Chiropractic: An Introduction

• People seek chiropractic care primarily for pain conditions such as back pain, neck pain, and headache.
• Side effects and risks depend on the type of chiropractic treatment used.
• Chiropractic practitioners in the United States are required to earn a Doctor of Chiropractic degree from properly accredited colleges.
• Ongoing research is looking at effects of chiropractic treatment approaches, how they might work, and diseases and conditions for which they may be most helpful.
• Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

The term "chiropractic" combines the Greek words cheir (hand) and praxis (action) to describe a treatment done by hand. Hands-on therapy - especially adjustment of the spine - is central to chiropractic care. Chiropractic, which in the United States is considered part of complementary and alternative medicine (CAM), is based on these key concepts:

• The body has a powerful self-healing ability;
• The body's structure (primarily that of the spine) and its function are closely related, and this relationship affects health;
• Therapy aims to normalize this relationship between structure and function and assist the body as it heals.

While some procedures associated with chiropractic care can be traced back to ancient times, the modern profession of chiropractic was founded by Daniel David Palmer in 1895 in Davenport, Iowa. Palmer, a self-taught healer, believed that the body has a natural healing ability. Misalignments of the spine can interfere with the flow of energy needed to support health, Palmer theorized, and the key to health is to normalize the function of the nervous system, especially the spinal cord.

According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, about 8 percent of American adults and nearly 3 percent of children had received chiropractic or osteopathic manipulation in the past 12 months. Adjusted to nationally representative numbers, these percentages mean that more than 18 million adults and 2 million children received chiropractic or osteopathic manipulation in the previous year.

Many people who seek chiropractic care have chronic, pain-related health conditions. Low-back pain, neck pain, and headache are common conditions for which people seek chiropractic treatment.

During the initial visit, chiropractors typically take a health history and perform a physical examination, with a special emphasis on the spine. Other examinations or tests such as x-rays may also be performed. If chiropractic treatment is considered appropriate, a treatment plan will be developed.

During followup visits, practitioners may perform one or more of the many different types of adjustments used in chiropractic care. Given mainly to the spine, a chiropractic adjustment (sometimes referred to as a manipulation) involves using the hands or a device to apply a controlled, sudden force to a joint, moving it beyond its passive range of motion. The goal is to increase the range and quality of motion in the area being treated and to aid in restoring health. Other hands-on therapies such as mobilization (movement of a joint within its usual range of motion) also may be used.

Chiropractors may combine the use of spinal adjustments with several other treatments and approaches such as:

• Heat and ice;
• Electrical stimulation;
• Rest;
• Rehabilitative;
• Counseling about diet, weight loss, and other lifestyle factors;
• Dietary supplements.

Side effects and risks depend on the specific type of chiropractic treatment used. For example, side effects from chiropractic adjustments can include temporary headaches, tiredness, or discomfort in parts of the body that were treated. The likelihood of serious complications, such as stroke, appears to be extremely low and related to the type of adjustment performed and the part of the body treated.

If dietary supplements are a part of the chiropractic treatment plan, they may interact with medicines and cause side effects. It is important that people inform their chiropractors of all medicines (whether prescription or over-the-counter) and supplements they are taking.

To practice chiropractic care in the United States, a practitioner must earn a Doctor of Chiropractic (D.C.) degree from a college accredited by the Council on Chiropractic Education (CCE). CCE is the agency certified by the U.S. Department of Education to accredit chiropractic colleges in the United States. Admission to a chiropractic college requires a minimum of 90 semester hour credits (approximately 3 years) of undergraduate study, mostly in the sciences.

Chiropractic training is a 4-year academic program that includes both classroom work and direct experience caring for patients. Coursework typically includes instruction in the biomedical sciences, as well as in public health and research methods. Some chiropractors pursue a 2- to 3-year residency for training in specialized fields.

Chiropractic is regulated individually by each state and the District of Columbia. Board examinations are required for licensing and include a mock patient encounter. Most states require chiropractors to earn annual continuing education credits to maintain their licenses. Chiropractors' scope of practice varies by state in areas such as laboratory tests or diagnostic procedures, the dispensing or selling of dietary supplements, and the use of other CAM therapies such as acupuncture or homeopathy.

Compared with other CAM therapies, insurance coverage for chiropractic services is extensive. Many HMOs (health maintenance organizations) and private health care plans cover chiropractic treatment, as do all state workers' compensation systems. Chiropractors can bill Medicare, and many states cover chiropractic treatment under Medicaid. If you have health insurance, check whether chiropractic services are covered before you seek treatment.

• Research to expand the scientific understanding of chiropractic treatment is ongoing.
• If you decide to seek chiropractic care, talk to your chiropractor about:
  • His education, training, and licensing;
  • Whether he has experience treating the health conditions for which you are seeking care;
  • Any special medical concerns you have and any medicines or dietary supplements you are taking.
• Tell all of your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Recent research projects on chiropractic care supported by the National Center for Complementary and Alternative Medicine (NCCAM) have focused on the:

• Effectiveness of chiropractic treatments for back pain, neck pain, and headache, as well as for other health conditions such as temporomandibular disorders;
• Development of a curriculum to increase the number of chiropractors involved in research;
• Influence of people's satisfaction with chiropractic care on their response to treatment.

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2. Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine. 2002;136(3):216–227.
3. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.
4. Coulter ID, Hurwitz EL, Adams AH, et al. Patients using chiropractors in North America: who are they, and why are they in chiropractic care? Spine. 2002;27(3):291–296.
5. The Council on Chiropractic Education. Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status January 2007. The Council on Chiropractic Education Web site. Accessed on June 28, 2007.
6. Dagenais S, Haldeman S. Chiropractic. Primary Care. 2002;29(2):419–437.
7. Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965–973.
8. Ernst, E, Pittler, MH, Wider, B, eds. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. 2nd ed. St. Louis, MO: Mosby Elsevier; 2006.
9. Kaptchuk TJ, Eisenberg DM.  Chiropractic: origins, controversies, and contributions. Archives of Internal Medicine. 1998;158(20):2215–2224.
10. Senstad O, Leboeuf-Yde C, Borchgrevink C.Frequency and characteristics of side effects of spinal manipulative therapy. Spine. 1997;22(4):435–440.
11. The National Center for Complementary and Alternative Medicine (NCCAM) in association with the National Institutes of Health (NIH) and the U.S. Department of Health and Human Services (HHS).

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

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