Chiropractic
Chiropractic is Conservative Care
Chiropractic care is complimentary to medicine rather than alternative,
it is considered drugless and conservative
Chiropractors have long recognized the importance of a wellness focus and active care. Concern lies not only upon the physical aspects of healing but also attitude, education, lifestyle modification, nutrition, and exercise. Chiropractors remain open to various forms of health care as long as the patient benefits from the chosen intervention.
Effective Relief | How It Helps | Treatment | Your First Visit
Cost | History | Education | Scientific Research
Chiropractic care provides fast effective relief
- lower & mid back pain
- neck pain and headaches
- arthritic pain
- sports injuries
- repetitive strain injuries (i.e. carpal tunnel syndrome)
- lateral nerve root entrapments (i.e. sciatica)
Times are changing...'The zealous and unsupportable assertion of many early chiropractors was that the vertebral subluxation, influencing the nervous system, was the source of all or most disease. This is as historical as a then current medical technique, blood letting with the leech. This skeleton in the chiropractic cupboard, rattled by a fringe movement of extremists, as exist in any profession, has proven a continued barrier to understanding and cooperation between the chiropractic and medical profession'.
- Chiropractic Report 1997
The last 15 years have produced explosive and dynamic change and growth for the chiropractic profession. The explanation of chiropractic care as putting bones back into place to remove nerve interference is no longer valid or acceptable. The description of chiropractic care is now one of: correcting mechanical dysfunction in the joints (joint restriction/dysfunction) and soft tissues (myofascial adhesions and scar tissue) with joint manipulation (adjustments) and soft tissue therapy (trigger points, massage, myofascial release), giving rehabilitative exercises (stretches, strength, endurance, balance), to assist with injury recovery and prevent recurrence of injuries and symptoms.
Chiropractors educate patients with regard to the nature of their injury, posture, ergonomics, exercise, lifestyle, prevention, the use of ice & heat, nutritional consultation, etc. Chiropractors work with other health professionals and refer to doctors/specialists, or on to other health care providers when appropriate.
How Chiropractic care helps
Studies in North America, Europe and Australia have reported that approximately 80% of chiropractic practice is focused on treating musculoskeletal pain, with low back pain the predominant presenting complaint. Headaches compose of another 10% of chiropractic treatment for which there is a growing body of research supporting its effectiveness.
Conditions Suitable for Referral to a Chiropractor:
- mechanical lower and mid-back pain - due to facet joint (sprain) or myofascial injury (strain)
- mechanical neck pain (including whiplash) - due to facet joint (sprain) or myofascial injury (strain)
- headaches - tension, migraines, cluster, and cervicogenic headaches due to dysfunction of the cervical spine and associated muscles or tmj dysfunction
- costo-vertebral joint injury - due to joint capsule or ligamentous sprain
- sacro-iliac joint dysfunction/injury - with associated sciatic nerve or joint referral myofascial syndromes/muscle strains such as piriformis, quadratus lumborum (QL), and other myofascial syndromes that can cause direct and referred pain
- acute torticollis - a common neck complaint that many 'wake up' with, causing severe neck and mid back pain, loss of motion of the neck (particularly in one direction), and referred pain to the upper arm and mid-scapular region
- temporo-mandibular joint dysfunction - due to aberrant joint mechanics, repetitive strain injury, muscle spasm or compensatory cervical trauma
- disc herniation - in the neck or low back with nerve root involvement, tension signs, and mild neurological deficits
- lateral nerve root irritation - from neck or low back lateral spinal canal stenosis due to degenerative changes and causing neurogenic referral and symptoms
- repetitive stain injuries - such as medial epicondylitis, lateral epicondylitis, carpal tunnel syndrome, patello-femoral syndrome
- peripheral joint injuries - ankles, shoulders (rotator cuff), knees, elbows, etc. - both chronic and acute, but particularly chronic with an emphasis on the break down of scar tissue and adhesions as a result of improper tissue repair
- sports injuries - many of the above injuries can occur while playing sports - generally injuries of a sprain/strain nature can be treated with proper soft tissue therapy, manipulation, rehabilitation exercises, and advice on home care.
Approximately 90% of chiropractic patients present with musculoskeletal complaints and headaches. The remaining 10% include a variety of disorders aggravated or caused in part by spinal dysfunction.
This is the 10% that concerns many Medical Doctors, and rightly so. No responsible chiropractor today claims to cure organic disease through adjustment of the spine without research to support such claims. However, clinical experience suggests that vertebrogenic pain plays an often unsuspected role in many conditions.
