"IT IS AMAZING HOW BLAIR UPPER CERVICAL HEALTH CARE IMPROVED MY OWN QUALITY OF LIFE"

- DR ALFRED TOMP DC

"CHARACTER - A person's true character can only be seen in service. Service can only be performed for another. Therefore, character and selfishness cannot exist together. Ask me about someone's character and I will show you their works. Question their progress and I will look to the progress of those around them that they have willed to a higher place with their vision, example, and service. Selfishness is character's eternal enemy just as service is character's accountable author." - Michael P. Watson

TYPES OF HEADACHES:

Frequently Asked Questions about Upper Cervical Health Care

“What is Body Imbalance and how do I know if it has happened to me?”

Body Imbalance occurs when the Cl or Atlas, and/or the C2 or Axis, the top two vertebra in the neck, are misaligned and out of their proper position. This can occur as a result of an accident, emotional trauma, or chemical toxicity in the body. Childbirth itself can move the atlas out of position because of the massive amounts of pressure on the head and neck of the baby as it passes down the birth canal. Or childhood accidents like falling from a tree, bike or skates can misalign it. In adulthood, the atlas can be shoved out of position during minor or major accidents such as sporting accidents, automobile accidents or slips and falls. Some of the worst cases of atlas misalignment and resulting pain have been caused by minor car accidents such as being rear-ended. One indication of body imbalance is having one leg slightly shorter than the other. You may also notice that when you stand in front of a mirror one shoulder is slightly higher than another, and one hip is higher than the other. Another indication your atlas may be out of position is by having different symptoms in your body that your medical doctor cannot explain or find the cause for on any tests.

“How can Body Imbalance cause me to have physical problems?”

The CL or Atlas is a donut-shaped bone that your skull rests on. Your spinal cord coming out of your brain and brain stem passes through the center of the donut shape. Your spinal cord at that point consists of trillions of nerve fibers (the nervous system) that “bottle-neck” through the small opening in the atlas. These fibers eventually branch off carrying information to every part of your body. If the CL is out of its proper position it can irritate, constrict or disrupt vital nerve signals to any portion of your body. This can cause muscle or joint pain, organ dysfunction, lowered immune system and countless other conditions that you would not ordinarily relate to a problem originating in your neck.

“Why do you call it Body Imbalance rather than a neck imbalance?”

Because it effects the entire spine and body. Wherever your atlas moves, your head moves with it. If this top bone in your neck has shifted out of position ever so slightly, no more than the thickness of a fingernail, it can move your head off center of your body. In an effort to keep the head over the center of the neck, the entire spine and pelvis will twist, pulling one hip up and one leg with it. You are now walking around on one leg that is shorter than the other. This places more weight on one side of your body than another. The wear and tear on your entire body is exactly like driving a car that is out of alignment. The result can be muscle and joint pain anywhere in the body. Without correcting the problem, which originated with a single bone (Atlas) at the top of your neck moving out of position, your entire body is now imbalanced.

When this continues over time, something else starts to happen. Because nerve flow is disrupted or distorted, degeneration of cells in organs can occur, causing internal physical problems that may not show up for years.

“Is it painful to correct?”

Fortunately, no. The Upper Cervical Correction can be described as a slight pre-determined direction of pressure applied to the first bone (Atlas) or second bone (Axis) in the neck. Depending on the technique, it can feel like a brisk thrust, a light tap, or a massage on the side of the neck just below the earlobe. That’s where the atlas is. Sometimes this is accompanied by a loud pop or series of tiny ticks as the bone moves back into place. There is NO twisting of the neck. This correction is engineered to reposition the weight of the head (10 to 14 pounds) over the center of the body in order to restore body balance and restore brain to body communication. When the correction is made, muscles begin to relax, blood and oxygen circulation is increased, the brain is able to Communicate with the affected are, and the body’s natural healing process begins. The healing process continues as long as the body balance is maintained and the brain can communicate with all parts of the body.

 “Does it have to be corrected often?”

That depends on your own body. Some people can hold their correction for several months, even a year at a time. Others have to be corrected once or twice a week in the beginning, then one or twice a month. Everyone is different. The Upper Cervical doctor’s objective is to make as precise an Upper Cervical correction as possible. Then he/she must help you maintain the correction with as few corrections as possible so that you may live pain free and enjoy a better quality of life. Periodic Upper Cervical checkups, just like dental checkups and physicals, should be part of your personal preventive health care program. If you are maintaining your correction and body balance then your Upper Cervical chiropractor will not adjust you.

“I am concerned about radiation from the x-rays. Are they completely necessary?”

Yes, they are the cornerstone of the Upper Cervical doctor’s practice and are very specialized. Most chiropractic equipment today along with lead aprons keeps radiation down to a minimum. Plus, any minimal danger from radiation, in our opinion, cannot be compared to the destruction that is going on in your body every minute your atlas obstructs brain to body communication. Any shift the atlas makes can cause multiple health problems. But sometimes that shift in position is no greater than the thickness of a fingernail. The Upper Cervical doctor has to rely on x-rays to determine the exact position your atlas/axis vertebrae have misaligned. The specific analysis of the x-rays will allow the doctor how to reposition your atlas to within a fraction of an inch back to the correct position it should be.

