Understanding Chiropractic
Evidence-based Practice?
With the focus on greatest patient benefit, Puffin Chiropractic Evidence-Based Practice’s core belief is in patient evaluation and treatment plans to incorporate current best evidence into all aspects of our clinical care. “Evidence-based [practice] is the integration of best research evidence with clinical expertise and patient values.” 1 It is a patient-centered approach to clinical management that explicitly utilizes research evidence, patient values and clinician experience. The strength of that evidence, the benefits and risks of alternative approaches and patient preferences all influence management strategies.
- Sackett D et al. Evidence-based Medicine: How to Practice and Teach EBM, 2nd Edition. Churchill Livingstone, Edinburgh, 2000, p.1.
- Guyatt G, Voelker R. Everything You Ever Wanted to Know About Evidence-based Medicine. JAMA 2015;313:1783-5.
Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic services are used most often to treat common musculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches. Through their whole-person, patient-centered approach, doctors of chiropractic (DCs) elevate the health and wellness of their communities by helping people of all ages live more fully and actively by evaluating and treating the neuromusculoskeletal and associated systems of the body for overall health and primary care.
Chiropractic is the third-largest primary health care profession, surpassed in number only by doctors of medicine and dentistry. Doctors of chiropractic treat about 35 million Americans annually.
Doctors of Chiropractic (DCs) – often referred to as chiropractors or chiropractic physicians – practice a hands-on approach (chiropractic spinal manipulation technique -CMT) to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling. CMT: The high-velocity, low-amplitude (HVLA) technique is among the oldest and most frequently used chiropractic techniques. We are both diversified practitioners.
Like their medical colleagues, chiropractors are subject to the boundaries established in state practice acts and are regulated by state licensing boards. Their education in four-year doctoral graduate school programs is nationally accredited through an agency that operates under the auspices of the U.S. Department of Education. After graduation, they must pass national board exams before obtaining a license to practice, and then must maintain their license annually by earning continuing education (CE) credits through state-approved CE programs. https://handsdownbetter.org/about-chiropractic/ DCs are educated in nationally accredited, four-year doctoral graduate school programs through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship, with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools.
Chiropractors are designated as physician-level providers in the vast majority of states and the federal Medicare program. The essential services provided by DCs are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the Federal Employees Health Benefits Program, Federal Workers’ Compensation, and all state workers’ compensation programs. https://handsdownbetter.org/about-chiropractic/certification-and-licensure/
Chiropractic: The History
The word ‘chiropractic’ comes from the Greek words cheir (meaning ‘hand’) and praktos (meaning ‘done’), i.e., done by hand. Manual healing methods can be traced back to ancient times; however, it was not until the late 19th century that the chiropractic profession in the United States began to take shape.
Daniel David (D.D.) Palmer is widely credited with giving the first chiropractic adjustment in 1895. While spinal manipulation continues to be a centerpiece of chiropractic care, modern chiropractors have developed a variety of practice styles, featuring different therapies and modalities, to address patients’ needs. They practice a holistic approach to health care that generally excludes drugs or surgery.1
As the new profession was getting on its feet in the early 20th century, chiropractors began organizing into professional societies. Today, there are almost 20 chiropractic colleges in the United States accredited by the Council on Chiropractic Education, which was officially recognized in 1974 by the U.S. Department of Education as the accrediting agency for chiropractic schools. In 1996, the U.S. government began funding chiropractic research through the National Institutes for Health and over the years the profession has received millions in federal funding for scientific research thanks to robust research programs at several of the colleges.
Chiropractic is a regulated healthcare profession in the United States and has been for more than 100 years. Before being granted a license to practice, doctors of chiropractic (DCs) must meet stringent educational and competency standards set forth by the National Board of Chiropractic Examiners and individual states. Kansas was the first state to license chiropractic in 1913. Today, all 50 U.S. states, the District of Columbia, all U.S. territories, and more than 40 countries worldwide license chiropractors.
With an increasing body of research supporting its approach, the chiropractic profession has over time become integrated into many healthcare systems, hospitals, and public and private health and managed care plans. Spinal manipulation was first included in Medicare in 1972 (efforts continue to expand the services that chiropractors can provide to Medicare beneficiaries), and two years later in 1974 chiropractic care became a benefit in the Federal Employee Health Benefits Program. Chiropractic is also a benefit in most state workers’ compensation programs.
Nondrug pain relief has been especially important to active-duty members of the military as well as veterans, many of whom experience chronic musculoskeletal pain as a result of their service. Congress passed legislation in 1993 to include chiropractic in the U.S. Department of Defense healthcare system. Today Chiropractic services are available to active-duty personnel at more than 60 military bases in the United States, Germany and Japan.
Legislation to include chiropractic in the U.S. Department of Veterans Affairs (VA) healthcare system was passed in 1999. Chiropractic is now available at 70 major VA medical facilities in the United States. In addition, in 2014 the VA launched a chiropractic residency program—the first of its kind in the country—where chiropractors train alongside their medical counterparts at VA medical systems around the country. The residency is a full-time one-year program in integrated clinical practice emphasizing the delivery of chiropractic care in hospitals and other integrated healthcare settings.
In recent years, the epidemic of opioid overuse has prompted many respected health organizations to recommend the use of nondrug approaches for pain relief as a first line of defense, potentially helping patients to reduce or avoid the need for prescription pain medications. Notably, the American College of Physicians (ACP) updated its guideline for the treatment of acute and chronic low back pain in 2017 to recommend first using noninvasive, nondrug treatments – including spinal manipulation – before resorting to drug therapies. A host of other organizations have since endorsed ACP’s guideline or issued similar recommendations.
The chiropractic profession continues to grow and evolve. There are more than 70,000 chiropractors licensed today in the United States – practicing in solo practices, multidisciplinary clinics and major hospital systems. It is estimated that more than 35 million people visit a chiropractor each year. 1. National Board of Chiropractic Examiners. “Practice Analysis of Chiropractic 2020.” www.nbce.org. Accessed April 1, 2021. https://mynbce.org/wp-content/uploads/2020/05/Practice-Analysis-of-Chiropractic-2020-5.pdf