CHASSE CHIROPRACTIC INFO-SITE
GENERAL QUESTIONS AND ANSWERS
This page was last updated on June 18, 2000
WHAT IS CHIROPRACTIC? IS CHIROPRACTIC TREATMENT DANGEROUS? WHAT HAPPENS DURING A TREATMENT? FACTS ABOUT CHIROPRACTORS WHAT RESULTS CAN I EXPECT FROM A TREATMENT? BECOMING A CHIROPRACTORWhat is Chiropractic?
Chiropractic is a healing discipline firmly grounded in science. Although its main focus is the relationship between the skeleton (particularly the spine) and the nervous system that runs through it, chiropractic is concerned with the care of the entire body. Chiropractors use various diagnostic methods, including x-rays, to discover the state of your health, paying particular attention to your spine and bone structure. Spinal manipulation and other manual adjustments are their primary methods of helping your body heal itself.The word chiropractic comes from a combination of the Greek words "choir" and "praktikis", meaning "done by hand".
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How Safe is Chiropractic?
Very safe. Chiropractic adjustment has been rigorously examined for safety, and its record is an enviable one. Six government inquiries into chiropractic worldwide in the last 25 years, for example, have all concluded that contemporary chiropractic health care is safe, effective and cost-efficient, leading them to recommend licensure and government funding.The thing to remember is that your chiropractor is trained to recognize when you may be at risk, and adapt the treatment accordingly. Communication with patients is a key element of chiropractic treatment, so ask questions. Your chiropractic doctor will keep you informed every step of the way.
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What Happens During a Treatment?
During your first visit, the chiropractor will want to know about your health history as well as your current complaint. Your home and work life and level of physical activity may also affect your health, so don't be surprised to be asked questions about these too.Although chiropractors use their hands for most treatments, they also use other methods such as heat, light, specialized adjustment instruments, ultrasound, electrotherapy, personalized exercise programs, muscle testing and balancing. Your chiropractor can also give you information and guidance on how you can stay healthy through proper nutrition, exercise and lifestyle changes.
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What Results Can I Expect From a Treatment?
That depends on your condition. The length of time you have had the problem, your age and the degree of your disability all affect the length of your treatment. Your chiropractic doctor should tell you the extent of treatment recommended, and how long you can expect it to last.One of the main reasons people like chiropractic is that they often get quick results. Individual cases vary and chronic conditions obviously need more treatment. Workers' Compensation Board studies show, for example, that people with low back pain get back to work much faster with chiropractic care.
You might also consider the benefits of regular chiropractic adjustments even when you feel healthy. Sometimes you won't know you have a disorder of the neuro-musculo-skeletal system until it becomes acute and painful. So, just as you see your dentist to have your teeth checked and your optometrist for eye exams, regular visits to your chiropractor can catch related health conditions early, often preventing them from developing into major problems. Remember, your spine is every bit as susceptible to wear and tear as your teeth and your eyes-you need to look after it.
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Facts About Chiropractic
Your chiropractor knows the structural integrity of your skeleton, how well it is working, how it makes you feel and how it affects your quality of life.Chiropractic's approach to health uses the body's natural powers of healing, and does not employ drugs or surgery.
Chiropractic pioneered the holistic approach to health care, continuing this philosophy through its practices in the areas of nutrition, exercise and lifestyle counselling.
Chiropractic is Maine's third largest primary contact health care profession, and the largest to use drugless treatments.
The scientific basis of chiropractic has been, and continues to be, demonstrated by quality research and scientific investigation.
The chiropractic profession celebrated its centennial in 1995. Over the past 100 years, public acceptance of chiropractic has grown continuously, and today Chiropractic treats close to 1/4th of the population every year.
Chiropractors undergo a lengthy and intensive professional education, which is described in detail in the "Becoming A Chiropractor" section.
