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Chiropractic medicine

Daniel David Palmer (founder)

1895 · Davenport, USA

D.C. MSc.Chiro, MTech.Chiro File:The chiropractic symbol big.jpg World Federation of Chiropractic

Schools · Accreditation

Chiropractic is health care profession concerned with the structural diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual and manipulative therapy and its role in joint dysfunction/subluxation . Currently, chiropractic medicine is regulated and practiced in over 100 countries, however chiropractors are most prevalent in North America, Australia and parts of Europe.^[1] The majority of mainstream health care and governmental organizations classify chiropractic as traditional/complementary alternative medicine^[2] Most people who seek chiropractic care do so for primarily for low back pain and other neuromusculoskeletal complaints.^[3]

Chiropractic was founded in 1895 by magnetic healer, D.D. Palmer, in Davenport, Iowa, United States. Chiropractic theory on spinal joint dysfunction/subluxation and its putative role in non-musculoskeletal disease has been a source of controversy since its inception in 1895. The controversy is due in part to chiropractic's vitalistic and metaphysical origins, and use of terminology that is not always amenable to scientific investigation. Far reaching claims and lack of scientific evidence supporting spinal joint dysfunction/subluxation as the sole cause of disease has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system.^[4] Although there is external and internal debate within the chiropractic profession regarding the clinical significance of joint dysfunction/subluxation,^[5] the manipulable lesion remains inextricably linked to the profession as basis for spinal manipulation.^[6]

Manual and conservative therapies commonly used by chiropractors are effective for the treatment of low back pain,^[7]^[8] and might also be effective for the treatment of lumbar disc herniation with radiculopathy,^[9]^[10] neck pain,^[11] some forms of headache,^[12]^[13] and some extremity joint conditions.^[14]^[15] There is insufficient evidence or known mechanisms for effects of chiropractic manipulation on non-musculoskeletal conditions.^[16] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. ^[17] A 2011 study, however, demonstrated that maintenance spinal manipulative therapy is effective for the treatment of chronic nonspecific low back pain.^[18] There has been considerable debate over the safety of the core clinical act of chiropractors: spinal manipulation, particularly with the cervical spine.^[19] Although serious injuries and fatal consequences can occur and may be under-reported,^[20] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.^[1]

Scope of practice

Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery ^[1] with an emphasis on the spinal manipulation.^[21] Chiropractors are generally regarded as primary contact, portal of entry health care providers. Although chiropractors have many attributes of primary care providers, chiropractic has more attributes of a limited medical specialty like dentistry or podiatry.^[22] Chiropractors are licensed to communicate a neuromusculoskeletal diagnosis and order X-rays and may use broad diagnostic methods including skeletal imaging, observational and tactile assessments as well as orthopedic and neurological evaluation.^[1] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.^[22] Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle counseling.^[23] When indicated chiropractors may also refer a patient to an appropriate specialist, or co-manage with another health care provider.^[22]

Due to the historical differences in philosophy and treatment approaches, there are range of 'broad' and 'narrow' scopes of practice for American chiropractors which tend to reflect 'straight' or 'mixer' underpinnings. ^[24] A focus on evidence-based research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.^[25] however the majority of chiropractors currently view themselves as "back/neck pain musculoskeletal specialists^[26] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;^[27]most do so specifically for low back pain.^[3] Although it is generally accepted that chiropractic care is appropriate for musculoskeletal complaints, there is considerable debate on their role in treating visceral disorders..^[28] Certain jurisdictions allows the practice animal chiropractic, whereby licensed chiropractors and veterinarians practice manual and manipulative therapies on animals for musculoskeletal disorders.^[29] Increasing evidence-based practice and aligning with conventional medicine has been suggested to obtain more university affiliation and access to hospitals and long-term facilities; aligning with the CAM movement could bring more patients looking for nonmedical approaches.^[30] In 2005, the World Health Organization developed chiropractic guidelines on basic training and safety to help standardize formal accreditation and licensure of chiropractors in countries where they remain unregulated. ,^[1]. Currently, chiropractic medicine is regulated and practiced in over 100 countries, however chiropractors are most prevalent in North America, Australia and parts of Europe. The majority of mainstream health care and governmental organizations classify chiropractic as traditional or complementary alternative medicine^[2]

History

Upon its founding 1895, chiropractic's early philosophy was rooted in vitalism, naturalism, magnetism, spiritualism and other constructs that were not amenable to the scientific method. Chiropractic's founder, D.D. Palmer, attempted to merge science and metaphysics.^[31] In 1896, D.D. Palmer's first descriptions and underlying philosophy of chiropractic was strikingly similar to Andrew Still's principles of osteopathy established a decade earlier.^[32] Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improve health. Palmer drew further distinctions by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. Additionally he described the effects of chiropractic spinal manipulation was mediated by the nervous system in contrast to osteopathy who believed the effects were attributed to the supremacy of the circulatory system. ^[33] Palmer initially denied being trained by osteopathic medicine founder A.T. Still. But Palmer's papers, held at the Palmer College of Chiropractic, indicate that he wrote in 1899:

"Some years ago I took and expensive course in Electropathy, Cranial Diagnosis, Hydrotherapy, Facial Diagnosis. Later I took Osteopathy [which] gave me such a measure of confidence as to almost feel it unnecessary to seek other sciences for the mastery of curable disease. Having been assured that the underlying philosophy of chiropractic is the same as that of osteopathy...Chiropractic is osteopathy gone to seed."^[31]

Despite their similarities, osteopathic practitioners sought to differentiate themselves by seeking licensure to regulate the profession calling chiropractic a "bastardized form of osteopathy"^[32] In 1907 in a test of the new osteopathy law, a Wisconsin based chiropractor was charged with practicing osteopathic medicine without a license. Ironically the Palmers legal defence of chiropractic consisted of the first chiropractic textbook 'Modernized Chiropractic' published in 1906, written by "mixer" chiropractors Longworthy, Smith et al. who the Palmers despised. Although the chiropractors won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974.^[34] In this regard, chiropractic is unique with CAM disciplines in North America having achieved regulation in all American states and Canadian provinces.^[26] By embracing both vitalism and materialism the philosophy of chiropractic has produced a diverse and eclectic mix of chiropractors which despite their emphasis of manual therapy they may vary on their perceived scope of practice, interventions and their role in the health care system.^[35]

Philosophy

The philosophy of chiropractic shares both vitalistic and mechanistic viewpoints and embrace naturalistic principles that suggest decreased "host resistance" of the body facilitates the disease process and that natural interventions are preferable towards strengthening the host in its effort to optimize function and return to homeostasis.^[36] The chiropractor's purpose is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being of the person as a whole.^[36] Chiropractic care primarily emphasizes manipulation and other manual therapies as an alternative to medications and surgery.^[37] The relationship between structure, especially the spine, and function as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. Chiropractors examine the biomechanics of the spine and other structures of the neuromusculoskeletal and its role in health and disease.^[38] It is hypothesized that significant neurophysiological consequences may occur as a result of mechanical spinal functional disturbances, described by chiropractors as the vertebral subluxation complex^[39] Most practitioners currently accept the importance of scientific research into chiropractic.^[35] Foundational concepts of the philosophy of chiropractic include:

Vitalism accepts that all living organisms are sustained by a vital force that is both different from, and greater than, physical and chemical forces. Contemporary is it is referred to as "vis medicatrix naturae" (the healing power of nature).

