What is Chiropractic?
The word "chiropractic" means to be done by hand. The practice of chiropractic was established in 1895. It evolved from energetic healing traditions to an eclectic American medical practice. Chiropractic is a licensed alternative health (also called integrative medicine) care profession that emphasizes the body's ability to heal itself. It focuses on the spine and other joints in connection to the nervous system. It is the most established discipline in alternative healthcare.
Treatment includes manual therapy. This includes spinal manipulation. Other treatments in this field are heat and ice, electrical stimulation, dietary supplements, lifestyle factors, exercise and nutritional counseling.
Chiropractors interview the patient and obtain a medical history, perform an exam and perform tests. They then develop a working diagnosis. They then develop a management plan, start treatment and monitor progress. Chiropractors usually treat problems related to the musculoskeletal system.
The manual treatment, or adjustments, range from stretching and sustaining pressure to specific join manipulations. This is usually done by hand and involve a quick and gentle thrust. The reasoning behind this is to improve joint motion and function. Adjustments are normally done on the spine bu tother parts of the body may be treated this way.
The scope of practice varies from state to state. Health insurance plans may cover it but not all insurance does.
Education and Licensure Required of Chiropractors in the US
In order to legally practice in the United States, chiropractors are required to ear a Doctor of Chiropractic (DC) degree, pass the National Board of Chiropractic Examiners exam, and have a state license. Many states, not all, require chiropractors to pass to pass an exam about state specific laws and all states require practicing chiropractors to take continuing education classes.
A prerequisite for enrolling into a DC program in the United States, which is a 4 year degree, students are required to have had completed three years of undergraduate education.
Institutions that award the DC degree are accredited by the Council on Chiropractic Education. This is a recognized agency by the US Secretary of Education. In 2017, there were 15 accredited programs on 18 campuses.
Chiropractic education includes classes in anatomy, physiology, and other basic sciences. This also includes supervised clinical hours where students learn skills such as spinal assessment, adjustment techniques and making diagnosis. Some chiropractors complete postgraduate education in specialized fields such as orthopedics and pediatrics.
Is there Scientific Evidence?
Physicians question whether or not there is scientific evidence in treating the variety of conditions in which it is used. Koes et al, after conducting a review of systematic randomized clinical trials, found insufficient evidence to prove that spinal manipulation is useful for treating acute or chronic low back pain.
In other studies, they suggest that manipulation may be effective for acute low back pain in adults. It has not been proven in patients with chronic pain.
There are no studies published on chiropractic treatment of back pain on pediatric patients.
There is no evidence to support manipulation for migraines. There are no specific well documented data for pediatrics.
There were very few studies on children for asthma. One was conducted by Balon et al. It involved children with stable asthma. They were treated with active or simulated chiropractic as an adjunct to medical therapy. No improvement of asthma symptoms were found by researchers. "In children with mild or moderate asthma the addition of chiropractic spinal manipulation to usual medical care provided no benefit."
There are some chiropractors who do not believe that controlled clinical trials are the best way to evaluate methods. They believe that anecdotal evidence is enough.
Chiropractic Issues for the Physician
Some chiropractors actively promote themselves as a primary care provider and encourage spinal manipulation as a way to maintain wellness. Some have advised that birth is a traumatic event for the spine and may be the primary cause of illness in children and recommend an adjustment for a newborn infant. Pediatric treatment may be offered initially without cost, while the parents visit for themselves. They would consult a chiropractor due to word of mouth because they fear side effects from medication and they try anything to help their child, even if there is a risk.
Many families use a chiropractor but may not disclose that to their primary care physician. There was a study in Montreal, Quebec at a pediatric outpatient department. Less than 50% of parents told their doctor about using alternative therapies. There were similar results in other pediatric populations. This can be dangerous as the doctor must have all the information.
The ability to define or evaluate improvement in several illnesses is problematic for physicians and chiropractors because chiropractors do not have an equivalent training in medical diagnosis.
Chiropractic for Children
An issue identified by doctors is the wide variety of pediatric condition treated in the chiropractic setting. Many physicians assume patients use chiropractic mainly for muscoskeletal problems and that treatments are rare. This is not the case. It was found that in children it is used for colic, asthma, recurrent otitis media (ear infections), cancer and illness prevention. This is outside the scope for chiropractic.
Colic is often treated by chiropractors. This is because it causes a lot of distress to the parents and they seek help. It is a self limiting condition and it eventually stops. There was a study of colic by using chiropractic in a random controlled study that compared drug therapy with spinal manipulation. The two study groups could not be compared because the treatment was not blind. There were more interactions between the families and the chiropractors than the physicians who were giving the medication.
A Boston study of chiropractic care used by children found that it is often inconsistent with recommended` medical guidelines. Chiropractors give advice on diet, immunizations and general health. They will also sell herbal remedies and homeopathic preparations. This is overstepping their bounds.
A study in Alberta was performed on chiropractors beliefs. Most respondents believed that they should play a role as a secondary physician in the treatment of nonmusculoskeletal health problems in children.
In a Canada wide survey:
- 40% were musculoskeletal conditions
- 24% were headaches
- 7% were otitis media
- 5% other conditions
- 23% prevention
Why for Autism?
Like with many other treatments, chiropractic was applied towards autism. There are several who are speakers at AutismOne promoting this. There is a guide to "Amazing Ways Chiropractic Therapy Can Benefit Kids with Autism." This guide starts off with the scientific word for constipation, which is encoperesis. While true, constipation can be more challenging due to sensory processing, chiropractic has nothing to do with the bowels. The bowels and GI tract are outside of its scope.
They explain a normal treatment plan prescribed by a doctor. its 6 months of Miralax. Its true that Miralax is not approved for children but doctors write medications off label all the time. Metformin, for example, is a type 2 diabetes medication. It is very often prescribed for uterus owners with PCOS. It is not an label use for it but doctors do prescribe it anyway because they know it is safe. The guide is pressing parents to look at more natural remedies to help constipation instead of consulting an actual doctor for constipation.
The chiropractor in this guide is Dr. Johnson. He claims "I have the best kind of evidence I can ask for. My treatments work. That's not anecdotal proof, but clinical experience. That's a world of difference. I'm 100% confident in what I do. Its based on results that I see."
He later says that not every chiropractor treats autism or even children. "We do not treat autism. We treat kids with autism who see a significant benefit to their life and decrease of symptoms."
There are no studies available to support these outrageous claims.
There are chiropractors that believe that autism influences the body's central nervous system. The movement of the system is endangered , several physical, as well as behavioral issues. The inner nerve balance and spinal misalignment subject to those being autistic to a lifespan of painful disorders needing specialized and long term care. They will align the spine and "healing" the nervous system.
They believe this will promote the body to self heal naturally. "If a child can be healed with the use of non invasive, holistic alternative, reducing the amount of prescription medication, this method is preferred"
There is no scientific evidence proving chiropractors can "treat" autism. There is nothing to treat.