IS AMAZING HOW BLAIR UPPER CERVICAL HEALTH CARE IMPROVED
MY OWN QUALITY OF LIFE"
DR ALFRED TOMP DC
- A person's true character can only be seen in service.
Service can only be performed for another. Therefore, character
and selfishness cannot exist together. Ask me about someone's
character and I will show you their works. Question their
progress and I will look to the progress of those around them
that they have willed to a higher place with their vision,
example, and service. Selfishness is character's eternal
enemy just as service is character's accountable author."
- Michael P. Watson
headaches are caused by irritation or injury to the
structures of the upper neck region, resulting in
local neck pain as well as referred pain to the temporal
and facial regions. This headache is often precipitated
or aggravated by head and neck movements and by applying
deep pressure to the muscles of the upper cervical
headaches refer to headaches which originate from
tissues and structures in the cervical spine or neck
region. The headache is generally a very constant,
strong, yet dull pain. The most common location of
pain is around the orbital (eye) region and upper
neck area but may also include other areas of the
face, head and neck. The headache will typically last
for one to three days and reoccur ever one to four
weeks until properly treated. The headache may also
be accompanied by nausea, vomiting, dizziness, ringing
of the ears, and sensitivity to light and sound -
similar to migraine headaches.
management of cervicogenic headaches is the best way
to eliminate these headaches. Without addressing the
problems in cervical spine the headache will continue
to persist and worsen. Individuals should be warned
that relying on analgesics to remedy cervicogenic
headaches does nothing to correct the cause of the
headache and generally worsens the headache in what's
known as the "rebound effect". See "Drug-Induced
Headaches" below for more information.
headaches are the most common headache type, representing
approximately 60% of all headaches. These headaches
are caused by the sustained contraction of the muscles
in the neck and head region. The sustained muscle
contraction is usually a result of a combination of
misalignments and faulty neck biomechanics
neck/upper back injury- not properly rehabilitated
sitting or driving
these headaches are generally mild to moderate in
intensity and can last from hours to days. There is
a constant tight or pressure sensation, generally
feeling like a tight band is wrapping around the head.
There is commonly pain and tightness in the area of
the neck and shoulder. Pain generally starts in the
base of the skull or temporal regions of the head
and spreads outwards to affect other areas of the
head and neck.
have great success treating muscle tension headaches.
By utilizing spinal adjustments, therapeutic exercises
and stretches, soft tissue techniques such as trigger
point work and massage, and by counseling on lifestyle
modification, tension headaches can become a thing
of the past. Individuals should be warned that relying
on analgesics to remedy tension headaches does nothing
to correct the cause of the headache and generally
worsens the headache in what's known as the "rebound
effect". See "Drug-Induced Headaches" below
for more information.
headaches are headaches initiated from head or neck
injury, such as in a whiplash-type injury or blow
to the head. The resulting headache varies from person
to person. Most commonly, the resulting post-traumatic
headache is one of the following:
muscle tension headache
most favorable outcomes are seen with those who seek
early treatment. It's also important immediately following
any head trauma to rule out subdural hematoma, a potentially
fatal condition caused by intracranial bleeding. Chiropractors
frequently treat post-traumatic headaches and do so
individuals should be warned that relying on analgesics
to remedy post-traumatic headaches does nothing to
correct the cause of the headache and generally worsens
the headache in what's known as the "rebound effect".
See "Drug-Induced Headaches" below for more
have claimed that as many as 60% of chronic headaches
are drug-induced. It's quite ironic that the abuse
or frequent use of medications used to relieve the
symptoms of a headache can actually end up perpetuating
the headache or cause new headaches. In addition,
physical dependency and organ damage are also extremely
common complications associated with chronic analgesic
headaches are usually dull, diffuse and non-throbbing
affecting both sides of the head. They are frequently
present first thing in the morning and persist throughout
experts say that analgesic medications (over the counter
or prescription) should not be used more frequently
than 1 to 2 days per week. Using medications beyond
this period will gradually increase the frequency
of the headaches and will further increase their intensity
of the pain. Unfortunately, although there is extensive
documentation on drug-induced headaches, many medical
physicians fail to pay attention to this fact or are
simply unaware. Worse yet, the many tv drug commercials
are made to make us feel as though pain relievers
are a safe effective means of relief for headaches.
However, taking pain medication for chronic headaches
without seeking corrective care is like unplugging
the flashing oil light in your car dash, instead of
adding oil to the engine.
most common medications which lead to the development
of drug-induced headaches include:
eliminating or limiting the use of analgesic use will
resolve most if not all of the headaches. However,
most individuals are unaware that the drugs they're
taking can sometimes do them more harm than good.
account for approximately 10% of all headaches. Researchers
have found that 3.4 million females and 1.1 million
males suffer from 1 migraine attack per month. Migraines
follow a hereditary course, with 70% of migraine sufferers
having other family members who are also affected.
Migraine headaches often have coexisting muscle tension
and cervicogenic factors which contribute to the frequency
and intensity of migraine attacks.
pain generated by migraines has a throbbing quality
and usually involves one side of the head initially.
The headache tends to reach its peak intensity after
about 30 minutes. Migraines are commonly accompanied
by nausea and vomiting. During severe attacks, sensitivity
to sound and light may occur forcing the individual
to seek a dark and quiet room mandatory. The duration
of the headache can vary from a few hours to 1 to
headaches are categorized into either "common" or
Migraines differ from common migraines in that the
actual headache is preceded by neurologic disturbances
which indicate a migraine attack is about to take
place. These include alterations in the visual field
(zigzag lines, blind spots, etc.), numbness or tingling
of the lips or hand, problems with balance and even
loss of consciousness. These neurologic disturbances
generally last 15 to 30 minutes and resolve before
the headache begins. In some cases, the neurologic
disturbances may persist several days after the headache
trials conducted on chiropractic's effectiveness in
the management of migraine headaches have shown remarkable
improvement in many cases.
headaches are most common in middle-aged male smokers
and are among the most painful of all headaches. The
individual is often awaken 1 to 3 hours after sleep
with the headache in its full-blown state. The headache
lasts about 1 hour and attacks occur frequently over
several days to weeks - thus their name "cluster".
The headaches will then disappear for periods of months
to years before returning. The pain in cluster headaches
is deep, nonthrobbing and severe located behind the
ear and may radiate to the forehead and temple regions.
There is also tearing of the affected eye, nasal congestion,
and nasal drip.
alcohol ingestion and napping often precipitate attacks.
Immediate administration of oxygen (100% at 7 liters
for 15 minutes) has been shown to provide some relief.
It has been suggested that immersing the hand in ice
water to the point of pain and elevating the bed may
also provide some relief.
Asked Questions about Upper Cervical Health Care
is Body Imbalance and how do I know if it has happened to
Imbalance occurs when the Cl or Atlas, and/or the C2 or Axis,
the top two vertebra in the neck, are misaligned and out of
their proper position. This can occur as a result of an accident,
emotional trauma, or chemical toxicity in the body. Childbirth
itself can move the atlas out of position because of the massive
amounts of pressure on the head and neck of the baby as it
passes down the birth canal. Or childhood accidents like falling
from a tree, bike or skates can misalign it. In adulthood,
the atlas can be shoved out of position during minor or major
accidents such as sporting accidents, automobile accidents
or slips and falls. Some of the worst cases of atlas misalignment
and resulting pain have been caused by minor car accidents
such as being rear-ended. One indication of body imbalance
is having one leg slightly shorter than the other. You may
also notice that when you stand in front of a mirror one shoulder
is slightly higher than another, and one hip is higher than
the other. Another indication your atlas may be out of position
is by having different symptoms in your body that your medical
doctor cannot explain or find the cause for on any tests.
can Body Imbalance cause me to have physical problems?”
CL or Atlas is a donut-shaped bone that your skull rests on.
Your spinal cord coming out of your brain and brain stem passes
through the center of the donut shape. Your spinal cord at
that point consists of trillions of nerve fibers (the nervous
system) that “bottle-neck” through the small opening
in the atlas. These fibers eventually branch off carrying
information to every part of your body. If the CL is out of
its proper position it can irritate, constrict or disrupt
vital nerve signals to any portion of your body. This can
cause muscle or joint pain, organ dysfunction, lowered
immune system and countless other conditions that you would
not ordinarily relate to a problem originating in your neck.
do you call it Body Imbalance rather than a neck imbalance?”
it effects the entire spine and body. Wherever your atlas
moves, your head moves with it. If this top bone in your neck
has shifted out of position ever so slightly, no more than
the thickness of a fingernail, it can move your head off center
of your body. In an effort to keep the head over the center
of the neck, the entire spine and pelvis will twist, pulling
one hip up and one leg with it. You are now walking around
on one leg that is shorter than the other. This places more
weight on one side of your body than another. The wear
and tear on your entire body is exactly like driving a car
that is out of alignment. The result can be muscle and joint
pain anywhere in the body. Without correcting the problem,
which originated with a single bone (Atlas) at the top of
your neck moving out of position, your entire body is now
this continues over time, something else starts to happen.
