Chiropractic Intervention

Chiropractic care, a form of complementary or alternative, or CAM, health practice, is technically considered a manipulative and body-based therapeutic method. Chiropractic care is a hands-on approach to therapy that often centers around the adjustment to the spine and joints in a way that influences the body’s nervous system and natural defense mechanisms for the purpose of alleviating pain and improving health and well-being.

What is chiropractic intervention?

Chiropractic care, considered a complementary or alternative health practice in the U.S., is becoming a sought-after remedy for pain management for children and adults, alike. Chiropractic interventions are used to improve forms of musculoskeletal pain, including lower-back, neck, shoulder, headaches, hand and foot problems, as well as for specific health conditions such as Cerebral Palsy, fibromyalgia and attention deficit hyperactivity disorder.

The Greek word “chiropractic” means “hand practice” or treatment done by hand. Chiropractic care is a hands-on approach to therapy that often centers around the adjustment to the spine and joints in a way that influences the body’s nervous system and natural defense mechanisms for the purpose of alleviating pain and improving health and well-being.

There are 2 million children and nearly 18 million adults in the United States who received chiropractic or osteopathic manipulation during a 12 month period, according to the 2007 National Health Interview Survey, or NHIS. The study found that children who have parents that use complementary and alternative medicine, or CAM, services are twice as likely as other children to use complementary health services, as well.

In fact, in 2007 the CDC National Health Statistics Report #12 indicates that chiropractic and osteopathic services are the second most popular form of CAM therapies used on children. CAM therapies were most commonly used on children for the following purposes:

• Back and neck pain, 6.7 percent
• Head or chest cold, 6.6 percent
• Anxiety and stress, 4.8 percent
• Other musculoskeletal, 4.2 percent
• Attention deficit hyperactivity disorder, 2.5 percent
• Insomnia, 1.8 percent

Although there is little in the way of formal studies on the effects of chiropractic care for use on persons with Cerebral Palsy, there are reports in the chiropractic community that purport improvements for the following conditions:

• Arthritis
• Back pain or problems
• Breathing
• Drooling (release of the TMJ-muscles)
• Gait patterns
• Hypertonic musculature
• Joint pain or stiffness
• Muscle contractures
• Neck pain or problems
• Pain and tension
• Scoliosis or curvature of the spine
• Seizures
• Sleep difficulties
• Other musculoskeletal conditions

Simply explained, the brain communicates with the body through nerves. Chiropractic care is based in improving the way brain control and muscles work together. The neuromuscular system sends messages from the brain, down the spine and into the nerves. If there is interference, the body is not able to function as effectively.

Chiropractic intervention aims to improve the structural aspects of the body to clear the pathway for the brain to communicate with the nerves. This can result in improved strength, balance, flexibility and coordination skills, especially in the limbs. One intervention doesn’t fix all, rather the intervention chosen and the location of treatment are relative to the symptom being addressed. Since Cerebral Palsy affects people differently, differing chiropractic modalities are used to address specific issues.

History in the development of chiropractic care

Founded in Davenport, Iowa in the late 1890s, chiropractic care was rooted in holistic concepts that, for many years, rendered the practice controversial. The contention of those in the chiropractic community that the sole cause of pain was spinal dysfunction called vertebral subluxation has been questioned by traditional medical practitioners. Additionally, physicians and other critics have questioned the ability of chiropractic care in treating conditions that are not linked to the neuromusculoskeletal system.

Although chiropractic care in recent years has gained acceptance by the medical community as a manual therapy because of its ability to relieve pain, the practice is still rooted in spinal manipulation as a gateway to improving a person’s overall health. Today, there are chiropractors in practice that are purists, and others that believe scientific research has a place in chiropractic care.

There is evidence that the chiropractic care can be helpful to children with Cerebral Palsy. A handful of studies indicates that children that underwent spinal manipulation could sit and stand with more ease. Also, the studies indicated that some children became more active, digested food more efficiently, slept more peacefully, and enjoyed improved coordination after undergoing chiropractic care.

