Chiropractic (1)

8/10/2019 Chiropractic (1)

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ChiropracticChiropractic

ByBy

Emily GreenoughEmily Greenough

Learning ObjectivesLearning Objectives

Name the founder of the modernName the founder of the modernprofession of chiropractic.profession of chiropractic.

Describe the basic concepts ofDescribe the basic concepts ofchiropractic.chiropractic.

What is the purpose of an adjustment?What is the purpose of an adjustment?

Learning ObjectivesLearning Objectives

Identify some of the commonIdentify some of the commonconditions treated by chiropractors.conditions treated by chiropractors.

What are some of the controversies orWhat are some of the controversies orcriticisms of chiropractic?criticisms of chiropractic?

What is Chiropractic?What is Chiropractic?

Manipulative and BodyManipulative and Body--Based practiceBased practiceof CAM interventions and therapies.of CAM interventions and therapies.

Profession which focuses on dx, tx, andProfession which focuses on dx, tx, andpreventing mechanical disorders of thepreventing mechanical disorders of themusculoskeletal system, their effects onmusculoskeletal system, their effects onthe nervous system and general health.the nervous system and general health.


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History of ChiropracticHistory of Chiropractic

ChiropracticChiropractic-- means done by hand,means done by hand,

referring to manipulation of the spine.referring to manipulation of the spine. Greek wordsGreek words cheircheir(hand) and(hand) and praxispraxis

(action)(action)

Chiropractic is a form of spinalChiropractic is a form of spinalmanipulation, one of the oldest healingmanipulation, one of the oldest healingpractices.practices.

Spinal manipulation was described bySpinal manipulation was described byHippocrates in ancient Greece.Hippocrates in ancient Greece.

The Founder of the ModernThe Founder of the ModernProfession of ChiropracticProfession of Chiropractic

Daniel DavidDaniel DavidPalmerPalmer

HealingHealingphilosophiesphilosophies

SpiritualismSpiritualism

Magnetic therapyMagnetic therapy

Background inBackground inosteopathicosteopathic

trainingtraining

DD PalmerDD Palmer

Observed the body had a natural healingObserved the body had a natural healingability controlled by the nervous system.ability controlled by the nervous system.

Coined the term subluxationsCoined the term subluxations--misalignments of the spine.misalignments of the spine.

Misalignments cause nerve compressionMisalignments cause nerve compressionthat interferes with proper flow of Innatethat interferes with proper flow of InnateIntelligence (God) to body organs, resultsIntelligence (God) to body organs, resultsin disease or disharmony.in disease or disharmony.

A.k.a. Innate Life Force, Universal IntelligenceA.k.a. Innate Life Force, Universal Intelligence

The First Experiment withThe First Experiment withChiropracticChiropractic

18951895--Palmers storyPalmers story

examination found a sore lump on Lillards back,examination found a sore lump on Lillards back,misalignment caused deafnessmisalignment caused deafness

Lillards storyLillards story-- daughter reports book to backdaughter reports book to back

Lillards deafness was told to be improved,Lillards deafness was told to be improved,

w/out any other explanation.w/out any other explanation. 18961896-- added treatment to schooladded treatment to school

Now known as Palmer College of ChiropracticNow known as Palmer College of Chiropractic

90% of chiropractors believe the vertebral90% of chiropractors believe the vertebralsubluxation plays significant role in all or mostsubluxation plays significant role in all or mostdiseasesdiseases


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Basic Concepts of ChiropracticBasic Concepts of Chiropractic

The body has a powerful selfThe body has a powerful self--healinghealingability.ability.

The bodys structure (primarily the spine)The bodys structure (primarily the spine)and its function are closely related, andand its function are closely related, andthis relationship affects health.this relationship affects health.

Chiropractic therapy is given with theChiropractic therapy is given with thegoals of normalizing this relationshipgoals of normalizing this relationshipbetween structure and function andbetween structure and function andassisting the body as it heals.assisting the body as it heals.

