Vertebral subluxation, a core concept of traditional chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.[43] In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.[43] This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions.[44][45]


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]


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]


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Spinal manipulation is associated with frequent, mild and temporary adverse effects,[14][138] including new or worsening pain or stiffness in the affected region.[139] They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours;[13] adverse reactions appear to be more common following manipulation than mobilization.[140] The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue.[141] Chiropractic is correlated with a very high incidence of minor adverse effects.[4] Chiropractic are more commonly associated with serious related adverse effects than other professionals following manipulation.[17] Rarely,[46] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[14] and children.[142] There is a case of a three-month-old dying following manipulation of the neck area.[137] Estimates vary widely for the incidence of these complications,[13] and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern.[14] Adverse effects are poorly reported in recent studies investigating chiropractic manipulations.[143] A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable.[144] Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region.[145] Estimates for serious adverse events vary from 5 strokes per 100,000 manipulations to 1.46 serious adverse events per 10 million manipulations and 2.68 deaths per 10 million manipulations, though it was determined that there was inadequate data to be conclusive.[13] Several case reports show temporal associations between interventions and potentially serious complications.[146] The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.[17]
Other. A 2012 systematic review found insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension.[120] A 2011 systematic review found moderate evidence to support the use of manual therapy for cervicogenic dizziness.[121] There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine)[122] and no scientific data for idiopathic adolescent scoliosis.[123] A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions.[124] Other reviews have found no evidence of significant benefit for asthma,[125][126] baby colic,[127][128] bedwetting,[129] carpal tunnel syndrome,[130] fibromyalgia,[131] gastrointestinal disorders,[132] kinetic imbalance due to suboccipital strain (KISS) in infants,[127][133] menstrual cramps,[134] insomnia,[135] postmenopausal symptoms,[135] or pelvic and back pain during pregnancy.[136] As there is no evidence of effectiveness or safety for cervical manipulation for baby colic, it is not endorsed.[137]

D.D. Palmer opened the first chiropractic school two years later, and in the century since, chiropractic professionals have used spinal adjustments to help people prevent and cope with back pain, carpal tunnel, muscle strain, headaches and migraines, and a variety of other physical ailments. Millions of people benefit from the work of Dr. Palmer today.


In most circumstances, a medical history and physical examination are the key parts of an evaluation required to diagnose neck pain/disorders. In some cases, individuals who do not respond to starting therapy may undergo specialized radiographic tests, such as plain X-rays, magnetic resonance imaging (MRI), or computerized tomography to screen for additional problems of soft tissues, herniated discs, spinal stenosis, tumors, or nerve injuries.
Cervical stenosis occurs when the spinal canal narrows and compresses the spinal cord and is most frequently caused by aging. The discs in the spine that separate and cushion vertebrae may dry out. As a result, the space between the vertebrae shrinks, and the discs lose their ability to act as shock absorbers. At the same time, the bones and ligaments that make up the spine become less pliable and thicken. These changes result in a narrowing of the spinal canal. In addition, the degenerative changes associated with cervical stenosis can affect the vertebrae by contributing to the growth of bone spurs that compress the nerve roots. Mild stenosis can be treated conservatively for extended periods of time as long as the symptoms are restricted to neck pain. Severe stenosis requires referral to a neurosurgeon.
Other Disease Processes: Although neck pain is commonly caused by strain, prolonged pain and/or neurologic deficit may be an indication of something more serious. These symptoms should not be ignored. Spinal infection, spinal cord compression, tumor, fracture, and other disorders can occur. If head injury has been sustained, more than likely the neck has been affected too. It is wise to seek medical attention promptly.

All treatment is based on an accurate diagnosis of your back pain. The chiropractor should be well informed regarding your medical history, including ongoing medical conditions, current medications, traumatic/surgical history, and lifestyle factors. Although rare, there have been cases in which treatment worsened a herniated or slipped disc, or neck manipulation resulted spinal cord injury. To be safe, always check with your medical doctor to make sure your condition will benefit from chiropractic or other pain relief alternatives. 
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