1. Chiropractic By Emily Greenough

2. Learning Objectives n Name the founder of the modern profession of chiropractic. n Describe the basic concepts of chiropractic. n What is the purpose of an adjustment?

3. Learning Objectives n Identify some of the common conditions treated by chiropractors. n What are some of the controversies or criticisms of chiropractic?

4. What is Chiropractic? n Manipulative and Body-Based practice of CAM interventions and therapies. n Profession which focuses on dx, tx, and preventing mechanical disorders of the musculoskeletal system, their effects on the nervous system and general health.

5. History of Chiropractic n Chiropractic- means “done by hand”, referring to manipulation of the spine. –Greek words cheir (hand) and praxis (action) n Chiropractic is a form of spinal manipulation, one of the oldest healing practices. –Spinal manipulation was described by Hippocrates in ancient Greece.

6. The Founder of the Modern Profession of Chiropractic n Daniel David Palmer –Healing philosophies –Spiritualism –Magnetic therapy –Background in osteopathic training

7. DD Palmer n Observed the body had a natural healing ability controlled by the nervous system. n Coined the term “subluxations”- misalignments of the spine. n Misalignments cause nerve compression that interferes with proper flow of “Innate Intelligence” (God) to body organs, results in disease or disharmony. –A.k.a. Innate Life Force, Universal Intelligence

8. The First Experiment with Chiropractic n 1895-Palmer’s story –examination found a sore lump on Lillard’s back, misalignment caused deafness n Lillard’s story- daughter reports book to back n Lillard’s deafness was told to be improved, w/out any other explanation. n 1896- added treatment to school –Now known as Palmer College of Chiropractic –90% of chiropractors believe the vertebral subluxation plays significant role in all or most diseases

9. Basic Concepts of Chiropractic n The body has a powerful self-healing ability. n The body’s structure (primarily the spine) and its function are closely related, and this relationship affects health. n Chiropractic therapy is given with the goals of normalizing this relationship between structure and function and assisting the body as it heals.

10. The Chiropractor n In the U.S. chiropractors perform over 90% of manipulative treatments. n Adjustments (special emphasis on spine) –Treatment that seeks to eliminate pain –Involve applying a controlled, sudden force to a joint – Increases the range and quality of motion in the area being treated

11. Conditions Commonly Treated by Chiropractors n Back pain including low-back pain n Neck pain n Headaches including migraines n Sports Injuries n Repetitive strains n Others –Asthma, Arthritis, Bursitis, Cerebral Palsy, Flu symptoms, DM, Infertility, etc

12. Prevalence n NCCAM –Estimated Americans (1997) made nearly 192 million visits a year to chiropractors. –Over 88 million of those visits were to treat back or neck pain. –18-38 million annually reported for relief of head and neck pain.

13. Cervical Spine Manipulation Before and After

14. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Objective –Acquire information for designing a large clinical trial and determine its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor n Study Design –Randomized, control trial

15. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Subjects –24 adults with chronic cervicogenic headache n Methods –Randomly allocated to 1, 3, or 4 visits per week for 3 weeks. –Chiropractors allowed 2 physical modalities each visit. (heat and soft tissue therapy)

16. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Outcomes Measured –Modified Von Korff Scales (MVK) n MVK pain scale rating: HA pain today, worst HA pain in last 4 weeks, average HA pain in last 4 weeks. n MVK disability scale measures interference with: daily activities, social and recreational activities, ability to work outside or around house.

17. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Feasibility of a larger study was determined by: –Completion rates for the f/u questionnaires had to be 90% –Participants had to attend at least 2/3 of scheduled visits –Participants reported number of visits sought outside the study.

18. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Baseline Variables –Sociodemographics –General health status n energy/fatigue n emotional well being n self rated health n depression –2 visits to establish baseline

19. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Compliance –Contacted by phone during weeks 1, 2, 3, 4, 6, 8, 10 and 12 to keep them engaged and remind them to fill out questionnaires –Reminder calls for appointments –Allowed to seek care outside the study

20. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Findings –For HA pain, substantial differences were found between participants receiving 1 treatment/week and those receiving either 3 or 4 treatments/week. –Comparable differences between groups were found for HA disability at 12 weeks. –Neck pain and associated disability appeared to parallel HA outcomes.

21. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Findings –Outside care n 3 sought unscheduled treatment or outside care –Noncompliance n Only 1 participant missed a treatment schedule

22. Dose Response For Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study Journal of Manipulative and Physiologic Therapies (2004) vol. 27 issue 9 n Conclusion –Participants willing to be randomized, follow tx protocol, and complete f/u questionnaires. –Data suggests support for a dose-response relationship between cervicogenic HA pain/disability and number of chiropractic treatments. –Larger number of visits produces greater benefits.

23. A Controlled Trial of Cervical Manipulation of Migraine Australian and New Zealand Journal of Medicine (1978) vol. 8 n Objective –Evaluate the efficacy of cervical manipulation for migraines n Study Design –Controlled trial of 6 months n Subjects –85 volunteers (males 33, females 52) –Suffering from migraines (mean 19 years) –Under the age of 55 years

24. A Controlled Trial of Cervical Manipulation of Migraine Australian and New Zealand Journal of Medicine (1978) vol. 8 n Treatment Groups- no more than 2 x/week –Chiropractic Manipulation n Required to manipulate the spine- “movement of joints beyond normal limitations” –Manipulation n Required medical practitioner and physiotherapist to manipulate the spine-”movement of joints beyond normal limitations” –Control n Require medical practitioner and physiotherapist to perform cervical mobilization- “movement of joints within normal limitations”

25. A Controlled Trial of Cervical Manipulation of Migraine Australian and New Zealand Journal of Medicine (1978) vol. 8 n Hypothesis –Post-treatment scores for the whole sample would be less than pre-treatment scores –Cervical manipulation (performed by any therapist) would be more effective than the control treatment –Chiropractic treatment would be more effective than the other 2 treatments

26. A Controlled Trial of Cervical Manipulation of Migraine Australian and New Zealand Journal of Medicine (1978) vol. 8 n Compliance – required “migraine form” at the end of each migraine. n duration of attack (duration hr/attack) n pain (visual analogue scale “intensity”) n disability (5 point scale-1=usual activities, 5=had to remain in bed) n Outcome Measures-phone – migraine frequency was compared to “migraine form” to compare data.

27. A Controlled Trial of Cervical Manipulation of Migraine Australian and New Zealand Journal of Medicine (1978) vol. 8 n Results –Whole sample, migraine symptoms were significantly reduced. –No difference in outcome found between therapists, or by those who received the control treatment. –Chiropractic was no more effective at reducing duration, disability, or frequency, but greater reduction in pain variant.

28. Controversies and Criticism n Inside the profession n The Mixers, Straights, and Reformers –Concept of subluxations –Use of appropriate physical therapy techniques for conditions

29. Controversies and Criticism n Outside the profession n Effectiveness of treatments –Non-manual treatments n heat and ice, magnetic therapy, nutrition counseling and dietary supplements n Potential risks –Presumed to be safe from what is known –Osteoporosis compared to healthier bone

30. Controversies and Criticism n Scientific basis –Research finding had missing or poor- quality data. –Overall research findings, unable to provide enough evidence to support effectiveness of treatment. –Maybe more effective than sham therapy, but no more or less than other treatments.

31. Conclusions? n Research studies are ongoing –Key area of research is the basic science of what happens in the body such as the cells and nerves when specific treatments are given. n Risk of complications from adjustments of low-back pain appear very low, but risks increase for adjustments of the neck.

32. Thank You n Any Questions?