Because nerve flow is disrupted or distorted, degeneration
of cells in organs can occur, causing internal physical problems
that may not show up for years.
it painful to correct?”
no. The Upper Cervical Correction can be described
as a slight pre-determined direction of pressure applied to
the first bone (Atlas) or second bone (Axis) in the neck.
Depending on the technique, it can feel like a brisk thrust,
a light tap, or a massage on the side of the neck just below
the earlobe. That’s where the atlas is. Sometimes this
is accompanied by a loud pop or series of tiny ticks as the
bone moves back into place. There is NO twisting of the
neck. This correction is engineered to reposition the
weight of the head (10 to 14 pounds) over the center of the
body in order to restore body balance and restore brain to
body communication. When the correction is made, muscles begin
to relax, blood and oxygen circulation is increased, the brain
is able to Communicate with the affected are, and the body’s
natural healing process begins. The healing process continues
as long as the body balance is maintained and the brain can
communicate with all parts of the body.
it have to be corrected often?”
depends on your own body. Some people can hold their correction
for several months, even a year at a time. Others have to
be corrected once or twice a week in the beginning, then one
or twice a month. Everyone is different. The Upper Cervical
doctor’s objective is to make as precise an Upper Cervical
correction as possible. Then he/she must help you maintain
the correction with as few corrections as possible
so that you may live pain free and enjoy a better quality
of life. Periodic Upper Cervical checkups, just like dental
checkups and physicals, should be part of your personal preventive
health care program. If you are maintaining your correction
and body balance then your Upper Cervical chiropractor will
not adjust you.
am concerned about radiation from the x-rays. Are they completely
they are the cornerstone of the Upper Cervical doctor’s
practice and are very specialized. Most chiropractic equipment
today along with lead aprons keeps radiation down to a minimum.
Plus, any minimal danger from radiation, in our opinion, cannot
be compared to the destruction that is going on in your body
every minute your atlas obstructs brain to body communication.
Any shift the atlas makes can cause multiple health problems.
But sometimes that shift in position is no greater than the
thickness of a fingernail. The Upper Cervical doctor has to
rely on x-rays to determine the exact position your atlas/axis
vertebrae have misaligned. The specific analysis of the x-rays
will allow the doctor how to reposition your atlas to within
a fraction of an inch back to the correct position it should
UC doctor will make the correction only after an intensive
analysis of how far out of position your atlas is. After correcting
the atlas, either a second series of x-rays are taken or a
post heat reading is utilized to determine if the adjustment
was done correctly. These are referred to as pre and post
x-rays and pre and post heat readings. The doctor will show
you these “before and after” x-rays and/or heat
readings so that you can see the difference the correction
soon should I get my children under this care?
soon after birth as possible, and then have them checked
periodically as they grow up. You could not possibly give
your child a better gift than to make certain that the one
organ of the body that controls all the other organs and body
functions, the brainstem, is doing its job without interference
from the tiny bone just below it.
much does it cost?
fraction of what you have probably already spent in your quest
to get well. There will be some expense at the beginning
because of the x-rays that are so necessary. But our organization
has asked that each doctor provide some type of payment plan
that enables you and your family to get under care as soon
as possible. Because insurance does not distinguish between
one form of chiropractic or another, if you have insurance
that covers chiropractic, it should cover Upper Cervical as
well. Unfortunately, some HMO’s and PPO’s only
have certain chiropractors on their list of providers and
you have to go to them. Most of these, though equally well
trained in other chiropractic procedures, may not be trained
in precision Upper Cervical chiropractic.
For many customers they have no insurance when they start
Upper Cervical care, but the concept made enough sense to
risk it. Plus, it cost no more than other forms of chiropractic
care. It turned out to be the best investment of their
is the Blair Technique?
chiropractic technique is a specific system of analyzing and
adjusting the upper cervical vertebrae of the spinal column.
When these vertebrae misalign in such a way as to interfere
with the brain stem and spinal cord as they exit through the
floor of the skull and into the neural canal. Special attention
is given to the first two cervical vertebrae, the atlas and
axis, as they are the most freely moveable vertebrae in the
spinal column and the ones most commonly misaligned.
many years of research and study of all the techniques that
were developing at the time, Dr. B.J. Palmer the developer
of chiropractic realized that the only place a person could
truly have interference to the nervous system was at the level
of the base of the skull; and the atlas and axis vertebrae.
There are no intervertebral discs between the skull and the
atlas, or between the atlas and axis vertebrae. Most movement
of the head and neck occur at this level. The joint surfaces
in this area move more on a horizontal plane rather than a
vertical plane as in the rest of the spine. This area is not
supplied with the abundance of supporting ligaments that are
found in the rest of the spine. As a result of these characteristics
of the cervical spine, it becomes the weakest link in the
chain when exposed to the forces of trauma such as the birth
process, falls, auto accidents, stress etc.
conducted studies in Germany on cadavers and found that the
brain stem or medulla, extended into the neural canal down
to the level of the lamina of the second cervical vertebrae,
at which point it becomes the spinal cord extending downward.
The brain stem has been referred to as "Houston Control".
It is the area where nerve cell centers are located that control
many of the major functions of the body such as heart beat,
respiration, digestion, elimination, our heating and cooling
mechanism, constriction and dilation of the veins and arteries,
muscle coordination, etc. Most of the functions of the body
that we don't have to consciously think about are controlled
at the brain stem level.
stem at the level of the atlas vertebrae consists of approximately
ten billion nerve fibers sending messages through the spinal
cord to the cells of the body and from the cells back to the
brain. These nerve fibers are arranged in small bundles called
nerve tracts. These nerve tracts are either sensory or motor.
The sensory nerves allow us function of the organs and systems
while moving the body about it's environment, via the musculoskeletal
system. Gray's Anatomy states, "the nervous system is the
master system of the body controlling and coordinating all
the functions of the body and relating the individual to his
and axis are the only vertebrae in proximity to the brain
stem. When they misalign to the extent that they put pressure
on the brain stem and or spinal cord they interfere with the
vital messages being sent to and from the brain to all parts
of the body. If for example the atlas is impinged against
the part of the cord that sends messages to the left hand,
that individual may experience a numbness, burning or tingling
sensation in that hand. If the nerve tracts at the brain stem
level go to the heart are being impinged that individual may
experience high blood pressure, palpitations or an irregular
heartbeat. Any part of the body can be effected when there
is pressure on the brain stem or spinal cord because almost
all of the nerves have to pass through this area before reaching
the part of the body they innervate.
vertebrae misaligns to the extent that it interferes with
nerve tissue and reduces the mental impulses it is termed
a subluxation. A subluxation may be present for months or
years before producing any outward signs such as pain or symptoms,
causing the body to break down to a state of diseases
of the Blair Chiropractic technique is not to diagnose or
treat diseases or conditions, but to analyze and correct vertebral
subluxations in an accurate, precise and specific manner to
allow the body's intelligence, (see chiropractic philosophy)
to mend, repair and maintain health from within.
technique utilizes neurological tests, heat sensitive instrumentation
and other means for detecting when the vertebral subluxation
is present or absent. The adjustment is administered only
when nerve pressure is present. The Blair technique utilizes
precise x-rays of the upper cervical area to determine which
way the vertebrae has misaligned so that a precise and specific
adjustment may be tailored and administered to that individual.
principles and philosophies which form the foundation of modern
chiropractic can be traced back to the late 1800’s to
a man by the name of David Daniel (D.D.) Palmer and later
his son Bartlett Joshua (B.J.) Palmer. In fact, according
to Terry A. Rondberg, D.C (see note), there is “evidence
of spinal manipulation discovered in prehistoric cave paintings”
and as practised by the ancient Chinese and Greeks and “In
Rome, Claudius Galen realigned the neck vertebrae of a Roman
scholar whose right hand was paralyzed. After the realignment
the scholar could use his hand again.”
Palmer was the pioneer of the ‘specific’ spinal
adjustment, and probably his most famous adjustment was the
one he delivered to Harvey Lillard on September 8th, 1895.
