By the late 20th century, chiropractic emerged as one of the most popular and accessible forms of health care.
Since its inception in 1895, chiropractic has provided treatment for patients with back pain, neck pain and headache. Throughout American chiropractic history, some chiropractors have claimed a relationship among the spine, nervous system and brain as essential to one’s health and have held that structural imbalances within the spine can affect functioning with the spinal cord, nerves, muscles, bones and joints of the body.
Over the years, based on evidence from the scientific literature, chiropractic physicians have increasingly focused on evidence-based treatment of spine-related disorders as well as other musculoskeletal problems.
Chiropractic treatment has traditionally been based on spinal manipulation, which generally involves applying a manual, controlled force into joints that have become restricted by tissue injury with the purpose of restoring the joint’s mobility, alleviating related pain and tightness, and allowing the tissues to heal.
While spinal manipulation has become more specialized since its earliest applications in chiropractic care, it has remained one of the most commonly used chiropractic treatments of a profession that does not prescribe medication or perform surgery.
However, as chiropractic doctors have evolved with the emerging evidence as to the most effective approaches to back pain, neck pain and headaches, they have embraced a variety of evidence-based treatment approaches.
A number of chiropractors have obtained additional degrees such as PhD’s and have begun to investigate the effects of manipulation as well as other treatments provided by chiropractors.
Spinal manipulation was not invented by a chiropractor, nor is it even a new or recent method. Manipulation of the spine dates back to the beginning of recorded time, with Hippocrates once noting it as a key to treating diseases.
Spinal manipulation is often associated with chiropractic care because of a man named Daniel David (D.D.) Palmer, the founder of chiropractic in the United States. Prior to the 20th century, Palmer maintained an interest in the spine’s role on health and began to study its anatomy, learn more about the use of spinal manipulation in ancient times, and teach himself how to manipulate the spine.
In 1895, Palmer was approached by a janitor who was deaf in one ear. Palmer theorized that the condition was likely related to the spine, possibly a displaced vertebra.
According to many historical accounts, Palmer examined the man’s back, noticed a bump near the spine, and manipulated the area. The hands-on adjustment was reported by Palmer to quickly restore the man’s hearing. This event is considered the start of chiropractic history.
A combination of the Greek words “cheir” (hand) and praktos (“done”), chiropractic means “Done by Hand”,6 although it is important to note that modern spinal manipulation has expanded beyond just hands-based adjustments.
In 1907, Palmer added the term “subluxation” to the chiropractic vocabulary. Palmer explained “subluxations” in terms of the spinal vertebrae and joints putting pressure on the nerves, thus impairing functioning, and then detailed how spinal adjustments could be used to reduce subluxation and improve patient symptoms.5
Subluxation is still used today by some chiropractors to describe specific misalignments of the spinal vertebrae and joints and to determine appropriate treatment options. Other terminology currently in use includes manipulative lesion, spinal dysfunction, or joint dysfunction.
At least one chiropractic school (National University of Health Sciences) has begun to refer to the term “subluxation” from a historical perspective only.
In 1897, Palmer founded the Palmer School of Chiropractic (which still exists today) to teach students about chiropractic principles and train them in chiropractic manipulation.
Palmer’s son Bartlett Joshua (B.J.) further developed and promoted chiropractic in the first half of the 20th century. B.J. Palmer not only provided training in chiropractic, but aided in the education of both the medical community and the general public on the profession.
During this time, chiropractic gradually grew in popularity for patients seeking alternatives to traditional treatments using drugs, and its core principles slowly gained more acceptance with continued research.
The scientific merit of spinal dysfunction and therapeutic benefits of spinal manipulation for neuromusculoskeletal conditions were challenged in the early days of chiropractic. Manipulation has been generally accepted for back pain, neck pain, sciatica, joint problems, sprains, strains, osteoarthritis, herniated discs and other musculoskeletal (MSK) conditions.
Scientific evidence has indicated that spinal manipulation is a safe, mild-to-moderate pain reliever for lower back pain, neck pain and headache, and recent health care guidelines have listed it as a viable treatment option for symptoms that do not respond to self-care.
Spinal manipulation in chiropractic medicine has evolved greatly since the first high-velocity adjustment performed by D.D. Palmer in the late 1800s. In addition, chiropractors have begun to embrace a variety of other evidence-based approaches to spine problems. Now, techniques include low-velocity adjustments involving the hands and even instruments and machines, and various other adjustments incorporating many specialized and individualized thrusts.
Modern chiropractic research has started to focus more on the efficacy of specific types of spinal manipulation, including when certain adjustments are performed and how long they are included as part of chiropractic treatment plans.9 Besides chiropractors, Doctors of Osteopathic Medicine (DO) and some Medical Doctors (MD) and Physical Therapists (PT) also perform spinal manipulation.
Concerns about the safety of manipulating the cervical spine for neck pain have been raised in relation to strokes. The medical literature does not substantiate that manipulation increases the risk of or causes strokes, but rather indicates that the reported stroke cases were patients who already had signs of impending stroke prior to manipulation. The literature shows no statistical difference in stroke occurrence among medical specialties, regardless if someone sees a Medical Doctor or Doctor of Chiropractic, and reports that chiropractic is generally and equally as safe of a treatment for neck pain as other nonsurgical care.
Chiropractic health care has also grown beyond spinal manipulation to include other manual therapy like soft-tissue mobilization and massage, instrument-assisted soft tissue mobilization, the McKenzie approach to mechanical diagnosis and therapy, as well as stabilization and strength training exercise, nutrition and postural programs, and the incorporation of a cognitive-behavioral context to treatment regimens.
Eighteen years after its founding in America, chiropractic received its first state licensing in 1913. In the following 18 years, chiropractic medicine became recognized in 39 states. Chiropractic is now recognized as a health care profession in not only all 50 states but the District of Columbia, Puerto Rico, U.S. Virgin Islands and many other countries. Chiropractic colleges are located in many countries in addition to the United States and Canada.
Chiropractic licensing is handled on a state-by-state basis according to specific state laws. There are currently more than 60,000 licensed chiropractors in the United States, making chiropractic the third largest doctoral level health care profession behind medicine and dentistry.
A 2009 evidence-based report on population, health and total health care spending suggested that chiropractic care of back pain and neck pain provides higher satisfaction, superior outcomes and more cost-effectiveness than other commonly-utilized back and neck pain treatments, which can include simple rest, medications, surgery and more.
This report also reviewed the scientific literature on chiropractic care, which was noted in other findings to be at least as effective as other widely-used therapies for lower back pain and more effective (when combined with exercise) than other common treatments for neck pain.
A further review of scientific literature indicated that patients with chiropractic coverage as part of their insurance benefits had lower costs and reduced imaging studies, fewer hospitalizations and less surgeries than patients without chiropractic included in their insurance.
Today, chiropractors enjoy hospital privileges in many hospitals, practice in multidisciplinary practices, work within the Department of Defense (DoD) and Veterans Affairs (VA) systems, and treat both Medicare and Medicaid patients. The profession continues to become more mainstream and integrated.
If you have chronic neck and/or back pain and are interested in beginning a multi-faceted chiropractic treatment plan, please call our office at (304) 263-4927. Dr Terry Chambers is a Board certified Doctor or Chiropractic and is licensed in WV. Check out our online store here.