What is Chiropractic?
- What is chiropractic
- Regulation of chiropractic
- Differences between a chiropractor, an osteopath and a physio
- How does it work?
- Chiropractic and the brain
- The research
What is Chiropractic?
Chiropractors treat problems with joints, bones and muscles, and the effects they have on the nervous system. Working on all the joints of the body, concentrating particularly on the spine, they use their hands to make often gentle, specific adjustments (the chiropractic word for manipulation) to improve the efficiency of the nervous system and release the body’s natural healing ability.
Chiropractic means “done by hand” and is a primary health-care profession, so you do not need to be referred by your doctor. A chiropractor is trained to diagnose your problem and will refer you to another health-care practitioner if necessary. Chiropractic does not involve the use of any drugs or surgery.
The effectiveness of chiropractic treatment is supported by research as well as by various UK government and medical organisations. Chiropractic may be available to patients under the umbrella of the NHS, but this will depend on the situation within a specific NHS Primary Care Trust. Otherwise patients see chiropractors in a private capacity either through self referral or as a result of a referral from their GP, other doctor or health professional. BCA chiropractors also treat people who are seeking treatment through private health insurers.
Regulation of chiropractic
In common with medical practitioners and dentists, all chiropractors are registered by law under the Chiropractors Act 1994 and the title ‘Chiropractor’ is protected under this legislation. The profession is statutorily regulated through the General Chiropractic Council (GCC) and it is illegal to practise as a chiropractor without being registered with the GCC.
We are also members or fellows of the Royal College of Chiropractors.
We are all members of the British Chiropractic Association members and registered with the General Chiropractic Council.
For more information on chiropractic and the BCA click here
Differences between a chiropractor, an osteopath and a physio
A few weeks ago I had a chat with a Daily Express journalist. He was exploring the differences between chiropractors, osteopaths and physiotherapists for a piece in the paper. I explained that, in my view, there were a lot of similarities between ostoepaths and chiropractors. Both are regulated by an Act of parliament like doctors and dentists; both study for 4 or 5 years for a BSc or MSc degree; both have been going for over 100 years; both use manipulation to treat muscle and joint problems; both have a special interest in treating spinal problems like back pain and neck pain; both advise exercises and lifestyle changes and both are mostly not available on the NHS – yet.
So what is the difference Adrian, the journalist, asked. The main things are some subtle differences in the spinal techniques used and probably most important of all – chiropractors will recommend preventative check-ups more often. Whether this is appealling to you depends on whether you like idea of preventing future episodes of, for example, back pain. If you go to a dentist for check-ups you probably like the idea of preventative chiropractic too.
There are a couple of other differences between chiropractors, osteopaths and physios. An important one is that chiropractors are qualified to take and read x-rays. We have an x-ray unit on site.
There are about 2500 chiropractors in the UK. Osteopaths number about 4000. In the rest of the world the situation is reversed with about 60,000 chiropractors and about 10,000 osteopaths. The difference in the UK is probably because there has been an osteopathic college here since the 1920’s but a chiropractic college only since 1965.
There are about 40,000 physios, mostly working in the NHS, whereas almost all osteopaths and chiropractors work in private practice. In the last few years, however, there are several Primary Care Trusts in the NHS employing them. Indeed the 2006 Department of Health Musculo-Skeletal Framework recommends that this should be more common. The NICE chronic back pain guidelines published in June 2009 back up this view.
The difference between chiropractors and physios boils down to spinal manipulation. Whilst a few physios do go on to gain a qualification in manipulation most don’t and it is not taught at an undergraduate level to any great extent. Physios do spinal mobilisation which is less vigorous and less effective for things like back problems.
Physios will tend to do more work on extremity problems like frozen shoulder and tennis elbow and other pulls and sprains. They are very good at this and use exercises and machines like ultrasound and in our clinic laser therapy which is wonderful.
How does it work?
Chiropractic works by unlocking stiff and dysfunctional joints, especially in the spine. Surely it can’t be that simple! Well no it’s not, but it is a good place to start. Whilst we do get the joints the moving, restoring flexibility decreases muscle spasm and inflammation. But the effects on the nervous system are even more profound.