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Becoming a Chiropractor
CHIROPRACTIC TRAININGIan D. Coulter, PhD; Alan H. Adams, DC; Ruth Sandefur, DC, PhD
A. Chiropractic College Profile
In 1996, there were 16 colleges of chiropractic in the United States (Table 3). The geographic distribution of chiropractic educational institutions demonstrates concentrations in the Midwest and the West with five colleges in each region. Ten of the colleges were established prior to 1945, though they may have gone through several reorganizations or mergers before achieving their current name and status. The most recently established college in the U.S. is the University of Bridgeport College of Chiropractic in Connecticut.
Table 3. Chiropractic Colleges in the United States (1996)
WestMidwestSouthNortheastCleveland Chiropractic College Carl S. Cleveland, III, DC President 590 N. Vermont Avenue Los Angeles, CA 90004
Cleveland Chiropractic College Carl S. Cleveland, III, DC President 6401 Rockhill Road Kansas City, MO 64131
Life College Sid E. Williams, DC President 1269 Barclay Circle Marietta, GA 30060
New York Chiropractic College Kenneth W. Padgett, DC President PO Box 800 Seneca Falls, NY 13148
Life Chiropractic College West Gerard W. Clum, DC President 2005 Via Barrett San Lorenzo, CA 94580
Logan College of Chiropractic George A. Goodman, DC President PO Box 1065 Chesterfield, MO 63006
Parker College of Chiropractic James W. Parker, DC President 2500 Walnut Hill Lane Dallas, TX 75229
University of Bridgeport College of Chiropractic Frank A. Zolli, DC Dean Bridgeport, CT 06601
Los Angeles College of Chiropractic Reed B. Phillips, DC, PhD President 16200 E. Amber Valley Drive Whittier, CA 90609
National College of Chiropractic James F. Winterstein, DC President 200 East Roosevelt Road Lombard, IL 60148
Sherman College of Straight Chiropractic Thomas A. Geraldi, DC President PO Box 1452 Spartanburg, SC 29304
Palmer College of Chiropractic West Peter A. Martin, DC President 90 E. Tasman Drive San Jose, CA 95134
Northwestern College of Chiropractic John F. Allenburg, DC President 2501 W. 84th Street Bloomington, MN 55431
Texas Chiropractic College Shelby M. Elliott, DC President 5912 Spencer Highway Pasadena, TX 77505
Western States Chiropractic College William H. Dallas, DC President 2900 NE 132nd Avenue Portland, OR 97230
Palmer College of Chiropractic Virgil Strang, DC President 1000 Brady Street Davenport, IA 52803
Since 1974, standards for chiropractic education have been established and monitored by the Council on Chiropractic Education (CCE), a not-for-profit organization located in Scottsdale, Arizona (CCE, 1995). Recognized by the U.S. Department of Education as the specialized accrediting agency for chiropractic education, the CCE sets standards for the curriculum, faculty and staff, facilities, patient care, and research. One of the CCE's major functions is to assess chiropractic institutional effectiveness and outcomes. This involves a periodic cycle of accreditation where member institutions perform a self-study of their strengths, weaknesses, and educational outcomes as they relate to CCE Standards. A visitation team made up of educators and practitioners conduct a site visit to review compliance with CCE Standards and the institution's mission and goals. The visitation team to the CCE Commission on Accreditation generates a report. The Commission holds a hearing for the institution for further clarification and verification of information and then renders a decision. The maximum length of accreditation is 7 years. Member institutions file yearly reports of their activities as they relate to CCE Standards.
All 16 chiropractic educational institutions currently have accredited status with the CCE. Regional accrediting bodies such as the North Central Association of Schools and Colleges also accredit 13 of the colleges. Admissions requirements of chiropractic colleges are influenced by CCE Standards and chiropractic licensing board requirements. A minimum of 2 years of undergraduate education are required with successful completion of courses with a grade of "C" (a 2.5 grade point) or better in Biology, General Chemistry, Organic Chemistry, Physics, Psychology, English/Communication, and the Humanities (CCE, 1995). Each required science course must include laboratories. The cumulative grade point average must not be less than 2.25. The total college preprofessional credit units must be at least 60 semester units. Two colleges currently require 75 semester units and one requires 90 semester units. Four colleges will soon require a bachelor's degree for admission. Currently, six State Licensing Boards require a bachelor's degree in addition to the doctor of chiropractic degree for licensure (Federation of Chiropractic Licensing Boards, 1997).
