What is Chiropractic

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Chiropractic (from Greek χείρ, -ος chir,-os and πρακτική praktike, sc. τέχνη techne, meaning "(Art of)doing by hand") is a complementary and alternative medicine health profession whose purpose is to diagnose and treat mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health. Chiropractic uses manual treatments including spinal adjustment and other joint and soft-tissue manipulation.[1]

Historically, it is based on the premise that a spinal joint dysfunction can interfere with the nervous system and result in many different conditions of diminished health, a concept known as vertebral subluxation. Today, chiropractors differ on how much emphasis should be placed on subluxation, with some entirely rejecting the concept and instead focusing on the relationship between structure and function and the impact of structure on neurological mechanisms.[2][3][4]

Chiropractors fall into four main groups: "traditional straights," "objective straights," "mixers," and "reform". Each group is based on its philosophical approach, claims made about treatment effects, and whether other treatment modalities accompany the chiropractic adjustment.
Chiropractic was founded in 1895 by D. D. Palmer in the USA, and is now practiced in more than 100 countries.[5][6] Since its inception, Chiropractic has been the subject of controversy, criticism, and attacks regarding the metaphysical approach that the early profession had taken. Controversy has come from philosophical conflicts within the profession, critics outside the profession, and from researchers in the scientific community.[7][8][9] This same criticism may have been the catalyst that allowed some within the profession to take a more neuromuscular approach in their educational standards (see Council on Chiropractic Education), leading them away from the more metaphysical explanations of their predecessors towards more scientific ones.[10][11]

Chiropractors, who in some countries are known as Doctors of Chiropractic, use a combination of treatments which are predicated on the specific needs of the individual patient. A chiropractor can develop and carry out a comprehensive treatment/management plan which can include spinal adjustments, soft tissue therapy, prescription of exercises, and health and lifestyle counseling.[12]

Although chiropractic has much in common with other health professions, its philosophical approach distinguishes it from modern medicine. The philosophy of chiropractic involves what has been described as a "contextual, naturopathic approach" to health care.[13] The chiropractic model favours a holistic and biopsychosocial model of disease in contrast to the reductionist and biomedical model used in mainstream medicine.[14][15]

The traditional, "allopathic" or "medical" model considers disease to be generally the result of some external influence, such as a toxin, a parasite, an allergen, or an infectious agent, and the solution to be the countering of the perceived environmental factor; for example, using an antibiotic for a bacterial infection. By contrast, the naturopathic approach considers that lowered "host resistance" is necessary for disease to occur, so the appropriate solution is to direct treatment to strengthen the host, regardless of the environment. In contemporary clinical practice, one can find elements of both naturopathic and allopathic philosophy among all types of providers.[13] The degree to which a practitioner emphasizes different tenets of these philosophies is one factor that determines the manner in which they practice.

The chiropractic approach to health care stresses the importance of prevention. Joseph Janse explains:
"Unless pathology is demonstrable under the microscope, as in the laboratory or by roentgenograms, to them [allopaths] it does not exist. For years the progressive minds in chiropractic have pointed out this deficiency. With emphasis they [chiropractors] have maintained the fact that prevention is so much more effective than attempts at a cure. They pioneered the all-important principle that effective eradication of disease is accomplished only when it is in its functional (beginning) phase rather than its organic (terminal) stage. It has been their contention that in general the doctor, the therapist and the clinician have failed to realize exactly what is meant by disease processes, and have been satisfied to consider damaged organs as disease, and to think in terms of sick organs and not in terms of sick people. In other words, we have failed to contrast disease with health, and to trace the gradual deteriorization along the downward path, believing almost that mild departures from the physiological normal were of little consequence, until they were replaced by pathological changes…"[16]

However, although most public health officials would agree that vaccination is one of the most cost-effective forms of prevention against infectious disease, it remains controversial in chiropractic. Most chiropractic writings on vaccination, particularly from Palmer's modern followers, focus on its negative aspects.[17] Although the Canadian Chiropractic Association supports vaccination, the American Chiropractic Association supports exemptions to compulsory vaccination laws.[18] Surveys in Canada in 2000 and 2002 found that about 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.[17]

According to a 2002 survey by the National Center for Complementary and Alternative Medicine, chiropractic care was among the ten most commonly used Complementary and Alternative Medicine (CAM) therapies among adults in the USA.[19] The U.S. Department of Labor's Occupational Outlook Handbook, suggests that chiropractic care will increasingly play an important role in health care:

"Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices."[20]