594 Complementary and Alternative Therapies
Clinical Applications
Research to date focuses on the philosophy of osteopathic
medicine and manipulation techniques and less on treatment
outcome. Patients with HIV disease have been reported to use
OMT for relaxation and pain management because of drug
toxicity or disease progression (Micozzi, 1999). Treatment
includes massage and myofascial release techniques to relax
muscle tension, counterstrain techniques to relax and elon-
gate muscle “ber for increased joint mobility and range
of motion, muscle energy techniques to foster normalization
of the musculoskeletal system, and visceral manipulation,
which may potentiate normal physiologic function of indi-
vidual organs.
Chiropractic
Chiropractic, derived from the Greek word meaning •done
by hands,Ž was founded by Daniel David Palmer in 1895
based on the premise that vertebral subluxation (a spinal mis-
alignment causing abnormal nerve transmission) is the cause
of virtually all disease and that chiropractic adjustment (a
manual manipulation of the subluxated vertebrae) is its cure
(Palmer, 1910). Similar to the fundamental principles of os-
teopathy and the foundation of the emerging holistic health or
wellness paradigm, a chiropractic approach views human
beings as possessing an innate healing potential. Like os-
teopathy, structure and function are believed to exist in inti-
mate relation with one another. Hence, structural distortions
of the spine are proposed to cause functional abnormalities,
which may impede the communication and balance between
the different branches of the nervous system (central, auto-
nomic, and peripheral) that are required for health mainte-
nance. This is believed to result in injury or stress, causing
pain. Restoration and maintenance of proper bodily function
involves realigning the spine to remove the pressure of bone
impingement on spinal nerves to restore spinal joint mobility
and nerve function. Whereas osteopaths provide manual ther-
apy to a variety of areas in the body, chiropractors focus
speci“cally on spinal maladjustments. A balanced, natural
diet and exercise is also considered an important part of treat-
ment for maintaining proper bodily function and optimal
health.
Therapeutic Approaches
Of the patients seeking chiropractors, 90% present with neu-
romuscular problems such as back pain, neck pain, and
headaches, conditions for which spinal manual therapy
(SMT) is most effective (Plamondon, 1995). The central
focus of chiropractic practice is to determine when and where
SMT is appropriate, and what type of adjustment is most
appropriate in a given situation. The most common form of
chiropractic SMT is the high-velocity, low-amplitude thrust
adjustment (HVLA), also known as osseous adjustment
(Micozzi, 1996). It involves manual movement of a joint to
the end point of its normal range of motion, followed by local
pressure on bony prominences and then imparting a swift,
speci“c, low-amplitude thrust for joint cavitation. Although
patients often report signi“cant functional improvements and
healing effects following chiropractic adjustment, positive
health changes have never been convincingly correlated with
vertebral alignment (Micozzi, 1996; Winkel, Aufdemkampe,
Matthijs, Meijer, & Phelps, 1996).Clinical ApplicationsSeveral comprehensive reviews exist on clinical outcome
studies in spinal manipulation. Shekelle, Adams, Chassin,
Hurwitz, and Brook (1992) analyzed nine randomized, con-
trolled trials that tested the effects of spinal manipulation
against various conservative treatments for patients with
acute low back pain (e.g., back pain that does not result from
fractures, tumors, infections, and vascular, abdominal, or uri-
nary diseases). All nine studies found spinal manipulation to
be ef“cacious, leading the authors to conclude that spinal
manipulation hastens recovery from uncomplicated low back
pain. Findings from two other meta-analyses (Abenhaim &
Bergeron, 1992; Anderson et al., 1992) provide some evi-
dence of the short-term effectiveness of spinal manipulation
in relieving acute and chronic back pain, although long-term
effects of this treatment have not been adequately evaluated.
Chiropractic treatment has also been demonstrated to be more
effective in treating the pain from muscle tension headaches
than the tricyclic antidepressant amitriptyline for long-term
relief of pain (Boline, 1991). Patients maintained their levels
of improvement after treatment was discontinued, while
those taking medication returned to pretreatment status in an
average of four weeks following its discontinuation. Further
research is needed to address the question of long-term ef“-
cacy of spinal manipulation for different types of pain.
Other studies have focused on applying chiropractic ma-
nipulation to spinal cord injury patients (Fritz-Ritson, 1995;
Woo, 1993), infantile colic (Klougart, Nilsson, & Jacobsen,
1989), and enuresis (Leboeuf et al., 1991; Reed, Beavers,
Reddy, & Kern, 1994). The results generated from these
studies are inconsistent and inconclusive because of limita-
tions in research design. Further research is needed to