Harvey had become deaf 17 years earlier when he felt “something
give in his neck”. DD Palmer discovered an out of place
vertebra in his neck and proceeded to ‘adjust’
it back to its normal position by using “the spinous
process as a lever”. It was soon after that Harvey’s
hearing returned to normal. It does not surprise me that hearing
is affected by misalignments of the spine, for hearing complaints
are common amongst people with
spinal malalignment. Certainly tinnitus and hearing difficulties
were amongst my first symptoms following my injury and they
are common in whiplash victims.
was B.J. Palmer who really established and developed chiropractic,
and worked tirelessly to promote and communicate the benefits
of chiropractic. The original Palmer Cure & Infirmary
Clinic in Davenport, Iowa opened by DD Palmer would be left
in the hands of B.J. after another falling out with his father,
who moved to Oregon and then California and opened chiropractic
clinics, B.J. continued to foster chiropractic. Palmer College
of Chiropractic in Iowa and a flourishing worldwide chiropractic
profession are a tribute to his devotion and perseverance.
For more information on chiropractic and a truly
wonderful summary of the history of chiropractic and its philosophy
I commend to you the following reference. Rondberg, Terry
A., DC (1996) Chiropractic First, USA, The Chiropractic Journal.
William G. Blair
Chiropractor, Research Scientist, Husband
George Blair was born in Pemeta, Oklahoma on July 30,
1922. He attended elementary, Junior and Senior High
School, graduating in 1940 in the top 10% of his class
in spite of considerable absences for health reasons.
He had been diagnosed with bronchial asthma at the age
of 9 months. His parents tried every method of healing
sources including chiropractic with no results.
graduation, he attended Oklahoma A&M College for 2 years.
At this time he was told he must go to a more favorable climate
for his health. He chose to go to Lubbock Texas because of
relatives living there. No real improvement was shown so he
moved to Albuquerque and finally to El Paso. In El Paso he
met his wife and was married on July 20, 1946. It was his
wife that introduced him to upper cervical chiropractic. He
had never had upper cervical chiropractic before. His wife’s
mother had been a close friend of a chiropractor practicing
in Houston, TX. Her friend was a full spine doctor but recommended
that Bill go to Dr. Leon Halsted in El Paso, since he was
a Palmer graduate and did upper cervical work that she thought
would help Bill the most. Bill decided to go to Dr. Halsted.
He was X-rayed, adjusted, told what to expect and sent home.
His results were almost immediately good, he had less trouble
breathing and he just generally felt better.
made him so enthusiastic that he wanted to help others as
he had been helped. Since he had been primarily a salesman,
a career that he didn’t relish, he wanted to immediately
go to school to become a chiropractor. So he packed up his
family and they moved to Davenport, Iowa.
he graduated from Palmer, he moved back to Lubbock, a city
that he liked and wanted to live in. Dr. Blair rented a small
building and converted it into an office in front with a small
apartment in the back. His practice started in December 1949
and began to grow beyond his wildest dreams.
not take very long before he realized to began to think that
something was missing. He had done extensive study on X-rays
to make sure he understood the theoretical, structural and
mechanical relationships of the spine. Being a perfectionist,
he wanted to make perfect X-rays, give totally correct adjustments
and have the best results possible. Therefore when one patient
did much better than another, he studied their X-rays, their
neurocalgraph readings, and their adjustments, trying to learn
what he could do to make the other patients results more satisfactory.
His patients noticed his dedication to perfection. He did
his best to make sure the steps he took to make sure his adjustment
was the correct one and that it was very carefully given to
assure the best he could do. Dr. Blair noticed that some patients
seemed to miraculously improve while others had only mediocre
results yet he had done everything in the best most careful
and specific way that he could.
May 1951, Dr. Blair began to research and study the X-rays
of his very successful patients and compare them with the
not so successful cases. He studied them form every angle
that he could think of and slowly a pattern began to develop.
Getting a patient in alignment correctly as taught by Palmer
was important but he began to notice that the information
gained from these X-rays could be correct one time and obviously
inaccurate at other times. What was the difference ? This
took time and lots of study before Dr. Blair came up with
the conclusion that there could be a malformation ! We don’t
look alike on the outside so why should we be identical on
the inside ??
began making stereoscopic views - A.P. Open Mouth, Nasium
and Base Posterior together with the usual flat views. With
all of these views he could then determine whether malformation
existed or not. He studied all bone specimens he could find-Palmer’s
Osteological collection, Dr. L.G.Fraser’s work on anatomical
measurements, any real bone specimen that he could find. This
study finally came to the end result- that malformation is
the rule and not the exception . This was a revelation!
Blair realized that just placing a patient in front of a film
will produce a cervical X-ray, but will it produce a precisionally,
correctly, aligned view for that patient? In order to do that,
he knew the patient had to be placed in his habitual head
carriage and posture to determine the absolute position of
the patient for the spinograph.
many ideas, many hours of studying X-rays, new ways to make
X-rays, new methods of positioning and on and on with every
conceivable idea that came to his mind. Through these studies,
Dr. Blair developed a new method of positioning the patient.
The films made from both systems were impossible to tell one
from the other, yet they could each reveal different alignment
information. This showed that one could lead to wrong or ineffective
adjustment while the other could lead to a more effective
and correct adjustment.
realizing the malformations of patients, learning to place
them in their habitual head carriage for the spinograph, made
Dr. Blair aware that a definition of this finding must be
designed. Ten long months later, he developed the "Blair Principle
of Occipital-Alanto Misalignment" Although the principle is
relatively simple, it took this length of time for observing
the overlapping, underlapping phenomenon before Dr. Blair
could recognize and put into words the mechanical principle
of the malformation and the ability to see them in spinographs
led Dr. Blair to the knowledge that there had to be developed
a way of adjusting that would compensate for these malformations.
Again, many hours were spent in thinking, practicing, and
finally developing the adjustments that he thought would be
the best for the new type of misalignment that he had come
up with. Since Dr. Blair had always strived for perfection,
here he began to emphasize that perfection was the key to
making the most accurate X-rays and giving the most accurate
adjustment. Dr. Blair knew that achieving the most accurate
spinographs and giving the most accurate adjustment would
require a dedication far above what most chiropractors want
to give. It takes extra time, extra study, extra diligence,
and an unrelenting desire to accomplish a goal of perfection
in your spinographs and adjustments. Working with this diligence
will eventually make it possible for a chiropractor to achieve
excellent if not outstanding results. This chiropractor will
eventually find that he will be able to make the spinographs
and give the adjustment with confidence and ease. Genuine
skill comes from practice, concentrated effort, and always
working toward accuracy. In time, this process will become
made a commencement address to a graduating class at Palmer
in which he outlined 4 points for the students to strive for
Chiropractically speaking following are these 4 points :
your skill. This is a never ending process. In skill it
is the small details that count. The more specific contact,
the precisely calculated line of drive, correct placement
for adjustment, precision and detail in your spinograph.
Put that extra something in all that you do and you will
be separated from the mediocre and become the special.
and utilize your chiropractic knowledge. This means keep
up with advancements and new breakthroughs that have been
brought about through research. Stay abreast of new developments
- each year should make you more competent that the year
before. No man remains static, he is either advancing or
your objectives. Doing this will make you more dedicated
to your practice, your patients and your competency in delivering
the best service you can do, even if you have to spend a
little more time at the office. If you do this, you can
probably achieve a more lucrative practice and a future
that looks very bright in every way.
yourself Chiropractically. Give chiropractic answers to
health questions. Practice the art and science of correcting
vertebral misalignment. After your patient has regained
health, help him to maintain it. Chiropractic’s is
a health science not a disease science. Stay strictly in
way to remember these points is D-A-V-E
A-Add to and utilize your chiropractic knowledge,
V-Visualize objectives and
E-Express yourself Chiropractically.
is a verse in the Bible- Chapter 9, Verse 6 in II Corinthians
which says "He which soweth sparingly, shall reap also sparingly,
and he which soweth bountifully, shall reap bountifully" by
changing a few words, we can make this revealing verse read
- "He which soweth competence and precision will reap outstanding
results, and he which soweth carelessness and inaccuracy will
reap guilt and mediocre results.
OF CHIROPRACTIC TERMS
- Back pain that lasts a short while, usually a few days to
several weeks. Episodes lasting longer than three months are
not considered acute.
- The specific application of forces used to facilitate the
body’s correction of nerve interference.
- Topmost vertebra of the neck and supports your head. Misalignment
of the atlas can place stress on your neuromusculoskeletal
- Another name for the second cervical vertebra, which is
located in your neck. This is an important joint that contributes
significantly to your neck's range of motion.
Idea" - The chiropractic concept that the body heals itself
when interference to the proper functioning of the nervous
system is removed.
- The body's mechanics, such as how muscles, bones, tendons
and ligaments work to produce movement.
- Pop that occurs in a spinal joint when vertebral surfaces
(facets) are separated to create a vacuum that pulls in nitrogen
spine - The area of your spine containing the seven vertebrae
that compose the neck.
- A primary health care profession in which professional responsibility
and authority are focused on the anatomy of the spine and
immediate articulation, and the condition of nerve interference.
