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CHIROPRACTIC INTRODUCTION
Chiropractic, now widely practiced in North America, is a system of therapy that is only about 100 years old. Chiropractic therapy was developed in the late 19th century and stems from a single healing event involving a grocer and mystic healer in Iowa, Daniel David Palmer. Daniel apparently helped a janitor regain his hearing by a push on the spine. Palmer later founded the first chiropractic school.
Today's many chiropractors do not necessarily believe, as Palmer did, that a disease is actually caused by a spinal misalignment. Practitioners believe that when body systems are in harmony, the body has the ability to heal itself from within.
Chiropractic seeks to diagnose and treat disorders of the spine, joints, and muscles with techniques of manipulation of the vertebrae, joints and muscles into proper alignment, and to maintain health of the central nervous system and organs. Many primarily treat skeletal and muscular problems instead, including neck and back pain, spasms, sprains and strains. To strengthen and enhance their realigning bodywork, chiropractors frequently offer advice on lifestyle, nutrition, and therapeutic exercise, too.
Chiropractic actually have a remarkable success rate with alleviating lower back pain, one of the most often-heard health complaints. One study showed that 2/3 of the chiropractic patients sought help for this condition alone. As a result of its success in treating back problems, headaches, and sports and other injuries, chiropractic is the most widely practiced branch of complementary medicine in the West, with around 60,0000 practitioners worldwide.
MAIN USES OF CHIROPRACTIC
Spine and neck disorders.
Back pain, especially lower back pain.
Shoulder pain. Strains and sprains. Muscle, joint and postural problems.
Muscle tension. Restricted mobility. Sciatica.
Headaches, migraine.
Gastrointestinal disorders.
Tinnitus, vertigo.
Pain relief. Menstrual pain. Asthma.
HISTORY OF CHIROPRACTIC
The term chiropractic comes from the ancient Greek cheiro, meaning hand, and praktikos, doing; literally, "done by hand" or "manipulation". Spinal manipulation has been practiced since at least the 5th century B.C., and variations, such as Native American "back-walking", are found all over the world.
Chiropractic was developed in 1895 by a Canadian, Daniel D. Parker, who tested his theories by manipulating the spine of his janitor, deaf for 17 years after a back injury. This reportedly caused a shift and the janitor's hearing returned.
In 1906 Palmer was jailed for practicing medicine without a license, but his son, B.J., continued his methods. The therapy was popular during the early 20th century, spreading to Australia, New Zealand, and Europe, but conventional health care providers were skeptical, and in the 1960s the American Medical Association (AMA) condemned it as an "unscientific cult". A 12-year legal battle ensued, which the AMA lost in 1987. Now recognized in American health care, chiropractors work in hospitals and sports clinics. British chiropractors built up research evidence to support their case; in 1994 the Chiropractors' Act allowed them to be state-registered as health professionals. In Australia, official recognition of chiropractic in 1978 lead to the world's first government-funded course.
KEY PRINCIPLES OF CHIROPRACTIC
Chiropractic sees the body as a naturally healthy system. Along with its mechanical structure of bones, joints, and muscles, it has a power source, lubrication, and wiring. The key to the system is the spine, which links the brain to the body, affecting how the body functions. Any distortion to the spine affects other parts of the body.
Chiropractors regard individuals as more than a set of bones, nerves, and muscles. They claim that treatment can ease muscle tension resulting from stress or problems in internal organs, such as the intestine or uterus. When the skeletal structure functions smoothly, the body's natural healing processes are free to keep the entire system working in harmony.
THE THEORY OF CHIROPRACTIC
The spine is the most important support in the body structure, and it protects the nervous system - the communication highway between the brain and the body. Any spinal misalignments, known to chiropractors as "subluxations" or "fixations", not only cause back pain, but may affect the functioning of the whole body. Treatment focuses on joint manipulation; some methods resemble those used in Osteopathy.
