Chiropractic - Treatment Methods

Editor-in-Chief: Dr. Stephen J. Press [mailto:drsjp@drpress.com]

Spinal manipulation, the most common modality in chiropractic care, is a passive manual maneuver during which a three-joint complex is taken past the normal physiological range of movement without exceeding the anatomical boundary limit. The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. Spinal manipulation gained mainstream recognition during the 1980s (see History). In the U.S., chiropractors perform over 90% of all manipulative treatments and consider themselves to be expertly qualified providers of spinal adjustment, manipulation and other manual treatments.

Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.

Many chiropractic treatment techniques/modalities are available for use by chiropractors. Although the chiropractic profession is primarily based on the use of the spinal adjustment, many other techniques exist for treating the spine, as well as other joints and tissues. A modern chiropractor may specialize in spinal adjustments only, or may use a wide range of methods intended to address an array of neuromusculoskeletal and general health issues. Examples include soft tissue therapy, strength training, dry needling (similar to acupuncture), functional electrical stimulation, traction, and nutritional recommendations. Chiropractors may also use other complementary alternative methods as part of a holistic treatment approach.

Spinal adjustment
"Spinal adjustment" and "chiropractic adjustment" are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term "adjustment".

Claims made for the benefits of spinal adjustments range from temporary, palliative (pain relieving) effects to long term wellness and preventive care. Some claims are controversial, particularly with regard to indications and health benefits. There is debate concerning the safety of some of the procedures used in spinal adjustments, particularly those including upper cervical manipulations.

The original spinal adjustment was a variation of a procedure known today as spinal manipulation. This form of treatment has documented use as far back as Hippocrates and the ancient Egyptians and was carried through the ages by families of bonesetters. The modern form of spinal manipulation techniques have characteristic biomechanical features, and are usually associated with an audible "popping" sound. There is strong evidence that this sound is the result of a phenomenon known as cavitation.

National Board of Chiropractic Examiners listing of the most frequently used techniques
Chiropractors may include any of hundreds of available techniques and methods in their practices. The National Board of Chiropractic Examiners has rated the following as the most frequently used techniques, here listed with percentages of chiropractors who use them and patients who are treated with them as of 2003:

WebMD listing of techniques
Over the years, many variations of these techniques have been delivered, most as proprietary techniques developed by individual practitioners. WebMD has made a partial list:


 * Activator Methods
 * Advanced BioStructural Correction
 * Applied Kinesiology
 * Atlas Orthogonal
 * Auricular
 * Barge Analysis
 * Bio Magnetic
 * Bio-Energetic Synchronization
 * Bio-Geometric Integration
 * Biomechanics


 * Blair
 * Body Restoration Technique
 * Carver Technique
 * Cervical Care
 * Cervical Drop
 * Chiropractic Biophysics
 * Clinical Kinesiology
 * Concept Therapy
 * Contact Reflex Analysis
 * Cox


 * Craniosacral Therapy
 * Directional Non-Force
 * Diversified
 * Flexion-Distraction
 * Gonstead
 * Grostic
 * Hole in one [HIO]
 * Kale
 * Leander
 * Logan Basic


 * Manual Adjusting
 * Meric
 * Motion Palpation
 * Network
 * Neural Organization Technique
 * Neuro Emotional Technique
 * Neuro Muscular Technique
 * Neuro Vascular Technique
 * Nimmo
 * Palmer Package


 * Pettibon
 * Pierce
 * Pierce Stillwagon
 * Pro-Adjuster
 * Receptor Tonus
 * Sacral Occipital Technique
 * Soft Tissue Orthopedics
 * Spinal Biomechanics
 * Spinal Biomedical Engineering
 * Spinal Biophysics


 * Thompson
 * Thompson Terminal Point
 * Toftness
 * Toggle Recoil
 * Torque Release
 * Total Body Modification
 * Traction
 * Upper Cervical
 * Vector Point Therapy
 * Versendaal

Canadian Chiropractic Association outline according to purpose
Most of these techniques can be divided according to the purpose:

A. Manual Articular Manipulative and Adjustive Procedures:


 * 1) Specific Contact Thrust Procedures
 * 2) high-velocity thrust
 * 3) high-velocity thrust with recoil
 * 4) low-velocity thrust
 * 5) Non-Specific Contact Thrust Procedures
 * 6) mobilization
 * 7) Manual Force, Mechanically Assisted Procedures
 * 8) drop tables and terminal point adjustive thrust
 * 9) flexion-distraction and traction-type tables
 * 10) Mechanical Force, Manually Assisted Procedures
 * 11) pelvic blocks
 * 12) mechanical adjusting devices

B. Manual Non-Articular Manipulative Procedures:


 * 1) Manual Reflex and Muscle Relaxation Procedures
 * 2) muscle energy techniques
 * 3) neurologic reflex techniques
 * 4) myofascial ischemic compression procedures
 * 5) miscellaneous soft tissue techniques

C. Miscellaneous Procedures:


 * 1) Neural retraining techniques

D. Non-Manual Procedures:


 * 1) Exercise and Rehabilitation
 * 2) Back school/spinal care courses
 * 3) Electrical Modalities
 * 4) Laser Therapy
 * 5) Thermal Modalities including Ultrasound
 * 6) Nutritional counselling
 * 7) Acupuncture

Manipulation under anesthesia (MUA) is spinal manipulation performed while the patient is under general anesthesia. This procedure is used in the hospital setting for patients whose condition is unresponsive to other forms of treatment.