What is Chiropractic

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Chiropractic today is one of the largest primary-contact health care professions in Canada with over 5,000 practicing chiropractors. Approximately four and a half million Canadians use the services of a chiropractor each year.1

Chiropractic is a regulated health profession recognized by statute in all Canadian provinces and American states. The benefits of chiropractic care are well recognized by other health practitioners. In a 1995 survey, 44 per cent of Ontario and Alberta physicians indicated that they refer patients for chiropractic treatment.2

Drug-free, non-invasive health care

Chiropractic manipulation is a drug-free, non-invasive manual procedure which utilizes the highly-refined skills developed during four intensive years of chiropractic education. Chiropractors assess disorders related to the spine, nervous system, and joints of the extremities and provide diagnosis, treatment and prevention of those disorders.

The primary goal of chiropractic manipulation, also referred to as adjustment, is to treat areas of decreased movement in the joints of the spine which can create a reaction in surrounding tissues (ligaments, muscles and nerves) resulting in pain, dysfunction and muscular spasm. Chiropractors are also trained to prescribe therapeutic exercise and other non-invasive therapies including dietary counselling.

Manipulation is a highly controlled procedure which 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.

The vast majority of patients who seek chiropractic care do so for complaints of the musculoskeletal system, most often for conditions affecting the spine.3

Scientific study of spinal manipulation has clearly demonstrated that chiropractic treatment improves function and is effective for common conditions such as headache, neck, and back pain.4 Between 86 and 96 per cent of all visits to chiropractors are for these or similar conditions.5

Primary & complementary care

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

Chiropractic care may also be palliative, providing symptomatic relief to patients with chronic conditions. By treating the musculoskeletal elements of such disorders, chiropractic treatment improves the general well-being of the patient. In this regard, Canada’s chiropractors frequently provide complementary care as one element of a patient’s overall treatment program.

For example, the Canadian Memorial Chiropractic College is a leader in working with other health care providers to offer complementary care to HIV-positive patients at St. Michael’s Hospital, Wellesley Central Site in Toronto, to dually-challenged children and adults at the Muki Baum Clinics, and to patients at St. John’s Rehabilitation Hospital.

Working with other health professionals

Governments and legislative bodies across Canada and around the world have conducted extensive reviews of the chiropractic profession and have consistently recommended that chiropractic services be included in the mainstream health care system.6

Regulation & standards

In Ontario, chiropractic has been governed by statute since 1925. Currently it is regulated by the Chiropractic Act (1991) which is administered by the College of Chiropractors of Ontario created in accordance with the Regulated Health Professions Act (RHPA)(1991).

Chiropractors along with medical doctors, dentists, psychologists, and optometrists have the legislated right and obligation to communicate a diagnosis and to use the title doctor. The College of Chiropractors of Ontario is established by legislation in the same manner, and with the same structure and similar regulations, as the regulatory bodies for other health professions. It is responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.

May, 2000

 

  1. Use of Alternative Health Care Practitioners by Canadians, Miller W, Canadian Journal of Public Health, 88(3):154-58, 1997.
  2. Alternative Medicine and General Practitioners: Opinions and Behaviours, Vernoef MJ, Sutherland LR, Canadian Family Physician, 41:1005-1011, 1995.
  3. Chiropractors: Do They Help?, Kelner M, Hall O, Coulter I, Toronto, Fitzhenry & Whiteside, 1980. Demographic and Clinical Characteristics of Chiropractic Patients: A five year study of patients treated at the Canadian Memorial Chiropractic College, Waalen DP, White TP, Waalen JK, Journal of the Canadian Chiropractic Association, 38(2):75-82, 1994. Canadian Chiropractic Resources Databank: A Profile of Canadian Chiropractors, Kopansky-Giles D, Papadopoulos C, Journal of the Canadian Chiropractic Association, 41(3): 155-191, 1997.
  4. See appendix of research references.
  5. Chiropractors: Do They Help?, Kelner M, Hall O, Coulter I, Toronto, Fitzhenry & Whiteside, 1980. Demographic and Clinical Characteristics of Chiropractic Patients: A five year study of patients treated at the Canadian Memorial Chiropractic College, Waalen DP, White TP, Waalen JK, Journal of the Canadian Chiropractic Association, 38(2):75-82, 1994. Canadian Chiropractic Resources Databank: A Profile of Canadian Chiropractors, Kopansky-Giles D, Papadopoulos C, Journal of the Canadian Chiropractic Association, 41(3): 155-191, 1997.
  6. The Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain, Manga P, Angus D, Papadopoulos C, Swan W. Commissioned by the OCA. Funded by the Ontario Ministry of Health, 1993.Chiropractic Services Review, An Internal Review, Wells et al. Commissioned by the Ontario Ministry of Health, 1994.

