Chiropractic

DEFINITION: The art and science of adjusting the spine and other bony articulations of the body to restore and maintain normal structure and function in the nervous system

ANATOMY OR SYSTEM AFFECTED: Back, bones, hips, musculoskeletal system, nervous system, spine

Science and Profession

The major premise of the field of chiropractic states that vertebrae of the spine can, and frequently do, become misaligned, causing pain and interference in the normal conduction of nerve impulses from the brain to the organs and tissues of the body. Although most spinal misalignments are corrected naturally through normal body movement, some become fixed. As a result, normal nerve transmission is impaired for long periods of time, and the health of the patient suffers as a result. Chiropractors perform adjustments aimed at correcting alignment problems to ease pain and improve bodily function.

What distinguishes doctors of chiropractic from other healthcare professionals is that they work primarily to identify, analyze, and adjust the vertebrae and pelvis to their correct positions. Treatment is directed at restoring and maintaining normal structure and mechanical function of the spine to reduce irritation of the spinal cord and spinal nerves. These irritations lead to pain and distress of the muscles and joints of the body. Less acknowledged and still in want of corroborating research is the relationship between the subluxation (partial dislocation), the neuromusculoskeletal system, and internal organ dysfunction.

Doctors of chiropractic may examine, diagnose, analyze, and use X-rays for diagnostic purposes according to generally recognized procedures taught in accredited chiropractic colleges. Clinical practice generally encompasses consultation and taking the medical history of the patient; physical, neurological, orthopedic, and chiropractic examinations; X-ray analysis of the spine and articulating structures; the administration of adjustments; physiotherapy; nutritional support; and the use of orthopedic supports. In most countries, chiropractic practice does not include the prescription or administration of medicine or drugs, performance of surgery, treatment of infectious diseases, performance of internal exams, reduction of fractures, or administration of anesthetics. Historically, chiropractic physicians practiced either solo or in a group setting with other chiropractors and did not have hospital privileges. This is changing as some chiropractic physicians are entering into group practice settings with other healthcare specialists and gaining admittance to hospitals in a limited capacity.

Chiropractic history dates back to ancient medical writings dating from 2700 BCE. Chiropractic was popularized in the United States in 1895, when D. D. Palmer experimented with a spinal adjustment on Harvey Lillard; Lillard, a janitor, had experienced a “popping sensation” in his upper spine caused by heavy lifting and subsequently suffered a loss of hearing. After treatment, Lillard’s hearing improved, and Palmer formulated the early chiropractic scientific premise and philosophy: that illness is essentially functional in nature and becomes organic only as an end process. His son, B. J. Palmer, was credited with refining and promoting the work of his father. The early educational program organized by D. D. Palmer was admittedly crude, abbreviated, and inadequate. As the profession grew and matured, however, so did the educational standards, to the current level. Chiropractic has emerged as a viable alternative healthcare system.

In the United States, chiropractic colleges are accredited by the Council on Chiropractic Education, which is, in turn, approved by the US Office of Education. The chiropractic curriculum is designed to prepare the chiropractic student to evaluate and manage conditions from a holistic point of view, in which the various factors that affect a person’s health are taken into consideration, including diet, nutritional supplementation, exercise, stress, and lifestyle.

Chiropractors have a full medical curriculum enabling them to make diagnoses. The education of a chiropractor begins with two years of preprofessional college study, with concentration in the human sciences. Although this prerequisite of two years is all that is required, the majority of students entering chiropractic college possess at least a bachelor’s degree. The student then begins the doctor of chiropractic (DC) course of study at an accredited chiropractic college. The DC program is composed of four academic years of study. The initial phase of study is much like any curriculum in the medical, dental, or veterinary schools, consisting of courses in the basic sciences: organic chemistry, biochemistry, anatomy of the musculoskeletal system (including limbs, trunk, and head), anatomy of the internal structures of the body (including all the organs, blood vessels, and internal systems), neuroanatomy (the anatomy of the brain, spinal cord, and entire nervous system), physiology (the study of how these systems function), neurophysiology, pathology (the study of disease), bacteriology, histology (the microscopic study of body tissues), and microbiology. The remainder of the courses are concentrated on the clinical sciences: X-ray physics, positioning, and interpretation; laboratory diagnosis (blood and urine studies); physical examination and diagnosis; neurology; orthopedics; cardiology; pediatrics; geriatrics; dermatology; gastrointestinal and genitourinary systems; physical therapy; nutrition; and chiropractic adjustment techniques.