Holism postulates that health is related to the balanced integration of the individual in all aspects and levels of being: body, mind and spirit, including interpersonal relationships and the interplay between lifestyle, environment, and health.

Naturalism states a preference for natural remedies. This is bound up with a set of philosophical principles which may be expressed as the body is built on nature’s order, it has natural ability to heal itself, that this is reinforced by the use of natural remedies, that it should not be tampered with unnecessarily through the use of drugs or surgery

Humanism is based on the postulate that individuals have immutable rights, for example the right to dignity. In CAM there is extensive concern about dehumanizing procedures and the dehumanizing institutions that have been created for the ill. Partly it is recognition of the personal, social and spiritual aspects of health and a move away from simply the biology of health.

Therapeutic Conservatism is the use therapies that have a low level of side effects and it tends to accept that the least care is the best care. This in some ways is derived from earlier principles. if the body is capable of healing itself, the role of the therapy is simply to initiate the process.^[39]

"Straight" chiropractic

Also known as 'subluxation-based' and 'principled chiropractic', chiropractors educated from this paradigm espouse traditional Palmer principles and philosophy. Historically straight chiropractors regarded spinal joint dsyfunction/subluxation as the primary cause of "dis-ease" and could be corrected via specific chiropractic adjustments. This monocausal view of disease has been abandoned by the profession ^[40] preferring a holistic view of subluxation that is viewed as theoretical construct in a"web of causation" along with other determinants of health.^[6] Palmerian philosophy focused on metaphysical constructs such as Innate Intelligence and Universal Intelligence to explain the effects of the chiropractic adjustment, whose intent was the reduce/correct spinal subluxations and improving the functioning of the nervous system. The subluxation was said to be "the cause of 95 percent of all diseases... the other five percent is caused by displaced joints other than those of the vertebral column."^[41] Misalignment of the vertebrae was believed to be cause impingement of the nerve root, a theory which has long been debunked^[42] Subluxation-based chiropractors view traditional chiropractic lexicon such as "analysis" and "adjustment" and as a critical distinction of chiropractic despite lack of prevalence of these terms in the chiropractic literature^[43] Subluxation-based chiropractors have been criticized both internally and externally for far-reaching claims of "killer" subluxations, pseudoscientific reasoning,^[32] dogmatic approaches ^[44] unethical business practices that invoke religious themes and high-volume treatments for a variety of conditions that lack supportive scientific evidence.^[45] This metaphysical and dogmatic and singular approach to chiropractic care has been criticized for failing to engage in critical and rational thinking and embracing evidence-based medicine.^[46] Straight chiropractors use a subluxation-based model as opposed to the patient-centered model now favored in health care.^[36] Although they are the minority within the profession, they are considered to have a disproportionate influence as "purists".^[47]

"Mixer" chiropractic

Mixers form the majority of chiropractors and attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;^[36] While D.D. Palmer considered vertebral misalignment to be the hallmark feature of subluxation, mixer pioneer Solon Langworthy asserted that intervertebral hypomobility, not misalignment, was subluxation’s cardinal biomechanical feature. This contrasting mechanistic emphasis, intervertebral misalignment vs. hypomobility, formed one the basis for a heated polemic in the profession. Although both misalignment and hypomobility are currently recognized as biomechanical features of subluxation, hypomobility has garnered much more attention in recent years.^[6]^[48] Mixers were disdained by the Palmers who disapproved of their use of instrumentation and mixing chiropractic diagnostic and treatment approaches with osteopathic, naturopathic and allopathic viewpoints.^[47] By embracing a mechanistic viewpoint, mixers are able balance the vitalistic notions with critical reasoning skills that led to legitimate scientific investigation of chiropractic principles. Mechanistic underpinnings have led to testable hypotheses that structure affects function via the nervous system by the scientific study of joint dysfunction (subluxation) and the biological mechanisms underlying manipulative therapies^[35] Scientific chiropractors suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.^[44] In contrast to subluxation-based chiropractors, evidence-based chiropractors favor and incorporate mainstream medical diagnostic and treatment approaches such as exercise, nutritional supplementation, rehabilitation, self-care, physiotherapeutic modalities, and other natural approaches. A majority of mixers retain belief that spinal dysfunction/subluxation may be involved in somato-visceral disorders. This group may represent the 'silent majority' of centrists who embrace evidence-based medicine but feel comfortable retaining elements of the subluxation complex that have not been validated through empirical evidence.^[49]

Investigations

Spinal dysfunction/subluxation

Spinal dysfunction dubbed subluxation by chiropractors, is hypothesized to interfere with optimal biomechanics (structure) thereby altering proper neurological function. Chiropractic theory suggests spinal dysfunction/subluxation may contribute to neuromusculoskeletal and visceral disorders via aberrant spinal segmental and suprasegmental reflexes.^[50]Chiropractors suggest spinal manipulation normalizes spine biomechanics, and as a consequence, normalizes afferent input to the central nervous system resulting in optimized neurological function and improved health outcomes.^[51]

Chiropractic emphasis on mechanical joint dysfunction/subluxation and it's putative role in non-musculoskeletal disease has been a source of controversy since its inception in 1895 due its vitalistic and metaphysical origins which used terminology that was not amenable to scientific investigation. Far reaching claims and lack of scientific evidence supporting spinal joint dysfunction as the sole cause of disease has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum disorders that are not related to the neuromusculoskeletal system.^[52] Today the monocausal view of disease has been abandoned by the profession ^[53]preferring a holistic view of subluxation that is viewed as theoretical construct in a "web of causation" along with other determinants of health.^[6] Although there is external and internal debate within the chiropractic profession regarding the clinical significance of joint dysfunction/subluxation^[54] the manipulable lesion remains inextricably linked to the profession as basis for spinal manipulation.^[6]

Definitions

According to the ICD-10 the chiropractic subluxation is a biomechanical lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.^[55] It is also referred to as joint dysfunction, fixation, hypomobility, segmental and somatic dysfunction.

