Chiropractic

Chiropractic is a form of alternative medicine[1] concerned with the diagnosis, treatment and
prevention of mechanical disorders of the musculoskeletal system, especially of the spine.[2] It
has esoteric origins[3] and is based on several pseudoscientific ideas.[4]
 Chiropractic

Alternative medicine

A chiropractor performing a vertebral adjustment

Claims Vertebral subluxation, spinal adjustment, Innate

Intelligence

Risks Vertebral artery dissection (stroke), compression

fracture, death

Related fields Osteopathy, vitalism

Year proposed 1895 in Davenport, Iowa, U.S.

Original proponents D. D. Palmer

Subsequent proponents B. J. Palmer

MeSH D002684 (https://www.nlm.nih.gov/cgi/mesh/201

1/MB_cgi?field=uid&term=D002684)

Many chiropractors, especially those in the field's early history, have proposed that mechanical
disorders of the joints, especially of the spine, affect general health,[2] and that regular
manipulation of the spine (spinal adjustment) improves general health. The main chiropractic
treatment technique involves manual therapy, especially manipulation of the spine, other joints,
and soft tissues, but may also include exercises and health and lifestyle counseling.[5] A
chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as "doctor" but is
not a Doctor of Medicine (M.D.)[6][7] While many chiropractors view themselves as primary care
providers,[8][9] chiropractic clinical training does not meet the requirements to be such a
provider.[2]
Systematic reviews of controlled clinical studies of treatments used by chiropractors have found
no evidence that chiropractic manipulation is effective, with the possible exception of treatment
for back pain.[8] A 2011 critical evaluation of 45 systematic reviews found that spinal
manipulation was ineffective at treating any condition.[10] Spinal manipulation may be cost-
effective for sub-acute or chronic low back pain, but the results for acute low back pain were
insufficient.[11] No compelling evidence exists to indicate that maintenance chiropractic care
adequately prevents symptoms or diseases.[12]

There is not sufficient data to establish the safety of chiropractic manipulations.[13] It is

frequently associated with mild to moderate adverse effects, with serious or fatal complications
in rare cases.[14] There is controversy regarding the degree of risk of vertebral artery dissection,
which can lead to stroke and death, from cervical manipulation.[15] Several deaths have been
associated with this technique[14] and it has been suggested that the relationship is
causative,[16][17] a claim which is disputed by many chiropractors.[17]

Chiropractic is well established in the United States, Canada, and Australia.[18] It overlaps with
other manual-therapy professions such as osteopathy and physical therapy.[19] Most who seek
chiropractic care do so for low back pain.[20] Back and neck pain are considered the specialties
of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues.[8]
Chiropractic has two main groups: "straights", now the minority, emphasize vitalism, "Innate
Intelligence", and consider vertebral subluxations to be the cause of all disease; and "mixers", the
majority, are more open to mainstream views and conventional medical techniques, such as
exercise, massage, and ice therapy.[21]

D. D. Palmer founded chiropractic in the 1890s,[22] after saying he received it from "the other
world";[23] Palmer maintained that the tenets of chiropractic were passed along to him by a
doctor who had died 50 years previously.[24] His son B. J. Palmer helped to expand chiropractic
in the early 20th century.[22] Throughout its history, chiropractic has been controversial.[25][26] Its
foundation is at odds with evidence-based medicine, and has been sustained by
pseudoscientific ideas such as vertebral subluxation and innate intelligence.[27] Despite the
overwhelming evidence that vaccination is an effective public health intervention, among
chiropractors there are significant disagreements over the subject,[28] which has led to negative
impacts on both public vaccination and mainstream acceptance of chiropractic.[29] The
American Medical Association called chiropractic an "unscientific cult" in 1966[30] and boycotted
it until losing an antitrust case in 1987.[9] Chiropractic has had a strong political base and
sustained demand for services. In the last decades of the twentieth century, it gained more
legitimacy and greater acceptance among conventional physicians and health plans in the
United States.[9] During the COVID-19 pandemic chiropractic professional associations advised
chiropractors to adhere to CDC, WHO, and local health department guidance.[31][32] Despite these
recommendations, a small but vocal and influential number of chiropractors spread anti-vaccine
disinformation.[33]

Conceptual basis

Philosophy

Chiropractic is generally categorized as complementary and alternative medicine (CAM),[1] which

focuses on manipulation of the musculoskeletal system, especially the spine.[2] Its founder, D. D.
Palmer, called it "a science of healing without drugs".[8]

Chiropractic's origins lie in the folk medicine of bonesetting,[8] and as it evolved it incorporated
vitalism, spiritual inspiration and rationalism.[34] Its early philosophy was based on deduction
from irrefutable doctrine, which 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.[34] This "straight"
philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the
scientific method,[34] and relies on deductions from vitalistic first principles rather than on the
materialism of science.[35] However, most practitioners tend to incorporate scientific research
into chiropractic,[34] 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.[35] 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.[36]
Two chiropractic belief system constructs
The testable principle The untestable metaphor

Chiropractic adjustment Universal intelligence

↓ ↓

Restoration of structural integrity Innate intelligence

↓ ↓

Improvement of health status Body physiology

Materialistic: Vitalistic:

Operational definitions possible Origin of holism in chiropractic

Lends itself to scientific inquiry Cannot be proven or disproven

Taken from Mootz & Phillips 1997[35]

Although a wide diversity of ideas exist among chiropractors,[34] 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.[37] Some chiropractors claim spinal manipulation can have an effect on a
variety of ailments such as irritable bowel syndrome and asthma.[38]

Chiropractic philosophy includes the following perspectives:[35]

Holism assumes that health is affected by everything in an individual's environment; some

sources also include a spiritual or existential dimension.[39] In contrast, reductionism in
chiropractic reduces causes and cures of health problems to a single factor, vertebral
subluxation.[36] Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's
early notion of innate intelligence can be thought of as a metaphor for homeostasis.[34]

A large number of chiropractors fear that if they do not separate themselves from the traditional
vitalistic concept of innate intelligence, chiropractic will continue to be seen as a fringe
profession.[21] A variant of chiropractic called naprapathy originated in Chicago in the early
twentieth century.[40][41] It holds that manual manipulation of soft tissue can reduce
"interference" in the body and thus improve health.[41]

Straights and mixers

Range of belief perspectives in chiropractic
Perspective attribute Potential belief endpoints

Scope of practice: narrow ("straight") ← → broad ("mixer")

Diagnostic approach: intuitive ← → analytical

Philosophic orientation: vitalistic ← → materialistic

Scientific orientation: descriptive ← → experimental

Process orientation: implicit ← → explicit

Practice attitude: doctor/model-centered ← → patient/situation-centered

Professional integration: separate and distinct ← → integrated into mainstream

Taken from Mootz & Phillips 1997[35]

Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer,
and retain metaphysical definitions and vitalistic qualities.[42] Straight chiropractors believe that
vertebral subluxation leads to interference with an "innate intelligence" exerted via the human
nervous system and is a primary underlying risk factor for many diseases.[42] Straights view the
medical diagnosis of patient complaints, which they consider to be the "secondary effects" of
subluxations, to be unnecessary for chiropractic treatment.[42] Thus, straight chiropractors are
concerned primarily with the detection and correction of vertebral subluxation via adjustment
and do not "mix" other types of therapies into their practice style.[42] Their philosophy and
explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon
terminology such as "perform spinal analysis", "detect subluxation", "correct with adjustment".[21]
They prefer to remain separate and distinct from mainstream health care.[21] Although
considered the minority group, "they have been able to transform their status as purists and
heirs of the lineage into influence dramatically out of proportion to their numbers."[21]

Mixer chiropractors "mix" diagnostic and treatment approaches from chiropractic, medical or
osteopathic viewpoints and make up the majority of chiropractors.[21] Unlike straight
chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend
to be open to mainstream medicine.[21] Many of them incorporate mainstream medical
diagnostics and employ conventional treatments including techniques of physical therapy such
as exercise, stretching, massage, ice packs, electrical muscle stimulation, therapeutic
ultrasound, and moist heat.[21] Some mixers also use techniques from alternative medicine,
including nutritional supplements, acupuncture, homeopathy, herbal remedies, and
biofeedback.[21]
Although mixers are the majority group, many of them retain belief in vertebral subluxation as
shown in a 2003 survey of 1,100 North American chiropractors, which found that 88 percent
wanted to retain the term "vertebral subluxation complex", and that when asked to estimate the
percent of disorders of internal organs that subluxation significantly contributes to, the mean
response was 62 percent.[43] A 2008 survey of 6,000 American chiropractors demonstrated that
most chiropractors seem to believe that a subluxation-based clinical approach may be of limited
utility for addressing visceral disorders, and greatly favored non-subluxation-based clinical
approaches for such conditions.[44] The same survey showed that most chiropractors generally
believed that the majority of their clinical approach for addressing
musculoskeletal/biomechanical disorders such as back pain was based on subluxation.[44]
Chiropractors often offer conventional therapies such as physical therapy and lifestyle
counseling, and it may for the lay person be difficult to distinguish the unscientific from the
scientific.[45]

Vertebral subluxation

In science-based medicine, the term "subluxation" refers to an incomplete or partial dislocation

of a joint, from the Latin luxare for 'dislocate'.[46][47] While medical doctors use the term
exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word
subluxation with a metaphysical and philosophical meaning drawn from pseudoscientific
traditions such as Vitalism.[48]

Palmer claimed that vertebral subluxations, interfered with the body's function and its inborn
ability to heal itself.[49] 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.[48] He
qualified this by noting that knowledge of innate intelligence was not essential to the competent
practice of chiropractic.[48] This concept was later expanded upon by his son, B. J. Palmer, and
was instrumental in providing the legal basis of differentiating chiropractic 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."[50]

Chiropractors use x-ray radiography to examine the bone structure of a patient.

Vertebral subluxation, a core concept of traditional chiropractic, remains unsubstantiated and

largely untested, and a debate about whether to keep it in the chiropractic paradigm has been
ongoing for decades.[51] 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.[51] This is still a
continuing source of debate within the chiropractic profession as well, with some schools of
chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others
have moved towards an evidence-based chiropractic that rejects metaphysical foundings and
limits itself to primarily neuromusculoskeletal conditions.[52][53]

In 2005, the chiropractic 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.[54] It
is essentially a functional entity, which may influence biomechanical and neural integrity."[54] 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.[54] This exposes patients to harmful
ionizing radiation for no evidentially supported reason.[55][56] The 2008 book Trick or Treatment
states "X-rays can reveal neither the subluxations nor the innate intelligence associated with
chiropractic philosophy, because they do not exist."[57] Attorney David Chapman-Smith,
Secretary-General of the World Federation of Chiropractic, has stated that "Medical critics have
asked how there can be a subluxation if it cannot be seen on X-ray. The answer is that the
chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more
visible on static X-ray than a limp or headache or any other functional problem."[58] The General
Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom,
states that the chiropractic vertebral subluxation complex "is not supported by any clinical
research evidence that would allow claims to be made that it is the cause of disease."[59]

As of 2014, the National Board of Chiropractic Examiners states "The specific focus of
chiropractic practice is known as the chiropractic subluxation or joint dysfunction. A subluxation
is a health concern that manifests in the skeletal joints, and, through complex anatomical and
physiological relationships, affects the nervous system and may lead to reduced function,
disability or illness."[60][27]

Pseudoscience versus spinal manipulation therapy

While some chiropractors limit their practice to short-term treatment of musculoskeletal

conditions, many falsely claim to be able treat a myriad of other conditions.[61][62] Some
dissuade patients from seeking medical care, others have pretended to be qualified to act as a
family doctor.[61]

Quackwatch, an alternative medicine watchdog, cautions against seeing chiropractors

who:[61][63]