The chiropractic college admissions process usually includes an application review, assessment of academic transcripts, letters of reference, and an interview. Currently, there is no standardized admissions test. At most chiropractic colleges a "rolling" admissions process is used with qualified applicants being admitted on an ongoing basis. The "typical" (median) successful applicant has completed more than 90 college credits with a "B- " (2.7) average (Coulter, submitted).
B. Chiropractic Students
Total enrollment in the United States chiropractic colleges in the fall of 1995 was 14,040. The mean enrollment per college was 878. Between 1990 and 1995 enrollment increased by 44 percent. During the same period the total number of graduates per year increased 13 percent, from 2,529 to 2,846 (CCE Report, 1996).
Wardwell described the characteristics of a chiropractic student in his comprehensive historical account of the chiropractic profession, Chiropractic: History and Evolution of a New Profession, published in 1992. Studies conducted more than 40 years ago found that students often pursued chiropractic as a second career. A 1978 study reported that chiropractic students are primarily from working and middle class backgrounds (Wardwell, 1992). A more recent study reported that the predominant reason students decided to pursue the DC degree was influence from a family member or friend who was a chiropractor (Kaynes, 1992). Secondary reasons were interest in health care and personal health interests. Wardwell concluded his profile of the chiropractic student by stating that today's students are most attracted to the profession of chiropractic by its holistic, drugless, and natural approach to health.
In an inventory of preadmission requirements comparing schools of medicine, dentistry, osteopathy, podiatry, chiropractic, and optometry (Doxey, 1997), chiropractic students scored the lowest of all professions evaluated on four outcome measures (minimum number of semester hours, completion of 4-year bachelor's degree, minimum GPA required on entrance, and average GPA of previous year's entering class). The study examined printed resources collected during 1995 from 17 medical schools, 16 chiropractic schools, 15 dental schools, 16 optometry schools, 16 osteopathic schools, and 7 podiatric schools. All of the included colleges were located in the United States and represented a broad geographic distribution. Table 4 compares the various professions in terms of entrance requirements. The authors were careful to note that although the data reflect differences among health care professions on a limited number of entrance criteria, they do not explain the causes of the differences nor do they offer any insight as to how these measures correlate with successful practice or patient care.
1. Program Length
A chiropractic program consists of 4 academic years of professional education averaging a total of 4,822 hours, and ranging from 4,400 hours to 5,220 hours in the 16 colleges.1 This includes an average of 1,975 hours in clinical sciences and 1,405 hours of clinical clerkship. The minimum hours for accreditation by the Council on Chiropractic Education is 4,200 hours.
2. Structure and Organization
The program of study at all chiropractic schools is divided into Basic and Clinical Sciences. The average total number of basic science contact hours is 1,420, which accounts for 30 percent of the entire chiropractic program.2 Basic sciences education includes an average of 570 hours of anatomy (40 percent of all basic science hours), 305 hours of physiology (21 percent), 205 hours of pathology (14 percent), 150 hours of biochemistry (11 percent), 120 hours of microbiology (8 percent), and 70 hours of public health (5 percent).
On average, 70 percent of the program is composed of clinical education. Chiropractic schools devote an average of 3,380 contact hours to clinical education: 1,975 hours (58 percent) are spent in chiropractic clinical sciences and the remaining 1,405 hours (42 percent) are spent in clinical clerkships. These contact hours are in lectures, laboratories, and clinics. Table 5 shows the distribution of hours in these three settings for both basic and clinical sciences.
