg neighborhood, now known as the Hamburg Historic District, contains the most architecturally significant residences in the old German neighborhoods.[45] Also in central Davenport, the Vander Veer Park Historic District is a neighborhood anchored by Vander Veer Park, a large park with a botanical garden and a fountain. The park was modeled after New York City’s Central Park and originally shared its name.[46] Vander Veer is surrounded by large Queen Anne and Tudor Revival style houses that were built between 1895 and 1915. Development of the Vander Veer Park was one of the first major beautification efforts.[46]

    Today, the eastern side of Davenport still contains many of the higher class houses in the city. The old Civil War parade grounds, in The Village of East Davenport (“The Village” for short), have been turned into Lindsay Park, which is surrounded by small specialty shops. West of The Village, Downtown contains the two tallest buildings in the Quad Cities; the Wells Fargo Bank Building, which is 255 feet tall, and the Mid-American Energy Building, which is 220 feet tall.[47] Other tall buildings include the 11-story Hotel Blackhawk, the 150 foot Kahl Building and the Davenport City Hall.[48]

    Davenport uses a mayor–council form of local government. As of 2021[update], city government consists of mayor Mike Matson[49] and a ten-person council. One person is elected from each of the eight wards and two at-large aldermen are elected to represent the whole city.[50] Nonpartisan elections are held in odd-numbered years. The mayor is the top elected individual for the city and presides over city council meetings, voting in case of a tie. He or she also appoints city board members.[51] The city council’s job is to make laws and set the city budget.[52] The city administrator, currently (no permanent administrator), is appointed by the mayor with confirmation by two-thirds of the council. Citywide goals through 2012 include having a financially responsible government, having a growing economy, revitalizing neighborhoods, and upgrading city infrastructure and public facilities.[53] The establishment of Davenport as a political and government unit came in 1839, three years after the city was settled.[54] The city was incorporated as a result of a resolution by Iowa Representative Jonathan W. Parker by special charter in the Iowa Territory on January 25, 1839.[54] Parker was a resident of Davenport and one of six trustees elected to govern the city with Rodolphus Bennet being the first mayor. Activity for the first four months was minimal as the council failed to meet.[54] In 1842, the city charter was amended for the first time. Changes include having six alderman replace the five trustees, dividing the city into three wards, and appointing a city clerk position to replace the recorder.[54] The charter was amended again in 1851 to expand the city area, provide greater detail of the duties of the mayor, city council, and other officials.[54] During the last half of the 19th century, government assumed expanding responsibilities for public welfare and public works improvements.

    The city expanded police protection, even temporarily having volunteer police officers to assist the three paid officers.[54] Fire protection was expanded in 1882, with the city’s first 13 paid firefighters.[54] Former mayor Henry Vollmer accomplished several public works achievements, including large street paving and new sub-divisions being plotted.[54] A large city budget surplus brought the creation of the Davenport City Hall.[55] After 1900, each mayor brought new agendas for city improvement. Waldo Becker encouraged new railroads for the city. He also promised a more business-like government, in terms of financial responsibility and to depoliticize the police department. In the mid-1920s the city established the first zoning ordinances, electrical traffic signals and street lighting. The city also expanded with the incorporation of the city of Rockingham and the establishment of the Davenport Municipal Airport.[55]

    The 2010 fiscal year budget was $199.2 million,[56] an increase of $35 million from 2009.[56] The city’s general fund receives the largest amount of funds from property taxes, followed by service fees such as solid waste collection and swimming pool or golf course admission and 80% of its expenses go to personnel costs.[56] The city has given a few surveys for citizens to rate the quality of life and city services. The largest department in the city is the public works department with a budget of $36.7 million.[56] The police department is second with a budget of $22.4 million, while the fire department has a budget of $15 million.[56] The parks department has $6.1 million, and the Davenport Public Library has a $3.8 million budget.[56]

    At the federal level, Davenport is in Iowa’s 2nd congressional district. It is represented by Republican Mariannette Miller-Meeks. The two Senators are Republicans Chuck Grassley and Joni Ernst. At the state level, Davenport is represented by the 45th, 46th, and 47th Iowa Senate districts and in the Iowa House of Representatives by the 89th, 90th, 92nd, 93rd, and 94th districts.[57]

    As of 2012[update], the 41st senate district covers the eastern third of the city and all of Bettendorf, Riverdale, and Panorama Park. It is more conservative then other Davenport districts being represented by a Republican since the 1970s. The district is slightly moving more liberal with an increase of 3,000 Democrats between 2006 and 2010.[58] The district is represented by Republican Senator Roby Smith.[59] The 42nd district covers the western third of the city along with all of Scott County that is not in Davenport, Bettendorf, Riverdale, or Panorama Park as well as western and southern rural Clinton County and is represented by Republican Senator Shawn Hamerlinck.[60] The 43rd senate district covers the central third of the city and is represented by Democrat Joe Seng.[61]

    The 81st house district covers the eastern third of the city along with small western portion of Bettendorf. The district shares the same western boundaries as the forty-first senate district. The district is represented by Democrat Phyllis Thede.[62] The 84th district covers the western third of the city, and has the same eastern boundary as Senate district forty-two and is represented by Republican Ross Paustian.[63] The 85th and 86th districts are made up of the same area as the forty-third senate district. The 85th district covers the north and west-central area while the 86th district covers southern and eastern part of the senate district.[64][65] Both are represented by Democrats with Jim Lykam representing the 85th and Cindy Winckler representing the 86th.

    Davenport has a Federal Court House for the United States District Court for the Southern District of Iowa.

    According to the 2010 United States Census estimate, the city population grew to 99,685 and the Quad Cities metropolitan area grew to 379,690.[67] As of the 2000 census, there were 98,359 people, 39,124 households, and 24,804 families residing in the city. The population density was 1,566.5 people per square mile (604.8/km2). There were 41,350 housing units at an average density of 658.5 per square mile (254.3/km2). Davenport’s population density was 30 times the average density of Iowa and 20 times the average density of the United States.[68][69] However, it was about a third less than Des Moines and 20 percent less than Cedar Rapids, the only two cities in Iowa with higher populations than Davenport. Sioux City, the next city smaller than Davenport in population, had a density of 5 people more per square mile.[68][69]

    The racial makeup of the area was 83.7% White (410,861), 11.43% Black or African American (27,757), 0.4% American Indian and Alaskan Native (1,255), 2.0% Asian (6,624), 0.03% Pacific Islander (156), and 2.0% from two or more races (11,929). 7.1% of the population was Hispanic or Latino of any race (37,070).[70] There were 39,124 households, out of which 31.8% had children under the age of 18 living with them, 46.0% were married couples living together, 13.4% had a female householder with no husband present, and 36.6% were non-families. Of all households, 29.5% were made up of individuals, and 9.4% had someone living alone who was 65 years of age or older. The average household size was 2.44 and the average family size was 3.03.[70]

    Davenport is less white than the rest of Iowa on average, but has a higher proportion of whites than the rest of the United States.[71]

    Age spread: 26.2% under the age of 18, 10.7% from 18 to 24, 30.1% from 25 to 44, 20.9% from 45 to 64, and 12.1% who were 65 years of age or older. The median age was 34 years. For every 100 females, there were 94.7 males.[70][72]

    Davenport’s biggest labor industry is manufacturing, with over 7,600 jobs in the sector.[73] John Deere is the second largest employer in the Quad Cities, after the Rock Island Arsenal as a whole. Deere, however, is the largest single employer, employing 7,200 workers in the Quad Cities and 948 on its north side Davenport plant.[56][74] John Deere World Headquarters is located in Moline. Other large employers in Davenport and the Quad Cities include, Genesis Health System with 5,125 employees and 4,900 in Davenport, Trinity Regional Health System with 3,333, regional grocery store Hy-Vee with 3,138 and the Davenport Community School District with 2,237 employees.[74]

    Davenport is the headquarters for department store Von Maur, which has 24 stores.[75] Davenport is also the headquarters of Lee Enterprises, which publishes fifty daily newspapers and more than 300 weekly newspapers, shoppers, and specialty publications, along with online sites in 23 states.[76] As of September 2009, the unemployment rate in Davenport and the rest of the Quad Cities, had risen to 8.4%.[77]

    The median income for a household in the city was $40,378, with families earning $51,445.[78] Males had a median income of $41,853 versus $30,002 for females.[78] The per capita income for the city was $18,828. About 10.5% of families and 14.1% of the population were below the poverty line, including 19.2% of those under age 18 and 6.4% of those ages 65 or over.

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    Davenport has a lower cost of living than the national average, in 2010 the average home price was $110,000; Forbes ranked Davenport as the best metropolitan area for cost of living, up from second in 2009.[79][80] CNN Money ranked Davenport as the 16th most affordable housing in the country.[81]

    The surrounding Quad Cities have a few major places of employment, including the Rock Island Arsenal, which is the largest government-owned weapons manufacturing arsenal in the United States.[82] KONE, Inc, a large manufacturer of elevators, is located in Moline, Illinois. Alcoa, a large aluminum manufacturer, is located in Riverdale, Iowa. Other local businesses include Whitey’s Ice Cream, Hungry Hobo sandwich shop, and Happy Joe’s and Harris Pizza – both local pizzerias (the former of which is also an ice cream parlor).

