Ross Chiropractic & Wellness
 

 What is Chiropractic?

Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic services are used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.

What is a Doctor of Chiropractic?

Doctors of Chiropractic (DCs) – often referred to as chiropractors or chiropractic physicians – practice a hands-on, drug-free approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling. 

DCs may assess patients through clinical examination, laboratory testing, diagnostic imaging and other diagnostic interventions to determine when chiropractic treatment is appropriate or when it is not appropriateChiropractors will readily refer patients to the appropriate health care provider when chiropractic care is not suitable for the patient’s condition, or the condition warrants co-management in conjunction with other health care providers. 

In many cases, such as lower back pain, chiropractic care may be a patient's primary method of treatment. When other medical conditions exist, chiropractic services may complement or support medical treatment by relieving the musculoskeletal aspects associated with the condition. 

Like their MD colleagues, doctors of chiropractic are subject to the boundaries established in state practice acts and are regulated by state licensing boards. Further, their education in four-year doctoral graduate school programs is nationally accredited through an agency that operates under the auspices of the U.S. Department of Education. After graduation, they must pass national board exams before obtaining a license to practice, and then must maintain their license annually by earning continuing education (CE) credits through state-approved CE programs.  

What is Spinal Manipulation?

One of the most common and well known therapeutic procedures performed by doctors of chiropractic is spinal manipulation (sometimes referred to as a "chiropractic adjustment"). The purpose of spinal manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile – or restricted in their movment – as a result of a tissue injury. Tissue injury can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses, such as sitting in an awkward position with poor spinal posture for an extended period of time. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for an individual. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal.

Chiropractic adjustment rarely causes discomfort. However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) that usually resolves within 12 to 48 hours. Compared to other common treatments for pain, such as over-the-counter and prescription pain medications, chiropractic's conservative approach offers a safe and effective option.





What to Expect on Your First Visit

Many new patients are not sure what to expect during their first appointment with a Doctor of Chiropractic (DC). Chiropractors start by taking a patient’s history and then performing a physical examination to develop a working diagnosis. Imaging or lab tests (such as MRI, CT scan or X-ray) may be used or ordered to confirm a diagnosis. 

The combination of the history, exam, and diagnostic studies will enable Dr. Ross to reach a diagnosis, which will help him determine whether chiropractic services are appropriate for your condition. If he determines you would be more appropriately managed or co-managed by another health care professional, Dr. Ross will make the proper referral. 

Through a process of shared decision-making, you and Dr. Ross will determine if chiropractic services are right for you. As part of this process, he will explain your condition, recommend a treatment plan and review the risks and benefits of all procedures. 

Based on the extent, timing or severity of the patient’s condition, chiropractic interventions may require several visits. Patients may also receive advice on home care, lifestyle modifications, exercise instruction and nutritional advice. 

Chiropractic Qualifications

Educational  and licensing requirements for doctors of chiropractic (DCs) are among the most stringent of any of the health care professions.

DCs are educated in nationally accredited, four-year doctoral graduate school programs through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship,  with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools. 

They are designated as physician-level providers in the vast majority of states and federal Medicare program. The essential services provided by DCs are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the Federal Employees Health Benefits Program, Federal Workers' Compensation, and all state workers' compensation programs. 

Chiropractic Education

The typical applicant at a chiropractic college has already acquired nearly four years of pre-medical undergraduate college education, including courses in biology, inorganic and organic chemistry, physics, psychology and related lab work. Once accepted into an accredited chiropractic college, the requirements become even more demanding — four to five academic years of professional study are the standard. Because of the hands-on nature of chiropractic, and the intricate adjusting techniques, a significant portion of time is spent in clinical training.

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 doctors, 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 4,200 hours of classroom, laboratory and clinical experience. The course of study is approved by an accrediting agency that is recognized by the U.S. Department of Education. This has been the case for more than 25 years. 

This extensive education prepares doctors of chiropractic to diagnose health care problems, treat the problems when they are within their scope of practice and refer patients to other health care practitioners when appropriate. 

Certification and Licensure 

Certification and licensure of chiropractors is governed by the National Board of Chiropractic Examiners (NBCE)

Chiropractors must pass a national board exam administred by NBCE and then obtain a license in the state in which they wish to practice. Additionally, they must meet yearly continuing education requirements to maintain their license. 

