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The history of the chiropractor dates back as far as 17,500 BC. Hippocrates believed that a misaligned spine contributed to the health of an individual. Modern day chiropractic goes back over 100 years, when the first adjustment was given by Dr. Daniel Palmer on September 18, 1895.

Dr. Palmer, born in Canada in 1845, was very much interested in the healing art and first learned magnetic healing. This form of healing used the magnetism in the body. In 1886, Dr. Palmer opened his first office of magnetic healing in Burlington, Iowa. From there, he went on to open another office in Burlington, Iowa in 1887.

His interest was finding the cause and effect of sickness. He studied to discover what causes sickness and what effects sickness has on the human body. The first chiropractic adjustment he gave in 1895 was performed on a man who had lost his hearing 17 years previously. He reported to Dr. Palmer that at the time of losing his hearing, he had strained his back and had heard a noise in his back when this happened. Suspecting that there could be a spinal misalignment, Dr. Palmer examined him and did find a vertebra out of line. Dr. Palmer adjusted the vertebra back into position and the man's hearing did improve.

This proved Dr. Palmer's theory that if the spine is aligned correctly, the nerve flow to all parts of the body will work correctly and, thus, the body will be healthy and free of disease. Dr. Palmer was excited to think that he may have discovered a cure for all sickness.

In 1897, Dr. Palmer opened his chiropractic school in Davenport, Iowa, calling it the Palmer Infirmary and Chiropractic Institute. The name was later changed in 1907 to Palmer School of Chiropractic. Enrollment at first was low, with only 24 students in 1906, but today there are over 20 schools with enrollment of over 10,000 students. Commonly referred to as "The Harvard of Chiropractic", Palmer graduates are trained by the top Doctors in the world, and every President of every other chiropractic college has been a Palmer College of Chiropractic Alumnus. hiropractic

Alternative medical systems

Acupuncture · Anthroposophic medicine · Ayurveda · Chiropractic · Herbalism · Homeopathy · Naturopathy · Osteopathy · Traditional medicine (Chinese · Tibetan)

NCCAM classifications

Whole medical systems · Mind-body interventions · Biologically based therapies · Manipulative therapy · Energy therapies

See also

Alternative medicine · Glossary · People

v • d • e

Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.^[1] It is generally categorized as complementary and alternative medicine (CAM),^[2] a characterization that many chiropractors reject.^[3] The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling.^[4] Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence,^[5] a vitalistic notion that brings ridicule from mainstream science and medicine.^[6]

D.D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century.^[7] 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.^[8] Chiropractic is well established in the U.S., Canada and Australia.^[9]

Throughout its history it has been controversial.^[10][11] For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation^[12] that are not based on solid science.^[13] Vaccination remains controversial among chiropractors.^[14] The American Medical Association called chiropractic an "unscientific cult"^[15] and boycotted it until losing a 1987 antitrust case.^[16] Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among medical physicians and health plans in the U.S.,^[16] and evidence-based medicine has been used to review research studies and generate practice guidelines.^[17] Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of treatment of back pain.^[13] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.^[18] Although spinal manipulation can have serious complications in rare cases,^[19][20] chiropractic care is generally safe when employed skillfully and appropriately.^[21]

Chiropractic Philosophy

Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism. A philosophy based on deduction from irrefutable doctrine 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. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method,^[23] and relies on deductions from vitalistic first principles rather than on the materialism of science.^[22] However, most practitioners currently accept the importance of scientific research into chiropractic,^[23] 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;^[22] 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.^[24]

Although a wide diversity of ideas currently exists among chiropractors,^[23] 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.^[25] Chiropractors study the biomechanics, structure and function of the spine, along with what they say are its effects on the musculoskeletal and nervous systems and its role in health and disease.^[26]

Chiropractic philosophy includes the following perspectives:^[22]

• Conservatism considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication.^[26]

• 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.^[23]

• Straights tend to use an approach that focuses on the chiropractor's perspective and the treatment model, whereas mixers tend to focus on the patient and the patient's situation.^[22]

Chiroprctortraights and mixers

Chiropractic is often described as two professions masquerading as one. Unlike the distinction between podiatry (a science-based profession for foot disorders) and foot reflexology (an unscientific philosophy which posits that many disorders arise from the feet), in chiropractic the two professions attempt to live under one roof,^[24] albeit with much tension between them.^[28]

Straight chiropractors adhere to the philosophical principles set forth by D.D. and B.J. Palmer, and retain metaphysical definitions and vitalistic qualities. 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. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for chiropractic treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies.^[29] Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care.

Mixer chiropractors "mix" diagnostic and treatment approaches from osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and they incorporate mainstream medical diagnostics and employ many treatments including conventional techniques of physical therapy such as exercise, massage, ice packs, and moist heat, along with nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback. Mixers tend to be open to mainstream medicine and are the majority group.^[8]

Vertebral subluxations and Chiropractic

Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn (innate) ability to heal itself.^[5] 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. D.D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.^[30] This concept was later expanded upon by his son, B.J. Palmer and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. In 1910, D.D. Palmer theorized that the nervous system controlled health:

"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality—too much or not enough action—which is disease."^[31] . For more information on chiropractors and Dr. Palmer, vist their website at www.palmer.edu. Vertebral subluxation, a core concept of chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.^[6]

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.^[6] 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.^[32][33]

A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of disorders of internal organs (such as the heart, the lungs, or the stomach) that subluxation significantly contributes to, the mean response was 62%.^[34] 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. It is essentially a functional entity, which may influence biomechanical and neural integrity." This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays.^[21] Attorney David Chapman-Smith, Secretary-General of the World Federation of Chiropractic, has stated that "subluxations are not structural entities and cannot be detected on x-ray."^[35]

Chiropractic Scope of practice

Chiropractors, also known as doctors of chiropractic or chiropractic physicians ^[36] in many jurisdictions,^[37] emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,^[21] with special emphasis on the spine.^[1] 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 of the attributes of a medical specialty like dentistry or podiatry.^[38] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,^[24][38] but the more expansive view of chiropractic is still widespread.^[39] Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);^[2] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.^[3] Aligning with conventional medicine could give chiropractors more university affiliation and access to hospitals and long-term facilities; aligning with the CAM movement could bring more patients looking for nonmedical approaches.^[40]

The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.^[21] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.^[38] 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 counseling.^[4]

Chiropractors are not licensed to write medical prescriptions or perform major surgery in the U.S.^[41] 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.^[42] 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.^[41] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.^[34] A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in a few U.S. states,^[43] but is not recognized by the American Chiropractic Association as being chiropractic.^[44]

Chiropractic overlaps with several other manual-therapy professions, including massage therapy, osteopathy, and physical therapy.^[45] Chiropractic is autonomous and competitive with mainstream medicine,^[46] and osteopathy outside the U.S. remains primarily a manual medical system;^[47] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.^[46] Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, 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.^[45]

No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors. 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.^[17] Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM, ^{but chiropractors are fully licensed to do so.}