1. An Introduction to Chiropractic Care Don Galovich Jeremy Lindstrom Dr. Peter Millar Mark Morris

2. What is Chiropractic? Chiropractic care centers around the diagnosis, treatment and prevention of neuro-musculoskeletal system disorders. Chiropractic care centers around the diagnosis, treatment and prevention of neuro-musculoskeletal system disorders.

3. What is Chiropractic? Chiropractic focuses on the relationship between structure (movements of the spine) and function (coordinated by the nervous system and how this relationship affects health) Chiropractic focuses on the relationship between structure (movements of the spine) and function (coordinated by the nervous system and how this relationship affects health)

4. How long has Chiropractic been recognized in traditional healthcare? The profession was founded in the US in 1895. The profession was founded in the US in 1895. Today there are over 65,000 chiropractors in the US today Today there are over 65,000 chiropractors in the US today

5. Educational Requirements Doctors of Chiropractic complete the equivalent of five academic years of advanced professional education Doctors of Chiropractic complete the equivalent of five academic years of advanced professional education

6. Educational Requirements Six semesters didactic course work (average course load 25-27 credits) Six semesters didactic course work (average course load 25-27 credits) Four semesters extensive Clinical experience Four semesters extensive Clinical experience National Board Examinations National Board Examinations Parts I-IVParts I-IV

7. Chiropractic case management protocol Specific spinal analysis Specific spinal analysis Physical, neurological, orthopedic examinations and consultation Physical, neurological, orthopedic examinations and consultation Specific restoration of normal biomechanics by means of the adjustment, soft tissue manipulation, and ancillary therapies Specific restoration of normal biomechanics by means of the adjustment, soft tissue manipulation, and ancillary therapies Referral for co-management if appropriate Referral for co-management if appropriate Appropriate attention to ergonomical considerations and other possible causes of biomechanical dysfunction Appropriate attention to ergonomical considerations and other possible causes of biomechanical dysfunction

8. Chiropractic Education Compiled as an average from 22 medical schools and 11 chiropractic colleges Compiled as an average from 22 medical schools and 11 chiropractic colleges Additional classes and clinic times vary according to school Additional classes and clinic times vary according to school

9. The primary lesion addressed in chiropractic is intersegmental dysfunction within the spinal column This refers to discrete areas of hypomobilty within the articulations of the spine This refers to discrete areas of hypomobilty within the articulations of the spine

10. What is a chiropractic adjustment? A high-velocity, low-amplitude thrust usually given by hand, directed at specific articulations of the spine or extremities A high-velocity, low-amplitude thrust usually given by hand, directed at specific articulations of the spine or extremities

11. The purpose of the adjustment…… restore normal movement and resolve the resultant biomechanical, physiological and neurological effects of segmental hypomobility. restore normal movement and resolve the resultant biomechanical, physiological and neurological effects of segmental hypomobility.

12. The Adjustment The type of adjustment varies with technique The type of adjustment varies with technique DiversifiedDiversified Flexion/DistractionFlexion/Distraction ThompsonThompson ActivatorActivator LoganLogan etc.etc.

13. The Adjustment Although many different techniques are used they all have a common goal: Although many different techniques are used they all have a common goal: To restore normal motion and normalize the nervous system to allow the body to function optimally To restore normal motion and normalize the nervous system to allow the body to function optimally

14. Putting it together…….. Loss of normal movement leads to… Loss of normal movement leads to… Changes in how all tissues involved are stressed and replenished, which causes… Changes in how all tissues involved are stressed and replenished, which causes… Chemical changes within those tissues and… Chemical changes within those tissues and… Predisposes them to mechanical failure giving us… Predisposes them to mechanical failure giving us… A good reason to restore normal movement through spinal adjustment. A good reason to restore normal movement through spinal adjustment.

15. What conditions can be treated using chiropractic?  Musculoskeletal conditions involving the articulations of body and surrounding soft tissue

16. Some examples of these conditions…… Neck and Back pain Neck and Back pain Headache Headache Sciatica Sciatica Stiff joints Stiff joints Sprain/Strain injuries Sprain/Strain injuries Herniated nucleus pulposus Herniated nucleus pulposus Sport related injuries Sport related injuries The list goes on………. The list goes on……….