Theory

Although many theories have been put forth to explain the putative effects of subluxation that are reported in clinical practice, they may be broadly classified into three mechanism-oriented categories that are not mutually exclusive ^[56]

1. Encroachment of the intervertebral foramen (IVF) or spinal canal, the oldest and most widely known of these theories, proposes that subluxations cause bulging intervertebral discs, hypertrophied facet joint capsules, or enlarged intra-foraminal ligaments that encroach on pressure-sensitive IVF contents (e.g., dorsal root ganglia, nerve roots, and associated vascular elements) or the spinal canal and its contents (spinal cord, nerve roots and vascular plexus). Narrowing of the spinal canal and intervertebral foramen has been demonstrated in association with vertebral misalignments ^[57] Cadaveric and animal studies have shown that intervertebral foramen encroachment can produce sufficient pressure on neural contents to retard axoplasmic flow and the latency and amplitude of action potential transmission ^[58]^[59] Vertebral canal and IVF stenosis, with encroachment upon neural structures can occur as a result of vertebral subluxation with osseous degeneration and/or soft-tissue changes; such as disc thinning and bulging; ligament laxity, fibrosis, bucking; and joint capsule hypertrophy ^[60]^[61] In an examination of the degenerative effects of experimentally induced intervertebral hypomobility in the rat it was observed substantial increased zygapophysial articular cartilage erosion and hypertrophic spur formation associated with hypomobile vertebrae.^[62]

2. Altered afferent input from spinal and paraspinal tissues is thought to attend subluxations and produce lasting and far-reaching effects via neuroplastic changes in the peripheral and central nervous systems.This widely held chiropractic theory posits that long-term changes in intervertebral mobility or alignment provides altered afferent input to the central nervous system, causing neuroplastic changes that impact biological function ^[56]^[63]^[64] This theory is generally extended to explain that spinal manipulation normalizes spine biomechanics, and as a consequence, normalizes afferent input to the central nervous system – resulting in normalized neurological function and improved health outcomes.

3. Dentate ligament mediated cord distortion has been proposed as a mechanism by which misaligned cervical vertebrae can directly stress sensitive brainstem and upper cervical cord structures, thereby disrupting critical neural processes. This theory is especially interesting to chiropractors that limit spinal manipulation to the upper cervical region.^[65] Recently several investigators have reported a connective tissue bridge between the rectus capitus posterior minor (RCPm) and the spinal dura in the region of the posterior atlanto-occipital membrane ^[66]^[67] It has been proposed that this connective tissue bridge has two important physiological roles. It may prevent brain stem compression that could occur as a result of dural infolding during cervical flexion and extension and it may also stabilize the cranio-cervical region^[67] In addition, a pathophysiological role has been proposed. It is thought that RCPm mediated tension on the pain sensitive posterior cerebro-spinal dura may be a primary mechanism for the etiology of cervicogenic headache.^[68] Chiropractors are also interested in the reflex effects of spinal dysfunction with regards to the autonomic nervous system. recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function."^[69]

Evidence-based practice guidelines

With growing mainstream acceptance of spinal manipulation in the 1980s^[70]the 1990s resulted in a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines. In the current advent of the evidence-based medicine era, chiropractic scholars have generated evidence-based systematic reviews and practice guidelines with respect to the management of acute/chronic low back pain,^[71]^[72] thoracic pain, neck pain,^[73] headache,^[74] radiography,^[75] ^[76] ^[77] and upper/lower extremity conditions.^[78]^[79] tendinopathy^[80] myofascial pain/trigger points,^[81] and non-musculoskeletal conditions.^[82]

Treatment

Manual and manipulative therapy

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques^[83] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.^[84] Spinal manipulation gained mainstream recognition during the 1980s.^[85] Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.^[86] It is the most common and primary intervention used in chiropractic care;^[87] In North America, chiropractors perform over 90% of all manipulative treatments^[88] with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.^[89] Typically, it is performed on patients who have failed to respond to other forms of treatment.^[90]There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.^[19] Although serious injuries and fatal consequences can occur and may be under-reported,^[20] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.^[1]

Definitions

High-velocity low amplitude (HVLA) manipulative therapy is also known as 'adjustment' and Grade V mobilisation^[91]

Musculoskeletal disorders

The use of manual and manipulative therapies is a commonly used intervention used by manual medicine practitioners in the treatment of neuromusculoskeletal disorders. Spinal manipulation, in particular, is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain^[93] Manual therapies, including spinal manipulation, commonly used by chiropractors and other manual medicine practitioners are effective for the treatment of spinal pain, including low back pain, neck pain, some forms of headache and a number of extremity joint conditions such as shoulder and hip pain. Specifically, spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain^[94]and might also be effective for the treatment of lumbar disc herniation with radiculopathy,^[9]^[10] neck pain,^[11] some forms of headache,^[12]^[13] and some extremity joint conditions.^[14]^[15]

Investigation of the effectiveness of spinal manipulation for specific musculoskeletal complaints include:

Low back pain. Most studies suggest spinal manipulation achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.^[8] A 2008 review found strong evidence that SM is similar in effect to medical care with exercise.^[95] A 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration.^[96] The American College of Physicians and the American Pain Society jointly recommended that clinicians consider spinal manipulation for patients who do not improve with self care options.^[97]
Radiculopathy. There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute lumbar radiculopathy^[9] and acute lumbar disc herniation with associated radiculopathy.^[10] The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy.^[9]
Neck pain. Manual therapies, including spinal manipulation, has been found to be effective for mechanical neck pain.^[94] ^[98]^[99]^[100]^[101] Thoracic spinal manipulation (TSM) has a therapeutic benefit to some patients with neck pain and therefore TSM or in combination with other interventions is a suitable intervention to use in the treatment of non-specific neck pain.^[102]
Headache Spinal manipulation improves migraine and cervicogenic headaches but cautioned type, frequency, dosage, and duration of treatments should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.^[103] SM might be as effective as propranolol or topiramate in the prevention of migraine headaches,^[12]
Cervicogenic dizziness There is moderate evidence to support the use of manual therapy for cervicogenic dizziness.^[104]
Extremity conditions. Manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.^[105] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.^[106] The addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) result in significantly better pain relief and functional improvements in both the short and long-term.^[107] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,^[108] limited to low level evidence supporting chiropractic management of shoulder pain^[15] and limited or fair evidence supporting chiropractic management of leg conditions.^[14]

