Chiropractic treatment techniques

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Chiropractors primarily use manipulation ("adjustment") of the spine as a treatment. Such treatments trace back to ancient China, Greece and Egypt.[1] It gained popularity in the late 19th century, with the development of osteopathic and chiropractic medicine in North America.[2]

Spinal manipulation (SMT) became more popular in the 1980s.[3] It includes manipulation and massage to "adjust" the spine and related tissues,[4] and is a primary basis of chiropractic.[5] Systematic reviews have not found evidence that chiropractic manipulation is effective for any medical condition, with the possible exception of treatment for back pain.[6] The safety of manipulation, particularly on the cervical spine has been debated.[7] Adverse results, including death, are rare, with very low mortality rates.[8][9] Chiropractors may use exercise and other treatments and advice.[5]

Interventions[edit]

Skilled, specific hands-on techniques, including manipulation and mobilization, are used to diagnose and treat soft tissues and joint structures, to reduce pain and to increase range of motion and general health.[10]

The approach is generally conservative, and treatment may include:

  • manual procedures, including spinal or joint manipulation or mobilization, soft‐tissue and reflex techniques;
  • exercise, and other active care;
  • psychosocial aspects of patient management;
  • patient education on spinal health, posture, nutrition and lifestyle modifications;
  • emergency treatment and acute pain management;
  • other supportive measures, including the use of back supports and orthotics;
  • recognition of the limitations of chiropractic care, and of the need for referral to other health professionals.

Chiropractors may also use exercise and other conservative treatments and advice.[5]

Manual and manipulative therapy[edit]

Lumbar, cervical and thoracic chiropractic spinal manipulation

The Chinese used such therapy more than 3000 years ago. Hippocrates also used such techniques[1] as did the ancient Egyptians and other cultures.

In the late 19th century in North America, therapies including osteopthic and chiropractic became popular.[2] Spinal manipulation gained mainstream recognition during the 1980s.[3]

In this system, hands are used to manipulate, massage or otherwise influence the spine and related tissues.[4] It is the most common and primary intervention used in chiropractic care.[5]

Effectiveness[edit]

Neuromusculoskeletal disorders[edit]

Treatment is usually for neck or low back pain and related disorders.[11]

For acute low back pain, it is not as effective as other treatments such as painkillers.[12][13][14]

National guidelines vary; some recommend the therapy for those who do not improve with other treatment.[15] It may be effective for lumbar disc herniation with radiculopathy,[16][17] as effective as mobilization for neck pain,[18] some forms of headache,[19][20][21] and some extremity joint conditions.[22][23] A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between spinal manipulation therapy and other treatments for reducing pain and improving function for chronic low back pain.[24] A 2008 review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition.[6][25]

Non-musculoskeletal disorders[edit]

The use of spinal manipulation for non-musculoskeletal is controversial. It has not been shown to be effective for asthma, headache, hypertension, or dysmenorrhea.[14] There is no scientific data that supports the use of SMT for idiopathic adolescent scoliosis.[26][27]

Cost-effectiveness[edit]

Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches.[28] Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.[29]

Safety[edit]

All treatments need a thorough medical history, diagnosis and plan of management. Chiropractors, must rule out contraindications to any treatments, including adverse events.

Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques may be treatments of choice. Most contraindications apply to the manipulation of the affected region.[30]

While safety has been debated,[7] and serious injuries and deaths can occur and may be under-reported,[8] these are generally rare and spinal manipulation is relatively safe[12] when employed skillfully and appropriately.[9]

Adverse events are believed to be under-reported [31] and appear to be more common following high velocity/ low amplitude manipulation than mobilization.[32] Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.[7] These effects generally are reduced within 24–48 hours [33] Serious injuries and fatal consequences, especially to SM in the upper cervical region, can occur.[34] but are regarded as rare when spinal manipulation is employed skillfully and appropriately.[30]

The relationship to stroke has been debated. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age, and these associations may be related to preexisting conditions.[35][36][37] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.[38] A 2012 review found that there is not enough evidence to support a strong association or no association between cervical manipulation and stroke.[39] A 2008 review found chiropractic are more commonly associated with serious related adverse effects than other professionals following manipulation and concluded that the risk of death from manipulations to the neck outweighs the benefits.[8]

Techniques[edit]

According to the American Chiropractic Association the most frequently used techniques by chiropractors are Diversified 95.9%, Extremity manipulating/adjusting 95.5%, Activator Methods 62.8%, Gonstead 58.5%, Cox Flexion/Distraction 58.0%, Thompson 55.9%, Sacro Occipital Technique [SOT] 41.3%, Applied Kinesiology 43.2%, NIMMO/Receptor Tonus 40.0%, Cranial 37.3%, Manipulative/Adjustive Instruments 34.5%, Palmer upper cervical [HIO] 28.8%, Logan Basic 28.7%, Meric 19.9%, and Pierce-Stillwagon 17.1%.[40][1][2]

See also[edit]

References[edit]

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