What is Chiropractic?
What is Chiropractic?
Concentrating on all areas of the body and particularly those of the spine, Chiropractic helps a wide range of injuries that involve joints, ligaments, tendons and nerves (World Health Organisation/ World Federation of Chiropractic, 2005).
History of Chiropractic
Manipulation of the joints of the body has been recorded as far back as the early Greek civilizations. D. D. Palmer was the founder of Chiropractic after performing the first chiropractic adjustment and later opening the world’s first College of Chiropractic in Davenport, USA in 1897.
In the late 19th century, a gentlemen and bone manipulator known as A. T. Still founded the belief that ‘the artery is supreme’ and that good improved blood flow was essential for a healthy bodily environment. D. D. Palmer however believed nerve function was of greater importance for optimal health. Both developed the art of spinal or vertebral manipulation to improve body function, yet this philosophical difference in opinion was significant. A. T. Still went on to become known as the founder of Osteopathy and the osteopathic profession. D. D. Palmer was seen as the founder of Chiropractic and the Chiropractic profession.
The word “chiro-practic” was coined by Rev. Samuel Weed from the Greek “to practice or treat by hand”. Palmer was initially jailed after a lawsuit taken up by the osteopathy profession for attempting to practice medicine without a licence. However, during the early 1900’s, chiropractic was recognized as its own specific and credible profession. New technologies were introduced such as the use of xrays by D.D. Palmer’s son, B.J. Palmer who oversaw the further growth and development of Chiropractic. Unlike osteopathy and physiotherapy, education in radiology and use of xray technology would later become a large component of modern day chiropractic.
The profession has grown a tremendous amount in the last 100 years and is now a globally accepted primary healthcare profession. An excellent standard of modern day quality scientific research has also assisted the worldwide development of Chiropractic.
Modern day Chiropractic is also now internationally governed and has established international standards for education and practice.
History of Back Pain
Back pain has existed for many generations in Gloucester, Gloucestershire and indeed the rest of the world as far back as the Bronze Age!
The father of medicine Hippocrates (460 BC) was the one of the earliest scholars to attempt to describe an injury to the spine involving pain in the sciatic nerve and more broadly the term ‘low back pain’. Hippocrates first coined the phrase ‘sciatica’, meaning ischios or hip. Sciatica followed on to mean pain in the leg as a result of problems with the hip. Hippocrates also noticed that sciatica symptoms often had seasonal differences in how common people suffered its pain. Treatment of sciatica and back pain in those days often involved warm water, fasting, boiled milk consumption and so on. Hippocrates concluded that back pain and sciatica would take far longer in those that were old, whereas the young recovered far quicker. Galen almost a century later noted strange repeated patterns of posture amongst back pain sufferers and normal people alike. This is where the phrases ‘lordosis, kyphosis and scoliosis’ come from and we still use these terms today. However, in those early days, back pain was treated by bleeding a patient to remove the pain by ridding the body of toxicity!
In the 5th century AD the Romans now started to use modalities to treat back pain that, believe it or not are still in use today. Traction of the back and spine to relieve sciatica was then implemented as a successful way of improving symptoms of back pain and sciatica. The Greeks and Romans also during this time made clear and specific references to the presence of symptoms that were attributed to sciatic nerve irritation. Buttock, leg, thigh, knee and back pain were now closer associated with irritation of the nerves as they exit the back. Other symptoms included muscle wasting, sensation disturbances, antalgic postures and even constipation. Traction is still a very popular and accepted form of treatment for back pain and sciatica alike.
In the 6th century, the Greeks were more specific about the origins of back pain and sciatic nerve irritation. It was now much clearer that back pain that involved the nerves as they exit the spine were able to cause leg pain and even foot irritation. Greek and Roman doctors often made reference to pain of the sciatic region of the body and back pain in many documented examples. However, there was confusion and there was often disagreement about their understanding of back pain and that it may emanate from the hip joint and in fact not the spine.
Surgical approaches towards back pain have also been variable through time, where at the end of the 10th century surgeons and doctors preferred not to attempt surgical intervention but to actually wait and observe what happens over time. In many cases people with back pain actually improved without any major intervention. Many people during medieval times also attributed low back pain to bad or evil spirits and the treating of this cause of back pain might help! In the 1700’s a scientist known as Cotugno concluded that there was a fundamental difference between back pain caused by nerve problems versus back pain caused by joint arthritis.
As history moved on to beyond the 1900’s, doctors now believed that back pain was a result of nerve aggravation and damage. This so created more irritation to surrounding tissues and hence caused back pain. Gradually this simplistic understanding of low back pain started to dwindle and was overtaken by more modern day thinking behind the mechanics of back pain. Harvey Williams Cushing was a Neurosurgeon in America and started to spread the notion that surgical intervention had its benefits in the treating of back pain, spine pain and sciatica.