The ChiropractorThe Chiropractor

In the U.S. chiropractors perform overIn the U.S. chiropractors perform over

90% of manipulative treatments.90% of manipulative treatments.Adjustments (special emphasis on spine)Adjustments (special emphasis on spine)

Treatment that seeks to eliminate painTreatment that seeks to eliminate pain

Involve applying a controlled, sudden forceInvolve applying a controlled, sudden forceto a jointto a joint

Increases the range and quality of motionIncreases the range and quality of motion

in the area being treatedin the area being treated

Conditions Commonly TreatedConditions Commonly Treatedby Chiropractorsby Chiropractors

Back pain including lowBack pain including low--back painback pain

Neck painNeck pain

Headaches including migrainesHeadaches including migraines

Sports InjuriesSports Injuries Repetitive strainsRepetitive strains

OthersOthers

Asthma, Arthritis, Bursitis, Cerebral Palsy,Asthma, Arthritis, Bursitis, Cerebral Palsy,Flu symptoms, DM, Infertility, etcFlu symptoms, DM, Infertility, etc

PrevalencePrevalence

NCCAMNCCAM

Estimated Americans (1997) madeEstimated Americans (1997) madenearly 192 million visits a year tonearly 192 million visits a year tochiropractors.chiropractors.

Over 88 million of those visits were toOver 88 million of those visits were totreat back or neck pain.treat back or neck pain.

1818--38 million annually reported for relief38 million annually reported for reliefof head and neck pain.of head and neck pain.


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Cervical Spine ManipulationCervical Spine ManipulationBefore and AfterBefore and After

Dose Response For Chiropractic Care of Chronic Cervi cogenic HeadacheDose Response For Chiropractic Care of Chronic Cervi cogenic Headacheand Associated Neck Pain: A Randomized Pilot Studyand Associated Neck Pain: A Randomized Pilot Study

Journal of Manipulative and Physiologic TherapiesJournal of Manipulative and Physiologic Therapies(2004) vol. 27 issue 9(2004) vol. 27 issue 9

ObjectiveObjectiveAcquire information for designing a largeAcquire information for designing a largeclinical trial and determine its feasibilityclinical trial and determine its feasibilityand to make preliminary estimates of theand to make preliminary estimates of therelationship between headache outcomesrelationship between headache outcomesand the number of visits to a chiropractorand the number of visits to a chiropractor

Study DesignStudy Design

Randomized, control trialRandomized, control trial

Dose Response For Chiropractic Care of Chronic Cervicogenic HeadacheDose Response For Chiropractic Care of Chronic Cervicogenic Headache

and Associated Neck Pain: A Randomized Pilot Studyand Associated Neck Pain: A Randomized Pilot StudyJournal of Manipulative and Physiologic TherapiesJournal of Manipulative and Physiologic Therapies

(2004) vol. 27 issue 9(2004) vol. 27 issue 9

SubjectsSubjects

24 adults with chronic cervicogenic24 adults with chronic cervicogenic

headacheheadache

MethodsMethods

Randomly allocated to 1, 3, or 4 visits perRandomly allocated to 1, 3, or 4 visits perweek for 3 weeks.week for 3 weeks.

Chiropractors allowed 2 physical modalitiesChiropractors allowed 2 physical modalitieseach visit. (heat and soft tissue therapy)each visit. (heat and soft tissue therapy)

Dose Response For Chiropractic Care of Chronic Cervi cogenic HeadacheDose Response For Chiropractic Care of Chronic Cervi cogenic Headache



Outcomes MeasuredOutcomes Measured

Modified Von Korff Scales (MVK)Modified Von Korff Scales (MVK)

MVK pain scale rating: HA pain today, worst HAMVK pain scale rating: HA pain today, worst HApain in last 4 weeks, average HA pain in last 4pain in last 4 weeks, average HA pain in last 4weeks.weeks.

MVK disability scale measures interferenceMVK disability scale measures interferencewith: daily activities, social and recreationalwith: daily activities, social and recreationalactivities, ability to work outside or aroundactivities, ability to work outside or aroundhouse.house.