It is also a practice, which encompasses educating, advising
about and addressing nerve interference.
back pain - Back pain episode that lasts more than three
- Commonly called the tailbone, the coccyx is composed of
four separate but fused vertebrae that make up the bottom
of your spine.
flexion-distraction technique - Method of applying manually
controlled distraction or stretching to specific spinal segments
with the assistance of a movable table.
- Abbreviation for "doctor of chiropractic."
- A comprehensive process of evaluation of the spinal column
and its immediate articulation to determine the presence of
nerve interference and other conditions that may contraindicate
thrust - Chiropractic adjustment delivered suddenly and
forcefully to move vertebrae, often resulting in a popping
technique - Useful method of stretching the spine in a
face down position on a table that allows manually applied
flexion and traction to be applied to specific spinal segments.
technique - Method of adjusting or manipulating any of
the vertebrae from the neck down.
Intelligence - The alleged inborn ability of the body
to heal itself, which many chiropractors believe is enhanced
by spinal adjustments.
disk - The tough cartilage that serves as a cushion between
two vertebrae. Each disk has a gelatinous-like center (nucleus
pulposus) that may protrude to form a disk herniation.
- A meeting point of two or more bones in your body that functions
like a door hinge. Joints, like hinges, sometimes get stuck,
- Tissue that bonds bone to bone. Ligaments are strong and
provide excellent support, which is especially important in
joints like your ankle.
- Abbreviated description of the position or movement of a
"subluxated" vertebra. Many techniques have their own listing
spinal joint - Sudden binding that occurs when two joint
surfaces are shifted out of their normal alignment by an awkward
movement that triggers muscle spasm. The result may also be
called an "acute locked back."
manipulation - Method of spinal manipulation in which
a general technique is used to stretch or loosen several vertebrae
at a time.
vertebrae - The five bones in the lower-back portion of
strain - Strain or injury of joints or ligaments at the
base of the spine where the last lumbar vertebra (L5) is connected
to the sacrum. Strain or disk degeneration in this area is
probably the most common cause of low-back pain.
care - Subluxation-based program of periodic spinal examinations
and "adjustments" to help maintain the patient's health. Also
called "preventive maintenance" or "preventative maintenance."
- The forceful passive movement of a joint beyond its active
limit of motion. It does not imply the use of precision, specificity
or the correction of nerve interference. Therefore, it is
not synonymous with chiropractic adjustment.
- Method of manipulation, movement, or stretching to increase
range of motion in muscles and joints that does not involve
a high-velocity thrust.
palpation - Useful method of locating fixations and loss
of mobility in the spine by feeling the motion of specific
spinal segments as the patient moves.
- Contractile tissue that allows body parts to move.
- Referring to structures involving tendons, muscles, ligaments,
root - One of the two nerve bundles emerging from the
spinal cord that join to form a segmental spinal
system - A broad term referring to the neurological system,
including the brain, spinal cord and nerves, the muscle system,
which includes muscles, ligaments, tendons and connective
tissues, and the skeletal system, which includes bones of
the skull, spine and limbs.
method - Technique that uses digital pressure on trigger
points to relax muscles said to be pulling vertebrae out of
techniques - Various reflex techniques and muscle-treatment
methods that do not involve forceful manipulation.
- Abbreviation for "personal injury." Used in the phrases
"PI practice" and "PI seminar," which focus on patients with
occupational or auto injuries.
Objective - The professional practice objective of chiropractic
is to correct nerve interference in a safe, effective manner.
The correction is not considered to be a specific cure for
any particular symptom or disease. It is applicable to any
patient who exhibits nerve interference regardless of the
presence or absence of symptoms or disease.
joint - The joint between the sacrum and the ilium, which
is a flat bone that helps compose your pelvis.
- The triangular bone that serves as a base for the spinal
column and connects the pelvic bones.
manipulation - A method of spinal manipulation in which
contact is made on a vertebral process to move a single vertebra.
- An abbreviation for "spinal manipulative therapy."
adjustment - A chiropractic term that most chiropractors
use to describe whatever method(s) they use to correct spinal
problems, whether by hand or with an instrument. Some equate
the terms "adjustment" and "manipulation."
manipulation - A forceful, high-velocity thrust that stretches
a joint beyond its passive range of movement in order to increase
its mobility. Manipulation is usually accompanied by an audible
pop or click.
- Your spine supports your body and protects the delicate
spinal cord and nerves. It comprises 33 vertebrae, grouped
into different categories based on location and anatomy. These
locations are the cervical, thoracic, lumbar, sacral and coccygeal
chiropractor - Chiropractors who tend to cling to chiropractic's
original doctrine that most health problems are caused by
misaligned spinal bones ("vertebral subluxations") and are
correctable by manual manipulation of the spine.
- The medical definition is incomplete or partial dislocation
-- a condition, visible on x-ray films, in which the bony
surfaces of a joint no longer face each other exactly but
remain partially aligned.
terminal point technique - A chiropractic adjustment performed
on a table in which the supporting cushions drop an inch or
two when a thrust is applied to the spine. Practitioners locate
"subluxations" by checking leg lengths with the legs straight,
the knees bent, or the head turned to either side.
vertebrae - There are twelve vertebrae in the thoracic
or upper-back portion of the spine.
recoil technique - Manipulation performed with a sudden
shallow thrust (toggle) followed by quick withdrawal (recoil)
of the chiropractor's hands while the patient is relaxed.
cervical specific - Technique that uses a number of specific
chiropractic adjustments designed to correct atlas and upper
- Bony segment of the spine that encircles and helps protect
the spinal cord and nerves. The plural of vertebra is vertebrae.
subluxation complex - A "modern" chiropractic term for
the chiropractic subluxation.
Subluxation - Also referred to as nerve interference,
is a misalignment of one or more of the 24 vertebrae in the
spinal column, which causes alteration of nerve function and
interference to the transmission of mental impulses, resulting
in a lessening of the body’s innate ability to express
its maximum health potential.
- The concept that the functions of an organism are due to
a "vital principle" or "life force" distinct from the physical
forces explainable by the laws of physics and chemistry. Chiropractors
refer to that force as "Innate Intelligence."
County is a county in Southern California, United States.
Its county seat is Santa Ana. According to the 2000 Census,
its population was 2,846,289, making it the second most populous
county in the state of California, and the fifth most populous
in the United States. The state of California estimates its
population as of 2007 to be 3,098,121 people, dropping its
rank to third, behind San Diego County. Thirty-four incorporated
cities are located in Orange County; the newest is Aliso Viejo.
Unlike many other large centers of population in the United
States, Orange County uses its county name as its source of
identification whereas other places in the country are identified
by the large city that is closest to them. This is because
there is no defined center to Orange County like there is
in other areas which have one distinct large city. Five Orange
County cities have populations exceeding 170,000 while no
cities in the county have populations surpassing 360,000.
Seven of these cities are among the 200 largest cities in
the United States.
Orange County is also famous as a tourist destination, as
the county is home to such attractions as Disneyland and Knott's
Berry Farm, as well as sandy beaches for swimming and surfing,
yacht harbors for sailing and pleasure boating, and extensive
area devoted to parks and open space for golf, tennis, hiking,
kayaking, cycling, skateboarding, and other outdoor recreation.
It is at the center of Southern California's Tech Coast, with
Irvine being the primary business hub.
The average price of a home in Orange County is $541,000.
Orange County is the home of a vast number of major industries
and service organizations. As an integral part of the second
largest market in America, this highly diversified region
has become a Mecca for talented individuals in virtually every
field imaginable. Indeed the colorful pageant of human history
continues to unfold here; for perhaps in no other place on
earth is there an environment more conducive to innovative
thinking, creativity and growth than this exciting, sun bathed
valley stretching between the mountains and the sea in Orange
Orange County was Created March 11 1889, from part of Los
Angeles County, and, according to tradition, so named because
of the flourishing orange culture. Orange, however, was and
is a commonplace name in the United States, used originally
in honor of the Prince of Orange, son-in-law of King George
II of England.
