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}}</ref> As opposed to earlier in its history when founder D.D. Palmer claimed that spinal dysfunction/subluxation was the cause of all disease, modern chiropractic instituions and the international chiropractic educational accrediting agency (CCEI) has disavowed the the monocausal theory of joint dysfunction/subluxation.<ref name="Henderson 2012 632–642">{{cite journal|last=Henderson|first=C.N.R|journal=Journal of Electromyography and Kinesiology|year=2012|month=October|volume=22|issue=5|pages=632–642|accessdate=27 January 2013}}</ref>


===Regulation===
===Regulation===

Revision as of 16:10, 19 February 2013


Doctor of Chiropractic (D.C.) is a doctoral degree of chiropractic for chiropractors in North America. In some countries it is a professional doctorate where training is entered after obtaining between 90 and 120 credit hours of university level work (see second entry degree) and in most cases after obtaining a Bachelors Degree. Chiropractors practice chiropractic medicine, a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health.[1] Chiropractors emphasize manual and manipulative therapy for the treatment of joint dysfunctions. Chiropractic is generally classified as complementary/alternative medicine. [2]

The World Health Organization lists three potential educational paths involving full‐time chiropractic education across the globe. This includes: 1 – 4 years of pre-requisite training in basic sciences at university level followed by a 4 year full‐time Doctorate program; DC. A 5 year integrated bachelor degree; BSc (Chiro). A 2 - 3 year Masters degree following the completion of a bachelor degree leads to the MSc (Chiro).[1] In South Africa the Masters of Technology in Chiropractic (M.Tech Chiro) is granted following 6 years of university. No less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training.[1] Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy.[3]

Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to practice, chiropractors must be licensed. The regulatory boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.[4] Currently, chiropractors practice in over 100 countries in all regions of the world, however chiropractors are most prevalent in North America, Australia and parts of Europe.[5] [1]

Scope of practice

Chiropractors emphasize manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders[6] Chiropractors are generally regarded as primary contact, portal of entry health care providers. Although chiropractors have many attributes of primary care providers, chiropractic has more attributes of a limited medical specialty like dentistry or podiatry.[7] Chiropractors are licensed to communicate a neuromusculoskeletal diagnosis and order X-rays and may use broad diagnostic methods including skeletal imaging, observational and tactile assessments as well as orthopedic and neurological evaluation.[1] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[7] 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.[8] When indicated, chiropractors may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[7]

Due to the historical differences in philosophy and treatment approaches, there are range of 'broad' and 'narrow' scopes of practice for American chiropractors which tend to reflect 'straight' or 'mixer' underpinnings. [9] A focus on evidence-based research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.[10] However, the majority of chiropractors currently view themselves as "back/neck pain musculoskeletal specialists[11] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[12]most do so specifically for low back pain.[13] Although it is generally accepted that chiropractic care is appropriate for musculoskeletal complaints, there is considerable debate on their role in treating visceral disorders.[14] Certain jurisdictions allows the practice of animal chiropractic, whereby licensed chiropractors and veterinarians practice manual and manipulative therapies on animals for musculoskeletal disorders.[15] Increasing evidence-based practice and aligning with conventional medicine has been suggested to obtain more university affiliation and access to hospitals and long-term facilities; aligning with the complementary and alternative medicine movement could bring more patients looking for non-medical approaches.[16] In 2005, the World Health Organization developed chiropractic guidelines on basic training and safety to help standardize formal accreditation and licensure of chiropractors in countries where they remain unregulated. [1] Currently, chiropractic medicine is regulated and practiced in over 100 countries, however chiropractors are most prevalent in North America, Australia and parts of Europe. The majority of mainstream health care and governmental organizations classify chiropractic as traditional or complementary alternative medicine[2]

History

Upon its founding 1895, chiropractic's early philosophy was rooted in vitalism, naturalism, magnetism, spiritualism and other constructs that were not amenable to the scientific method. Chiropractic's founder, D.D. Palmer, attempted to merge science and metaphysics.[17] 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.[18] 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/subluxation to improve health. Palmer drew further distinctions by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. Additionally he described the effects of chiropractic spinal manipulation was mediated by the nervous system in contrast to osteopathy who believed the effects were attributed to the supremacy of the circulatory system. [19] Palmer initially denied being trained by osteopathic medicine founder A.T. Still. But Palmer's papers, held at the Palmer College of Chiropractic, indicate that he wrote in 1899:

"Some years ago I took and 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."[17]

Despite their similarities, osteopathic practitioners sought to differentiate themselves by seeking licensure to regulate the profession calling chiropractic a "bastardized form of osteopathy"[18] In 1907 in a test of the new osteopathy law, a Wisconsin based chiropractor was charged with practicing osteopathic medicine without a license. Ironically the Palmers legal defence of chiropractic consisted of the first chiropractic textbook 'Modernized Chiropractic' published in 1906, written by "mixer" chiropractors Longworthy, Smith et al. who the Palmers despised. Although the chiropractors 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.[20] In this regard, chiropractic is unique with CAM disciplines in North America having achieved regulation in all American states and Canadian provinces.[11] By embracing both vitalism and materialism the philosophy of chiropractic has produced a diverse and eclectic mix of chiropractors which despite their emphasis of manual therapy they may vary on their perceived scope of practice, interventions and their role in the health care system.[6]

Philosophy

The philosophy of chiropractic is rooted in traditional and complementary medicine; it shares both vitalistic and mechanistic viewpoints. Chiropractic medicine embraces naturalistic principles that suggest decreased "host resistance" of the body facilitates the disease process. Chiropractors propose manual, conservative and natural interventions are preferable towards optimizing health and functional well-being. Chiropractors emphasize manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders[6] The relationship between structure, especially the spine, and function as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. Chiropractors examine the biomechanics of the spine and other joints of the neuromusculoskeletal system and examines its role in health and disease. [21]It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction, described by chiropractors as the vertebral subluxation complex.[22]The majority of practitioners currently accept the importance of scientific research into chiropractic.[6]

"Straight" Chiropractic

Half-length sitting portrait of man in his fifties with large gray beard and moustache, wearing coat and vest

Also known as 'subluxation-based' and 'principled chiropractic', chiropractors educated from this paradigm espouse traditional Palmer principles and philosophy. Historically straight chiropractors regarded spinal joint dsyfunction/subluxation as the primary cause of "dis-ease" and could be corrected via specific chiropractic adjustments. This monocausal view of disease has been abandoned by the profession [23] preferring a holistic view of subluxation that is viewed as theoretical construct in a"web of causation" along with other determinants of health.[24] Palmerian philosophy focused on metaphysical constructs such as Innate Intelligence and Universal Intelligence to explain the effects of the chiropractic adjustment, whose intent was the reduce/correct spinal subluxations and improving the functioning of the nervous system. The subluxation was said to be "the cause of 95 percent of all diseases... the other five percent is caused by displaced joints other than those of the vertebral column."[25] Misalignment of the vertebrae was believed to be cause impingement of the nerve root, a theory which has long been debunked[26] Subluxation-based chiropractors view traditional chiropractic lexicon such as "analysis" and "adjustment" and as a critical distinction of chiropractic despite lack of prevalence of these terms in the chiropractic literature[27] Subluxation-based chiropractors have been criticized both internally and externally for far-reaching claims of "killer" subluxations, pseudoscientific reasoning,[18] dogmatic approaches [28] unethical business practices that invoke religious themes and high-volume treatments for a variety of conditions that lack supportive scientific evidence.[29] This metaphysical and dogmatic and singular approach to chiropractic care has been criticized for failing to engage in critical and rational thinking and embracing evidence-based medicine.[30] Straight chiropractors use a subluxation-based model as opposed to the patient-centered model now favored in health care.[31] Although they are the minority within the profession, they are considered to have a disproportionate influence as "purists".[32]