During the later part of the student chiropractor’s education, they will see patients in a college-affiliated clinic as an “extern,” which prepares the future doctor for patient care and management. In addition to the basic chiropractic curriculum, there are residencies available in both radiology and orthopedics. A chiropractic graduate may apply to study an additional three years to become either a chiropractic radiologist or a chiropractic orthopedist. The training received in these programs is highly specialized, and both of these chiropractic specialists are the equal of their medical counterparts in terms of diagnostic abilities. In addition, comprehensive 360-hour programs of study in orthopedics, neurology, radiology, and sports medicine exist; doctors completing such programs are eligible to sit for an examination to be awarded diplomate status by chiropractic boards in the corresponding specialties. Postgraduate education for the practicing chiropractor includes seminars and workshops in soft tissue injuries, disk syndromes, lower back pain, and other common and difficult conditions. Interdisciplinary seminars and conferences in nutrition, fitness, biochemical imbalances, and numerous other areas of common interest allow physicians from every discipline the opportunity to exchange views and perspectives. The licensing procedure for the graduate chiropractic doctor varies from state to state and country to country.

Diagnostic and Treatment Techniques

To understand fully how chiropractic healthcare works, it is necessary to understand the spine and the role that it plays in overall body function. The nervous system—consisting of the brain, cranial nerves (nerves that originate in the head), the spinal cord, and thirty-one pairs of spinal nerves that branch out much as the limbs of a tree do—generates and regulates all activities in the body. Signals, or impulses, travel along the nerve fibers conveying information between the brain and the rest of the body. Since every tissue and organ of the body is connected to and controlled by nerves from the spinal cord and brain, removal of nerve interference can bring dramatic results. Interference with the transmission of these impulses results in alteration of normal body function. The cranium (skull) and spinal column, composed of twenty-four bones called vertebrae, house the brain and spinal cord. In addition to protecting the spinal cord, the spine is the core of the skeletal framework that supports upright posture, provides for organ and muscle attachment, and allows for the dynamics of human movement. Given this monumental job, the spine and its connecting framework are subject to much activity and abuse.

For the mechanics of body motion to occur properly, there must be full, free, and harmonious movement in every one of the spinal joints. The working unit of the spine is referred to as the motor unit. The motor unit is composed of two vertebrae joined by cartilage cushions called disks and four posterior joints called facet joints, two located to attach the superior vertebra and two to attach the inferior vertebra. The disks separate the vertebrae while allowing flexibility and shock absorption for the spine. They also maintain openings between the vertebrae that are necessary for the passage of the spinal nerves. The facet joints provide additional movement and are limited in their range of motion by ligaments. Restriction in any of them can be compensated for only by the other joints and adjoining structures (such as ribs, muscles, or tendons), thus producing strain in the compensating structures.

It is at the location of the facet joints of the spine where subluxation occurs—an alteration of the alignment and proper movement of the spinal joint resulting in irritation of the exiting spinal nerve via compression, stretch, or chronic (constant) irritation—and leads to alteration of normal body functions. Subluxations can result from various factors, including trauma, toxic irritation, muscular imbalance caused by disuse or repetitive tasks, ligamental weakening, organic dysfunction, and stress. The altered nerve impulse transmission, left uncorrected, results in accumulative dysfunction in the tissue cells of the body.

Spinal biomechanics, the basis of the chiropractor’s evaluation, refers to the manner in which the spine works in movement. Restoration of spinal motion is the primary treatment on which chiropractors depend to alleviate patients’ symptoms. The single most distinguishing element of chiropractic procedures is the spinal adjustment. This chiropractic adjustment is a technique of physically moving the spine by hand or by instrument with the objective of mobilizing a fixated joint. It is a gentle but dynamic thrust applied to a specific joint in a way that generates joint movement in a specific direction. Basically, it is a way to “coax” a restricted joint into moving. Applied repeatedly over a period of time, spinal adjustments are capable of restoring mobility to even the most chronic spinal subluxations. Deep-rooted subluxations that have existed for several years typically require months of care. Fixations of lesser duration and severity respond in less time, often the mildest in one treatment. The procedure works because the restoration of the proper mechanics of spinal motion via the spinal adjustment improves joint function, corrects specific joint problems, and helps prevent injury through increased spinal strength brought about by spinal joints that function properly.

