Prácticas lingüísticas relativas al continuum puro-combinado

Universal Intelligence

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• origin of holism within chiropractic • cannot be proven or disproven

Source: R. B. Phillips and R. D. Mootz, “Contemporary chiropractic philosophy,” in Principles and Practice of

Chiropractic, 2nd Ed., S. Halderman, ed. (Norwalk, CT: Appleton & Lange, 1992); cited in Mootz and Phillips,

“Chiropractic Belief Systems,” Chap. 2 in D. C. Cherkin and R. D. Mootz, eds., Chiropractic in the United States:

Training, Practice and Research (Washington, DC: Agency for Health Care Policy and Research, US Department of

Health and Human Services, 1997).

Since its inception, chiropractic has weathered continual challenges to its validity,

starting with the 1910 Flexner Report. A critical rating of 155 American medical schools, the Flexner Report favored a scientific, allopathic approach to medical education

modeled on that of Johns Hopkins University (which funded the report). By

recommending state licensure only of graduates from those schools that used this approach, the report helped make allopathic medicine the de facto standard of care in America. The American Medical Association (AMA), as the lead association of

allopathic physicians, spent much of the rest of this century working to suppress

chiropractic practitioners. In 1981 the US Supreme Court curtailed these assaults in the

Wilk decision, finding the AMA guilty of trying to illegally boycott the chiropractic

profession through “restraint of trade.”

The Flexner Report helped trigger other fundamental changes in health care: adoption of an allopathic orientation by federal research and development policy, particularly in the creation and direction of the National Institutes of Health (NIH), and federal funding of allopathic graduate medical education (GME) through a variety of agenciesto the exclusion of funding doctors of chiropractic and other CAA doctoral training programs.

Despite these challenges and lack of equity in federal policy, the chiropractic profession today enjoys widespread recognition and use. In the United States, 55,000 doctors of chiropractic (DCs) are consulted by anywhere from 3.6% to 16% of the US population, according to various estimates (for this report we will use 10% as our approximate estimate for 1997).2 Chiropractic care is licensed in 50 states; 45 states require insurers

to include it in their plans. Consumer awareness of chiropractic is growing and hospitals and HMOs are including chiropractic in their services.

Considerable research has been done on patient satisfaction; the focus groups for this project, as well as major polls conducted by the Harris and Gallup organizations, have consistently shown that patients’ support for and satisfaction with chiropractors is high.

What does chiropractic do? While chiropractors are trained to use a range of

approaches including nutrition, and some have made a point of learning other CAAs such as acupuncture, the prime component of chiropractic care is spinal manipulation. Essentially, manipulation involves kneading and adjusting the components of the spine to achieve a therapeutic effectoften to relieve back pain, but also facilitating the transmission of nerve signals along the spine from the brain to other parts of the body.

Chiropractors achieve their therapeutic benefit by manipulating the joints of the spine beyond what an individual could do alone. Figure 4-2 below illustrates the range of motion culminating in called “paraphysiological,” where the therapeutic effects are thought to occur.3 In normal activity, the spine has a “neutral active” range of motion as we move through the day. Beyond this is a range of “passive motion” which individuals can mobilize themselves. However, the greatest therapeutic effect is believed to come from manipulation beyond this passive rangehence, paraphysiological. Manipulation in the paraphysiological range of motion is thought to stimulate the body’s innate curative powers. In the area of pain relief, for example, studies have shown that chiropractic spinal manipulation facilitates the release of beta-endorphins. Since it is believed that pain sufferers have become endorphin-deficient, chiropractors claim that chiropractic manipulation can play a large role in pain management.4

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Figure 4-2

Chiropractors vary widely in how they practice. Some chiropractors have been criticized for over-treating.5 To address the variability issue, in 1992 chiropractors met to develop the Guidelines for Chiropractic Quality Assurance and Practice Parameters (the Mercy Guidelines), an effort to establish consensus on treatment approaches and outcomes. These Guidelines recommend, for example, that for uncomplicated cases (acute episodes) treatment should achieve “significant improvement within 10 to 14 days” based on “three to five treatments per week.” To “return to pre-episode status” should require “six to eight weeks” based on “up to three treatments per week.”6

Currently, chiropractors provide 94% of manipulation in the United States, while other providers (mostly osteopaths) provide the other 6%.7 As outcomes research confirms spinal manipulation’s value, however, many other types of health care providers are likely to seek training in its techniques. In the near future, physical therapists,

osteopaths, massage therapists, physicians and nurses trained in manipulation will compete with chiropractors.

Chiropractors have traditionally practiced solo. Because of the various competitive pressures, however, chiropractors will face strong incentives to work in or for groups, and to be able to work on multidisciplinary teams.

Neutral Active Range of Motion Mobilization: Passive Range of Motion Manipulation: Paraphysiological Range of Motion

JOINT MOBILIZATION and MANIPULATION

Source: W . H. Kirkaldy- W illis and J. D. Cassidy, “Spinal Manipulation in the Treatment of Low-Back Pain,” Canadian Family

Physician, Vol. 31 (March