    Downtown Davenport has many points of interest including the Davenport Public Library, the Davenport Skybridge, Figge Art Museum, River Music Experience, Putnam Museum, the RiverCenter/Adler Theater, Modern Woodmen Park which is home of the Quad City River Bandits baseball team and the Centennial Bridge. The former Chicago, Milwaukee, St. Paul and Pacific Freight House, now known as The Freight House, is home to several small businesses featuring locally grown items, such as a deli, a grocery hub, and a tap room for a local brewery.

    Davenport’s cultural and educational institutions include the Figge Art Museum, which houses The National Center for Midwest Art and Design, and was founded in 1925 as the Davenport Municipal Art Gallery.[84][85] The Putnam Museum, which was founded in 1867 and was one of the first museums west of the Mississippi River.[86] The Quad City Symphony Orchestra, headquartered in downtown Davenport, was founded in 1915.[87] The Davenport Public Library was opened in 1839.[88] The German American Heritage Center is located at the foot of the Centennial Bridge.

    Uptown features a few historic landmarks such as the Iowa Soldiers’ Orphans’ Home which took in homeless children from all of Iowa’s ninety-nine counties following the Civil War[89] and Ambrose Hall which was the original building of St. Ambrose University.[90] Aside from landmarks, uptown contains some entertainment venues too, such as the Great Mississippi Valley Fairgrounds, which hosts fairs, stock car racing, and many other events. NorthPark Mall is the city’s main shopping mall and has 160 stores. Its companion, SouthPark Mall, is located in Moline. Brady Street Stadium is home to Davenport high school and Saint Ambrose University football games. Davenport has a number of parks, including Credit Island park which has a bike path, baseball diamonds, tennis courts, and fishing along the Mississippi River. Vander Veer Botanical Park has a small botanical garden and also features a walking path, a lagoon, and a large fountain.[91] The Stampe Lilac Garden is located in Duck Creek Park, on Locust St.

    Additional Parks and Recreation amenities:
    • 50+ parks and facilities
    • 25+ picnic areas and shelters
    • 20+ miles of recreational trails
    • 2 dog off leash parks
    • Multiple natural prairies and no-mow zones
    • 32 playgrounds
    • 30 ball diamonds
    • 17 outdoor basketball courts
    • 8 tennis/pickle ball courts
    • 8 volleyball courts
    • 3 golf courses
    • FootGolf course (Red Hawk Golf Course)
    • 3 disc golf courses
    • 8 river views
    • Multiple lagoons and pond
    • Various fishing locations including 3 boat launches
    • 3 pools
    • Spray park
    • 3 splash pads
    • Soccer complex
    • Indoor ice and turf facility (The River’s Edge)
    • Skate park
    • Iowa’s only indoor human foosball (The River’s Edge)
    • Mobile environmental education trailer
    • Mobile show wagon
    • Botanical park and conservatory
    • 5 fountains
    • 2 lodges
    • Cemetery
    • Community center
    • Several historic sites including a bandshell
    • The second oldest children’s theatre in America (Junior Theatre)

    Bix Fest is a three-day music festival with many traditional jazz bands held in tribute to internationally renowned jazz cornetist, pianist, composer, and Davenport native Bix Beiderbecke. The festival was started in August 1971 and the Bix Beiderbecke Memorial Society was founded one year later to organize and sponsor it.[92] 2009 was the 39th consecutive festival. In addition to the Bix Fest, the Wells Fargo Street Fest features live music, food, and vendors.

    The annual Bix 7 is a 7-mile (11 km) road race held in late July in Davenport. The race was founded in 1975 by John A. Hudetz a resident of Bettendorf, Iowa, who wanted to bring to the Quad Cities some of the excitement he felt when he ran his first Boston Marathon.[93] The first race had 84 participants, but today 12,000 to 18,000 runners take part.[93][94][95] In late July or early August the six-day Great Mississippi Valley Fair features major grandstand concerts, carnival rides, attractions, and food vendors.[96] Sturgis on the River is a large annual gathering of motorcycles which includes bands and food vendors.[97] Other local expositions include River Roots Live, Beaux Arts Fair and many others.

    Davenport (along with neighboring Rock Island, Illinois), won the 2007 City Livability Award in the small-city category from the U.S. Conference of Mayors. Tom Cochran, Executive Director of the Conference, stated that the award “gives the Conference a chance to highlight mayoral leadership in making urban areas safer, cleaner and more livable.”[98] The award acknowledges achievements from the RiverVision plan of Davenport and Rock Island.[99]

    Davenport and the Quad Cities are home to many sports teams. The Quad Cities River Bandits baseball team play games at Downtown Davenport’s Modern Woodmen Park. The TaxSlayer Center in Moline is home the Quad City Steamwheelers indoor football team and the Quad City Storm hockey team. Davenport high schools are in the Mississippi Athletic Conference for sports.

    Davenport has over fifty parks or recreational trails.[100] Major parks include Credit Island, which is a 450-acre (1.8 km2) park in southwest Davenport located alongside the Mississippi River.[100] Fejervary Park contains a pool and has had approximately 20,000 visitors each year since 1996.[100] Junge Park is situated along the Duck Creek Parkway and includes baseball and softball fields, sand volleyball, and basketball courts.[100] LeClaire Park is located right on the banks of the Mississippi River next to Modern Woodmen Park and hosts many summer events including River Roots Live and Ribfest.[101] Bands for the Bix Fest play in the park each July. Vander Veer Botanical Park welcomes approximately 25,000 visitors to continuous floral shows.[100]

    The city features two recreational trails for biking or walking. Duck Creek Parkway extends from Emeis Park in west Davenport 8.26 miles (13.29 km) east to Bettendorf along Duck Creek. Riverfront Parkway extends 4.75 miles (7.64 km) along the Mississippi waterfront from Credit Island to Bettendorf. Both these trails continue into Bettendorf.[100] Plans are being discussed to connect the two trails in Riverdale.[102] Three public golf courses are offered in the city.[103] For river-related activities, The Channel Cat boat offers rides across the river and has two stops in Iowa and three stops in Illinois and connects the bike paths that each state has on its river front.[104]

    Davenport is also home to Daytrotter, a recording studio and venue which has hosted and recorded many different indie-rock bands throughout the country. Daytrotter is located at 324 Brady Street in the heart of downtown Davenport.

    There are two major daily newspapers in Davenport. The Quad-City Times is based out of Davenport and The Dispatch/Rock Island Argus is based out of Moline. An alternative free newspaper, the River Cities’ Reader, is published in Davenport. All four major television networks have stations in the area, including KWQC (NBC) and KLJB (Fox) in Davenport. WHBF (CBS) is located in Rock Island and WQAD (ABC) is in Moline.

    The Quad Cities ranks as the 97th largest market for television[105] and the 147th largest market for radio.[106] Radio station WOC made its local broadcasting debut on February 18, 1922. It was the second licensed station on the air.[107] In 1933 WOC hired future president Ronald Reagan as a staff announcer.[107]

    Davenport public schools serve nearly 14,500[109] students in the communities of Davenport, Blue Grass, Buffalo, and Walcott. The Davenport Community School District is the fourth-largest school district in Iowa. Davenport has four public high schools: Central, West, Mid City[110] and North and one private high school: Assumption. There are six public intermediate schools and 23 public elementary schools.[111] Sudlow, one of the intermediate schools, was named after Phebe Sudlow, the first female public school superintendent in the United States.[112] She was superintendent for Davenport schools from 1874 to 1878.[112] The high schools are part of the Mississippi Athletic Conference for sports.

    The city has four colleges and universities: Saint Ambrose University, established in 1882, is the oldest; Kaplan University, Palmer Chiropractic College, and Hamilton Technical College. Palmer College is the first chiropractic school and the site of the first chiropractic adjustment in the world.[113][114][115]

    Marycrest International University was a university in Davenport from 1939 to 2002, when it closed. The campus was renovated and adapted to senior citizen housing.[116]

    Three interstate highways serve Davenport: Interstate 80, Interstate 280, and Interstate 74. Interstate 88 serves the Illinois Quad Cities and runs east to Chicago. U.S. Route 6, U.S. Route 61, and U.S. Route 67 also go through Davenport; U.S. 67 crosses over to Illinois via the Rock Island Centennial Bridge. Davenport is connected to the Illinois side of the Quad Cities by a total of three bridges across the Mississippi River. The Government Bridge and the Centennial Bridge connect Downtown Davenport with the Rock Island Arsenal and downtown Rock Island, respectively. The I-280 Bridge connects the western edge of Davenport with the western edge of Rock Island.

    Other highways include Iowa Highway 22, which is on the city’s southwest side, and Iowa Highway 130, which runs along Northwest Boulevard on Davenport’s north edge. For air travel, Davenport Municipal Airport – located adjacent to the city’s northern city limits – serves smaller aircraft, and is the home of the annual Quad City Airshow. The Quad City International Airport across the river in Moline, Illinois, is the closest commercial airport. Major railroads include the Iowa Interstate Railroad and the Iowa, Chicago and Eastern. Two national U.S. recreation trails intersect in Davenport: the Mississippi River Trail and the American Discovery Trail.

