Chiropractic

Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.^[1] It is generally categorized as complementary and alternative medicine (CAM),^[2] a characterization that many chiropractors reject.^[3] The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling.^[4] Traditional chiropractic assumes that avertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence,^[5] a vitalistic notion that brings ridicule from mainstream science and medicine.^[6]

D.D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century.^[7] 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.^[8] Chiropractic is well established in the U.S., Canada and Australia.^[9]

Throughout its history it has been controversial.^[10][11] For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation^[12] that are not based on solid science.^[13] Vaccination remains controversial among chiropractors.^[14] The American Medical Association called chiropractic an "unscientific cult"^[15] and boycotted it until losing a 1987 antitrustcase.^[16] Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among medical physicians and health plans in the U.S.,^[16] and evidence-based medicine has been used to review research studies and generate practice guidelines.^[17] Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of treatment of back pain.^[13] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.^[18]Although spinal manipulation can have serious complications in rare cases,^[19][20] chiropractic care is generally safe when employed skillfully and appropriately.^[21]