Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic services are used most often to treat common musculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.
Chiropractic is the third-largest primary health care profession, surpassed in number only by doctors of medicine and dentistry. Doctors of chiropractic (DCs) treat about 35 million Americans annually.
- DCs are licensed to practice in all 50 states and the District of Columbia–and in many nations around the world–and undergo a rigorous education in the healing sciences at institutions accredited by the U.S. Department of Education.
- Chiropractic is used extensively by amateur and professional athletes, professional dancers and others to prevent and treat injuries as well as achieve optimal health and functioning.
Doctors of chiropractic (DCs) must meet stringent educational and competency standards.
Along with completing pre-professional college education and graduating from an accredited chiropractic college, DCs who wish to attain a license to practice in the U.S. must first pass rigorous national board exams to verify that they have the knowledge and skills necessary to effectively and safely treat patients. Individual state chiropractic boards, which approve and manage licensure, have additional requisites that must be met. In addition, Texas Healthcare Chiropractors are also board tested and certified in physiotherapy.
National Testing
The national board exam system for the chiropractic profession is managed by the National Board of Chiropractic Examiners (NBCE). NBCE develops, administers and scores standardized exams that assess chiropractic college graduates’ knowledge, higher-level cognitive abilities and problem-solving in various basic science and clinical science subjects. NBCE’s exam is divided into four parts: basic sciences (Part I), clinical sciences (Part II), clinical competency (Part III), and practical skills (Part IV).
State Licensure
Each state has its own requirements for chiropractic licenses, based in part on the scope of practice determined by the state for DCs within its borders. In some states, chiropractors may provide a wide variety of treatments; in others, their services are more focused. In addition to meeting established educational requirements and passing national board exams, licensure in a state might include testing to verify a doctor’s knowledge of the state scope of practice, a background check, providing personal references, and proof of malpractice insurance.
Most states have their own chiropractic regulatory board that not only administers licensing for chiropractors but also takes action in cases where consumer complaints are reported. In some states where there is no chiropractic-specific board, this role is administered through a state medical board or a board that represents multiple healthcare professions.
Like their medical colleagues, chiropractors must renew their licenses on a regular basis. As a requirement for renewal, most states mandate that chiropractors take continuing education (CE) courses and earn a specific number of CE credits each year.
The Federation of Chiropractic Licensing Boards (FCLB) provides a forum in which state chiropractic licensing board members meet to address common areas of interest and concern with respect to chiropractic regulatory law. Among its activities, FCLB compiles and publishes regulatory board contact information (see list here) and summaries of the requirements to obtain and maintain licensed status in the United States and its territories, Canada, and Australia. FCLB also maintains a database of public actions taken with regard to individual chiropractic licenses, provides certification of chiropractic continuing education courses through its PACE program and provides a certification course for chiropractic assistants.
Education
DCs are educated in nationally accredited, four-year doctoral graduate school programs through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship, with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools.
Chiropractors are designated as physician-level providers in the vast majority of states and the federal Medicare program. The essential services provided by DCs are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the Federal Employees Health Benefits Program, Federal Workers’ Compensation, and all state workers’ compensation programs.
The typical applicant at a chiropractic college has already acquired nearly a pre-medical undergraduate college education, including courses in biology, inorganic and organic chemistry, physics, psychology and related lab work. Once accepted into an accredited chiropractic college, the requirements become even more demanding — four to five academic years of professional study are the standard. Because of the hands-on nature of chiropractic, and the intricate adjusting techniques, a significant portion of time is spent in clinical training.
In some areas, such as anatomy, physiology, rehabilitation, nutrition and public health, they receive more intensive education than their MD counterparts. Like other primary health care doctors, chiropractic students spend a significant portion of their curriculum studying clinical subjects related to evaluating and caring for patients. Typically, as part of their professional training, they must complete a minimum of a one-year clinical-based program dealing with actual patient care.
This extensive education prepares doctors of chiropractic to diagnose health care conditions, treat those that are within their scope of practice and refer patients to other healthcare practitioners when appropriate.
This course of study is approved by an accrediting agency, the Council on Chiropractic Education, that is recognized by the U.S. Department of Education.
After an accident or personal injury, visiting a chiropractor who specializes in motor vehicle/personal injuries can help alleviate headaches, neck pain, lower back pain, muscle soreness, and other conditions. Chiropractors provide personalized assessments and can make decisions on how best to alleviate a patient’s symptoms. Car accident, slip and fall or workplace injuries left untreated can heal with scar tissue. Scar tissue can lead to ongoing pain and discomfort.
Whether or not pain is present, it’s a good idea to seek treatment from a chiropractor within three to seven days of an accident. The sooner the better. While a negligent act leading to a minor accident might not warrant a trip to the emergency room, it can lead to unseen injuries. Pain and injuries can surface within hours, days or, in some cases, months after an accident. Failing to seek care can result in a number of chronic conditions that may take months or years to fully heal. Without a quick and accurate assessment of your potential injuries, you could end up paying thousands of dollars in medical treatment.
Many injuries do not cause stiffness, pain, soreness or discomfort until days or weeks after an accident. Seeking treatment from a chiropractor immediately after an accident can catch and prevent injuries from worsening.
Chiropractors start by asking patients questions to gather information about their present condition and health history and then performing a physical examination to develop a working diagnosis. Imaging or lab tests (such as MRI, CT scan or X-ray) may be used to confirm a diagnosis.
The combination of the history, exam and diagnostic studies will enable your doctor of chiropractic to reach a diagnosis, which will in turn help him or her to determine whether chiropractic services are appropriate for your condition. If your doctor determines you would be more appropriately managed or co-managed by another health care professional, he or she will make the proper referral.
Through a process of shared decision-making, you and your doctor will determine if chiropractic services are right for you. As part of this process, the doctor will explain your condition, recommend a treatment plan and review the risks and benefits of all procedures.
As noted in the previous question “What should I expect on my initial visit” all these processes are very important and sometimes can be time consuming. On average, time spent in the clinic for an initial exam can range from 1 to 1.5 hours.
One of the most common and well known therapeutic procedures performed by doctors of chiropractic is spinal manipulation (sometimes referred to as a “chiropractic adjustment”). The purpose of spinal manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile – or restricted in their movement – as a result of a tissue injury. Tissue injury can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses, such as sitting in an awkward position with poor spinal posture for an extended period of time. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for an individual. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal.
Chiropractic services are some of the safest drug-free, noninvasive therapies available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches and other neuromusculoskeletal complaints. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects. Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness or aching (like that experienced after some forms of exercise), headaches and tiredness. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.
In addition to being a safe form of treatment, spinal manipulation is incredibly effective, in some cases getting patients back on their feet faster than traditional medical care. A clinical comparative trial published by the Journal of the American Medical Association found that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone. In addition, a study in the Annals of Internal Medicine found that spinal manipulative therapy and exercise are more effective at relieving neck pain than pain medication.
The popping sound that may be heard during a Chiropractic Adjustment, also known as joint cavitation, is the result of tiny pockets of air that have built up in the joints of the spine being released, which can actually help reduce the amount of pressure on the spine. It's basically the same noise you hear when you 'pop' your knuckles.