    Amtrak currently does not serve Davenport or the Quad Cities. The closest station currently is about 50 miles (80 km) away in Galesburg, Illinois. In 2008, United States Senators Tom Harkin, Chuck Grassley, Dick Durbin, and Barack Obama sent a letter to Amtrak asking them to begin plans to bring rail service to the Quad Cities.[117] In October 2010, a $230 million federal fund was announced that will bring Amtrak service to the Quad Cities, with a new line running from Moline to Chicago. They had hoped to have the line completed in 2015, and offer two round trips daily to Chicago.[118] Currently the Moline station does not have any Amtrak service. Greyhound Lines/Burlington Trailways bus service has a station in Davenport. The building is shared with the local Davenport Citibus.[119] Davenport does not have any river ports.

    Davenport has an infamous “truck-eating bridge”.[120] The bridge, or rather three bridges, is a set of railroad bridges that cross over north and southbound U.S. Route 61 and another street. Every year an average of 12 semi trucks hit the bridge, usually causing massive damage to the trucks.[120] The bridges, made out of iron, steel, and concrete, are rarely damaged.[120]

    Public transit appeared in Davenport in 1969 when the city created a City Transit Authority.[119] The authority at first provided monetary support to Davenport City Lines Bus Company, which was a privately owned company. After a few years the city purchased the Davenport City Lines and placed the operation of public transportation under the jurisdiction of the City’s Department of Municipal Transportation. Today, CitiBus is a division of the Department of Public Works. CitiBus has a total of 20 vehicles and covers approximately 30 square miles (78 km2) of the city. CitiBus connects with both Bettendorf Transit and the Illinois Quad Cities mass transit system, MetroLINK.[119] In 2007 Citibus saw a ridership of 1,022,815 customers. Ridership as of September 2008 had grown to 1,045,000 due in part to high gas prices.[121]

    Electricity to Davenport, and the rest of the Iowa Quad Cities, is provided by MidAmerican Energy Company. Water is provided by the Mississippi River and is treated by the Iowa American Water Company. The water treatment facility is located in southeast Davenport.

    Davenport is served by two hospitals: Genesis Medical Center East – Rusholme Street and Genesis Medical Center – West Central Park Avenue part of the Genesis Health System. Together the facilities, along with two other facilities outside Davenport have 665 beds.[122] The hospitals employ more than 600 physicians and 5,000 staff members.[122] The American Nurses Credentialing Center, awarded Genesis Medical Center the Magnet designation for excellence in nursing services.[123] Fewer than three percent of hospitals receive this honor.[123]

    Notable Davenporters include jazz musician Bix Beiderbecke, after whom the Bix 7 road race and jazz festival are named.[124] The artist Isabel Bloom was raised in Davenport; she is the creator of decorative concrete figurines that bear her name.[125][126]

    Guitarist and vocalist John Kadlecik, who founded The Dark Star Orchestra and toured with the members of The Grateful Dead in the band Furthur, also grew up in Davenport.

    Sports figures born in Davenport include NFL running back Roger Craig, NFL offensive lineman Julian Vandervelde, former NBA guard Ricky Davis, former middleweight boxing champion Michael Nunn,[127][128] UFC welterweight champion Robbie Lawler, NFL wide receiver Kenny Shedd and professional wrestler Seth Rollins.

    Other natives include the aviation pioneer Samuel Cody, actors Stuart Margolin, Lara Flynn Boyle, Sue Lyon, Linnea Quigley,[129][130][131] and Greg Stolze. Otto Frederick Rohwedder, the inventor of mass-produced sliced bread, and actor Jock Mahoney, grew up in Davenport.

    The former mayor of St. Louis, Lyda Krewson, was born in Davenport.

    Davenport’s sister cities are:[132]

    Davenport has friendly relations with:[133]



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    In the pseudoscientific[1] alternative medicine[2] chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action, or makeup (defined by D.D. Palmer and B.J. Palmer, founders of chiropractic), not necessarily visible on X-rays.

    Straight chiropractors continue to follow Palmer’s tradition, claiming that vertebral subluxation has considerable health effects and also adding a visceral component to the definition.

    The use of the word vertebral subluxation should not be confused with the term’s precise usage in medicine, which considers only the anatomical relationships.”[3]

    According to the World Health Organization (WHO), a chiropractic subluxation is a “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”. Chiropractic subluxation should not be confused with medical condition subluxation, which is a “significant structural displacement” visible on static imaging studies such as X-rays.[4] Chiropractic is a field of alternative treatment outside scientific mainstream medicine, whose practitioners (chiropractors) are not medical doctors.

    The exact definition of subluxation in the medical field depends on the anatomical part being involved.

    are chiropractors doctors

    In 1910, D.D. Palmer, the founder of chiropractic, wrote:

    In 1909, D.D. Palmer’s son, B.J. Palmer, incorrectly claimed that chiropractic subluxation caused contagious diseases, writing:

    Chiropractors use and have used various terms to express this concept: subluxation, vertebral subluxation (VS), vertebral subluxation complex (VSC),[7] “killer subluxations,”[8] and the “silent killer.”[9][dead link]

    Chiropractors along with some physical therapists and osteopathic physicians,[10] have also used another term, BOOP, meaning “bone out of place.”[11]

    The WHO definition of the chiropractic vertebral subluxation is:

    The purported displacement is not necessarily visible on static imaging studies, such as X-rays.[4] This is in contrast to the medical definition of spinal subluxation which, according to the WHO, is a “significant structural displacement”, and therefore visible on X-rays.[4]

  • pexy suffix
  • As of 2014, the National Board of Chiropractic Examiners states:

    In 1996 an official consensus definition of subluxation was formed. Cooperstein and Gleberzon have described the situation: “… although many in the chiropractic profession reject the concept of “subluxation” and shun the use of this term as a diagnosis, the presidents of at least a dozen chiropractic colleges of the Association of Chiropractic Colleges (ACC) developed a consensus definition of “subluxation” in 1996. It reads:

    In 2001 the World Federation of Chiropractic, representing the national chiropractic associations in 77 countries, adopted this consensus statement which reaffirms belief in the vertebral subluxation.[14]

    The ACC paradigm has been criticized by chiropractic authors:

    In May 2010 the General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, issued guidance for chiropractors stating that the chiropractic vertebral subluxation complex “is an historical concept” and “is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.”[15]

    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,[13] many in the chiropractic profession reject it and shun the use of this term as a diagnosis.[13][14] In the United States and in Canada the term nonallopathic lesion may be used in place of subluxation.[16]
    Other chiropractors consider subluxation as more of an abstract concept rather than a medical condition. Tedd Koren says,

    The vertebral subluxation cannot be precisely defined because it is an abstraction, an intellectual construct used by chiropractors, chiropractic researchers, educators and others to explain the success of the chiropractic adjustment.

    This is not a unique state of affairs, abstract entities populate many branches of science…

    Subluxations, genes, gravity, the ego and life are all heuristic devices, “useful fictions” that are used to explain phenomenon that are far larger than our understanding. We use them as long as they work for us and discard or limit their application when they become unwieldy or unable to account for new observations…

    Critics of chiropractic have incorrectly assumed that chiropractic is based on the theory or principle that vertebral subluxations cause “pinched” nerves that cause disease. They have it backwards. Chiropractic is based on the success of the spinal adjustment. The theory attempting to explain the success of the adjustment (nerve impingement, disease, subluxations) followed its clinical discovery.

    Examples of such erroneous criticisms based on this straw man argument abound in the medical literature. Some examples: “The teachers, research workers and practitioners of medicine reject the so-called principle on which chiropractic is based and correctly and bluntly label it a fraud and hoax on the human race.” “The basis of chiropractic is completely unscientific.” The theory on which chiropractic is based [is false], namely that a “subluxation” of a spinal vertebra presses on a nerve interfering with the passage of energy down that nerve causing disease to organs supplied by that nerve, and that chiropractic “adjustments” can alleviate the pressure thereby treating or preventing such disease. There is no scientific evidence for the validity of this theory.”

    To be fair, statements by some chiropractors have tended to perpetuate this misunderstanding: “Pressure on nerves causes irritation and tension with deranged functions as a result.”

    When chiropractors declare that “pinched nerves” “nerve impingement” “spinal fixations” or others mechanisms of action explain how subluxations affect the person and how chiropractic works they are making the same mistake medical critics make – assuming chiropractic is based on theory. Mechanisms and theories are useful tools, but their limitations should always be kept in mind.[17]

    The differences between a medical subluxation and a chiropractic “vertebral subluxation” create confusion and difficulties when it comes to following official ICD-9 and ICD-10 coding. In a 2014 article in Dynamic Chiropractic[18] by a chiropractor who is a certified professional coder, these difficulties were discussed in detail. He noted that the WHO recognizes the differences between the two types of “subluxations”, and also pointed out certain difficulties for chiropractors:

    At the time of writing (August 2014) it was still uncertain which codes in the newer ICD-10 would be useful for chiropractors and how they would be interpreted.[18]

    Traditionally there have been 5 components that form the chiropractic subluxation.