Non-musculoskeletal disorders

The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.^[94] ^[109] and no scientific data for idiopathic adolescent scoliosis.^[110]

Safety

The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manipulative therapists, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindication apply only to the manipulation of the affected region.^[101]

Adverse events in spinal manipulation studies are believed to be under-reported ^[111] and appear to be more common following HVLA manipulation than mobilization.^[112] Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.^[19] These events typically dissipates within 24–48 hours ^[113] Serious injuries and fatal consequences , especially to SM in the upper cervical region, can occur.^[114] but are regarded as rare when spinal manipulation is employed skillfully and appropriately.^[101]

There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.^[100]^[115]^[116] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.^[117] A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.^[118]

Cost-effectiveness

Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches.^[119] 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.^[120]

Training

The entry criteria, structure, teaching methodology and nature of Chiropractic programs offered at Chiropractic schools vary considerably around the world. To help standardize and ensure quality of Chiropractic education, in 2005 the World Health Organization published guidelines for basic training and safety in Chiropractic. ^[121] In general, the World Health Organization lists three potential educational paths involving full‐time chiropractic education across the globe. This includes: 1 – 4 years of pre-requisite training in basic sciences at university level followed by a 4 year full‐time Doctorate program; DC. A 5 year integrated bachelor degree; BSc (Chiro). A 2 - 3 year Masters program following the completion of a bachelor degree; MSc (Chiro)^[1] as well MTech (Chiro), a Masters of Technology in Chiropractic.^[122]

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training.^[1] Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy.^[121] Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed.

All Chiropractic Examining Boards require candidates to complete a 12 month clinical internship to obtain licensure. Licensure is granted following successful completion of all state/provincial and national board exams so long as the chiropractor maintains malpractice insurance. Nonetheless, there still some variations in educational standards internationally depending on admission and graduation requirements. chiropractic medicine is regulated in North America by state/provincial statute. The regulatory boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.^[123]

Ethics and medicolegal issues

Chiropractors, like other health care professionals, are self-regulated and have a fiduciary responsibility to protect the public and ensure competent, professional and ethical behaviour. Chiropractors have been noted to have increased instances of fraud, abuse and quackery compared to other health professions.^[46] Internal criticism identified dubious practice techniques that promote high-volume treatments (which can increase dependency) and far-reaching and outlandish claims regarding the clinical significance of joint dysfunction/subluxation and its role in health and disease^[124] As opposed to earlier in its history when founder D.D. Palmer claimed that spinal dysfunction/subluxation was the cause of all disease, modern chiropractic instituions and the international chiropractic educational accrediting agency (CCEI) has disavowed the the monocausal theory of joint dysfunction/subluxation.^[6]

Regulation

Since its inception, chiropractic was controversial amongst the established medical orthodoxy. Chiropractors were jailed for "practicing medicine without a license" which the profession designed a legal and political defence against prosecution arguing that chiropractic was "separate and distinct from medicine", asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease.^[34] In 1963 the American Medical Association formed a "Committee on Quackery" designed to "contain and eliminate" the chiropractic profession. In 1966, the AMA referred to chiropractic an "unscientific cult" and until 1980 and held that it was unethical for medical doctors to associate themselves with "unscientific practitioners".^[125] The 1987, the AMA was found guilty of being engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession." ^[34] In the 1980s, spinal manipulation gained mainstream recognition^[126] and has spurred ongoing collaboration into research of manipulative therapies and models of delivery of chiropractic care for musculoskeletal conditions in the mainstream healthcare sector.^[127]^[128]^[129]

Public health

Public health is becoming an increasingly important topic for chiropractors and what role they may play in the public health arena with recommendations suggesting the natural focus for the chiropractic profession is maintaining spinal and musculoskeletal health, good nutrition and an active lifestyle from childhood and throughout life, thereby promoting general health and freedom from chronic pain, disease and disability.^[130] However, traditionally chiropractic has not endorsed mainstream public health measures such as mandatory vaccination and water fluoridation stating the patient should be able to freely choose for themselves.^[131]^[131]^[132] ^[133]

Diagnostic imaging

Chiropractors employ diagnostic imaging techniques such as X-rays and CT scans to assist in the management of patient care. External and internal criticism regarding the frequency and inappropriate use of X-Rays, such as full spine radiographs, resulted in the development of evidence-based general practice guidelines in 2007 to improve patient safety by eliminating unnecessary exposure to radiation.^[134]^[135]