Clinical Updates

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  • Our elderly are adrift in a sea of drugs (June 3, 2004)
  • It’s Your Health: Breast Cancer (May 26, 2004)
  • Eating Fish Regularly in Late Pregnancy Boosts Fetal Growth Rate (May 10, 2004)
  • Benefits and Risks of Hormone Replacement Therapy (Estrogen with or without Progestin) (May 11, 2004)
  • Cosmetic Laser Treatments (May 5, 2004)
  • Obese teens more likely to be victims or perpetrators of bullying (May 5, 2004)
  • Exercise Helps Heart Attack Patients Who Are Depressed, Without Social Support (May 4, 2004)
  • Hospitalizations due to Bicycle-Related Injuries Among Children and Youth Down 15% in Five Years, Reports CIHI (April28, 2004)
  • High-Fat Fast-Food Breakfast Produces Rush of Inflammatory Factors into Blood Stream, UB Study Finds – Repeated bouts may leave blood vessels in chronic state of inflammation (April 21, 2004)
  • Top 10 Functional Food Trends for 2004 (April 13, 2004)
  • Cdn. reaction to antidepressants advisory cautious (April 6, 2004)
  • Top 10 Functional Food Trends for 2004 (April 6, 2004)
  • Red wine fights cancer, leaves healthy cells alone, new study shows (April 6, 2004)
  • Low Activity Levels Found Among Children With Asthma Due to Parental Health Beliefs, Disease Severity (April 6, 2004)
  • Drop Your Walkie-Talkie (April 2004)
  • Kids who avoid milk break more bones (March 30, 2004)
  • Nuts are chock-full of nutrients and several large, randomized trials suggest regular consumption cuts risk of heart disease (March 23, 2004)
  • Research council pores over back pain (March 2, 2004)
  • Fighting Infertility At The Chiropractor (February 25, 2004)
  • Safe Use of Natural Health Products (January 29, 2004)
  • Benefits and Risks of Combined (Estrogen and Progestin) Hormone Replacement Therapy (January 23, 2004)
  • Study Finds Huge Variability in Vitamin E Absorption (January 16, 2004)
  • RSNA: Cartilage injuries give golfers hip pain (January 6, 2004)
  • High Intake of Vitamin D Linked to Reduced Risk of Multiple Sclerosis (January 2004)
  • Motor Vehicle Accidents: the Most Common Cause of Traumatic Vertebrobasilar Ischemia PDF (November 2003)
  • Cervical Artery Dissection, Imaging, Trauma and Causal Inference PDF (November 2003)
  • Protection of Personal Health Information – Privacy legislation (December 10, 2003)
  • New warning on herbs

What Happens During a Treatment?

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During your first visit, the chiropractor will want to know about your health history as well as your current complaint. Your home and work life as well as your level of physical activity may also affect your health, so don’t be surprised to be asked questions about these.

Although chiropractors use their hands for most treatments, they also use other methods such as heat, light, specialized adjusting instruments, ultrasound, electrotherapy, personalized exercise programs, muscle-testing and balancing. Your chiropractor can also give you information and guidance on how you can stay healthy through proper nutrition, exercise and lifestyle changes.

Efficacy Of Chiropractic Treatment

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The following is a small sampling of the large volume of research conducted into chiropractic effectiveness and safety.

Efficacy of Chiropractic Treatment

The Appropriateness of Spinal Manipulation for Low Back Pain, Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brooke RH. Commissioned by the RAND research corporation, Document No. R-4025/1-CCR/FCER, 1991.

Conclusion: Support is consistent for the use of spinal manipulation as a treatment for patients with acute low-back pain and an absence of other signs of lower-limb, nerve-root involvement.

Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, a Nonsteroidal Anti-Inflammatory Drug and Spinal Manipulation, Lynton GF, Muller, R, Journal of Manipulative and Physiological Therapeutics, 22:376-81, 1999.

Conclusion: Spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.

Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow-up, Meade TW, Dyer S, Browne W, Frank AO, The British Medical Journal, Vol 311, August 5, 1995.

Conclusion: Those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.

Trunk Exercise Combined with Spinal Manipulative or NSAID therapy for Chronic Low Back Pain: A Randomized, Observer-Blinded Clinical Trial, Bronfort G, Goldsmith CH, Nelson CF, Boline PD, Anderson AV, Journal of Manipulative and Physiological Therapeutics, Vol 19, No 9 Nov/Dec 1996.

Conclusion: Each of the three therapeutic regimes was associated with similar and clinically important improvement over time, however, there was an increase in adverse reactions with NSAIDS.

Manipulative Therapy Versus Education Programs in Chronic Low Back Pain, Triano JJ, McGregor M, Hondras MA, Brennan PC, Spine, Vol 20, No 8, 948-955, 1995.

Conclusion: Greater improvement was noted in pain and activity tolerance in the manipulation group. Immediate benefit from pain relief continued to accrue after manipulation, even for the last encounter at the end of the 2-week treatment interval.

Multicenter Trial of Physiotherapy in the Management of Sciatic Symptoms, Coxhead CE et al, Lancet, 1:1065-1068, 1981.

Conclusion: Greater reductions in perceived pain were reported by those in the spinal manipulative therapy (SMT) group. Combinations of SMT and exercise produced the optimal results.

Chiropractic in the United States: Training, Practice and Research, U.S. Department of Health and Human Services, AHCPR Research Report, Dec.1997.

Chiropractic in New Zealand, Report of the Commission of Inquiry, Hasselberg PD, Government Printer, Wellington, 1979.

Medicare Benefits Review Committee, Thompson CJ, Commonwealth Government Printer, Australia 1986.

Legitimization for Vissa Kiropraktorer, Commission on Alternative Medicine, SOU, 1987.

Efficacy of Various Forms of Conservative Treatment in Low Back Pain, Postacchini F, et al, Neuro-Orthop, 6:28-35, 1988.

Conclusion: Spinal manipulative therapy was found to be the superior treatment in acute cases.