    Historically, the detection of spinal misalignment (subluxations) by the chiropractic profession has relied on X-ray findings and physical examination. At least two of the following four physical signs and/or symptoms must be documented to qualify for reimbursement:

    It has been proposed that a vertebral subluxation can negatively affect general health by altering the neurological communication between the brain, spinal cord and peripheral nervous system. Although individuals may not always be symptomatic, straight chiropractors believe that the presence of vertebral subluxation is in itself justification for correction via spinal adjustment.

    V. Strang, D.C., describes several hypotheses on how a misaligned vertebra may cause interference to the nervous system in his book, Essential Principles of Chiropractic:[21]

    The vertebral subluxation has been described as a syndrome with signs and symptoms which include: altered alignment; aberrant motion; palpable soft tissue changes; localized/referred pain; muscle contraction or imbalance; altered physiological function; reversible with adjustment/manipulation; focal tenderness.[22]

    Chiropractic treatment of vertebral subluxation focuses on delivering a chiropractic adjustment which is a high velocity low amplitude (HVLA) thrust to the dysfunctional spinal segments to help correct the chiropractic subluxation complex. Spinal adjustment is the primary procedure used by chiropractors in the adjustment.

    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.[citation needed]

    Some chiropractors have described the disagreements within the profession about the concept, and have written skeptically about BOOP as an antiquated idea. In 1992 one wrote:

    One wrote in 1994 about the “brutal civil war”:

    Ten years later (in 2004) he openly disparaged the idea still propounded by “modern-day advocates of this concept”:

    Believers within the chiropractic tradition assert that spinal health and function are directly related to general health and well-being, including visceral disorders, but the efficacy and validity of spinal manipulation to address visceral disorders systems remains a source of controversy within the chiropractic profession. Although research is ongoing on this topic, conclusions that support the usefulness of spinal manipulation for organic disorders remains to be seen. Additionally, to complicate matters, chiropractic professors and researchers, Nansel and Szlazak, found that:

    the proper differential diagnosis of somatic (musculoskeletal) vs. visceral (organ) dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, suggest it is not unreasonable that this somatic visceral-disease mimicry could very well account for the “cures” of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to “holistic” health care claims on the part of such clinical disciplines.[26]

    Considering this phenomenon, Seaman suggests that the chiropractic concept of joint complex (somatic) dysfunction should be incorporated into the differential diagnosis of pain and visceral symptoms because these dysfunctions often generate symptoms similar to those produced by true visceral disease and notes that this mimicry leads to unnecessary surgical procedures and medications.[27]

    Other chiropractic researchers have also questioned some of the claimed effects of vertebral subluxation:

    are chiropractors doctors

    The literature supports the existence of somatovisceral and viscerosomatic reflexes, but there is little or no evidence to support the notion that the spinal derangements (often referred to as subluxations by chiropractors) can cause prolonged aberrant discharge of these reflexes. Equally unsupported in the literature is the notion that the prolonged activation of these reflexes will manifest into pathological state of tissues, and most relevantly, that the application of spinal manipulative therapy can alter the prolonged reflex discharge or be associated with a reversal of the pathological degeneration of the affected reflexes or tissues. The evidence that has been amassed is largely anecdotal or case report based and it has attracted much intra disciplinary debate because of its frequent association with certain approaches to management (largely described as being traditional or “philosophical” in nature).[28]

    Still other chiropractic researchers stated quite directly:

    … early chiropractic philosophy … considered disease the result of spinal nerve dysfunction caused by misplaced (subluxated) vertebrae. Although rejected by medical science, this concept is still [2000] accepted by a minority of chiropractors. … Indeed, many progressive chiropractors have rejected the historical concept of the chiropractic subluxation in favor of ones that more accurately describe the nature of the complex joint disfunctions they treat.”[6]

    Professor Philip S. Bolton of the School of Biomedical Sciences at University of Newcastle, Australia writes in Journal of Manipulative and Physiological Therapeutics, “The traditional chiropractic vertebral subluxation hypothesis proposes that vertebral misalignment cause illness, disease, or both. This hypothesis remains controversial.” His objective was, “To briefly review and update experimental evidence concerning reflex effects of vertebral subluxations, particularly concerning peripheral nervous system responses to vertebral subluxations. Data source: Information was obtained from chiropractic or, scientific peer-reviewed literature concerning human or animal studies of neural responses to vertebral subluxation, vertebral displacement or movement, or both.” He concluded, “Animal models suggest that vertebral displacements and putative vertebral subluxations may modulate activity in group I to IV afferent nerves. However, it is not clear whether these afferent nerves are modulated during normal day-to-day activities of living and, if so, what segmental or whole-body reflex effects they may have.”[29]

    Edzard Ernst has stated that the “core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science.”[30]

    An area of debate among chiropractors is whether “vertebral subluxation” is a metaphysical concept (as posited in B. J. Palmer’s philosophy of chiropractic) or a real phenomenon. In an article on vertebral subluxation, the chiropractic authors wrote:

    Subluxation syndrome is a legitimate, potentially testable, theoretical construct for which there is little experimental evidence. Acceptable as hypothesis, the widespread assertion of the clinical meaningfulness of this notion brings ridicule from the scientific and health care communities and confusion within the chiropractic profession. We believe that an evidence-orientation among chiropractors requires that we distinguish between subluxation dogma vs. subluxation as the potential focus of clinical research. We lament efforts to generate unity within the profession through consensus statements concerning subluxation dogma, and believe that cultural authority will continue to elude us so long as we assert dogma as though it were validated clinical theory.[8]

    Other chiropractors have declared its unproven status as an area that needs reform:

    Some may suggest that chiropractors should promote themselves as the experts in “correcting vertebral subluxation.” However, the scientific literature has failed to demonstrate the very existence of the subluxation. Until and unless sound research published in credible journals demonstrates the existence and reliable identification of vertebral subluxation, and vertebral subluxation is found to be an important public health problem, society at large will not care about its correction. Thus, “subluxation correction” alone is not a viable option for chiropractic’s future.[31]

    A Beth Israel Deaconess Medical Center article describes the mainstream understanding of vertebral subluxation theory:

    Since its origin, chiropractic theory has based itself on “subluxations,” or vertebrae that have shifted position in the spine. These subluxations are said to impede nerve outflow and cause disease in various organs. A chiropractic treatment is supposed to “put back in” these “popped out” vertebrae. For this reason, it is called an “adjustment.”

    However, no real evidence has ever been presented showing that a given chiropractic treatment alters the position of any vertebrae. In addition, there is as yet no real evidence that impairment of nerve outflow is a major contributor to common illnesses, or that spinal manipulation changes nerve outflow in such a way as to affect organ function.[32]

    In 2009, four scholarly chiropractors concluded that epidemiologic evidence does not support chiropractic’s most fundamental theory. Since its inception, the vast majority of chiropractors have postulated that “subluxations” (misalignments) are the cause or underlying cause of ill health and can be corrected with spinal “adjustments.” After searching the scientific literature, the chiropractic authors concluded:

    No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal, this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.[33]

    In 2005, four leading chiropractic researchers leveled strong critiques of chiropractic dogma:

    Lastly, the ACC claims that chiropractors use the ‘best available rational and empirical evidence’ to detect and correct subluxations. This strikes us as pseudoscience, since the ACC does not offer any evidence for the assertions they make, and since the sum of all the evidence that we are aware of does not permit a conclusion about the clinical meaningfulness of subluxation. To the best of our knowledge, the available literature does not point to any preferred method of subluxation detection and correction, nor to any clinically practical method of quantifying compromised “neural integrity,” nor to any health benefit likely to result from subluxation correction.[8]

    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 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.”[34]


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    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.[1]

    The intention of a chiropractic adjustment is to affect or correct the alignment, motion and/or function of a vertebral joint. Specifically, they are intended to correct “vertebral subluxations”, the term given to the signs and symptoms that are said by chiropractors to result from abnormal alignment of vertebrae. (p. 218)[2] This intention forms the legal and philosophical foundation of the profession, and US Medicare law formulates it in this manner:

    Chiropractic authors and researchers Meeker and Haldeman write that the core clinical method that all chiropractors agree upon is spinal manipulation, although chiropractors much prefer to use the term spinal “adjustment”, a term which reflects “their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities.” (p. 218)[2]

    The International Chiropractor’s Association (ICA) states that the “chiropractic spinal adjustment is unique and singular to the chiropractic profession”, and that it “is characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion. Chiropractic is a specialized field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession.”[4] One author claims that this concept is now repudiated by mainstream chiropractic.[5] The definition of this procedure describes the use of a load (force) to specific body tissues with therapeutic intent. This “load” is traditionally supplied by hand, and can vary in its velocity, amplitude, duration, frequency, and body location (p. 218)[2] and is usually abbreviated HVLA (high velocity low amplitude) thrust.[6][7]

    are chiropractors doctors

    As the chiropractic profession grew, individual practitioners and institutions proposed and developed various proprietary techniques and methods. While many of these techniques did not endure, hundreds of different approaches remain in chiropractic practice today. Not all of them involve HVLA thrust manipulation. Most cite case studies, anecdotal evidence, and patient testimonials as evidence for effectiveness. These techniques include:

    There are many techniques which chiropractors can specialize in and employ in spinal adjustments. Some of the most notable techniques include:

    Over the years, many variations of these techniques have been delivered, most as proprietary techniques developed by individual practitioners. WebMD has made a partial list:[8]


    The effects of spinal adjustment vary depending on the method performed. All techniques claim effects similar to other manual therapies, ranging from decreased muscle tension to reduced stress. Studies show that most patients go to chiropractors for musculoskeletal problems: 60% with low back pain, and the rest with head, neck and extremity symptoms. (p. 219)[2] Also the article “Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine” states that, “chiropractic was to be a revolutionary system of healing based on the premise that neurologic dysfunction caused by ‘impinged’ nerves at the spinal level was the cause of most dis-ease”. (p. 218)[2] The mechanisms that are claimed to alter nervous system function and affect overall health are seen as speculative in nature, however, clinical trials have been conducted that include “placebo-controlled comparisons [and] comparisons with other treatments”. (p. 220)[2] The American Chiropractic Association promotes chiropractic care of infants and children under the theory that “poor posture and physical injury, including birth trauma, may be common primary causes of illness in children and can have a direct and significant impact not only on spinal mechanics, but on other bodily functions”.[9]

    The effects of spinal manipulation have been shown to include: temporary relief of musculoskeletal pain, increased range of joint motion, changes in facet joint kinematics, increased pain tolerance and increased muscle strength. (p. 222)[2] Common side effects of spinal manipulative therapy (SMT) are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort. (p. 222).[2]

  • secular
  • Historically, the profession has always claimed that spinal adjustments have physiological effects on inner organs and their function, and thus affect overall health, not just musculoskeletal disorders, a view that originated with Palmer’s original thesis that all diseases were caused by subluxations of the spine and other joints. With time, fewer chiropractors hold this view, with “a small proportion of chiropractors, osteopaths, and other manual medicine providers use[ing] spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial.”[10]

    A 2019 global summit of “50 researchers from 8 countries and 28 observers from 18 chiropractic organizations” conducted a systematic review of the literature, and 44 of the 50 “found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function.”[10]

    There is no sufficient data to establish safety of spinal manipulations.[11] The rate of adverse events is unknown.[12] Adverse events are increasingly reported in randomized clinical trials of spinal manipulation but remain under–reported despite recommendations in the 2010 CONSORT guidelines.[13][14] It is frequently associated with mild to moderate temporary adverse effects, and also serious outcomes which can result in permanent disability or death,[12] which include strokes, spinal disc herniation, vertebral and rib fractures and cauda equina syndrome.[2][15] Serious outcomes are very rare.[16] About half of people reported encountering adverse effects following spinal manipulation[citation needed].


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    Throughout its history chiropractic has been the subject of internal and external controversy and criticism.[1][2] 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 disease.[3] 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”.[4] A critical evaluation stated “Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.”[3] Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license.[3] D.D. Palmer considered establishing chiropractic as a religion to resolve this problem.[5] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.[6]

    Chiropractic researchers have documented that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions.[7] Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.[3] The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science.[3] 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.[3] Spinal manipulation, particularly of the upper spine, can, rarely,[8] cause complications in adults[9] and children[10] that can cause permanent disability or death.

    In 2008, Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian.[11] 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.[12] 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.[13] The libel case ended with the BCA withdrawing its suit in 2010.[14][15]

    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.[16] Some chiropractors continue to be opposed to vaccination.[17] 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. More recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.[18]

    The birth of chiropractic was on September 18, 1895. There is controversy over what happened with several different accounts. Daniel D. Palmer later claimed that on that day he manipulated the spine of Harvey Lillard, a man who was nearly deaf, allegedly curing him of deafness. Palmer said “there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing ‘crude’ about this adjustment; it was specific so much so that no chiropractor has equaled it.”[19]

    are chiropractors doctors

    However, this version was disputed by Lillard’s daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer’s office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said “the compact was that if they can make [something of] it, then they both would share. But, it didn’t happen.”[20]

    In spite of the fact that Lillard could hear well enough to tell jokes, B.J. Palmer claimed under sworn testimony that Lillard had been “thoroughly deaf”.[21] Since 1895, the story of Palmer’s curing a man of deafness has been a part of chiropractic tradition. Palmer’s account differs significantly from what actually happened, in that, according to Lillard’s daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard’s body and not, as claimed by D.D. Palmer, caused by a “specific” adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation.

    Chiropractic included vitalistic ideas of Innate Intelligence with religious attributes of Universal Intelligence as substitutes for science.[3] Evidence suggests that D.D. Palmer had acquired knowledge of manipulative techniques from Andrew Taylor Still, the founder of osteopathy.[3] Although D.D. Palmer combined bonesetting to give chiropractic its method, and “magnetic healing” for the theory, he acknowledged a special relation to magnetic healing when he wrote, “chiropractic was not evolved from medicine or any other method, except that of magnetic.”[1] He also “claimed that his profession had nothing to do with medicine, that he healed by the laying on of hands;… He also said that he had a diploma from no earthly school but from High Heaven.”[22]

    According to D.D. Palmer, subluxation was the sole cause of all diseases and manipulation was the cure for all diseases of the human race.[3] A 2003 profession-wide survey found “most chiropractors (whether “straights” or “mixers”) still hold views of Innate and of the cause and cure of disease (not just back pain) consistent with those of the Palmers. On one hand, modern promotional brochures make a bid for medical legitimacy by describing Innate and adjustments using more scientific-sounding terms such as “inherent” and “nerve force.””[4]

    Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on “…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it”.[23] D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him:[23]

    Before adopting the term “chiropractic” in about 1896, his advertising used the term “magnetic”. In 1891–92, a city business directory stated: “Dr. Palmer can cure with his Magnetic Hands Diseases of the Head, Throat, Heart, Lungs, Stomach, Liver, Spleen, Kidneys, Nerves, and Muscles, ten times quicker than any one can with medicines.”[22]

  • an office is divided into 8 cubicles. how man
  • Chiropractic was rooted in mystical concepts, leading to internal conflicts between straights and mixers which still persist.[3] It has two main groups: “straights”, now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; “mixers” are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture.[1] The straights adhere religiously to the gospel of its founders while mixers are more open.[3] There is a lack of uniformity and consensus among chiropractors in regard to their role. Depending upon whose point of view, chiropractors are, for example, subluxation-correctors, primary care physicians, neuromusculoskeletal specialists, or holistic health specialists.[24] Straights have claimed mixers are not real chiropractors because they do not acknowledge Palmer’s foundation of chiropractic therapy.[25]

    In 1906, D.D. Palmer was the first of hundreds of chiropractors who went to jail.[26] Chiropractors were jailed for practicing medicine without a license.[3] In the 1920s hundreds of unlicensed chiropractors chose jail rather than fines.[27] Herbert Reaver was the most jailed chiropractor in the U.S.[28] Chiropractors were charged with not complying with the medical practice act. California chiropractors adopted the motto, “Go to jail for chiropractic.” 450 chiropractors were jailed in a single year at the peak of the controversy. Many chiropractors treated fellow prisoners and visiting patients while in jail.[1]

    D.D. Palmer defined chiropractic as “a science of healing without drugs” and considered establishing chiropractic as a religion as a means to use religious “exemption clauses” to resolve legal difficulties presented by restrictive “chiro laws”. In 1911, he stated (emphasis in original):[5]

    Chiropractors have struggled with survival and identity during its formative years, including internal struggles between its leaders and colleges.[29] For much of the history of the chiropractic profession chiropractors showed little interest in scientific research and regarded their principles and practices as valid.[17] Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S.[30] Long-standing American Medical Association (AMA) policies against chiropractic contributed to a lack of acceptance within mainstream public health.[31] The AMA created the Committee on Quackery “to contain and eliminate chiropractic.” Using the Committee on Quackery, efforts were made to prevent the participation of chiropractic in organized health care. In 1966 a policy passed by the AMA House of Delegates stating:[31]

    It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation.