In 1901 the first successful operation was completed on the back to remove part of a disc that encroached upon a nerve. In 1934 it was proposed that the contents of a disc squeezing out was a big common cause of back pain. In 1927 it was discovered that the hole that the spinal nerve root exits in the spine causes back pain and so irritate the sciatic nerve and 2 years later in 1929, it was discovered that the bits of the disc that squeeze out of the main body of the disc can float around the nerve and cause irritation and eventual back pain. These findings are not too distant from the modern day understanding of what happens to the spine over time as it degenerates and gives a great insight as to what causes back pain….and perhaps its treatment thereof.
The ability to investigate back pain further, in a objective manner arrived with the dawn of x-rays and radiology. X-rays gave the doctor the ability to look closer into the spine, into the disc space and health of the facet joints. These structures for the first time rose as possible contributors towards back pain and spine pain in general, perhaps all the way up to the neck and neck pain. The disc of the spine being the foundation to all injuries to the spines of all sufferers of back pain was popularised by someone called Dr JS Barr who successfully operated on disc injuries and reported significant results in reduced back pain, sciatica, and back aches. The disc as a big cause of back pain then seemed to flourish with great popularity and acceptance amongst the medical community worldwide right up through to the 1980’s when the dawn of better, more efficient methods of back pain analysis came about through MRI scans and CT scans. By this point in time the western world was now heavily impacted upon by back pain and it had risen to become one of the most common reasons people visited their doctor for help! Back pain is also the most common reason why people miss days at work. This means that businesses productivity is hit as well as a greater strain on the public health services. With this greater technology came the understanding that the disc of the spine was not necessarily the sole problem and that back pain was indeed far more complex in its cause and management.
In the last 20 years back pain has gone from strength to strength in terms of how many people suffer it, but also how many people who treat it. Back pain has a huge impact on home life as well as work life. Many employers now have much improved appreciation of back injuries and laws in the UK now protect the employee much better in the last 15 years or so. Businesses must allow sufficient time for rest and recuperation, plus also amend working conditions so that a sufferer of back pain or sciatica can work with as minimal chance of relapse as possible. For example, height adjustable desk, back pain stools, regular breaks and even rooms set aside for employees to stretch and ease their back pain are now common place.
History of Chiropractic
Manipulation of the joints of the body has been recorded as far back as the early Greek civilizations. D. D. Palmer was the founder of Chiropractic after performing the first chiropractic adjustment and later opening the world’s first College of Chiropractic in Davenport, USA in 1897.
In the late 19th century, a gentlemen and bone manipulator known as A. T. Still founded the belief that ‘the artery is supreme’ and that good improved blood flow was essential for a healthy bodily environment. D. D. Palmer however believed nerve function was of greater importance for optimal health. Both developed the art of spinal or vertebral manipulation to improve body function, yet this philosophical difference in opinion was significant. A. T. Still went on to become known as the founder of Osteopathy and the osteopathic profession. D. D. Palmer was seen as the founder of Chiropractic and the Chiropractic profession.
The word “chiro-practic” was coined by Rev. Samuel Weed from the Greek “to practice or treat by hand”. Palmer was initially jailed after a lawsuit taken up by the osteopathy profession for attempting to practice medicine without a licence. However, during the early 1900’s, chiropractic was recognized as its own specific and credible profession. New technologies were introduced such as the use of xrays by D.D. Palmer’s son, B.J. Palmer who oversaw the further growth and development of Chiropractic. Unlike osteopathy and physiotherapy, education in radiology and use of xray technology would later become a large component of modern day chiropractic.
The profession has grown a tremendous amount in the last 100 years and is now a globally accepted primary healthcare profession. An excellent standard of modern day quality scientific research has also assisted the worldwide development of Chiropractic.
Modern day Chiropractic is also now internationally governed and has established international standards for education and practice.
Research & Chiropractic
The current health care system in the UK is heavily involved in the research of back pain. The question still remains as to why certain sufferers of back pain recover relatively well and make full recoveries, whilst other sufferers of back pain seem to never fully regain normal function? Their back pain seem to continue despite multiple attempts to ‘fix’ the problem. This is a small clue as to how complicated back pain is and how difficult it is to treat successfully across the broad spectrum of people whom suffer back pain, sciactica and back aches. Believe it or not, a lot of research in the last 20 years has looked into chronic sufferers of back pain and found that there are certain specific neurological changes that occur in the brain that make continuation of chronic back pain more likely. Some people show this neurological change or ‘re-wiring’ whereas some do not. This could be helpful in determining which members of society are more likely to go on further with back pain and be at a far higher risk of long term chronicity. Treatment of back pain could therefore be adapted accordingly and research in this area is ongoing.
