Introduction to Chiropractic Introduction to Chiropractic

Introduction to Chiropractic - PowerPoint Presentation

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Presentation to ltinsert name of organizationgt ltinsert dategt Presented by ltinsert name of presentergt What is Chiropractic Assessment diagnosis and treatment of neuromusculoskeletal ID: 238194

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Introduction to Chiropractic

Presentation to:

<insert name of organization>

<insert date>

Presented by:

<insert name of presenter>Slide2

What is Chiropractic?

Assessment, diagnosis and treatment of


disorders, primarily through manipulation and other manual therapies

.Treatment & management of conditions resulting from: joint, ligament, tendon, muscle, nerve and spinal disorders; their effect on the body & nervous system.Nutrition, therapeutic exercise, lifestyle & ergonomic counsellingSlide3

Chiropractic Education (CDN)

Two degree-granting, full-time, accredited chiropractic programs:


4 year, full-time program at the Canadian Memorial Chiropractic College following

a minimum of three years of university study.Quebec: 5 year, full-time program at Université de Qu


bec a

Trois Riviéres following graduation from CEGEP. Multidisciplinary faculty and training: anatomy, biochemistry, biomechanics, physiology, neurology, radiology, immunology, microbiology, pathology, clinical nutrition and clinical sciences specifically relating to diagnosis.Slide4

Chiropractic Regulation

Chiropractic is a regulated health profession:

Legislated scope of practice in all Provinces/Territories; controlled act of manipulation

Provincial regulatory colleges charged with licensing, continued competence and public protection

Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (CFCREAB) provides a national forum for the provincial collegesThree

standardized national exams (clinical competency and written cognitive)


licensure exam conducted in province of practice.Slide5

Chiropractic Facts

Canadian practitioners:


Utilization: 4.5 million Canadians/year

Average patient load/week fulltime DCs (2011 CCRD):


Average fee /visit:

$40 to $45Most common conditions treated: musculoskeletal injuries & complaints (87%)Slide6

Health Plan Coverage

Covered by some provincial health care plans.

Widely covered under extended health care plans with majority of plans providing coverage of at least $500 per annum*.

Covered by all Workers Compensation Boards and most automobile insurance plans.

Included in federal programs, e.g. Veterans Affairs, RCMP etc.Slide7

Chiropractic & WCB

All provincial Worker Compensation Boards utilize chiropractic to treat injured workers.

Data consistently illustrates chiropractic’s high effectiveness in getting injured workers back to work.

Other findings with WCB chiropractic patients*:

Reduced time to care - average time to treatment 3 daysReduced chronicity - 11% required care beyond 12 weeks Earlier return to work - median lost time 9 days

*Ont. WSIB 2003 Program of Care Evaluation for Acute Low Back InjuriesSlide8

Scientific Support

Six formal government reviews (worldwide). All concluded that contemporary chiropractic care is safe and effective.

Canadian Institute for Health Research partnerships with The Canadian Chiropractic Association to provide grants for chiropractic research.

Canada Research Chair in Spinal Function awarded to Dr. Greg

Kawchuk, DC.Slide9


Trained and licensed to perform differential diagnosis:

Clinical history, MSK assessment, posture/


examination, radiology if indicatedIs this musculoskeletal (not pathological)?What is the specific functional disorder? Slide10

Chiropractic Treatment Modalities

Manual Care:

Adjustment (90%), mobilization,


release techniquesInstrument assisted soft tissueExercise:Instruction and/or supervision (75%)


Adjunctive Therapies:

Ultrasound, TENS, IFC, laser etc.Ice, heat, massage etc.Acupuncture Education:

Condition specific: lifestyle

, ergonomics

, nutritionSlide11

Indications for Referral

Back pain/sciatica

Neck pain

HeadacheRepetitive strain injuries


pain syndromes

Conditions of the extremitiesSlide12

Treatment Goals

Acute Care:Relieve pain

Reduce muscle spasm and inflammation

Increase flexibility

Restore function and range of motionReturn to normal activities of daily living as quickly as possibleSlide13

Treatment Goals




Increase strengthMaintain flexibilityPreventionCorrect habitsErgonomic modificationMinimize recurrencesSlide14

Distribution of Complaints

Duration: 50% < 3


; 25% >12


Onset: 26% significant


Shekelle et al. Ann Intern Med 1998Slide15

Back Pain

Most common condition treated.

According to the Institute for Work & Health, low back pain affects 85% of the working population and is a leading cause of disability and absence


*Cassidy et al, Spine 1998Slide16

UK Beam Trial (2004)

“…this is the first study…to show convincingly that both manipulation alone and manipulation followed by exercise provide cost-effective additions to best care [for low back pain patients] in general practice.”


, Nov. 19, 2004Slide17


et al (2004)

Benefit plan members with chiropractic coverage vs. members without; 4 year study of low back pain related claims.

With chiropractic care:

Reduced utilization of radiographs and MRIReduced hospitalizationsReduced surgeryReduced costs


et al. Arch Int. Med 2004Slide18

Expert Reviews

U.K. Clinical Standards Advisory Group 1994:

recommends manipulation with exercise and physical activity for low back pain.

New Zealand Acute Low Back Pain Guide 1997:

includes manipulation as appropriate treatment for acute low back pain.Slide19

Expert Reviews

cont’dDanish Institute for Higher Technology Assessment 1999:

adjustment is indicated for management of acute, recurrent and chronic low back pain.

Ontario WCB Guidelines for Chronic Pain 2001:

adjustment more effective for chronic low back pain than usual care, bed rest, analgesics or massage.Slide20

Neck Pain


Lifetime 65%

Chronic 10%

Cochrane review of spinal manipulative therapy and mobilization for mechanical neck pain: Multi-modal care (SMT/Mobs) plus exercise is more effective than physiotherapy or usual care.*

* Cote et al. Pain, 2004

* Gross et al. Spine,



ConditionsTension headache with myogenic trigger

Sports injuries

Repetitive strain injuries

Whiplash and whiplash associated disorder injuriesSlide22

Adverse Affects

Short-term muscle soreness or stiffness

Rib fracture


Risk Rates

Serious adverse events associated with cervical manipulation are rare:

Estimates vary

One to two events per million cervical

adjustmentsThere was an association between chiropractic visits and a similar association observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having a stroke.

Meeker WC,


S. Annals of Internal Medicine, 2002Rothwell DM, Bondy SJ, Williams JI. Stroke, 2001Herzog W, Symons BP, Leonard T. Journal of Manipulative and Physiological Therapeutics, 2002 Haldemann et al. Spine 2008Slide24

What to expect when referring

Musculoskeletal physical examination and diagnosis

Radiology – if necessary

Informed consent to treatment

MD communication (initial, update, discharge)

Referral back if no progress, contraindications to care or pathologies

Outcomes-based therapySlide25

Benefits of Collaborative Care

Continuity of care

Timely assessment, treatment and reporting

Network with other providers

Patient satisfaction