Chiropractic and the brain
The nerve endings in the muscles, tendons and ligaments are stimulated by a chiropractic adjustment and this has an important effect on the brain. The pain threshold is raised and the brain improves control of those very muscles and this helps prevent re-injury. The combined effect is to solve the problem and take the pain away.
The effects of a single adjustment last for a few days. Each session builds on the one before so you may need several sessions to get a lasting improvement. It is a bit like getting fit. Going to the gym once may make you a bit sore but you won’t get much benefit without going several times. We will give you a clear idea how many sessions will be needed.
Don’t look…unless you’re really interested. (It can be a bit dull!). On the other hand the research does show that chiropractic works for back pain, neck pain, headaches and some other things.
Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis
Gert Bronfort PhD, DC, Mitchell Haas DC, MAb, Roni L. Evans DC, MSa and Lex M. Bouter PhDc
The Spine Journal, Volume 4, Issue 3, May-June 2004, Pages 335-356
Despite the many published randomized clinical trials (RCTs), a substantial number of reviews and several national clinical guidelines, much controversy still remains regarding the evidence for or against efficacy of spinal manipulation for low back pain and neck pain.
To reassess the efficacy of spinal manipulative therapy (SMT) and mobilization (MOB) for the management of low back pain (LBP) and neck pain (NP), with special attention to applying more stringent criteria for study admissibility into evidence and for isolating the effect of SMT and/or MOB.
RCTs including 10 or more subjects per group receiving SMT or MOB and using patient-oriented primary outcome measures (eg, patient-rated pain, disability, global improvement and recovery time).
Articles in English, Danish, Swedish, Norwegian and Dutch reporting on randomized trials were identified by a comprehensive search of computerized and bibliographic literature databases up to the end of 2002. Two reviewers independently abstracted data and assessed study quality according to eight explicit criteria. A best evidence synthesis incorporating explicit, detailed information about outcome measures and interventions was used to evaluate treatment efficacy. The strength of evidence was assessed by a classification system that incorporated study validity and statistical significance of study results. Sixty-nine RCTs met the study selection criteria and were reviewed and assigned validity scores varying from 6 to 81 on a scale of 0 to 100. Forty-three RCTs met the admissibility criteria for evidence.
Acute LBP: There is moderate evidence that SMT provides more short-term pain relief than MOB and detuned diathermy, and limited evidence of faster recovery than a commonly used physical therapy treatment strategy.
Chronic LBP: There is moderate evidence that SMT has an effect similar to an efficacious prescription nonsteroidal anti-inflammatory drug, SMT/MOB is effective in the short term when compared with placebo and general practitioner care, and in the long term compared to physical therapy. There is limited to moderate evidence that SMT is better than physical therapy and home back exercise in both the short and long term. There is limited evidence that SMT is superior to sham SMT in the short term and superior to chemonucleolysis for disc herniation in the short term. However, there is also limited evidence that MOB is inferior to back exercise after disc herniation surgery.
Mix of acute and chronic LBP: SMT/MOB provides either similar or better pain outcomes in the short and long term when compared with placebo and with other treatments, such as McKenzie therapy, medical care, management by physical therapists, soft tissue treatment and back school.
Acute NP: There are few studies, and the evidence is currently inconclusive.
Chronic NP: There is moderate evidence that SMT/MOB is superior to general practitioner management for short-term pain reduction but that SMT offers at most similar pain relief to high-technology rehabilitative exercise in the short and long term.
Mix of acute and chronic NP: The overall evidence is not clear. There is moderate evidence that MOB is superior to physical therapy and family physician care, and similar to SMT in both the short and long term. There is limited evidence that SMT, in both the short and long term, is inferior to physical therapy.
Our data synthesis suggests that recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP. There have been few high-quality trials distinguishing between acute and chronic patients, and most are limited to shorter-term follow-up. Future trials should examine well-defined subgroups of patients, further address the value of SMT and MOB for acute patients, establish optimal number of treatment visits and consider the cost-effectiveness of care.
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