What Research Shows About Chiropractic

A growing list of research studies and reviews demonstrate that the services provided by chiropractors are clinically effective, safe and cost effective.  Following are excerpts and summaries from a few of those studies. The evidence supports the natural, whole-body, drug-free approach of chiropractic for a variety of conditions. To find more research supporting chiropractic services, visit the World Federation of Chiropractic's Reading List and the Clinical Compass for both guidelines and research.

For Acute and Chronic Pain

“Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence).”

          American College of Physicians (2017)

"For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence)."

          American College of Physicians (2017)

“Many treatments are available for low back pain. Often exercises and physical therapy can help. Some people benefit from chiropractic therapy or acupuncture.”

          Goodman et al. (2013), Journal of the American Medical Association  

“[Chiropractic Manipulative Therapy] in conjunction with [standard medical care] offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute low back pain."

          Goertz et al. (2013), Spine

In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.

          Korthals-de Bos et al (2003), British Medical Journal

“Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”

          Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics

 In Comparison to Other Treatments 

The results of a clinical trial showed that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone. The study, which featured 750 active-duty members of the military, is one of the largest comparative effectiveness trials between usual medical care and chiropractic care ever conducted.

          Goertz et al. (2018) JAMA Open Network

"Manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain compared with usual medical care. 94% of the manual-thrust manipulation group achieved greater than 30% reduction in pain compared with 69% of usual medical care."

          Schneider et al (2015), Spine 

"Reduced odds of surgery were observed for...those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor."

          Keeney et al (2012), Spine 

“Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”

          Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

“In our randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.”

          Hoving et al (2002), Annals of Internal Medicine

For Headaches

“Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.”

          McCrory, Penzlen, Hasselblad, Gray (2001), Duke Evidence Report

“The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values.” 

          Boline et al. (1995), Journal of Manipulative and Physiological Therapeutics

For Neck Pain

In a study funded by NIH’s National Center for Complementary and Alternative Medicine to test the effectiveness of different approaches for treating mechanical neck pain, 272 participants were divided into three groups that received either spinal manipulative therapy (SMT) from a doctor of chiropractic (DC), pain medication (over-the-counter pain relievers, narcotics and muscle relaxants) or exercise recommendations. After 12 weeks, about 57 percent of those who met with DCs and 48 percent who exercised reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group. After one year, approximately 53 percent of the drug-free groups continued to report at least a 75 percent reduction in pain; compared to just 38 percent pain reduction among those who took medication.

          Bronfort et al. (2012), Annals of Internal Medicine

Cost Effectiveness

Findings from a study utilizing data from the North Carolina State Health Plan collected between 2000-2009 show that care by a doctor of chiropractic (DC) alone or DC care in conjunction with care by a medical doctor (MD)  incurred “appreciably fewer charges” for uncomplicated lower back pain than MD care with or without care by a physical therapist. 

          Hurwitz et al. (2016), Journal of Manipulative and Physiological Therapeutics 

Older Medicare patients with chronic low back pain and other medical problems who received spinal manipulation from a chiropractic physician had lower costs of care and shorter episodes of back pain than patients in other treatment groups. Patients who received a combination of chiropractic and medical care had the next lowest Medicare costs, and patients who received medical care only incurred the highest costs.

          Weeks et al (2016), Journal of Manipulative and Physiological Therapeutics

Low back pain initiated with a doctor of chiropractic (DC) saves 20 to 40 percent on health care costs when compared with care initiated through a medical doctor (MD), according to a study that analyzed data from 85,000 Blue Cross Blue Shield (BCBS) beneficiaries in Tennessee over a two-year span. The study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays. Researchers estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee. They also concluded that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.

          Liliedahl et al (2010), Journal of Manipulative and Physiological Therapeutics

“Chiropractic care appeared relatively cost-effective for the treatment of chronic low-back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulative efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis.”

          Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

Patient Satisfaction

“Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks.”

          Hertzman-Miller et al (2002), American Journal of Public Health

Widespread Use of Chiropractic

“Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades.”

          Meeker, Haldeman (2002), Annals of Internal Medicine 

Frequently Asked Questions About Chiropractic

Q: What conditions do chiropractors treat?
A: Doctors of Chiropractic (DCs) care for patients of all ages, with a variety of health conditions.  DCs are especially well known for their expertise in caring for patients with back pain, neck pain and headaches...particularly with their highly skilled  manipulations or chiropractic adjustments. They also care for patients with a wide range of injuries and disorders of the musculoskeletal system, involving the muscles, ligaments and joints. These painful conditions often involve or impact the nervous system, which can cause referred pain and dysfunction distant to the region of injury. The benefits of chiropractic care extend to general health issues, as well, since our body structure affects our overall function. DCs also counsel patients on diet, nutrition, exercise, healthy habits, and occupational and lifestyle modification.