Spinal Manipulation in the Treatment of Low Back Pain, Kirkaldy-Willis WH, Cassidy JD, Canadian Family Physician, 31:535-540, 1985.

Conclusion: Strong support for the value of manipulation in the treatment of chronic lumbar facet and sacroiliac syndrome.

Spinal Manipulation for Chronic Low Back Pain: A Review of the Evidence, Vernon H, Journal of the Canadian Chiropractic Association, 40(3), 1996.

The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. Manga P, Angus D, Papadopoulos C, Swan W. Commissioned by the OCA. Funded by the Ontario Ministry of Health. 1993.

Conclusion: On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP [lower back pain]. Many medical therapies are of questionable validity or are clearly inadequate. There is an overwhelming body of evidence indicating that chiropractic management of LBP is more cost-effective than medical management.

Chiropractic Services Review, An Internal Review, Wells et al. Commissioned by the Ontario Ministry of Health, 1994.

Conclusion: On the grounds of effectiveness, safety, patient satisfaction and public acceptance of chiropractic services, particularly in the treatment of musculoskeletal disorders, chiropractic services should continue to be funded by the Ontario Health Insurance Plan.

Paediatric Chiropractic

The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized, Controlled, Clinical Trial with a Blinded Observer, Wiberg JMM, Nordsteen J, Nilsson N, Journal of Manipulative and Physiological Therapeutics, Vol 22, No 8, October 1999.

Conclusion: Spinal Manipulation is effective in relieving infantile colic.

Musculoskeletal Pain in Primary Paediatric Care: Analysis of 1000 Consecutive General Paediatric Clinic Visits, de Inocenio J, Paediatrics, Vol. 102 No. 6, Dec. 1998.

Conclusion: MSP [musculoskeletal pain] represents a frequent presenting complaint in general paediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing paediatrics continuing medical education and training programs.

A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma, Balon J et al, The New England Journal of Medicine, Vol. 339, No. 15, October 1998.

Conclusion: Spinal manipulative therapy is not effective in relieving childhood asthma.

Conditions Treated

Use of Chiropractic Services from 1985 through 1991 in the United States and Canada. Hurwitz EL, Coulter ID, Adams AH, Genovese B, Shekelle PG, American Journal of Public Health, Vol. 88, No 5, 771-776, May 1998.

Conclusions: Approximately 96 percent of patients seek chiropractic care for conditions mostly related to the neuromusculoskeletal system. These health problems included back disorders, arthritis and rheumatism, headaches and other musculoskeletal disorders.

Job Analysis of Chiropractic in Canada. Published by the National Board of Chiropractic Examiners, 1993.

Chiropractors: Do They Help?, Kelner M, Hall O, Coulter I, Fitzhenry & Whiteside, Toronto, 1980.

Demographic and Clinical Characteristics of Chiropractic Patients: A five year study of patients treated at the Canadian Memorial Chiropractic College, Waalen DP, White TP, Waalen JK, Journal of the Canadian Chiropractic Association, 38(2): 75-82, 1994.

Canadian Chiropractic Resources Databank: A Profile of Canadian Chiropractors, Kopansky-Giles D, Papadopoulos C, Journal of the Canadian Chiropractic Association, 41(3): 155-191, 1997.

Trends in Alternative Medicine Use in the United States. 1990-1997. Results of a Follow-up National Survey. Eisenberg DM, Davis RB, Ettner SL, et al. The Journal of the American Medical Association, 280: 1569-1575, 1998.

Use of Alternative Health Care Practitioners by Canadians. Millar WJ, Canadian Journal of Public Health, May-June 1997.

Chiropractic and Safety

The conclusions from the following references are summarized in the Fact File document titled Chiropractic and Safety.

The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine, 21(15); 1746-1760, 1996.

Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation. Haldeman S, Kohlbeck FJ, McGregor M, Spine, 24(8); 785-794, 1999.

Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents, Rome PL, Chiropractic Journal of Australia, Vol. 29, No. 3, September 1999.

Carotid Artery Dissection due to Elongated Styloid Process, Zuber M, Mos JI, Neurology, November 1999.

A Risk Assessment of Cervical Manipulation v. NSAIDS for the Treatment of Neck Pain, Dabbs V, Lauretti WJ, Journal of Manipulative and Physiological Therapeutics, 18:530-6, 1995.

Redefining Whiplash and Its Management: Scientific monograph of the Quebec task force on whiplash-associated disorders. Spitzer WO, Skovron ML et al, Spine, 20:85, 1995.

Conservative Management of Mechanical Neck Pain: A Systematic Overview and Meta-Analysis. Aker PD, Gross AR, et al, The British Medical Journal, 313: 1291-96, 1996.

May, 2000

Chiropractic Profession Responds to Inquest Recommendations Supports Jury’s Call for Research and Collaboration

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Toronto, March 25, 2004 – The Canadian Chiropractic Association (CCA) today stated its support for key recommendations made by the jury in the Lana Dale Lewis inquest which concluded in Ontario in January of this year. The jury’s recommendations on research and inter-professional collaboration are welcomed said the CCA, and reinforce the value of the many activities already taking place in the chiropractic profession in these areas.

Ms. Lewis died of a stroke 17 days following a neck adjustment by her chiropractor whom she had been seeing for treatment of migraine headaches for approximately eighteen months. The jury in the inquest ruled that the cause of her stroke was “accidental” and made recommendations to the profession regarding research, collaboration, and professional practices. Recommendations were also directed to the Ontario Ministry of Health and Long-Term Care, the Coroner’s Office of Ontario and other health professions.