The UC doctor will make the correction only after an intensive analysis of how far out of position your atlas is. After correcting the atlas, either a second series of x-rays are taken or a post heat reading is utilized to determine if the adjustment was done correctly. These are referred to as pre and post x-rays and pre and post heat readings. The doctor will show you these “before and after” x-rays and/or heat readings so that you can see the difference the correction has made.

How soon should I get my children under this care?

As soon after birth as possible, and then have them checked periodically as they grow up. You could not possibly give your child a better gift than to make certain that the one organ of the body that controls all the other organs and body functions, the brainstem, is doing its job without interference from the tiny bone just below it.

 How much does it cost?

A fraction of what you have probably already spent in your quest to get well. There will be some expense at the beginning because of the x-rays that are so necessary. But our organization has asked that each doctor provide some type of payment plan that enables you and your family to get under care as soon as possible. Because insurance does not distinguish between one form of chiropractic or another, if you have insurance that covers chiropractic, it should cover Upper Cervical as well. Unfortunately, some HMO’s and PPO’s only have certain chiropractors on their list of providers and you have to go to them. Most of these, though equally well trained in other chiropractic procedures, may not be trained in precision Upper Cervical chiropractic.

**** For many customers they have no insurance when they start Upper Cervical care, but the concept made enough sense to risk it. Plus, it cost no more than other forms of chiropractic care. It turned out to be the best investment of their lives.

What is the Blair Technique?

The Blair chiropractic technique is a specific system of analyzing and adjusting the upper cervical vertebrae of the spinal column. When these vertebrae misalign in such a way as to interfere with the brain stem and spinal cord as they exit through the floor of the skull and into the neural canal. Special attention is given to the first two cervical vertebrae, the atlas and axis, as they are the most freely moveable vertebrae in the spinal column and the ones most commonly misaligned.

After many years of research and study of all the techniques that were developing at the time, Dr. B.J. Palmer the developer of chiropractic realized that the only place a person could truly have interference to the nervous system was at the level of the base of the skull; and the atlas and axis vertebrae. There are no intervertebral discs between the skull and the atlas, or between the atlas and axis vertebrae. Most movement of the head and neck occur at this level. The joint surfaces in this area move more on a horizontal plane rather than a vertical plane as in the rest of the spine. This area is not supplied with the abundance of supporting ligaments that are found in the rest of the spine. As a result of these characteristics of the cervical spine, it becomes the weakest link in the chain when exposed to the forces of trauma such as the birth process, falls, auto accidents, stress etc.

Dr. Palmer conducted studies in Germany on cadavers and found that the brain stem or medulla, extended into the neural canal down to the level of the lamina of the second cervical vertebrae, at which point it becomes the spinal cord extending downward. The brain stem has been referred to as "Houston Control". It is the area where nerve cell centers are located that control many of the major functions of the body such as heart beat, respiration, digestion, elimination, our heating and cooling mechanism, constriction and dilation of the veins and arteries, muscle coordination, etc. Most of the functions of the body that we don't have to consciously think about are controlled at the brain stem level.

The brain stem at the level of the atlas vertebrae consists of approximately ten billion nerve fibers sending messages through the spinal cord to the cells of the body and from the cells back to the brain. These nerve fibers are arranged in small bundles called nerve tracts. These nerve tracts are either sensory or motor. The sensory nerves allow us function of the organs and systems while moving the body about it's environment, via the musculoskeletal system. Gray's Anatomy states, "the nervous system is the master system of the body controlling and coordinating all the functions of the body and relating the individual to his environment."

The atlas and axis are the only vertebrae in proximity to the brain stem. When they misalign to the extent that they put pressure on the brain stem and or spinal cord they interfere with the vital messages being sent to and from the brain to all parts of the body. If for example the atlas is impinged against the part of the cord that sends messages to the left hand, that individual may experience a numbness, burning or tingling sensation in that hand. If the nerve tracts at the brain stem level go to the heart are being impinged that individual may experience high blood pressure, palpitations or an irregular heartbeat. Any part of the body can be effected when there is pressure on the brain stem or spinal cord because almost all of the nerves have to pass through this area before reaching the part of the body they innervate.

When a vertebrae misaligns to the extent that it interferes with nerve tissue and reduces the mental impulses it is termed a subluxation. A subluxation may be present for months or years before producing any outward signs such as pain or symptoms, causing the body to break down to a state of diseases

The purpose of the Blair Chiropractic technique is not to diagnose or treat diseases or conditions, but to analyze and correct vertebral subluxations in an accurate, precise and specific manner to allow the body's intelligence, (see chiropractic philosophy) to mend, repair and maintain health from within.

The Blair technique utilizes neurological tests, heat sensitive instrumentation and other means for detecting when the vertebral subluxation is present or absent. The adjustment is administered only when nerve pressure is present. The Blair technique utilizes precise x-rays of the upper cervical area to determine which way the vertebrae has misaligned so that a precise and specific adjustment may be tailored and administered to that individual.

