Introduction to Chiropractic

World Health Organization (W.H.O.) Definition: Chiropractic is a healthcare profession focused on diagnosing, treating, and preventing issues related to the neuro-musculoskeletal system and how these problems impact overall health (See reference 1). Like medical doctors, chiropractors are trained to both diagnose and treat, but chiropractors specialize in the neuro-musculoskeletal system.

EducationTo become a Doctor of Chiropractic in Canada, a student must complete at least three years of a university-level undergraduate degree with a minimum GPA of 3.0, followed by a four-year accredited Doctor of Chiropractic program. In 2010, the majority of students (87%) entering the Canadian Memorial Chiropractic College (CMCC) had already earned a university degree. CMCC, the only English-speaking chiropractic college in Canada, follows an evidence-based medicine approach, in contrast to the traditional vertebral subluxation model sometimes taught in the United States. 

The 'Doctor of Chiropractic' program at CMCC entails four years of full-time study, including 12 months of hands-on clinical experience under faculty supervision. This training covers clinical assessment, diagnosis, treatment, and referral protocols. CMCC's faculty includes experts with diverse backgrounds, including MDs and PhDs, providing students with a broad range of expertise in medical and clinical sciences. 

The curriculum at CMCC includes courses in anatomy, neuroanatomy, neuro-diagnosis, neuroscience, biochemistry, physiology, orthopedics, diagnosis and symptomatology, laboratory diagnosis, embryology, radiology, immunology, microbiology, pathology, clinical nutrition, and other fundamental and clinical medical sciences.

Scope of PracticeChiropractic practice in all Canadian provinces includes making clinical diagnoses, requesting and interpreting X-rays, and performing spinal manipulation (adjustments) on the spine and peripheral joints. Chiropractic is regulated by law in Canada, the U.S., and more than 50 other countries (See reference 3).

Health Professions ActChiropractic is among the regulated healthcare professions in Ontario, alongside medical doctors, nurses, dentists, podiatrists, and optometrists. These professions are regulated by self-governing colleges under the Health Professions Act (HPA). In Ontario, the College of Chiropractors of Ontario (CCO) and the Ontario Chiropractic Association (OCA) are responsible for licensing, ensuring continued competence, and safeguarding the public. 

To practice chiropractic in Ontario, one 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). Notably, there are over 6000 licensed chiropractors actively practicing in Canada, with approximately 970 in British Columbia.

Conditions treatedThe majority of patients visiting a chiropractor seek treatment for back-related issues (76%). When specifying their ailment or injury, 27% report neck or cervical problems, 22% mention low back problems, and 21% cite back/spine problems. Extremity issues account for 13% of visits to chiropractors (See reference 2).

Treatment methods: Chiropractors are primarily known for their expertise in spinal manipulative therapy. Additionally, more than 50% of chiropractors in North America utilize various complementary treatments, including patient education, rehabilitation such as stretching and strengthening exercises, massage therapy, ice/heat therapy, physical therapy (physiotherapy), electrical therapy, ultrasound, low-level laser therapy, acupressure, acupuncture, spinal decompression traction, nutritional supplementation, and lifestyle management (See reference 2).

Efficacy and Safety: A review in 2010 concluded that the manual therapies commonly employed by chiropractors are effective for treating low back pain, neck pain, certain types of headaches, and various extremity joint conditions (See reference 4). 

Regarding safety, manual therapies are generally very safe when performed by trained professionals. However, there have been some concerns associated with cervical spine manipulation. Most patients experience immediate relief following a cervical adjustment, but some may encounter temporary soreness, stiffness, or slight myofascial swelling. In rare cases, patients may experience symptoms like dizziness, local numbness, or radiating pain (See reference 5). 

Research indicates that cervical adjustments are performed well within the normal range of head motion and do not excessively stress the vertebral artery (See reference 6). Moreover, a recent analysis of over 19,000 chiropractic patients and more than 50,000 neck adjustments found no instances of serious adverse effects (See reference 5). 

Recent medical research suggests that patients visiting chiropractors are no more likely to experience a stroke than those visiting family physicians (See reference 7).

A systematic review in 2012 concluded that there was insufficient evidence to establish a strong association, or lack thereof, between neck manipulation and stroke (See reference 8). Chiropractors are trained to gather thorough health histories and perform sensitive cranial nerve screens before deciding on a cervical adjustment. Patients with unusual neck pain symptoms are referred by Dr. Pisarek to their patient's medical healthcare providers for further evaluation.

Health Plan Coverage: In Ontario, chiropractic services have not been provincially funded since 2004, except for the technical part of X-ray examinations for chiropractic patients. Radiology services currently do not include ultrasonography, MRI, and CT scans. Chiropractic treatment services are covered by most federal programs, including Veterans Affairs, RCMP, and First Nation People. Additionally, chiropractic care is widely covered by extended health care plans such as Manulife, Sunlife, Great West Life, with many plans providing at least $500 annually, and some offering unlimited coverage. Chiropractic care is also covered by auto 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/ind...

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.

Location

HOURS OF OPERATION

Monday

8:00 am - Noon

2:00 pm - 6:00 pm

Tuesday

By Appointment

By Appointment

Wednesday

8:00 am - Noon

2:00 pm - 6:00 pm

Thursday

By Appointment

2:00 pm - 6:00 pm

Friday

8:00 am - Noon

By Appointment

Saturday

By Appointment

By Appointment

Sunday

By Appointment

By Appointment

Monday
8:00 am - Noon 2:00 pm - 6:00 pm
Tuesday
By Appointment By Appointment
Wednesday
8:00 am - Noon 2:00 pm - 6:00 pm
Thursday
By Appointment 2:00 pm - 6:00 pm
Friday
8:00 am - Noon By Appointment
Saturday
By Appointment By Appointment
Sunday
By Appointment By Appointment