Q: Is chiropractic treatment safe?
A: Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small. Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness, stiffness or aching, just as they do after some forms of exercise. Current research shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck manipulation, when performed by a skilled and well-educated professional such as a doctor of chiropractic, is a remarkably safe procedure.

Some reports have associated high-velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection. However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or family physician—but that care is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare—about one to three cases in 100,000 patients who get treated with a course of care. This is similar to the incidence of this type of stroke among the general population.

If you are visiting your doctor of chiropractic with upper-neck pain or headache, be very specific about your symptoms. This will help your doctor of chiropractic offer the safest and most effective treatment, even if it involves referral to another health care provider.

When discussing the risks of any health care procedure, it is important to look at that risk in comparison to other treatments available for the same condition. In this regard, the risks of serious complications from spinal manipulation for conditions such as neck pain and headache compare very favorably with even the most conservative care options. For example, the risks associated with some of the most common treatments for musculoskeletal pain—over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDS) and prescription painkillers—are significantly greater than those of chiropractic manipulation.

According to the American Journal of Gastroenterology, people taking NSAIDS are three times more likely than those who do not to develop serious adverse gastrointestinal problems such as hemorrhage (bleeding) and perforation. That risk rises to more than five times among people age 60 and older.

Moreover, the number of prescriptions for powerful drugs such as oxycodone and hydrocodone have tripled in the past 12 years. The Centers for Disease Control and Prevention (CDC) has reported that abuse of these commonly prescribed painkillers are among the leading causes of accidental death in the United States. Overdoses of opioid painkillers are responsible for some 15,000 deaths per year; that’s more than the number of deaths from cocaine and heroin combined.
Doctors of chiropractic are well trained professionals who provide patients with safe, effective care for a variety of common conditions. Their extensive education has prepared them to identify patients who have special risk factors and to get those patients the most appropriate care, even if that requires referral to a medical specialist.

Q: Does chiropractic treatment require a referral from an MD?
A: A referral is usually not needed to see a doctor of chiropractic (DC); however, your health plan may have specific referral requirements. You may want to contact your employer’s human resources department—or the insurance plan directly—to find out if there are any referral requirements. Most plans allow you to just call and schedule an appointment with a DC. 

Q: Is chiropractic treatment appropriate for children?
A: Yes, children can benefit from chiropractic care. Children are very physically active and experience many types of falls and blows from activities of daily living as well as from participating in sports. Injuries such as these may cause many symptoms including back and neck pain, stiffness, soreness or discomfort. Chiropractic care is always adapted to the individual patient. It is a highly skilled treatment, and in the case of children, very gentle.

Q: Are chiropractors allowed to practice in hospitals or use medical outpatient facilities?
A: Chiropractors are being recognized to admit and treat patients in hospitals and to use outpatient clinical facilities (such as labs, x-rays, etc.) for their non-hospitalized patients.  Hospital privileges were first granted in 1983.

Q: Do insurance plans cover chiropractic?
A: Yes. Chiropractic care is included in most health insurance plans, including major medical plans, workers’ compensation, Medicare, some Medicaid plans, and Blue Cross Blue Shield plans for federal employees, among others. Chiropractic care is also available to active-duty members of the armed forces at more than 60 military bases and is available to veterans at more than 60 major veterans medical facilities. 

Q: What type of education and training do chiropractors have?
A: Doctors of chiropracticare educated as primary-contact health care providers, with an emphasis on diagnosis and treatment of conditions related to the musculoskeletal system (the muscles, ligaments and joints of the spine and extremities) and the nerves that supply them. Educational requirements for doctors of chiropractic are among the most stringent of any of the health care professions. The typical applicant for chiropractic college has already acquired nearly four years of pre-medical undergraduate college education, including courses in biology, inorganic and organic chemistry, physics, psychology and related lab work. Once accepted into an accredited chiropractic college, the requirements become even more demanding — four to five academic years of professional study are the standard. Doctors of chiropractic are educated in orthopedics, neurology, physiology, human anatomy, clinical diagnosis including laboratory procedures, diagnostic imaging, exercise, nutrition rehabilitation and more. Because chiropractic care includes highly skilled manipulation/adjusting techniques, a significant portion of time is spent in clinical technique training to master these important manipulative procedures. In total, the chiropractic college curriculum includes a minimum of 4,200 hours of classroom, laboratory and clinical experience. The course of study is approved by the Council on Chiropractic Education, an accrediting agency that is fully recognized by the U.S. Department of Education.