HISTORY OF CHIROPRACTIC

The principles and philosophies which form the foundation of modern chiropractic can be traced back to the late 1800’s to a man by the name of David Daniel (D.D.) Palmer and later his son Bartlett Joshua (B.J.) Palmer. In fact, according to Terry A. Rondberg, D.C (see note), there is “evidence of spinal manipulation discovered in prehistoric cave paintings” and as practised by the ancient Chinese and Greeks and “In Rome, Claudius Galen realigned the neck vertebrae of a Roman scholar whose right hand was paralyzed. After the realignment the scholar could use his hand again.”

DD Palmer was the pioneer of the ‘specific’ spinal adjustment, and probably his most famous adjustment was the one he delivered to Harvey Lillard on September 8th, 1895. Harvey had become deaf 17 years earlier when he felt “something give in his neck”. DD Palmer discovered an out of place vertebra in his neck and proceeded to ‘adjust’ it back to its normal position by using “the spinous process as a lever”. It was soon after that Harvey’s hearing returned to normal. It does not surprise me that hearing is affected by misalignments of the spine, for hearing complaints are common amongst people with spinal malalignment. Certainly tinnitus and hearing difficulties were amongst my first symptoms following my injury and they are common in whiplash victims.

It was B.J. Palmer who really established and developed chiropractic, and worked tirelessly to promote and communicate the benefits of chiropractic. The original Palmer Cure & Infirmary Clinic in Davenport, Iowa opened by DD Palmer would be left in the hands of B.J. after another falling out with his father, who moved to Oregon and then California and opened chiropractic clinics, B.J. continued to foster chiropractic. Palmer College of Chiropractic in Iowa and a flourishing worldwide chiropractic profession are a tribute to his devotion and perseverance.

Note: For more information on chiropractic and a truly wonderful summary of the history of chiropractic and its philosophy I commend to you the following reference. Rondberg, Terry A., DC (1996) Chiropractic First, USA, The Chiropractic Journal.

About Dr. Blair Dr. William G. Blair Chiropractor, Research Scientist, Husband Background: William George Blair was born in Pemeta, Oklahoma on July 30, 1922. He attended elementary, Junior and Senior High School, graduating in 1940 in the top 10% of his class in spite of considerable absences for health reasons. He had been diagnosed with bronchial asthma at the age of 9 months. His parents tried every method of healing sources including chiropractic with no results.

After graduation, he attended Oklahoma A&M College for 2 years. At this time he was told he must go to a more favorable climate for his health. He chose to go to Lubbock Texas because of relatives living there. No real improvement was shown so he moved to Albuquerque and finally to El Paso. In El Paso he met his wife and was married on July 20, 1946. It was his wife that introduced him to upper cervical chiropractic. He had never had upper cervical chiropractic before. His wife’s mother had been a close friend of a chiropractor practicing in Houston, TX. Her friend was a full spine doctor but recommended that Bill go to Dr. Leon Halsted in El Paso, since he was a Palmer graduate and did upper cervical work that she thought would help Bill the most. Bill decided to go to Dr. Halsted. He was X-rayed, adjusted, told what to expect and sent home. His results were almost immediately good, he had less trouble breathing and he just generally felt better.

This change made him so enthusiastic that he wanted to help others as he had been helped. Since he had been primarily a salesman, a career that he didn’t relish, he wanted to immediately go to school to become a chiropractor. So he packed up his family and they moved to Davenport, Iowa.

After he graduated from Palmer, he moved back to Lubbock, a city that he liked and wanted to live in. Dr. Blair rented a small building and converted it into an office in front with a small apartment in the back. His practice started in December 1949 and began to grow beyond his wildest dreams.

It did not take very long before he realized to began to think that something was missing. He had done extensive study on X-rays to make sure he understood the theoretical, structural and mechanical relationships of the spine. Being a perfectionist, he wanted to make perfect X-rays, give totally correct adjustments and have the best results possible. Therefore when one patient did much better than another, he studied their X-rays, their neurocalgraph readings, and their adjustments, trying to learn what he could do to make the other patients results more satisfactory. His patients noticed his dedication to perfection. He did his best to make sure the steps he took to make sure his adjustment was the correct one and that it was very carefully given to assure the best he could do. Dr. Blair noticed that some patients seemed to miraculously improve while others had only mediocre results yet he had done everything in the best most careful and specific way that he could.

So in May 1951, Dr. Blair began to research and study the X-rays of his very successful patients and compare them with the not so successful cases. He studied them form every angle that he could think of and slowly a pattern began to develop. Getting a patient in alignment correctly as taught by Palmer was important but he began to notice that the information gained from these X-rays could be correct one time and obviously inaccurate at other times. What was the difference ? This took time and lots of study before Dr. Blair came up with the conclusion that there could be a malformation ! We don’t look alike on the outside so why should we be identical on the inside ??

Dr. Blair began making stereoscopic views - A.P. Open Mouth, Nasium and Base Posterior together with the usual flat views. With all of these views he could then determine whether malformation existed or not. He studied all bone specimens he could find-Palmer’s Osteological collection, Dr. L.G.Fraser’s work on anatomical measurements, any real bone specimen that he could find. This study finally came to the end result- that malformation is the rule and not the exception . This was a revelation!

Here Dr. Blair realized that just placing a patient in front of a film will produce a cervical X-ray, but will it produce a precisionally, correctly, aligned view for that patient? In order to do that, he knew the patient had to be placed in his habitual head carriage and posture to determine the absolute position of the patient for the spinograph.