Treat young children

Discourage immunization

Pretend to be a family doctor

Take full spine X-rays

Promote unproven dietary supplements

Are antagonistic to scientific medicine

Claim to treat non-musculoskeletal problems

Writing for the Skeptical Inquirer, one physician cautioned against seeing even chiropractors who
solely claim to treat musculoskeletal conditions:

"I think Spinal Manipulation Therapy (SMT) is a reasonable option for

patients to try ... But I could not in good conscience refer a patient to a
chiropractor... When chiropractic is effective, what is effective is not
'chiropractic': it is SMT. SMT is also offered by physical therapists, DOs,
and others. These are science-based providers ... If I thought a patient
might benefit from manipulation, I would rather refer him or her to a
science-based provider.[61]

Scope of practice

A treatment table at a chiropractic office

Chiropractors emphasize the conservative management of the neuromusculoskeletal system

without the use of medicines or surgery,[54] with special emphasis on the spine.[2] Back and neck
pain are the specialties of chiropractic but many chiropractors treat ailments other than
musculoskeletal issues.[8] There is a range of opinions among chiropractors: some believed that
treatment should be confined to the spine, or back and neck pain; others disagreed.[64] For
example, while one 2009 survey of American chiropractors had found that 73% classified
themselves as "back pain/musculoskeletal specialists", the label "back and neck pain
specialists" was regarded by 47% of them as a least desirable description in a 2005 international
survey.[64] Chiropractic combines aspects from mainstream and alternative medicine, and there
is no agreement about how to define the profession: although chiropractors have many
attributes of primary care providers, chiropractic has more attributes of a medical specialty like
dentistry or podiatry.[65] It has been proposed that chiropractors specialize in nonsurgical spine
care, instead of attempting to also treat other problems,[36][65] but the more expansive view of
chiropractic is still widespread.[66]

Mainstream health care and governmental organizations such as the World Health Organization
consider chiropractic to be complementary and alternative medicine (CAM);[1] and a 2008 study
reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated
medicine, and 12% as mainstream medicine.[67] Many chiropractors believe they are primary
care providers,[8][9] including US[68] and UK chiropractors,[69] but the length, breadth, and depth of
chiropractic clinical training do not support the requirements to be considered primary care
providers,[2] so their role on primary care is limited and disputed.[2][9]

Chiropractic overlaps with several other forms of manual therapy, including massage therapy,
osteopathy, physical therapy, and sports medicine.[19][70] Chiropractic is autonomous from and
competitive with mainstream medicine,[71] and osteopathy outside the US remains primarily a
manual medical system;[72] physical therapists work alongside and cooperate with mainstream
medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[71]
Practitioners may distinguish these competing approaches through claims that, compared to
other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer
manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of
treatment procedures; and that physical therapists emphasize machinery and exercise.[19]

Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational
and tactile assessments, and orthopedic and neurological evaluation.[54] A chiropractor may also
refer a patient to an appropriate specialist, or co-manage with another health care provider.[65]
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 advice.[5]
A chiropractic adjustment of a horse

Chiropractors are not normally licensed to write medical prescriptions or perform major surgery
in the United States,[73] (although New Mexico has become the first US state to allow "advanced
practice" trained chiropractors to prescribe certain medications.[74][75]). In the US, their scope of
practice varies by state, based on inconsistent views of chiropractic care: some states, such as
Iowa, broadly allow treatment of "human ailments"; some, such as Delaware, use vague
concepts such as "transition of nerve energy" to define scope of practice; others, such as New
Jersey, specify a severely narrowed scope.[76] US states also differ over whether chiropractors
may conduct laboratory tests or diagnostic procedures, dispense dietary supplements, or use
other therapies such as homeopathy and acupuncture; in Oregon they can become certified to
perform minor surgery and to deliver children via natural childbirth.[73] A 2003 survey of North
American chiropractors found that a slight majority favored allowing them to write prescriptions
for over-the-counter drugs.[43] A 2010 survey found that 72% of Swiss chiropractors considered
their ability to prescribe nonprescription medication as an advantage for chiropractic
treatment.[77]

A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in
many US states,[78] but is not recognized by the American Chiropractic Association as being
chiropractic.[79] It remains controversial within certain segments of the veterinary and
chiropractic profession.[80]

No single profession "owns" spinal manipulation and there is little consensus as to which
profession should administer SM, raising concerns by chiropractors that other medical
physicians could "steal" SM procedures from chiropractors.[81] 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.[81] Two US states (Washington and Arkansas)
prohibit physical therapists from performing SM,[82] some states allow them to do it only if they
have completed advanced training in SM, 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.[83]

Treatments

A chiropractor performs an adjustment on a patient.

Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is

the most common treatment used in chiropractic care.[84] 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.[85] 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.[85] High-velocity, low-amplitude spinal manipulation (HVLA-SM) thrusts have
physiological effects that signal neural discharge from paraspinal muscle tissues, depending on
duration and amplitude of the thrust are factors of the degree in paraspinal muscle spindles
activation.[86] Clinical skill in employing HVLA-SM thrusts depends on the ability of the
practitioner to handle the duration and magnitude of the load.[86] 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.[85]
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 10% of patients of licensed US chiropractors in a 2003 survey:[84] Diversified technique (full-
spine manipulation, employing various techniques), extremity adjusting, Activator technique
(which uses a spring-loaded tool to deliver precise adjustments to the spine), Thompson
Technique (which relies on a drop table and detailed procedural protocols), Gonstead (which
emphasizes evaluating the spine along with specific adjustment that avoids rotational vectors),
Cox/flexion-distraction (a gentle, low-force adjusting procedure which mixes chiropractic 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, applied kinesiology (which emphasises "muscle testing" as a
diagnostic tool), and cranial.[87] Chiropractic biophysics technique uses inverse functions of
rotations during spinal manipulation.[88] Koren Specific Technique (KST) may use their hands, or
they may use an electric device known as an "ArthroStim" for assessment and spinal
manipulations.[89] Insurers in the US and UK that cover other chiropractic techniques exclude
KST from coverage because they consider it to be "experimental and investigational".[89][90][91][92]
Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or
local anesthetic and is done by a team that includes an anesthesiologist; a 2008 systematic
review did not find enough evidence to make recommendations about its use for chronic low
back pain.[93]

Lumbar, cervical and thoracic chiropractic spinal manipulation

Many other procedures are used by chiropractors for treating the spine, other joints and tissues,
and general health issues. The following procedures were received by more than one-third of
patients of licensed US 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.[84]

A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium
mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the
spine.[94] The diversified technique is the most often applied technique at 93%, followed by the
Activator mechanical-assisted technique at 41%.[94] A 2009 study assessing chiropractic
students giving or receiving spinal manipulations while attending a United States chiropractic
college found Diversified, Gonstead, and upper cervical manipulations are frequently used
methods.[95]

Practice guidelines

Reviews of research studies within the chiropractic community have been used to generate
practice guidelines outlining standards that specify which chiropractic treatments are legitimate
(i.e. supported by evidence) and conceivably reimbursable under managed care health payment
systems.[81] Evidence-based guidelines are supported by one end of an ideological continuum
among chiropractors; the other end employs antiscientific reasoning and makes
unsubstantiated claims.[2][27][51][96][97] Chiropractic remains at a crossroads, and that in order to
progress it would need to embrace science; the promotion by some for it to be a cure-all was
both "misguided and irrational".[98] 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.[99] Specific guidelines concerning the treatment of nonspecific (i.e.,
unknown cause) low back pain are inconsistent between countries.[100]

Effectiveness

Numerous controlled clinical studies of treatments used by chiropractors have been conducted,
with varied results.[8] There is no conclusive evidence that chiropractic manipulative treatment is
effective for the treatment of any medical condition, except perhaps for certain kinds of back
pain.[8][10]

Generally, the research carried out into the effectiveness of chiropractic has been of poor
quality.[101][102] Research published by chiropractors is distinctly biased: reviews of SM for back
pain tended to find positive conclusions when authored by chiropractors, while reviews by
mainstream authors did not.[8]

There is a wide range of ways to measure treatment outcomes.[103] Chiropractic care benefits
from the placebo response,[104] but it is difficult to construct a trustworthy placebo for clinical
trials of spinal manipulative therapy (SMT).[105] The efficacy of maintenance care in chiropractic
is unknown.[106]

Available evidence covers the following conditions:

Low back pain. A 2013 Cochrane review found very low to moderate evidence that SMT was
no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low
back pain.[107] The same review found that SMT appears to be no better than other
recommended therapies.[107] A 2012 overview of systematic reviews found that collectively,
SM failed to show it is an effective intervention for pain.[108] A 2011 Cochrane review found
strong evidence that suggests there is no clinically meaningful difference between SMT and
other treatments for reducing pain and improving function for chronic low back pain.[109] A
2010 Cochrane review found no difference between the effects of combined chiropractic
treatments and other treatments for chronic or mixed duration low back pain.[110] A 2010
systematic review found that most studies suggest SMT achieves equivalent or superior
improvement in pain and function when compared with other commonly used interventions
for short, intermediate, and long-term follow-up.[111]

Radiculopathy. A 2013 systematic review and meta-analysis found a statistically significant

improvement in overall recovery from sciatica following SM, when compared to usual care,
and suggested that SM may be considered.[112] There is moderate quality evidence to support
the use of SM for the treatment of acute lumbar radiculopathy[113] and acute lumbar disc
herniation with associated radiculopathy.[114] There is low or very low evidence supporting SM
for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity
symptoms of any duration and no evidence exists for the treatment of thoracic
radiculopathy.[113]

Whiplash and other neck pain. There is no consensus on the effectiveness of manual
therapies for neck pain.[115] A 2013 systematic review found that the data suggests that there
are minimal short- and long-term treatment differences when comparing manipulation or
mobilization of the cervical spine to physical therapy or exercise for neck pain
improvement.[116] A 2013 systematic review found that although there is insufficient evidence
that thoracic SM is more effective than other treatments, it is a suitable intervention to treat
some patients with non-specific neck pain.[117] A 2011 systematic review found that thoracic
SM may offer short-term improvement for the treatment of acute or subacute mechanical
neck pain; although the body of literature is still weak.[118] A 2010 Cochrane review found low
quality evidence that suggests cervical manipulation may offer better short-term pain relief
than a control for neck pain, and moderate evidence that cervical manipulation and
mobilization produced similar effects on pain, function and patient satisfaction.[119] A 2010
systematic review found low level evidence that suggests chiropractic care improves cervical
range of motion and pain in the management of whiplash.[120]

Headache. There is conflicting evidence surrounding the use of chiropractic SMT for the
treatment and prevention of migraine headaches.[121][122] A 2006 review found no rigorous
evidence supporting SM or other manual therapies for tension headache.[123] A 2005 review
found that the evidence was weak for effectiveness of chiropractic manipulation for tension
headache, and that it was probably more effective for tension headache than for migraine.[124]

Extremity conditions. A 2011 systematic review and meta-analysis concluded that the
addition of manual mobilizations to an exercise program for the treatment of knee
osteoarthritis resulted in better pain relief than a supervised exercise program alone and
suggested that manual therapists consider adding manual mobilization to optimize
supervised active exercise programs.[125] There is silver level evidence that manual therapy is
more effective than exercise for the treatment of hip osteoarthritis, however this evidence
could be considered to be inconclusive.[126] There is a small amount of research into the
efficacy of chiropractic treatment for upper limbs,[127] limited to low level evidence supporting
chiropractic management of shoulder pain[128] and limited or fair evidence supporting
chiropractic management of leg conditions.[129]

