What is Chiropractic Care?

"Doctors of chiropractic (DCs) assess and manage patients with neuromusculoskeletal disorders and related clinical conditions including, but not limited to, back pain, neck pain, and headaches.  When addressing patients' needs, DCs utilize appropriate diagnostic procedures and conservative therapeutic interventions, with a primary focus on spinal manipulation.  As with other health care disciplines, chiropractic is committed to accountability and predictability in obtaining measurable outcomes.  These would include, but are not limited to, pain, physical function, and patient satisfaction."  (Dobson 1997)

The main therapeutic procedure performed by DCs is known as manipulation also called chiropractic adjustment.  DCs also utilize diagnostic procedures, including but not limited to physical examinations and x-rays when called for; physiotherapeutic modalities; and counseling of patients on appropriate lifestyle changes that could improve their musculoskeletal functioning - for example, exercises aimed at building flexibility, strength and overall well-being.  In addition, DCs have broad diagnostic skills and readily refer patients to the appropriate health care provider when chiropractic care is not suitable to the patient's condition.

The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile due to tissue injury.  Tissue injury can be caused by a single traumatic event, such as improperly lifting a heavy object, or through repetitive stresses, such as sitting in an awkward position with poor spinal posture for an extended period of time.  In either case, injured tissues undergo chemical changes that can cause both inflammation and pain for the sufferer.  Manipulation of the joint restores mobility, thereby alleviating pain and allowing tissues to heal.

Although other practitioners may also administer manipulation (including some PCPs), DCs are the most common providers of the treatment, delivering approximately 94 percent of the manipulation reimbursed by health insurance.   (Shekelle 1992)  This extensive experience, combined with the patient-centered focus of DCs, makes them the providers of choice for manipulation.

What Conditions Does Chiropractic Treat Most Effectively?

Chiropractic is used most often to treat neuromusculoskeletal complaints, including but not limited to low back pain, midback pain, neck pain, joint pain, headaches, and sciatica.  It is often used to relieve symptoms, including pain, which are persistent or recur and for which there is no other adequate treatment.  Further study is needed to better understand the mechanisms by which spinal manipulation provides relief from pain, but the evidence on effectiveness is clear:  chiropractic care relieves pain and increases mobility for many people who suffer from neuromusculoskeletal conditions.

Who Are Doctors of Chiropractic?

Doctors of chiropractic, also known as chiropractic physicians in Arkansas, are licensed health care practitioners who have undergone a rigorous course of clinical and practical training.  Before they are allowed to practice, DCs must pass national board exams and become state-licensed.   Arkansas requires continuing education of 24 hours per year and yearly license renewal as well.  DCs participating in managed care organizations are subject to the strict credentialing standards set by the National Committee on Quality Assurance (NCQA).

• The U.S. Congress has authorized the provision of chiropractic services for all Americans covered by Medicare and Medicaid.

• Federal employees have chiropractic coverage in the Federal Employee Health Benefit Program and in the Federal Employee Workers' Compensation Program.
  
• Fifty-nine (59) percent of workers at firms with 20 or more employees have chiropractic coverage through their employer-sponsored insurance.  This represents approximately 39.8 million Americans.   (Lippman 1996)
  

• Two thirds of HMOs covered chiropractic care for some portion of their membership in 1993, and just over one-half (51.5 percent) covered care for all of their enrollees.  (1993 Group Health Association of America (GHAA) annual industry-wide survey of HMOs, as reported in:   Palsbo 1995)

• All 50 states have authorized the provision of chiropractic care under state workers' compensation laws.
  
• Chiropractic services are included in the Railroad Retirement Act.
  

• The Internal Revenue Service includes chiropractic services as a valid medical deduction.

Education

To be accepted at a chiropractic college, a student must have completed a minimum of two years of college with a prescribed science content, including biology, zoology, general or inorganic chemistry, and related lab work.   More than half of practicing chiropractors have four or more years of college education in addition to the four-year D.C. degree.  Approximately 7% have a Master's degree or another doctorate-level degree.  (National Board of Chiropractic Examiners 1993)

Typical academic training and clinical internships for chiropractic students include:

• At least four years of professional study at one of 16 chiropractic colleges in the United States accredited by the Council on Chiropractic Education (CCE), the federally recognized accrediting agency
• More than 2,000 study hours of biological and clinical sciences, such as anatomy, physiology, nutrition, public health, orthopedics, neurology, pediatrics, geriatrics, and other health sciences
• More than 1,000 study hours of chiropractic sciences, such as body mechanics, spinal analysis and adjustments, and diagnostic imaging and interpretation
• Internships in clinical radiology and interpretation
• At least 900 hours of clinical practice before graduation covering aspects of patient care:  taking patient histories and doing physical exams; diagnosing physical problems and their underlying causes; referring patients who would benefit from other specialties or emergency medical care; and performing adjustments and related chiropractic treatments on the spine and other joints.

Chiropractic colleges also offer postgraduate and continuing education programs in fields ranging from sports injuries and occupational health to orthopedics and neurology, allowing doctors of chiropractic to specialize or meet state relicensure requirements.

Components of a Typical Initial Visit to a DC

Patient History

• A clear understanding of the nature and extent of the illness helps the DC decide whether chiropractic care is an appropriate treatment for the condition, and if additional examination procedures are necessary.  Like other health professionals, doctors of chiropractic have a network of health providers available for referral when necessary.  In managed care settings, the DC collaborates with the PCP when non-chiropractic care is indicated.

Physical Examinations

• Orthopedic, neurological, and spinal examination, as well as postural analysis, are performed to determine the patient's general health status and specific problem(s).

X-rays/Lab tests

• May be utilized to further assess the health condition.

Diagnosis

• Based on history, examination, and x-ray/lab findings.

Treatment Plan

• Treatment methods, along with spinal manipulation, may include ultrasound, electrical stimulation, controlled exercise, and lifestyle counseling.

Resource:  1997 American Chiropractic Association