Many patients seek chiropractors for pain relief and preventative health care. They may also have other health issues that can benefit from chiropractic treatment, such as digestive issues or sleep problems.
At the worldview level, there will probably be no queues forming in a hurry outside chiropractic offices and it will take time for the profession to gain acceptance and legitimacy. However, engagement in public health initiatives will help achieve this goal.
Prevention
Unlike many physicians, chiropractors are trained in the diagnosis of spinal misalignments (subluxations) that can interfere with the normal transmission of nerve messages between the brain and the rest of the body. To correct these problems, chiropractors use hands-on therapies, therapeutic exercises and holistic lifestyle counseling to promote the body’s ability to heal itself.
Almost all chiropractic training takes place in private, freestanding schools established for that purpose. Few chiropractors have graduate degrees in public health or medicine, although this is slowly changing. As a result, most chiropractors cannot function as primary care practitioners. They may, however, be able to help patients prevent illness and maintain good health.
Chiropractors can also be important supplemental providers in multidisciplinary teams in primary healthcare settings, such as health centers and hospitals. They may even act as gatekeepers to limit access to more expensive specialty care.
The scope of practice for chiropractic varies from state to state and is often defined by legislation or by individual insurance contracts. In some states, chiropractors can be licensed to prescribe medications and perform certain surgical procedures. Most chiropractors, however, do not prescribe medication and do not perform invasive surgeries. The vast majority of chiropractic treatments involve manipulating the spine and other joints in order to relieve pain, treat injuries and improve movement. Chiropractors also may use a number of other modalities, including massage therapy and electrical stimulation.
Some studies have shown that spinal manipulation can reduce the symptoms of rheumatic conditions such as rheumatoid arthritis and psoriatic arthritis, but only in conjunction with other medical treatment. These studies have not found evidence that chiropractic can help other autoimmune diseases, such as systemic lupus or Crohn’s disease.
Because chiropractic practices often are outside the mainstream of medical care, their relationship with other health professionals is sometimes strained. The AMA once made it unethical for medical doctors to refer their patients to chiropractors, but this policy was reversed after the loss of a landmark antitrust case that went all the way to the U.S. Supreme Court. Nevertheless, some chiropractors have established their own managed care organizations in an attempt to control the delivery of chiropractic services and gain increased market share with employer-sponsored insurance products.
Treatment
Chiropractors have traditionally viewed themselves as primary care practitioners who can conservatively diagnose and manage a variety of health problems. Many chiropractic schools train students to perform differential diagnosis and can recognize when a health problem requires medical referral (Hawk, 1996a). In addition, chiropractors generally believe that spinal manipulation is safe, cost-effective, and a natural treatment for most musculoskeletal disorders.
Despite the fact that the medical profession’s initial response to chiropractic was almost universally negative, there have been signs of improvement in interprofessional relations. For example, until recently most medical physicians regarded chiropractors as “unlicensed providers” and discouraged patients from seeking their services, even when they were covered by insurance (Wolinsky, 1994). However, a major change has occurred since the loss of an antitrust lawsuit brought against the AMA and resulting in a new policy of permitting professional association with chiropractic (Hansen, 1995).
As a result, some chiropractic organizations have been pushing for recognition as a legitimate part of the primary healthcare delivery system. In addition, most jurisdictions now have chiropractors serving on examining, licensing, quality assurance, and disciplinary boards. Some also serve as reviewers and consultants for government agencies such as the National Institutes of Health, the Agency for Health Care Policy and Research, and the Department of Defense.
In addition to these administrative functions, most chiropractors provide therapeutic massage and can help design exercise programs for their patients that include stretches and exercises that will help to promote a healthy back and musculoskeletal system. Most chiropractors, especially experienced ones like the Tampa chiropractors, also encourage patients to incorporate regular chiropractic visits into their holistic health and wellness routine, because they believe that these preventive practices can reduce the risk of future health problems by ensuring that their spines and musculoskeletal systems are functioning properly.
