What Kind of Training Do Chiropractors Receive?

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4. What kind of training do chiropractors receive?
Chiropractic training is a 4-year academic program consisting of both classroom and clinical instruction. At least 3 years of preparatory college work are required for admission to chiropractic schools.(12,13) Students who graduate receive the degree of Doctor of Chiropractic (D.C.) and are eligible to take state licensure board examinations in order to practice. Some schools also offer postgraduate courses, including 2- to 3-year residency programs in specialized fields.(14)

Chiropractic training typically includes:(12)

• Coursework in anatomy, physiology, microbiology, biochemistry, pathology, nutrition, public health, and many other subjects

• The principles and practice of chiropractic

• Research methods and procedures

• Direct experience in caring for patients

The Council on Chiropractic Education, an agency certified by the U.S. Department of Education, is the accrediting body for chiropractic colleges in the United States.(14)

5. What do chiropractors do in treating patients?
If you become a chiropractic patient, during your initial visit the chiropractor will take your health history. He will perform a physical examination, with special emphasis on the spine, and possibly other examinations or tests such as x-rays.(15) If he determines that you are an appropriate candidate for chiropractic therapy, he will develop a treatment plan.

When the chiropractor treats you, he may perform one or more adjustments. An adjustment (also called a manipulation treatment) is a manual therapy, or therapy delivered by the hands. Given mainly to the spine, chiropractic adjustments involve applying a controlled, sudden force to a joint. They are done to increase the range and quality of motion in the area being treated. Other health care professionals--including physical therapists, sports medicine doctors, orthopedists, physical medicine specialists, doctors of osteopathic medicine, doctors of naturopathic medicine, and massage therapists--perform various types of manipulation. In the United States, chiropractors perform over 90 percent of manipulative treatments.(16)

Most chiropractors use other treatments in addition to adjustment, such as mobilization, massage, and nonmanual treatments.(1)

Examples of Nonmanual Chiropractic Treatments(1)
• Heat and ice
• Ultrasound
• Electrical stimulation
• Rehabilitative exercise
• Magnetic therapy
• Counseling about diet, weight loss, and other lifestyle factors
• Dietary supplements
• Homeopathy
• Acupuncture

6. Have side effects or problems been reported from using chiropractic to treat back pain?
Patients may or may not experience side effects from chiropractic treatment. Effects may include temporary discomfort in parts of the body that were treated, headache, or tiredness. These effects tend to be minor and to resolve within 1 to 2 days.(7,17)

The rate of serious complications from chiropractic has been debated. There have been no organized prospective studies on the number of serious complications. From what is now known, the risk appears to be very low.(14,16,17) It appears to be higher for cervical-spine, or neck, manipulation (e.g., cases of stroke have been reported.(18,19) The rare complication of concern from low back adjustment is cauda equina syndrome, estimated to occur once per millions of treatments (the number of millions varies; one study placed it at 100 million16).(1,20)

For your safety, it is important to inform all of your health care providers about any care or treatments that you are using or considering, including chiropractic. This is to help ensure a coordinated course of care.

7. Does the government regulate chiropractic?
Chiropractic practice is regulated individually by each state and the District of Columbia. Most states require chiropractors to earn continuing education credits to maintain their licenses.(1,13) Chiropractors' scope of practice varies by state--including with regard to laboratory tests or diagnostic procedures, the dispensing or selling of dietary supplements, and the use of other CAM therapies such as acupuncture or homeopathy.(13,14,23) Chiropractors are not licensed in any state to perform major surgery or prescribe drugs. In Oregon, chiropractors can become certified to perform minor surgery (such as stitching cuts) and to deliver children by natural childbirth.(14,23,24)

8. Do health insurance plans pay for chiropractic treatment?
Compared with CAM therapies as a whole (few of which are reimbursed), coverage of chiropractic by insurance plans is extensive. As of 2002, more than 50 percent of health maintenance organizations (HMOs), more than 75 percent of private health care plans, and all state workers' compensation systems covered chiropractic treatment.1 Chiropractors can bill Medicare, and over two dozen states cover chiropractic treatment under Medicaid.(23)

If you have health insurance, check whether chiropractic care is covered before you seek treatment. Your plan may require care to be approved in advance, limit the number of visits covered, and/or require that you use chiropractors within its network.

National Center for Complementary and Alternative Medicine(NCCAM)
http://nccam.nih.gov/health/chiropractic/index.htm
National Institutes of Health, U.S. Department of Health and Human Services
NCCAM Publication No. D196 November 2003