"Mixer" Chiropractic

Mixers form the majority of chiropractors and attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;[31] While D.D. Palmer considered vertebral misalignment to be the hallmark feature of subluxation, mixer pioneer Solon Langworthy asserted that intervertebral hypomobility, not misalignment, was subluxation’s cardinal biomechanical feature. This contrasting mechanistic emphasis, intervertebral misalignment vs. hypomobility, formed one the basis for a heated polemic in the profession. Although both misalignment and hypomobility are currently recognized as biomechanical features of subluxation, hypomobility has garnered much more attention in recent years.[24][33] Mixers were disdained by the Palmers who disapproved of their use of instrumentation and mixing chiropractic diagnostic and treatment approaches with osteopathic, naturopathic and allopathic viewpoints.[32] By embracing a mechanistic viewpoint, mixers are able balance the vitalistic notions with critical reasoning skills that led to legitimate scientific investigation of chiropractic principles. Mechanistic underpinnings have led to testable hypotheses that structure affects function via the nervous system by the scientific study of joint dysfunction (subluxation) and the biological mechanisms underlying manipulative therapies[6] Scientific chiropractors suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.[28] In contrast to subluxation-based chiropractors, evidence-based chiropractors favor and incorporate mainstream medical diagnostic and treatment approaches such as exercise, nutritional supplementation, rehabilitation, self-care, physiotherapeutic modalities, and other natural approaches. A majority of mixers retain belief that spinal dysfunction/subluxation may be involved in somato-visceral disorders. This group may represent the 'silent majority' of centrists who embrace evidence-based medicine but feel comfortable retaining elements of the subluxation complex that have not been validated through empirical evidence.[34]

Interventions

Chiropractic education and training prepares future chiropractors to be able multi-modal treatment approaches includes:

  • manual procedures, particularly spinal adjustment, spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;
  • exercise, rehabilitative programmes and other forms of active care;
  • psychosocial aspects of patient management;
  • patient education on spinal health, posture, nutrition and other lifestyle modifications;
  • emergency treatment and acute pain management procedures as indicated;
  • other supportive measures, which may include the use of back supports and orthotics;
  • recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Spinal dysfunction/subluxation

Main article: Spinal dysfunction

Spinal dysfunction, dubbed subluxation by chiropractors, is hypothesized to interfere with optimal biomechanics, thereby altering proper neurological function. Chiropractic theory suggests spinal dysfunction/subluxation may contribute to neuromusculoskeletal and visceral disorders via aberrant spinal segmental and suprasegmental reflexes. While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial.[35] Chiropractors suggest spinal manipulation normalizes spine biomechanics, and as a consequence, normalizes afferent input to the central nervous system resulting in optimized neurological function and improved health outcomes.[36]

Manual and manipulative therapy

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques,[37] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.[38]It describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.[39] Spinal manipulation gained mainstream recognition[40] and acceptance during the 1980s,[41]which has led to increased collaboration between chiropractors and medical doctors. Currently they are developing inter-professional pathways of care for manual and conservative treatment of neuromusculoskeletal disorders.[42][43][44] It is the most common intervention used in chiropractic care. [45] In North America, chiropractors perform over 90% of all manipulative treatments[46] with the balance provided by osteopathic medicine and physical therapy. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.[47] Typically, it is performed on patients who have failed to respond to other forms of treatment.[48]There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.[49] Although serious injuries and fatal consequences can occur and are likely to be under-reported,[50] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.[1]

Safety

The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manual medicine practitioners, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindication apply only to the manipulation of the affected region.[51]

Adverse events in spinal manipulation studies are believed to be under-reported [52] and appear to be more common following HVLA manipulation than mobilization.[53] Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.[49] These events typically dissipates within 24–48 hours [54] Serious injuries and fatal consequences , especially to SM in the upper cervical region, can occur.[55] but are regarded as rare when spinal manipulation is employed skillfully and appropriately.[51]

There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.[56][57][58] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.[59] A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.[60]

Evidence-based practice guidelines

The 1990s resulted in a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines. In the current advent of the evidence-based medicine era, chiropractic scholars have generated evidence-based systematic reviews and practice guidelines with respect to the management of acute and chronic low back pain,[61][62] thoracic pain, neck pain,[63] headache,[64] radiography,[65] [66] [67] as well as extremity conditions;[68][69] tendinopathy[70] myofascial pain/trigger points,[71] and non-musculoskeletal conditions.[72]

Training

Main articles: Chiropractic education and List of chiropractic schools

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training.[1] Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy.[3] Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed. All Chiropractic Examining Boards require candidates to complete a 12 month clinical internship to obtain licensure. Licensure is granted following successful completion of all state/provincial and national board exams so long as the chiropractor maintains malpractice insurance. Nonetheless, there still some variations in educational standards internationally depending on admission and graduation requirements. chiropractic medicine is regulated in North America by state/provincial statute. The regulatory boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.[73]

Regulation and Accreditation

Main article: Councils on Chiropractic Education International

Regulations for chiropractic practice vary considerably from country to country. In some countries, such as. the United States of America, Canada and some European countries, chiropractic has been legally recognized and formal university degrees have been established. In these countries, the profession is regulated and the prescribed educational qualifications are generally consistent, satisfying the requirements of the respective accrediting agencies.  However, many countries have not yet developed chiropractic education or established laws to regulate the qualified practice of chiropractic. In addition, in some countries, other qualified health professionals and lay practitioners may use techniques of spinal manipulation and claim to provide chiropractic services, although they may not have received chiropractic training in an accredited programme.

