Chiropractic

Classic Chiropractic was founded by D.D. Palmer in 1895 and was expanded into the early 20th century by his son B.J. Palmer.

Chiropractic as a primary health care profession is concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system as well as with the effects of those disorders on the overall health of the body.

Classic Chiropractic was very much philosophically based using the vertebral subluxation model as being the cause of disease and the use of spinal adjustments or manipulations as being the method of treatment. Of central focus in Chiropractic is the nervous system, which controls the functions and performance of the various body systems, and how problems within the neuromusculoskeletal system have an effect on the overall functioning of the nervous system.

Although still based on many of the original principles that have existed for over 120 years of the profession, modern Chiropractic has developed and evolved incorporating ever increasing scientific research, technology and knowledge.

Modern Chiropractic is evidence based and and uses a variety of tested diagnostic and treatment methods on a wide range of disorders of the neuromusculoskeletal system including those of the extremities (knees, shoulders, elbows, feet). Proactively aiming for the cause of the problem, rather than just treating the symptoms, modern Chiropractic looks at dysfunction in the neuromusculoskeletal system, how this affects the overall health of the body, and how this dysfunction can be addressed to restore optimal function.

Modern Chiropractic is widely practised and accepted in Australia, the USA and the UK and is regarded as the third largest primary health care profession behind medicine and dentistry.

Is It Safe

Chiropractors in Australia are regulated through the Chiropractic Board of Australia which is part of the Australian Health Practitioner Regualtory Agency (AHPRA) a government body which manages the National Registration and Accreditation Scheme. Part of the functions of this scheme is to not only regulate the education and registration of members, but to also ensure public safety by only allowing competent, suitable trained and qualified practitioners are registered.

Unfortunately there is an inhernet risk associated with any medical procedure which may include amongst others, adverse drug interactions, complications from surgery or human error. In fact preventable adverse events: (when medical personnel do the wrong thing, or fail to do the right thing, or do the right thing but do it wrong) occurred in 546 544 public and private hospital separations in 2013 - 2014 in Australia¹ with adverse effects of drugs, medicaments and biological substances accounting for 174 465 and misadventures to patients during surgical and medical care accounting for 26 170 separations.² A 2006 study showed that adverse drug events in general practice in Australia occurred in 10.4% of GP encounters (N = 8215)³.

These figures show that despite our best intentions, risks are always present and may sometimes be difficult to identify.

 

Graphical representation of a comparison of some health risk factors.

The Australia Bureau of Statistics shows that in 2004 - 2005 there were an estimated 11.2 million chiropractic visits in Australia⁴ increasing from 7.4 million in 1995 which shows just how widely used Chiropractic really is. It is interesting to note that of the 432 600 people who had visited a chiropractor in 2004 - 2005 only 27.3% had visited a GP or specialist in the preceeding 2 weeks.⁵ Spinal manipulative therapy (SMT) is nowdays incorporated as a form of treatment in other professions besides chiropractic such as physiotherapy and osteopathy. Two of the more important areas of concern associated with SMT is in relation to the adverse responses patients may experience after treatment, and the risk of stroke in the vertebrobasilar system as a result of a neck (cervical spine) manipulation.

Adverse Responses

Adverse responses may include increased pain, headaches or muscle stiffness and are usually of short duration, beginning immediately or shortly after care. While not preferential, as no one in pain wants to experience more pain, these reactions which do not have a negative impact or outcome to the effectiveness of the treatment, are relatively common and may be the result of natural history variation and non- specific events. Interestingly a 2013 published study showed very little difference in adverse events experienced between two groups receiving normal chiropractic care and those receiving a sham treatment, with the sham group experiencing a higher frequency of headaches compared to the treatment group.^6,7,8

At Hornsby Spine Centre we encourage constant feedback during and after treatment and we adjust our treatment protocols so as to reduce any discomfort experienced where possible.

Vertebrobasilar Stroke

Historically health professionals and researchers have drawn an association between certain seemingly benign everyday movements of the neck such as cradling a telephone between the neck and shoulder or during a golf swing and the onset of stroke symptoms. Cervical adjustments and the rotational movment of the neck have also been associated with the occurrence of a stroke occuring minutes to some days after the treatment. Two postulated mechanisms of this are thought to be from a thrombus forming due to damage to the lining of either of the vertebral arteries supplying blood to the brain which would then inhibit blood flow to the brain; or an existing thrombus becoming dislodged during the neck adjustment, travelling into the brain and blocking blood supply to part of the brain.⁹ Research done in 2002 challenged this mechanism of action by finding that SMT resulted in strains to the vertebral artery that were almost an order of magnitude lower than the strains required to mechanically disrupt it. The study went on to conclude that under normal circumstances the thrust involved in single high velocity/ low amplitude cervical adjustments was highly unlikely to mechanically disrupt the vertebral artery¹⁰.

The risk of verterbrobasilar stroke due to a chiropractic adjustment remains very low though and has been estimated to be between 5 - 10 in 10 000 000¹¹ and 1 in 5 850 000¹² procedures. Recent research done in 2015 found that the incidence of vertebrobasilar stroke was extremely low for patients aged 66 to 99 and there was little clinical significance in the risk of verterbrobasilar stroke between patients who saw a primary care physician or a chiropractor¹³.

Mitigating The Risk

At Hornsby Spine Centre we truly believe that outside of education and training of practitioners, the greatest form of risk mitigation lies with the individual practitioner and with their thoroughness and care in the application of their clinical practice. That is not to say that we rely solely on instinct, we ensure that a thorough case history producing a clinical picture and risk profile is always completed. With this we look for clinical red flags or warning signs for anything outside of our scope of practice that may be causing the problem or anything that would contraindicate any form of care. We conduct focussed orthopaedic and neurological examinations designed to highlight any further red flags as well as confirm or disprove our working differential diagnosis made during the case history.

Armed with all this information, only then do we provide care if indicated choosing appropriate treatment modalities to the individual set of circumstances and as a policy of our clinic at Hornsby Spine Centre, never applying excessive force.