“The jury’s first recommendation to conduct a study ‘to assess the relationship, if any, between high neck manipulation and stroke’ speaks directly to the profession’s current research agenda,” said CCA president, Dr. Grayden Bridge. “While considerable research has already taken place, the rarity of complications associated with neck adjustment has made this a difficult area to study. Further study can only help to shed more light. In fact, three such studies are currently underway in Canada.”

Three Studies Underway
The Canadian chiropractic profession is currently involved in three studies into neck adjustment. The Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders is an international, multi-centre, multi-disciplinary study in which the Canadian chiropractic profession is involved. Two of the Task Force’s five studies are focused specifically on risks associated with the treatment of neck pain. One of the studies will examine neck adjustment and the other will examine the prescription of non-steroidal anti-inflammatory drugs for the treatment of neck pain. Second, the Chiropractic Neck Study is a case control study to assess the risk of stroke associated with neck adjustment under the direction of Dr. Michael Hill, a neurologist and epidemiologist with the Departments of Community Health Sciences and Clinical Neurosciences at the University of Calgary.

Third, the work of Dr. Walter Herzog, Associate Dean of Research, Faculty of Kinesiology, at the University of Calgary into the biomechanics of neck adjustment is ongoing.

“These are excellent studies that directly address the jury’s recommendations and which will help further inform patient care,” said Dr. Bridge.

Inter-Professional Collaboration
The CCA also expressed strong support for the two jury recommendations directed at fostering inter-professional co-operation and collaboration. A significant area of inter-professional collaboration is in research. The Consortium of Canadian Chiropractic Research Centres (CCCRC) currently has 12 university-based research sites established including the chiropractic research programs at l’Université du Québec à Trois Rivières and the Canadian Memorial Chiropractic College. It has sponsored two Research Chairs in chiropractic – one at the University of Toronto and one at the University of Calgary. The CCCRC has also sponsored four significant inter-professional research symposia since its inception. As well, the CCA is an affiliate member of the international Canadian Cochrane Network and Centre and a member of the chiropractic profession serves on the Executive Committee of the Network. The mission of the Cochrane Collaboration is to prepare, maintain and promote the accessibility of systematic reviews of the effects of health care interventions.

“These inter-professional research alliances speak to the intent of the jury’s recommendations and will further inform the quality, efficacy and safety of patient care,” said Dr. Bridge.

The jury also recommended the establishment of inter-professional committees to “promote constructive dialogue and sharing of information between the professions.” Dr. Bridge noted that such a committee exists in Manitoba and that the CCA supports the establishment of similar committees in all jurisdictions. He also stated the profession’s support for further improvements in patient co-management between doctors of chiropractic and medical doctors and noted that the chiropractic profession is developing materials and guidelines to assist members in taking leadership in this regard.

Clinical Practice Guidelines
Regarding the jury’s recommendation that the profession review and update its current Clinical Practice Guidelines (CPGs), Dr. Wanda-Lee MacPhee, president of the Canadian Federation of Chiropractic Regulatory Boards, advised that the chiropractic profession commenced review and development of new CPGs in 2001. The first new guideline will be on neck pain and is expected to be released for public consultation in the spring of this year. “These new Guidelines are being developed to international standards and the Guidelines Development Committee includes representatives from the medical community and the public,” said Dr. MacPhee.

Informed Consent
“We are pleased to report that action on the jury’s recommendations to obtain written informed consent to treatment and to be advised of both the risk and benefits of treatment has been in place for more than 15 years,” said Dr. Bridge. “All regulated health professions are required in law to obtain informed consent to treatment and the chiropractic profession has been a leader in obtaining written consent.” The CCA also advised that a patient hand-out specifically on neck adjustment has been available to all members of the profession to use in their practices since 1998.

Professional Practices
The jury also made a variety of recommendations regarding specific practices. The profession’s responses are summarized below.

X-Rays: The jury recommended the taking of X-rays before any spinal adjustment. “The use of X-rays carries a risk to patients and should only be utilized when clinically necessary,” said Dr. Bridge. “To take X-rays of every patient prior to adjustment would be irresponsible and contrary to the clinical practice guidelines of all health care professions. This is a recommendation that cannot be implemented.”

Screening: The jury noted that provocative testing to screen for risk factors has not been demonstrated to be of benefit and should not be performed. “The rarity of serious complications has made it hard to determine what factors may be involved,” said Dr. Bridge. “We are hopeful that as research progresses, we will better understand the nature of the association.”

Continuing Education: The profession supports continuing education for all health professions as required by their respective provincial regulatory colleges. The provincial chiropractic regulatory colleges are active in ensuring the provision of continuing education.

Record Keeping: The records of regulated health professionals are subject to legislation and regulation in each province and standards currently exist regarding the clear and appropriate recording of patient treatment.

“The chiropractic profession is committed to providing safe, effective, evidence-based care,” said Dr. Bridge. “Ongoing research, collaboration with other health professions and the evolution of clinical practice guidelines will all enhance our ability to serve patients. We thank the jury for the considerable time they contributed to this inquest and support the general direction of their recommendations. This is clearly demonstrated by the policies, practices and activities of the profession – both past and present.”