March 11, 1889
* Congressional: 38th-40th, 42nd & 43
* California Senate: 31st-33rd, 35th & 37
* California Assembly: 58th, 64th, 67th, 69th, 72nd &
County Seat: Santa Ana
Robert E. Thomas Hall of Administration
10 Civic Center Plaza, 3rd Floor, Santa Ana 92701
Telephone: (714)834-2345 Fax: (714)834-3098
County Government Website: http://www.oc.ca.gov
CITIES OF ORANGE COUNTY CALIFORNIA:
communities Some of the communities that exist within
city limits are listed below:
* Anaheim Hills, Anaheim * Balboa Island, Newport Beach
* Corona del Mar, Newport Beach * Crystal Cove/Pelican
Hill, Newport Beach * Capistrano Beach, Dana Point *
El Modena, Orange * French Park, Santa Ana * Floral
Park, Santa Ana * Foothill Ranch, Lake Forest * Monarch
Beach, Dana Point * Nellie Gail, Laguna Hills * Northwood,
Irvine * Woodbridge, Irvine * Newport Coast, Newport
Beach * Olive, Orange * Portola Hills, Lake Forest *
San Joaquin Hills, Laguna Niguel * San Joaquin Hills,
Newport Beach * Santa Ana Heights, Newport Beach * Tustin
Ranch, Tustin * Talega, San Clemente * West Garden Grove,
Garden Grove * Yorba Hills, Yorba Linda * Mesa Verde,
Unincorporated communities These communities are
outside of the city limits in unincorporated county
territory: * Coto de Caza * El Modena * Ladera Ranch
* Las Flores * Midway City * Orange Park Acres * Rossmoor
* Silverado Canyon * Sunset Beach * Surfside * Trabuco
Canyon * Tustin Foothills
Adjacent counties to Orange County Are: * Los
Angeles County, California - north, west * San Bernardino
County, California - northeast * Riverside County, California
- east * San Diego County, California - southeast
County is home to many colleges and universities, including:
Chiropractic is a health care
profession that focuses on diagnosis, treatment and prevention
of mechanical disorders of the musculoskeletal system, with
special emphasis on the spine, under the hypothesis that these
disorders affect general health via the nervous system. Chiropractic
is generally considered to be complementary and alternative
medicine, a characterization many chiropractors reject. Chiropractic
treatment emphasizes manual therapy including spinal manipulation
and other joint and soft tissue manipulation, and includes
exercises and health and lifestyle counseling. Traditionally,
it assumes that a vertebral subluxation or spinal joint dysfunction
can interfere with the body's function and its innate ability
to heal itself.
D. D. Palmer founded chiropractic
in the 1890s and his son B.J. Palmer helped to expand it in
the early 20th century. It has two main groups: "straights",
now the minority, emphasize vitalism, innate intelligence
and spinal adjustments, and consider subluxations to be the
leading cause of all disease; "mixers" are more
open to mainstream and alternative medical techniques such
as exercise, massage, nutritional supplements, and acupuncture.
Chiropractic is well established in the U.S., Canada and Australia.
For most of its existence, chiropractic
has battled with mainstream medicine, sustained by ideas such
as subluxation that are considered significant barriers to
scientific progress within chiropractic. Vaccination remains
controversial among chiropractors. In recent decades chiropractic
has gained more legitimacy and greater acceptance among medical
physicians and health plans and has had a strong political
base and sustained demand for services,] and evidence-based
medicine has been used to review research studies and generate
practice guidelines. Opinions differ as to the efficacy of
chiropractic treatment and the efficacy and cost-effectiveness
of maintenance chiropractic care are unknown. Although spinal
manipulation can have serious complications in rare cases,
chiropractic care is generally safe when employed skillfully
Chiropractic's early philosophy
was rooted in vitalism, spiritual inspiration and rationalism.
A philosophy based on deduction from irrefutable doctrine
helped distinguish chiropractic from medicine, provided it
with legal and political defenses against claims of practicing
medicine without a license, and allowed chiropractors to establish
themselves as an autonomous profession. This "straight"
philosophy, taught to generations of chiropractors, rejects
the inferential reasoning of the scientific method, and relies
on deductions from vitalistic principles rather than on the
materialism of science. However, most practitioners currently
accept the importance of scientific research into chiropractic,
and most practitioners are "mixers" who attempt
to combine the materialistic reductionism of science with
the metaphysics of their predecessors and with the holistic
paradigm of wellness;18] a 2008 commentary proposed that chiropractic
actively divorce itself from the straight philosophy as part
of a campaign to eliminate untestable dogma and engage in
critical thinking and evidence-based research.
Although a wide diversity of
ideas currently exists among chiropractors, they share the
belief that the spine and health are related in a fundamental
way, and that this relationship is mediated through the nervous
system. Chiropractors study the biomechanics, structure and
function of the spine, along with what they say are its effects
on the musculoskeletal and nervous systems and its role in
health and disease.
Chiropractic philosophy includes
the following perspectives:
Holism assumes that
health is affected by everything in people's complex
environments; some sources also include a spiritual
or existential dimension. In contrast, reductionism
in chiropractic reduces causes and cures of health problems
to a single factor, vertebral subluxation.
approach focuses on the patient rather than the disease,
preventing unnecessary barriers in the doctor-patient
encounter. The patient is considered to be indispensable
in, and ultimately responsible for, the maintenance
Schools of thought and practice
Chiropractic is often described
as two professions in one. Unlike the distinction between
podiatry (a science-based profession for foot disorders) and
foot reflexology (an unscientific philosophy which posits
that many disorders arise from the feet), in chiropractic
the two professions attempt to live under one roof. Significant
differences exist amongst the practice styles, claims and
beliefs between various chiropractors.
Straight chiropractors adhere
to the philosophical principles set forth by D. D. and B.
J. Palmer, and retain metaphysical definitions and vitalistic
qualities. Straight chiropractors believe that vertebral subluxation
leads to interference with an "Innate Intelligence"
within the human nervous system and is a primary underlying
risk factor for almost any disease. Straights view the medical
diagnosis of patient complaints (which they consider to be
the "secondary effects" of subluxations) to be unnecessary
for treatment. Thus, straight chiropractors are concerned
primarily with the detection and correction of vertebral subluxation
via adjustment and do not "mix" other types of therapies.
Their philosophy and explanations are metaphysical in nature
and prefer to use traditional chiropractic lexicon (i.e. perform
spinal analysis, detect subluxation, correct with adjustment,
etc.). They prefer to remain separate and distinct from mainstream
Mixer chiropractors "mix"
diagnostic and treatment approaches from osteopathic, medical,
and chiropractic viewpoints. Unlike straight chiropractors,
mixers believe subluxation is one of many causes of disease,
and they incorporate mainstream medical diagnostics and employ
many treatments including conventional techniques of physical
therapy such as exercise, massage, ice packs, and moist heat,
along with nutritional supplements, acupuncture, homeopathy,
herbal remedies, and biofeedback. Mixers tend to be open to
mainstream medicine, and are the majority group.
Palmer hypothesized that vertebral
joint misalignments, which he termed vertebral subluxations,
interfered with the body's function and its inborn (innate)
ability to heal itself. D.D. Palmer repudiated his earlier
theory that vertebral subluxations caused pinched nerves in
the intervertebral spaces in favor of subluxations causing
altered nerve vibration, either too tense or too slack, affecting
the tone (health) of the end organ. D.D. Palmer, using a vitalistic
approach, imbued the term subluxation with a metaphysical
and philosophical meaning. He qualified this by noting that
knowledge of innate intelligence was not essential to the
competent practice of chiropractic. This concept was later
expanded upon by his son, B.J. Palmer and was instrumental
in providing the legal basis of differentiating chiropractic
medicine from conventional medicine. In 1910, D.D. Palmer
theorized that the nervous system controlled health:
divide nerve-fibers, which form the nerves, into two classes,
afferent and efferent. Impressions are made on the peripheral
afferent fiber-endings; these create sensations that are transmitted
to the center of the nervous system. Efferent nerve-fibers
carry impulses out from the center to their endings. Most
of these go to muscles and are therefore called motor impulses;
some are secretory and enter glands; a portion are inhibitory
their function being to restrain secretion. Thus, nerves carry
impulses outward and sensations inward. The activity of these
nerves, or rather their fibers, may become excited or allayed
by impingement, the result being a modification of functionality—too
much or not enough action—which is disease."
The concept of subluxation remains
unsubstantiated and largely untested, and a debate about whether
to keep it in the chiropractic paradigm has been ongoing for
decades. In general, critics of traditional subluxation-based
chiropractic (including chiropractors) are skeptical of its
clinical value, dogmatic beliefs and metaphysical approach.
While straight chiropractic still retains the traditional
vitalistic construct espoused by the founders, evidence-based
chiropractic suggests that a mechanistic view will allow chiropractic
care to become integrated into the wider health care community.
This is still a continuing source of debate within the chiropractic
profession as well, with some schools of chiropractic (for
example, Palmer College of Chiropractic) still teaching the
traditional/straight subluxation-based chiropractic, while
others (for example, Canadian Memorial Chiropractic College)
have moved towards an evidence-based chiropractic that rejects
metaphysical foundings and limits itself to primarily neuromusculoskeletal
conditions. A 2003 survey of North American chiropractors
found that 88% wanted to retain the term vertebral subluxation
complex, and that when asked to estimate the percent of disorders
of internal organs (such as the heart, the lungs, or the stomach)
that subluxation significantly contributes to, the mean response
was 62%. In 2005, subluxation was defined by the World Health
Organization as "a lesion or dysfunction in a joint or
motion segment in which alignment, movement integrity and/or
physiological function are altered, although contact between
joint surfaces remains intact. It is essentially a functional
entity, which may influence biomechanical and neural integrity."
