An Introduction to Chiropractic Care Don Galovich Jeremy Lindstrom Dr. Peter Millar Mark Morris
What is Chiropractic? • Chiropractic care centers around the diagnosis, treatment and prevention of neuro-musculoskeletal system disorders.
What is Chiropractic? • Chiropractic focuses on the relationship between structure (movements of the spine) and function (coordinated by the nervous system and how this relationship affects health)
How long has Chiropractic been recognized in traditional healthcare? • The profession was founded in the US in 1895. • Today there are over 65,000 chiropractors in the US today
Educational Requirements • Doctors of Chiropractic complete the equivalent of five academic years of advanced professional education
EducationalRequirements • Six semesters didactic course work (average course load 25-27 credits) • Four semesters extensive Clinical experience • National Board Examinations • Parts I-IV
Chiropractic case management protocol • Specific spinal analysis • Physical, neurological, orthopedic examinations and consultation • Specific restoration of normal biomechanics by means of the adjustment, soft tissue manipulation, and ancillary therapies • Referral for co-management if appropriate • Appropriate attention to ergonomical considerations and other possible causes of biomechanical dysfunction
Chiropractic Education • Compiled as an average from 22 medical schools and 11 chiropractic colleges • Additional classes and clinic times vary according to school
The primary lesion addressed in chiropractic is intersegmental dysfunction within the spinal column • This refers to discrete areas of hypomobilty within the articulations of the spine
What is a chiropractic adjustment? • A high-velocity, low-amplitude thrust usually given by hand, directed at specific articulations of the spine or extremities
The purpose of the adjustment…… • restore normal movement and resolve the resultant biomechanical, physiological and neurological effects of segmental hypomobility.
The Adjustment • The type of adjustment varies with technique • Diversified • Flexion/Distraction • Thompson • Activator • Logan • etc.
The Adjustment • Although many different techniques are used they all have a common goal: To restore normal motion and normalize the nervous system to allow the body to function optimally
Putting it together…….. • Loss of normal movement leads to… • Changes in how all tissues involved are stressed and replenished, which causes… • Chemical changes within those tissues and… • Predisposes them to mechanical failure giving us… • A good reason to restore normal movement through spinal adjustment.
What conditions can be treated using chiropractic? • Musculoskeletal conditions involving the articulations of body and surrounding soft tissue
Some examples of these conditions…… • Neck and Back pain • Headache • Sciatica • Stiff joints • Sprain/Strain injuries • Herniated nucleus pulposus • Sport related injuries • The list goes on……….
Review of Chiropractic research • Satisfaction with treatment • In conditions dealing with back pain, patient satisfaction has been shown to be greater with chiropractic treatment over conventional management (PCP, HMO provider, or orthopedist) New England Journal of Medicine 1995; 333(14) : 913-917 Western Journal of Medicine 1989; 150: 351-355
Review of research Chiropractic is an extremely safe form of therapy. However as with any therapeutic intervention contraindications exist. Two primary complications exist with spinal manipulation.
Review of research • Cauda Equina Syndrome • Following lumbar manipulation in patients, disc herniation, neurological bowel and bladder disturbances, saddle anesthesia, leg weakness may occur. • The frequency of developing this condition from manipulation has been estimated to be 1 per 100 million manipulations. • Spine 21 (15): 1746-1760
Review of research • Cerebrovascular accidents following manipulation of the upper cervical region. • The frequency of developing this condition following manipulation has been estimated to be 1in 5.85 million manipulations. Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation the chiropractic experience. CMAJ 2001; 165:905-6
Review of research • Putting the numbers in perspective • The rates given for CVA’s caused by spinal manipulation are 400x less then the death rate observed from GI bleeding due to the use of NSAID medication • Journal of Manipulative and Physiological Therapeutics 1995; 18 (8): 530-536
Review of Research • Appropriateness and Guidelines • In 1994 the Agency for Health Care Policy and Research (AHCPR) placed spinal manipulation at the top of the list for clinical options in the treatment of certain types of back pain.
Back pain treatment • Among 23 options for treatment of low back pain, spinal manipulation and the use of NSAID’s had the most beneficial effect. • Acute low back pain in adults. Clinical practice guideline No. 14 AHCPR Publication No. 95-0642 (1994)
Wellness Model • The public has widely embraced many forms of wellness care and alternative therapies • Other healthcare professions have embarked on a paradigm shift to include alternative therapies, including spinal manipulation • Many conditions respond best with a multidisciplinary approach
Our Goals in Healthcare“The Wellness Model” • Patient-centered paradigm • Improving interdisciplinary communication • Maximizing the benefits of healthcare from all perspectives
Closing Remarks • In a little over a hundred years of existence chiropractic has become the third largest profession of health care delivery in the world
Closing Remarks • For the treatment of musculoskeletal conditions chiropractic is a conservative first step that should not be over looked. • If a problem can be corrected with minimal risk, and without the use of drugs or surgery it makes sense to try it.