For more information, please contact: Maureen McCandless, Director Communications, Canadian Chiropractic Association (416) 781-5656 Ext. 242 or 1-800-668-2076.

Canadian Memorial Chiropractic College & The Canadian Chiropractic Association

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January 24, 2002

Hon. Roy Romanow
Commission on the Future of Health Care in Canada
P.O. Box 160, Station Main
Saskatoon, Saskatchewan
S7K 3K4

Dear Mr. Romanow:

On behalf of the Canadian Memorial Chiropractic College (CMCC) and the Canadian Chiropractic Association (CCA), we are pleased to enclose our submission to the Commission on the Future of Health Care in Canada.

As primary contact health care practitioners, Canada’s chiropractors have seen the impact on patients of changes in the health care system in terms of their access to quality health care services. Our submission makes recommendations which, if implemented, will improve patient care, alleviate system pressures, and demonstrate cost effectiveness.

Canada’s health care system has adequately met the needs of Canadians since the inception of the Canada Health Act. However, the sustainability of the system based on traditional Canadian values of fairness, equity, and commonality has been compromised. This has resulted in a system which has moved from being patient centred to one which is now provider and institutionally centred. The national debate on health care sees Canadians demanding the protection of their health care system while recognizing that change, both organizational and fiscal, is required to ensure its sustainability.

Major technological breakthroughs and new research based knowledge, with its promise of improved patient outcomes, combine with an increasingly sophisticated health care consumer to exert ever-increasing pressure on the health care system. Inequity and inadequacy in funding services from province to province, the lack of primary health care integrative models of patient care, the traditional and restrictive results of silo funding, and the lack of recognition by health care planners of the proven benefits of non-medical regulated health care need redressing.

The chiropractic profession supports the establishment of a framework for improving the delivery of health care services which is integrative, patient centred and reflective of outcomes. Concepts of equity and fairness demand that the delivery of “medically necessary” services be extended to non-medical regulated health professions based on quality outcome and patient satisfaction measures supported by both clinical and fiscal research.

We are confident that our recommendations will provide you with further insight into searching for comprehensive measures to protect and maintain Canada’s health care system. We request participation in the public consultation and dialogue taking place in Toronto on April 2nd and look forward to working with you in seeking solutions for a sustainable and cost-effective health care system.

Yours sincerely,

Jean A. Moss, D.C., M.B.A.
President
Canadian Memorial Chiropractic College

H. James Duncan, BFA, CHRP, CAE
Executive Director
The Canadian Chiropractic Association

What Results Can I Expect From Treatment?

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CCAChiro.org – That depends on your condition. The length of time you have had the problem, your age and the degree of your disability all affect the length of your treatment. Your chiropractic doctor should tell you the extent of treatment recommended, and how long you can expect it to last.

One of the main reasons people choose chiropractic is that they often get quick results. Individual cases vary and chronic conditions obviously need more treatment, but Workers’ Compensation Board studies show, for example, that people with low back pain get back to work much faster with chiropractic care.

You might also consider the benefits of regular chiropractic adjustments even when you feel healthy. Sometimes you won’t know you have a disorder of the neuro-musculo-skeletal system until it becomes acute and painful. So, just as you see your dentist to have your teeth checked and your optometrist for eye exams, regular visits to your chiropractor can catch related health conditions early, often preventing them from developing into major problems. Remember, your spine is every bit as susceptible to wear and tear as your teeth and your eyes so you should look after it.

How Do I Find A Chiropractor?

Chiropractors are “primary contact” health care providers, which means you don’t have to be referred to them by a physician or anyone else. You can select your own chiropractor. As with any other professional, referrals from friends and acquaintances are an excellent way to find a good chiropractor. The Yellow Pages can also come in handy to help you find one in your area. There are over 6,000 chiropractors in Canada. Another way is to use the CCA’s own Chiropractic Locator found on the upper right-hand corner of the home page.

Is Chiropractic Treatment Dangerous?

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Chiropractic is recognized as one of the safest, drug-free, non- invasive treatments available for headache, neck, and back pain. During the last 25 years there have been five formal government inquiries into chiropractic, all of which have found the profession to be both safe and effective.1 Based on the results of more than 85 studies into the safety and efficacy of chiropractic treatment, no other profession, including medicine, can demonstrate greater effectiveness or a better safety record for the treatment of spinal pain syndromes.

The risk of stroke from manipulation of the upper neck is small. Current published reports put the risk at between one or two out of one million treatments with the risk of serious consequences being even less likely.2

In fact, strokes may occur from normal everyday activities such as cradling a phone between your ear and shoulder during a prolonged conversation.3 Strokes have also been associated with simple activities such as having one’s hair washed at a beauty parlour, dental procedures, painting a ceiling, and turning one’s head while driving.4 Occurrences like this cannot be predicted.

Other likely treatments for head, neck and back pain carry a notably higher risk. For example:

  • The risk of gastrointestinal bleeding, caused by common pain relievers, such as ASA, is 400 times greater than the risk of damage from neck manipulation.5
  • Serious neurological complications from cervical spine surgery are more than 15,000 per million, and the mortality rate is almost 7,000 per million.6

Informed Consent

The chiropractor makes a diagnosis by taking a thorough health history and performing a physical examination. After determining any contraindications to treatment, an appropriate plan of care is developed.

