This guideline provides guidance on the assessment and management of major trauma, including resuscitation following major blood loss associated with trauma. For the purposes of this guideline, major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. This guideline covers both the pre-hospital and immediate hospital care of major trauma patients but does not include any management after definitive lifesaving intervention. It has been developed for health practitioners and professionals, patients and carers and commissioners of health services.
Jump up ^ Weeks, William B; Goertz, Christine M; Meeker, William C; Marchiori, Dennis M (2015-01-01). "Public Perceptions of Doctors of Chiropractic: Results of a National Survey and Examination of Variation According to Respondents' Likelihood to Use Chiropractic, Experience With Chiropractic, and Chiropractic Supply in Local Health Care Markets". Journal of Manipulative and Physiological Therapeutics. 38 (8): 533–44. doi:10.1016/j.jmpt.2015.08.001. PMID 26362263.
No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM, some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.
A personal worry example One day I became convinced that the terrible stubborn pain in my neck had to be a cancer. It was one of the lowest moments of my life. The pain had been escalating slowly for months, and eventually it got so severe and unrelenting that I lost my cool. But then, after an emergency massage appointment, I felt almost completely better…and that particular pain never bothered me again.
Requirements vary between countries. In the U.S. chiropractors obtain a first professional degree in the field of chiropractic. Chiropractic education in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine. The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has been more similar than not, both in the kinds of subjects offered and in the time assigned to each subject. Accredited chiropractic programs in the U.S. require that applicants have 90 semester hours of undergraduate education with a grade point average of at least 3.0 on a 4.0 scale. Many programs require at least three years of undergraduate education, and more are requiring a bachelor's degree. Canada requires a minimum three years of undergraduate education for applicants, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program. Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education. The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.
In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients." An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights. The libel case ended with the BCA withdrawing its suit in 2010.
In 2005, the chiropractic subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity." This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays. This exposes patients to harmful ionizing radiation for no evidentially supported reason. The 2008 book Trick or Treatment states "X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist." Attorney David Chapman-Smith, Secretary-General of the World Federation of Chiropractic, has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on X-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static X-ray than a limp or headache or any other functional problem." The General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, states that the chiropractic vertebral subluxation complex "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease."
Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine. Chiropractic is autonomous from and competitive with mainstream medicine, and osteopathy outside the US remains primarily a manual medical system; physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. 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.
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.
How do you stretch the latissimus dorsi? The latissimus dorsi is a large muscle that stretches from the middle to lower back. While overuse can lead to pain, some movement may provide relief. We describe exercises that stretch and alleviate pain in this muscle, also known as the lats. Here, learn to identify, relieve, and prevent pain in the latissimus dorsi. Read now
My niece has some spine disorders, and I think that being able to visit a chiropractor would be helpful for her. I’m glad that you talked about chiropractors being able to have a knowledge of anatomy and physiology, and I think that being able to have this knowledge would help them with her spine disorders. I’m going to have to see if a chiropractor would be the best option, or if we could find a specialist for spine disorders! Thanks for the information!
Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation. Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year. Practice guidelines aim to reduce unnecessary radiation exposure, which increases cancer risk in proportion to the amount of radiation received. Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based. Although, there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain.
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. 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." The International Chiropractor's Association (ICA) also has a set of professional canons.
Jump up ^ Brantingham, James W.; Bonnefin, Debra; Perle, Stephen M.; Cassa, Tammy Kay; Globe, Gary; Pribicevic, Mario; Hicks, Marian; Korporaal, Charmaine (2012). "Manipulative Therapy for Lower Extremity Conditions: Update of a Literature Review". Journal of Manipulative and Physiological Therapeutics. 35 (2): 127–66. doi:10.1016/j.jmpt.2012.01.001. ISSN 0161-4754. PMID 22325966.
Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1100 North American chiropractors, which found that 88% wanted to retain the term "vertebral subluxation complex", and that when asked to estimate the percent of disorders of internal organs (such as the heart, the lungs, or the stomach) that subluxation significantly contributes to, the mean response was 62%. A 2008 survey of 6,000 American chiropractors demonstrated that most chiropractors seem to believe that a subluxation-based clinical approach may be of limited utility for addressing visceral disorders, and greatly favored non-subluxation-based clinical approaches for such conditions. The same survey showed that most chiropractors generally believed that the majority of their clinical approach for addressing musculoskeletal/biomechanical disorders such as back pain was based on subluxation. Chiropractors often offer conventional therapies such as physical therapy and lifestyle counseling, and it may for the lay person be difficult to distinguish the unscientific from the scientific.