MoonDragon's Alternative Health Therapy: Touch & Movement - Osteopathy
The spinal cord is the link that carries the nerves to the rest of the body. Any disruption to this link affects not only the muscles, nerves, and ligaments of the back, but also of the neck, shoulders, arms and legs.
Protected by the spine, this system regulates seemingly automatic internal body functions such as sweating, digestions, and heart rate. The nerves in each of these body systems emerge from the spine of particular vertebrae. Any strain, damage, or distortion of the spine can interfere with these nerves, causing disruption to the smooth working of the internal organs, glands, blood vessels, and the heart, preventing homeostasis - the body's self-regulating and healing processes.
EVIDENCE & RESEARCH
A substantial body of scientific research now exists to support the efficacy of chiropractic for acute lower back pain. Recent studies have found it not only clinically convincing but also cost-effective.
Studies at the College of William and Mary in Williamsburg, Virginia (1992), showed that chiropractic compared favorably with traditional medical treatments in terms of effectiveness and cost. A study by the Rand Corporation in Los Angeles (1992) marked the first time that representatives of the medical community went on record stating that chiropractic is an appropriate treatment for certain causes of lower back pain.
In 1990 and 1995, the British Medical Journal published results of multi-center trials that showed that patients receiving chiropractic treatment for lower back pain improved more than those receiving standard hospital outpatient care.
Studies undertaken by the Australian Centre for Chiropractic Research in 1991 showed chiropractic to be twice as effective as standard medical health care for back injuries, with major savings in compensation for injury at work.
CONVENTIONAL MEDICAL OPINION
Thanks to positive studies in reputable journals, medical opinion is generally well disposed. Chiropractic has gained acceptance in the medical establishment for its research-confirmed ability to treat acute lower back pain. Many conventional health care providers are open to its use for muscular and skeletal problems in general, yet most conventional health care providers know little about chiropractic and are unsure how to incorporate it into their practice. However, many conventional health care providers fiercely deny claims that chiropractic can address other health problems.
Outside the US, it is still unusual for a chiropractor to work in a conventional medical setting, but as research accumulates and the profession establishes legal codes of practice, the situation is likely to improve.
With the patient seated, the practitioner uses her hands to discover which spinal joints are moving freely and which joints are stiff or "locked". This is known as "motion palpation". the practitioner is usually able to locate the exact source of any general pain.
A physical examination will be necessary, so expect to undress to your underwear; if you feel uncomfortable, a gown will be provider. The practitioner applies pressure to the vertebrae and locates the site of pain. Adjustable seats allow the patient and practitioner to sit in a suitable position.
CONSULTING A PRACTITIONER
MEDICAL HISTORY
The practitioner begins by taking a detailed and complete medical history, both of current and past problems, including any past injuries or surgery that may have contributed to your condition. She will ask you about your lifestyle and work. Your diet and any recreational drugs (including caffeine and tobacco) will be noted, and you will be asked how you sit at your desk, what exercise you get, and even what kind of bed you have.
PHYSICAL EXAM
A physical exam involves an analysis of posture, including the degree of right-left symmetry; joint and spine mobility (range of motion); muscle tension and reactivity; gait (how you walk); agility; and discrepancies in leg length. The chiropractor also feels for painful or tender areas. The practitioner will maneuver you into various positions so that she can examine the functioning of your spinal column, joints and muscles. You will be asked to sit, stand, or lie on a specially adjustable chiropractic table which enables even sufferers of severe back pain to be lowered from a standing position.
DIAGNOSTIC TESTS
The chiropractor may carry out some diagnostic tests. X-rays are often taken, and sometimes tests such as nerve-conduction tests are done, as well.
Great care is taken to ensure that diagnosis is precise, so other standard medical, neurological, and orthopedic tests may also be carried out.
- Blood pressure is often taken. (1)
- Reflexes are often tested with a reflex hammer. (2)
- An X-ray may be taken if considered clinically necessary. (3)
QUESTIONS FOR YOUR CHIROPRACTOR
How long does a treatment session last?
