Chiropractic Medicine

Education

In the United States, chiropractic care is regulated by state and federal laws. A chiropractor must be licensed by the state in which they practice.

To become licensed as a Doctor of Chiropractic Medicine (DC), an individual must complete four years of undergraduate education, including biology, chemistry, anatomy, physiology, and other sciences. After completing the undergraduate program, students must attend an accredited chiropractic college for four additional years of study to earn a Doctor of Chiropractic degree.

In addition to taking courses specific to chiropractic medicine, such as spinal manipulation techniques, diagnostic imaging, and clinical nutrition, students must also complete clinical rotations where licensed chiropractors supervise them.

Licensure includes passing national board examinations, a series of 4 parts that include exams of approximately 5 hours each with an additional, 90-minute physiotherapy exam. Chiropractors are then required to pass state examinations pertinent to the scope of practice.

Once licensed, practitioners are required to take continuing education courses throughout their careers to maintain their licensure. This ensures that the practitioner keeps up with the latest treatments and technologies to provide the best possible care for patients.

Specialties and Approaches to Care

Chiropractors focus on the musculoskeletal system, specializing in specific areas such as sports medicine, neurology, or orthopedics.

Diplomates of Chiropractic are specialty areas certified by the National Board of Chiropractic Examiners (NBCE). Each Diplomate program is a comprehensive, post-doctoral level of study and examination focused on an area of concentration. There are currently nine Diplomate degrees available in chiropractic, including:

• Acupuncture
• Clinical Nutrition
• Clinical Biomechanics of Posture
• Internal Disorders
• Electromyography/Neurodiagnostics
• Neuromusculoskeletal Diagnosis and Intervention
• Orthopedics
• Radiology
• Rehabilitation and Sports Injuries.

Chiropractors with these specialties will have an additional designation in their professional name. Additionally, the NBCE offers a Physiotherapy specialty certification program.

Each Diplomate program is designed to provide chiropractors with additional knowledge and skills in the specific specialty.

Many chiropractors may also use additional treatments such as massage therapy, acupuncture, physical therapy, and nutritional counseling to help their patients achieve optimal health.

What conditions do chiropractors treat?

Chiropractors treat a wide range of conditions, including:

• Back pain and neck pain

• Sciatica

• Joint pains such as shoulder, elbow, or knee pain

• Headaches and migraines

• Carpal tunnel syndrome

• Disc herniation and degenerative disc disease

• TMJ disorders

• Strains and sprains

• Sports injuries

• Osteoarthritis

• Fibromyalgia

• Post-surgical rehabilitation

Some chiropractors specialize in nutrition counseling and typically have advanced degrees, such as a Diplomate in Clinical Nutrition or Lifestyle Medicine.

Evidence on Chiropractic Care

Evidence to support chiropractic care comes from various sources, including systematic reviews and randomized clinical trials. For example, a recent systematic review of studies with meta-analysis on the effectiveness of manual therapy for neck pain found that cervical spinal manipulation was associated with improvements in pain and disability, although limitations were included.

A comparison study found that chiropractic interventions were significantly more effective than placebo in reducing pain and improving function in people with chronic low back pain.

Much of the research on chiropractic care is limited to spinal manipulation on specified pain. However, there are a few limitations to this.

Evidence-based chiropractors use a variety of treatments

Evidence-based chiropractors utilize a variety of treatment tools and methods. Soft tissue treatment in the form of manual and instrument-assisted mobilization, both of which have evidence to support efficacy.

The manual myofascial release needs further study to provide continued support, but the current evidence supports its use as a low-risk treatment.

Rehabilitation exercises are the gold standard for musculoskeletal pain, and many chiropractors incorporate home exercise plans as a part of a comprehensive treatment plan. In addition, some chiropractors focus their entire practice on functional, practical exercise training to treat musculoskeletal disorders and injuries.

Chiropractors, specifically evidence-based chiropractors, typically include other components of a treatment plan rather than just spinal manipulation.

Low-force techniques are common

Chiropractors can perform mobilization or manipulation to mobilize a joint. The difference is in the force and amount of movement directed to the joint. Gentle mobilization and manipulation are effective in mobilizing joints and providing pain relief.

Chiropractors are perhaps best known for this skill, the “crack” of the joint. However, many other professions also manipulate joints. Osteopathic physicians are trained in manipulation, along with physical therapists and some Traditional Chinese Medicine Doctors. Manipulation has roots as far back as 400 BC and has been a part of many medical cultures.  Many medical doctors also take advanced courses in manipulation.