    The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an “unscientific cult” in 1966,[31] and until 1980 held that it was unethical for medical doctors to associate with “unscientific practitioners”.[32] 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.[33] The rivalry was not solely with conventional medicine; many osteopaths proclaimed that chiropractic was a bastardized form of osteopathy.[3]

    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.[6] Some people believe chiropractic has little more than a placebo effect, while some randomized trials of spinal manipulation have supported its effectiveness for the treatment of (specifically) low back pain.[34] There are several barriers between primary care physicians and chiropractors for having positive referral relationships which includes a lack of good communication.[35] The medical establishment has not entirely accepted chiropractic care as mainstream.[36] After 100 years, the chiropractic profession has failed to define a message that is understandable, credible, and scientifically valid.[24] The future of chiropractic is uncertain due to the economic struggles and restrictions of the science and methods in chiropractic.[37]

    Chiropractic has seen considerable controversy within the profession over its philosophy.[38] In connection with a controversial and divisive 2015 organizational split in the Australian chiropractic community, an article described the profession’s long standing and current problems:[39]

    The 2008 book Trick or Treatment states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, during a homecoming parade at the Palmer School of Chiropractic. Weeks later D.D. Palmer died. The official cause of death was recorded as typhoid. The book Trick or Treatment indicated “it seems more likely that his death was a direct result of injuries caused by his son. Indeed there is speculation that this was not an accident, but rather a case of patricide.”[25] A 1999 documentary study suggests D.D. Palmer’s widow may have also played a role in the patricide controversy.[40] D.D. Palmer’s attending physicians were persuaded to change their opinions about the main cause of death.[40] Chiropractic historian Joseph C. Keating Jr. has described the attempted patricide of D.D. Palmer as a “myth” and “absurd on its face” and cites an eyewitness who recalled that D.D. was not struck by B.J.’s car, but rather, had stumbled.[41] He also says that “Joy Loban, DC, executor of D. D.’s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son.”[41] A 1969 article stated that in July 1913 at the Palmer School of Chiropractic B.J. Palmer:[42]

    insisted on leading the alumni procession, but was prohibited from doing so by the marshal of the parade, who was a student at the school. An altercation ensued. B.J. drove up in his automobile. Words passed between father and son. What happened after that depends on whom you believe. Daniel David claimed that B.J. struck him with his automobile, and D.D.’s friends and allies later produced affidavits of witnesses to prove it. B.J. flatly denied it, and produced many more affidavits to this effect than D.D.’s cohorts were able to muster.

    A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical doctors, and the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical doctors (0.20).[43] According to a 2006 Gallup Poll of U.S. adults, when asked how they would “rate the honesty and ethical standards of people in these different fields”, chiropractic compared unfavorably with mainstream medicine. When chiropractic was rated, it “rated dead last amongst healthcare professions”. While 84% of respondents considered nurses’ ethics “very high” or “high”, only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for other medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists.[7][44][45][46] Similar results were found in the 2003 Gallup Poll.[47] Chiropractic authors have placed these results in perspective in articles, with one writing that “we were the least trusted and least believed health care discipline”,[48] and another writing that chiropractors who use unethical marketing methods “poison the well” for others in the profession, and that they “might be responsible for the negative opinion people have about the ethics of the chiropractic profession.”[49] Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners.[50]

    Historically the profession has often been accused of quackery, with the profession often responding negatively to such accusations. In its early days, the accusation of quackery was voiced in a 1913 editorial in the Journal of the American Medical Association:[51] (p. 29)

    The view that chiropractic was a trade, rather than a profession, was stated clearly by B.J. Palmer, who asserted that chiropractic was founded on “a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it”.[23]

    In more modern times (1991), when the president of the ACA called accusations of quackery a “myth”, chiropractic historian, Joseph C. Keating Jr. responded by calling his comments “absurd” and stated:[52]

    In an article on quackery, W. T. Jarvis has stated that “Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist.”[53]

    In a 2008 commentary,[7] the chiropractic authors proposed that “the chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery, which are more rampant[43] in our profession than in other healthcare professions”, a situation which violates the social contract between patients and physicians. Such self-regulation “will dramatically increase the level of trust in and respect for the profession from society at large.”[7] Another chiropractic study documented that the largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims.[54] Chiropractors, especially in America, have a reputation for unnecessarily treating patients.[25] 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.[3] In English-speaking countries the majority of chiropractors and their associations appear to make efficacy claims that are unsupported by scientific evidence. Claims not supported by solid evidence were made about asthma, ear infection, earache, otitis media, and neck pain.[55]

    A 2009 chiropractic spinal manipulation review for infant colic stated “Some chiropractors claim that spinal manipulation is an effective treatment for infant colic but the “evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.”[56]

    Some New Zealand chiropractors appeared to have used the title “Doctor” in a New Zealand Yellow Pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true.[57] In New Zealand, chiropractors are allowed to use the title ‘doctor’ when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the Yellow Pages under the heading of “Chiropractors” fulfills this obligation when suitably qualified.[58] If a chiropractor is not a registered medical practitioner, then the misuse of the title “Doctor” while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.[57]

    UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behavior on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous.[59] This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,[60][61] 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.”[60]

    On 19 April 2008, Simon Singh wrote a cautionary article about chiropractic therapies in The Guardian,[63] which resulted in him being sued for libel by the British Chiropractic Association. Singh wrote in The Guardian criticizing the claims made by chiropractors about the efficacy of spinal manipulation in treating childhood ailments, among other things. He suggested there was “not a jot” of evidence to support such interventions for these ailments, and argued that the British Chiropractic Association “happily promotes bogus treatments”.[64] Singh stated that he would “contest the action vigorously… There is an important issue of freedom of speech at stake.”[11] The article developed the theme of Singh’s published book Trick or Treatment? Alternative Medicine on Trial, making various claims about the usefulness of chiropractic.[63] Commentators suggested this ruling could set a precedent to restrict freedom of speech to criticize alternative medicine.[65][66] The charity Sense About Science launched a campaign[62] to draw attention to this particular case. They issued a statement entitled “The law has no place in scientific disputes”,[67] which was signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. As of April 16, 2010[update], over 50,000 had signed.[62] On April 1, 2010, in British Chiropractic Association v Singh Singh won his court appeal for the right to rely on the defense of fair comment. On April 15, 2010, the BCA officially withdrew its lawsuit, thus ending the case.[68]

    Evidence-based research into the efficacy of chiropractic techniques is motivated by concerns that are antithetical to its vitalistic origins.[69] Not all the criticism, however, has origins in the medical profession. Some chiropractors are cautiously calling for reform.[2] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and unsubstantiated claims[6][24][70][71] that are ethically suspect when they let practitioners maintain their beliefs to patients’ detriment.[24]

    It is widely held that chiropractic extends into areas of medicine beyond the limits of its efficacy. In the opinion of Samuel Homola, “A good chiropractor can do a lot to help you when you have mechanical-type back pain and other musculoskeletal problems. But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you’ll have to exercise caution and informed judgment when seeking chiropractic care.”[72] Quackwatch is critical of chiropractic. Its founder, Stephen Barrett, has written that it is “absurd” to think that chiropractors are qualified to be primary care providers[73] and considers applied kinesiology to be pseudoscience.[74]

    William T. Jarvis emphasizes the commercial, rather than professional, nature of chiropractic:[75]

    Chiropractic is a controversial health-care system that has been legalized throughout the United States and in several other countries. In the United States in 1984, roughly 10.7 million people made 163 million office visits to 30,000 chiropractors. More than three fourths of the states require insurance companies to include chiropractic services in health and accident policies. The federal government pays for limited chiropractic services under Medicare, Medicaid, and its vocational rehabilitation program, and the Internal Revenue Service allows a medical deduction for chiropractic services. Chiropractors cite such facts as evidence of “recognition.” However, these are merely business statistics and legal arrangements that have nothing to do with chiropractic’s scientific validity.

    The efficacy and safety of spinal manipulation are uncertain.[3][76] A 2008 review found that with the possible exception of chronic back pain, chiropractic manipulation has not been shown to be effective for any medical condition.[3] The efficacy and safety of chiropractic for children are particularly doubtful. A 2009 review found that “the best evidence available to date fails to demonstrate clinically relevant benefits of chiropractic for paediatric patients, and some evidence even suggests that chiropractors can cause serious harm to children”.[77] According to David Colquhoun, chiropractic is no more effective than conventional treatment at its best, has a disadvantage of being “surrounded by gobbledygook about ‘subluxations'”, and, more seriously, it does kill patients occasionally.[23]

    A 2009 defense of chiropractic, written by chiropractor Alan Breen, stated there is consistent evidence that manual therapies such as chiropractic manipulations are “helpful and generally produce moderate but significant and sustained improvement for back pain”[78] and dismissed the suggestion that chiropractic does more harm than good as “specious”. The author admitted, however, the possibility that chiropractic manipulation can cause strokes and even death.[78]

    Although rare,[8] spinal manipulation, particularly of the neck, can result in complications that lead to permanent disability or death.[79][80] These events can occur in both adults[9] and children.[10] A 2010 systematic review found that numerous deaths since 1934 have been recorded after chiropractic neck manipulation typically associated with vertebral artery dissection.[81]


    Singh’s 2008 book Trick or Treatment states that:[25]

    chiropractors may X-ray the same patient several times a year, even though there is no clear evidence that X-rays will help the therapist treat the patient. X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist. There is no conceivable reason at all why X-raying the spine should help a straight chiropractor treat an ear infection, asthma or period pains. Most worrying of all, chiropractors generally require a full spine X-ray, which delivers a significant higher radiation dose than most other X-ray procedures.

    are chiropractors doctors

    Practice guidelines aim to reduce unnecessary radiation exposure,[82] which increases cancer risk in proportion to the amount of radiation received.[83] Research suggests that radiology instruction given at chiropractic schools worldwide is evidence-based, but that radiography is overused for low back pain.[84]