Prior to starting treatment, chiropractors are required to obtain informed consent from their patients. A consumer’s choice of health care should always be based on informed consent. Health consumers must receive adequate and accurate information to assist them in evaluating their health care choices, and in balancing the relative risks of treatment options with the benefits.

Ongoing research

Chiropractic researchers continue to be actively involved in studying the benefits and risk of manipulation in the treatment of neck and back pain. Faculty from the Canadian Memorial Chiropractic College have played a leadership role in this research through participation in clinical trials and literature reviews.

Currently a large-scale, multi-disciplinary trial is underway to assess the efficacy of different types of treatment, including chiropractic care, for managing tension-type headache. In addition, the profession has published papers reviewing the risks and complications of cervical manipulation.

Attention has recently been directed to cervical manipulation by Dr. John Norris of the Canadian Stroke Consortium. His data, which is preliminary, and has yet to be analysed and published, will hopefully contribute to a better understanding of the relationship between cervical manipulation and stroke.

The chiropractic profession continues to conduct research that will ensure that care is provided as effectively and safely as possible.

May, 2000

 

1. Chiropractic in the United States: Training, Practice and Research, U.S. Department of Health and Human Services, AHCPR Research Report, Dec.1997.Chiropractic in New Zealand, Report of the Commission of Inquiry, Hasselberg PD, Government Printer, Wellington, 1979. Medicare Benefits Review Committee, Thompson CJ, Commonwealth Government Printer, Australia, 1986 Legitimization for Vissa Kiropraktorer, Commission on Alternative Medicine, SOU, 1987. The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, Manga P, Angus D, et al. Commissioned by the OCA and funded by the Ontario Ministry of Health. Pran Manga & Associates, University of Ottawa, 1993.

2. The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of Literature, Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine, 21(15); 1753-1755, 1996. Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation, Haldeman S, Kohlbeck FJ, McGregor M, Spine, 24(8); 785-794, 1999.

3. Carotid Artery Dissection due to Elongated Styloid Process, Zuber M, Meder JF, Mos JI, Neurology, Nov. 1999.

4. Beauty Parlour Stroke Syndrome: Report of Five Cases, Weintraub MI, Journal of the American Medical Association, 269:2085-86, 1993 Abrupt Change in Head Position and Cerebral Infarction, Sherman DG, Hart RG, Easton JD, Stroke, 12:2-6, 1981. Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head, Okawara S, Nibbelink D, 5:640-42, 1974. Cervical Manipulation and Stroke, Stroke, 8:594-97, 1977.

5. A Risk Assessment of Cervical Manipulation v. NSAIDS for the Treatment of Neck Pain, Dabbs V, Lauretti WJ, Journal of Manipulative and Physiological Therapeutics, 18.530-36, 1995.

6. Ibid.

About Chiropractic FAQ

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Content

  • Does chiropractic treatment require a referral from an MD?
  • How is chiropractic manipulation performed?
  • Can chiropractic treatment cure colds, earaches and other ailments?
  • Is chiropractic manipulation a safe procedure?
  • Is chiropractic treatment appropriate for children?
  • Does chiropractic treatment require x-rays?
  • Can chiropractic treatment provide a preventative function?

 

Does chiropractic treatment require a referral from an MD?

No. A patient does not have to be referred. Chiropractors are legislated as primary contact health professionals in every province in Canada. This means that patients can consult them directly. However, chiropractors often work closely with MDs, 44 per cent of whom refer their patients to chiropractors when they believe chiropractic treatment will help alleviate a patient’s condition.1

How is chiropractic manipulation performed?

Chiropractic manipulation is a manual procedure which utilizes the highly-refined skills developed during four intensive years of chiropractic education. The chiropractor uses his/her hands to manipulate the spine in order to restore or enhance spinal functioning.

Manipulation is a highly controlled procedure which 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.

Can chiropractic treatment cure colds, earaches and other ailments?

Chiropractic care cannot “cure” these conditions, but there is evidence to indicate that spinal manipulation may have a beneficial effect on a variety of conditions. More research is needed in these areas before definitive benefits can be claimed.

It is important to distinguish between primary treatment and treatment of secondary symptoms. For example, if a patient has an aching ear that is related to the musculoskeletal structures around the ear, and which is not the result of a bacterial infection, then chiropractic treatment may alleviate the pain. This would be considered primary treatment.

If there is ear pain caused by a bacterial infection, then chiropractic care is not the primary treatment, but may help alleviate some of the secondary – or referred – pain arising from the musculoskeletal reaction to the ear infection. This would be considered secondary treatment where chiropractic plays a complementary role in the treatment of a condition.

So, chiropractic care cannot cure a cold or an ear infection, but it may reduce the pain response. Similarly, chiropractic care can be of benefit in relieving musculoskeletal symptoms that are present with other chronic diseases such as cancer or AIDS.

Is chiropractic manipulation a safe procedure?

Chiropractic treatment is a drug-free, non-invasive approach to common musculoskeletal conditions such as neck and back pain. As such, it is a very low risk therapy. In extremely rare situations – between one or two out of one million treatments – there is a possibility that manipulation of the upper neck may contribute to a stroke.

Is chiropractic treatment appropriate for children?

There are many reasons why a child might benefit from chiropractic care. Children are very physically active and experience many types of falls and blows from participating in sports which can cause back pain and discomfort. Chiropractic care is always adapted to the individual patient. It is highly skilled and, in the case of children, is very gentle.

