Chiropractic was founded in 1895 by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease.[215] The first chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer's office was located.[37] He claimed that he had severely reduced hearing for 17 years, which started soon following a "pop" in his spine.[37] A few days following his adjustment, Lillard claimed his hearing was almost completely restored.[37] Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing and bonesetting; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health.[215] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic.[23] One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment.[23]
A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of spinal manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[161] A 2005 American systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.[162] The cost-effectiveness of maintenance chiropractic care is unknown.[12]

Chiropractic doctors diagnose and treat patients whose health problems are associated with the body’s muscular, nervous and skeletal systems. Chiropractors believe that interference with these systems can impair normal functioning, cause pain and lower resistance to disease. They are most well known for the hands-on technique they practice to adjust imbalances in the patient’s skeletal system, particularly the spine.
Like their MD colleagues, doctors of chiropractic are subject to the boundaries established in state practice acts and are regulated by state licensing boards. Further, their education in four-year doctoral graduate school programs is nationally accredited through an agency that operates under the auspices of the U.S. Department of Education. After graduation, they must pass national board exams before obtaining a license to practice, and then must maintain their license annually by earning continuing education (CE) credits through state-approved CE programs.  
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The chiropractic oath is a modern variation of the classical Hippocratic Oath historically taken by physicians and other healthcare professionals swearing to practice their professions ethically.[190] The American Chiropractic Association (ACA) has an ethical code "based upon the acknowledgement that the social contract dictates the profession's responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the chiropractic doctor's professional services shall be to benefit the patient."[191] The International Chiropractor's Association (ICA) also has a set of professional canons.[192]

Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief than a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.[115] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.[116] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,[117] limited to low level evidence supporting chiropractic management of shoulder pain[118] and limited or fair evidence supporting chiropractic management of leg conditions.[119]
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]
There is a wide range of ways to measure treatment outcomes.[91] Chiropractic care, like all medical treatment, benefits from the placebo response.[92] It is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect.[93] The efficacy of maintenance care in chiropractic is unknown.[12]
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The treatment plan may involve one or more manual adjustments in which the doctor manipulates the joints, using a controlled, sudden force to improve range and quality of motion. Many chiropractors also incorporate nutritional counseling and exercise/rehabilitation into the treatment plan. The goals of chiropractic care include the restoration of function and prevention of injury in addition to back pain relief.
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