    Vertebral subluxation, the core concept of chiropractic, is not based on solid science.[3] The concept of subluxation remains unsubstantiated and largely untested, and has been the subject of a debate about whether to keep it in the chiropractic paradigm that has lasted for decades.[70] It has been argued that dogmatic commitment to subluxation is a significant barrier to chiropractic as a profession: it brings ridicule from the scientific community and perpetuates a marketing tradition in chiropractic that leads to charges of quackery.[70]

    Lon Morgan, DC, a reform chiropractor, expressed his view of Innate Intelligence this way: “Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity.”[85]

    Chiropractic historian Joseph C. Keating Jr. articulated that “So long as we propound the “One cause, one cure” rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers’ Innate should be rejected.”[86]

    Many forms of alternative medicine are based on philosophies that oppose vaccination and have practitioners who voice their opposition.[87] These include some elements of the chiropractic community.[87] The reasons for this negative vaccination view are complicated and rest, at least in part, on the early philosophies which shape the foundation of these professions.[87] 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; D.D. Palmer wrote, “It is the very height of absurdity to strive to ‘protect’ any person from smallpox or any other malady by inoculating them with a filthy animal poison.”[16] Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history.[17] Many deny the eradication of smallpox and believed it was renamed monkeypox.[16]

    Some chiropractic groups still oppose attempts to limit or eliminate nonmedical exemptions to vaccination. In March 2015, the Oregon Chiropractic Association invited Andrew Wakefield, a discredited former doctor and chief author of a fraudulent research paper, to testify against Senate Bill 442,[88] “a bill that would eliminate nonmedical exemptions from Oregon’s school immunization law.”[89] The California Chiropractic Association lobbied against a 2015 bill ending belief exemptions for vaccines. They had also opposed a 2012 bill related to vaccination exemptions.[90] On April 24, 2015, Wakefield received two standing ovations from the students at Life Chiropractic College West when he told them to oppose Senate Bill SB277, a bill which proposes limits on non-medical vaccine exemptions. Responding to his critics, he stated that “[i]t doesn’t matter if I go to the grave discredited. I don’t care what they say about me. In fact, I have nothing to lose now. This is such an important issue.”[91] Wakefield had previously been a featured speaker at a 2014 “California Jam” gathering of chiropractors,[92] as well as a 2015 “California Jam” seminar, with continuing education credits, sponsored by Life Chiropractic College West.[93]

    In response to threatening activities by anti-vaccination activists, the California Medical Association (CMA) sent a warning letter to California Chiropractic Association President Brian Stenzler, whom they could document had encouraged the stalking of lobbyists who supported Senate Bill SB277. The CMA also filed a police report.[94]

    Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. More recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.[18]

    While no single profession “owns” spinal manipulation (SM), and there is little consensus as to which profession should administer SM, chiropractors have expressed concern that orthodox medical physicians and physical therapists could “steal” SM procedures from chiropractors. Chiropractors regularly introduce bills into state legislatures to further prohibit non-chiropractors from performing SM, and they are opposed by physical therapist organizations.[95] Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM,[96] while some states allow them to do it only if they have completed advanced training in SM. In the most restrictive states, SM is limited to chiropractors and medical physicians.


    D. D. Palmer’s Religion of ChiropracticDownloads-icon


    “How can chiropractic become a respected mainstream profession? The example of podiatry”Downloads-icon


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    “WHO guidelines on basic training and safety in chiropractic – 2005”Downloads-icon


    D.D. Palmer’s LifelineDownloads-icon


    “Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor”Downloads-icon


    “The Meanings of Innate”Downloads-icon


    Lifelines, Winter 2014: Cal Jam in ReviewDownloads-icon


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    Faulty Logic and Non-skeptical Arguments in ChiropracticDownloads-icon

    Originally published: April 2018

    Many Canadians continue to have questions about the role that chiropractors play in the healthcare team, and what benefit chiropractic care may have to their health. While you can always find a chiropractor in your community to discuss your specific needs, today we’re busting some commonly shared chiropractic myths:

    This is false. When seeking care from a chiropractor, we will perform an assessment including a history and physical examination to determine the cause of the pain or dysfunction. From these observations, a diagnosis will be made and the treatment plan developed in collaboration with the patient – according to their needs and goals. The treatment plan will recommend a number of initial visits to see if the patient responds to care and scheduled re-evaluations. Depending on the patient and the condition, the recommended course of care may vary. Ultimately, the decision to continue care is yours. As a patient, if you have questions or concerns about care, you should feel comfortable to ask the chiropractor for more information on the recommendations made and address any concerns. The care plan should be part of a shared decision-making between the patient and practitioner.

    Chiropractors are regulated in all 10 Canadian provinces, and are designated to use the title “doctor” similar to physicians, optometrists and dentists after completing the extensive Doctor of Chiropractic degree program. Those professions who are recognized to use the “doctor” title have extensive training in their area of expertise that allows them to be diagnosticians – to provide a diagnosis.

    are chiropractors doctors

    Chiropractic care in Canada

    In all provinces in Canada, chiropractors are primary contact providers, which means you can access them directly. Due to the extensive training of chiropractors as diagnosticians, chiropractors will perform a comprehensive assessment to help determine a diagnosis or clinical impressions. Depending on the outcome, the chiropractor can discuss a course of care or refer to another healthcare professional, as needed. However, in some cases, you may need a referral to access coverage depending on your benefits provider.

    Chiropractic treatment is at times questioned on its effectiveness. Yet, the chiropractic profession and others have invested significant resources to build a robust body of evidence studying the impact of manual therapies on musculoskeletal conditions. For example, spinal and joint manipulation has been shown to be effective treatment for acute and chronic musculoskeletal conditions, like back pain. In fact, spinal manipulative therapy (SMT) is recommended as first line intervention for back pain in numerous clinical practice guidelines including the Bone and Joint Decade Task Force1, the American College of Physicians and American Pain Society2 as well as Britain’s National Institute of Health and Care Excellence3.

    Chiropractors are musculoskeletal experts and are trained in assessing, diagnosing, treating and preventing biomechanical disorders that originate from the muscular, skeletal and nervous system. In addition to the evidence that supports chiropractic care in managing musculoskeletal complaints of the spine, there is also evidence that it supports chiropractic management of the extremities, headaches and even TMJ pain,5,6. Chiropractors are also able to provide lifestyle counselling about nutrition, fitness and ergonomics among others that may be useful in managing or preventing a variety of health conditions. The health of your musculoskeletal system doesn’t just start with a healthy spine, you need to be fully aware of your health to maintain a well-rounded healthy lifestyle!

    In general, adjustments or joint manipulations do not hurt. In fact, many patients report immediate pain relief. Patients may be nervous about the ‘cracking’ or popping sound that may occur during an adjustment. The sound is believed to result from the release of gas bubbles from the joint – similar to cracking your knuckles!

    Asking questions about your health and treatment options is very important. You are a partner in your care and your participation is critical to helping us provide the best care to meet your goal. If you have any questions beyond this blog about chiropractic treatment, visit a chiropractor in your area.

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  • The CCA acknowledges the enduring and vibrant presence, culture, history and inherent rights of First Nations people, Métis and Inuit across Canada on whose traditional territories CCA members live and work, as well as where the CCA has its head office in Toronto.


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    Harmony Clinic
    MEDICAL & CHIROPRACTIC

    Many people believe the term doctor refers only to a person who holds a medical doctor (M.D.) degree. This would require medical school, as well as completion of an internship, a residency, and a state license. Because chiropractors do not have an M.D. degree, they are not ‘medical doctors’. However they are doctors of chiropractic medicine – health professionals who care about helping people and dedicated to treating their patients with non-invasive, personalized care. Both are Medical and Chiropractic doctors are considered physicians.

    are chiropractors doctors

    At Harmony Clinic, our aim is to help patients distinguish between the truth and common misconceptions that frequently plague chiropractic care. Unfortunately, if a myth is prevalent, it can be accepted as fact, even if it’s lacking proof. Here is a glimpse at some of the top myths our doctors have encountered and the truth behind each of them.

    A common myth is that chiropractors don’t receive a substantial amount of training. Chiropractors generally graduate with a pre-med major after having taken classes in sciences, such as biology, chemistry, psychology, and physics. They then attend a chiropractic graduate program. Normally, these involve 4 years of education using a total of 4,485 educational hours course credits while medical students get around 4,248 hours. In reality, they generally finish about 8 years of higher education before they are licensed. Both medical physicians and Chiropractors have to successfully complete National Board Exams before obtaining a license. Continuing education is subsequently required to keep a high level of proficiency and to remain current on the latest research and methods for both Doctorate degrees. Myth Busted!

    Chiropractors are known for treating back pain, however, the origin of chiropractic care is a lot deeper than that. Chiropractic care is used to resolve or manage various health conditions such as:

    Some parents fear that chiropractic care is unsafe or unnecessary for children. However, chiropractic care can be quite valuable for both children and babies.

    Childhood is your stage in life in which you develop, learn, research, and play, resulting in a great deal of stress on the musculoskeletal system. Chiropractic care can help children stay healthy and prevent many disorders that present throughout youth, such as:

    Among the most common sources of contention regarding chiropractic treatments is safety. Chiropractic adjustments are safe when done by a Doctor of Chiropractic, but may be harmful if performed by a different healthcare professional that is trained in the area of expertise. Chiropractic adjustments are in reality one of the safest and most effective ways to treat back and neck pain. The result of trauma following chiropractic therapy is significantly less than 0.01% according to medical studies. This contrasts with a higher risk of invasive processes involving medications, injections, and surgeries.