The first treatment is roughly 30 to 60 minutes; subsequent sessions last 15 to 20 minutes.
How many sessions will I need?
You may have 2 or 3 sessions a week, and weekly sessions later, but this depends on the condition and on how quickly you respond to treatment. Usually 5 to 10 treatments are advised; if there is not improvement after 10 sessions, other options should be explored. Many chiropractors advise maintenance visits to keep potential problems at bay.
Will it be uncomfortable?
Treatment, which draws on 100 or more specific manual maneuvers, includes thrusts to the spine and tissues and movement of the joints. Some immediate pain may accompany the adjustment but this eases quickly.
Will there be any aftereffects?
Though athletes frequently compete right after treatment, you may get aches and stiffness for a few days as muscles and joints realign, and feel a little tired for a day as your body recovers.
TREATMENT
Treatment usually begins with your second consultation, after any diagnostic tests have been returned. The practitioner usually uses precise and well-controlled techniques known as "adjustments", although sometimes other, less forceful techniques might be employed, or gentle touch applied along the spine, skull, and pelvis.
Some chiropractors may use massage techniques to loose up tight muscles prior to adjustments.
Surgery is never used, and if drugs or treatment other than chiropractic is considered necessary, such as in the case of severe inflammation, you will be referred to your conventional health care provider or a suitable specialist.
A rubber-tipped instrument known as an Activator, rather than the hand, is sometimes used to manipulate the vertebrae. It is used particularly with older patients or babies, since it is designed to deliver a very small, precise, measured thrust. This extra control is important if the patient is frail or delicate, or if the bones are still young.
CHIROPRACTIC TECHNIQUES
Chiropractors use an array of techniques. These are the basic categories:
Adjustments: These include a large number of specific thrusts ranging from slow and sinking to rapid and forceful.
Mobilization: This involves slowly and repeatedly moving a joint within its current range of motion. The patient's muscles are stretched. Eventually, they become too tired to hold the bones in the improper, misaligned position.
Manipulation: This involves pushing a joint rapidly and with mild force back into its proper position. This takes the joint beyond its current range of motion and often produces a pop or click as carbon dioxide from cells is released.
CHECKING THE HIP, PELVIS & LOWER SPINE
Using her hands, the practitioner tests how the pelvis moves in relation to the sacrum (lower spine). These are linked by the sacroiliac joints, and further tests may be done on these and other spinal and pelvic joints.
Marching in place shows the pelvic action.
You may also be asked to bend over to check flexibility and alignment.
This test determines the extent of mobility in a hip joint by checking the length of the psoas muscle connecting the leg to the spine. The practitioner gently pushes on the raised leg to encourage the lumbar region of the spine to stretch, the hip joint to rotate, and the psoas muscle to flex.
Pushing gently on the raise knee flexes the psoas muscle.
The practitioner may use this to test the joints between the vertebrae. Asking the patient to raise his leg, she pushes against it, using the groin and upper leg muscles to exert gentle tension on the lower spine. This tests for pain, inflammation, and imbalance.
If the sacroiliac joints (which link the sacrum to the pelvis) are strained, the patient may experience pain in the lower back and buttocks. The practitioner flexes the patient's leg and extends the thigh to test the joints for any sprain and for mobility.
LOWER BACK TREATMENT
Back pain is a commonly encountered health problems, and one with which chiropractic has demonstrated particular success. "Unlocking" a joint by using chiropractic adjustment is usually painless, and can bring immediate relief from pain and an increased range of movement for the patient. With any chiropractic adjustment, there may be an audible, painless "click" in the relevant joint. This is caused by a tiny gas bubble that is created when the pressure in the joint changes, as happens when it is suddenly stretched.
This treatment aims to improve mobility in the vertebral joints between the sacrum and pelvis. With hands crossed, the practitioner presses down swiftly to adjust a specific vertebra with a precise thrust.
