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.[70] 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.[70] Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM,[71] 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.[72]
Our shoulder joints have the greatest range of motion of any of the musculoskeletal joints in our bodies. The shoulder joint is really two joints, the glenohumeral joint between the arm bone (humerus) and the shoulder blade (scapula) and the acromioclavicular joint between the acromion (a bony projection off the scapula) and the collarbone (clavicle). The glenohumeral joint is a ball-and-socket joint and the acromioclavicular joint is a gliding joint. ...
Research suggests that not just sleep position, but sleep itself, can play a role in musculoskeletal pain, including neck and shoulder pain. In one study, researchers compared musculoskeletal pain in 4,140 healthy men and women with and without sleeping problems. Sleeping problems included difficulty falling asleep, trouble staying asleep, waking early in the mornings, and non-restorative sleep. They found that people who reported moderate to severe problems in at least three of these four categories were significantly more likely to develop chronic musculoskeletal pain after one year than those who reported little or no problem with sleep. One possible explanation is that sleep disturbances disrupt the muscle relaxation and healing that normally occur during sleep. Additionally, it is well established that pain can disrupt sleep, contributing to a vicious cycle of pain disrupting sleep, and sleep problems contributing to pain.

Mixer chiropractors "mix" diagnostic and treatment approaches from chiropractic, medical and/or osteopathic viewpoints and make up the majority of chiropractors.[22] Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine.[22] Many of them incorporate mainstream medical diagnostics and employ conventional treatments including techniques of physical therapy such as exercise, stretching, massage, ice packs, electrical muscle stimulation, therapeutic ultrasound, and moist heat.[22] Some mixers also use techniques from alternative medicine, including nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.[22]

Chiropractors use hands-on spinal manipulation and other alternative treatments, the theory being that proper alignment of the body's musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication. Manipulation is used to restore mobility to joints restricted by tissue injury caused by a traumatic event, such as falling, or repetitive stress, such as sitting without proper back support.
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