17. Review of Chiropractic research Satisfaction with treatment Satisfaction with treatment In conditions dealing with back pain, patient satisfaction has been shown to be greater with chiropractic treatment over conventional management (PCP, HMO provider, or orthopedist)In conditions dealing with back pain, patient satisfaction has been shown to be greater with chiropractic treatment over conventional management (PCP, HMO provider, or orthopedist) New England Journal of Medicine 1995; 333(14) : 913-917 Western Journal of Medicine 1989; 150: 351-355

18. Review of research Chiropractic is an extremely safe form of therapy. However as with any therapeutic intervention contraindications exist. Two primary complications exist with spinal manipulation.

19. Review of research Cauda Equina Syndrome Cauda Equina Syndrome Following lumbar manipulation in patients, disc herniation, neurological bowel and bladder disturbances, saddle anesthesia, leg weakness may occur.Following lumbar manipulation in patients, disc herniation, neurological bowel and bladder disturbances, saddle anesthesia, leg weakness may occur. The frequency of developing this condition from manipulation has been estimated to be 1 per 100 million manipulations.The frequency of developing this condition from manipulation has been estimated to be 1 per 100 million manipulations. Spine 21 (15): 1746-1760Spine 21 (15): 1746-1760

20. Review of research Cerebrovascular accidents following manipulation of the upper cervical region. Cerebrovascular accidents following manipulation of the upper cervical region. The frequency of developing this condition following manipulation has been estimated to be 1in 5.85 million manipulations.The frequency of developing this condition following manipulation has been estimated to be 1in 5.85 million manipulations. Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation the chiropractic experience. CMAJ 2001; 165:905-6

21. Review of research Putting the numbers in perspective Putting the numbers in perspective The rates given for CVA’s caused by spinal manipulation are 400x less then the death rate observed from GI bleeding due to the use of NSAID medication The rates given for CVA’s caused by spinal manipulation are 400x less then the death rate observed from GI bleeding due to the use of NSAID medication Journal of Manipulative and Physiological Therapeutics 1995; 18 (8): 530-536 Journal of Manipulative and Physiological Therapeutics 1995; 18 (8): 530-536

22. Review of Research Appropriateness and Guidelines Appropriateness and Guidelines In 1994 the Agency for Health Care Policy and Research (AHCPR) placed spinal manipulation at the top of the list for clinical options in the treatment of certain types of back pain.In 1994 the Agency for Health Care Policy and Research (AHCPR) placed spinal manipulation at the top of the list for clinical options in the treatment of certain types of back pain.

23. Back pain treatment Among 23 options for treatment of low back pain, spinal manipulation and the use of NSAID’s had the most beneficial effect. Acute low back pain in adults. Clinical practice guideline No. 14 AHCPR Publication No. 95- 0642 (1994)

24. Wellness Model l The public has widely embraced many forms of wellness care and alternative therapies l Other healthcare professions have embarked on a paradigm shift to include alternative therapies, including spinal manipulation l Many conditions respond best with a multidisciplinary approach

25. Our Goals in Healthcare “The Wellness Model” Our Goals in Healthcare “The Wellness Model” l Patient-centered paradigm l Improving interdisciplinary communication l Maximizing the benefits of healthcare from all perspectives

26. Closing Remarks In a little over a hundred years of existence chiropractic has become the third largest profession of health care delivery in the world In a little over a hundred years of existence chiropractic has become the third largest profession of health care delivery in the world

27. Closing Remarks For the treatment of musculoskeletal conditions chiropractic is a conservative first step that should not be over looked. For the treatment of musculoskeletal conditions chiropractic is a conservative first step that should not be over looked. If a problem can be corrected with minimal risk, and without the use of drugs or surgery it makes sense to try it. If a problem can be corrected with minimal risk, and without the use of drugs or surgery it makes sense to try it.

28. Questions? Questions?