Other. A 2012 systematic review found insufficient low bias evidence to support the use of
spinal manipulation as a therapy for the treatment of hypertension.[130] A 2011 systematic
review found moderate evidence to support the use of manual therapy for cervicogenic
dizziness.[131] There is very weak evidence for chiropractic care for adult scoliosis (curved or
rotated spine)[132] and no scientific data for idiopathic adolescent scoliosis.[133] A 2007
systematic review found that few studies of chiropractic care for nonmusculoskeletal
conditions are available, and they are typically not of high quality; it also found that the entire
clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients
with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to
draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including
ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions.[134] Other
reviews have found no evidence of significant benefit for asthma,[135][136] baby colic,[137][138]
 bedwetting,[139] carpal tunnel syndrome,[140] fibromyalgia,[141] gastrointestinal disorders,[142]
kinetic imbalance due to suboccipital strain (KISS) in infants,[137][143] menstrual cramps,[144]
insomnia,[145] postmenopausal symptoms,[145] or pelvic and back pain during pregnancy.[146]
As there is no evidence of effectiveness or safety for cervical manipulation for baby colic, it is
not endorsed.[147]

Safety

Chiropractic adjustment on children

The World Health Organization found chiropractic care in general is safe when employed
skillfully and appropriately.[54] There is not sufficient data to establish the safety of chiropractic
manipulations.[13] Manipulation is regarded as relatively safe but complications can arise, and it
has known adverse effects, risks and contraindications.[54] 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.[54] 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.[54] 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.[148]
Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a
chiropractor.[8]

Spinal manipulation is associated with frequent, mild and temporary adverse effects,[14][148]
including new or worsening pain or stiffness in the affected region.[149] They have been
estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment
and disappear within 24 to 48 hours;[13] adverse reactions appear to be more common following
manipulation than mobilization.[150] The most frequently stated adverse effects are mild
headache, soreness, and briefly elevated pain fatigue.[151] Chiropractic is correlated with a very
high incidence of minor adverse effects.[8] Rarely,[54] 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[14] and children.[152] Estimates vary widely for the incidence of these
complications,[13] and the actual incidence 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.[14] Adverse effects are poorly reported in recent studies investigating chiropractic
manipulations.[153] A 2016 systematic review concludes that the level of reporting is unsuitable
and unacceptable.[154] Reports of serious adverse events have occurred, resulting from spinal
manipulation therapy of the lumbopelvic region.[155] Estimates for serious adverse events vary
from 5 strokes per 100,000 manipulations to 1.46 serious adverse events per 10 million
manipulations and 2.68 deaths per 10 million manipulations, though it was determined that
there was inadequate data to be conclusive.[13] Several case reports show temporal
associations between interventions and potentially serious complications.[156] The published
medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations
and many more seem to remain unpublished.[17]

Vertebrobasilar artery stroke (VAS) 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.[156][157] Weak
to moderately strong evidence supports causation (as opposed to statistical association)
between cervical manipulative therapy (CMT) and VAS.[158] There is insufficient evidence to
support a strong association or no association between cervical manipulation and stroke.[15]
While the biomechanical evidence is not sufficient to support the statement that CMT causes
cervical artery dissection (CD), clinical reports suggest that mechanical forces have a part in a
substantial number of CDs and the majority of population controlled studies found an
association between CMT and VAS in young people.[159] It is strongly recommended that
practitioners consider the plausibility of CD as a symptom, and people can be informed of the
association between CD and CMT before administrating manipulation of the cervical spine.[159]
There is controversy regarding the degree of risk of stroke from cervical manipulation.[15] Many
chiropractors state that, the association between chiropractic therapy and vertebral arterial
dissection is not proven.[17] However, it has been suggested that the causality between
chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is
probable[17] or definite.[16] There is very low evidence supporting a small association between
internal carotid artery dissection and chiropractic neck manipulation.[160] The incidence of
internal carotid artery dissection following cervical spine manipulation is unknown.[161] The
literature infrequently reports helpful data to better understand the association between cervical
manipulative therapy, cervical artery dissection and stroke.[162] The limited evidence is
inconclusive that chiropractic spinal manipulation therapy is not a cause of intracranial
hypotension.[163] Cervical intradural disc herniation is very rare following spinal manipulation
therapy.[164]

Chiropractors, like other primary care providers, sometimes employ diagnostic imaging
techniques such as X-rays and CT scans that rely on ionizing radiation.[165] Although there is no
clear evidence for the practice, some chiropractors may still X-ray a patient several times a
year.[57] Practice guidelines aim to reduce unnecessary radiation exposure,[165] which increases
cancer risk in proportion to the amount of radiation received.[166] Research suggests that
radiology instruction given at chiropractic schools worldwide seem to be evidence-based.[56]
Although, there seems to be a disparity between some schools and available evidence regarding
the aspect of radiography for patients with acute low back pain without an indication of a
serious disease, which may contribute to chiropractic overuse of radiography for low back
pain.[56]

Risk-benefit

A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for
cervical manipulation.[15] A 2010 systematic review stated that there is no good evidence to
assume that neck manipulation is an effective treatment for any medical condition and
suggested a precautionary principle in healthcare for chiropractic intervention even if a causality
with vertebral artery dissection after neck manipulation were merely a remote possibility.[17] The
same review concluded that the risk of death from manipulations to the neck outweighs the
benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not
evaluate the potential benefits of spinal manipulation.[167] Edzard Ernst stated "This detail was
not the subject of my review. I do, however, refer to such evaluations and should add that a
report recently commissioned by the General Chiropractic Council did not support many of the
outlandish claims made by many chiropractors across the world."[167] A 1999 review of 177
previously reported cases published between 1925 and 1997 in which injuries were attributed to
manipulation of the cervical spine (MCS) concluded that "The literature does not demonstrate
that the benefits of MCS outweigh the risks." The professions associated with each injury were
assessed. Physical therapists (PT) were involved in less than 2% of all cases, with no deaths
caused by PTs. Chiropractors were involved in a little more than 60% of all cases, including 32
deaths.[168]

A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is
associated with considerable harm and no compelling evidence exists to indicate that it
adequately prevents symptoms or diseases, thus the risk-benefit is not evidently favorable.[12]

Cost-effectiveness

A 2012 systematic review suggested that the use of spine manipulation in clinical practice is a
cost-effective treatment when used alone or in combination with other treatment
approaches.[169] A 2011 systematic review found evidence supporting the cost-effectiveness of
using spinal manipulation for the treatment of sub-acute or chronic low back pain; the results for
acute low back pain were insufficient.[11]

A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of

spinal manipulation in the United Kingdom compared favorably with other treatments for back
pain, but that reports were based on data from clinical trials without placebo controls and that
the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains
uncertain.[170] A 2005 American 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.[171] The
cost-effectiveness of maintenance chiropractic care is unknown.[106]

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative
medicine independent physician association (IPA) which looked the chiropractic services
utilization found that the clinical and cost utilization of chiropractic services based on 70,274
member-months over a 7-year period decreased patient costs associate with the following use
of services by 60% for in-hospital admissions, 59% for hospital days, 62% for outpatient
surgeries and procedures, and 85% for pharmaceutical costs when compared with conventional
medicine (visit to a medical doctor primary care provider) IPA performance for the same health
maintenance organization product in the same geography and time frame.[172]

Education, licensing, and regulation

Requirements vary between countries. In the U.S. chiropractors obtain a non-medical accredited
diploma in the field of chiropractic.[173] Chiropractic education in the U.S. has been criticized for
failing to meet generally accepted standards of evidence-based medicine.[174] The curriculum
content of North American chiropractic and medical colleges with regard to basic and clinical
sciences has little similarity, both in the kinds of subjects offered and in the time assigned to
each subject.[175] Accredited chiropractic programs in the U.S. require that applicants have 90
semester hours of undergraduate education with a grade point average of at least 3.0 on a 4.0
scale. Many programs require at least three years of undergraduate education, and more are
requiring a bachelor's degree.[176] Canada requires a minimum three years of undergraduate
education for applicants, and at least 4200 instructional hours (or the equivalent) of full‐time
chiropractic education for matriculation through an accredited chiropractic program.[177]
Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to
have at least 7–8 years of university level education.[178][179] 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.[54]

Upon graduation, there may be a requirement to pass national, state, or provincial board
examinations before being licensed to practice in a particular jurisdiction.[180][181] Depending on
the location, continuing education may be required to renew these licenses.[182][183] 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.[184]

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.[185][186] The U.S. CCE requires a mixing
curriculum, which means a straight-educated chiropractor may not be eligible for licensing in
states requiring CCE accreditation.[76] 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.[187] Today, there are 18 accredited Doctor of Chiropractic
programs in the U.S.,[188] 2 in Canada,[189] 6 in Australasia,[190] and 5 in Europe.[191] 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.[25] Of the two chiropractic colleges in Canada,
one is publicly funded (UQTR) and one is privately funded (CMCC). In 2005, CMCC was granted
the privilege of offering a professional health care degree under the Post-secondary Education
Choice and Excellence Act, which sets the program within the hierarchy of education in Canada
as comparable to that of other primary contact health care professions such as medicine,
dentistry and optometry.[178][179]

Regulatory colleges and chiropractic boards in the U.S., Canada, Mexico, and Australia are
responsible for protecting the public, standards of practice, disciplinary issues, quality
assurance and maintenance of competency.[192][193] There are an estimated 49,000
chiropractors in the U.S. (2008),[194] 6,500 in Canada (2010),[195] 2,500 in Australia (2000),[29] and
1,500 in the UK (2000).[196]

Chiropractors often argue that this education is as good as or better than medical physicians',
but most chiropractic training is confined to classrooms with much time spent learning theory,
adjustment, and marketing.[76] The fourth year of chiropractic education persistently showed the
highest stress levels.[197] Every student, irrespective of year, experienced different ranges of
stress when studying.[197] The chiropractic leaders and colleges have had internal struggles.[198]
Rather than cooperation, there has been infighting between different factions.[198] A number of
actions were posturing due to the confidential nature of the chiropractic colleges in an attempt
to enroll students.[198]

Ethics

The chiropractic oath is a modern variation of the classical Hippocratic Oath historically taken by
physicians and other healthcare professionals swearing to practice their professions
ethically.[199] The American Chiropractic Association (ACA) has an ethical code "based upon the
acknowledgement that the social contract dictates the profession's responsibilities to the
patient, the public, and the profession; and upholds the fundamental principle that the
paramount purpose of the chiropractic doctor's professional services shall be to benefit the
patient."[200] The International Chiropractor's Association (ICA) also has a set of professional
canons.[201]

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.[36] According to a
2015 Gallup poll of U.S. adults, the perception of chiropractors is generally favorable; two-thirds
of American adults agree that chiropractors have their patient's best interest in mind and more
than half also agree that most chiropractors are trustworthy. Less than 10% of US adults
disagreed with the statement that chiropractors were trustworthy.[202][203]
The charity Sense About Science launched a campaign to draw attention to the BCA legal case against science writer
Simon Singh.[204] In 2009, a number of organizations and public figures signed a statement entitled "The law has no place
in scientific disputes".[205]

Chiropractors, especially in America, have a reputation for unnecessarily treating patients.[57] In

many circumstances the focus seems to be put on economics instead of health care.[57]
Sustained chiropractic care is promoted as a preventive tool, but unnecessary manipulation
could possibly present a risk to patients.[8] Some chiropractors are concerned by the routine
unjustified claims chiropractors have made.[8] A 2010 analysis of chiropractic websites found
the majority of chiropractors and their associations made claims of effectiveness not supported
by scientific evidence, while 28% of chiropractor websites advocate lower back pain care, which
has some sound evidence.[206]

The US Office of the Inspector General (OIG) estimated that for calendar year 2013, 82% of
payments to chiropractors under Medicare Part B, a total of $359 million, did not comply with
Medicare requirements.[207] There have been at least 15 OIG reports about chiropractic billing
irregularities since 1986.[207]