This took many ideas, many hours of studying X-rays, new ways to make X-rays, new methods of positioning and on and on with every conceivable idea that came to his mind. Through these studies, Dr. Blair developed a new method of positioning the patient. The films made from both systems were impossible to tell one from the other, yet they could each reveal different alignment information. This showed that one could lead to wrong or ineffective adjustment while the other could lead to a more effective and correct adjustment.

After realizing the malformations of patients, learning to place them in their habitual head carriage for the spinograph, made Dr. Blair aware that a definition of this finding must be designed. Ten long months later, he developed the "Blair Principle of Occipital-Alanto Misalignment" Although the principle is relatively simple, it took this length of time for observing the overlapping, underlapping phenomenon before Dr. Blair could recognize and put into words the mechanical principle it revealed.

This understanding of the malformation and the ability to see them in spinographs led Dr. Blair to the knowledge that there had to be developed a way of adjusting that would compensate for these malformations. Again, many hours were spent in thinking, practicing, and finally developing the adjustments that he thought would be the best for the new type of misalignment that he had come up with. Since Dr. Blair had always strived for perfection, here he began to emphasize that perfection was the key to making the most accurate X-rays and giving the most accurate adjustment. Dr. Blair knew that achieving the most accurate spinographs and giving the most accurate adjustment would require a dedication far above what most chiropractors want to give. It takes extra time, extra study, extra diligence, and an unrelenting desire to accomplish a goal of perfection in your spinographs and adjustments. Working with this diligence will eventually make it possible for a chiropractor to achieve excellent if not outstanding results. This chiropractor will eventually find that he will be able to make the spinographs and give the adjustment with confidence and ease. Genuine skill comes from practice, concentrated effort, and always working toward accuracy. In time, this process will become second nature.

Dr. Blair made a commencement address to a graduating class at Palmer in which he outlined 4 points for the students to strive for Chiropractically speaking following are these 4 points :

1. Develop your skill. This is a never ending process. In skill it is the small details that count. The more specific contact, the precisely calculated line of drive, correct placement for adjustment, precision and detail in your spinograph. Put that extra something in all that you do and you will be separated from the mediocre and become the special.
2. Augment and utilize your chiropractic knowledge. This means keep up with advancements and new breakthroughs that have been brought about through research. Stay abreast of new developments - each year should make you more competent that the year before. No man remains static, he is either advancing or slipping backwards.
3. Visualize your objectives. Doing this will make you more dedicated to your practice, your patients and your competency in delivering the best service you can do, even if you have to spend a little more time at the office. If you do this, you can probably achieve a more lucrative practice and a future that looks very bright in every way.
4. Express yourself Chiropractically. Give chiropractic answers to health questions. Practice the art and science of correcting vertebral misalignment. After your patient has regained health, help him to maintain it. Chiropractic’s is a health science not a disease science. Stay strictly in your field.

An easy way to remember these points is D-A-V-E

D-Develop your skills,
A-Add to and utilize your chiropractic knowledge,
V-Visualize objectives and
E-Express yourself Chiropractically.

There is a verse in the Bible- Chapter 9, Verse 6 in II Corinthians which says "He which soweth sparingly, shall reap also sparingly, and he which soweth bountifully, shall reap bountifully" by changing a few words, we can make this revealing verse read - "He which soweth competence and precision will reap outstanding results, and he which soweth carelessness and inaccuracy will reap guilt and mediocre results.

Acute back pain - Back pain that lasts a short while, usually a few days to several weeks. Episodes lasting longer than three months are not considered acute.

Adjustment - The specific application of forces used to facilitate the body’s correction of nerve interference.

Atlas - Topmost vertebra of the neck and supports your head. Misalignment of the atlas can place stress on your neuromusculoskeletal system.

Axis - Another name for the second cervical vertebra, which is located in your neck. This is an important joint that contributes significantly to your neck's range of motion.

"Big Idea" - The chiropractic concept that the body heals itself when interference to the proper functioning of the nervous system is removed.

Biomechanics - The body's mechanics, such as how muscles, bones, tendons and ligaments work to produce movement.

Cavitation - Pop that occurs in a spinal joint when vertebral surfaces (facets) are separated to create a vacuum that pulls in nitrogen gas.

Cervical spine - The area of your spine containing the seven vertebrae that compose the neck.

Chiropractic - A primary health care profession in which professional responsibility and authority are focused on the anatomy of the spine and immediate articulation, and the condition of nerve interference. It is also a practice, which encompasses educating, advising about and addressing nerve interference.

Chronic back pain - Back pain episode that lasts more than three months.

Coccyx - Commonly called the tailbone, the coccyx is composed of four separate but fused vertebrae that make up the bottom of your spine.

Cox flexion-distraction technique - Method of applying manually controlled distraction or stretching to specific spinal segments with the assistance of a movable table.

DC - Abbreviation for "doctor of chiropractic."

Diagnosis - A comprehensive process of evaluation of the spinal column and its immediate articulation to determine the presence of nerve interference and other conditions that may contraindicate chiropractic procedures.

