Frequently Asked Questions: Chiropractic

1. What is the education of chiropractors?
2. Do I need a medical referral before seeing a chiropractor?
3. Is chiropractic treatment safe?
4. What about the safety of neck adjustments?
5. Is chiropractic appropriate for children?
6. Does chiropractic require x-rays?
7. Can chiropractic provide a preventative function?
8. Are chiropractors trained to make diagnosis?

What is the education of chiropractors?

Chiropractic students undergo a rigorous course of study similar to that of other health care professionals, and entrance requirements are also similar. At minimum, 3 years of undergraduate study of university is required before becoming eligible to apply for admission to the Canadian Memorial Chiropractic College (CMCC). The vast majority (greater than 80%) of students have already completed a baccalaureate degree before applying.  The chiropractic program itself is an additional four years of full-time study, including a year long internship in the College’s clinics.

The academic program at CMCC, like the other accredited health professionals, includes courses in anatomy, biochemistry, physiology, neurology, embryology, radiology, immunology, microbiology, pathology, nutrition, principles/ethics, and the clinical sciences. In addition to the academic program, chiropractic education requires hands-on clinical experience under direct supervision of highly-qualified chiropractic faculty. This experience includes clinical assessment, diagnosis, treatment, and referral protocols.

As well, chiropractors receive training in radiology which covers a range of topics from radiation biophysics and protection to clinical x-ray interpretation and diagnosis. Radiology training consists of more than 360 contact hours followed by application during clinical internship.

CMCC faculty is comprised of experts in such disciplines as medicine, pathology, psychology, biological sciences, as well as chiropractic.

Do I need a medical referral before seeing a chiropractor?

No. The chiropractic profession is legislated as a “primary-contact” profession, meaning patients can consult them directly. However, some chiropractors work very closely with medical doctors, welcoming referrals to manage or co-manage their patients’ conditions. Our office takes great pride in working with the local medical community to provide the best co-managed care possible for patients.

Is chiropractic treatment safe?

In a word – yes. Chiropractic is recognized as one of the safest, drug-free, non-invasive treatments available for back pain, neck pain, and headaches. In fact, during the last 25 years there have been six formal government studies of chiropractic, all of which have found the profession to be both safe and effective (1). Based on the results of more than 44 studies into the safety and efficacy of chiropractic treatment, no other profession can demonstrate greater effectiveness or a better safety record for the treatment of spinal pain syndromes.

What about the safety of neck adjustments?

Indeed there has been negative press pertaining to this subject -make no mistake, we do not take this subject lightly. Our office recognizes the concern and anxiety that exists over this procedure, and for this reason, we offer several other effective alternatives to the treatment of neck injuries (including: gentle mobilizations, the use of gentle modern adjustive equipment, Active Release Techniques, PNF stretching, rehabilitative exercises, physical therapy modalities (ultrasound, TENS/IFC), acupuncture).

It should be noted, however – for the record - the risk of a serious adverse reaction (eg. stroke) as a result of traditional spinal manipulation is very, very low. The Canadian Medical Association Journal, based on the most factual data available, puts the risk at 1 in 5.8 million (1). To put that in perspective, the risk of a serious neurological complication from cervical spine surgery is greater than 15,000 per million, and the mortality rate is almost 7,000 per million (2). The risk of a serious gastrointestinal bleed from taking aspirin over an extended period is approximately 1 in 1000, or 400 times greater than the risk of damage from a neck adjustment (3).

Another recent study, conducted by the Institute for Clinical Evaluative Studies, concluded that the risk is so low that it is difficult to calculate an accurate risk ratio (4).

Most recently, a study published in the journal Spine, concluded that there is no more risk of suffering from a stroke from visiting a chiropractor’s office than visiting a physician’s office. (5). For more information, you may read a Globe and Mail summary of this study.

In summary, this office does use alternatives to traditional neck manipulation in the treatment of neck injuries. We felt the need to address this important issue, however, and clarify what the published studies have concluded about the true risks of serious adverse reactions associated with neck manipulation.

References:

1. Arterial dissections following cervical manipulation: the chiropractic experience. Haldeman, S, Carey P, Townsend M, Papadopoulos, C, Canadian Medical Association Journal, Vol 165, No 7, 905-6, 2001.
2. A risk Assessment of Cervical Manipulation V. NSAIDs for the Treatment of Neck Pain. Dabbs V, Lauretti WJ. Journal of Manipulative and Physiological Therapeutics. 18:530-36, 1995.
3. Ibid.
4. Chiropractic Manipulation and Stroke: A Population-Based Case-Control Study. Rothwell, DM, Bondy Sj, Williams JI, Stroke, May 2001.
5. Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-crossover study. Cassidy JD, Boyle E, Cote P, He Y, Hog-Johnson S, Silver F, Bondy, SJ. Spine;33 (4S): S176-S183, 2008.

Is chiropractic care appropriate for children?

Children are very physically active and experience many falls, and blows from participating in sports. Others suffer with back pain from inactivity and poor posture – sitting, slumped over while playing video games, for example, can lead to significant pain in some. So yes – absolutely - they can benefit from chiropractic care.

Chiropractic care, of course, is adapted for the individual patient. A child or adolescent, for example, does not receive the same treatment as an adult. In both cases, the treatment is highly skilled, but in the case of the child, the care is gentler.

Does chiropractic treatment require x-rays?

No.  The use of x-rays as a diagnostic tool by chiropractors (and all health professions) is governed in Ontario by guidelines as set out by the Healing Arts Radiation protection Commission (HARP). X-rays can play an important role in diagnosis, but should only be taken when a need has been determined by a careful case history and physical examination. In our office, the vast majority of patients do not require x-rays.

Can chiropractic provide a preventative function?

Yes.  For example, in some chronic conditions, such as osteoarthitis, chiropractic care can decrease the intensity and frequency of pain, and improve mobility. However, in this case, chiropractic (nor any other treatment) can actually cure the (arthritic) condition. Another example is individuals who are in highly stressful situations, and or those who experience highly repetitive physical and postural strain from their daily activities. In this example, although chiropractic treatment cannot take away the stressful situation or the repetitive strain, it can address the physical response to the stress/strain. In other words, it can address the muscle tension, joint immobility, and associated pain that can be associated with the physical stressors.

Are chiropractors trained to make a diagnosis?

Yes, chiropractors, along with medical doctors, dentists, psychologists, and optometrists have the legislated right and obligation to communicate a diagnosis, and to use the title “doctor”.

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