There are five curricular areas that are emphasized in chiropractic education: adjustive techniques/spinal analysis (averaging 555 hours or 23 percent of the clinical program), principles/practices of chiropractic (averaging 245 hours or 10 percent), physiologic therapeutics (averaging 120 hours or 5 percent), and biomechanics (averaging 65 hours or 3 percent).
The clinical courses offered in chiropractic colleges are shown in Table 6. Subjects dealing with diagnosis and chiropractic principles are given the most time, followed by orthopedics, physiologic therapeutics, and nutrition. Three areas within the clinical sciences shown in Table 6 (adjustive techniques/spinal analysis, physical/clinical/laboratory diagnosis, and diagnostic imaging) account for an average of 52 percent of the education in clinical sciences. Thus the emphasis in chiropractic clinical sciences is clearly on diagnosis and manipulative therapy.
3. Content
The sequencing of subjects in two chiropractic colleges are illustrated in Tables 7 and 8 (Coulter, submitted). Table 7 represents a year-round trimester program and Table 8 illustrates a semester program. Both programs are representative of other colleges in terms of total numbers of hours of clinical and basic sciences. The program from Table 7 is spread over 4 years with 10 trimesters. The first 2 years of the program are heavily focused on the basic and clinical sciences. In year 1 (three trimesters of 15 weeks each) there are a total of 1,515 contact hours (960 hours in basic sciences and 555 in clinical education), of which 585 are spent in lectures and 930 in the laboratory. This represents an average of 34 contact hours per week for the students.
In year 2, the focus is again on basic sciences (375 hours) and clinical sciences (1,110 hours). There are a total of 1,485 contact hours in year 2 (795 in lectures, 690 in laboratory), and there are an average of 33 contact hours per week. In year 3, all of the contact hours are spent on clinical education (which includes clinical sciences and clinical clerkships). Year 3 has a total of 1,410 contact hours (330 in lectures, 300 in laboratory, 780 in clinic), an average of 31 contact hours per week. Year 4 is given over to a clinical internship for 15 weeks (one trimester) for a total of 450 hours or 30 hours per week.
Table 6. Average Total Contact Hours in Specific Clinical Subjects Taught in 16 Chiropractic Colleges (Includes lectures and laboratories).
4. Faculty
Despite a growing body of literature about chiropractic education, the role of faculty has received little attention. As a result of standards set by the Council on Chiropractic Education (CCE) for chiropractic college faculty, all basic sciences faculty members at chiropractic colleges have earned university degrees of MS or PhD in their discipline, and many of the D.C. faculty also hold higher degrees (Wardwell, 1992). Clinical sciences faculty must either have a baccalaureate degree, several years of chiropractic experience, or teaching experience at an institution of higher education (CCE, 1995).
Table 7. Subjects Taught in a Typical Trimester-Based Chiropractic Program, by Year and Numbers of Contact Hours
General anatomy (210)*Pharmacotoxicology (30)Integrated chiropractic clinical application (90)Clinical internship (450)Functional anatomy and biomechanics (210)Clinical microbiology (90)Physiological therapeutics (30) Histology (90)Pathology (135)Chiropractic principles (75) Human biochem. (105)Chiropr. principles (60)Practice management (75) Chiropr. principles (90)Chiropr. procedures (300)Imaging interpretation (90) Clinical chiropractic (60)Physics and clinical imaging (90)Radiological position and technique (30) Palpation (120)Clinical orthopedics and neurology (180)Differential diagnosis (90) Neuroscience (120)Nutritional assessment (60)Clinical application of manual procedures (60) Normal radiological anatomy (90)Community health (60)Clinical internship (390) Human physiology (135)Physiological therapeutics (105)Dermatology (15) Fundamentals of nutrition (60)Clinical nutrition (60)Clinical psychology (15) Introduction to physical examination skills (120)Research methods (30)Obstetrics/gynecology (15) Chiropractic procedures (105)Practice management (30)Pediatrics (15) Imaging interpretation (75)Geriatrics (15) Differential diagnosis (90)Clinical laboratory clerkship (15) Clinical chiropr. applied (90) Total hours: 1,515TOTAL HRS: 1,485TOTAL HRS: 1,410TOTAL: 450
*Number of contact hours is noted in parentheses.