This differs from the medical definition of subluxation as
a significant structural displacement, which can be seen with
static imaging techniques such as X-rays
Scope of practice
Chiropractors, also known as
doctors of chiropractic or chiropractic physicians in many
jurisdictions, emphasize the conservative management of the
neuromusculoskeletal system without the use of medicines or
surgery, with special emphasis on the spine.1] Chiropractic
combines aspects from mainstream and alternative medicine:
although chiropractors have many attributes of primary care
providers, chiropractic has more of the attributes of a medical
specialty like dentistry or podiatry. It has been proposed
that chiropractors specialize in nonsurgical spine care, instead
of attempting to also treat other problems, but the more expansive
view of chiropractic is still widespread. Mainstream health
care and governmental organizations such as the World Health
Organization consider chiropractic to be complementary and
alternative medicine (CAM); however, a 2008 study reported
that 31% of surveyed chiropractors categorized chiropractic
as CAM, 27% as integrated medicine, and 12% as mainstream
The practice of chiropractic
medicine involves a range of diagnostic methods including
skeletal imaging, observational and tactile assessments, and
orthopedic and neurological evaluation. A chiropractor may
also refer a patient to an appropriate specialist, or co-manage
with another health care provider. Common patient management
involves spinal manipulation (SM) and other manual therapies
to the joints and soft tissues, rehabilitative exercises,
health promotion, electrical modalities, complementary procedures,
and lifestyle counselling.
Chiropractors cannot write medical
prescriptions or perform major surgery. In the U.S. their
scope of practice varies by state in areas such as conducting
laboratory tests or diagnostic procedures, dispensing dietary
supplements, and using other therapies such as homeopathy
and acupuncture; in the state of Oregon they can become certified
to perform minor surgery and to deliver children via natural
childbirth. A 2003 survey of North American chiropractors
found that a slight majority favored allowing them to write
prescriptions for over-the-counter drugs. A related field,
veterinary chiropractic, applies manual therapies to animals
and is recognized in a few U.S. states, but is not recognized
by the American Chiropractic Association as being chiropractic.
Spine care is offered by several
other professions, including massage therapists, osteopaths,
and physical therapists. No single profession "owns"
spinal manipulation and there is little consensus as to which
profession should administer SM, raising concerns by chiropractors
that orthodox medical physicians could "steal" SM
procedures from chiropractors. A focus on evidence-based SM
research has also raised concerns that the resulting practice
guidelines could limit the scope of chiropractic practice
to treating backs and necks. Some U.S. states prohibit physical
therapists from performing SM, some states allow them to do
it only if they have completed chiropractic training, and
some states allow only chiropractors to perform SM, or only
chiropractors and physicians. Bills to further prohibit non-chiropractors
from performing SM are regularly introduced into state legislatures
and are opposed by physical therapist organizations.
Spinal manipulation, which chiropractors
call "spinal adjustment" or "chiropractic adjustment",
is the most common treatment used in chiropractic care; in
the U.S., chiropractors perform over 90% of all manipulative
treatments. Spinal manipulation is a passive manual maneuver
during which a three-joint complex is taken past the normal
range of movement, but not so far as to dislocate or damage
the joint; its defining factor is a dynamic thrust, which
is a sudden force that causes an audible release and attempts
to increase a joint's range of motion. More generally, spinal
manipulative therapy (SMT) describes techniques where the
hands are used to manipulate, massage, mobilize, adjust, stimulate,
apply traction to, or otherwise influence the spine and related
tissues; in chiropractic care SMT most commonly takes the
form of spinal manipulation.
There are several schools of
chiropractic adjustive techniques, although most chiropractors
mix techniques from several schools. The following adjustive
procedures were received by more than 20% of patients of licensed
U.S. chiropractors in a 2003 survey: Diversified technique
(full-spine manipulation), extremity adjusting, Activator
technique (which uses a spring loaded tool to deliver precise
adjustments to the spine), Thompson Technique, Gonstead (which
looks at the whole spine with the philosophy that a vertebral
misalignment may affect other areas of the spine, emphasizing
the mechanical aspects of the spine), Cox/flexion-distraction
(a gentle, non-force adjusting procedure which mixes chiropractic
principles with osteopathic principles and utilizes specialized
adjusting tables with movable parts), adjustive instrument,
Sacro-Occipital Technique (which models the spine as a torsion
bar), Nimmo Receptor-Tonus Technique, and Applied Kinesiology
(which emphasises "muscle testing" as a diagnostic
tool). Medicine-assisted manipulation, such as manipulation
under anesthesia, involves sedation or local anesthetic and
is done by a team that includes an anesthesiologist.
Many other treatment forms are
used by chiropractors for treating the spine, other joints
and tissues, and general health issues. The following procedures
were received by more than 1/3 of patients of licensed U.S.
chiropractors in a 2003 survey: Diversified technique (full-spine
manipulation; mentioned in previous paragraph), physical fitness/exercise
promotion, corrective or therapeutic exercise, ergonomic/postural
advice, self-care strategies, activities of daily living,
changing risky/unhealthy behaviors, nutritional/dietary recommendations,
relaxation/stress reduction recommendations, ice pack/cryotherapy,
extremity adjusting (also mentioned in previous paragraph),
trigger point therapy, and disease prevention/early screening
Education, licensing, and regulation
Chiropractors obtain a first
professional degree in the field of chiropractic. The U.S.
and Canada require a minimum 90 semester hours of undergraduate
education as a prerequisite for chiropractic school, and at
least 4200 instructional hours (or the equivalent) of full‐time
chiropractic education for matriculation through an accredited
chiropractic program. The World Health Organization (WHO)
guidelines suggest three major full-time educational paths
culminating in either a DC, DCM, BSc, or MSc degree. Besides
the full-time paths, they also suggest a conversion program
for people with other health care education and limited training
programs for regions where no legislation governs chiropractic.
Upon graduation, there may be
a requirement to pass national, state, or provincial board
examinations before being licensed to practice in a particular
jurisdiction.49]50] Depending on the location, continuing
education may be required to renew these licenses. Specialty
training is available through part-time postgraduate education
programs such as chiropractic orthopedics and sports chiropractic,
and through full-time residency programs such as radiology
Chiropractic is established in
the U.S., Canada, and Australia, and is present to a lesser
extent in many other countries. In the U.S., chiropractic
schools are accredited through the Council on Chiropractic
Education (CCE) while the General Chiropractic Council (GCC)
is the statutory governmental body responsible for the regulation
of chiropractic in the UK. CCEs in the U.S., Canada, Australia
and Europe have joined to form CCE-International (CCE-I) as
a model of accreditation standards with the goal of having
credentials portable internationally. Today, there are 18
accredited Doctor of Chiropractic programs in the U.S., in
Canada, in Australasia, and 4 in Europe. All but one of the
chiropractic colleges in the U.S. are privately funded, but
in several other countries they are in government-sponsored
universities and colleges. Chiropractic education in the U.S.
is divided into straight or mixer educational curricula depending
on the philosophy of the institution.
Regulatory colleges and chiropractic
boards in the U.S., Canada, and Australia are responsible
for protecting the public, standards of practice, disciplinary
issues, quality assurance and maintenance of competency. There
are an estimated 53,000 chiropractors in the U.S. (2006),
in Canada (2006), 2500 in Australia (2000) and 1,500 in the
A 2008 commentary proposed that
the chiropractic profession actively regulate itself to combat
abuse, fraud, and quackery, which are more prevalent in chiropractic
than in other health care professions, violating the social
contract between patients and physicians. A study of California
disciplinary statistics during 1997–2000 reported 4.5
disciplinary actions per 1000 chiropractors per year, compared
to 2.27 for MDs; the incident rate for fraud was 9 times greater
among chiropractors (1.99 per 1000 chiropractors per year)
than among MDs (0.20).
Utilization, satisfaction rates,
and third party coverage
In the U.S., chiropractic is
the largest alternative medical profession, and is the third
largest doctored profession, behind medicine and dentistry.
The percentage of population that utilizes chiropractic care
at any given time generally falls into a range from 6% to
12% in the U.S. and Canada,69] with a global high of 20% in
Alberta. The vast majority who seek chiropractic care do so
for relief from back and neck pain and other neuromusculoskeletal
complaints; most do so specifically for low back pain. Practitioners
such as chiropractors are often used as a complementary form
of care to primary medical intervention. Satisfaction rates
are typically higher for chiropractic care compared to medical
care, with a 1998 U.S. survey reporting 83% of persons satisfied
or very satisfied with their care; quality of communication
seems to be a consistent predictor of patient satisfaction
Chiropractic does not have the
same level of mainstream credibility as other healthcare professions.