Safety

There has been considerable debate on the safety of spinal manipulation, the core clinical act of chiropractors, in particular with the cervical spine.^[19] Adverse events in SM studies are believed to be under-reported ^[111] and appear to be more common following HVLA manipulation than mobilization.^[112] Although serious injuries and fatal consequences can occur and may be under-reported,^[20] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.^[1] There is ongoing research investigating upper cervical manipulation and incidence of stroke.^[118]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). ISBN 92-4-159371-7. Retrieved 2008-02-29. {{cite journal}}: Cite journal requires |journal= (help) Cite error: The named reference "WHO-guidelines" was defined multiple times with different content (see the help page).
^ ^a ^b Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
^ ^a ^b Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM Utilization: A Descriptive Review". Chiropr Osteopat. 15 (1): 2. doi:10.1186/1746-1340-15-2. PMC 1784103. PMID 17241465.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Murphy D.R., Schneider M.J., Seaman D.R., Perle S.M., Nelson C.F., http://www.ncbi.nlm.nih.gov/pubmed/18759966
^ Mirtz T.A., Perle S.M. http://www.ncbi.nlm.nih.gov/pubmed/21682859
^ ^a ^b ^c ^d ^e ^f Henderson, C.N.R (2012). Journal of Electromyography and Kinesiology. 22 (5): 632–642. {{cite journal}}: |access-date= requires |url= (help); Missing or empty |title= (help); Unknown parameter |month= ignored (help)
^ Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (2011). Rubinstein, Sidney M (ed.). "Spinal manipulative therapy for chronic low-back pain". Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010). "NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain". Spine J. 10 (10): 918–940. doi:10.1016/j.spinee.2010.07.389. PMID 20869008.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c ^d Leininger B, Bronfort G, Evans R, Reiter T (2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review". Phys Med Rehabil Clin N Am. 22 (1): 105–25. doi:10.1016/j.pmr.2010.11.002. PMID 21292148.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c Hahne AJ, Ford JJ, McMeeken JM (2010). "Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review". Spine. 35 (11): E488–504. doi:10.1097/BRS.0b013e3181cc3f56. PMID 20421859.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL (2010). "Manipulation or mobilisation for neck pain: a Cochrane Review". Manual Therapy. 15 (4): 315–333. doi:10.1016/j.math.2010.04.002. PMID 20510644.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c Chaibi A, Tuchin PJ, Russell MB (2011). "Manual therapies for migraine: a systematic review". J Headache Pain. 12 (2): 127–33. doi:10.1007/s10194-011-0296-6. PMC 3072494. PMID 21298314.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Bronfort G, Nilsson N, Haas M; et al. (2004). Brønfort, Gert (ed.). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W (2009). "Manipulative therapy for lower extremity conditions: expansion of literature review". J Manipulative Physiol Ther. 32 (1): 53–71. doi:10.1016/j.jmpt.2008.09.013. PMID 19121464.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 21109059, please use {{cite journal}} with |pmid=21109059 instead.
^ Singh S, Ernst E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6.
^ Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic – what do we know?". Chiropr Osteopat. 16 (1): 3. doi:10.1186/1746-1340-16-3. PMC 2396648. PMID 18466623.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Senna, MK (2011). "SA". Spine: 1427–37. doi:10.1097/BRS.0b013e3181f5dfe0. {{cite journal}}: |access-date= requires |url= (help); Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ ^a ^b ^c ^d Ernst, E (2007). "Adverse effects of spinal manipulation: a systematic review". Journal of the Royal Society of Medicine. 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. ISSN 0141-0768. PMC 1905885. PMID 17606755. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help); Unknown parameter |month= ignored (help) Cite error: The named reference "Ernst-adverse" was defined multiple times with different content (see the help page).
^ ^a ^b ^c E Ernst (2010). "Deaths after chiropractic: a review of published cases". Int J Clinical Practice. 64 (8): 1162–1165. doi:10.1111/j.1742-1241.2010.02352.x. PMID 20642715.
^ Nelson CF, Lawrence DJ, Triano JJ; et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat. 13 (1): 9. doi:10.1186/1746-1340-13-9. PMC 1185558. PMID 16000175. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
^ ^a ^b ^c Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498.
^ Mootz RD, Shekelle PG (1997). "Content of practice". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002.
^ Parkman CA (2004). "Issues in credentialing CAM providers". Case Manager. 15 (4): 24–7. doi:10.1016/j.casemgr.2004.05.004. PMID 15247891.
^ Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med. 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303.
^ ^a ^b Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1016/j.socscimed.2011.03.038, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1016/j.socscimed.2011.03.038 instead.
^ Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: Findings from the joint Canada/United States survey of health, 2002–03". BMC Health Serv Res. 6 (49): 49. doi:10.1186/1472-6963-6-49. PMC 1458338. PMID 16600038.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Gleberzon BJ, Cooperstein R, Perle SM (2005). "Can chiropractic survive its chimerical nature?". J Can Chiropr Assoc. 49 (2): 69–73. PMC 1840015. PMID 17549192.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Ramey DW (2003). "Regulatory aspects of complementary and alternative veterinary medicine". J Am Vet Med Assoc. 222 (12): 1679–82. doi:10.2460/javma.2003.222.1679. PMID 12830858.
^ Cooperstein & Gleberzon. "Current and future utilization rates and trends". pp. 297–305. {{cite book}}: Missing or empty |title= (help)
^ ^a ^b Leach, Robert (2004). The Chiropractic Theories: A Textbook of Scientific Research. Lippincott, Williams and Wilkins. p. 15. ISBN 0683307479.
^ ^a ^b ^c Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
^ "98_04_13~1.PDF" (PDF). Retrieved 2010-10-14.
^ ^a ^b ^c Joseph C. Keating, Jr., Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16. A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).{{cite web}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link) Cite error: The named reference "Keating05" was defined multiple times with different content (see the help page).
^ ^a ^b ^c ^d Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002.
^ Hansen DT, Mootz RD (1999). "Formal processes in health care technology assessment: a primer for the chiropractic profession". In Mootz RD, Hansen DT (ed.). Chiropractic technologies. Jones & Bartlett. pp. 3–17. ISBN 0834213737.
^ American Chiropractic Association. "History of chiropractic care". Retrieved 2008-02-21.^{[dead link]}
^ ^a ^b Coulter, ID (1999). Chiropractic: A Philosophy for Alternative Health Care. Butterworth-Heinemann. pp. 19–29. ISBN 0750640065.
^ Bergmann, T.F., Perterson D.H (2011). Chiropractic Technique: Principles and Procedures. Elsevier. ISBN 9780323049696.
^ Palmer D.D., The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.
^ "The great subluxation debate: a centrist's perspective". Journal of Chiropractic Humanities. 17 (1): 33–39. 2010. PMID 22693474. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ "Quantitative corpus-based analysis of the chiropractic literature - a pilot study". Journal of the Canadian Chiropractic Association. 55 (1): 56–60. 2011. PMID 21403783. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ ^a ^b Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13 (1): 17. doi:10.1186/1746-1340-13-17. PMC 1208927. PMID 16092955.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
^ "Can chiropractic survive its chimerical nature?". J Can Chiropr Assoc. 49 (2): 69–73. 2005. PMID 17549192. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ ^a ^b Murphy, DR; Schneider, MJ; Seaman, DR; Perle, SM; Nelson, CF (2008). "How can chiropractic become a respected mainstream profession? The example of podiatry" (PDF). Chiropractic & osteopathy. 16: 10. doi:10.1186/1746-1340-16-10. PMC 2538524. PMID 18759966. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: unflagged free DOI (link)
^ ^a ^b Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. doi:10.1001/archinte.158.20.2215. PMID 9818801.
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^ "The great subluxation debate: a centrist's perspective". Journal of Chiropractic Humanities. 17 (1): 33–39. 2010. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ "Visceral responses to spinal manipulation". J Electromyogr Kinesiol. 22 (5): 777–784. 2012. PMID 22440554. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
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^ Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF.http://www.ncbi.nlm.nih.gov/pubmed/18759966
^ Bergmann, T.F., Perterson D.H (2011). Chiropractic Technique: Principles and Procedures. Elsevier. ISBN 9780323049696.
^ Mirtz TA, Perle SM.http://www.ncbi.nlm.nih.gov/pubmed/21682859
^ "ICD 10:2010". World Health Organization. Retrieved 10 February 2013.
^ ^a ^b Cramer, CN (2005). Three neurophysiologic theories on the chiropractic subluxation. St-Louis: Mosby. pp. 296–303.
^ J.W. Frymoyer, S.W. Wiesel (2004). The adult and pediatric spine. Philadelphia: Lippincott Williams & Wilkins.
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^ Eriksen (2004). Upper cervical subluxation complex. A review of the chiropractic and medical literature. Philadelphia: ippincott Williams & Wilkins.
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^ Budgell BS (2000). "Reflex effects of subluxation: the autonomic nervous system". J Manipulative Physiol Ther. 23 (2): 104–6. doi:10.1016/S0161-4754(00)90076-9. PMID 10714536. {{cite journal}}: Unknown parameter |month= ignored (help)