Chiropractic is governed internationally by the Councils on Chiropractic Education International (CCEI). This body is officially recognized by the World Federation of Chiropractic and the World Health Organization as the accrediting agency for schools of chiropractic across the world. [74] The minimum prerequisite for enrollment in a chiropractic college set forth by the CCEI is 90 semester hours, and the minimum cumulative GPA for a student entering is 3.0 on a 4.0 scale.[2] Common prerequisite classes include those of the biological, chemical, & physical sciences, including: human anatomy and physiology, embryology, genetics, microbiology, immunology, cellular biology, exercise physiology, kinesiology, general chemistry, organic chemistry, analytical chemistry, biochemistry, toxicology/pharmacology, nutrition, nuclear medicine, physics, biomechanics, and statistics.[75] Chiropractic programs require at least 4,200 hours of combined classroom, laboratory, and clinical experience.

United States

American chiropractors received their Doctorate in Chiropractic (D.C.) following a minimum of 7 years of university. There are currently 18 schools of chiropractic in the United States.: Unique to to the United States, schools of chiropractic following either a 'mixer' or 'straight' paradigm leading to two national bodies, International Chiropractic Association and the American Chiropractic Association. Mixers form the majority of American chiropractors[6] however straights are believed to have a disproportionate influence as "purists"[32]

Australia

In Australia, a minimum of five-years worth of chiropractic education is needed before one may register as a practicing chiropractor. Chiropractic is taught at four public universities: RMIT in Melbourne, Murdoch University in Perth, Macquarie University in Sydney and new in 2012 Central Queensland University in Mackay. The RMIT, UCQ and Macquarie programs graduate chiropractors with a bachelors degree followed by a masters degree while Murdoch University graduates attain a double bachelors degree, any of which is necessary for registration with state registration boards.[76]

A graduate of RMIT will have attained a Bachelor of Applied Science (Chiropractic) and a Master of Clinical Chiropractic.[77] Similarly, a typical graduate of Macquarie University will have a Bachelor of Chiropractic Science followed by a Master of Chiropractic.[78] Murdoch University graduates possess the double-degree of Bachelor of Science (Chiropractic Science) / Bachelor of Chiropractic.[79] Students at University of Central Queensland graduate with a Bachelor of Science (Chiropractic) followed by a Master of Chiropractic Science.[80]

Canada

Canadian chiropractors received their Doctorate in Chiropractic (D.C.) following a minimum of 7 years of university. There are currently two schools of chiropractic in Canada: Canadian Memorial Chiropractic College, in Toronto, Ontario and the Universite du Quebec a Trois Rivieres, in Trois Rivieres, Quebec. Both programs are fully accredited by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards.[81] In 2010, the majority of students (87%) entering the CMCC program had completed a baccalaureate university degree, and approximately 3% have a graduate degree.[82]

South Africa

In SA (South Africa) there are two schools of chiropractic: the Durban Institute of Technology and the University of Johannesburg.[83] They are both 6-year full-time courses leading to an MTECH or Masters of technology in Chiropractic. It's a legal requirement that chiropractors must be registered with the Allied Health Professions Council of SA (AHPCSA) the governmental statutory body in order to practice Chiropractic in SA. Being a member of the Chiropractic Association of SA (CASA) is voluntary. CASA is the only voluntary national association in the country and aims to promote the profession through publications in newspaper, interviews, internet and public enquires over the phone.