Source: Los Angeles College of Chiropractic, Whittier, California.
5. Recent Trends and Innovations
Within the health sciences in the past decade there have been numerous innovations in educational principles and practice. In chiropractic, most of the teaching institutions are involved in curriculum reform. Key innovations include the move to problem-based learning, self-directed learning, computer-assisted learning, the use of standardized patients, and the use of objective structured clinical examinations (Adams, 1991; Traina, 1994).
Unlike most public- and private-sector institutions of higher learning, limited external education and research funding have hindered chiropractic institutional development thereby contributing to excessive tuition dependence. Recent Federal initiatives focusing on developing and prioritizing research within the chiropractic profession have highlighted this issue, emphasizing the need for directed educational research and faculty development (Adams, 1997). A number of chiropractic schools are well aware of the challenges confronting their programs and attempts are under way to fund innovative ways of enhancing chiropractic educational programs (Adams, 1997). However, if significant improvement is to occur, substantial resources will need to be identified and earmarked for educational enhancement.
D. Specialty Training
Specialty training is available through U.S. chiropractic colleges for part-time postgraduate education programs or full-time residency programs. Postgraduate education programs are available in family practice, applied chiropractic sciences, clinical neurology, orthopedics, sports injuries, pediatrics, nutrition, rehabilitation, and industrial consulting. Rehabilitation has become a particularly popular program (Liebenson, 1996). Residency programs include radiology, orthopedics, family practice, and clinical sciences (Christensen, 1993). A typical residency program is 2-3 years in duration and includes ambulatory care and inpatient clinical rotations at chiropractic and medical facilities, along with didactic and research experiences. Other less rigorous postgraduate training programs may take 1-3 years to complete on a part-time basis. Both the residency and postgraduate programs lead to eligibility to sit for competency examinations offered by specialty boards recognized by the American Chiropractic Association, the International Chiropractors' Association, and the American Board of Chiropractic Specialties. Specialty boards may confer "Diplomate" status in a given area of focus upon successful examination. Chiropractic orthopedics and sports chiropractic are the most prevalent specialty certifications.
Opportunities for chiropractors to participate in medical and multidisciplinary residencies are currently limited. Some fellowship programs exist in orthopedics and radiology and new opportunities in occupational medicine and physiatry may be on the horizon. Some chiropractic schools are pursuing joint training opportunities in the areas of public health, epidemiology, and health care administration.
E. Continuing Education
Participation in Continuing Education by chiropractors is commonplace as 47 of 50 States have mandatory continuing education requirements to maintain or renew a license to practice (FCLB, 1997). The annual number of required hours ranges from zero in 3 states to 50 in Kansas (FCLB, 1997) (see Table 12 in Chapter V). The most prevalent requirement is 12 hours per year (25 of the 50 States). In addition, a number of States specify that topical content areas are to be included in annual continuing educational requirements. Examples include diagnostic imaging, chiropractic technique, risk management, public health (infection control and AIDS prevention), and professional boundaries issues. Several State Licensing Boards limit who may sponsor continuing educational activities (e.g., accredited chiropractic colleges or approved associations) and what the program is about (e.g., practice management seminars are typically excluded).
Chiropractic continuing education programs often involve a 1- to 2-day seminar or conference (8-16 hours) focusing on a variety of topics related to chiropractic principles, clinical skills development, diagnosis, patient care, and practice management. These programs are usually sponsored by chiropractic colleges and other educational institutions, professional associations, and sometimes by commercial vendors or individual entrepreneurs. There is a growing interest in practice-based continuing education and distance learning (Jamison, 1991; Ebrall, 1995). Several colleges and publishers have created opportunities for chiropractors to participate in distance learning activities including the use of self-directed learning modules with audiovisual support and computer-enhanced learning. In addition, several States grant continuing education credits for self-directed learning.