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^ "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash". JCCA. 49 (3): 158-209. 2005. PMID 17549134. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Evidence-based guidelines for the chiropractic treatment of adults with headache". J Manipulative Physiol Ther. 34 (5): 274–89. 2011. PMID 21640251. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
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^ "Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders". JMPT. 31 (1): 33–88. 2008. PMID 18308153. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Diagnostic imaging practice guidelines for musculoskeletal complaints in adults--an evidence-based approach: introduction". JMPT. 30 (9): 617-83. 2007. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Manipulative therapy for lower extremity conditions: expansion of literature review". JMPT. 32 (1): 53–71. 2009. PMID 19121464. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Chiropractic treatment of upper extremity conditions: a systematic review". JMPT. 31 (2): 146–159. 2008. PMID 18328941. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Chiropractic management of tendinopathy: a literature synthesis". JMPT. 32 (1): 41–52. 2009. PMID 19121463. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature". JMPT. 32 (1): 14–24. 2009. PMID 19121461. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research". J Altern Complement Med. 13 (5): 491–512. 2007. PMID 17604553. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ Swedlo DC (2002). "The historical development of chiropractic" (PDF). In Whitelaw WA (ed.) (ed.). Proc 11th Annual History of Medicine Days. Faculty of Medicine, The University of Calgary. pp. 55–58. Retrieved 2008-05-14. {{cite conference}}: |editor= has generic name (help); Unknown parameter |booktitle= ignored (|book-title= suggested) (help)
^ Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.
^ Francis RS (2005). "Manipulation under anesthesia: historical considerations". International MUA Academy of Physicians. Retrieved 2008-07-06.
^ Winkler K, Hegetschweiler-Goertz C, Jackson PS; et al. (2003). "Spinal manipulation policy statement" (PDF). American Chiropractic Association. Retrieved 2008-05-24. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
^ Christensen MG, Kollasch MW (2005). "Professional functions and treatment procedures". Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners. pp. 121–38. ISBN 1-884457-05-3. {{cite book}}: |access-date= requires |url= (help); |format= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)^{[dead link]}
^ "About chiropractic and its use in treating low-back pain" (PDF). NCCAM. 2005. Archived from the original (PDF) on 2008-02-27. Retrieved 2008-03-24.
^ Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES (2005). "Manipulation under anesthesia: a report of four cases". J Manipulative Physiol Ther. 28 (7): 526–33. doi:10.1016/j.jmpt.2005.07.011. PMID 16182028.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Michaelsen MR (2000). "Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin". J Manipulative Physiol Ther. 23 (2): 127–9. doi:10.1016/S0161-4754(00)90082-4. PMID 10714542.
^ Maitland, G.D. Peripheral Manipulation 2nd ed. Butterworths, London, 1977.
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^ Chapter 10 - Modes Of Care And Management. Canadian Chiropractic Association
^ "Visceral responses to spinal manipulation". J Electromyogr Kinesiol. 22 (5): 777-84. 2012. PMID 22440554. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ ^a ^b ^c Bronfort G, Haas M, Evans R, Leininger B, Triano J (2010). "Effectiveness of manual therapies: the UK evidence report". Chiropractic & Osteopathy. 18 (3): 3. doi:10.1186/1746-1340-18-3. PMC 2841070. PMID 20184717.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
^ Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J. 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Lawrence DJ, Meeker W, Branson R; et al. (2008). "Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis". J Manipulative Physiol Ther. 31 (9): 659–74. doi:10.1016/j.jmpt.2008.10.007. PMID 19028250. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) An earlier, freely readable version is in: Meeker W, Branson R, Bronfort G; et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. Retrieved 2008-11-28. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
^ Chou R; Qaseem A; Snow V; et al. (October 2, 2007). "Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society". Ann Intern Med. 147 (7): 478–91. doi:10.7326/0003-4819-147-7-200710020-00006. PMID 17909209. {{cite journal}}: Unknown parameter |author-separator= ignored (help)
^ "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4): 123–152. 2008. PMID 18204386. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783.
^ ^a ^b Hurwitz EL, Carragee EJ, van der Velde G; et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. PMC 1839918. PMID 17549134. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
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^ McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680.
^ Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review". Scoliosis. 3 (1): 2. doi:10.1186/1748-7161-3-2. PMC 2262872. PMID 18211702.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ ^a ^b Ernst E, Posadzki P (2012). "Reporting of adverse effects in randomised clinical trials of chiropractic manipulations: a systematic review". N Z Med J. 125 (1353): 87–140. PMID 22522273.
^ ^a ^b Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM (2005). "Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study". Spine. 30 (13): 1477–84. doi:10.1097/01.brs.0000167821.39373.c1. PMID 15990659. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Gouveia LO, Castanho P, Ferreira JJ (2009). "Safety of chiropractic interventions: a systematic review". Spine. 34 (11): E405–13. doi:10.1097/BRS.0b013e3181a16d63. PMID 19444054.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine. 32 (21): 2375–8. doi:10.1097/BRS.0b013e3181557bb1. PMID 17906581.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Paciaroni M, Bogousslavsky J (2009). "Cerebrovascular complications of neck manipulation". Eur Neurol. 61 (2): 112–8. doi:10.1159/000180314. PMID 19065058.
^ Cassidy, JD (15). "Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study". Spine. 33 (4 Suppl): S176-83. PMID 18204390. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ. (2012). "Assessing the risk of stroke from neck manipulation: a systematic review". International Journal of Clinical Practice. 66 (10): 940–947. doi:10.1111/j.1742-1241.2012.03004.x. PMID 22994328.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Michaleff ZA, Lin CW, Maher CG, van Tulder MW (2012). "Spinal manipulation epidemiology: Systematic review of cost effectiveness studies". J Electromyogr Kinesiol. doi:10.1016/j.jelekin.2012.02.011. PMID 22429823.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW (2011). "Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review". European Spine Journal. 20 (7): 1024–1038. doi:10.1007/s00586-010-1676-3. PMC 3176706. PMID 21229367.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf
^ "CASA : Student Info". Retrieved 2009-10-19.
^ Facts & FAQs
^ Gleberzon, Brian J.; Cooperstein, Robert; Perle, Stephen M. (2005). "Can chiropractic survive its chimerical nature?". Journal of the Canadian Chiropractic Association. 49 (2). {{cite journal}}: Unknown parameter |medline= ignored (help)
^ Johnson C, Baird R, Dougherty PE; et al. (2008). "Chiropractic and public health: current state and future vision". J Manipulative Physiol Ther. 31 (6): 397–410. doi:10.1016/j.jmpt.2008.07.001. PMID 18722194. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
^ Francis RS (2005). "Manipulation under anesthesia: historical considerations". International MUA Academy of Physicians. Retrieved 2008-07-06.
^ DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
^ "Designing a framework for the delivery of collaborative musculoskeletal care involving chiropractors and physicians in community-based primary care". J Interprof Care. 24 (6): 678–89. 2010. PMID 20441400. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ "Changes in primary care physician's management of low back pain in a model of interprofessional collaborative care: an uncontrolled before-after study". Chiropr Man Therap. 21 (1). 2013. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ Johnson, C (2012). "Chiropractic Care and Public Health: Answering Difficult Questions About Safety, Care Through the Lifespan, and Community Action". JMPT. 35: 494–513. doi:10.1016/j.jmpt.2012.09.001.. PMID 23069244. {{cite journal}}: |access-date= requires |url= (help); Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ ^a ^b Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics. 105 (4): e43. doi:10.1542/peds.105.4.e43. PMID 10742364.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". J Manipulative Physiol Ther. 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success" (PDF). Am J Public Health. 79 (10): 1405–8. doi:10.2105/AJPH.79.10.1405. PMC 1350185. PMID 2782512.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Bussières AE, Taylor JAM, Peterson C (2008). "Diagnostic imaging practice guidelines for musculoskeletal complaints in adults—an evidence-based approach—part 3: spinal disorders". J Manipulative Physiol Ther. 31 (1): 33–88. doi:10.1016/j.jmpt.2007.11.003. PMID 18308153.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Ammendolia C, Côté P, Hogg-Johnson S, Bombardier C (2007). "Do chiropractors adhere to guidelines for back radiographs? A study of chiropractic teaching clinics in Canada". Spine. 32 (22): 2509–2514. doi:10.1097/BRS.0b013e3181578dee. PMID 18090093.{{cite journal}}: CS1 maint: multiple names: authors list (link)