While there is a wealth of clinical evidence that musculoskeletal treatment of infants has many positive effects, well-controlled studies are required to verify some of the benefits that are commonly seen in practice.

Most recently, a research report published in the Journal of Manipulative and Physiological Therapeutics concluded that “spinal manipulation is effective in relieving infantile colic.”2 The study was a randomized, controlled clinical trial with a blinded observer and compared the effect of chiropractic therapy with a commonly prescribed medication used to relieve colic.

A study of chiropractic as complementary therapy for children receiving asthma medication, concluded that spinal manipulation did not provide additional benefits.3 This study which was published in the New England Journal of Medicine in October 1998, is another example of how research continues to inform chiropractic treatment.

Does chiropractic treatment require x-rays?

Guidelines have been developed by the chiropractic profession with regard to the use of X-rays as a diagnostic tool. X-rays provide vital information to help determine a diagnosis but they are not required in every case. In fact, at CMCC from 1997 to 1998 fewer than 20 per cent of chiropractic patients received X-rays, and only 6 percent of patients under the age of 16 required an X-ray.

Use of X-ray as a diagnostic tool by chiropractors, and all other health professionals, is governed in Ontario by guidelines as set out by the Healing Arts Radiation Protection Commission (HARP). X-rays can play an important role in diagnosis but are only taken when a need has been determined by a careful case history and physical examination. Chiropractors receive 360 hours of education in radiology covering a full range of topics from protection to X-ray interpretation and diagnosis. Governments in every province have recognized the training and competence of chiropractors to perform X-rays and have granted them this right.

Can chiropractic treatment provide a preventative function?

Clinical experience suggests that individuals with chronic conditions such as osteoarthritis or recurrent neck pain, back pain or headaches experience less frequent and less severe symptoms when under regular chiropractic care. This also applies to individuals in highly stressful situations and those who experience repetitive physical and postural strain from their daily activities.

Whether ongoing chiropractic treatment can prevent back pain from occurring in the first place or prevent a previous condition from re-occurring requires further study.

May, 2000

 

1. Alternative Medicine and General Practitioners: Opinions and Behaviours, Vernoef MJ, Sutherland LR, Canadian Family Physician, 41:1005-11, 1995.

2. The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic, Wiberg JMM et al, Journal of Manipulative and Physiological Therapeutics, Vol. 22, No. 8, October 1999.

3. A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma, Balon J et al, The New England Journal of Medicine, Vol. 339, No. 15, October 1998.

Commonly Held Views About Chiropractic

by admin

Content

  • What kind of education and training do chiropractors have?
  • Is chiropractic regulated in Canada?
  • Is chiropractic covered by government health plans?
  • How many people see chiropractors?
  • What conditions do chiropractors treat?
  • Why do chiropractors take X-rays?
  • Is chiropractic really scientific?
  • Isn’t there a risk of stroke associated with neck manipulation?
  • Why do chiropractors treat children?
  • Do chiropractors refer patients to medical doctors when necessary?
  • Do medical doctors refer patients to chiropractors?
  • Do chiropractors take a medical history?
  • Once you go to a chiropractor, don’t they make you keep going for the rest of your life?
  • Is every patient’s treatment the same?
  • Even if I want to refer to a chiropractor, can patients afford it?
  • How can I find a suitable chiropractor for my patient if I want to make a referral?

What kind of education and training do chiropractors have?

Chiropractors are educated as primary contact health care practitioners, with an emphasis on neuromusculoskeletal diagnosis and treatment. Preparation for the practice of chiropractic is concentrated on three areas: basic training in the biological and health sciences, specialized training in the chiropractic discipline, and extensive clinical training. Becoming a chiropractor in Canada requires a minimum of 6 years of post-secondary education including no less than 4500 hours of classroom and clinical instruction at an institution approved by the Council on Chiropractic Education Canada.

Is chiropractic regulated in Canada?

Like medicine and dentistry, chiropractic is a self-regulating profession, and each provincial chiropractic regulatory body has the authority to grant a license to practice chiropractic. There are Chiropractic Acts in all 10 provinces and the Yukon Territory which establish a self-regulatory process which includes extensive testing for licensure. In all provinces, licensure requirements include a minimum of two years pre-professional university studies, graduation from an accredited chiropractic institution (4 or 5 years), and passing national and provincial board examinations.

Is chiropractic covered by government health plans?

Chiropractic services are partially covered by the provincial health plans of Ontario, Manitoba, Saskatchewan, Alberta and British Columbia. Most federal government departments (such as the RCMP and Veteran’s Affairs) also cover chiropractic services. All worker’s compensation boards and most employer and other third party insurance plans cover chiropractic services as well, thereby making it affordable health care by most Canadians.

How many people see chiropractors?

Public surveys and published studies are finding that the proportion of Canadians that are consulting chiropractors is rising every year. Statistics Canada data found that over 11 percent (3 million) Canadians consulted a chiropractor in 1996. The figures today are closer to 15 percent, or over 4 million Canadians annually. There are approximately 35 million office visits to chiropractors each year.

What conditions do chiropractors treat?

Chiropractors are experts trained in the neuromusculoskeletal system . They diagnose and treat disorders of the spine and other body joints by adjusting the spinal column or through other corrective manipulation. Chiropractors provide conservative management of neuromusculoskeletal disorders including, but not limited to, back, neck and head pain (over 90 percent of conditions treated). They also advise patients on corrective exercises, lifestyle and nutrition.

