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World Health Organization Definition: Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuro-musculoskeletal system and the effects of these disorders on general health (See reference 1). Like medical physicians, chiropractors are trained to diagnose as well as treat, except the expertise of the chiropractor is specifically with regard to the neuro-musculoskeletal system.


Treatment methods: Chiropractors are best known for their expertise in spinal manipulative therapy. In addition, over 50% of North American chiropractors reported using the following adjunctive therapies: Patient Education; Rehabilitation consisting of: Stretching and Strengthening Exercise; Massage Therapy; Ice/Heat Therapy (Cryotherapy); Physical Therapy (Physiotherapy); Electrical Therapy; Ultrasound; Low-Level Laser Therapy; Acupressure; Acupuncture; Spinal Decompression Traction (Distraction); Nutritional Supplementation and Lifestyle Mamgement (See reference 2).

Click here for more information on how does a chiropractic adjustment work.

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Conditions treated: Overwhelmingly, patients seen in a chiropractic office are most often being treated for a back-related problem (76%). When asked to specify their illness or injury, 27% reported it as a neck/cervical problem, 22% as a low back problem, and 21% as a back/spine problem. Extremities account for 13% of the visits to a chiropractor (See reference 2).

Restricted Activities Within Scope: In all Provinces, chiropractic scope of practice includes making/providing a clinical impression/diagnosis, requisitioning and interpreting radiographs, and spinal manipulation (adjustments) of the spine and peripheral joints.

Chiropractic Regulation: Chiropractic is regulated by Law in Canada, the U.S. and over 50 other Countries (See reference 3).

Health Professions Act: Chiropractic is one of many regulated health care professions in Ontario (along with medical doctors, nurses, dentists, podiatrists and optometrists), regulated by self governing colleges under the Health Professions Act (HPA).

Provincial Regulatory College: Provincial regulatory colleges are charged with licensing, continued competence and public protection. For chiropractors in Ontario, that is the College of Chiropractors of Ontario (CCO) and the Ontario Chiropractic Association (OCA). To be a chiropractor in Ontario, you must be a member, in good standing, with the CCO. Dr. Pisarek is also a member in good standing with the Canadian Chiropractic Association (CCA).

Fact: There are over 6000 chiropractors licensed and actively practicing in Canada; ~970 in BC.

Efficacy and Safety:

Efficacy – A 2010 review concluded that the manual therapies commonly used by chiropractors are effective for the treatment of low back pain, neck pain, some kinds of headaches and a number of extremity joint conditions (See reference 4)

Safety – Manual therapies are generally very safe, when performed by trained professionals, however, there have been some concerns associated with manipulation of the cervical spine. Most patients experience immediate relief following a cervical adjustment, however, some may experience temporary soreness, stiffness or slight swelling. In very rare situations, patients may experience symptoms such as dizziness, local numbness, or radiating pain (See reference 5). Most symptoms dissipate within 24 hours.

A cervical adjustment (cervical manipulation) is performed well within the normal turning range of the head and research indicates that it does not put undo stress on the vertebral artery (See reference 6). Furthermore, a recent prospective analysis looked at over 19,000 chiropractic patients and tracked more than 50,000 neck adjustments - it found no instances of serious adverse effects (See reference 5). The most recent medical research into rare cases of stroke found that patients who visit their chiropractor are no more likely to experience a stroke than are patients who visit their family physician (See reference 7). A 2012 systematic review determined that there was not enough evidence to conclude a strong association, or no association, between neck manipulation and stroke (See reference 8).

Chiropractors are trained to take a careful health histories and perform sensitive cranial nerve screens before deciding whether a cervical adjustment is right for a patient. Chiropractic treatment guidelines help doctors of chiropractic identify patients whose neck pain symptoms are unusual and provide clear advice on when not to perform a neck adjustment. These types of patients are referred by Dr. Pisarek to their medical health providers for further investigation.

Education:

In order to become a doctor of chiropractic in Canada, a student must complete at least 3 years of a university-level undergraduate degree (with a minimum GPA of 3.0), followed by a 4 year accredited Doctor of Chiropractic program. The majority of students (87% in 2010) entering the Canadian Memorial Chiropractic College (CMCC) had completed a baccalaureate university degree. CMCC is Canada’s only English-speaking chiropractic college; it teaches an evidence-based medicine paradigm, as opposed to the traditional vertebral subluxation model sometimes taught in the United States. Click here for further information on chiropractic education.

The Doctor of Chiropractic program at CMCC requires four years of full-time study, including 12 months of hands-on clinical experience under faculty supervision. This experience includes training in clinical assessment, diagnosis, treatment, and referral protocols. The multidisciplinary faculty at CMCC have diverse backgrounds including MD’s and PhD’s that offer students a wide range of expertise in the medical and clinical sciences. In addition to training in manual therapies, courses at CMCC include: anatomy, neuroanatomy, neuro-diagnosis, neuroscience, biochemistry, physiology, orthopedics, diagnosis and symptomotalogy, laboratory diagnosis, embryology, radiology, immunology, microbiology, pathology, clinical nutrition and other basic and clinical medical sciences.

Health Plan Coverage:

  • In Ontario, there has been no provincial budgetary coverage for chiropractic services since 2004.
  • Chiropractic services are covered by most federal programs, e.g. Veterans Affairs, RCMP, First Nation People, etc.
  • Chiropractic services are widely covered under extended health care plans, such as Manulife, Sunlife, Great West Life and others, with the majority of plans providing coverage of at least $500 per annum and in some cases, open-ended.
  • Chiropractic care is also covered by auto insurance and WSIB insurance providers.

References:

1.  World Health Organization (2005) (PDF). WHO guidelines on basic training and safety in chiropractic. Retrieved 2012-02-29.

2.  Coulter ID, Shekelle PG. Chiropractic in North America: a descriptive analysis. J Manipulative Physiol Ther. 2005 Feb;28(2):83-9.

3.  World Federation of Chiropractic. Legal Status of Chiropractic by Country . Retrieved on April 18, 2012 - http://www.wfc.org/website/index.php?option=com_content&view=article&id=123&Itemid=139&lang=en

4.  Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010 Feb 25;18:3.

5.  Thiel HW, Bolton JE, Docherty S, Portlock JC. Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine (Phila Pa 1976). 2007 Oct 1;32(21):2375-8; discussion 2379.

6.  Herzog W, Leonard TR, Symons B, Tang C, Wuest S. Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation.J Electromyogr Kinesiol. 2012 Apr 5. [Epub ahead of print]

7.  Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83.

8.  Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ. Assessing the risk of stroke from neck manipulation: a systematic review. Int J Clin Pract. 2012 Oct;66(10):940-7.

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