^ Jump up to: a b Palmer DD (1910). The Chiropractor's Adjuster: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland, OR: Portland Printing House Co. OCLC 17205743. A subluxated vertebra ... is the cause of 95 percent of all diseases ... The other five percent is caused by displaced joints other than those of the vertebral column.
Age, injury, poor posture or diseases such as arthritis can lead to degeneration of the bones or joints of the cervical spine, causing disc herniation or bone spurs to form. Sudden severe injury to the neck may also contribute to disc herniation, whiplash, blood vessel destruction, vertebral injury and, in extreme cases, permanent paralysis. Herniated discs or bone spurs may cause a narrowing of the spinal canal or the small openings through which spinal nerve roots exit. Pressure on a nerve root by a herniated disc or a bone spur may result in:
Low back pain. A 2013 Cochrane review found very low to moderate evidence that SMT was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain. The same review found that SMT appears to be no better than other recommended therapies. A 2016 review found moderate evidence indicating that chiropractic care seems to be effective as physical therapy for low back pain. A 2012 overview of systematic reviews found that collectively, SM failed to show it is an effective intervention for pain. A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between SMT and other treatments for reducing pain and improving function for chronic low back pain. A 2010 Cochrane review found no current evidence to support or refute a clinically significant difference between the effects of combined chiropractic interventions and other interventions for chronic or mixed duration low back pain. A 2010 systematic review found that most studies suggest SMT achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries.
Employment of chiropractors is projected to grow 12 percent from 2016 to 2026, faster than the average for all occupations. People across all age groups are increasingly becoming interested in integrative or complementary healthcare as a way to treat pain and improve overall wellness. Chiropractic care is appealing to patients because chiropractors use nonsurgical methods of treatment and do not prescribe drugs.
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Your neck is a complex interlocking structure consisting of bones, joints, nerves, muscles, tendons and ligaments. Its main job is to hold up the weight of your head which, at around 5 kilograms, is no mean task. Add to this the requirement that the head must be able to move from side to side and up and down (and do these simultaneously), plus the fact that the neck has to form a conduit for the spinal cord, carry blood vessels to and from the head, and contain passageways for air and food, and you have quite a complex feat of engineering. No wonder then that our necks cause us pain and discomfort, not only on occasion, but for some people in an ongoing fashion.The main physical structures in the neck are the seven interlocking vertebrae. They are called the cervical vertebrae, numbered C1 through to C7. C1, also known as the atlas, is the closest one to your head, followed by C2, which is also known as the axis. Each vertebra is connected to the next by facet joints, and between the vertebrae are intervertebral discs — rubbery cushions made mostly of cartilage that act as shock-absorbers.When should I seek immediate medical treatment for neck pain?Severe neck pain that occurs after a neck injury can be a serious problem, and you should see your doctor immediately. Also, if you have problems with neck pain and experience symptoms such as loss of bladder or bowel control, shooting pains, numbness, tingling, or weakness in the arms or legs, especially if these symptoms come on suddenly or get worse quickly, you should see your doctor straight away.Neck pain and stiffness that’s associated with headache and fever can be a sign of meningitis (an infection of the membranes surrounding your brain and spinal cord). Meningitis is a serious disease, and you should seek immediate medical treatment if you or your child are experiencing these symptoms.Symptoms of neck painSymptoms of neck pain and the sensations you feel can help your doctor to diagnose the cause. Here are some symptoms.Muscle spasmA spasm is a sudden, powerful, involuntary contraction of muscles. The muscles feel painful, stiff and knotted. If you have neck muscle spasms, you may not be able to move your neck — sometimes people call it a crick in the neck. Your doctor or physiotherapist may call it acute torticollis or wry neck.Muscle acheThe neck muscles are sore and may have hard knots (trigger points) that are tender to touch. Pain is often felt up the middle of the back of the neck, or it may ache on one side only.StiffnessThe neck muscles are tight and if you spend too long in one position they feel even tighter. Neck stiffness can make it difficult or painful to move your neck.Nerve painPain from the neck can radiate down the arms, and sometimes, the legs. You may feel a sensation of pins and needles or tingling in your arms, which can be accompanied by numbness, burning or weakness. This pain is typically worse at night.HeadachesHeadaches are common in conjunction with neck problems. They are usually a dull aching type of headache, rather than sharp pain. While the headaches are often felt at the back of the head, the pain may also radiate to the sides, and even the front of the head.Reduced range of motionIf you can’t turn your head to the side to the same degree towards each shoulder, or you feel limited in how far forward you can lower your head to your chest, or how far you can tilt your head back, you may have reduced