This clinical experience is shared by all professions engaged in spinal manual therapy, including medicine, osteopathy, chiropractic and physiotherapy. Certain conditions have been supported by a growing number of practitioners as follows:
- Dr. Nilsson, MD, DC, PHD compared medical and chiropractic management of infants with a medical diagnosis of colic. He found chiropractic management to be significantly more effective than standard medical treatment with dimethicone.
- Grieve, a noted and well-published English physiotherapist notes that all those experienced in manipulation can report a benefit from manual or mechanical treatment for conditions such as migraines, vertigo, subjective visual disturbances, feelings of retro-orbital pressure, dysphagia, dysphonia, heaviness of a limb, restriction of respiratory excursion, abdominal nausea and sciatica.
- One prominent cardiologist, Kunert, from West Germany, has shown links between spinal dysfunction and chest pain & breathing problems (often called pseudo-angina).
- A neurologist, Dr. Karl Lewit, from Prague, writes at length of his experimental and clinical experience using spinal manipulation to treat patients with respiratory problems, heart dysfunction, digestive problems, gynecological disorders, migraine, vertigo/dizziness, and other conditions.
What does Chiropractic treatment involve?
The major objectives of treatment are to: relieve pain, to restore and maintain function, to promote proper healing, to reduce the chance of re-aggravation, and to prevent chronic pain and premature degeneration.
- Manipulation / Adjustments
A skilled and specific form of treatment, in which the joint is taken beyond its passive end range barrier to what is known as the paraphysiological space. The objective of the adjustment is to release connective tissue adhesions, and to break the cycle of muscle spasticity, ultimately working towards restoring normal joint motion, improved healing capacity, and decreased pain. Adjustments involve a fast (high velocity), short (low amplitude) thrust, in the direction of joint restriction. Generally, there is a 'popping' noise directly after the thrust, which is pressurized gas (CO2) being released from the joint fluid. There is a growing body of research showing that manipulation has superior results to mobilization in reducing back pain, reducing neck pain, and increasing range of motion in a joint. Adjustment/manipulation is considered very safe.
- Joint Mobilization
A slower (low velocity) technique in which the joint remains within its passive range of movement. Mobilization places a tension on the joint capsule and ligaments and is designed to reduce ligamentous adhesions, and improve motion.
- Stretching
Stretching is used to improve range of motion, relax tight muscles, and assist in the soft tissue healing process. Re-alignment of muscle fibres may be achieved after more aggressive soft tissue techniques such as advanced myofascial release techniques.
- Massage & Trigger Point Therapy
Soft tissue techniques are often used prior to manipulation/adjustments to relax the area thus allowing the joints to move.
- Home Rehabilitative Exercises
Individual exercise programs are designed to improve fitness levels by promoting flexibility, strength, endurance and cardiovascular fitness. Home exercises will also speed the rate of recovery. There are many ways to perform exercises at home including thera-band and exercise balls.
- Ice/Heat
Ice therapy constricts blood vessels, numbs painful areas, and relaxes muscle spasms. Ice is used for acute injuries or for re-aggravation of chronic injuries. When in doubt, use ice.
Heat therapy increases blood vessel size and thus, increases circulation, relaxing soft tissues and relieving painful symptoms. Heat is used for tight, aching muscles and joints.
- Education
Education regarding the nature of the injury, posture, lifestyle, ergonomics, exercise, nutrition, prevention, etc. is given. The objective is to educate patients so they can learn to manage and prevent recurrence of ongoing problems. Simply put, we help others help themselves.
The first visit - what to expect
The major objective in the first visit is to render an accurate diagnosis. It is then determined if chiropractic treatment will benefit the patient and if there is a 'problem' to treat?
This is done by taking a thorough history and performing an examination (using appropriate orthopaedic and neurological tests, specialized chiropractic analysis for joint function, and radiological imaging as necessary).
Once an accurate diagnosis is rendered, a specific treatment program is initiated (with patients informed consent) or the patient is referred to the appropriate health care provider, who may best assist with his/her condition.
The aim of chiropractic care is to work together with other health care providers, in a multi-disciplinary way for the overall benefit of the patient.
Download New Patient Form (pdf)
Download Pediatric Patient Form (pdf)
What will it cost?
Extended Health Care plans generally cover between 80% to 100% of chiropractic fees.
Insurance Coverage for Chiropractic Care: ICBC and WCB will generally cover costs, call the office for details.
The medical services plan (MSP) covers patients who qualify for premium assistance or social services (net household income < 20,000).
Veterans Affairs & RCMP receive full coverage for chiropractic care.
The cost at our office is: $60 for the initial visit and $45 for subsequent visits.