In the book, “Chiropractic Care of Special Populations,” author Robert D. Mootz reports on a few specific treatments that have been reported to have improved some conditions of Cerebral Palsy:

• Adjustment of the atlanto-occipital subluxations helped with children who had difficulty with sleeping, personality disturbances, and hypertonic musculature.
• Upper cervical spine adjustments created clinical improvements in a 5-year-old male with quadriplegic Cerebral Palsy.
• Adjustments can be helpful in cases of cranial dysfunction in the sphenobasilar junction in children who have a history of birth trauma or head injury where motor tracts of the medulla may be compromised.
• Manual release of the TMJ-related muscles, such as the masseter and temporalis, may ease excessive drooling.
• Myofascial release may be used to assist in decreasing the severity of spinal distortion and aid in stabilizing gait patterns in children with spastic Cerebral Palsy who have muscle contractures in the paraspinals, lateral thigh muscles, lower extremity abductors, Achilles tendons, and wrist extensors.

What is chiropractic care?

Chiropractic care is technically considered a manipulative and body-based therapeutic method that affects the body systems and structures – bones, joints, soft tissues, and neuromuscular system – that are manipulated beyond their passive range of motion and with appropriate use of force. It is a therapy that uses the manipulation of the spine and joints to relieve pain. The spinal manipulations are made using the chiropractor’s hands, and are referred to as “adjustments.” The dysfunctions or abnormalities in the joints of the spine are called “vertebral subluxations.” Vertebral subluxations are a set of symptoms in the spine.

Most people seek chiropractic care to address:

• Neck pain
• Back pain
• Spinal discomfort
• Inability to sit or stand

Chiropractic care depends on three main concepts, which are:

• Reductionism – attributing the cause of pain or illness to vertebral subluxation alone.
• Conservatism – committing to non-invasive interventions as a mode of treatment.
• Homeostasis – emphasizing self-healing.

These three concepts are heeded by both traditional, purist chiropractors and “mixers” chiropractors that are influenced by evidence-based scientific findings and principles. Mixers may introduce other treatments to bring relief to individuals including:

• Ice and heat
• Vitamins and nutritional supplements
• Homeopathic or holistic medicine
• Herbs

However, all chiropractors use the basic tenet of the profession – vertebral subluxation – as the centerpiece of all clinical remedies, along with a combination of other interventions.

What are the benefits of chiropractic therapy, and when is care advised?

Although there have been few studies that assess the impact of chiropractic care on children with Cerebral Palsy, the few that have been completed have shown that children respond well to therapy.

In one 2006 study, originally published in the Journal of Vertebral Subluxation Research indicated that children with Cerebral Palsy that were determined to have subluxations showed improvement in their mobility after one month of care. One child demonstrated improvement in her ability to sit up, walk, and ambulate after 22 adjustments.

In a study published by the Journal of Pediatric, Maternal & Family Health determined that a 2-year-old boy with Cerebral Palsy was relieved of several symptoms that interfered with his mobility and ability to sleep. After seven months of care, he was able to pull himself into an upright position and was sleeping regularly. However, other features of his condition, such as uncontrolled movements, persisted.

People in many walks of life, from the elderly to children, seek chiropractic care. Many indicate that they realize significant relief from adjustments. However, individual benefits are dependent on a child’s condition at the onset of care; parents – with the guidance of the child’s primary care physician – will need to determine how chiropractic care fits in with a child’s overall treatment plan.

What happens during chiropractic care?

At the beginning of a chiropractic appointment, a full medical history will be taken to acquaint the practitioner of the symptoms an individual is coping with. From there, a series of examinations and tests will take place.

One of the first of these will be an X-ray, which should provide some valuable information about the condition of a child’s spinal column. This information includes:

• Curvature
• Misalignments (subluxations)
• Abnormalities
• Muscle tone changes
• Tissue abnormalities

A physical examination will help the chiropractor locate a child’s source of pain. Once the assessment is complete, the chiropractor will recommend a plan of treatment, which is very likely to include adjustments. If he or she suspects that another condition is causing pain or discomfort, a referral will be issued.