Chiropractors are one of many healthcare professionals who are trained in joint mobilization and manipulation.

Unspecific diagnosis in studies

Many studies focus on manipulation and a specific pain area, such as low back pain or manipulation and neck pain. The glaring limitation is that low back and neck pain are not accurate diagnoses. They describe the pain but do not specify the origin of that pain.

Low back pain can have several etiologies: disc herniation, disc bulge, facet syndrome, spondylolisthesis, spondylosis, sacroiliac joint strain, or lumbar muscle strain are all common causes of low back pain. Manual manipulation may not be appropriate in each of these cases.

When studying the efficacy of manipulation on low back pain, there needs to be more specificity to the diagnosis to determine whether the manipulation treatment should even be considered.

Is chiropractic care right for you?

Ultimately, finding a chiropractor who understands your condition and can provide evidence-based treatment tailored to your individual needs is essential. While there are many potential benefits of chiropractic care for specific situations, there are better choices for some.

Chronic conditions such as fibromyalgia, osteoarthritis, and other conditions that cause chronic musculoskeletal pain often include chiropractic care as an overall management strategy. This management strategy may include specific nutrition, exercise, massage therapy, medications, or other natural remedies. The goal of treatment, in this case, is to help manage symptoms and improve quality of life.

Tips on visiting the chiropractor

Here are a few tips to consider before starting chiropractic treatment.

1. Check with your insurance company to understand your benefits. Discuss with your chiropractor any additional services or fees that might be outside of your insurance plan.
2. Effective treatment should have a treatment plan that includes the number of visits, goals of treatment, and specifics of each treatment. Plans should also include expectations of progress and a referral to a specialist if that progress still needs to be met.
3. You should have a thorough evaluation at your first visit, with a medical history and physical and functional exam performed.
4. Chiropractors should communicate with their other healthcare providers, if applicable. Be sure to bring in any pertinent imaging or notes to your appointment. Imaging should only be performed in medically necessary.
5. Manipulation and mobilization are about restoring motion. There isn’t a bone that is “out of place” and is being “put back in.” If this is communicated to you by your chiropractor, there may be better fits.
6. Ask for a recommendation from your doctor or trusted source. Direct referrals from someone familiar with your needs are the best way to find a chiropractor.

Frequently Asked Questions

What is chiropractic medicine used for?

Chiropractic medicine is used to treat a variety of musculoskeletal conditions and pain. It focuses on manipulating the joints, muscles, and soft tissue to reduce pain, improve the range of motion and function, and help restore standard movement patterns.

Can chiropractors prescribe medications?

No. Chiropractors are not licensed to prescribe medications. However, some chiropractors have advanced training in herbal and nutritional therapies.

Does chiropractic care hurt?

No. Chiropractic adjustment techniques, when performed correctly, should not cause pain. Some people may experience mild discomfort during treatment depending on their condition and the method used, but this is temporary and should subside quickly after treatment.

What diseases can chiropractors treat?

Chiropractors can treat musculoskeletal conditions such as low back pain, neck pain, sciatica, headaches and migraines, carpal tunnel syndrome, plantar fasciitis, shoulder impingement syndrome, rotator cuff injuries, and more.

Depending on their qualifications and experience, they may also be able to treat specific sports injuries, herniated discs, and other conditions. It is always best to speak with a chiropractor about your particular situation. They can determine if chiropractic care is the right choice for you.

How often should you go to the chiropractor?

The frequency of visits will depend on the severity and complexity of your condition and the goals you have set. Your chiropractor should discuss a treatment plan that outlines how often you should visit and any other treatments they may recommend.

Generally speaking, most people feel improvement after 3-4 visits with a complete treatment plan of up to 8-10 visits. However, some conditions may require more sessions and ongoing maintenance treatments. Your chiropractor will be able to discuss this with you in detail.

It’s important to remember that chiropractic care is not a one-size-fits-all approach and should be tailored to your individual needs. Make sure you find a qualified, experienced, and reputable chiropractor who can provide the best care for you.

Be sure to ask questions and discuss any concerns, such as additional services or fees outside your insurance plan. Your chiropractor should always work with you to create a treatment plan tailored to your needs. This will help ensure the best possible outcome for your condition.