Chiropractic history
The chiropractic profession was founded in Davenport Iowa, USA in 1895 by Daniel David Palmer. At this time, (early 1900's), all health care was an art or craft rather than an organized body of knowledge. The medical profession had not developed the dominant and respected role it has enjoyed this century. Chiropractic was only one of many new groups of healers that emerged at that time, others included bonesetters, herbal healers, homeopaths, hydro-healers, magnetic healers, and osteopaths to name a few.
Chiropractic has proven to be the most popular and effective and is now taught and practised throughout the world. There is a new level of acceptance that has developed internationally. In Denmark (University of Odense) for example, chiropractic and medical students take the same basic science courses for three years before entering separate streams for clinical training. In Canada, chiropractors are one of five professions authorized to perform and communicate a diagnosis and use the title "doctor", on par with physicians, optometrists, psychologists, and dentists, and are often part of multi-disciplinary health care teams.
Chiropractic education
Chiropractic education in Canada follows a formal University degree program (4 years) and involves 4 years of further education, working towards a Doctorate of Chiropractic degree, consisting of courses in anatomy, clinical sciences, pathology, histology, orthopaedics, neurology, chiropractic sciences and technique, clinical diagnosis and treatment, physiology, nutrition, research, etc. as well as a clinical internship.
Some chiropractors have additional post-graduate training to become Chiropractic Specialists in areas such as sports, radiology and nutrition. Independent investigation by government inquiries and medical practitioners affirms that chiropractic training (in Canada) is today of equivalent standard to medical training in all pre-clinical subjects. Chiropractic students are taught by appropriate medical and science specialists (MD, PhD), as well as qualified chiropractors (DC).
Scientific research - the evidence
Chiropractic spinal manipulation, both in terms of safety and effectiveness, has been assessed and researched more than any other health care intervention.
There have been at least six government inquires into chiropractic worldwide over the last 25 years (including Canada, Australia, New Zealand and Sweden). All studies have concluded that contemporary chiropractic care is safe, effective, cost effective and have recommended public funding for chiropractic services.
In addition, there have been many scientific clinical studies (randomized controlled trials included) assessing the appropriateness, effectiveness, and/or cost effectiveness of spinal manipulation.
Effectiveness and Cost-Effectiveness:
- Meade, TW, et al. (1990 & 1995) 'Randomized Comparison of chiropractic and hospital outpatient treatment for managing low back pain', British Medical Journal
In 1990, this widely reported randomized controlled trial conducted by the British Medical Research Council compared chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. The investigators concluded that chiropractic treatment almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management. They also related that consideration should be given to providing chiropractic coverage within The National Health System and in hospitals. BMJ, Vol. 300, pp. 1431-37.
A follow-up study was published in the British Medical Journal in 1995, which presents the full results and concludes that at three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals. BMJ, Vol. 311, pp. 349-51
- Shekelle, PG, Adams, AH, et al (1991) 'The Appropriateness of Spinal Manipulation for Low Back Pain. Project Overview and Literature Review', RAND, Santa Monica, California.
RAND, a prestigious research organization in the US, released a report on the appropriateness of spinal manipulation for low back pain. Although the investigators found that the literature on spinal manipulation is of unequivocal quality, they concluded that support is consistent for the use of spinal manipulation as a treatment for patients with acute low back pain and an absence of other signs or symptoms of lower limb nerve root involvement'. RAND.
- Jarvis, KB, Phillips, RB, Morris, EK(1991) 'Cost per Case Comparison of Bad Injury Claims of Chiropractic versus Medical Management for Conditions with Identical Diagnostic Codes', Journal of Occupational Medicine.
This worker's compensation study compared chiropractic care to medical care back injury claims. It was concluded that for the total data set, cost for care was significantly more for medical claims. For example, compensation costs for medical care were ten times the costs compared to chiropractic claims. It also found that chiropractic patients return to work ten times sooner after an injury. Total costs per case for the ICD-9 code for lumbar disc were found to be $8175 for total medical care versus $1065 for chiropractic care.
- Ebrall, PS (1992) 'Mechanical Low Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian WorkCare Scheme', Chiropractic Journal of Australia
This was a retrospective study of all work-related low back pain claimants within a twelve month period in Victoria, Australia. This study drew on the database of the Victorian Accident Compensation Commission, and compared costs of outcomes between chiropractic and medical care. The study found that 1) there was a significantly lower number of claimants requiring compensation days when chiropractic management was chosen; 2) there were fewer compensation days taken by claimants who received chiropractic care; 3) a greater number of patients progressed to chronic status when medical management was chosen, and; 4) there was a greater average payment per claim with medical management ($2308.10) versus chiropractic management ($963.47). The investigator concluded that if the Victorian chiropractors managed 40% of low back pain cases (substituting medical care) then the direct savings within the Victorian WorkCare scheme for the study period would have been $10 million over 7,482 claims. CJA, Vol. 22(2), pp. 47-53.
