The Practice of Chiropractic

Last week we looked at the chiropractic profession from the who, what, where, and when viewpoints. This week and in following articles, we will discuss the how and why of chiropractic.

The main focus of chiropractic practice is the relationship between the function of spinal joints, muscles and other holding elements and the nervous system (i.e. the favorite term of the chiropractor "the neuromusculoskeletal condition") and the effects of these disorders on human health.

The spine is our principle area of importance. However, chiropractors concern themselves with all the joints of the human frame and especially those of the weight-bearing system.

Chiropractic treatment consists of spinal adjustments or manipulation of these joints but also includes therapeutic devices such as ultrasound, diatherapy, synaptic and interferential current, exercise programmes, the use of orthotics, nutritional advice, patient education and lifestyle modification.

Chiropractors place an emphasis on health promotion, education, patient empowerment, and an early return to activities. Most of the time we prefer to work in the early stages of human disease and disability, the stage in which problems are manifesting themselves as functional changes rather than structural changes.

The chiropractic notion that function governs structure was considered radical and absurd 50 years ago, but now it is more and more accepted as being a descriptive term relating to a continuum of pain and disability. A simple example can be given in the case of a chronic but uncomplicated lower back problem persisting for many years causing accelerated wear and tear on the spinal joints of the low back. The aberrant spinal movements which causes the pain eventually leads to disc degeneration and arthritic changes to the spine.

I will attempt to elaborate on this example in an attempt to make it clearer. In this hypothetical case, the patient, usually a male, has pain and other symptoms in his lower spine on a periodic or episodic basis, but with self care, rest when sore, lifestyle limitations and the use of drugs, he sort of "gets along" and "learns to live with it". At first in this example, we would, upon examination, see mild functional changes in his spine. Progressively, however, over the course of years chronic functional changes occur as he alters his gait, posture and activities to accommodate the pain which he is experiencing more and more. Finally, if we examined his spine, we would discover chronic structural changes and disease processes in the form of thinning and degenerated disks as well as spinal arthritis.

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