A large number of chiropractors fear that if they do not separate themselves from the traditional vitalistic concept of innate intelligence, chiropractic will continue to be seen as a fringe profession.[22] A variant of chiropractic called naprapathy originated in Chicago in the early twentieth century.[35][36] It holds that manual manipulation of soft tissue can reduce "interference" in the body and thus improve health.[36]
Attached to the back of each vertebral body is an arch of bone that forms a continuous hollow longitudinal space, which runs the whole length of the back. This space, called the spinal canal, is the area through which the spinal cord and nerve bundles pass. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by three protective layers called the meninges (dura, arachnoid and pia mater).
Figure 1. (side view) The neck region is called the cervical spine. Protected within the bones of the cervical spine are the spinal cord and nerves. The seven cervical bones (vertebrae) are numbered C1 to C7. Each bone is separated and cushioned by shock-absorbing discs. The spinal nerves pass through bony canals to branch out to the neck and arms.
A 2010 study describing Belgium chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine.[83] The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%.[83] A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a U.S. chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.[84]

Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States,[62] (although New Mexico has become the first US state to allow "advanced practice" trained chiropractors to prescribe certain medications.[63][64]). In the US, their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa, broadly allow treatment of "human ailments"; some, such as Delaware, use vague concepts such as "transition of nerve energy" to define scope of practice; others, such as New Jersey, specify a severely narrowed scope.[65] US states also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements, or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth.[62] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.[38] A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.[66]
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There are several surgical treatments available to treat cervical spine disorders. Factors that help determine the type of surgical treatment include the specifics of the disc disease and the presence or absence of pressure on the spinal cord or spinal nerve roots. Other factors include age, how long the patient has had the disorder, other medical conditions and if there has been previous cervical spine surgery.
Neck pain is just that – pain in the neck. Pain can be localized to the cervical spine or may travel down an arm (radiculopathy). All age groups are at risk of developing neck pain. People who sit in one location staring at computer screens for long periods of time may be at an increased risk. About 30% of the population has an episode of neck pain each year. Neck pain may occur slightly more frequently in women than men.
In addition to practicing chiropractic, Dr. Robins has taught on the college/university level since 1999 instructing and developing courses in health sciences as well as health care management. Being in Indianapolis has provided the opportunity for Dr. Robins to actively participate in legislative bodies addressing issues that impact governmental health policies and regulations toward healthcare. She has also worked with health care lobbies to affect change in legislation and has had the opportunity to participate in a professional exchange to Korea with a U.S. Delegation.
Admission to D.C. programs requires at least 90 semester hours of undergraduate education, and some D.C. programs require a bachelor’s degree for entry. Most students typically earn a bachelor’s degree before applying to a chiropractic program. Schools have specific requirements for their chiropractic programs, but they generally require coursework in the liberal arts and in sciences such as physics, chemistry, and biology. Candidates should check with individual schools regarding their specific requirements.

Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.[19][59] Chiropractic is autonomous from and competitive with mainstream medicine,[60] and osteopathy outside the US remains primarily a manual medical system;[61] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[60] Practitioners may distinguish these competing approaches through claims that, compared to other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.[19]
Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[171][172] Depending on the location, continuing education may be required to renew these licenses.[173][174] Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics.[175]
Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care.[73] Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint.[74] Its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion.[74] High-velocity, low-amplitude spinal manipulation (HVLA-SM) thrusts have physiological effects that signal neural discharge from paraspinal muscle tissues, depending on duration and amplitude of the thrust are factors of the degree in paraspinal muscle spindles activation.[75] Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load.[75] More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.[74]
Among people seeking back pain relief alternatives, most choose chiropractic treatment. About 22 million Americans visit chiropractors annually. Of these, 7.7 million, or 35%, are seeking relief from back pain from various causes, including accidents, sports injuries, and muscle strains. Other complaints include pain in the neck, arms, and legs, and headaches.
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