An Introduction to An Introduction to Chiropractic CareChiropractic Care

Don GalovichDon Galovich

Jeremy LindstromJeremy Lindstrom

Dr. Peter MillarDr. Peter Millar

Mark MorrisMark Morris

What is Chiropractic?What is Chiropractic?

Chiropractic care centers around the Chiropractic care centers around the diagnosis, treatment and prevention diagnosis, treatment and prevention

of neuro-musculoskeletal system of neuro-musculoskeletal system disorders. disorders.

What is Chiropractic?What is Chiropractic?

Chiropractic focuses on the Chiropractic focuses on the relationship between structure relationship between structure (movements of the spine) and (movements of the spine) and

function (coordinated by the nervous function (coordinated by the nervous system and how this relationship system and how this relationship

affects health)affects health)

How long has Chiropractic been How long has Chiropractic been recognized in traditional healthcare?recognized in traditional healthcare?

The profession was founded in the US The profession was founded in the US in 1895.in 1895.

Today there are over 65,000 Today there are over 65,000 chiropractors in the US todaychiropractors in the US today

Educational RequirementsEducational Requirements

Doctors of Doctors of Chiropractic Chiropractic complete the complete the equivalent of equivalent of five academic five academic

years of years of advanced advanced

professional professional education education

EducationalEducational RequirementsRequirements

Six semesters didactic course work Six semesters didactic course work (average course load 25-27 credits)(average course load 25-27 credits)

Four semesters extensive Clinical Four semesters extensive Clinical experienceexperience

National Board ExaminationsNational Board Examinations• Parts I-IVParts I-IV

Chiropractic case management Chiropractic case management protocolprotocol

Specific spinal analysis Specific spinal analysis Physical, neurological, orthopedic Physical, neurological, orthopedic

examinations and consultationexaminations and consultation Specific restoration of normal Specific restoration of normal

biomechanics by means of the biomechanics by means of the adjustment, adjustment, soft tissue manipulation, and ancillary soft tissue manipulation, and ancillary therapiestherapies

Referral for co-management if appropriateReferral for co-management if appropriate Appropriate attention to ergonomical Appropriate attention to ergonomical

considerations and other possible causes considerations and other possible causes of biomechanical dysfunctionof biomechanical dysfunction

Chiropractic EducationChiropractic Education

Compiled as an Compiled as an average from 22 average from 22 medical schools medical schools and 11 and 11 chiropractic chiropractic collegescolleges

Additional Additional classes and classes and clinic times vary clinic times vary according to according to schoolschool

The primary lesion addressed in chiropractic is The primary lesion addressed in chiropractic is intersegmental dysfunction within the spinal intersegmental dysfunction within the spinal

columncolumn

This refers to This refers to discrete areas of discrete areas of

hypomobilty within hypomobilty within the articulations of the articulations of

the spinethe spine

What is a chiropractic What is a chiropractic adjustment?adjustment?

A high-velocity, A high-velocity, low-amplitude low-amplitude thrust usually thrust usually given by hand, given by hand,

directed at directed at specific specific

articulations of articulations of the spine or the spine or extremitiesextremities

The purpose of the The purpose of the adjustment……adjustment……

restore normal movement and restore normal movement and resolve the resultant biomechanical, resolve the resultant biomechanical, physiological and neurological effects physiological and neurological effects of segmental hypomobility.of segmental hypomobility.

The AdjustmentThe Adjustment

The type of adjustment varies with The type of adjustment varies with techniquetechnique• DiversifiedDiversified• Flexion/DistractionFlexion/Distraction• ThompsonThompson• ActivatorActivator• LoganLogan• etc.etc.

The AdjustmentThe Adjustment

Although many different techniques Although many different techniques are used they all have a common are used they all have a common goal: goal:

To restore normal motion and To restore normal motion and normalize the nervous system to normalize the nervous system to allow the body to function optimallyallow the body to function optimally

Putting it together……..Putting it together……..

Loss of normal movement leads to…Loss of normal movement leads to… Changes in how all tissues involved are Changes in how all tissues involved are

stressed and replenished, which causes…stressed and replenished, which causes… Chemical changes within those tissues Chemical changes within those tissues

and…and… Predisposes them to mechanical failure Predisposes them to mechanical failure

giving us…giving us… A good reason to restore normal A good reason to restore normal

movement through spinal adjustment.movement through spinal adjustment.

What conditions can be treated What conditions can be treated using chiropractic?using chiropractic?

Musculoskeletal Musculoskeletal conditions conditions involving the involving the articulations of articulations of body and body and surrounding soft surrounding soft tissuetissue

Some examples of these Some examples of these conditions……conditions……

Neck and Back painNeck and Back pain HeadacheHeadache SciaticaSciatica Stiff jointsStiff joints Sprain/Strain injuriesSprain/Strain injuries Herniated nucleus Herniated nucleus

pulposuspulposus Sport related injuriesSport related injuries The list goes on……….The list goes on……….

