Chiropractic is a Primary Spine Care (PSC) profession that focuses on the management of patients with spine-related disorders (SRDs), with a focus on the use of conservative therapies which now constitute the recommended first-line approach. Chiropractic is viewed as a systems-based, whole-person approach to health and wellness. A Doctor of Chiropractic recognizes and honours the body’s physiological mechanisms for adaptation and homeostasis, and understands that physical structure, biological function, and mental well-being are harmoniously interrelated. Effective health care is aimed at optimizing and supporting the body’s natural self-healing and intrinsic regulatory systems to address the cause and/or contributing factors of disease and dysfunction.
Chiropractors serve as the initial or early point of contact for neuromusculoskeletal conditions and utilize evidence-based pathways to improve outcomes, reduce overall costs (e.g., spinal injections, diagnostic imaging, hospitalizations, referrals to a specialist), and escalation of care. Doctors of Chiropractic, often referred to as chiropractors or chiropractic physicians, practice a non-surgical, conservative, hands-on approach to health care, that includes patient examination, diagnosis, and treatment or referral. Chiropractors have broad diagnostic skills and can order/take/interpret X-rays and MRIs, prescribe therapeutic and rehabilitative exercises, and provide lifestyle counseling.
Chiropractic is not only limited to back pain and neck pain, but also traumatic and non-traumatic injuries of any nerve, joint, disc, or bone, as well as headaches and “vertigo.” Many people seek care for carpal tunnel syndrome, foot pain, muscle strains, and tennis elbow to list a few. Chiropractors are primary spine providers that work with the rest of your health team (Dentists, Family Doctors, Orthopedists, Neurologists, etc.) to help you reach your health goals.
One of the many therapeutic procedures performed by doctors of chiropractic is known as an adjustment, or spinal manipulative therapy (SMT). The purpose of an adjustment/SMT is to restore nerve and joint function, by manually applying a very specific thrust into joints that have become restricted in their movement. Like physiotherapists, osteopaths, and sports medicine physicians, chiropractors utilize many other modalities and procedures to conservatively assist the body to return to balance. Tissue injury can be caused by a single traumatic event, such as a slip and fall, or through repetitive stresses, such as sitting in an awkward position for an extended period of time - day in and day out. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for the sufferer. In many cases, such as spine and other musculoskeletal disorders, chiropractic care is the most cost-effective and safest treatment. When other medical conditions exist, chiropractic care may complement or support medical treatment by relieving the musculoskeletal aspects associated with the condition.
Chiropractic Education
Chiropractors undergo a rigorous education in the healing sciences, similar to that of medical doctors. In some areas, such as anatomy, physiology, rehabilitation, nutrition, and public health, they receive more intensive education than their MD counterparts. Like other primary health care students, chiropractic students spend a significant portion of their curriculum studying clinical subjects related to evaluating and caring for patients. Typically, as part of their professional training, they must complete a minimum of a one-year clinical-based program dealing with actual patient care. In total, the curriculum includes a minimum of 4,600 hours of classroom, laboratory, and clinical experience.
This extensive education prepares doctors of chiropractic to diagnose and treat health conditions when they are within their scope of practice, and refer patients to other health care practitioners when appropriate. In the bar graph below, professionals are listed in alphabetical order. Hours are based on the content of the core curriculum at institutions and do not take into individual extra certification, continuing education, or residency hours. Given the variability, doctoral-level programs do not include any undergraduate classes.
Research
2021 Chiropractic Outcomes & Patient Satisfaction Synopsis - LINK
Studies by leading medical journals in recent years have confirmed the benefits and cost-efficacy of chiropractic care:
A 1993 report by the Ontario Ministry of Health concluded that chiropractic care was the most effective treatment for lower back pain. The agency also recommended that chiropractic care be fully integrated into the Canadian government’s health care system.
In 1994, the federal Agency for Health Care Policy and Research published its Clinical Practice Guidelines, which asserted that spinal manipulation was effective in reducing pain and speeding recovery among patients with acute low back symptoms, without radiculopathy.
A 1996 New England Journal of Medicine study of outcomes and costs for acute low back pain found that patients treated by chiropractors were significantly more satisfied than those who saw primary care, orthopedic, or managed care practitioners.
A 1996 study in the medical journal Spine echoed that study and found that patients who sought chiropractic care were more likely to feel that treatment was helpful, more likely to be satisfied with their care, and less likely to seek care from another provider for the same condition, compared to those who sought care from medical doctors.
In 2001, the Center for Clinical Health Policy Research, at Duke University, concluded that spinal manipulation resulted in almost immediate improvement for cervicogenic headaches, or those that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication. LINK
This 2014 review identified limited evidence indicating that manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy consisting of manipulation and mobilization techniques, and chiropractic manipulation), in addition to other treatments or alone, are more cost-effective than usual GP care (alone or with exercise), spinal stabilization, GP advice, advice to remain active, or brief pain management, for improving low back pain and/or disability. Similarly, one study demonstrated that spinal manipulation, in addition to GP care, was more cost-effective than GP care alone in reducing shoulder pain and related disability. LINK
Americal College of Physicians 2017 Clinical Practice Guideline recommends non-invasive treatment for acute, subacute, and chronic back pain. Treatments such as spinal manipulation, contemporary medical acupuncture, rehabilitation, low-level laser therapy, and rehabilitation (all utilized in our clinic) are suggested as the first-line treatment options.
In 2021 The Official Journal of the College of Family Physicians of Canada classified the treatments for chronic low back pain by benefits and harms and offered further information. Exercise and spinal manipulation were the only modalities classified as “benefits likely exceed harms.” Whereas oral NSAIDs (benefits may not exceed harms), cortisone injections (no benefit), and opioids (harms likely exceed benefits) did not perform as well.
SAFETY
Research summary regarding cervical manipulation and “stroke.” DOWNLOAD
In 2008 the largest VBA medical study to date, encompassing 100 million-person years, found that strokes occur at a similar increased rate regardless of whether the patient sees a chiropractor for manipulation or their medical doctor for consultation. The authors found: “no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.“ This landmark paper discovered that patients in the developing stage of a stroke are more likely to visit a chiropractor or PCP for complaints of headache and neck pain. The study suggested that the chiropractic or medical doctor treatment was not the cause of the stroke, but rather a non-contributory mid-point of an undetected developing crisis. LINK
A risk assessment of cervical manipulation vs. NSAIDs (anti-inflammatories) for the treatment of neck pain. Conclusion of the 1995 paper? “The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain.” LINK
What about comparing taking NSAIDs (conventional first-line treatment for musculoskeletal pain) to cervical manipulation? Dabbs and Lauretti suggested that the risk of complications (eg, gastrointestinal ulcers, hemorrhage) or death from the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is 100 to 400 times greater than for the use of cervical manipulation. LINK
Neurosurgeons reported in 2016 that… “There is no convincing evidence to support a causal link between chiropractic manipulation and CAD (stroke).” LINK
The doctors at Spine & Sport Bermuda are members of the Bermuda Chiropractic Association.