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Dose Response For Chiropractic Care of Chronic Cervicogenic HeadacheDose Response For Chiropractic Care of Chronic Cervicogenic Headacheand Associated Neck Pain: A Randomized Pilot Studyand Associated Neck Pain: A Randomized Pilot Study


Feasibility of a larger study wasFeasibility of a larger study wasdetermined by:determined by:

Completion rates for the f/u questionnairesCompletion rates for the f/u questionnaireshad to be 90%had to be 90%

Participants had to attend at least 2/3 ofParticipants had to attend at least 2/3 ofscheduled visitsscheduled visits

Participants reported number of visitsParticipants reported number of visitssought outside the study.sought outside the study.



Baseline VariablesBaseline Variables SociodemographicsSociodemographics

General health statusGeneral health status

energy/fatigueenergy/fatigue

emotional well beingemotional well being

self rated healthself rated health

depressiondepression

2 visits to establish baseline2 visits to establish baseline

Dose Response For Chiropractic Care of Chronic Cervicogenic HeadacheDose Response For Chiropractic Care of Chronic Cervicogenic Headache



ComplianceCompliance

Contacted by phone during weeks 1, 2, 3,Contacted by phone during weeks 1, 2, 3,

4, 6, 8, 10 and 12 to keep them engaged4, 6, 8, 10 and 12 to keep them engagedand remind them to fill out questionnairesand remind them to fill out questionnaires

Reminder calls for appointmentsReminder calls for appointmentsAllowed to seek care outside the studyAllowed to seek care outside the study

Dose Response For Chiropractic Care of Chronic Cervi cogenic HeadacheDose Response For Chiropractic Care of Chronic Cervi cogenic Headache



FindingsFindings

For HA pain, substantial differences wereFor HA pain, substantial differences were

found between participants receiving 1found between participants receiving 1treatment/week and those receiving eithertreatment/week and those receiving either

3 or 4 treatments/week.3 or 4 treatments/week. Comparable differences between groupsComparable differences between groups

were found for HA disability at 12 weeks.were found for HA disability at 12 weeks.

Neck pain and associated disabilityNeck pain and associated disabilityappeared to parallel HA outcomes.appeared to parallel HA outcomes.


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Dose Response For Chiropractic Care of Chronic Cervicogenic HeadacheDose Response For Chiropractic Care of Chronic Cervicogenic Headacheand Associated Neck Pain: A Randomized Pilot Studyand Associated Neck Pain: A Randomized Pilot Study


FindingsFindings Outside careOutside care 3 sought unscheduled treatment or outside3 sought unscheduled treatment or outside

carecare

NoncomplianceNoncompliance

Only 1 participant missed a treatment scheduleOnly 1 participant missed a treatment schedule



ConclusionConclusion

Participants willing to be randomized,Participants willing to be randomized,follow tx protocol, and complete f/ufollow tx protocol, and complete f/uquestionnaires.questionnaires.

Data suggests support for a doseData suggests support for a dose--responseresponserelationship between cervicogenic HArelationship between cervicogenic HApain/disability and number of chiropracticpain/disability and number of chiropractictreatments.treatments.

Larger number of visits produces greaterLarger number of visits produces greaterbenefits.benefits.

A Controlled Trial of Cervical Manipulation of MigraineA Controlled Trial of Cervical Manipulation of MigraineAustralian and New Zealand Journal of MedicineAustralian and New Zealand Journal of Medicine

(1978) vol. 8(1978) vol. 8

ObjectiveObjective Evaluate the efficacy of cervical manipulation forEvaluate the efficacy of cervical manipulation for

migrainesmigraines

Study DesignStudy Design

Controlled trial of 6 monthsControlled trial of 6 months SubjectsSubjects

85 volunteers (males 33, females 52)85 volunteers (males 33, females 52)

Suffering from migraines (mean 19 years)Suffering from migraines (mean 19 years)

Under the age of 55 yearsUnder the age of 55 years


(1978) vol. 8(1978) vol. 8

Treatment GroupsTreatment Groups-- no more than 2 x/weekno more than 2 x/week Chiropractic ManipulationChiropractic Manipulation