Review of Chiropractic researchReview of Chiropractic research

Satisfaction with treatmentSatisfaction with treatment• In conditions dealing with back pain, In conditions dealing with back pain,

patient satisfaction has been shown to patient satisfaction has been shown to be greater with chiropractic treatment be greater with chiropractic treatment over conventional management (PCP, over conventional management (PCP, HMO provider, or orthopedist)HMO provider, or orthopedist)

New England Journal of Medicine 1995; 333(14) : 913-917New England Journal of Medicine 1995; 333(14) : 913-917

Western Journal of Medicine 1989; 150: 351-355Western Journal of Medicine 1989; 150: 351-355

Review of researchReview of research

Chiropractic is an extremely safe form Chiropractic is an extremely safe form of therapy. However as with any of therapy. However as with any

therapeutic intervention therapeutic intervention contraindications exist. Two primary contraindications exist. Two primary

complications exist with spinal complications exist with spinal manipulation.manipulation.

Review of researchReview of research Cauda Equina SyndromeCauda Equina Syndrome

• Following lumbar manipulation in Following lumbar manipulation in patients, disc herniation, neurological patients, disc herniation, neurological bowel and bladder disturbances, saddle bowel and bladder disturbances, saddle anesthesia, leg weakness may occur.anesthesia, leg weakness may occur.

• The frequency of developing this The frequency of developing this condition from manipulation has been condition from manipulation has been estimated to be estimated to be 1 per 100 million1 per 100 million manipulations.manipulations.

• Spine 21 (15): 1746-1760Spine 21 (15): 1746-1760

Review of researchReview of research

Cerebrovascular accidents following Cerebrovascular accidents following manipulation of the upper cervical manipulation of the upper cervical region.region.• The frequency of developing this The frequency of developing this

condition following manipulation has been condition following manipulation has been estimated to be 1in 5.85 million estimated to be 1in 5.85 million manipulations.manipulations.

Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation the chiropractic dissections following cervical manipulation the chiropractic experience. CMAJ 2001; 165:905-6experience. CMAJ 2001; 165:905-6

Review of researchReview of research

Putting the numbers in perspectivePutting the numbers in perspective

The rates given for CVA’s caused by The rates given for CVA’s caused by spinal manipulation are spinal manipulation are 400x less400x less then the death rate observed from GI then the death rate observed from GI bleeding due to the use of NSAID bleeding due to the use of NSAID medication medication

Journal of Manipulative and Physiological Therapeutics Journal of Manipulative and Physiological Therapeutics 1995; 18 (8): 530-5361995; 18 (8): 530-536

Review of ResearchReview of Research

Appropriateness and GuidelinesAppropriateness and Guidelines

• In 1994 the Agency for Health Care In 1994 the Agency for Health Care Policy and Research (AHCPR) placed Policy and Research (AHCPR) placed

spinal manipulation at the top of the list spinal manipulation at the top of the list for clinical options in the treatment of for clinical options in the treatment of

certain types of back pain.certain types of back pain.

Back pain treatmentBack pain treatment

• Among 23 options Among 23 options for treatment of for treatment of low back pain, low back pain, spinal spinal manipulation and manipulation and the use of NSAID’s the use of NSAID’s had the most had the most beneficial effect.beneficial effect.

• Acute low back pain in adults. Acute low back pain in adults. Clinical practice guideline No. 14 Clinical practice guideline No. 14 AHCPR Publication No. 95-0642 AHCPR Publication No. 95-0642 (1994)(1994)

Wellness ModelWellness Model

The public has widely embraced many forms The public has widely embraced many forms of wellness care and alternative therapiesof wellness care and alternative therapies

Other healthcare professions have embarked Other healthcare professions have embarked on a paradigm shift to include alternative on a paradigm shift to include alternative therapies, therapies, including spinal manipulationincluding spinal manipulation

Many conditions respond best with a Many conditions respond best with a multidisciplinary approachmultidisciplinary approach

Our Goals in HealthcareOur Goals in Healthcare“The Wellness Model”“The Wellness Model”

Patient-centered paradigmPatient-centered paradigm Improving interdisciplinary communicationImproving interdisciplinary communication Maximizing the benefits of healthcare from all Maximizing the benefits of healthcare from all

perspectivesperspectives

Closing RemarksClosing Remarks

In a little over a hundred years of In a little over a hundred years of existence chiropractic has become existence chiropractic has become

the third largest profession of health the third largest profession of health care delivery in the worldcare delivery in the world

Closing RemarksClosing Remarks

For the treatment of musculoskeletal For the treatment of musculoskeletal conditions chiropractic is a conditions chiropractic is a conservative first step that should conservative first step that should not be over looked.not be over looked.

If a problem can be corrected with If a problem can be corrected with minimal risk, and without the use of minimal risk, and without the use of drugs or surgery it makes sense to drugs or surgery it makes sense to try it.try it.

Questions?Questions?