In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against
Simon Singh inspired the filing of formal complaints of false advertising against more than 500
individual chiropractors within one 24-hour period,[208][209] prompting the McTimoney
Chiropractic Association to write to its members advising them to remove leaflets that make
claims about whiplash and colic from their practice, to be wary of new patients and telephone
inquiries, and telling their members: "If you have a website, take it down NOW" and "Finally, we
strongly suggest you do NOT discuss this with others, especially patients."[208] An editorial in
Nature suggested that the BCA may have been trying to suppress debate and that this use of
English libel law was a burden on the right to freedom of expression, which is protected by the
European Convention on Human Rights.[210] The libel case ended with the BCA withdrawing its
suit in 2010.[211][212]

Reception
Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in
many other countries.[18] It is viewed as a marginal and non-clinically–proven attempt at
complementary and alternative medicine, which has not integrated into mainstream
medicine.[64] Billions are spent annually for chiropractic services.[8]

Australia

In Australia, there are approximately 2488 chiropractors, or one chiropractor for every 7980
people.[213] Most private health insurance funds in Australia cover chiropractic care, and the
federal government funds chiropractic care when the patient is referred by a medical
practitioner.[214] In 2014, the chiropractic profession had a registered workforce of 4,684
practitioners in Australia represented by two major organizations — the Chiropractors’
Association of Australia (CAA) and the Chiropractic and Osteopathic College of Australasia
(COCA).[215] Annual expenditure on chiropractic care (alone or combined with osteopathy) in
Australia is estimated to be between AUD$750–988 million with musculoskeletal complaints
such as back and neck pain making up the bulk of consultations; and proportional expenditure is
similar to that found in other countries.[215] While Medicare (the Australian publicly funded
universal health care system) coverage of chiropractic services is limited to only those directed
by a medical referral to assist chronic disease management, most private health insurers in
Australia do provide partial reimbursement for a wider range of chiropractic services in addition
to limited third party payments for workers compensation and motor vehicle accidents.[215]

Of the 2,005 chiropractors who participated in a 2015 survey, 62.4% were male and the average
age was 42.1 (SD = 12.1) years.[215] Nearly all chiropractors (97.1%) had a bachelor's degree or
higher, with the majority of chiropractor's highest professional qualification being a bachelor or
double bachelor's degree (34.6%), followed by a master's degree (32.7%), Doctor of Chiropractic
(28.9%) or PhD (0.9%).[215] Only a small number of chiropractor's highest professional
qualification was a diploma (2.1%) or advanced diploma (0.8%).[215]

United Kingdom

In the United Kingdom, there are over 2,000 chiropractors, representing one chiropractor per
29,206 people.[213] Chiropractic is available on the National Health Service in some areas, such
as Cornwall, where the treatment is only available for neck or back pain.[216]
A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of
chiropractors disclosed to patients the serious risk associated with manipulation of the cervical
spine and that 46% believed there was possibility patients would refuse treatment if the risks
were correctly explained. However 80% acknowledged the ethical/moral responsibility to
disclose risk to patients.[217]

United States and Canada

The percentage of the population that utilizes chiropractic care at any given time generally falls
into a range from 6% to 12% in the U.S. and Canada,[218] with a global high of 20% in Alberta in
2006.[219] In 2008, chiropractors were reported to be the most common CAM providers for
children and adolescents, these patients representing up to 14% of all visits to chiropractors.[220]

There were around 50,330 chiropractors practicing in North America in 2000.[213] In 2008, this
has increased by almost 20% to around 60,000 chiropractors.[8] In 2002–03, the majority of
those who sought chiropractic did so for relief from back and neck pain and other
neuromusculoskeletal complaints;[20] most do so specifically for low back pain.[20][218] The
majority of U.S. chiropractors participate in some form of managed care.[9] Although the
majority of U.S. chiropractors view themselves as specialists in neuromusculoskeletal
conditions, many also consider chiropractic as a type of primary care.[9] In the majority of cases,
the care that chiropractors and physicians provide divides the market, however for some, their
care is complementary.[9]

In the U.S., chiropractors perform over 90% of all manipulative treatments.[221] Satisfaction rates
are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey
reporting 83% of respondents satisfied or very satisfied with their care; quality of communication
seems to be a consistent predictor of patient satisfaction with chiropractors.[222]

Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the
patient.[1] 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.[223] As of 2007 7% of the U.S. population is being reached by chiropractic.[224] They were
the third largest medical profession in the US in 2002, following physicians and dentists.[225]
Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster
than the average for all occupations.[194]
In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these
services.[220]

History

Daniel David (D.D.) Palmer, founder of Chiropractic

Chiropractic's origins lie in the folk medicine practice of bonesetting, in which untrained
practitioners engaged in joint manipulation or resetting fractured bones.[8] Chiropractic was
founded in 1895 by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer,
hypothesized that manual manipulation of the spine could cure disease.[226] The first
chiropractic patient of D.D. Palmer was Harvey Lillard, a worker in the building where Palmer's
office was located.[42] He claimed that he had severely reduced hearing for 17 years, which
started soon following a "pop" in his spine.[42] A few days following his adjustment, Lillard
claimed his hearing was almost completely restored.[42] Another of Palmer's patients, Samuel
Weed, coined the term chiropractic, from the Greek χειρο- chiro- (itself from χείρ cheir "hand"),
"hand" and πρακτικός praktikos, "practical".[227][228] Chiropractic is classified as a field of
pseudomedicine on account of its esoteric origins.[3]

Chiropractic competed with its predecessor osteopathy, another medical system based on
magnetic healing; both systems were founded by charismatic midwesterners in opposition to
the conventional medicine of the day, and both postulated that manipulation improved
health.[226] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching
it to a few students at his new Palmer School of Chiropractic.[22] 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.[22]

Early chiropractors believed that all disease was caused by interruptions in the flow of innate
intelligence, a vitalistic nervous energy or life force that represented God's presence in man;
chiropractic leaders often invoked religious imagery and moral traditions.[22] D.D. Palmer said he
"received chiropractic from the other world".[23] 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.[22][23] 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).[22]

B. J. Palmer, early developer of chiropractic

Chiropractic has seen considerable controversy and criticism.[25][26] Although D.D. and B.J. were
"straight" and disdained the use of instruments, some early chiropractors, whom B.J. scornfully
called "mixers", advocated the use of instruments.[22] 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.[22] The mixer camp grew until by 1924 B.J.
estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight.[22] That year, B.J.'s
invention and promotion of the neurocalometer, a temperature-sensing device, was highly
controversial among B.J.'s fellow straights. By the 1930s, chiropractic was the largest alternative
healing profession in the U.S.[22]

Harvey Lillard, first chiropractic patient

Chiropractors faced heavy opposition from organized medicine.[42] DD Palmer was jailed in 1907
for practicing medicine without a license.[229] Thousands of chiropractors were prosecuted for
practicing medicine without a license, and D.D. and many other chiropractors were jailed.[42] 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.[42] B.J. cofounded the Universal Chiropractors'
Association (UCA) to provide legal services to arrested chiropractors.[42] Although the UCA won
their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards
became increasingly common and in many cases were successful. In response, chiropractors
conducted political campaigns to secure separate licensing statutes, eventually succeeding in
all fifty states, from Kansas in 1913 through Louisiana in 1974.[42] The longstanding feud
between chiropractors and medical doctors continued for decades. The AMA labeled
chiropractic an "unscientific cult" in 1966,[30] and until 1980 advised its members that it was
unethical for medical doctors to associate with "unscientific practitioners".[230] 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.[9]
Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to
be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its
long battle with organized medicine.[42] 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.[42] 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.[9] 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.[9] The profession responded by marketing
natural products and devices more aggressively, and by reaching deeper into alternative
medicine and primary care.[9]

Public health

Some chiropractors oppose vaccination and water fluoridation, which are common public health
practices.[36] Within the chiropractic community there are significant disagreements about
vaccination, one of the most cost-effective public health interventions available.[231] Most
chiropractic writings on vaccination focus on its negative aspects,[28] claiming that it is
hazardous, ineffective, and unnecessary.[29] 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.[29] The extent to
which anti-vaccination views perpetuate the current chiropractic profession is uncertain.[28] 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.[29] The Canadian Chiropractic Association supports vaccination;[28] a survey in Alberta
in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating
themselves or their children.[232] Many even reject the fact that smallpox has been eradicated
and they believe it was renamed monkeypox.[232]

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose
it as being incompatible with chiropractic philosophy and an infringement of personal freedom.
Other chiropractors have actively promoted fluoridation, and several chiropractic organizations
have endorsed scientific principles of public health.[233] In addition to traditional chiropractic
opposition to water fluoridation and vaccination, chiropractors' attempts to establish a positive
reputation for their public health role are also compromised by their reputation for
recommending repetitive lifelong chiropractic treatment.[36]

Controversy

Throughout its history chiropractic has been the subject of internal and external controversy and
criticism.[21][234] According to Daniel D. Palmer, the founder of chiropractic, subluxation is the
sole cause of disease and manipulation is the cure for all diseases of the human race.[8][50] A
2003 profession-wide survey[43] found "most chiropractors (whether 'straights' or 'mixers') still
hold views of innate intelligence and of the cause and cure of disease (not just back pain)
consistent with those of the Palmers."[235] A critical evaluation stated "Chiropractic is rooted in
mystical concepts. This led to an internal conflict within the chiropractic profession, which
continues today."[8] Chiropractors, including D.D. Palmer, were jailed for practicing medicine
without a license.[8] For most of its existence, chiropractic has battled with mainstream
medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.[42]
Collectively, systematic reviews have not demonstrated that spinal manipulation, the main
treatment method employed by chiropractors, is effective for any medical condition, with the
possible exception of treatment for back pain.[8] Chiropractic remains controversial, though to a
lesser extent than in past years.[25]

See also

List of topics characterized as pseudoscience

Chiropractic education

Chiropractic schools

Councils on Chiropractic Education International

Toftness device

World Federation of Chiropractic

References

1. Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the
chiropractic profession". In Haldeman S, Dagenais S, Budgell B, et al. (eds.). Principles and Practice of
Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 978-0-07-137534-4.
2. Nelson CF, Lawrence DJ, Triano JJ, Bronfort G, Perle SM, Metz RD, Hegetschweiler K, LaBrot T (2005).
"Chiropractic as spine care: a model for the profession" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
1185558) . Chiropractic & Osteopathy. 13 (1): 9. doi:10.1186/1746-1340-13-9 (https://doi.org/10.1186%
2F1746-1340-13-9) . PMC 1185558 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1185558) .
PMID 16000175 (https://pubmed.ncbi.nlm.nih.gov/16000175) .

3. Swanson ES (2015). "Pseudoscience" (https://books.google.com/books?id=tQmhCgAAQBAJ&pg=PA6

5) . Science and Society: Understanding Scientific Methodology, Energy, Climate, and Sustainability.
Springer. p. 65. ISBN 978-3-319-21987-5.

4. For an explanation regarding the description of chiropractic as a pseudoscience, see:

Singh, Simon; Ernst, Edzard (2008). "The Truth About Chiropractic Therapy". Trick or Treatment?
Alternative Medicine on Trial. London: Bantam Press. ISBN 978-0-593-06129-9. OCLC 190777228 (ht
tps://www.worldcat.org/oclc/190777228) .

Hall, Harriet (March 11, 2008). "Science and Chiropractic" (https://sciencebasedmedicine.org/scienc

e-and-chiropractic/) . sciencebasedmedicine.org. New England Skeptical Society. Archived (https://
web.archive.org/web/20190512192031/https://sciencebasedmedicine.org/science-and-chiropract
ic/) from the original on May 12, 2019. Retrieved 2020-02-15.