F. Comparison with Medical Education and Training
A recent study comparing chiropractic and medical education collected data on all chiropractic and medical schools in North America and performed an in-depth analysis of three chiropractic and three medical schools (Coulter, submitted). Three States providing a broad geographic representation of the United States were chosen: California, Iowa, and Texas. These States account for almost half of the chiropractic colleges in the United States. A single chiropractic college and school of medicine were studied in each State.
The chiropractic schools included in this study had enrollments of 521, 773, and 1880, compared with a mean enrollment for all colleges of 878 (CCE Report, 1996). The three medical schools had enrollments of 691, 734, and 745, all moderately above the national average of 536 (JAMA, 1995).
1. Program Length
The chiropractic programs consist of 4 years of undergraduate education totaling approximately 4,800 contact hours. The medical programs consist of 4 undergraduate years, with approximately the same number of contact hours (4,667), but typically with an additional 3-year residency to meet the requirements for practice.
2. Selection of Students
Medical schools require at least 3 years of college education prior to admission, while chiropractic colleges require a minimum of 2 years. In fact, most medical students complete 4 or more years of college (Coulter, submitted). However, national data on graduate chiropractors show that 78 percent have degrees other than chiropractic, of which 54 percent are Bachelor's or higher. Most chiropractors completed these degrees prior to the D.C. degree (Christensen, 1993).
A recent study found the grade point average of students entering chiropractic schools is 2.7 compared to 3.5 for those entering medical schools (Coulter, submitted). Medical schools use the results of a standardized examination, the MCAT, as part of the selection process. Chiropractic schools have no standardized equivalent.
3. Prerequisites
There is considerable overlap in the two professions in terms of the courses they require as prerequisites for entrance. Both require biology, general inorganic chemistry, organic chemistry, and general physics. In medicine it is common to require mathematics, which is not required in chiropractic. Both require a humanities prerequisite with chiropractic also requiring a social science/psychology credit as well as English and/or communication skills.
4. The Curriculum
Two questions are of paramount importance in comparing the curricula of the two professions; what subjects are taught and how much is taught? The two programs are relatively similar in total student contact hours: an average of 4,822 hours in chiropractic schools compared with 4,667 hours in medical schools (Coulter, et al, submitted).
Basic science comprises 25-30 percent of the total contact hours in both the chiropractic and medical programs (Table 9) and the two programs have roughly similar contact hours in biochemistry, microbiology, and pathology (Table 10). Chiropractors receive substantially more hours in anatomy education and physiology but many fewer in public health.
The contrast between the two programs is dramatic in the area of clinical clerkships, which averaged 3,467 hours in medicine versus 1,405 hours in chiropractic. In medicine this comprises, on average, 74 percent of the total contact hours, while in chiropractic it comprises only 29 percent (Table 9). Part of the difference can be explained by the way in which the programs are structured. In chiropractic 41 percent of the program (averaging 1,975 hours) is allocated to chiropractic clinical sciences, which consists of extensive laboratory and hands-on training in manual procedures and has no equivalent in medicine. Combining the chiropractic clinical sciences with the clinical clerkships, the percentage of a chiropractic program devoted to clinical education is 70 percent compared to medicine's 74 percent. The major difference therefore is in didactic teaching and clinical experience.
Thus, on average, medical students receive twice the number of hours in clinical experience but receive over 1,000 fewer hours in lectures and laboratory education. If the medical residency is included, the total number of hours of clinical experience for medicine rises to 6,413 (Coulter, submitted).
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1. Center for Studies in Health Policy, Inc., Washington, DC. Personal communication of 1995 unpublished data from Meredith Gonyea, PhD.
2. Source: Center for Studies in Health Policy, Inc., Washington, DC. Personal communication of 1995 unpublished data from Meredith Gonyea, PhD.
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