Funnily enough, a lot of research now concentrates back on the disc between the vertebrae as a key cause of the chronic and degenerative low back pain that some people suffer in their spine. Research is heading in the direction of understanding what happens at a molecular level to the disc as it wears over time. A weak link seems to be that the treatment and easing of back pain and disc damage is abruptly impeded by the simple fact that cartilaginous structures ( ie: squashy bits between the bones in a joint) cannot regenerate itself like for like. With this in mind, stem cell research is attempting to uncover advances in future. Stem cell research is looking into the possibility of ‘growing’ disc tissue to help repair degenerative parts of the disc….research again continues!
A recent study implemented by the NIH into epidural injections of steroid drugs looked at its use when treating back pain and sciatica. Injections are used for back pain sufferers as they reduce the tissue inflammation that often will aggravate nerve pain, joint pain, muscle spasm and other surround structures. This interesting back pain research continues into the link between back pain, sciatica, nerve pain and inflammation. Studies are now using state of the art computer imaging modalities to measure and assess specific signs of inflammation in the hope that an understanding of back pain can be improved.
The NIH is also looking into the non-surgical methods of treating back pain that is chronic. Chiropractic is a method that has received close scrutiny in recent years as it has grown and received greater acceptance within the healthcare community. Research regarding back pain and Chiropractic has been concentrating on programs of treatment for back pain that are run by the Chiropractor and involve exercises that engage the core muscles of the low back, and rehabilitation exercises that strengthen the supporting muscles so that back pain sufferers are far more self sufficient in the long term.
Manipulation is also being researched for its effectiveness as part of a package of care for back pain. Chiropractors have been implementing this method of treatment for over 100 years, although the modern day Chiropractor when treating back pain will often turn attention to rehabilitation of weak muscles that support the back and spine once the spine is best placed to receive such intervention.
Though limited in the present day, the psychological and emotional state of back pain sufferers is also a key topic of research. The management of ‘pain’ and its consequences is an area that will gain more attention into the future. Back pain is an obvious candidate for research in this regard as it is so common and indeed back pain is in great need of improved understanding in future as the number of people affected by back pain grows.
Bronfort et al, 2010; Effectiveness of Manual Therapies, The UK Evidence Report.
UK Beam Trial; Back pain, exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. British Medical Journal Nov 2004; 329; 1377 (doi: 10.1136 /bmj. 38282. 669225.AE)
Medical Research Council; ‘Low Back pain of mechanical origin: randomised comparison of Chiropractic from hospital outpatient treatment’; Meade et al.
Medical Research Council (Follow-up-study; Trial ‘Randomised comparison of Chiropractic and hospital outpatient management for low back pain; results from extended follow up’; Meade et al.
RCGP – Clinical Guidelines for the Management of Acute Low Back Pain 1996, 1999, 2001.
Clinical Standards Advisory Group; Backpain Report 1994.
Acute Back Pain – Primary Care Project; The Wiltshire and Bath Health Commission.
Carter JT, Birrell LN (Editors) 2000. Occupational health guidelines for the management of low back pain at work – principal recommendations. Faculty of Occupational Medicine. London. Occupational health guidelines for the management of low back pain at work – leaflet for practitioners. Faculty of Occupational Medicine. London. 2000. Waddell G, Burton AK 2000. Occupational health guidelines for the management of low back pain at work – evidence review. Faculty of Occupational Medicine. London.
Chiropractic Treatment in Workers with Musculoskeletal Complaints; Mark P Blokland DC et al;Journal of the Neuromusculoskeletal System vol 8 No 1, Spring 2000
House of Lords Select Committee on Science and Technology report on Complementary and Alternative Medicine November 2000
Regulation of chiropractic
Since the 1994 Chiropractors Act, all Chiropractors must be registered by law with the General Chiropractic Council (GCC) to practice in the UK. The introduction of government regulation was to ensure that the public are given access to the best quality care and to uphold excellent standards in education in Chiropractic within the UK.
Advancements in the development of chiropractic as a science, chiropractic teaching, and quality research into chiropractic is orchestrated at a European level by the European Chiropractic Union (ECU) and at a global level by the World Federation of Chiropractic (WFC). The WFC has had ‘non-government organisation’ status with official relations to the World Health Organisation (WHO) since 1997. Links to these organisations and information regarding chiropractic are located below.
The Royal College of Chiropractors Clinical Management Quality Mark
Managing the Clinical Environment
The Royal College of Chiropractors Patient Partnership Quality Mark
Meeting Patient Expectations