Hansson, Sven Ove (2017-06-01). "Science denial as a form of pseudoscience". Studies in History
and Philosophy of Science Part A. 63: 39–47. Bibcode:2017SHPSA..63...39H (https://ui.adsabs.harv
ard.edu/abs/2017SHPSA..63...39H) . doi:10.1016/j.shpsa.2017.05.002 (https://doi.org/10.1016%2
Fj.shpsa.2017.05.002) . ISSN 0039-3681 (https://www.worldcat.org/issn/0039-3681) .
PMID 28629651 (https://pubmed.ncbi.nlm.nih.gov/28629651) .

Ernst, Edzard (2009-04-01). "Complementary/alternative medicine: engulfed by postmodernism, anti-

science and regressive thinking" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662117) . The
British Journal of General Practice. 59 (561): 298–301. doi:10.3399/bjgp09X420482 (https://doi.org/
10.3399%2Fbjgp09X420482) . ISSN 0960-1643 (https://www.worldcat.org/issn/0960-1643) .
PMC 2662117 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662117) . PMID 19341568 (http
s://pubmed.ncbi.nlm.nih.gov/19341568) .

Hall, Harriet (May 2020). "Applied kinesiology and other chiropractic delusions". Skeptical Inquirer.
44 (3): 21–23.

Novella, Steven (March 22, 2017). "Cracking Down on Chiropractic Pseudoscience" (https://web.arch
ive.org/web/20191219214428/https://sciencebasedmedicine.org/cracking-down-on-chiropractic-ps
eudoscience/) . sciencebasedmedicine.org. New England Skeptical Society. Archived from the
original (https://sciencebasedmedicine.org/cracking-down-on-chiropractic-pseudoscience/) on
December 19, 2019. Retrieved 2019-12-19.

Williams, William F. (2000). Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy.
Facts on File Inc. p. 51. ISBN 1-57958-207-9
 5. Mootz RD, Shekelle PG (1997). "Content of practice" (http://chiroweb.com/archives/ahcpr/chapter3.ht
m) . In Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and Research.
Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366 (https://www.wo
rldcat.org/oclc/39856366) . AHCPR Pub No. 98-N002.

6. "The DC as PCP? Drug Wars Resume – Science-Based Medicine" (https://sciencebasedmedicine.org/the-

dc-as-pcp-drug-wars-resume/) . sciencebasedmedicine.org. 2019-12-18. Archived (https://web.archive.
org/web/20191218003248/https://sciencebasedmedicine.org/the-dc-as-pcp-drug-wars-resume/) from
the original on 2019-12-18. Retrieved 2020-03-27.

7. Bellamy, Jann (December 20, 2018). "Legislative Alchemy 2018: Chiropractors rebranding as primary care
physicians continues" (https://sciencebasedmedicine.org/legislative-alchemy-2018-chiropractors-rebran
ding-as-primary-care-physicians-continues/) . sciencebasedmedicine.org. Archived (https://web.archiv
e.org/web/20191219062602/https://sciencebasedmedicine.org/legislative-alchemy-2018-chiropractors-r
ebranding-as-primary-care-physicians-continues/) from the original on December 19, 2019. Retrieved
2019-12-18.

8. Ernst E (May 2008). "Chiropractic: a critical evaluation" (https://doi.org/10.1016%2Fj.jpainsymman.2007.

07.004) . Journal of Pain and Symptom Management. 35 (5): 544–62.
doi:10.1016/j.jpainsymman.2007.07.004 (https://doi.org/10.1016%2Fj.jpainsymman.2007.07.004) .
PMID 18280103 (https://pubmed.ncbi.nlm.nih.gov/18280103) .

9. Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues" (https://www.ncbi.nl
m.nih.gov/pmc/articles/PMC2690192) . Milbank Quarterly. 81 (1): 107–38, table of contents.
doi:10.1111/1468-0009.00040 (https://doi.org/10.1111%2F1468-0009.00040) . PMC 2690192 (https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2690192) . PMID 12669653 (https://pubmed.ncbi.nlm.nih.go
v/12669653) .

10. Posadzki P, Ernst E (2011). "Spinal manipulation: an update of a systematic review of systematic
reviews". The New Zealand Medical Journal. 124 (1340): 55–71. PMID 21952385 (https://pubmed.ncbi.nl
m.nih.gov/21952385) .

11. Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW (2011). "Cost-effectiveness of guideline-
endorsed treatments for low back pain: a systematic review" (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC3176706) . European Spine Journal. 20 (7): 1024–38. doi:10.1007/s00586-010-1676-3 (https://d
oi.org/10.1007%2Fs00586-010-1676-3) . PMC 3176706 (https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3176706) . PMID 21229367 (https://pubmed.ncbi.nlm.nih.gov/21229367) .

12. Ernst E (2009). "Chiropractic maintenance treatment, a useful preventative approach?". Preventive
Medicine. 49 (2–3): 99–100. doi:10.1016/j.ypmed.2009.05.004 (https://doi.org/10.1016%2Fj.ypmed.200
9.05.004) . PMID 19465044 (https://pubmed.ncbi.nlm.nih.gov/19465044) .
13. Gouveia LO, Castanho P, Ferreira JJ (2009). "Safety of chiropractic interventions: a systematic review" (htt
p://www.chiropratiquelasource.com/recherches/safety.pdf) (PDF). Spine. 34 (11): E405–13.
doi:10.1097/BRS.0b013e3181a16d63 (https://doi.org/10.1097%2FBRS.0b013e3181a16d63) .
PMID 19444054 (https://pubmed.ncbi.nlm.nih.gov/19444054) . S2CID 21279308 (https://api.semantics
cholar.org/CorpusID:21279308) .

14. Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review" (https://web.archive.org/we
b/20100516074554/http://jrsm.rsmjournals.com/cgi/content/full/100/7/330) . Journal of the Royal
Society of Medicine. 100 (7): 330–38. doi:10.1258/jrsm.100.7.330 (https://doi.org/10.1258%2Fjrsm.100.
7.330) . PMC 1905885 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905885) . PMID 17606755
(https://pubmed.ncbi.nlm.nih.gov/17606755) . Archived from the original on 2010-05-16. Lay summary
(http://www.medicalnewstoday.com/articles/75754.php) – Med News Today (2007-07-02).

15. Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ (2012). "Assessing the risk of stroke
from neck manipulation: a systematic review" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC35067
37) . International Journal of Clinical Practice. 66 (10): 940–47. doi:10.1111/j.1742-1241.2012.03004.x
(https://doi.org/10.1111%2Fj.1742-1241.2012.03004.x) . PMC 3506737 (https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3506737) . PMID 22994328 (https://pubmed.ncbi.nlm.nih.gov/22994328) .

16. Ernst E (2010). "Vascular accidents after neck manipulation: cause or coincidence?". International
Journal of Clinical Practice. 64 (6): 673–77. doi:10.1111/j.1742-1241.2009.02237.x (https://doi.org/10.1
111%2Fj.1742-1241.2009.02237.x) . PMID 20518945 (https://pubmed.ncbi.nlm.nih.gov/20518945) .
S2CID 38571730 (https://api.semanticscholar.org/CorpusID:38571730) .

17. Ernst E (2010). "Deaths after chiropractic: a review of published cases". International Journal of Clinical
Practice. 64 (8): 1162–65. doi:10.1111/j.1742-1241.2010.02352.x (https://doi.org/10.1111%2Fj.1742-12
41.2010.02352.x) . PMID 20642715 (https://pubmed.ncbi.nlm.nih.gov/20642715) . S2CID 45225661
(https://api.semanticscholar.org/CorpusID:45225661) .

18. Tetrault M (2004). "Global professional strategy for chiropractic" (https://web.archive.org/web/20080625

173624/http://chiropracticdiplomatic.com/strategies/global_strategy.pdf) (PDF). Chiropractic
Diplomatic Corps. Archived from the original (http://chiropracticdiplomatic.com/strategies/global_strate
gy.pdf) (PDF) on 2008-06-25. Retrieved 2008-04-18.

19. Norris P (2001). "How 'we' are different from 'them': occupational boundary maintenance in the treatment
of musculo-skeletal problems". Sociology of Health and Illness. 23 (1): 24–43. doi:10.1111/1467-
9566.00239 (https://doi.org/10.1111%2F1467-9566.00239) .

20. Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in
North America: findings from the joint Canada/United States Survey of Health, 2002-03" (https://www.ncb
i.nlm.nih.gov/pmc/articles/PMC1458338) . BMC Health Services Research. 6: 49. doi:10.1186/1472-
6963-6-49 (https://doi.org/10.1186%2F1472-6963-6-49) . PMC 1458338 (https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC1458338) . PMID 16600038 (https://pubmed.ncbi.nlm.nih.gov/16600038) .
21. Kaptchuk TJ, Eisenberg DM (November 1998). "Chiropractic: origins, controversies, and contributions" (ht
tps://doi.org/10.1001%2Farchinte.158.20.2215) . Archives of Internal Medicine. 158 (20): 2215–24.
doi:10.1001/archinte.158.20.2215 (https://doi.org/10.1001%2Farchinte.158.20.2215) . PMID 9818801
(https://pubmed.ncbi.nlm.nih.gov/9818801) .

22. Martin SC (October 1993). "Chiropractic and the social context of medical technology, 1895-1925".
Technology and Culture. 34 (4): 808–34. doi:10.2307/3106416 (https://doi.org/10.2307%2F3106416) .
JSTOR 3106416 (https://www.jstor.org/stable/3106416) . PMID 11623404 (https://pubmed.ncbi.nlm.ni
h.gov/11623404) .

23. D.D. Palmer's Religion of Chiropractic (http://www.chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's

_Religion-of-Chiro.pdf)  – Letter from D.D. Palmer to P.W. Johnson, D.C., May 4, 1911. In the letter, he
often refers to himself with royal third person terminology and also as "Old Dad".

24. Lazarus, David (June 30, 2017). Column: Chiropractic treatment, a $15-billion industry, has its roots in a
ghost story. (https://www.latimes.com/business/lazarus/la-fi-lazarus-chiropractic-quackery-20170630-st
ory.html) Archived (https://web.archive.org/web/20200719094829/https://www.latimes.com/busines
s/lazarus/la-fi-lazarus-chiropractic-quackery-20170630-story.html) July 19, 2020, at the Wayback
Machine --- "Daniel David Palmer, the 'father' of chiropractic who performed the first chiropractic
adjustment in 1895, was an avid spiritualist. He maintained that the notion and basic principles of
chiropractic treatment were passed along to him during a seance by a long-dead doctor. 'The knowledge
and philosophy given me by Dr. Jim Atkinson, an intelligent spiritual being ... appealed to my reason,'
Palmer wrote in his memoir The Chiropractor, which was published in 1914 after his death in Los
Angeles. Atkinson had died 50 years prior to Palmer's epiphany." Los Angeles Times. Retrieved:
September 25, 2019.

25. DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint".
Clinical Orthopaedics and Related Research. 444: 243–49. doi:10.1097/01.blo.0000203460.89887.8d (ht
tps://doi.org/10.1097%2F01.blo.0000203460.89887.8d) . PMID 16523145 (https://pubmed.ncbi.nlm.ni
h.gov/16523145) . S2CID 35775630 (https://api.semanticscholar.org/CorpusID:35775630) .

26. Homola S (2006). "Chiropractic: history and overview of theories and methods" (https://zenodo.org/recor
d/889994) . Clinical Orthopaedics and Related Research. 444: 236–42.
doi:10.1097/01.blo.0000200258.95865.87 (https://doi.org/10.1097%2F01.blo.0000200258.95865.87) .
PMID 16446588 (https://pubmed.ncbi.nlm.nih.gov/16446588) .
27. Joseph C. Keating, Jr.; Cleveland CS III; Menke M (2005). "Chiropractic history: a primer" (https://web.arch
ive.org/web/20130619204140/http://www.historyofchiropractic.org/assets/documents/ChiroHistoryPri
mer.pdf) (PDF). Association for the History of Chiropractic. Archived from the original (http://www.histo
ryofchiropractic.org/assets/documents/ChiroHistoryPrimer.pdf) (PDF) on 19 June 2013. Retrieved
2008-06-16. "A significant and continuing barrier to scientific progress within chiropractic are the anti-
scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a
century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness
of various theories and methods as a counterpoint to allopathic charges of quackery has created a
defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz
1989). One example of this conundrum is the continuing controversy about the presumptive target of
DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994)."

28. Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments" (http://jmptonline.or
g/article/S0161-4754(05)00111-9/fulltext) . Journal of Manipulative and Physiological Therapeutics. 28
(5): 367–73. doi:10.1016/j.jmpt.2005.04.011 (https://doi.org/10.1016%2Fj.jmpt.2005.04.011) .
PMID 15965414 (https://pubmed.ncbi.nlm.nih.gov/15965414) .

29. Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective" (htt
p://pediatrics.aappublications.org/cgi/content/full/105/4/e43) . Pediatrics. 105 (4): e43.
doi:10.1542/peds.105.4.e43 (https://doi.org/10.1542%2Fpeds.105.4.e43) . PMID 10742364 (https://pu
bmed.ncbi.nlm.nih.gov/10742364) .

30. Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, Hawk C, Injeyan HS, Killinger L,
Kopansky-Giles D, Lisi AJ, Mior SA, Smith M (2008). "Chiropractic and public health: current state and
future vision". Journal of Manipulative and Physiological Therapeutics. 31 (6): 397–410.
doi:10.1016/j.jmpt.2008.07.001 (https://doi.org/10.1016%2Fj.jmpt.2008.07.001) . PMID 18722194 (http
s://pubmed.ncbi.nlm.nih.gov/18722194) .

31. WFC Public Health Committee and WFC Research Committee (March 17, 2020). COVID-19 Advice for
Chiropractors (https://www.wfc.org/website/images/wfc/Latest_News_and_Features/Coronavirus_state
ment_2020_03_17.pdf) World Federation of Chiropractic.

32. Robert C. Jones, et al. Not Business as Usual: A Safe, Responsible Response to COVID-19 (https://www.a
catoday.org/News-Publications/Coronavirus-COVID-19/Safe-Responsible-Response) American
Chiropractic Association

33. MICHELLE R. SMITH, SCOTT BAUER and MIKE CATALINI (October 8, 2021). Anti-vaccine chiropractors
rising force of misinformation. (https://apnews.com/article/anti-virus-chiropractors-rising-force-misinfor
mation-02b347767b45cab1d6d532be03c57529) Associated Press.

34. Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B, et al. (eds.).
Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 77–98. ISBN 978-0-07-137534-4.
35. Mootz RD, Phillips RB (1997). "Chiropractic belief systems" (http://chiroweb.com/archives/ahcpr/chapter
2.htm) . In Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and
Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366 (http
s://www.worldcat.org/oclc/39856366) . AHCPR Pub No. 98-N002.

36. Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF (Aug 2008). "How can chiropractic become a
respected mainstream profession? The example of podiatry" (https://web.archive.org/web/20090325124
358/http://chiroandosteo.com/content/pdf/1746-1340-16-10.pdf) (PDF). Chiropractic & Osteopathy.
16: 10. doi:10.1186/1746-1340-16-10 (https://doi.org/10.1186%2F1746-1340-16-10) . PMC 2538524 (ht
tps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2538524) . PMID 18759966 (https://pubmed.ncbi.nlm.ni
h.gov/18759966) . Archived from the original (http://chiroandosteo.com/content/pdf/1746-1340-16-1
0.pdf) (PDF) on 2009-03-25. Retrieved 2008-09-16.

37. Gay RE, Nelson CF (2003). "Chiropractic philosophy" (https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=altr

ehab.section.336) . In Wainapel SF, Fast A (eds.). Alternative Medicine and Rehabilitation: a Guide for
Practitioners. New York: Demos Medical Publishing. ISBN 978-1-888799-66-8.

38. "Chiropractic" (http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx) . NHS Choices. 20

August 2014. Retrieved 19 September 2016.

39. Freeman J (February 2005). "Towards a definition of holism" (https://www.ncbi.nlm.nih.gov/pmc/articles/

PMC1463203) . The British Journal of General Practice. 55 (511): 154–55. PMC 1463203 (https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC1463203) . PMID 15720949 (https://pubmed.ncbi.nlm.nih.gov/1572
0949) .

40. Martin Gardner (1 June 1957). Fads and Fallacies in the Name of Science (https://books.google.com/boo
ks?id=TwP3SGAUsnkC&pg=PA227) . Courier Corporation. pp. 227–. ISBN 978-0-486-20394-2.

41. Raso J (1997). "Dictionary of Metaphysical Healthcare – Glossary" (http://www.quackwatch.com/01Quac

keryRelatedTopics/dictionary/mdglos.html) . Quackwatch. Retrieved 12 February 2016.

42. Keating JC Jr; Cleveland CS III; Menke M (2005). "Chiropractic history: a primer" (https://web.archive.org/
web/20140424011335/http://ahc.memberclicks.net/assets/documents/ChiroHistoryPrimer.pdf) (PDF).
Association for the History of Chiropractic. Archived from the original (http://ahc.memberclicks.net/asset
s/documents/ChiroHistoryPrimer.pdf) (PDF) on 2014-04-24. Retrieved 2008-06-16.

43. McDonald WP, Durkin KF, Pfefer M, et al. (2003). How Chiropractors Think and Practice: The Survey of
North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 978-
0-9728055-5-1. Summarized in: McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and
practice: the survey of North American chiropractors". Seminars in Integrative Medicine. 2 (3): 92–8.
doi:10.1016/j.sigm.2004.07.002 (https://doi.org/10.1016%2Fj.sigm.2004.07.002) . Lay summary (htt
p://chiroweb.com/archives/21/12/19.html) – Dyn Chiropr (2003-06-02).
44. Smith M, Carber LA (2008). "Survey of US Chiropractor Attitudes and Behaviors about Subluxation" (http
s://web.archive.org/web/20120425234244/http://archive.journalchirohumanities.com/Vol%2015/JChiro
prHumanit2008v15-19-26.pdf) (PDF). Journal of Chiropractic Humanities. 15: 19–26.
doi:10.1016/s1556-3499(13)60166-7 (https://doi.org/10.1016%2Fs1556-3499%2813%2960166-7) .
Archived from the original (http://archive.journalchirohumanities.com/Vol%2015/JChiroprHumanit2008v
15-19-26.pdf) (PDF) on 2012-04-25.

45. Benedetti, Paul; MacPhail, Wayne (2002-01-01). Spin Doctors: The Chiropractic Industry Under
Examination (https://books.google.com/books?id=zHxockt9CWQC) . Dundurn. p. 18.
ISBN 9781550024067.

46. "Definition of Subluxation" (https://www.merriam-webster.com/dictionary/subluxation) . Merriam-

Webster. Retrieved January 4, 2018.

47. "luxation (n.)" (https://www.etymonline.com/word/luxation#:~:text=luxation%20(n.),a%20word%20of%20

uncertain%20origin) . Online Etymology Dictionary. Retrieved July 28, 2021.

48. Keating J. C. Jr (1995). "D. D. Palmer's forgotten theories of chiropractic" (http://chiro.org/Plus/History/P

ersons/PalmerDD/PalmerDD's_Forgotten_Theories1995.pdf) (PDF). Association for the History of
Chiropractic. Retrieved 2008-05-14.

49. Keating JC Jr (2005). "A brief history of the chiropractic profession". In Haldeman S, Dagenais S, Budgell
B, et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 23–64. ISBN 978-0-07-
137534-4.

50. Palmer DD (1910). The Chiropractor's Adjuster: Text-book of the Science, Art and Philosophy of
Chiropractic for Students and Practitioners (https://www.scribd.com/doc/45233534/s-Adjuster-1910) .
Portland, OR: Portland Printing House Co. OCLC 17205743 (https://www.worldcat.org/oclc/17205743) .
"A subluxated vertebra ... is the cause of 95 percent of all diseases ... The other five percent is caused by
displaced joints other than those of the vertebral column."

51. Keating JC, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (August 2005). "Subluxation:
dogma or science?" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1208927) . Chiropractic &
Osteopathy. 13: 17. doi:10.1186/1746-1340-13-17 (https://doi.org/10.1186%2F1746-1340-13-17) .
PMC 1208927 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1208927) . PMID 16092955 (https://pu
bmed.ncbi.nlm.nih.gov/16092955) .

52. Rose KA, Adams A (2000). "A survey of the use of evidence-based health care in chiropractic college
clinics" (https://wayback.archive-it.org/all/20081002073736/http://www.journalchiroed.com/2000/JCEF
all2000Rose.PDF) (PDF). Journal of Chiropractic Education. 14 (2): 71–77. Archived from the original (h
ttp://www.journalchiroed.com/2000/JCEFall2000Rose.PDF) (PDF) on 2008-10-02.
53. Homola S (2006). "Can chiropractors and evidence-based manual therapists work together? an opinion
from a veteran chiropractor" (http://jmmtonline.com/documents/HomolaV14N2E.pdf) (PDF). Journal of
Manual & Manipulative Therapy. 14 (2): E14–18. CiteSeerX 10.1.1.366.2817 (https://citeseerx.ist.psu.ed
u/viewdoc/summary?doi=10.1.1.366.2817) . doi:10.1179/jmt.2006.14.2.14E (https://doi.org/10.1179%
2Fjmt.2006.14.2.14E) . S2CID 71826135 (https://api.semanticscholar.org/CorpusID:71826135) .

54. World Health Organization (2005). WHO guidelines on basic training and safety in chiropractic (https://w
ww.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf) (PDF). ISBN 978-92-4-159371-7.
Retrieved 2008-02-29.

55. Jenkins, HJ (5 October 2016). "Awareness of radiographic guidelines for low back pain: a survey of
Australian chiropractors" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051064) . Chiropractic &
Manual Therapies. 24: 39. doi:10.1186/s12998-016-0118-7 (https://doi.org/10.1186%2Fs12998-016-011
8-7) . PMC 5051064 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051064) . PMID 27713818 (htt
ps://pubmed.ncbi.nlm.nih.gov/27713818) .

56. Ammendolia C, Taylor JA, Pennick V, Côté P, Hogg-Johnson S, Bombardier C (2008). "Adherence to
radiography guidelines for low back pain: A survey of chiropractic schools worldwide". Journal of
Manipulative and Physiological Therapeutics. 31 (6): 412–18. doi:10.1016/j.jmpt.2008.06.010 (https://do
i.org/10.1016%2Fj.jmpt.2008.06.010) . PMID 18722195
(https://pubmed.ncbi.nlm.nih.gov/18722195) .

57. Singh, S; Ernst, E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts
about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6.

58. David Chapman-Smith (2000). "Principles and Goals of Chiropractic Care". The Chiropractic Profession:
Its Education, Practice, Research and Future Directions. NCMIC Group. p. 160. ISBN 978-1-892734-02-0.

59. "Guidance on claims made for the chiropractic vertebral subluxation complex" (https://www.webcitation.
org/5xywlByZ0?url=http://www.gcc-uk.org/files/link_file/Guidance_on_claims_made_for_the_chiropractic
_VSC_18August10.pdf) (PDF). General Chiropractic Council. Archived from the original (http://www.gcc-
uk.org/files/link_file/Guidance_on_claims_made_for_the_chiropractic_VSC_18August10.pdf) (PDF) on
2011-04-16. Retrieved 2010-09-30.