For this maneuver, the table is adjusted to curve the patient's spine slightly. Using precise, gentle pressure, the practitioner pushes with her hands to stretch apart the vertebrae of the lower spine.
The chiropractor gently separates the projections of the vertebrae with her fingers to release tension.
In this classic chiropractic treatment, the practitioner works on the lumbar region of the spine. After preparing the relevant spinal joint for movement, she applies a rapid measured thrust on the vertebrae, moving it into its proper position (adjustment).
A precise, quick adjustment with the hand realigns the vertebrae of the spine.
The patient lies on his side with his spine flexed.
THE EFFECTS
Chiropractors treat patients for lower back pain, shoulder and neck pain or tension, carpal tunnel syndrome, tendinitis, strains, sprains and other sports injuries, as well as discomfort due to mild spinal curvature and headaches. Those chiropractors who hold to the traditional belief that adjustments can affect internal organs also work on patients with such problems as ulcers and asthma. Some contend there is a direct relation between organs and misaligned muscle and bone. Proponents claim that misalignments - especially of the spine, connected by nerves to all body systems - may alter the flow of nerve transmissions, which then alter organ function. Others simply believe that adjustments allow the body to return to its natural state of balance.
CHIROPRACTIC AND PREGNANCY
Midwives often refer their pregnant clients to a chiropractor just prior to giving birth to make sure the spine and pelvis are aligned (to prevent the baby from presenting in a breech or posterior birth position or getting "stuck" in the misaligned pelvis, often resulting in a cesarean delivery) and to relieve any sciatica and other lower back pain (both are common in pregnancy). A chiropractic adjustment will often help facilitate a smoother, less painful or complicated delivery of the baby. After the birth, another visit is recommended for the new mother to make sure everything is back into its proper alignment. If the delivery was long and difficult, both mother and infant may be seen by a chiropractor familiar with prenatal and neonatal chiropractic care. Note: Not all chiropractors will work with pregnant mothers or newborn infants. Make sure the chiropractor you use has had training and experience in working with these types of clients.
A PATIENT'S EXPERIENCE
Angela, aged 45, is a schoolteacher and mother. She had suffered from lower back pain and headaches for some time. "When the chiropractor asked me about past accidents, I remembered being hit by a car when I was 10 years old. On the first visit he made minor adjustments to my lower back and I felt much better, though I was very tired the next day and the pain eventually returned. Further adjustments were made on the next 2 visits, but it was the 4th visit that provided a turning point. Now I hardly ever have back pain or headaches, and if I get the slightest twinge in my back, I return to my chiropractor for a maintenance session."
Gentle exercise that stretches muscles without strain or active movement can help to realign the spine and major joints. With regular stretching, you can relieve spasms, add to joint mobility and improve overall posture and flexibility, thus reinforcing the work of the chiropractor. Yoga is ideal; it stretches the muscles in a balanced way, lengthens the spine and lessens stress.
TIPS FOR BACK PAIN
Back pain afflicts most of us at one time or another. Keep the following in mind to avoid back injuries and keep you away from the chiropractor's office.
To lift heavy objects, keep your feet slightly apart, and bend your knees instead of bending at the waist. Straighten your legs slowly. Keep your back straight, and do not twist your torso. Hold the object close to you, no higher than your chest.
Sitting on a ball seat (see below) helps you to adopt a proper sitting position.
Do your best to avoid sitting or standing for long periods of time.
Try not to sleep on your stomach. This position forces the back to sway.
Swimming and walking are excellent vigorous exercises for overall good health and for strengthening the back.
RELATED CHIROPRACTIC INFORMATION
MCTIMONEY & MCTIMONEY-CORLEY CHIROPRACTIC
These variations were developed by John McTimoney and Hugh Corley. McTimoney, a British chiropractor practicing in the 1950s, believed that the body constantly compensates for misalignments by making minor structural adjustments, and that the whole body should be reintegrated at each consultation to ensure full alignment. In 1972 he established a school of McTimoney chiropractic in the UK. Corley, also British, trained under McTimoney, but further developed the "whole body" approach with his own techniques, and established a chiropractic college in the UK in 1984 to teach the McTimoney-Corley method. He also designed preventive exercises that allow patients to control problems themselves.