Dynamic thrust - Chiropractic adjustment delivered suddenly and forcefully to move vertebrae, often resulting in a popping sound.

Flexion-distraction technique - Useful method of stretching the spine in a face down position on a table that allows manually applied flexion and traction to be applied to specific spinal segments.

Full-spine technique - Method of adjusting or manipulating any of the vertebrae from the neck down.

Innate Intelligence - The alleged inborn ability of the body to heal itself, which many chiropractors believe is enhanced by spinal adjustments.

Intervertebral disk - The tough cartilage that serves as a cushion between two vertebrae. Each disk has a gelatinous-like center (nucleus pulposus) that may protrude to form a disk herniation.

Joint - A meeting point of two or more bones in your body that functions like a door hinge. Joints, like hinges, sometimes get stuck, or subluxated.

Ligament - Tissue that bonds bone to bone. Ligaments are strong and provide excellent support, which is especially important in joints like your ankle.

Listing - Abbreviated description of the position or movement of a "subluxated" vertebra. Many techniques have their own listing system.

Locked spinal joint - Sudden binding that occurs when two joint surfaces are shifted out of their normal alignment by an awkward movement that triggers muscle spasm. The result may also be called an "acute locked back."

Long-lever manipulation - Method of spinal manipulation in which a general technique is used to stretch or loosen several vertebrae at a time.

Lumbar vertebrae - The five bones in the lower-back portion of the spine.

Lumbosacral strain - Strain or injury of joints or ligaments at the base of the spine where the last lumbar vertebra (L5) is connected to the sacrum. Strain or disk degeneration in this area is probably the most common cause of low-back pain.

Maintenance care - Subluxation-based program of periodic spinal examinations and "adjustments" to help maintain the patient's health. Also called "preventive maintenance" or "preventative maintenance."

Manipulation - The forceful passive movement of a joint beyond its active limit of motion. It does not imply the use of precision, specificity or the correction of nerve interference. Therefore, it is not synonymous with chiropractic adjustment.

Mobilization - Method of manipulation, movement, or stretching to increase range of motion in muscles and joints that does not involve a high-velocity thrust.

Motion palpation - Useful method of locating fixations and loss of mobility in the spine by feeling the motion of specific spinal segments as the patient moves.

Muscle - Contractile tissue that allows body parts to move.

Musculoskeletal - Referring to structures involving tendons, muscles, ligaments, and joints.

Nerve root - One of the two nerve bundles emerging from the spinal cord that join to form a segmental spinal

Neuromusculoskeletal system - A broad term referring to the neurological system, including the brain, spinal cord and nerves, the muscle system, which includes muscles, ligaments, tendons and connective tissues, and the skeletal system, which includes bones of the skull, spine and limbs.

Nimmo method - Technique that uses digital pressure on trigger points to relax muscles said to be pulling vertebrae out of alignment.

Nonforce techniques - Various reflex techniques and muscle-treatment methods that do not involve forceful manipulation.

PI - Abbreviation for "personal injury." Used in the phrases "PI practice" and "PI seminar," which focus on patients with occupational or auto injuries.

Practice Objective - The professional practice objective of chiropractic is to correct nerve interference in a safe, effective manner. The correction is not considered to be a specific cure for any particular symptom or disease. It is applicable to any patient who exhibits nerve interference regardless of the presence or absence of symptoms or disease.

Sacroiliac joint - The joint between the sacrum and the ilium, which is a flat bone that helps compose your pelvis.

Sacrum - The triangular bone that serves as a base for the spinal column and connects the pelvic bones.

Short-lever manipulation - A method of spinal manipulation in which contact is made on a vertebral process to move a single vertebra.

SMT - An abbreviation for "spinal manipulative therapy."

Spinal adjustment - A chiropractic term that most chiropractors use to describe whatever method(s) they use to correct spinal problems, whether by hand or with an instrument. Some equate the terms "adjustment" and "manipulation."

Spinal manipulation - A forceful, high-velocity thrust that stretches a joint beyond its passive range of movement in order to increase its mobility. Manipulation is usually accompanied by an audible pop or click.

Spine - Your spine supports your body and protects the delicate spinal cord and nerves. It comprises 33 vertebrae, grouped into different categories based on location and anatomy. These locations are the cervical, thoracic, lumbar, sacral and coccygeal regions.

Straight chiropractor - Chiropractors who tend to cling to chiropractic's original doctrine that most health problems are caused by misaligned spinal bones ("vertebral subluxations") and are correctable by manual manipulation of the spine.

Subluxation - The medical definition is incomplete or partial dislocation -- a condition, visible on x-ray films, in which the bony surfaces of a joint no longer face each other exactly but remain partially aligned.

Thompson terminal point technique - A chiropractic adjustment performed on a table in which the supporting cushions drop an inch or two when a thrust is applied to the spine. Practitioners locate "subluxations" by checking leg lengths with the legs straight, the knees bent, or the head turned to either side.

Thoracic vertebrae - There are twelve vertebrae in the thoracic or upper-back portion of the spine.

Toggle recoil technique - Manipulation performed with a sudden shallow thrust (toggle) followed by quick withdrawal (recoil) of the chiropractor's hands while the patient is relaxed.