60. NBCE (2014), About Chiropractic (https://web.archive.org/web/20150619234625/http://www.nbce.org/a

bout/about_chiropractic/) , National Board of Chiropractic Examiners, archived from the original (http://
www.nbce.org/about/about_chiropractic/) on June 19, 2015, retrieved February 1, 2015

61. Hall, Harriet (June 1, 2017). "Chiropractors: Pro and Con" (https://skepticalinquirer.org/exclusive/chiropra
ctors-pro-and-con/) . Skeptical Inquirer. Retrieved July 28, 2021.

62. Benedetti, Paul; MacPhail, Wayne (2002). Spin Doctors: The Chiropractic Industry Under Examination (htt
ps://books.google.com/books?id=vagrYOk47VEC&pg=PA198) . Toronto: Dundurn Group. p. 198.
ISBN 1-55002-406-X.

63. "Chirobase" (https://quackwatch.org/chiropractic/) . Quackwatch. 7 May 2019. Retrieved July 28, 2021.
64. Villanueva-Russell Y (June 2011). "Caught in the crosshairs: identity and cultural authority within
chiropractic". Social Science & Medicine. 72 (11): 1826–37. doi:10.1016/j.socscimed.2011.03.038 (http
s://doi.org/10.1016%2Fj.socscimed.2011.03.038) . PMID 21531061 (https://pubmed.ncbi.nlm.nih.gov/
21531061) .

65. Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and
alternative medicine". Annals of Internal Medicine. 136 (3): 216–27. CiteSeerX 10.1.1.694.4126 (https://ci
teseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.694.4126) . doi:10.7326/0003-4819-136-3-
200202050-00010 (https://doi.org/10.7326%2F0003-4819-136-3-200202050-00010) . PMID 11827498
(https://pubmed.ncbi.nlm.nih.gov/11827498) . S2CID 16782086 (https://api.semanticscholar.org/Corpu
sID:16782086) .

66. Gleberzon BJ, Cooperstein R, Perle SM (2005). "Can chiropractic survive its chimerical nature?" (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC1840015) . The Journal of the Canadian Chiropractic
Association. 49 (2): 69–73. PMC 1840015 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1840015) .
PMID 17549192 (https://pubmed.ncbi.nlm.nih.gov/17549192) .

67. Redwood D, Hawk C, Cambron J, Vinjamury SP, Bedard J (2008). "Do chiropractors identify with
complementary and alternative medicine? results of a survey". The Journal of Alternative and
Complementary Medicine. 14 (4): 361–68. doi:10.1089/acm.2007.0766 (https://doi.org/10.1089%2Fac
m.2007.0766) . PMID 18435599 (https://pubmed.ncbi.nlm.nih.gov/18435599) .

68. Bellamy, Jann J (2010). "Legislative alchemy: the US state chiropractic practice acts". Focus on
Alternative and Complementary Therapies. 15 (3): 214–22. doi:10.1111/j.2042-7166.2010.01032.x (http
s://doi.org/10.1111%2Fj.2042-7166.2010.01032.x) .

69. Jones-Harris, Amanda R (October 2010). "Are chiropractors in the uk primary healthcare or primary
contact practitioners?: a mixed methods study" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161
390) . Chiropractic & Osteopathy. 18 (28): 28. doi:10.1186/1746-1340-18-28 (https://doi.org/10.1186%2
F1746-1340-18-28) . PMC 3161390 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161390) .
PMID 20979615 (https://pubmed.ncbi.nlm.nih.gov/20979615) .

70. Theberge N (January 2008). "The integration of chiropractors into healthcare teams: a case study from
sport medicine". Sociology of Health & Illness. 30 (1): 19–34. doi:10.1111/j.1467-9566.2007.01026.x (htt
ps://doi.org/10.1111%2Fj.1467-9566.2007.01026.x) . PMID 18254831 (https://pubmed.ncbi.nlm.nih.go
v/18254831) .

71. Pettman E (2007). "A history of manipulative therapy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2

565620) . Journal of Manual & Manipulative Therapy. 15 (3): 165–74.
doi:10.1179/106698107790819873 (https://doi.org/10.1179%2F106698107790819873) .
PMC 2565620 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565620) . PMID 19066664 (https://pu
bmed.ncbi.nlm.nih.gov/19066664) .
72. Baer HA (2006). "The drive for legitimization by osteopathy and chiropractic in Australia: between
heterodoxy and orthodoxy" (https://doi.org/10.1177%2F1533210106292467) . Complementary Health
Practice Review. 11 (2): 77–94. doi:10.1177/1533210106292467 (https://doi.org/10.1177%2F15332101
06292467) .

73. Parkman CA (2004). "Issues in credentialing CAM providers". The Case Manager. 15 (4): 24–27.
doi:10.1016/j.casemgr.2004.05.004 (https://doi.org/10.1016%2Fj.casemgr.2004.05.004) .
PMID 15247891 (https://pubmed.ncbi.nlm.nih.gov/15247891) .

74. Occupational And Professional Licensing, Chiropractic Practitioners, Chiropractic Advanced Practice
Certification Registry (http://www.nmcpr.state.nm.us/nmac/parts/title16/16.004.0015.htm) Archived
(https://web.archive.org/web/20100317015229/http://www.nmcpr.state.nm.us/nmac/parts/title16/16.0
04.0015.htm) 2010-03-17 at the Wayback Machine. Retrieved 2010-05-03.

75. Occupational And Professional Licensing, Chiropractic Practitioners, Chiropractic Advanced Practice
Certification Registry (PDF) (http://www.rld.state.nm.us/uploads/files/2010%20APC%20Formulary%28
1%29.pdf) Retrieved 2010-05-03.

76. Morrison P (2009). "Adjusting the role of chiropractors in the United States: why narrowing chiropractor
scope of practice statutes will protect patients". Health Matrix. 19 (2): 493–537. PMID 19715143 (https://
pubmed.ncbi.nlm.nih.gov/19715143) .

77. Wangler M, Zaugg B, Faigaux E (2010). "Medication Prescription: A Pilot Survey of Bernese Doctors of
Chiropractic Practicing in Switzerland". Journal of Manipulative and Physiological Therapeutics. 33 (3):
231–37. doi:10.1016/j.jmpt.2010.01.013 (https://doi.org/10.1016%2Fj.jmpt.2010.01.013) .
PMID 20350678 (https://pubmed.ncbi.nlm.nih.gov/20350678) .

78. "Scope of Practice: Complementary and alternative veterinary medicine (CAVM) and other practice act
exemptions" (https://www.avma.org/Advocacy/StateAndLocal/Pages/sr-cavm-exemptions.aspx) .
American Veterinary Medical Association. May 2019. Retrieved April 1, 2016.

79. ACA House of Delegates (1994). " 'Veterinary' chiropractic" (https://web.archive.org/web/200805170559

38/http://www.amerchiro.org/level2_css.cfm?T1ID=10&T2ID=117#107) . American Chiropractic
Association. Archived from the original (http://amerchiro.org/level2_css.cfm?T1ID=10&T2ID=117#107)
on May 17, 2008. Retrieved 2008-07-05.

80. Kamen, Daniel (June 18, 2001). "Politics and technique" (https://www.dynamicchiropractic.com/mpacm
s/dc/article.php?id=18081) . Dynamic Chiropractic. 19 (13).

81. Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of
chiropractic". Social Science & Medicine. 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017 (https://
doi.org/10.1016%2Fj.socscimed.2004.05.017) . PMID 15550303 (https://pubmed.ncbi.nlm.nih.gov/155
50303) .
82. Anderson, Chantal (2009-01-22). "Physical therapists, chiropractors square off over bill" (https://web.arch
ive.org/web/20100922091855/http://blog.seattletimes.nwsource.com/politicsnorthwest/2009/01/22/th
e_campus_is_heating_up.html) . The Seattle Times. Archived from the original (http://blog.seattletimes.
nwsource.com/politicsnorthwest/2009/01/22/the_campus_is_heating_up.html) on 2010-09-22.
Retrieved 2010-09-23.

83. Hilliard JW, Johnson ME (2004). "State practice acts of licensed health professions: scope of practice" (h
ttps://via.library.depaul.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=
1155&context=jhcl) . DePaul Journal of Health Care Law. 8 (1): 237–61.

84. Christensen MG, Kollasch MW (2005). "Professional functions and treatment procedures" (https://wayba
ck.archive-it.org/all/20080910235612/http://nbce.org/pdfs/job-analysis/chapter_10.pdf) (PDF). Job
Analysis of Chiropractic (http://nbce.org/pdfs/job-analysis/chapter_10.pdf) (PDF). Greeley, CO:
National Board of Chiropractic Examiners. pp. 121–38. ISBN 978-1-884457-05-0. Archived from the
original (http://nbce.org/pdfs/job-analysis/chapter_10.pdf) (PDF) on 2008-09-10. Retrieved 2008-08-25.

85. Winkler K, Hegetschweiler-Goertz C, Jackson PS, et al. (2003). "Spinal manipulation policy statement" (htt
ps://web.archive.org/web/20110720114044/http://www.acatoday.org/pdf/spinal_manipulation_policy.
pdf) (PDF). American Chiropractic Association. Archived from the original (http://acatoday.org/pdf/spin
al_manipulation_policy.pdf) (PDF) on 2011-07-20. Retrieved 2008-05-24.

86. Pickar JG, Sung PS, Kang YM, Ge W (2007). "Response of lumbar paraspinal muscles spindles is greater
to spinal manipulative loading compared with slower loading under length control" (https://www.ncbi.nl
m.nih.gov/pmc/articles/PMC2075482) . The Spine Journal. 7 (5): 583–95.
doi:10.1016/j.spinee.2006.10.006 (https://doi.org/10.1016%2Fj.spinee.2006.10.006) . PMC 2075482 (h
ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075482) . PMID 17905321 (https://pubmed.ncbi.nlm.ni
h.gov/17905321) .

87. Cooperstein R, Gleberzon BJ (2004). Technique Systems in Chiropractic. Churchill Livingstone. ISBN 978-
0-443-07413-4.

88. Harrison DD, Janik TJ, Harrison GR, Troyanovich S, Harrison DE, Harrison SO (1996). "Chiropractic
biophysics technique: a linear algebra approach to posture in chiropractic". Journal of Manipulative and
Physiological Therapeutics. 19 (8): 525–35. PMID 8902664 (https://pubmed.ncbi.nlm.nih.gov/890266
4) .

89. "Provider Manual for Chiropractic Services" (https://web.archive.org/web/20160408173429/http://www.n

d.gov/dhs/services/medicalserv/medicaid/docs/chiropractic-manual.pdf) (PDF). North Dakota
Department of Human Services. State of North Dakota. Archived from the original (https://www.nd.gov/d
hs/services/medicalserv/medicaid/docs/chiropractic-manual.pdf) (PDF) on 2016-04-08. Retrieved
2016-04-14.
90. NHS Leeds West CCG Assurance Committee (2014-01-02). "Complementary and Alternative Therapies
Evidence Based Decision Making Framework" (https://web.archive.org/web/20160304065519/http://ww
w.leedswestccg.nhs.uk/content/uploads/2014/07/Complementary-and-alternative-therapies.pdf)
(PDF). leedswestccg.nhs.uk. Archived from the original (http://www.leedswestccg.nhs.uk/content/upload
s/2014/07/Complementary-and-alternative-therapies.pdf) (PDF) on 2016-03-04. Retrieved 2015-06-30.

91. "Chiropractic Services - Policy" (https://web.archive.org/web/20160324082643/http://www.aetna.com/c

pb/medical/data/100_199/0107.html) , Aetna, archived from the original (http://www.aetna.com/cpb/m
edical/data/100_199/0107.html) on 24 March 2016, retrieved 29 March 2016

92. "Chiropractic Policy" (https://web.archive.org/web/20170105054235/https://osuhealthplan.com/sites/al

l/themes/osuhealthplan/pdf/policies/Chiropractic%20Policy.pdf) (PDF). Oklahoma State University
Health Plan. 1 April 2016. Archived from the original (https://osuhealthplan.com/sites/all/themes/osuhe
althplan/pdf/policies/Chiropractic%20Policy.pdf) (PDF) on 5 January 2017. Retrieved 14 April 2016.