Required to manipulate the spineRequired to manipulate the spine-- movement ofmovement ofjoints beyond normal limitationsjoints beyond normal limitations

ManipulationManipulation

Required medical practitioner and physiotherapistRequired medical practitioner and physiotherapistto manipulate the spineto manipulate the spine--movement of jointsmovement of jointsbeyond normal limitationsbeyond normal limitations

ControlControl

Require medical practitioner and physiotherapist toRequire medical practitioner and physiotherapist toperform cervical mobilizationperform cervical mobilization-- movement of jointsmovement of jointswithin normal limitationswithin normal limitations


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(1978) vol. 8(1978) vol. 8

HypothesisHypothesis PostPost--treatment scores for the wholetreatment scores for the wholesample would be less than presample would be less than pre--treatmenttreatmentscoresscores

Cervical manipulation (performed by anyCervical manipulation (performed by any

therapist) would be more effective than thetherapist) would be more effective than thecontrol treatmentcontrol treatment

Chiropractic treatment would be moreChiropractic treatment would be moreeffective than the other 2 treatmentseffective than the other 2 treatments


(1978) vol. 8(1978) vol. 8

ComplianceCompliance

required migraine form at the end ofrequired migraine form at the end ofeach migraine.each migraine.

duration of attack (duration hr/attack)duration of attack (duration hr/attack)

pain (visual analogue scale intensity)pain (visual analogue scale intensity)

disability (5 point scaledisability (5 point scale--1=usual activities,1=usual activities,5=had to remain in bed)5=had to remain in bed)

Outcome MeasuresOutcome Measures--phonephone

migraine frequency was compared tomigraine frequency was compared tomigraine form to compare data.migraine form to compare data.


(1978) vol. 8(1978) vol. 8

ResultsResults

Whole sample, migraine symptoms wereWhole sample, migraine symptoms were

significantly reduced.significantly reduced.

No difference in outcome found betweenNo difference in outcome found between

therapists, or by those who received thetherapists, or by those who received thecontrol treatment.control treatment.

Chiropractic was no more effective atChiropractic was no more effective atreducing duration, disability, or frequency,reducing duration, disability, or frequency,but greater reduction in pain variant.but greater reduction in pain variant.

Controversies and CriticismControversies and Criticism

Inside the professionInside the profession

The Mixers, Straights, and ReformersThe Mixers, Straights, and Reformers

Concept of subluxationsConcept of subluxations

Use of appropriate physical therapyUse of appropriate physical therapytechniques for conditionstechniques for conditions


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Outside the professionOutside the profession

Effectiveness of treatmentsEffectiveness of treatments NonNon--manual treatmentsmanual treatments

heat and ice, magnetic therapy, nutritionheat and ice, magnetic therapy, nutritioncounseling and dietary supplementscounseling and dietary supplements

Potential risksPotential risks

Presumed to be safe from what is knownPresumed to be safe from what is known

Osteoporosis compared to healthier boneOsteoporosis compared to healthier bone


Scientific basisScientific basis

Research finding had missing or poorResearch finding had missing or poor--

quality data.quality data.

Overall research findings, unable to provideOverall research findings, unable to provideenough evidence to support effectivenessenough evidence to support effectiveness

of treatment.of treatment.

Maybe more effective than sham therapy,Maybe more effective than sham therapy,but no more or less than other treatments.but no more or less than other treatments.

Conclusions?Conclusions?

Research studies are ongoingResearch studies are ongoing

Key area of research is the basic science ofKey area of research is the basic science of

what happens in the body such as the cellswhat happens in the body such as the cellsand nerves when specific treatments areand nerves when specific treatments are

given.given. Risk of complications from adjustmentsRisk of complications from adjustments

of lowof low--back pain appear very low, butback pain appear very low, butrisks increase for adjustments of therisks increase for adjustments of theneck.neck.

Thank YouThank You

Any Questions?Any Questions?

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Chiropractic (1)