Chiropractic

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Skilled, specific hands-on techniques, including manipulation and mobilization, are used to diagnose and treat soft tissues and joint structures, to reduce pain and to increase range of motion and general health.

The approach is generally conservative, and treatment may include:

  • manual procedures, including spinal or joint manipulation or mobilization, soft‐tissue and reflex techniques;
  • exercise, and other active care;
  • psychosocial aspects of patient management;
  • patient education on spinal health, posture, nutrition and lifestyle modifications;
  • emergency treatment and acute pain management;
  • other supportive measures, including the use of back supports and orthotics;
  • recognition of the limitations of chiropractic care, and of the need for referral to other health professionals.

Chiropractors may also use exercise and other conservative treatments and advice.

Manual and manipulative therapy

The Chinese used such techniques more than 3000 years ago. Hippocrates also used such techniques[1] as did the ancient Egyptians and other cultures.

In the late 19th century in North America, therapies including osteopathy andchiropractic became popular.[2] Spinal manipulation gained mainstream recognition during the 1980s.[3]

In this system, hands are used to manipulate, massage or otherwise influence the spine and related tissues.[4] It is the most common and primary intervention used in chiropractic care.[5]

Effectiveness

Neuromusculoskeletal disorders

Treatment is usually for neck or low back pain and related disorders.[11]

For acute low back pain, low quality evidence has suggested no difference between real and sham spine manipulation,[12] and moderate quality evidence has suggested no difference between spine manipulation and other commonly used treatments, such as medication and physical therapy.[12][13][14]

National guidelines vary; some recommend the therapy for those who do not improve with other treatment.[15] It may be effective for lumbar disc herniation withradiculopathy,[16][17] as effective as mobilization for neck pain,[18] some forms of headache,[19][20][21] and some extremity joint conditions.[22][23] A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between spinal manipulation therapy and other treatments for reducing pain and improving function for chronic low back pain.[24] A 2008 review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition.[6][25]

Non-musculoskeletal disorders

The use of spinal manipulation for non-musculoskeletal is controversial. It has not been shown to be effective for asthma, headache, hypertension, or dysmenorrhea.[14] There is no scientific data that supports the use of SMT for idiopathic adolescent scoliosis.[26][27]

Cost-effectiveness

Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches.[28] Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.[29]

Safety

All treatments need a thorough medical history, diagnosis and plan of management. Chiropractors, must rule out contraindications to any treatments, includingadverse events.

Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissuetechniques may be treatments of choice. Most contraindications apply to the manipulation of the affected region.[30]

While safety has been debated,[7] and serious injuries and deaths can occur and may be under-reported,[8] these are generally rare and spinal manipulation is relatively safe[12] when employed skillfully and appropriately.[9]

Adverse events are believed to be under-reported [31] and appear to be more common following high velocity/ low amplitude manipulation than mobilization.[32]Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.[7] These effects generally are reduced within 24–48 hours [33] Serious injuries and fatal consequences, especially to SM in the upper cervical region, can occur.[34] but are regarded as rare when spinal manipulation is employed skillfully and appropriately.[30]

The relationship to stroke has been debated. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age, and these associations may be related to preexisting conditions.[35][36][37] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.[38] A 2012 review found that there is not enough evidence to support a strong association or no association between cervical manipulation and stroke.[39] A 2008 review found chiropractic are more commonly associated with serious related adverse effects than other professionals follo

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