Why do chiropractors take X-rays?

Chiropractors are trained in physical diagnosis including the use of X-rays. The science of radiology is a major component of chiropractic education, and chiropractors are licensed in each province, through chiropractic legislation, to take and interpret X-rays for their patients. An important reason for the use of X-rays is to detect contra-indications for spinal manipulation.

Is chiropractic really scientific? [Top]

Chiropractic is a healing discipline firmly grounded in science. Few other health care interventions have been assessed as extensively as chiropractic manipulation, both in terms of safety and effectiveness. Furthermore, few other health care professions have been as thoroughly researched as chiropractic. There have been at least six formal government inquiries into chiropractic worldwide over the last 25 years and all have concluded that contemporary chiropractic care is safe, effective, cost-effective and have recommended public funding for chiropractic services. In addition, there have been countless scientific clinical studies (randomized controlled trials included) assessing the appropriateness, effectiveness, and/or cost-effectiveness of spinal manipulation or chiropractic manipulation, most notably for low back pain. The Medical Research Council of Canada now offers research grants in partnership with the Canadian Chiropractic Association to chiropractors and other scientists for high quality, chiropractic research.

Isn’t there a risk of stroke associated with neck manipulation?

The risk of stroke from neck manipulation is extremely remote, and probably not greater than the risk from natural neck movements such as tilting your head into a sink for hair washing, or turning your head to back up when driving. Medical literature estimates the risk of having a stroke that may be related to chiropractic treatments to be anywhere from 1 in 400,000 to 1 in several million. In fact, the risk of serious complications or even death attributed to the use of NSAIDs is much greater for neck pain than the slight risk of injury from chiropractic manipulation. Chiropractors are well trained to recognize risk factors in patients, and treatments are not performed when there is a risk identified.

Why do chiropractors treat children?

Chiropractic treatment is based on the basic biological and physiological sciences which apply equally to children as they do to the adults. Chiropractic treatment is as beneficial to children as it is to adults, and children should be seen by chiropractors when appropriate. The scientific literature is now demonstrating that low back pain is a very prevalent condition amongst school children. For example a 1992 study in the American Journal of Public Health found that the prevalence of low back pain in adolescents up to age 15 is over 36 percent, and thus concluding that LBP in adolescents is a serious public health problem.1 As well, children can benefit by periodic spinal examinations where the chiropractor will look for clues to possible postural weaknesses that may predispose children to later problems related to their spine and skeleton.

Do chiropractors refer patients to medical doctors when necessary?

Yes, like medical doctors, chiropractors refer patients to other professionals when they feel it is appropriate. Chiropractors are well trained to recognize risk factors as well as individual disease patterns and will not hesitate to make a referral when it is in the best interest of the patient’s health.

Do medical doctors refer patients to chiropractors?

Absolutely. Recent studies have shown that the majority of medical doctors in Canada refer patients to chiropractors for musculoskeletal conditions. For example, a 1995 study in the Canadian Family Physician found that almost 60 percent of Canadian family physicians perceived chiropractic as useful or very useful and that over 83 percent referred patients to chiropractors. 2

Do chiropractors take a medical history?

Like M.D.’s, the chiropractor will take a detailed health history during the first visit, prior to initial treatment. This will include details on lifestyle and risk factors to give the chiropractor a full picture of the patient’s health in order to determine the best treatment. As well, a detailed health history is important to rule out any contra-indications and fully investigate risk factors before a diagnosis and treatment recommendation can be reached.

Once you go to a chiropractor, don’t they make you keep going for the rest of your life?

The hands-on nature of the chiropractic treatment is essentially what sends patients back to 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 (ie. taking a course of antibiotics once a day for a couple of weeks). A chiropractor may provide acute, preventative and/or maintenance care thus making a certain number of visits sometimes necessary. The average number of annual visits per patient is eight.

Is every patient’s treatment the same?

The treatment a patient receives is related to the specific condition diagnosed by the chiropractor, and will vary from person to person depending on each person’s unique situation. Like M.D.’s chiropractors follow generally accepted protocols and guidelines.

Even if I want to refer to a chiropractor, can patients afford it?

Chiropractic services are partially covered by the health plans of five provinces, all worker’s compensation boards, most federal departments and a majority of private insurer plans. Most employees have chiropractic coverage under their work insurance plan as well. Therefore, cost of care should not be an impediment to referring your patients to a chiropractor.

How can I find a suitable chiropractor for my patient if I want to make a referral?

As with any other health care professional, patients usually seek the services of a specific chiropractor through the referral of friends and acquaintances. Some family physicians are now working with chiropractors in a group practice setting or referring patients to one. Therefore, your medical colleagues could provide you with a name of a local chiropractor. Don’t hesitate to visit the chiropractors in your building or down the street from your practice. The Canadian Chiropractic Association (CCA) has a chiropractor locator service on its web site, for finding chiropractors through the first three digits of the postal code. Only chiropractors who are CCA members and therefore must have malpractice insurance coverage are on this site.

References

1. Olsen et al. The Epidemiology of Low Back Pain in an Adolescent Population. American Journal of Public Health. 1992; 82(4): 606-608.
2. Verhoef, M.J., Sutherland. L.R. Alternative Medicine and General Practitioners; Opinions and Behaviour. Canadian Family Physician 1995; 41: 1005-1011.