United Kingdom

In 1993 Princess Diana visited the Anglo-European College of Chiropractic and became its patron by calling for legislation to prevent unqualified individuals from practicing Chiropractic in the UK.[84] In 1994, Parliament passed legislation regulating the practice of Chiropractic, like other health care professions, and creating the General Chiropractic Council as the regulatory board. Since that time, it is illegal to call oneself a Chiropractor in the UK without being registered with the General Chiropractic Council.[85]There are three UK chiropractic colleges with chiropractic courses recognised by the General Chiropractic Council (GCC), the statutory governmental body responsible for the regulation of chiropractic in the UK.[86] McTimoney College of Chiropractic offers an Undergraduate Master Degree in human Chiropractic and two post-graduate Masters programmes in Animal Manipulation, plus a masters in Paediatric Chiropractic.[87] The Anglo-European College of Chiropractic and the University of Glamorgan chiropractic graduates with the Masters degree (MChiro).

New Zealand

As of 2005, the New Zealand College of Chiropractic (NZCC). obtained accreditation by the CCEA (Council on Chiropractic Education Australasia) and subsequently the CCEI.

Chiropractic specialities

Chiropractic scientists (DC/PhD)

Chiropractors can conduct clinical and basic scientific research and publish in peer-reviewed journals during training and after graduation. Chiropractors can also pursue a Ph.D degree in various health care disciplines including including epidemiology, biomechanics, neurophysiology and kinesiology, [88]

Fellowships and other credentials

Chiropractors, like other health care professionals, can pursue post-graduate education in various chiropractic specialties. Most are 2 year post-graduates degrees in chiropractic specialities such as including clinical sciences, sports chiropractic, radiology, animal chiropractic and others.There are some other chiropractic credentials, however that are not post-graduate degrees but other means of continuing education they may or may not be recognized by the major health care organizations, medical or chiropractic communities. The following is a comprehensive list of the various designations that chiropractors can attain with further continuing education and post-graduate education programmes.

Ethics and medicolegal issues

Chiropractors, like other health care professionals, are self-regulated and have a fiduciary responsibility to protect the public and ensure competent, professional and ethical behaviour. Chiropractors have been noted to have increased instances of fraud, abuse and quackery compared to other health professions.[30] Internal criticism identified dubious practice techniques that promote high-volume treatments (which can increase dependency) and far-reaching and outlandish claims regarding the clinical significance of joint dysfunction/subluxation and its role in health and disease[89]

Regulation

Since its inception, chiropractic was controversial amongst the established medical orthodoxy. Chiropractors were jailed for "practicing medicine without a license" which the profession designed a legal and political defence against prosecution arguing that chiropractic was "separate and distinct from medicine", asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease.[20] In 1963 the American Medical Association formed a "Committee on Quackery" designed to "contain and eliminate" the chiropractic profession. In 1966, the AMA referred to chiropractic an "unscientific cult" and until 1980 and held that it was unethical for medical doctors to associate themselves with "unscientific practitioners".[90] The 1987, the AMA was found guilty of being engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession." [20] In the 1980s, spinal manipulation gained mainstream recognition[91] and has spurred ongoing collaboration into research of manipulative therapies and models of delivery of chiropractic care for musculoskeletal conditions in the mainstream healthcare sector.[42][92][93]

Public health

Public health is becoming an increasingly important topic for chiropractors and what role they may play in the public health arena with recommendations suggesting the natural focus for the chiropractic profession is maintaining spinal and musculoskeletal health, good nutrition and an active lifestyle from childhood and throughout life, thereby promoting general health and freedom from chronic pain, disease and disability.[94] However, traditionally chiropractic has not endorsed mainstream public health measures such as mandatory vaccination and water fluoridation stating the patient should be able to freely choose for themselves.[95][95][96] [97]

Diagnostic imaging

Chiropractors employ diagnostic imaging techniques such as X-rays and CT scans to assist in the management of patient care. External and internal criticism regarding the frequency and inappropriate use of X-Rays, such as full spine radiographs, resulted in the development of evidence-based general practice guidelines in 2007 to improve patient safety by eliminating unnecessary exposure to radiation.[98][99]

Safety

There has been considerable debate on the safety of spinal manipulation, the core clinical act of chiropractors, in particular with the cervical spine.[49] Adverse events in SM studies are believed to be under-reported [52] and appear to be more common following HVLA manipulation than mobilization.[53] Although serious injuries and fatal consequences can occur and may be under-reported,[50] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.[1] There is ongoing research investigating upper cervical manipulation and incidence of stroke.[60]

References

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See also

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