External links

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[WHO-guidelines-1] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). ISBN 92-4-159371-7. Retrieved 2008-02-29. {{cite journal}}: Cite journal requires |journal= (help) Cite error: The named reference "WHO-guidelines" was defined multiple times with different content (see the help page).

[Chapman-Smith-2] Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)

[Lawrence-Meeker-3] Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM Utilization: A Descriptive Review". Chiropr Osteopat. 15 (1): 2. doi:10.1186/1746-1340-15-2. PMC 1784103. PMID 17241465.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[How_profession?_podiatry-4] Murphy D.R., Schneider M.J., Seaman D.R., Perle S.M., Nelson C.F., http://www.ncbi.nlm.nih.gov/pubmed/18759966

[The_prevalence_of_the_term_subluxation_in_North_American_English-Language_Doctor_of_chiropractic_programs-5] Mirtz T.A., Perle S.M. http://www.ncbi.nlm.nih.gov/pubmed/21682859

[Henderson_2012_632–642-6] ^ ^a ^b ^c ^d ^e ^f Henderson, C.N.R (2012). Journal of Electromyography and Kinesiology. 22 (5): 632–642. {{cite journal}}: |access-date= requires |url= (help); Missing or empty |title= (help); Unknown parameter |month= ignored (help)

[Cochrane-2011-7] Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (2011). Rubinstein, Sidney M (ed.). "Spinal manipulative therapy for chronic low-back pain". Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Dagenais-2010-8] Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010). "NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain". Spine J. 10 (10): 918–940. doi:10.1016/j.spinee.2010.07.389. PMID 20869008.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Leininger_B,_Bronfort_G,_Evans_R,_Reiter_T_2011_105–25-9] Leininger B, Bronfort G, Evans R, Reiter T (2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review". Phys Med Rehabil Clin N Am. 22 (1): 105–25. doi:10.1016/j.pmr.2010.11.002. PMID 21292148.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Hahne_AJ,_Ford_JJ,_McMeeken_JM_2010_E488–504-10] Hahne AJ, Ford JJ, McMeeken JM (2010). "Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review". Spine. 35 (11): E488–504. doi:10.1097/BRS.0b013e3181cc3f56. PMID 20421859.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Gross_A,_Miller_J,_D'Sylva_J,_Burnie_SJ,_Goldsmith_CH,_Graham_N,_Haines_T,_Brønfort_G,_Hoving_JL_2010_315–333-11] Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL (2010). "Manipulation or mobilisation for neck pain: a Cochrane Review". Manual Therapy. 15 (4): 315–333. doi:10.1016/j.math.2010.04.002. PMID 20510644.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Chaibi_A,_Tuchin_PJ,_Russell_MB_2011-12] Chaibi A, Tuchin PJ, Russell MB (2011). "Manual therapies for migraine: a systematic review". J Headache Pain. 12 (2): 127–33. doi:10.1007/s10194-011-0296-6. PMC 3072494. PMID 21298314.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Bronfort_G,_Nilsson_N,_Haas_M_et_al._2004_CD001878-13] Bronfort G, Nilsson N, Haas M; et al. (2004). Brønfort, Gert (ed.). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

[Brantingham_JW,_Globe_G,_Pollard_H,_Hicks_M,_Korporaal_C,_Hoskins_W_2009_53–71-14] Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W (2009). "Manipulative therapy for lower extremity conditions: expansion of literature review". J Manipulative Physiol Ther. 32 (1): 53–71. doi:10.1016/j.jmpt.2008.09.013. PMID 19121464.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[pmid21109059-15] Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 21109059, please use {{cite journal}} with |pmid=21109059 instead.

[Trick-or-Treatment-16] Singh S, Ernst E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6.