Public perception of chiropractic compares unfavorably with
mainstream medicine with regard to ethics and honesty: in
a 2006 Gallup Poll of U.S. adults, chiropractors rated last
among seven health care professions for being very high or
high in honesty and ethical standards, with 36% of poll respondents
rating chiropractors very high or high; the corresponding
ratings for other professions ranged from 62% for dentists
to 84% for nurses.
Utilization of chiropractic care
is sensitive to the costs incurred by the co-payment by the
patient. The use of chiropractic declined from 9.9% of U.S.
adults in 1997 to 7.4% in 2002; this was the largest relative
decrease among CAM professions, which overall had a stable
use rate. Employment of U.S. chiropractors is expected to
increase 14% between 2006 and 2016, faster than the average
for all occupations.
In the U.S., most insurances
cover chiropractic. In Canada, there is lack of coverage under
the universal public health insurance system. In Australia,
most private health insurance funds cover chiropractic care,
and the federal government funds chiropractic care when the
patient is referred by a medical practitioner.
Chiropractic was founded in the
1890s by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer,
a magnetic healer, hypothesized that manual manipulation of
the spine could cure disease. Although initially keeping the
theory a family secret, in 1898 he began teaching it to a
few students at his new Palmer School of Chiropractic. One
student, his son Bartlett Joshua (B.J.) Palmer, became committed
to promoting chiropractic, took over the Palmer School in
1906, and rapidly expanded its enrollment. Prosecutions and
incarcerations of chiropractors for practicing medicine without
a license grew common, and to defend against medical statutes
B.J. argued that chiropractic was separate and distinct from
medicine, asserting that chiropractors "analyzed"
rather than "diagnosed", and "adjusted"
subluxations rather than "treated" disease. Early
chiropractors believed that all disease was caused by interruptions
in the flow of innate intelligence, a vital nervous energy
or life force that represented God's presence in man; chiropractic
leaders often invoked religious imagery and moral traditions.
D.D. and B.J. both seriously considered declaring chiropractic
a religion, which might have provided legal protection under
the U.S. constitution, but decided against it partly to avoid
confusion with Christian Science. Early chiropractors also
tapped into the Populist movement, emphasizing craft, hard
work, competition, and advertisement, aligning themselves
with the common man against intellectuals and trusts, among
which they included the American Medical Association (AMA).
Although D.D. and B.J. were "straight"
and disdained the use of instruments, some early chiropractors,
whom B.J. scornfully called "mixers", advocated
use of instruments. In 1910 B.J. changed course and endorsed
X-rays as necessary for diagnosis; this resulted in a significant
exodus from the Palmer School of the more conservative faculty
and students. The mixer camp grew until by 1924 B.J. estimated
that only 3,000 of the U.S.'s 25,000 chiropractors remained
straight. That year, B.J.'s promotion of the neurocalometer,
a new temperature-sensing device, was another sign of chiropractic's
gradual acceptance of medical technology, although it was
highly controversial among B.J.'s fellow straights. Despite
heavy opposition by organized medicine, by the 1930s chiropractic
was the largest alternative healing profession in the U.S.6]
The longstanding feud between chiropractors and medical doctors
continued for decades. Until 1983, the AMA labeled chiropractic
"an unscientific cult" and held that it was unethical
for medical doctors to associate with an "unscientific
practitioner". This culminated in a landmark 1987 decision,
Wilk v. AMA, in which the court found that the AMA had engaged
in unreasonable restraint of trade and conspiracy, and which
ended the AMA's de facto boycott of chiropractic.
Serious research to test chiropractic
theories did not begin until the 1970s, and was hampered by
what are characterized as antiscientific and pseudoscientific
ideas that sustained the profession in its long battle with
organized medicine. By the mid 1990s there was a growing scholarly
interest in chiropractic, which helped efforts to improve
service quality and establish clinical guidelines that recommended
manual therapies for acute low back pain. In recent decades
chiropractic gained legitimacy and greater acceptance by medical
physicians and health plans, and enjoyed a strong political
base and sustained demand for services. However, its future
seemed uncertain: as the number of practitioners grew, evidence-based
medicine insisted on treatments with demonstrated value, managed
care restricted payment, and competition grew from massage
therapists and other health professions. The profession responded
by marketing natural products and devices more aggressively,
and by reaching deeper into alternative medicine and primary
The principles of evidence-based
medicine have been used to review research studies and generate
practice guidelines outlining professional standards that
specify which chiropractic treatments are legitimate and perhaps
reimbursable under managed care. Evidence-based guidelines
are supported by one end of an ideological continuum among
chiropractors; the other end employs what is considered by
many chiropractic researchers to be antiscientific reasoning
and unsubstantiated claims, that have been called ethically
suspect when they let practitioners maintain their beliefs
to patients' detriment. A 2007 survey of Alberta chiropractors
found that they do not consistently apply research in practice,
which may have resulted from a lack of research education
and skills. Evidence-based chiropractors possess the ability
to apply research in practice. Continued education enhances
the scientific knowledge of the practitioner.
Opinions differ as to the efficacy
of chiropractic treatment; many other medical procedures also
lack rigorous proof of effectiveness. Many controlled clinical
studies of spinal manipulation (SM) are available, but their
results disagree,85] and they are typically of low quality.
Health claims made by chiropractors about using manipulation
for pediatric health conditions are supported by only low
levels of scientific evidence. Although a 2008 critical review
found that with the possible exception of back pain, chiropractic
SM has not been shown to be effective for any medical condition,
and suggested that many guidelines recommend chiropractic
care for low back pain because no therapy has been shown to
make a real difference,88] a 2008 supportive review found
serious flaws in the critical approach, and found that SM
and mobilization are at least as effective for chronic low
back pain as other efficacious and commonly used treatments.
Most research has focused on spinal manipulation (SM) in general,
rather than solely on chiropractic SM. A 2002 review of randomized
clinical trials of SM was criticized for not distinguishing
between studies of SM in general, and studies on chiropractic
SM in particular; however the review's authors stated that
they did not consider this difference to be a significant
point as research on SM is equally useful regardless of which
practitioner provides it.
There is a wide range of ways
to measure treatment outcomes. Chiropractic care, like all
medical treatment, benefits from the placebo response. It
is hard to construct a trustworthy placebo for clinical trials
of spinal manipulative therapy (SMT), as experts often disagree
about whether a proposed placebo actually has no effect. The
efficacy of maintenance care in chiropractic is unknown.
Available evidence covers the
Low back pain. There is continuing conflict
of opinion on the efficacy of SMT for nonspecific (i.e.,
unknown cause) low back pain; methods for formulating
treatment guidelines differ significantly between
countries, casting some doubt on the guidelines' reliability.
A 2007 U.S. guideline weakly recommended SM as one alternative
therapy for spinal low back pain in nonpregnant adults
when ordinary treatments fail, whereas the Swedish guideline
for low back pain was updated in 2002
to no longer suggest considering SMT for acute low back
pain for patients needing additional help, possibly
because the guideline's recommendations were based
on a high evidence level. A 2008 review found strong
evidence that SM is similar in effect to medical care
with exercise, and moderate evidence that SM is similar
to physical therapy and other forms of conventional
care. A 2007 literature synthesis found good evidence
supporting SM and mobilization for low back pain and
exercise for chronic low back pain; it also found fair
evidence supporting customizable exercise programs for
subacute low back pain, and supporting assurance and
advice to stay active for subacute and chronic low back
pain. Of four systematic reviews published between 2000
and May 2005, only one recommended SM, and a 2004 Cochrane
review stated that SM or mobilization is no more or
less effective than other standard interventions for
back pain. A 2008 systematic review found insufficient
evidence to make any recommendations concerning medicine-assisted
manipulation for chronic low back pain. A 2005 systematic
review found that exercise appears to be slightly effective
for chronic low back pain, and that it is no more effective
than no treatment or other conservative treatments for
acute low back pain.
Whiplash and other neck pain. There
is no overall consensus on manual therapies for neck
pain. A 2008 review found evidence that educational
videos, mobilization, and exercises appear more beneficial
for whiplash than alternatives; that SM, mobilization,
supervised exercise, low-level laser therapy and perhaps
acupuncture are more effective for non-whiplash neck
pain than alternatives but none of these treatments
is clearly superior; and that there is no evidence that
any intervention improves prognosis. A 2007 review found
that SM and mobilization are effective for neck pain.