range of motion. Your doctor will be able to test this.Common causes of neck painWhiplashThis commonly follows a car accident in which the person’s car is hit from behind while it is stationary or slowing down. The person’s head is first thrown backwards and then when their body stops moving, the head is thrust forward. This type of injury can strain your neck muscles and cause ligaments in the neck to stretch or tear.The pain from whiplash, which is usually worse with movement, does not always start immediately — it may take several days to come on. Neck pain and stiffness may be accompanied by muscle spasm, dizziness, headaches, nerve pain and shoulder pain.Muscle strainOngoing overuse of your neck muscles (which can be caused by a poor neck position during everyday activities, particularly computer work) can trigger neck muscle strain, causing chronic neck pain and stiffness. The pain is often worse with movement and may be associated with headaches, muscle spasms and restriction of neck movements.Degenerative disc diseaseAs we grow older, the soft gelatinous centre of the shock-absorbing discs in our spines dries out. This causes the discs to become narrowed, and the distance between the vertebrae to decrease.Herniated discIf the tough outside layer of one of the cervical discs tears, the soft gelatinous centre may bulge outwards — this is known as a herniated disc. Herniated discs can put pressure on nerve roots as they leave the spinal cord, causing pain in the neck as well as pain, numbness and weakness in the arms.Cervical spondylosisThis degenerative condition of the cervical spine is due to normal ageing and wear and tear on the cervical discs and the vertebrae. It is also known as cervical osteoarthritis, and is more common among older people.The development of bone spurs often accompanies this degeneration of the spine. Bone spurs, also known as osteophytes, are small outgrowths of bone tissue that are formed when the cartilage covering bone is worn away and bone starts to rub on adjacent bone. The bone spur is the body’s attempt to protect the bone surface. Unfortunately, the bone spur can sometimes pinch or press upon the nerve roots as they leave the spinal canal.Symptoms associated with cervical spondylosis include neck pain and stiffness that often improves with rest. The pain may radiate to the shoulders or between the shoulder blades. If there is nerve root compression, there may be numbness, pain or weakness in the arms.Cervical spinal canal stenosisDegenerative changes in the vertebrae can lead to narrowing of the canal in which your spinal cord lies — this is known as cervical spinal canal stenosis. As the canal becomes narrower, it can put pressure on the spinal cord. The associated neck pain is usually worse with activity, and may radiate to the arms or legs. Arm or leg weakness can also occur. Sometimes people with cervical spinal canal stenosis have no symptoms. Occasionally, it may give rise to Lhermitte's sign — an electric shock-like feeling down the body when the neck is bent forward.Tests and diagnosisYour doctor may be able to determine the cause of your neck pain from your history and physical examination, but sometimes tests such as X-rays, MRI scans and CT scans are required to find the exact cause of your symptoms. These scans can assess the spine and be used to show disc problems, spinal cord problems or compression of your nerve roots.Sometimes doctors will order electromyography (EMG) or nerve conduction studies — tests that evaluate the electrical activity in nerves and muscles to help determine if there is any nerve damage related to your neck problems.It can be difficult to identify the precise source of neck pain even after investigations. Generally, X-ray abnormalities do not correlate well with pain. Some people have severe spondylosis on X-rays, but have no pain. The key thing that your doctor should be able to tell is if the pain is involving pressure on the nerve roots or spinal cord. Last Reviewed: 18 December 2012
As with so many things, when it comes to neck pain, an ounce of prevention may be worth a pound of cure. It's true that some causes of neck pain, such as age-related wear and tear, are not under your control. On the other hand, there are many things you can do to minimize your risk. One place to start is to look at how you sleep and what effect this may have on neck pain.
A small number of neck pain patients, particularly those with arm pain or signs of spinal cord compression, require cervical spine surgery. A new option for neck surgery is an artificial disc. This device made of metal and plastic, is the correct choice for a very small number of individuals with neck pain only and no other abnormality in the cervical spine than a worn out disc.
Neck injuries can occur during motor vehicle accidents, other traumatic events or sports. Symptoms of these injuries include neck stiffness, shoulder or arm pain, headache, facial pain and dizziness. Pain from a motor vehicle injury may be caused by tears in muscles or injuries to the joints between vertebrae. Other causes of pain are ligament rupture or damage to a disc. Conservative treatment of these injuries includes pain medication, bed rest, reduction of physical activity and physical therapy.
Chiropractic's origins lie in the folk medicine of bonesetting, and as it evolved it incorporated vitalism, spiritual inspiration and rationalism. Its early philosophy was based on deduction from irrefutable doctrine, which helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic first principles rather than on the materialism of science. However, most practitioners tend to incorporate scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness. A 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.