One of the clearest definitions of the role of chiropractic care comes from the American Chiropractic Association (ACA):
"Doctors of chiropractic (DCs) assess and manage patients with neuro-musculoskeletal disorders and related clinical conditions including, but not limited to, back pain, neck pain, and headaches. When addressing patients' needs, DCs utilize appropriate diagnostic procedures and conservative therapeutic interventions, with a primary focus on spinal manipulation. As with other health care disciplines, chiropractic is committed to accountability and predictability in obtaining measurable outcomes. These would include, but are not limited to, pain, physical function, and patient satisfaction. " (Dobson 1997)
What conditions does Chiropractic treat most effectively?
Chiropractic Care Can Benefit a Significant Proportion of the U.S. Population
"Low back problems affect virtually everyone at some time during their life.
Surveys indicate a yearly prevalence of symptoms in 50 percent of working age adults; 15-20 percent seek medical care. Low back problems rank high among the reasons for physician office visits and are costly in terms of medical treatment, lost productivity, and non-monetary costs such as diminished ability to perform or enjoy usual activities. In fact, for persons under age 45, low back problems are the most common cause of disability. II (Bigos 1994)
Doctors of chiropractic (DCs) receive extensive training in clinical and diagnostic procedures. The main therapeutic procedure performed by DCs is known as spinal and joint manipulation, also called the chiropractic adjustment. DCs also utilize diagnostic procedures, including but not limited to physical examinations, and x-rays when called for; physiotherapeutic modalities; and counseling of patients on diet, nutrition and appropriate rehabilitation and lifestyle changes that could improve neuro-musculoskeletal functioning - for example, exercises aimed at building flexibility, strength, and overall well-being. In addition, DCs have broad diagnostic skills and readily refer patients to the appropriate health care provider when chiropractic care is not suitable to the patient's condition.
The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypo-mobile due to tissue injury. Tissue injury can be caused by a single traumatic event, such as improperly lifting 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 chemical changes that can cause both inflammation and pain for the sufferer. Manipulation of the joint restores mobility, thereby alleviating pain and allowing tissues to heal.
What Value Will Chiropractic Care Bring To My Patients?
Many practitioners find neuro-musculoskeletal complaints, especially nonspecific back pain, difficult and costly to treat. Spinal manipulation is one of the few demonstrated methods for safely and effectively relieving the pain and lack of mobility caused by neuro-musculoskeletal difficulties. Thus, a skilled DC can be a substantial resource in the quest to provide high-quality, cost-effective care.
AHCPR guidelines, which are based on a review of the scientific literature, have confirmed the efficacy of spinal manipulation for treating acute low back pain. Similar efforts are underway to evaluate the literature on chiropractic effectiveness for headaches, and empirical evidence points to the appropriateness of chiropractic for a majority of other neuro-musculoskeletal complaints.
Will patients be satisfied with the care they will receive from a doctor of chiropractic?
One component of health care that has become more prominent under managed care is patient satisfaction. Patients are increasingly looked upon as partners in their own health care, and their opinions about the care they receive are considered important to their well-being. The chiropractic field has long emphasized strong collaborative relationships between DCs and their patients, and chiropractic patients have praised the empathy and communication skills of DCs, as well as the outcomes they have enjoyed from chiropractic care.
Some specifics on patient satisfaction:
In a 1997 study by Group Health Cooperative of South Central Wisconsin, 95.8% of chiropractic patients surveyed indicated overall satisfaction with chiropractic care and services. Satisfaction levels with some specific aspects of care were as follows:
Friendliness and courtesy shown by the DC: 97.9%
Skill, experience, and training of the DC: 96.2%
Explanation of tests and procedures: 95.7%
Advice given about ways to stay healthy: 95.7%
Personal interest in patient problems: 93.1 % (Hansen 1997)
A follow-up study to a randomized comparison of chiropractic and hospital outpatient management for low back pain found that, after three years, more patients rated chiropractic care more helpful than hospital care. In addition to patients' reported satisfaction with care, the researchers measured outcomes in the two groups of patients. Scores on the Oswestry pain-disability questionnaire showed 29% more improvement for chiropractic patients than for those treated at a hospital. (Meade 1995).
To be accepted at a chiropractic college, a student must have completed a minimum of two years of pre- professional college education with prescribed science content, including biology, zoology, general or inorganic chemistry, and related lab work. More than half of the practicing chiropractors have four or more years of an undergraduate college education in addition to their four-year DC degree. Approximately 7% have a Master's degree or another doctorate-level degree. (National Board of Chiropractic Examiners 1993)
Typical academic training and clinical internships for chiropractic students include:
At least four years of professional study at one of 16 chiropractic colleges in the United States accredited by the Council on Chiropractic Education (CCE), a federally recognized accrediting agency
More than 2,000 study hours of biological and clinical sciences, such as anatomy, physiology, nutrition, public health, orthopedics, neurology, pediatrics, geriatrics, and other health sciences
More than 1,000 study hours of chiropractic sciences, such as body mechanics, spinal analysis and adjustments, and diagnostic imaging and interpretation.
At least 900 hours of clinical practice before graduation covering all aspects of patient care:
Taking patient histories and doing physical exams; diagnosing physical problems and their underlying causes; referring patients who would benefit from other specialties or emergency medical care; and performing adjustments and related chiropractic treatments on the spine and other joints.