Upper cervical specific - Technique that uses a number of specific chiropractic adjustments designed to correct atlas and upper cervical subluxations.

Vertebra - Bony segment of the spine that encircles and helps protect the spinal cord and nerves. The plural of vertebra is vertebrae.

Vertebral subluxation complex - A "modern" chiropractic term for the chiropractic subluxation.

Vertebral Subluxation - Also referred to as nerve interference, is a misalignment of one or more of the 24 vertebrae in the spinal column, which causes alteration of nerve function and interference to the transmission of mental impulses, resulting in a lessening of the body’s innate ability to express its maximum health potential.

Vitalism - The concept that the functions of an organism are due to a "vital principle" or "life force" distinct from the physical forces explainable by the laws of physics and chemistry. Chiropractors refer to that force as "Innate Intelligence."

Orange County is a county in Southern California, United States. Its county seat is Santa Ana. According to the 2000 Census, its population was 2,846,289, making it the second most populous county in the state of California, and the fifth most populous in the United States. The state of California estimates its population as of 2007 to be 3,098,121 people, dropping its rank to third, behind San Diego County. Thirty-four incorporated cities are located in Orange County; the newest is Aliso Viejo.

Unlike many other large centers of population in the United States, Orange County uses its county name as its source of identification whereas other places in the country are identified by the large city that is closest to them. This is because there is no defined center to Orange County like there is in other areas which have one distinct large city. Five Orange County cities have populations exceeding 170,000 while no cities in the county have populations surpassing 360,000. Seven of these cities are among the 200 largest cities in the United States.

Orange County is also famous as a tourist destination, as the county is home to such attractions as Disneyland and Knott's Berry Farm, as well as sandy beaches for swimming and surfing, yacht harbors for sailing and pleasure boating, and extensive area devoted to parks and open space for golf, tennis, hiking, kayaking, cycling, skateboarding, and other outdoor recreation. It is at the center of Southern California's Tech Coast, with Irvine being the primary business hub.

The average price of a home in Orange County is $541,000. Orange County is the home of a vast number of major industries and service organizations. As an integral part of the second largest market in America, this highly diversified region has become a Mecca for talented individuals in virtually every field imaginable. Indeed the colorful pageant of human history continues to unfold here; for perhaps in no other place on earth is there an environment more conducive to innovative thinking, creativity and growth than this exciting, sun bathed valley stretching between the mountains and the sea in Orange County.

Orange County was Created March 11 1889, from part of Los Angeles County, and, according to tradition, so named because of the flourishing orange culture. Orange, however, was and is a commonplace name in the United States, used originally in honor of the Prince of Orange, son-in-law of King George II of England.

Incorporated: March 11, 1889 Legislative Districts: * Congressional: 38th-40th, 42nd & 43 * California Senate: 31st-33rd, 35th & 37 * California Assembly: 58th, 64th, 67th, 69th, 72nd & 74 County Seat: Santa Ana County Information: Robert E. Thomas Hall of Administration 10 Civic Center Plaza, 3rd Floor, Santa Ana 92701 Telephone: (714)834-2345 Fax: (714)834-3098 County Government Website: http://www.oc.ca.gov

Chiropractic

Chiropractic is a health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, with special emphasis on the spine, under the hypothesis that these disorders affect general health via the nervous system. Chiropractic is generally considered to be complementary and alternative medicine, a characterization many chiropractors reject. Chiropractic treatment emphasizes manual therapy including spinal manipulation and other joint and soft tissue manipulation, and includes exercises and health and lifestyle counseling. Traditionally, it assumes that a vertebral subluxation or spinal joint dysfunction can interfere with the body's function and its innate ability to heal itself.

D. D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century. It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture. Chiropractic is well established in the U.S., Canada and Australia.

For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are considered significant barriers to scientific progress within chiropractic. Vaccination remains controversial among chiropractors. In recent decades chiropractic has gained more legitimacy and greater acceptance among medical physicians and health plans and has had a strong political base and sustained demand for services,] and evidence-based medicine has been used to review research studies and generate practice guidelines. Opinions differ as to the efficacy of chiropractic treatment and the efficacy and cost-effectiveness of maintenance chiropractic care are unknown. Although spinal manipulation can have serious complications in rare cases, chiropractic care is generally safe when employed skillfully and appropriately.

Philosophy

Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism. A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;18] a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.

Although a wide diversity of ideas currently exists among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Chiropractors study the biomechanics, structure and function of the spine, along with what they say are its effects on the musculoskeletal and nervous systems and its role in health and disease.

Chiropractic philosophy includes the following perspectives:

Schools of thought and practice styles

Chiropractic is often described as two professions in one. Unlike the distinction between podiatry (a science-based profession for foot disorders) and foot reflexology (an unscientific philosophy which posits that many disorders arise from the feet), in chiropractic the two professions attempt to live under one roof. Significant differences exist amongst the practice styles, claims and beliefs between various chiropractors.

Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an "Innate Intelligence" within the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies. Their philosophy and explanations are metaphysical in nature and prefer to use traditional chiropractic lexicon (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care.