Q: How is a chiropractic adjustment performed?
A: Chiropractic adjustment or manipulation is a manual procedure that utilizes the highly refined skills developed during the doctor of chiropractic’s intensive years of chiropractic education. The chiropractic physician typically uses his or her hands--or an instrument--to manipulate the joints of the body, particularly the spine, in order to restore or enhance joint function. This often helps resolve joint inflammation and reduces the patient's pain. Chiropractic manipulation is a highly controlled procedure that rarely causes discomfort. The chiropractor adapts the procedure to meet the specific needs of each patient. Patients often note positive changes in their symptoms immediately following treatment. 

Q: Is chiropractic treatment ongoing?
A: The hands-on nature of the chiropractic treatment is essentially what requires patients to visit the chiropractor a number of times. To be treated by a chiropractor, a patient needs to be in his or her office. In contrast, a course of treatment from medical doctors often involves a pre-established plan that is conducted at home (i.e. taking a course of antibiotics once a day for a couple of weeks). A chiropractor may provide acute, chronic, and/or preventive care thus making a certain number of visits sometimes necessary. Your doctor of chiropractic should tell you the extent of treatment recommended and how long you can expect it to last.

Q: Why is there a popping sound when a joint is adjusted?
A: Adjustment (or manipulation) of a joint may result in the release of a gas bubble between the joints, which makes a popping sound. The same thing occurs when you “crack” your knuckles. The noise is caused by the change of pressure within the joint, which results in gas bubbles being released. There is usually minimal, if any, discomfort involved. 

Key Facts About the Chiropractic Profession

Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. These disorders include, but are not limited to: back pain, neck pain, pain in the joints of the arms or legs, and headaches. Doctors of chiropractic (DCs) practice a conservative approach to health care that includes patient examination, diagnosis and treatment. DCs have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, lifestyle and dietary counseling.

  • There are 77,000 chiropractors in the United States who are required to pass a series of four national board exams1  and be state licensed.2 Roughly another 3,000 chiropractors work in academic and management roles. 

  • There are approximately 10,000 chiropractic students3  in 18 nationally accredited, chiropractic doctoral graduate education programs4  across the United States with 2,500 chiropractors entering the workforce every year.5 

  • An estimated 40,000 chiropractic assistants (CAs)6  are in clinical7  and business management roles for chiropractic practices across the United States.

  • It is estimated that chiropractors treat more than 35 million Americans (adults and children) annually.8  

  • Chiropractors are educated in nationally accredited, four-year doctoral graduate school programs9  through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship,10  with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools.11 

  • Chiropractors are designated as physician-level providers in the vast majority of states and federal Medicare program. The essential services provided by chiropractors are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Departments of Veterans Affairs and Defense, Federal Employees Health Benefits Program, Federal Workers' Compensation, and all state workers' compensation programs.12 

Patient Satisfaction/Clinical Effectiveness

  • In 2017, the American College of Physicians released updated low back pain guidelines that recommend first using non-drug treatments, such as spinal manipulation, for acute and chronic low back pain.13

  • Similarly,  a study published in the Journal of the American Medical Association in 2017 supports the use of spinal manipulative therapy as a first line treatment for acute low back pain.14

  • 95% of past-year chiropractic users say it's effective, and 97% of past-year chiropractic users are likely to see a chiropractor if they have neck/back pain.8

  • In a consumer survey, chiropractic outperformed all other back pain treatments, including prescription medication, deep-tissue massage, yoga, pilates, and over-the-counter medication therapies.15

  • Chiropractors are the highest rated healthcare practitioner for low-back pain treatments above physical therapists (PTs), specialist physician/MD (i.e., neurosurgeons, neurologists, orthopaedic surgeons), and primary care physician/MD (i.e., family or internal medicine).16  

  • With prescription pain drug abuse now classified as an epidemic17  in the United States and the number of spinal fusions soaring 500% over the last decade,18  the essential services provided by chiropractors represent a primary care approach for the prevention, diagnosis and conservative management of back pain and spinal disorders that can often enable patients to reduce or avoid the need for these riskier treatments.

