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Seven things you should know about Chiropractors and Chiropractic treatment

1. Which patients should I consider for chiropractic care?

2. How much care is necessary for a patient to improve with chiropractic treatment?

3. Is chiropractic manipulation safe?

4. How does manipulation work?

5. Why is there such variation in treatment among chiropractors?

6. With all of the variation in chiropractic, how does one identify a qualified chiropractor?

7. How well-educated are chiropractors?

1. Which patients should I consider for chiropractic care?

• The outcomes for chiropractic treatment is commonly excellent for patients with acute/subacute mechanical/myofascial cervical, thoracic or lumbosacral joint pain. Diagnostic classifications include whiplash, stable radiculopathy, lumbar stenosis, facet syndrome, costotransverse capsulitis, sacroilliac joint pain, spinal strain/sprain, non-specific spinal pain, discogenic low back pain, myofascial pain syndromes and cervical headaches.

• Patients with cervical or lumbar intervertebral disc herniations often respond positively to chiropractic management. Treatments are likely to include forms of manipulative traction (e.g., Cox flexion-distraction or a Mackenzie approach).

• Patients with repetitive strain injuries, carpal tunnel syndrome, thoracic outlet syndrome, temporomandibular joint pain and other musculoskeletal disorders, such as degenrative joint disease with associated pain and loss of mobility. 

2. How much care is necessary for a patient to improve with chiropractic treatment?

• Patients with spinal pain commonly show functional improvement and pain relief within a few treatment sessions, while others require more extensive care. The acute, uncomplicated spine patient should have significant relief withn six visits. Chronic or complicated acute patients may require twelve or more visits before a cumulative response is shown. Interim examinations are frequent in order to document patient response and to evaluate the treatment plan.

• Patients with chronic or permanent conditions may be treated under a "disease management" model. Once the patient has reached a point of maximum therapeutic benefit, a comprehensive treatment program of manipulation and adjunctive therapies may be provided on a periodic basis to maintain functional and symptom gains. Our goal is to encourage indepedence from treatment if possible.

3. Is chiropractic manipulation safe?

• When the correct manipulation technique is paired with the appropriately-selected patient, spinal manipulation is a very safe procedure. There are relative and absolute contraindictions to spinal manipulation that have been identified in the physical medicine literature.

The most common side effect experienced by patients receiving spinal manipulation is short-term soreness in the area of treatment; commonly 1:5.

The most serious potential complications from spinal manipulation are cauda equina syndrome (CES) and vertebral basilar artery injury (VBAI). The likelihood of these complications is approximately 1:4.5 million (VBAI) to 1:100 million (CES).

• A history of spinal surgery, osteoporosis, healed fracture, disc herniation without significant or progressive neurlogic deficit, scoliosis, chronic arthropathies, degenerative changes, some acute injuries and joint instability are not absolute containdications to treatment. 

•Absolute contraindictions: severe or progressive neurologic deficit, infections or malignancies of the area treated, acute bone demineralization, acute fracture,dislocation and acute arthropathies.

• A contraindiction to spinal manipulation in one region of the spine rarely  precludes treatment in another region. If techniques cannot be modified to accommodate the patient's condition, manipulation is withheld.

4. How does manipulation work?

•Although the exact mechanism is not clear, current models that explain the treatment benefits following manipulative therapy include: motion segment unbuckling, meniscoid inclusion release, intra-articular adhesion/fringe release, stimulation of joint mechanoreceptors and/or relaxation of hypertonic muscle. Centrally mediated reflexes are being investigated.

•Spinal manipulation studies have demonstrated that there is an immediate post-treatment increase in range of motion, decreased adjacent soft-tissue tenderness, improved function and decreased pain.

5. Why is there such variation in treatment among chiropractors?

•The chiropractic profession is philosophically divided into two primary groups: (1) those who adhere to many of the traditional chiropractic theories that promote lifelong care, and (2) those who work on an integrated, evidence-based care model.

•Philosophically based chiropractors advocate that spinal manipulation (referred to as an "adjustment") improves health through reducing sub-clinical neurological impairment by correcting inervertebral joint dysfunction (referred to as a "subluxation"). Theoretically, spinal adjustments are directed at restoring neural homeostasis, rather than administered to treat a clinical disorder. Also, regular adjustments are administered as a means of preventive healthcare. Most of these chiropractors do not seek a clinial diagnosis other than "subluxation".

• Evidence-based chiropractors commonly work on a physical medicine model to diagnose and treat their patients. Spinal manipulation is one component of the management strategy. These chiropractic physicians perform differential diagnosis, administer therapeutic treatment modalities such as ultrasound, electric muscle stimulation, hot/cold therapes and instruct their patients in rehabilitative exercises, stretches, lifestyle changes and proper diet. Many evidence-based chiropractic physicians work cooperatively with hospitals and integrated care centers.

•Dr Lumsden has particular interest and experience in the examination and diagnosis of ambulatory patients, and is very concerned about musculoskeletal health, as well as general health and wellness, supported by regular professional and self examinations.

Note: Dr. Lumsden is a former member of the Oregon Board of Chiropractic Examiners Evidence-Based Practice Review Committee.

6. With all of the variation in chiropractic, how does one identify a qualified chiropractor?

The Journal of Family Practice (1992) published the following guidelines to consider when selecting a chiropractor:

°Treats mainly musculoskeletal disorders

°Does not radiograph every patient

°Willing to be clinically observed

°Positive feedback from patients

°Communicates with the referring physician

°Administers reasonable treatment programs

°Does not charge a global, up-front fee

7. How well-educated are chiropractors?

• Candidates for entry into most chiropractic colleges are required to complete a four-year undergraduate program. Ten trimesters or 12 quarters of chiropractic school (4-5 years) must be completed to graduate. The first 3/4 of the course is primarily didactic training. Courses include human anatomy and dissection, branches of physiology, pharmacology, diagnostic imaging, nutrition, rehabilitation, physiological therapeutics. orthopedics, neurology, spinal manipulation and medical management strategies. The remainder of the course is completed through an internship under the direction of a licensed clinicians. Upon graduation, most chiropractors enter private practice after successfully passing national and state board examinations. More in depth information on Chiropractic education can be seen at 

     1. National Health Sciences University:

     2. University of Western States;

•Residency programs after chiropractic training are optional and include specialties in Orthopedics, Diagnostic imaging, Clinical Studies, Rehabilitation and Research. Many post-graduate lectures are also offered and continuing education is required annually.

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