Chiropractic Care

What is Chiropractic?

Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic services are used most often to treat common musculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.

Through their whole-person, patient-centered approach, doctors of chiropractic (DCs) elevate the health and wellness of their communities by helping people of all ages live more fully and actively.

Why Choose Chiropractic?

Chiropractic is the third-largest primary health care profession, surpassed in number only by doctors of medicine and dentistry. Doctors of chiropractic treat about 35 million Americans annually.

• DCs are licensed to practice in all 50 states and the District of Columbia–and in many nations around the world–and undergo a rigorous education in the healing sciences at institutions accredited by the U.S. Department of Education. 

• A growing list of research studies and reviews demonstrate that the services provided by chiropractic physicians are both safe and effective. The evidence strongly supports the natural, whole-body and cost-effective approach of chiropractic services for a variety of conditions.

• Chiropractic is used extensively by amateur and professional athletes, professional dancers and others to prevent and treat injuries as well as achieve optimal health and functioning.

What is Spinal Manipulation?

One of the most common and well known therapeutic procedures performed by doctors of chiropractic is spinal manipulation (sometimes referred to as a “chiropractic adjustment”). The purpose of spinal manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile – or restricted in their movement – as a result of a tissue injury. Tissue injury can be caused by a single traumatic event, such as improper lifting of 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 physical and chemical changes that can cause inflammation, pain, and diminished function for an individual. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal.

Chiropractic adjustment rarely causes discomfort. However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) that usually resolves within 12 to 48 hours. Compared to other common treatments for pain, such as over-the-counter and prescription pain medications, chiropractic’s conservative approach offers a safe and effective option.

What is a Doctor of Chiropractic?

Doctors of Chiropractic (DCs) – often referred to as chiropractors or chiropractic physicians – practice a hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling. 

DCs may assess patients through clinical examination, laboratory testing, diagnostic imaging and other diagnostic interventions to determine when chiropractic treatment is appropriate or when it is not appropriate. Chiropractors will readily refer patients to the appropriate health care provider when chiropractic care is not suitable for the patient’s condition, or the condition warrants co-management in conjunction with other health care providers. 

Safe and Effective

Chiropractic services are some of the safest drug-free, noninvasive therapies available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches and other neuromusculoskeletal complaints. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small.

Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness or aching (like that experienced after some forms of exercise), headaches and tiredness. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.

In addition to being a safe form of treatment, spinal manipulation is incredibly effective, in some cases getting patients back on their feet faster than traditional medical care. A clinical comparative trial published by the Journal of the American Medical Association found that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone. In addition, a study in the Annals of Internal Medicine found that spinal manipulative therapy and exercise are more effective at relieving neck pain than pain medication.

Safety of Neck Manipulation 

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment or neck manipulation, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Patients typically notice a reduction in pain, soreness and stiffness, along with an improved ability to move the neck. Neck manipulation is a remarkably safe procedure. While some reports have associated high-velocity, upper-neck manipulation with a certain kind of stroke, or vertebral artery dissection, research suggests that patients are no more likely to suffer a stroke following a chiropractic neck treatment than they are after visiting their primary care medical doctor’s office. Researchers who examined the issue closely concluded that vertebrobasilar artery (VBA) stroke is a very rare event, and that this type of arterial injury often takes place spontaneously or following everyday activities such as turning the head while driving, swimming or having a shampoo in a hair salon.

It’s important to note that patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or medical doctor—but the care they receive there is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity, upper-neck manipulation is extremely rare – about 1 case in 5.85 million manipulations. To put this risk into perspective, if you drive more than a mile to get to your chiropractic appointment, you are at greater risk of serious injury from a car accident than from your chiropractic visit.

When assessing treatment options, patients should understand the risks associated with some of the most common treatments for neck and back pain—prescription nonsteroidal anti-inflammatory drugs (NSAIDs) as well as prescription opioid pain medications—as these options carry risks significantly greater than those of manipulation.

Ongoing Research and Education 

The American Chiropractic Association believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic. Today, chiropractic researchers are involved in studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials, literature reviews and publishing papers reviewing the risks and complications of neck adjustment.

All available evidence demonstrates that chiropractic treatment holds an extremely small risk. The chiropractic profession takes the issue of stroke and the safety of patients very seriously and engages in training and postgraduate education courses to recognize risk factors in patients and to continue rendering treatment in the most effective and responsible manner.

References

1. Senstad O, et al. Frequency and characteristics of side effects of spinal manipulative therapy. Spine 1997 Feb15; 435-440.

2. Goertz CM et al. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: A comparative effectiveness clinical trial. JAMA Network Open, 2018; 1(1): e180105. doi:10.1001/jamanetworkopen.2018.0105.

3. Bronfort G, Evans R, Anderson A, Svendsen K, Bracha Y, Grimm R. Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine. 2012; 156(1):1-10.

4. Cassidy D, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008; 33: S176–S183.

5. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.

6. Lanas A, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol 2005; 100:1685–1693.

7. Boscarino JA. Risk factors for drug dependence among outpatients on opioid therapy in large US health-care system. Addiction. 2010 Oct;105(10):1776-82. doi: 10.1111/j.1360-0443.2010.03052.x. Epub 2010 Aug 16.

8. Lauretti W. “The Comparative Safety of Chiropractic.” In Daniel Redwood, ed., Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p.230-8.

9. Hurwitz E, et al. Treatment of neck pain: noninvasive interventions. Spine 2008;33(4S):S123-S152.