  • Chiropractors' collaborative, whole person-centered approach reflects the changing realities of health care delivery and fits well into Accountable Care Organization (ACO) and patient-centered, medical home (PCMH) models bringing greater clinical efficiency, patient satisfaction and cost savings.19 

  • In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches by adding chiropractic to its pain management standard.20

References

[1]  National Board of Chiropractic Examiners (NBCE) www.NBCE.org. Accessed December 2013.

[2]  Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org Accessed December 2013.

[3]  Association of Chiropractic Colleges, www.acc.org. Accessed December 2013.

[4]  Council on Chiropractic Education (CCE) www.cce-usa.org is the agency certified by the U.S. Department of Education to accredit doctoral graduate school programs who offer Doctor of Chiropractic (D.C.) degree; Accessed December 2013.

[5]  Association of Chiropractic Colleges, www.acc.org. Accessed December 2013.

[6]  American Chiropractic Association (ACA) www.ACAtoday.org and Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org 2013.

[7]  Certified Chiropractic Clinical Assistant (CCCA) program.  Federation of Chiropractic Licensing Boards (FCLB), 2013.

[8] Gallup-Palmer College of Chiropractic Annual Report: Americans' Perceptions of Chiropractic. Gallup and Palmer College of Chiropractic. http://bit.ly/2jrr7TG

[9]  Council on Chiropractic Education (CCE) www.cce-usa.org 2013.

[10] Meeker, DC, MPH; Scott Haldeman, DC, PhD, MD; Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. 2002; 136(3): 216-227. http://annals.org/article.aspx?articleid=474085

[11] Coulter, Adams, Coggan, Wilkes, Gonyea. A Comparative Study of Chiropractic and Medical Education. Alternative Therapy Health Medicine. 1998; 4:64-75.

[12] American Chiropractic Association (ACA), 2013. https://www.acatoday.org/pdf/physicianstatus.pdf

[13] Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & for the Clinical Guidelines Committee of the American College of Physicians. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 166(7), 514. https://doi.org/10.7326/M16-2367 

[14] Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., … Shekelle, P. G. (2017). Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA, 317(14), 1451–1460. https://doi.org/10.1001/jama.2017.3086

[15] Consumer Reports Health Ratings Center. Back-Pain Treatments. ConsumerReports.org; July 2011.

[16] Consumer Reports Health Ratings Center. Relief for your aching back: What worked for our readers. ConsumerReports.org; March 2013.

[17] Unintentional Drug Poisoning in the United States. Centers for Disease Control and Prevention, 2010.  Prescription Drug Abuse. White House Office on National Drug Policy. Accessed November 2013.

[18] Whoriskey, Keating. Boom in spinal fusions questioned. Washington Post. Page 1. October 28, 2013; Rise in spinal fusion surgeries driven partly by financial incentives. Washington Post. November 13, 2013.

[19] Accountable Care Organizations Optimize Outcomes, Cost Savings and Patient Satisfaction with Chiropractic Care. Foundation for Chiropractic Progress. May 2013.

[20] Clarification of the Pain Management Standard. Joint Commission. https://www.jointcommission.org/assets/1/18/Clarification_of_the_Pain_Management__Standard.pdf  

Chiropractic: A Safe Treatment Option

Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches, and other neuromusculoskeletal complaints. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small. Many patients feel immediate relief following chiropractic treatment, but some may sometimes experience mild soreness or aching, just as they do after some forms of exercise. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.1

In addition to being a safe form of treatment, spinal manipulation is incredibly effective, getting patients back on their feet faster than traditional medical care. A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients who have experienced symptoms for one year or less. Similarly, a study published in the July 15, 2003, edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications. Moreover, a 2012 study in Spine found that only 1.5 percent of workers with back injuries whose first point of treatment was a doctor of chiropractic required surgery, compared to the 42.7 percent of workers whose first contact was a surgeon. 2

Neck Adjustments

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation—often called a neck adjustment—works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension.

Neck manipulation is a remarkably safe procedure. While some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, the best evidence3 suggests that this type of arterial injury often takes place spontaneously, or following everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or family physician—but that care is not the cause of the injury. The evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare – about 1 case in 5.85 million manipulations.4
 
To put this risk into perspective, if you drive more than a mile to get to your chiropractic appointment, you are at greater risk of serious injury from a car accident than from your chiropractic visit.