[Leboeuf-Yde-C-17] Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic – what do we know?". Chiropr Osteopat. 16 (1): 3. doi:10.1186/1746-1340-16-3. PMC 2396648. PMID 18466623.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[Senna_2011_1427–37-18] Senna, MK (2011). "SA". Spine: 1427–37. doi:10.1097/BRS.0b013e3181f5dfe0. {{cite journal}}: |access-date= requires |url= (help); Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)

[Ernst-adverse-19] Ernst, E (2007). "Adverse effects of spinal manipulation: a systematic review". Journal of the Royal Society of Medicine. 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. ISSN 0141-0768. PMC 1905885. PMID 17606755. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help); Unknown parameter |month= ignored (help) Cite error: The named reference "Ernst-adverse" was defined multiple times with different content (see the help page).

[Ernst-death-20] E Ernst (2010). "Deaths after chiropractic: a review of published cases". Int J Clinical Practice. 64 (8): 1162–1165. doi:10.1111/j.1742-1241.2010.02352.x. PMID 20642715.

[Nelson-21] Nelson CF, Lawrence DJ, Triano JJ; et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat. 13 (1): 9. doi:10.1186/1746-1340-13-9. PMC 1185558. PMID 16000175. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)

[Meeker-Haldeman-22] Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498.

[content-of-practice-23] Mootz RD, Shekelle PG (1997). "Content of practice". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002.

[Parkman-24] Parkman CA (2004). "Issues in credentialing CAM providers". Case Manager. 15 (4): 24–7. doi:10.1016/j.casemgr.2004.05.004. PMID 15247891.

[Villanueva-Russell-25] Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med. 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303.

[V-H-26] Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1016/j.socscimed.2011.03.038, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1016/j.socscimed.2011.03.038 instead.

[27] Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: Findings from the joint Canada/United States survey of health, 2002–03". BMC Health Serv Res. 6 (49): 49. doi:10.1186/1472-6963-6-49. PMC 1458338. PMID 16600038.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[28] Gleberzon BJ, Cooperstein R, Perle SM (2005). "Can chiropractic survive its chimerical nature?". J Can Chiropr Assoc. 49 (2): 69–73. PMC 1840015. PMID 17549192.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[29] Ramey DW (2003). "Regulatory aspects of complementary and alternative veterinary medicine". J Am Vet Med Assoc. 222 (12): 1679–82. doi:10.2460/javma.2003.222.1679. PMID 12830858.

[30] Cooperstein & Gleberzon. "Current and future utilization rates and trends". pp. 297–305. {{cite book}}: Missing or empty |title= (help)

[Leach_2004_15-31] Leach, Robert (2004). The Chiropractic Theories: A Textbook of Scientific Research. Lippincott, Williams and Wilkins. p. 15. ISBN 0683307479.

[Ernst-eval-32] Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.

[lifeline-33] "98_04_13~1.PDF" (PDF). Retrieved 2010-10-14.

[History-Primer-34] Joseph C. Keating, Jr., Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16. A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).{{cite web}}: CS1 maint: multiple names: authors list (link)

[Keating05-35] Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link) Cite error: The named reference "Keating05" was defined multiple times with different content (see the help page).

[Chiro-Beliefs-36] Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002.

[37] Hansen DT, Mootz RD (1999). "Formal processes in health care technology assessment: a primer for the chiropractic profession". In Mootz RD, Hansen DT (ed.). Chiropractic technologies. Jones & Bartlett. pp. 3–17. ISBN 0834213737.

[ACA-history-38] American Chiropractic Association. "History of chiropractic care". Retrieved 2008-02-21.^{[dead link]}

[Coulter_1999_19–29-39] Coulter, ID (1999). Chiropractic: A Philosophy for Alternative Health Care. Butterworth-Heinemann. pp. 19–29. ISBN 0750640065.

[40] Bergmann, T.F., Perterson D.H (2011). Chiropractic Technique: Principles and Procedures. Elsevier. ISBN 9780323049696.

[textbook-41] Palmer D.D., The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.

[42] "The great subluxation debate: a centrist's perspective". Journal of Chiropractic Humanities. 17 (1): 33–39. 2010. PMID 22693474. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[43] "Quantitative corpus-based analysis of the chiropractic literature - a pilot study". Journal of the Canadian Chiropractic Association. 55 (1): 56–60. 2011. PMID 21403783. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)

[Keating-subluxation-44] Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13 (1): 17. doi:10.1186/1746-1340-13-17. PMC 1208927. PMID 16092955.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)

[45] "Can chiropractic survive its chimerical nature?". J Can Chiropr Assoc. 49 (2): 69–73. 2005. PMID 17549192. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)

[Murphy-pod-46] Murphy, DR; Schneider, MJ; Seaman, DR; Perle, SM; Nelson, CF (2008). "How can chiropractic become a respected mainstream profession? The example of podiatry" (PDF). Chiropractic & osteopathy. 16: 10. doi:10.1186/1746-1340-16-10. PMC 2538524. PMID 18759966. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: unflagged free DOI (link)

[Kaptchuk-Eisenberg-47] Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. doi:10.1001/archinte.158.20.2215. PMID 9818801.

[48] Vernon, Howard (2010). "Historical overview and update on subluxation theories". Journal of Chiropractic Humanities. 22 (1): 22–32. doi:10.1016/j.echu.2010.07.001. PMID 22693473. {{cite journal}}: |access-date= requires |url= (help)

[49] "The great subluxation debate: a centrist's perspective". Journal of Chiropractic Humanities. 17 (1): 33–39. 2010. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

[50] "Visceral responses to spinal manipulation". J Electromyogr Kinesiol. 22 (5): 777–784. 2012. PMID 22440554. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)

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v t e Chiropractic
Chiropractic	History Sports chiropractic Veterinary chiropractic Controversy and criticism
Techniques	Cervical manipulation Activator technique Gonstead technique Koren Specific Technique Manual therapy Myofascial release Spinal adjustment Torque release technique
Education	Schools Credentials
Accrediting bodies	CCEI CCE-USA
International organizations	WFC FICS
People	D.D. Palmer B.J. Palmer Joseph C. Keating Jr. Joseph Janse Clarence Gonstead Tedd Koren
Category

Revision as of 01:54, 11 February 2013

Scope of practice

History

Philosophy

"Straight" chiropractic

"Mixer" chiropractic

Investigations

Spinal dysfunction/subluxation

Definitions

Theory

Evidence-based practice guidelines

Treatment

Manual and manipulative therapy

Definitions

Categories

Musculoskeletal disorders

Non-musculoskeletal disorders

Safety

Cost-effectiveness

Training

Ethics and medicolegal issues

Regulation

Public health

Diagnostic imaging

Safety

References

External links