Of three systematic reviews of SM published between
2000 and May 2005, one reached a positive conclusion,
and a 2004 Cochrane review found that SM and mobilization
are beneficial only when combined with exercise, the
benefits being pain relief, functional improvement,
and global perceived effect for subacute/chronic mechanical
neck disorder.A 2005 review found consistent evidence
supporting mobilization for acute whiplash, and limited
evidence supporting SM for whiplash.
Headache. A 2006 review found no rigorous
evidence supporting SM or other manual therapies for
tension headache. A 2005 review found that the evidence
was weak for effectiveness of chiropractic manipulation
for tension headache, and that it was probably more
effective for tension headache than for migraine. A
2004 review found that SM may be effective for migraine
and tension headache, and SM and neck exercises may
be effective for cervicogenic headache. Two other systematic
reviews published between 2000 and May 2005 did not
find conclusive evidence in favor of SM.
Other. There is a small amount of research
into the efficacy of chiropractic treatment for upper
limbs, and a lack of higher-quality publications supporting
chiropractic management of leg conditions. A 2007 literature
synthesis found fair evidence supporting assurance and
advice to stay active for sciatica and radicular pain
in the leg. There is very weak evidence for chiropractic
care for adult scoliosis (curved or rotated spine) and
no scientific data for idiopathic adolescent scoliosis.
A 2007 systematic review found that few studies of chiropractic
care for nonmusculoskeletal conditions are available,
and they are typically not of high quality; it also
found that the entire clinical encounter of chiropractic
care (as opposed to just SM) provides benefit to patients
with asthma, cervicogenic dizziness, and baby colic,
and that the evidence from reviews is negative, or too
weak to draw conclusions, for a wide variety of other
nonmusculoskeletal conditions, including ADHD/learning
disabilities, dizzinesss, and vision conditions. Other
reviews have found no evidence of benefit for asthma,]
baby colic,bedwetting, carpal tunnel syndrome, fibromyalgia,
kinetic imbalance due to suboccipital strain (KISS)
in infants,menstrual cramps, or pelvic and back pain
Chiropractic care in general
is safe when employed skillfully and appropriately. Manipulation
is regarded as relatively safe, but as with all therapeutic
interventions, complications can arise, and it has known adverse
effects, risks and contraindications. Absolute contraindications
to spinal manipulative therapy are conditions that should
not be manipulated; these contraindications include rheumatoid
arthritis and conditions known to result in unstable joints.
Relative contraindications are conditions where increased
risk is acceptable in some situations and where low-force
and soft-tissue techniques are treatments of choice; these
contraindications include osteoporosis. Although most contraindications
apply only to manipulation of the affected region, some neurological
signs indicate referral to emergency medical services; these
include sudden and severe headache or neck pain unlike that
Spinal manipulation is associated
with frequent, mild and temporary adverse effects, including
new or worsening pain or stiffness in the affected region.
They have been estimated to occur in 34% to 55% of patients,
with 80% of them disappearing within 24 hours. Rarely, spinal
manipulation, particularly on the upper spine, can also result
in complications that can lead to permanent disability or
death; these can occur in adults and children. The incidence
of these complications is unknown, due to high levels of underreporting
and to the difficulty of linking manipulation to adverse effects
such as stroke, which is a particular concern. Several case
reports show temporal associations between interventions and
potentially serious complications. Vertebrobasilar artery
stroke is statistically associated with chiropractic services
in persons under 45 years of age, but it is similarly associated
with general practitioner services, suggesting that these
associations are likely explained by preexisting conditions.
Weak to moderately strong evidence supports causation (as
opposed to statistical association) between cervical manipulative
therapy (whether chiropractic or not) and vertebrobasilar
Chiropractors sometimes employ
diagnostic imaging techniques such as X-rays and CT scans
that rely on ionizing radiation; practice guidelines aim to
reduce unnecessary radiation exposure, which causes cancer
in proportion to the amount of radiation received.
A 2006 qualitative review found
that the research literature suggests that chiropractic obtains
at least comparable outcomes to alternatives with potential
cost savings. A 2006 UK systematic cost-effectiveness review
found that the reported cost-effectiveness of chiropractic
manipulation compares favorably with other treatments for
back pain, but that reports are based on data from clinical
trials without sham controls and that the specific cost-effectiveness
of the treatment (as opposed to non-specific effects) remains
uncertain. A 2005 systematic review of economic evaluations
of conservative treatments for low back pain found that significant
quality problems in available studies meant that definite
conclusions could not be drawn about the most cost-effective
intervention. The cost-effectiveness of maintenance chiropractic
care is unknown.
Within the chiropractic community
there are significant disagreements about vaccination, one
of the most cost-effective forms of prevention against infectious
disease. Most chiropractic writings on vaccination focus on
its negative aspects, claiming that it is hazardous, ineffective,
and unnecessary. Some chiropractors have embraced vaccination,
but a significant portion of the profession rejects it, as
original chiropractic philosophy traces diseases to causes
in the spine and states that vaccines interfere with healing.
The American Chiropractic Association and the International
Chiropractors Association support individual exemptions to
compulsory vaccination laws, and a 1995 survey of U.S. chiropractors
found that about a third believed there was no scientific
proof that immunization prevents disease. The Canadian Chiropractic
Association supports vaccination; a survey in Alberta in 2002
found that 25% of chiropractors advised patients for, and
27% against, vaccinating themselves or their children.129]
A survey of Canadian Memorial Chiropractic College students
in 1999–2000 reported that seniors opposed vaccination
more strongly than freshmen, with 29.4% of fourth-year students
Osteopathic manipulative medicine
Osteopathic Manipulative Medicine
(abbreviated as OMM) is an approach to manual therapy, form
of therapy that uses physical contact, used to improve the
impaired or altered function of the musculo-skeletal system
(somatic dysfunction). With roots in ancient Greek "frictions,"
manual manipulation has long been a part of health care. Today's
OMM was first practiced by Andrew Taylor Still, M.D., the
founder of modern osteopathic medicine. In the United States,
its country of origin, OMM is used by Doctors of Osteopathic
Medicine (D.O.s) along with surgery and medication in treatment
of patients. Outside the United States, practitioners of osteopathy
(who may have the qualification of D.O. as a Diploma of Osteopathy,
but do not necessarily have the same medical training as American-trained
D.O.s) generally limit their scope to manual manipulation.
There are different techniques
applied to the musculoskeletal system as OMM. These techniques
can be applied to the joints, their surrounding soft tissues,
muscles and fasciae.
Also, OMM is a treatment that
is intended to be used in conjunction with mainstream treatments
where it is deemed appropriate. It is rarely used as a primary
treatment regimen unless the D.O. is absolutely certain that
the patient's problems are a result of a musculoskeletal somatic
dysfunction. Furthermore, as with other medical treatment
methodologies, there are certain situations where use of OMM
is strictly contraindicated (for example, cervical spine HVLA
techniques may never be used on patients with Down Syndrome).citation
While this OMM practice is traditionally
ascribed to D.O.'s, it should also be noted that there are
M.D. practitioners of OMM since many Osteopathic medical schools
have created training programs for their M.D. counterparts.
Recently OMM training programs have likewise been extended
to other medical professionals including, but not limited
to: Physician Assistants, Nurse Practitioners, Nurses, etc.
Some techniques used in OMM are:
* Balanced ligamentous tension
* Cranial osteopathy
* High Velocity Low Amplitude Thrust (HVLAT)
* Joint mobilization - articulatory techniques
* Lymphatic Pump
* Muscle Energy Technique (MET)
* Myofascial Release
* Neuromuscular therapy, trigger point therapy or myodysneuric
* Soft Tissue Technique
* Visceral manipulation
It is probably the comprehensive
and eclectic style of OMM that distinguishes it most from
that employed by most other manual therapists. The immediate
goal of musculoskeletal manipulation is to restore maximal,
pain-free movement of the musculoskeletal system in postural
The Cochrane Library has systematically
reviewed evidence on the effectiveness of spinal manipulation
for a number of conditions. The conclusions are summarised
in the table below. Note that in many cases the manipulation
was carried out by chiropractors or osteopaths rather than
by osteopathic doctors.
Dysmenorrhoea (painful menstrual
spinal manipulation (using hands
to put pressure on certain parts of the back bone)
neck pain, neck pain plus related
exercises plus mobilisation movement
imposed onto joints and muscles] or manipulation
These treatments when combined were
better than no treatment.
neck pain, neck pain plus related
May be effective, with a short-term
effect similar to amitriptyline.
chronic tension-type headache
Less effective than amitriptyline
during treatment. More effective than amitriptyline
in the short term after end of treatment
Effective at least in the short
Spinal manipulation, chest tapping,
shaking, vibration, postures, massage
Not enough evidence
No more or less effective than pain
medication, physical therapy, exercises, back school
or the care given by a general practitioner.
More effective than sham (fake) therapy.
Manipulation and other treatments
Not enough evidence