Mixer chiropractors "mix" diagnostic and treatment approaches from osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and they incorporate mainstream medical diagnostics and employ many treatments including conventional techniques of physical therapy such as exercise, massage, ice packs, and moist heat, along with nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback. Mixers tend to be open to mainstream medicine, and are the majority group.

Vertebral subluxation

Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn (innate) ability to heal itself. D.D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. D.D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic. This concept was later expanded upon by his son, B.J. Palmer and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. In 1910, D.D. Palmer theorized that the nervous system controlled health:

"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality—too much or not enough action—which is disease."

The concept of subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades. In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community. This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer College of Chiropractic) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions. A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of disorders of internal organs (such as the heart, the lungs, or the stomach) that subluxation significantly contributes to, the mean response was 62%. In 2005, subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity." This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays

Scope of practice

Chiropractors, also known as doctors of chiropractic or chiropractic physicians in many jurisdictions, emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery, with special emphasis on the spine.1] Chiropractic combines aspects from mainstream and alternative medicine: although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry. It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems, but the more expansive view of chiropractic is still widespread. Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM); however, a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.

The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation. A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle counselling.

Chiropractors cannot write medical prescriptions or perform major surgery. In the U.S. their scope of practice varies by state in areas such as conducting laboratory tests or diagnostic procedures, dispensing dietary supplements, and using other therapies such as homeopathy and acupuncture; in the state of Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs. A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in a few U.S. states, but is not recognized by the American Chiropractic Association as being chiropractic.

Spine care is offered by several other professions, including massage therapists, osteopaths, and physical therapists. No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Some U.S. states prohibit physical therapists from performing SM, some states allow them to do it only if they have completed chiropractic training, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.

Treatment techniques

Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care; in the U.S., chiropractors perform over 90% of all manipulative treatments. Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint; its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues; in chiropractic care SMT most commonly takes the form of spinal manipulation.

There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools. The following adjustive procedures were received by more than 20% of patients of licensed U.S. chiropractors in a 2003 survey: Diversified technique (full-spine manipulation), extremity adjusting, Activator technique (which uses a spring loaded tool to deliver precise adjustments to the spine), Thompson Technique, Gonstead (which looks at the whole spine with the philosophy that a vertebral misalignment may affect other areas of the spine, emphasizing the mechanical aspects of the spine), Cox/flexion-distraction (a gentle, non-force adjusting procedure which mixes chiropractic principles with osteopathic principles and utilizes specialized adjusting tables with movable parts), adjustive instrument, Sacro-Occipital Technique (which models the spine as a torsion bar), Nimmo Receptor-Tonus Technique, and Applied Kinesiology (which emphasises "muscle testing" as a diagnostic tool). Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist.

Many other treatment forms are used by chiropractors for treating the spine, other joints and tissues, and general health issues. The following procedures were received by more than 1/3 of patients of licensed U.S. chiropractors in a 2003 survey: Diversified technique (full-spine manipulation; mentioned in previous paragraph), physical fitness/exercise promotion, corrective or therapeutic exercise, ergonomic/postural advice, self-care strategies, activities of daily living, changing risky/unhealthy behaviors, nutritional/dietary recommendations, relaxation/stress reduction recommendations, ice pack/cryotherapy, extremity adjusting (also mentioned in previous paragraph), trigger point therapy, and disease prevention/early screening advice.

Education, licensing, and regulation

Chiropractors obtain a first professional degree in the field of chiropractic. The U.S. and Canada require a minimum 90 semester hours of undergraduate education as a prerequisite for chiropractic school, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program. The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.

Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.49]50] Depending on the location, continuing education may be required to renew these licenses. Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries. In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK. CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally. Today, there are 18 accredited Doctor of Chiropractic programs in the U.S., in Canada, in Australasia, and 4 in Europe. All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges. Chiropractic education in the U.S. is divided into straight or mixer educational curricula depending on the philosophy of the institution.

Regulatory colleges and chiropractic boards in the U.S., Canada, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. There are an estimated 53,000 chiropractors in the U.S. (2006), in Canada (2006), 2500 in Australia (2000) and 1,500 in the UK (2000).

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).

Utilization, satisfaction rates, and third party coverage

In the U.S., chiropractic is the largest alternative medical profession, and is the third largest doctored profession, behind medicine and dentistry. The percentage of population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada,69] with a global high of 20% in Alberta. The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints; most do so specifically for low back pain. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention. Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of persons satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.

Chiropractic does not have the same level of mainstream credibility as other healthcare professions. Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in a 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for other professions ranged from 62% for dentists to 84% for nurses.

Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient. The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate. Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.

In the U.S., most insurances cover chiropractic. In Canada, there is lack of coverage under the universal public health insurance system. In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.