Both methods adjust joints with a rapid thrust followed by immediate release, using the elasticity of ligaments and tendons to encourage misaligned bones to "toggle" back into proper position. McTimoney-Corley chiropractors also practice a gentle technique using only the fingertips. Called the Reflux Recoil Adjustment, it is a light method of vertebral manipulation. These gentle techniques are relatively comfortable to receive, and babies and the elderly may find them particularly acceptable.
NETWORK CHIROPRACTIC
This variation was initiated in 1979 by Dr. Donald Epstein, an American chiropractic. Using light, supple movements, practitioners adjust each vertebra in relationship to the rest of the spine, since they believe that the spine protects an essential channel of energy and information to the body.
MAIN USES
Spinal misalignment. Muscular stiffness. Stress. Improved well-being.
HISTORY
Dr. Epstein's system of Network Spinal Analysis integrates points of agreement from diverse chiropractic approaches. The system diverges in its belief that there are 2 types of subluxations, structural (arising from physical stresses) and facilitated (arising from emotional stresses). The practitioner addresses them in different ways.
A 1995 survey of 3,000 patients of Network Spinal Analysis conducted by the University of California at Irvine suggests that Network Spinal Analysis is associated with improvements in self-reported health, an important indicator of actual health.
Postgraduate training in Network Spinal Analysis was first offered in the US in 1995. Certification is now granted in the three levels of care that the system provides.
CONSULTING A NETWORK CHIROPRACTIC PRACTITIONER
The practitioner uses a specialized system of evaluating the spine that focuses on the way individual vertebrae interact. She makes adjustments to subluxations, following a unique sequence, or "network". The sequence involves 12 different techniques, which are applied with careful timing.
Facilitated subluxations are generally addressed with the Logan Basic Technique - light steady pressure applied to the spine, mainly in the upper cervical area. Structural subluxations may be addressed with the Toggle-Recoil Technique - a quick thrust with the heel of the hand. The types of adjustments used change according to improvements in spinal function.
At your first consultation the practitioner will take a history of previous chiropractic care and an inventory of physical and mental stresses. She will examine your muscle tone, leg length, and any tension in the ankles and heels, and assess spinal function in respect to breathing. X-rays may be taken, but they are not standard. Level 1 care then begins.
The goal of Level 1 care, which is usually given 3 times a week for 1-2 months, is to return as much function to the spine as possible and to increase body awareness. At Level 2, visits twice a week for 2-4 months ease not only the spine, but the whole body. Self-help begins at Level 2, when you have developed sufficient body awareness to be able to focus on specific sites and release any tension.
By this point, the spine is self-correcting. General function and well-being have been improved. Some people continue on to Level 3, also called Wellness Care. Self-directed, it is determined by each person's needs and goals. Sessions may take place once a week; a quality-of-life inventory is made periodically.
CONVENTIONAL MEDICAL OPINION
Many conventional health care providers do not distinguish between the different chiropractic approaches. The effectiveness of the more vigorous manipulations would seem more understandable to a health care provider than the gentle maneuvers of Network Chiropractic, which is currently the subject of research studies.
CHIROPRACTIC PRECAUTIONS
Tell your chiropractor if you have osteoporosis or inflammation, signs of infection, tumors, circulatory problems (particularly aneurysms), or a recent fracture. While chiropractors may decide not to treat some of these conditions, they are skilled in pain relief methods that can ease discomfort in some of the conditions listed.
TAKE CARE!
Chiropractic is not advised for those with whiplash, fractures, bone or spinal-cord disease or osteoporosis. For chronic back pain, it is best to see a conventional health care provider first.
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