Nonetheless, a number of factors have limited the expansion of chiropractic’s role in healthcare. Among them are the ongoing suspicion of some medical doctors that chiropractic may have some untoward effects, and the difficulty in establishing the legitimacy of chiropractic as a distinct discipline from medicine. Finally, the model of physician gatekeeper that has become dominant in managed care, and the fact that chiropractic is not generally recognized by medical insurers as a cost-effective alternative to medicine, have prevented greater integration of chiropractic into health care delivery structures.
Rehabilitation
The main goal of rehabilitation is to reduce the effects of injury, illness or long-term conditions. The nervous system plays a vital role in the control and coordination of bodily functions, so any interference with this delicate process can result in pain, loss of mobility and other health problems. Chiropractors utilize a number of techniques to minimize such interference by improving spinal function and reducing stress on the nervous system. The result is improved health, lower vulnerability to illnesses and injuries, and an overall higher quality of life.
A chiropractor’s primary therapeutic procedure is spinal manipulation, also known as a chiropractic adjustment or “chiropractic adjustment.” This technique involves manually applying a controlled force into joints that have become restricted in their movement due to damaged tissue. Tissue damage can occur as the result of a single traumatic event, such as lifting a heavy object incorrectly, or through repetitive stresses, such as sitting in an uncomfortable position for prolonged periods of time. The resulting physical and chemical changes in tissues can cause pain, inflammation and decreased range of motion.
Chiropractors use a variety of techniques to assess a patient’s condition and determine an appropriate treatment plan. They may recommend various exercises, stretches and nutritional/dietary advice to promote recovery from injuries and to prevent future problems. Chiropractors can help manage headaches, back pain and neck pain. There is some evidence that they can also relieve migraines by addressing pressure on nerves which connect the spine to the head.
Because chiropractic developed outside of the medical mainstream, it has not yet fully integrated into the health care system. However, as it gains popularity, the profession has sought to expand its role beyond that of a primary care practitioner for musculoskeletal issues and into a broader spectrum of health care needs. This expansion includes a potential managed care role, wherein chiropractors serve as gatekeepers for specialty physicians by managing or co-managing patients with more than a musculoskeletal problem. Different constituencies—patients, chiropractors themselves, physicians, and third-party payers—have a variety of views on what that broader scope should involve.
Lifestyle Counseling
A significant element of chiropractic practice focuses on wellness and prevention. This includes nutritional counseling, exercise prescription and education, and stress management techniques. Increasingly, chiropractors are also trained in sports injury prevention and can work in conjunction with medical physicians, physical therapists and other specialists to help prevent future injuries.
Historically, a variety of factors have kept chiropractors apart from the health care mainstream. Most notably, the lack of recognition by the American Medical Association (AMA) as a legitimate health profession and its refusal to allow physician referral to chiropractors ensured that the vast majority of patients seeking chiropractic services went directly to chiropractors rather than through medical channels. This situation served to foster a perception of chiropractic as an alternative/complementary care specialist, distinct from and often in competition with the established mainstream health care disciplines.
However, recent changes in health care delivery structures and increased interest among third-party payers have brought about a more realistic view of the role of chiropractic within the health care system. The growing emergence of managed care organizations has placed greater accountability on providers and their practice patterns. This trend, coupled with a shift in the health care industry toward a cost-effectiveness focus and greater emphasis on patient outcomes, has given chiropractic renewed interest as a primary health care provider (Mootz, 1995b).
Because of their extensive training in musculoskeletal disorders, many chiropractors find themselves managing or co-managing more than just back pain. They are now involved in the treatment of a wide range of other conditions, including neck and shoulder problems, carpal tunnel syndrome, tennis elbow, plantar fasciitis, and many common sports injuries.
With this growing responsibility, it is important that the chiropractic profession take a more active role in research and professional development to assure its place within the health care system. Several of the major chiropractic organizations now sponsor research programs, and their journals have been expanding their coverage to include topics related to health promotion and disease prevention. In addition, established scientific journals are attracting increasing numbers of chiropractic authors and their readership base is now wider than ever.