It is important for patients to understand the risks associated with some of the most common treatments for neck and back pain—such as nonsteroidal anti-inflammatory drugs (NSAIDS)—as these options may carry risks significantly greater than those of manipulation. According to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.5

Furthermore, surgery for conditions for which manipulation may also be used carries risks many times greater than those of chiropractic treatment. Even prolonged bed rest carries some risks, including muscle atrophy, cardiopulmonary deconditioning, bone mineral loss and thromoembolism.6

If you are visiting your doctor of chiropractic with upper-neck pain or headache, be very specific about your symptoms. This will help your doctor of chiropractic offer the safest and most effective treatment, even if it involves referral to another health care provider. If the issue of stroke concerns you, do not hesitate to discuss it with your doctor of chiropractic. Depending on your clinical condition, he or she can forego manipulation, and instead can recommend joint mobilization, therapeutic exercise, soft-tissue techniques, or other therapies.

Research Ongoing

ACA believes patients have the right to know about the health risks associated with any type of treatment, including chiropractic. Today, chiropractic researchers are involved in studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials, literature reviews and publishing papers reviewing the risks and complications of neck adjustment. All available evidence demonstrates that chiropractic treatment holds an extremely small risk. The chiropractic profession takes this issue very seriously and engages in training and postgraduate education courses to recognize the risk factors in patients, and to continue rendering treatment in the most effective and responsible manner.
 

References

1. Senstad O, et al. Frequency and characteristics of side effects of spinal manipulative therapy. Spine 1997 Feb 15;435-440.
2. Keeney BJ, et al. Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine 2013 May 15;38(11):953-64.
3. Cassidy D, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008; 33:S176–S183.
4. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.
5. Lanas A, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol 2005;100:1685–1693.
6. Lauretti W. The Comparative Safety of Chiropractic. In Daniel Redwood, ed., Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p. 230-8.

Chiropractic and the Opioid Epidemic: Rethinking Our Approach to Pain 

Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of tens of thousands of people in the United States. According to the Centers for Disease Control and Prevention (CDC), as many as one in four patients who receive prescription opioids long term for non-cancer pain in primary care settings struggles with addiction. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.

Deaths involving opioids have quadrupled since 1999; in 2014 alone, more than 14,000 people died from overdoses involving the drugs. That same year, another 2 million people abused or were dependent on opioids.

Beyond the risks of addiction and overdose, prescription drugs that numb pain may convince a patient that a musculoskeletal condition is less severe than it is or that it has healed. This misunderstanding can lead to overexertion and a delay in the healing process…or even permanent injury. Chiropractic and other conservative (non-drug) approaches to pain management can be an important first line of defense against pain and addiction caused by the overuse of prescription opioid pain medications.

Rising Recognition of the Value of Non-drug Approaches to Pain

There is a growing body of research that validates the effectiveness of chiropractic services, leading many respected health care organizations to recommend chiropractic and its drug-free approach to pain relief.

In 2017, the American College of Physicians (ACP) updated its guidelines for the treatment of acute and chronic low back pain to recommend first using non-invasive, non-drug treatments before resorting to drug therapies. ACP’s guidelines, published in the Annals of Internal Medicine and based on a review of randomized controlled trials and observational studies, cite heat therapy, massage, acupuncture and spinal manipulation (a centerpiece of chiropractic care) as possible options for non-invasive, non-drug therapies for low back pain. Only when such treatments provide little or no relief, the guidelines state, should patients move on to medicines such as ibuprofen or muscle relaxants, which research indicates have limited pain-relief effects. According to the guidelines, prescription opioids should be a last resort for those suffering from low back pain, as the risk of addiction and overdose may outweigh the benefits. (Listen to a podcast about this study by clicking the link above.)

In March 2016, the Centers for Disease Control and Prevention released guidelines for prescribing opioids that also promote non-pharmacologic alternatives for the treatment of chronic pain. In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S., including every major hospital, recognized the value of non-drug approaches by adding chiropractic and acupuncture to its pain management standard.

Conservative Care First: A Common Sense Approach


The American Chiropractic Association (ACA) encourages patients and health care providers to first exhaust conservative forms of pain management, when appropriate, before moving on to riskier, potentially addictive treatments such as opioids. To this end, ACA delegates met in Washington, D.C., in 2016 and adopted a policy statement proposing a solution to the dual public health concerns of inadequate pain management and opioid abuse. ACA’s policy statement supports:

  1. The investigation of non-pharmacologic interventions for pain treatment across a variety of patient populations and healthcare delivery setting

  2. The promotion of evidence-based non-pharmacologic therapies within best practice models for pain management

  3. The improvement of access to providers of non-pharmacologic therapies

  4. Interprofessional education to augment the training of pain management team

  5. Public health campaigns to raise awareness of drug-free treatment options for pain syndromes.