- Manga, P., et al (1993) 'The Effectiveness and Cost-effectiveness of Chiropractic Management of Low Back Pain', Kenilworth Publishing, Ottawa.
In 1993, the Ontario Ministry of Health commissioned and funded a study to examine the effectiveness and cost effectiveness of chiropractic management of low back pain. The report concluded that there is an overwhelming body of evidence indicating that chiropractic management of low back pain is the most cost effective, and that there would be highly significant cost savings if more management of low back pain was transferred to chiropractors. This report also recommended that there should be a shift in policy to encourage chiropractic services for most patients with low back pain and that chiropractic services should be fully insured under the Ontario Health Insurance Plan.
- Stano, M., Smith, M. (1996) 'Chiropractic and Medical Costs of Low Back Pain', Medical Care, Vol 34 (3), pp 191-204.
This study compared health insurance payments and utilization for episodes of care for common low back conditions treated by chiropractors and medical providers, using 2 years of insurance data. The mean total payments were lower for chiropractic care ($518) versus medical care ($1020) as were the mean total outpatient payments ($477 versus $598). The authors concluded that the lower costs for episodes in which chiropractors serve as initial contact providers along with the favourable satisfaction and quality indicators suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending.
*From the Canadian Chiropractic Association publication on Chiropractic Health Care, Synopsis of Recent Studies, 1998
Patient Satisfaction:
In today's consumer driven health care environment, patient satisfaction is an important health outcome measure. There have been several surveys conducted in recent years assessing patient satisfaction with chiropractic care, which was found to be extremely high. Surveys have also indicated that chiropractic patients are willing to return for chiropractic treatment for a similar condition and would recommend chiropractic treatment to friends, family, and colleagues.
Government Recommendations For Management Protocols:
In today's evidence based health care environment, governments are engaged in developing scientific protocols for the management of various health care conditions. The chiropractic profession encourages guideline development based on scientific research. Recent government guidelines continue to support the previous studies on the effectiveness, cost effectiveness, and safety of chiropractic spinal manipulation, recommending chiropractic management for acute low back pain, for example, as the preferred approach.
- Biogos, s., Bowyer, O., et al (1994) Acute Low Back Pain Problems in Adults. Clinical Practice Guidelines No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, US. In December, 1994, the AHCPR, a division of the US Department of Health and Human Services, released a clinical practice guideline entitled Acute Low Back Problems in Adults. The guideline was developed by a 23 member expert multi-disciplinary panel. The guideline concluded that relief of low back pain can be accomplished most safely by non-prescription medication and/or spinal manipulation. Most other therapies currently in use for the treatment of low back pain were found to be ineffective or unsubstantiated by scientific research. Side effects associated with the use of medication were found to be greater than those associated with spinal manipulation, which were very limited.
- Spitzer, WO, et al (1995) Whiplash Associated Disorders (WAD): Redefining whiplash and its management. Quebec Task Force on Whiplash Associated Disorder. The Quebec Task Force consisted of an 18-member expert multi-disciplinary panel whose mandate was to undertake a comprehensive review and study of whiplash-associated disorders (WAD). One of the sections of the report dealt with clinical guidelines for the diagnosis, treatment and prognosis of WAD. It was the Task Force consensus that the use of non-steroidal anti-inflammatory agents and analgesics, short term manipulation and mobilization by trained persons and active exercises are useful in Grade ll and lll WAD, and that manipulative treatment by trained persons for the relief of pain and facilitating early mobility can be used in WAD.
- Royal College of General Practitioners (1996). Clinical Guidelines for the Management of Acute Low Back Pain, Great Britain. The Royal College of General Practitioners, in consultation with the Chartered Society of Physiotherapy, Osteopathic Association of Great Britain, British Chiropractic Association and the National Back Pain Association constructed clinical guidelines on low back pain management, based on extensive international scientific evidence. One of the principal recommendations of the guidelines is to consider manipulative treatment within the first 6 weeks for patients who need additional help with pain relief or who are failing to return to normal activities based on evidence that within the first six weeks onset of acute or recurrent low back pain, manipulation provides better short term improvement in pain and activity level and higher patient satisfaction that the treatments to which it has been compared.
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