Chiropractic healthcare can be useful for the detection and correction of existing health problems and for preventive purposes. Chiropractors look for the reason that a patient’s symptom developed, including such contributing factors as environmental conditions, lifestyle, systemic stress, and malfunction.

Perspective and Prospects

Chiropractic history dates back to 2700 BCE. Modern chiropractic originated in the second half of the nineteenth century during a time when many theories of healing were being promulgated. Chiropractic and osteopathy shared their early beginnings amid the emergence of several alternatives to the regular school of healing (medicine), including the Thomsonian system (the use of botanicals), the Hygienic movement (the use of fresh fruits and vegetables, fresh air, exercise, and better food preparation), and homeopathy. Daniel David Palmer, born in 1845 in Canada, was involved in making and losing several small mercantile fortunes when he made his way to Iowa in 1886 to become a magnetic healer. Over the next decade, he attracted patients from throughout the Midwest until one day in September 1895, a janitor named Harvey Lillard came into his office, received an “adjustment,” and regained his lost hearing. Soon afterward, the term “chiropractic” (Greek meaning “done by hand”) was coined by Samuel Weed, a Palmer patient. D. D. Palmer began giving instruction at Dr. Palmer’s School and Cure, later becoming Palmer Institute and Chiropractic Infirmary and finally Palmer Chiropractic College.

Brian Inglis, a distinguished British historian, commentator, and author of the two-volume work The History of Medicine (1965), wrote: “The rise of chiropractic . . . has been one of the most remarkable social phenomena in American history . . . yet it has gone virtually unexplored.” In spite of its humble origins and formulative years, chiropractic has had a decided impact on the evolution of healthcare attitudes. For more than a century, it fought for its very survival, overcoming a strong medical lobby in 1977 when the American Medical Association (AMA) reversed its long-standing policy against professional interrelationships between medical doctors and chiropractors. In March 1977, the AMA’s Judicial Council announced:

"A physician may refer a patient for diagnostic or therapeutic services to another physician, a limited practitioner, or any other provider of healthcare services permitted by law to furnish such services, whenever he believes that this may benefit the patient. As in the case of referrals to physician-specialists, referrals to limited practitioners should be based on their individual competence and ability to perform the services needed by the patient."

Despite the AMA’s policy change toward chiropractic, however, complete acceptance by the medical profession has not occurred. This reluctance has not been attributable solely to the attitudes of the medical profession. Rather, it is the result of a combination of the continued opposition of the medical profession and the resistance of chiropractors to subordinate themselves to medical prescription, as with physical therapists who practice under medical supervision. Chiropractors have been independent practitioners for too long, functioning at a high level in the diagnosis and treatment of illness, for them to be willing to regress in status.

It is likely that the chiropractic profession will continue on the course of becoming a health profession with parallels to general medicine. Emphasizing the uniqueness of chiropractic treatment and the contrasting philosophical approaches of health maintenance and therapy, chiropractic has not only survived but also flourished. Whether used as a preventive means to ensure good health or as a way to help the body cure itself of disease, chiropractic has sometimes succeeded where other healthcare measures have failed.

Bibliography

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"Chiropractic." Britannica, 14 Jan. 2025, www.britannica.com/science/chiropractic. Accessed 15 Jan. 2025.

"Chiropractic Adjustment." Cleveland Clinic, 25 Apr. 2022, my.clevelandclinic.org/health/treatments/21033-chiropractic-adjustment. Accessed 25 July 2023.

Haldeman, Scott, ed. Principles and Practice of Chiropractic. 3rd ed., McGraw-Hill, 2005.

Lenarz, Michael, and Victoria St. George. The Chiropractic Way. Bantam, 2003.

Tousley, Dirk, and David M. Lees. The Chiropractic Handbook for Patients. 3rd ed., White Dove, 1985.