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  • The preventative approach in health care has gained large support in the health care community as it has been shown to be cost and health-effective in the long term. Regular chiropractic check-ups are safe, convenient, rapid, and natural and can prevent health issues later on.

    A dentist will most likely recommend regular check-ups to aid their patients stop cavities and gum disease. Just like a dentist, a chiropractor will promote preventative services to help patients avoid disease, pain, and disease.

    Set an appointment with us now at our chiropractic office off Saxon Blvd in Deltona, FL. Experience the best chiropractors in Deltona!

    To learn more, enter your email below. Whether you are trying to find immediate and safe pain relief or are just looking to find a chiropractor to get regular care, we can help. Our experts at Harmony Clinic medical & Chiropractic can help you achieve maximum health benefits targeted towards your specific needs. Maintain a healthy, joyful, and pain-free lifestyle today.

    Call: 386-774-6337

    Get In Touch With Us


    Harmony Clinic
    MEDICAL & CHIROPRACTIC

    Harmony Clinic is a full service integrated medical office. Dr. H. Lester Carrero is a licensed chiropractor serving the areas of Volusia County, Seminole County, and Orange County.

    1948 Saxon Blvd.

    Deltona, FL 32725

    Mon, Tue, & Thu

    9:00 am – 6:00 pm

    Wednesday

    9:00 am – 9:00 pm

    Friday

    9:00 am – 12:00 pm

    Saturday – Sunday

    Closed

    © 2021 Harmony Clinic All Rights Reserved.
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    by Dr Jed Shepherd | Jan 15, 2020 | Uncategorized | 0 comments

    A common question that we get in the clinic, especially from patients new to chiropractic is “Chiropractors, are they doctors?”

    As chiropractors we may refer to ourselves as doctors or use the title ‘Doctor/Dr’, although we are different to medical doctors, such as GP’s.

    So are chiropractors doctors?

    The answer to this really depends on what you mean by the word ‘Doctor’. When most people think of a Doctor they would generally think of their family Doctor/GP, surgeons and other specialists. Chiropractors definately aren’t this type of Doctor.

    are chiropractors doctors

    Although the word Doctor does have many definitions. It is also an academic title for those who have undergone postgraduate PhD studies, similar to calling someone a professor.

    ‘Doctor’ is not a protected title (1). This means that chiropractors as well as osteopaths, pharmacists, optometrists, dentists, vets, podiatrists, chinese medicine practitioners and other specific registered health professionals are allowed to use the title ‘Dr’ as a courtesy title. 

    Think of ‘Dr’ as a title. Although it is most commonly used by Medical Doctors, it can also be used by other health-care professionals who have undertaken specific studies in an area.

    However, if a Chiropractor, Pharmacist or Optometrist advertises themselves using the title ‘Dr’, it is important that they make their profession clear and don’t try to portray themselves as a medical doctor or GP (2).

    For example: ‘Dr John Smith (Chiropractor)’, or ‘Dr John Doe (Osteopath)’ are acceptable.

    However if a pharmacist called themselves ‘Dr John Citizen’ on their website or signs without clarifying that they are pharmacist and not a medical doctor, this could be confusing to the public.

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  • As trained primary health professionals Chiropractors are trained to recognize situations where referral to another practitioner such as the family doctor might be required as the most appropriate action.

    This means we can be seen as a ‘first point of contact’ by patients, without them requiring a referral.

    We hope you found this blog informative and it helped to clear up some confusion regarding ‘Chiropractors are they Doctors?’ Our experienced team is here to help with all things Chiropractic related (no we don’t prescibe medications or perform surgeries, to our patients relief).

    To get in touch with us to book an appointment for more information you can Book Online or call our clinic on (08) 6184 8835 today!

    If we’re too far from you, you can always attend our sister clinics in Morley and South Perth.

     

    References:

    1) Health Practitioner Regulation National Law Act 2009. (2019, July 1). Retrieved from Queensland Government Legislation website: https://www.legislation.qld.gov.au/view/pdf/inforce/current/act-2009-045

    2) Further information on advertising and the National Law. (2017, June 1). Retrieved from Australian Health Practitioner Registry Agent website: https://www.ahpra.gov.au/Publications/Advertising-resources/Further-information.aspx

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    In the world of medicine, the practice of treating musculoskeletal injuries, called chiropractic, seems to hover in that gray area between standard health care and alternative. (Physicians dominate the first type, while acupuncturists and massage therapists populate the second.)

    “Chiropractic was the original holistic medicine in that it focused on treating the whole person, not just the body part that hurt,” says Michael Schneider, an associate professor of health sciences at the University of Pittsburgh. His research on chiropractic suggests that cervical and lumbar manipulation—the back and neck adjustments most people associate with a visit to a chiropractor—can be an effective treatment for low back pain. A study published in April 2017 in the Journal of the American Medical Association supported this, finding that based on the latest research, spinal manipulation can modestly reduce a person’s lower back pain.

    Chiropractic manipulation also often leads to better patient outcomes, especially when combined with standard medical care, other studies suggest.

    “The benefits of chiropractic for acute low back pain have been pretty widely accepted for years now within the medical community,” says Dr. Ronald Glick, assistant professor of psychiatry, physical medicine and rehabilitation at the University of Pittsburgh School of Medicine and coauthor of several of Schneider’s research papers. “When I started in practice over 30 years ago, people would look askance at a physician who recommended chiropractic, but that’s not the case anymore,” he adds.

    While the strongest evidence in support of chiropractic involves the treatment of back pain, Schneider says there’s also evidence for neck pain and some types of non-migraine headaches. Still, his profession is not without controversy, he says. “The controversy comes in when chiropractors make claims about treating non-musculoskeletal conditions”—claims he says have little to no basis in science.

    are chiropractors doctors

    This “failure to present a unified front” is the biggest problem facing chiropractors today, says Dr. Scott Haldeman, a neurologist and chiropractor who teaches at both UCLA and UC Irvine. “You could walk into a chiropractor’s office and find someone who is a pure back-and-neck-pain guy—a guy who has embraced the scientific research—or someone who says he can cure all things and provide general wellness,” Haldeman explains.

    “Like any other type of doctor, some chiropractors are good, some are just OK and some are bad,” says Dr. Simon Dagenais, a chiropractor and clinical epidemiologist. “It takes just a few rotten apples to spoil the bunch.”

    Another thorny issue for chiropractors of all stripes is the public perception that spinal manipulation can result in injury or, more ominously, stroke or torn arteries.

    “The stroke question is basically resolved,” Haldeman says, citing research that shows the risk of suffering a stroke following a chiropractic visit is extremely low, on par with the risk associated with visiting a physician. “Neck pain can be a sign of a stroke in process,” he says, “so people may go see a doctor or chiropractor about that pain and then associate the subsequent stroke with their visit.” When it comes to artery tears, Haldeman’s own research turned up only 23 such cases among more then 134 million chiropractic manipulations.

    More of an open question is whether less-serious injuries can result from a chiropractor’s touch. One study of neck pain patients found 30% had some kind of “adverse” reaction following chiropractic treatment. “In most cases, that adverse event was increased pain or stiffness, and it resolved itself quickly,” says Dr. Eric Hurwitz, first author of the study and graduate chair of epidemiology at the University of Hawaii.

    Hurwitz says more severe reactions were “very rare,” and most patients didn’t experience any adverse event at all. “But we can’t predict who will or won’t experience an adverse event,” he adds.

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  • “There’s some risk involved,” Haldeman agrees. “But there’s also risk from surgery or from taking medications.” Compared to opioids—a class of painkillers commonly prescribed for back and neck pain, and one also linked to dependence and death due to overdose—the potential for soreness and ache seems minor, he adds.

    Schneider agrees and points out that malpractice and liability insurance premiums for chiropractors are much lower than for physicians or surgeons. “Insurance actuaries aren’t dumb,” he says. “They know that based on the malpractice data, chiropractic is very safe.”

    But the biggest unsolved mystery about chiropractic treatment is exactly how spinal manipulation reduces back or neck pain. “Increased mobility of the spinal vertebrae and muscle relaxation probably has a lot to do with it,” Haldeman says. “But the truth is the mechanism is not well understood, just as back and neck pain are not well understood.”

    A recent study published in The Lancet found low back pain was the most common cause of disability globally. But despite its ubiquity, back pain—like many other forms of pain—is difficult to explain. “We know some things that cause it, but not exactly where it comes from or why it persists,” Haldeman says. Looked at in this context, he says, it’s not odd that he and other researchers who have studied chiropractic can’t pinpoint why their treatment is effective. What’s more important is that for many patients, it does work, he says.

    “Chiropractors tend to have very high patient satisfaction rates,” Schneider says. “And from a public health perspective, we’d see a lot fewer unnecessary tests and hospitalizations and opioid prescriptions if people visited chiropractors for their back and neck pain.”

    Contact us at [email protected]

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