History

Chiropractic was founded in the 1890s by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease. Although initially keeping the theory a family secret, in 1898 he began teaching it to a few students at his new Palmer School of Chiropractic. One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment. Prosecutions and incarcerations of chiropractors for practicing medicine without a license grew common, and to defend against medical statutes B.J. argued that chiropractic was separate and distinct from medicine, asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease. Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence, a vital nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions. D.D. and B.J. both seriously considered declaring chiropractic a religion, which might have provided legal protection under the U.S. constitution, but decided against it partly to avoid confusion with Christian Science. Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, among which they included the American Medical Association (AMA).
B.J. Palmer

Although D.D. and B.J. were "straight" and disdained the use of instruments, some early chiropractors, whom B.J. scornfully called "mixers", advocated use of instruments. In 1910 B.J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students. The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J.'s promotion of the neurocalometer, a new temperature-sensing device, was another sign of chiropractic's gradual acceptance of medical technology, although it was highly controversial among B.J.'s fellow straights. Despite heavy opposition by organized medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S.6] The longstanding feud between chiropractors and medical doctors continued for decades. Until 1983, the AMA labeled chiropractic "an unscientific cult" and held that it was unethical for medical doctors to associate with an "unscientific practitioner". This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.

Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. In recent decades chiropractic gained legitimacy and greater acceptance by medical physicians and health plans, and enjoyed a strong political base and sustained demand for services. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.

Evidence basis

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be antiscientific reasoning and unsubstantiated claims, that have been called ethically suspect when they let practitioners maintain their beliefs to patients' detriment. A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills. Evidence-based chiropractors possess the ability to apply research in practice. Continued education enhances the scientific knowledge of the practitioner.

Effectiveness

Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness. Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree,85] and they are typically of low quality. Health claims made by chiropractors about using manipulation for pediatric health conditions are supported by only low levels of scientific evidence. Although a 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference,88] a 2008 supportive review found serious flaws in the critical approach, and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments. Most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM. A 2002 review of randomized clinical trials of SM was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular; however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it.

There is a wide range of ways to measure treatment outcomes. Chiropractic care, like all medical treatment, benefits from the placebo response. It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. The efficacy of maintenance care in chiropractic is unknown.

Available evidence covers the following conditions:

Safety

Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis. Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.

Spinal manipulation is associated with frequent, mild and temporary adverse effects, including new or worsening pain or stiffness in the affected region. They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours. Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. The incidence of these complications is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern. Several case reports show temporal associations between interventions and potentially serious complications. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.

Chiropractors sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation; practice guidelines aim to reduce unnecessary radiation exposure, which causes cancer in proportion to the amount of radiation received.

Cost-effectiveness

A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings. A 2006 UK systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation compares favorably with other treatments for back pain, but that reports are based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain. A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention. The cost-effectiveness of maintenance chiropractic care is unknown.

Vaccination

Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective forms of prevention against infectious disease. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous, ineffective, and unnecessary. Some chiropractors have embraced vaccination, but a significant portion of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.129] A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that seniors opposed vaccination more strongly than freshmen, with 29.4% of fourth-year students opposing vaccination.

Osteopathic manipulative medicine

Osteopathic Manipulative Medicine (abbreviated as OMM) is an approach to manual therapy, form of therapy that uses physical contact, used to improve the impaired or altered function of the musculo-skeletal system (somatic dysfunction). With roots in ancient Greek "frictions," manual manipulation has long been a part of health care. Today's OMM was first practiced by Andrew Taylor Still, M.D., the founder of modern osteopathic medicine. In the United States, its country of origin, OMM is used by Doctors of Osteopathic Medicine (D.O.s) along with surgery and medication in treatment of patients. Outside the United States, practitioners of osteopathy (who may have the qualification of D.O. as a Diploma of Osteopathy, but do not necessarily have the same medical training as American-trained D.O.s) generally limit their scope to manual manipulation.

There are different techniques applied to the musculoskeletal system as OMM. These techniques can be applied to the joints, their surrounding soft tissues, muscles and fasciae.

Also, OMM is a treatment that is intended to be used in conjunction with mainstream treatments where it is deemed appropriate. It is rarely used as a primary treatment regimen unless the D.O. is absolutely certain that the patient's problems are a result of a musculoskeletal somatic dysfunction. Furthermore, as with other medical treatment methodologies, there are certain situations where use of OMM is strictly contraindicated (for example, cervical spine HVLA techniques may never be used on patients with Down Syndrome).citation needed]

While this OMM practice is traditionally ascribed to D.O.'s, it should also be noted that there are M.D. practitioners of OMM since many Osteopathic medical schools have created training programs for their M.D. counterparts. Recently OMM training programs have likewise been extended to other medical professionals including, but not limited to: Physician Assistants, Nurse Practitioners, Nurses, etc.

Some techniques used in OMM are:

* Balanced ligamentous tension (BLT)
* Counterstrain
* Cranial osteopathy
* High Velocity Low Amplitude Thrust (HVLAT)
* Joint mobilization - articulatory techniques
* Lymphatic Pump
* Muscle Energy Technique (MET)
* Myofascial Release
* Neuromuscular therapy, trigger point therapy or myodysneuric point therapy
* Soft Tissue Technique
* Visceral manipulation

It is probably the comprehensive and eclectic style of OMM that distinguishes it most from that employed by most other manual therapists. The immediate goal of musculoskeletal manipulation is to restore maximal, pain-free movement of the musculoskeletal system in postural balance.

Effectiveness

The Cochrane Library has systematically reviewed evidence on the effectiveness of spinal manipulation for a number of conditions. The conclusions are summarised in the table below. Note that in many cases the manipulation was carried out by chiropractors or osteopaths rather than by osteopathic doctors.