A chiropractor will use several techniques to determine where a subluxation, or misalignment, is. The most common methods that will help the practitioner determine which adjustments will be necessary to bring relief to a child are:

• Static palpitation – when a practitioner uses his or her hands to detect signs of misalignment
• Motion palpitation – when a doctor moves bones to separate them
• Leg check – moving the legs to reveal spinal subluxation

An adjustment is completed when the joints of the spine are moved beyond the point where they would normally move in a way where it does not harm or dislocate the joints. Doing so will require the chiropractor to use gentle force and trained expertise to complete the movements. Note, untrained individuals should not attempt to perform these procedures on another individual.

There are several specific types of adjustment that can be used to help a child. They include, but are not limited to:

• Diversified movement – full spine manipulation
• Activator technique – using a device to adjust the spine
• Cox technique – low-force adjustment
• Gonstead technique – using a specific path to adjust the spine

These adjustments will be made over a period of time – consisting of several appointments – to help a patient regain movement and minimize discomfort.

Chiropractors most often operate private practices, but often, their services can be found in other medical settings including:

• Hospitals
• Physician’s office
• Clinics
• Assisted living centers
• Residential facilities and nursing homes

Who provides chiropractic therapy?

Chiropractors offer a wide range of services and, depending on where a person lives, the scope of their duties can vary. In a handful of states, practitioners are allowed to perform minor surgery and write prescriptions, in others, these acts are prohibited.

Internationally, requirements to practice as a chiropractor vary. In the United States, a chiropractor must complete a professional degree program. Accredited programs require an applicant to complete 90 credit hours of undergraduate education, and others require students to earn a bachelor’s degree.

Doctors of chiropractic, however, must complete an intensive program that revolves around healing arts that many consider to be as challenging as medical school. A doctor of chiropractic typically pursues a bachelor’s of science degree prior to attending a chiropractic college.

Bachelor’s degree coursework includes:

• Biology
• Chemistry
• Physics
• Nutrition
• Psychology
• Anatomy
• Physiology

Chiropractic college curriculums consist of further coursework, as well as hands-on training and clinical study that lasts four or five years.

Licensure is required to practice in the United States. Most states will grant licenses to individuals who have successfully completed an accredited program and passed a test administered by the National Board of Chiropractic examiners.

Practitioners that choose to offer additional services such as massage or acupuncture may need to pursue other courses of study and certifications if they intend to provide these services personally.

Are there special considerations or risks for chiropractic therapy?

Generally, chiropractic is considered safe. In the hands of a fully-qualified practitioner, chiropractic care may cause some mild discomfort, but it should not be painful. If a child complains that treatment is highly uncomfortable, or is painful, a parent should investigate the matter by asking the chiropractor why this is the case. If a parent is uncomfortable with the answer, he or she should seek the care of another practitioner.

Often during the process of making an adjustment, a child and his or her parents will hear a popping sound. This occurs when gases escape from fluids that surround joints. This is similar to popping that occurs in the joints of the toes or ankles; it’s not indicative of a serious condition. Also, to the untrained eye, the quick and quirky adjustments could look alarming to those unfamiliar with chiropractic interventions.

Tips for selecting a chiropractor

According to the National Center for Complementary and Alternative Medicine, or NCCAM, a division of the National Institute of Health that is considered the lead agency for scientific research on diverse medical and health care practices, when choosing a practitioner, ask:

• Their experience in coordinating care with conventional health care providers
• Their experience in delivering care to children
• Their education, training and licensure

You should also ask about their experience and expertise in treating children, or adults, with Cerebral Palsy.

NCCAM also recommends that when considering a complementary health approach for a child:

• Make sure the child has an accurate diagnosis from a licensed health care provider.
• Understand the potential risks, benefits and effectiveness of the specific approach.
• Discuss any and all CAM approaches with the child’s primary care physician before agreeing to the treatment protocol, especially with the physician that overseas your child’s care plan so that there is no conflict with other forms of treatment.
• Never use any health product or practice that has not been proven safe and effective to replace or delay conventional care or prescribed medications.
• When a health care practitioner suggests a CAM approach, do not increase the dose or duration of the treatment beyond what is recommended without practitioner approval.
• Discuss any and all concerns about the effects of a CAM approach with your child’s primary health care provider.
• To ensure coordinated and safe care, tell all your child’s health care providers about any CAM approach your child uses, providing them with a full picture of what you do to manage your child’s health.