93. Dagenais S, Mayer J, Wooley JR, Haldeman S (2008). "Evidence-informed management of chronic low
back pain with medicine-assisted manipulation". The Spine Journal. 8 (1): 142–49.
doi:10.1016/j.spinee.2007.09.010 (https://doi.org/10.1016%2Fj.spinee.2007.09.010) . PMID 18164462
(https://pubmed.ncbi.nlm.nih.gov/18164462) .

94. Ailliet L, Rubinstein SM, de Vet HC (October 2010). "Characteristics of chiropractors and their patients in
Belgium". Journal of Manipulative and Physiological Therapeutics. 33 (8): 618–25.
doi:10.1016/j.jmpt.2010.08.011 (https://doi.org/10.1016%2Fj.jmpt.2010.08.011) . PMID 21036284 (http
s://pubmed.ncbi.nlm.nih.gov/21036284) .

95. Ndetan HT, Rupert RL, Bae S, Singh KP (February 2009). "Prevalence of musculoskeletal injuries
sustained by students while attending a chiropractic college". Journal of Manipulative and Physiological
Therapeutics. 32 (2): 140–48. doi:10.1016/j.jmpt.2008.12.012 (https://doi.org/10.1016%2Fj.jmpt.2008.1
2.012) . PMID 19243726 (https://pubmed.ncbi.nlm.nih.gov/19243726) .

96. Joseph C. Keating, Jr. (1997). "Chiropractic: science and antiscience and pseudoscience side by side".
Skeptical Inquirer. 21 (4): 37–43.

97. Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman
S, Dagenais S, Budgell B, et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill.
pp. 65–76. ISBN 978-0-07-137534-4.

98. Reggars JW (2011). "Chiropractic at the crossroads or are we just going around in circles?" (https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC3119029) . Chiropractic & Manual Therapies. 19: 11.
doi:10.1186/2045-709X-19-11 (https://doi.org/10.1186%2F2045-709X-19-11) . PMC 3119029 (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC3119029) . PMID 21599991 (https://pubmed.ncbi.nlm.nih.gov/2
1599991) .
 99. Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (February 2007). "How important is
research-based practice to chiropractors and massage therapists?". Journal of Manipulative and
Physiological Therapeutics. 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013 (https://doi.org/10.1016%2F
j.jmpt.2006.12.013) . PMID 17320731 (https://pubmed.ncbi.nlm.nih.gov/17320731) .

100. Murphy AY, van Teijlingen ER, Gobbi MO (September 2006). "Inconsistent grading of evidence across
countries: a review of low back pain guidelines". Journal of Manipulative and Physiological Therapeutics.
29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005 (https://doi.org/10.1016%2Fj.jmpt.2006.07.
005) . PMID 16949948 (https://pubmed.ncbi.nlm.nih.gov/16949948) .

101. Ernst E, Canter PH (April 2006). "A systematic review of systematic reviews of spinal manipulation" (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420782) . Journal of the Royal Society of Medicine. 99
(4): 192–96. doi:10.1258/jrsm.99.4.192 (https://doi.org/10.1258%2Fjrsm.99.4.192) . PMC 1420782 (htt
ps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420782) . PMID 16574972 (https://pubmed.ncbi.nlm.ni
h.gov/16574972) . Lay summary (http://news.bbc.co.uk/2/hi/health/4824594.stm) – BBC News
(March 22, 2006).

102. Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW (April 2008). "The use of expertise-based
randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a
systematic review". Spine. 33 (8): 914–18. doi:10.1097/BRS.0b013e31816b4be4 (https://doi.org/10.109
7%2FBRS.0b013e31816b4be4) . PMID 18404113 (https://pubmed.ncbi.nlm.nih.gov/18404113) .
S2CID 28092478 (https://api.semanticscholar.org/CorpusID:28092478) .

103. Khorsan R, Coulter ID, Hawk C, Choate CG (June 2008). "Measures in chiropractic research: choosing
patient-based outcome assessments". Journal of Manipulative and Physiological Therapeutics. 31 (5):
355–75. doi:10.1016/j.jmpt.2008.04.007 (https://doi.org/10.1016%2Fj.jmpt.2008.04.007) .
PMID 18558278 (https://pubmed.ncbi.nlm.nih.gov/18558278) .

104. Kaptchuk TJ (June 2002). "The placebo effect in alternative medicine: can the performance of a healing
ritual have clinical significance?". Annals of Internal Medicine. 136 (11): 817–25.
CiteSeerX 10.1.1.694.4848 (https://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.694.4848) .
doi:10.7326/0003-4819-136-11-200206040-00011 (https://doi.org/10.7326%2F0003-4819-136-11-20020
6040-00011) . PMID 12044130 (https://pubmed.ncbi.nlm.nih.gov/12044130) . S2CID 207535762 (http
s://api.semanticscholar.org/CorpusID:207535762) .

105. Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of
spinal manipulative therapy" (https://doi.org/10.1016%2FS0004-9514%2806%2970049-6) . Australian
Journal of Physiotherapy. 52 (2): 135–38. doi:10.1016/S0004-9514(06)70049-6 (https://doi.org/10.101
6%2FS0004-9514%2806%2970049-6) . PMID 16764551
(https://pubmed.ncbi.nlm.nih.gov/16764551) .
106. Leboeuf-Yde C, Hestbaek L (2008). "Maintenance care in chiropractic – what do we know?" (https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC2396648) . Chiropractic & Osteopathy. 16: 3. doi:10.1186/1746-
1340-16-3 (https://doi.org/10.1186%2F1746-1340-16-3) . PMC 2396648 (https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC2396648) . PMID 18466623 (https://pubmed.ncbi.nlm.nih.gov/18466623) .

107. Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW (February 2013). "Spinal
manipulative therapy for acute low back pain: an update of the cochrane review". Spine (Systematic
Review). 38 (3): E158–77. doi:10.1097/BRS.0b013e31827dd89d (https://doi.org/10.1097%2FBRS.0b013
e31827dd89d) . hdl:2066/109576 (https://hdl.handle.net/2066%2F109576) . PMID 23169072 (https://
pubmed.ncbi.nlm.nih.gov/23169072) . S2CID 28795577 (https://api.semanticscholar.org/CorpusID:287
95577) .

108. Posadzki P (2012). "Is spinal manipulation effective for pain? An overview of systematic reviews" (http
s://doi.org/10.1111%2Fj.1526-4637.2012.01397.x) . Pain Medicine. 13 (6): 754–61. doi:10.1111/j.1526-
4637.2012.01397.x (https://doi.org/10.1111%2Fj.1526-4637.2012.01397.x) . PMID 22621391 (https://p
ubmed.ncbi.nlm.nih.gov/22621391) .

109. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (June 2011). "Spinal
manipulative therapy for chronic low-back pain: an update of a Cochrane review". Spine (Systematic
review). 36 (13): E825–46. doi:10.1097/BRS.0b013e3182197fe1 (https://doi.org/10.1097%2FBRS.0b013
e3182197fe1) . hdl:1887/117578 (https://hdl.handle.net/1887%2F117578) . PMID 21593658 (https://
pubmed.ncbi.nlm.nih.gov/21593658) . S2CID 5061433 (https://api.semanticscholar.org/CorpusID:50
61433) .

110. Walker BF, French SD, Grant W, Green S (2010). Walker BF (ed.). "Combined chiropractic interventions for
low-back pain" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984631) . Cochrane Database of
Systematic Reviews (4): CD005427. doi:10.1002/14651858.CD005427.pub2 (https://doi.org/10.1002%2F
14651858.CD005427.pub2) . PMC 6984631 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC698463
1) . PMID 20393942 (https://pubmed.ncbi.nlm.nih.gov/20393942) .

111. Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (October 2010). "NASS Contemporary Concepts
in Spine Care: spinal manipulation therapy for acute low back pain". The Spine Journal. 10 (10): 918–40.
doi:10.1016/j.spinee.2010.07.389 (https://doi.org/10.1016%2Fj.spinee.2010.07.389) . PMID 20869008
(https://pubmed.ncbi.nlm.nih.gov/20869008) .

112. Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, Hendry M, Phillips CJ, Nafees S,
Fitzsimmons D, Rickard I, Wilkinson C (2013). "Comparative clinical effectiveness of management
strategies for sciatica: systematic review and network meta-analyses" (http://eprints.hud.ac.uk/id/eprint/
19023/3/Manuscript_-_sciatica_MTC_paper_%252820130628%2529.pdf) (PDF). The Spine Journal. 15
(6): 1461–77. doi:10.1016/j.spinee.2013.08.049 (https://doi.org/10.1016%2Fj.spinee.2013.08.049) .
PMID 24412033 (https://pubmed.ncbi.nlm.nih.gov/24412033) .
113. Leininger B, Bronfort G, Evans R, Reiter T (February 2011). "Spinal manipulation or mobilization for
radiculopathy: a systematic review". Physical Medicine and Rehabilitation Clinics of North America. 22
(1): 105–25. doi:10.1016/j.pmr.2010.11.002 (https://doi.org/10.1016%2Fj.pmr.2010.11.002) .
PMID 21292148 (https://pubmed.ncbi.nlm.nih.gov/21292148) .

114. Hahne AJ, Ford JJ, McMeeken JM (May 2010). "Conservative management of lumbar disc herniation
with associated radiculopathy: a systematic review". Spine. 35 (11): E488–504.
doi:10.1097/BRS.0b013e3181cc3f56 (https://doi.org/10.1097%2FBRS.0b013e3181cc3f56) .
PMID 20421859 (https://pubmed.ncbi.nlm.nih.gov/20421859) . S2CID 19121111 (https://api.semantics
cholar.org/CorpusID:19121111) .

115. Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials
and systematic reviews" (http://www.minervamedica.it/en/getfreepdf.php?cod=R33Y2007N01A0091)
(PDF). Europa Medicophysica. 43 (1): 91–118. PMID 17369783 (https://pubmed.ncbi.nlm.nih.gov/1736
9783) .

116. Schroeder J, Kaplan L, Fischer DJ, Skelly AC (2013). "The Outcomes of Manipulation or Mobilization
Therapy Compared with Physical Therapy or Exercise for Neck Pain: A Systematic Review" (https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC3699243) . Evidence-Based Spine-Care Journal. 4 (1): 30–41.
doi:10.1055/s-0033-1341605 (https://doi.org/10.1055%2Fs-0033-1341605) . PMC 3699243 (https://ww
w.ncbi.nlm.nih.gov/pmc/articles/PMC3699243) . PMID 24436697 (https://pubmed.ncbi.nlm.nih.gov/24
436697) .

117. Huisman PA, Speksnijder CM, de Wijer A (January 2013). "The effect of thoracic spine manipulation on
pain and disability in patients with non-specific neck pain: a systematic review". Disability and
Rehabilitation. 35 (20): 1677–85. doi:10.3109/09638288.2012.750689 (https://doi.org/10.3109%2F0963
8288.2012.750689) . PMID 23339721 (https://pubmed.ncbi.nlm.nih.gov/23339721) . S2CID 12159586
(https://api.semanticscholar.org/CorpusID:12159586) .

118. Cross KM, Kuenze C, Grindstaff TL, Hertel J (September 2011). "Thoracic spine thrust manipulation
improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a
systematic review" (https://doi.org/10.2519%2Fjospt.2011.3670) . Journal of Orthopaedic & Sports
Physical Therapy. 41 (9): 633–42. doi:10.2519/jospt.2011.3670 (https://doi.org/10.2519%2Fjospt.201
1.3670) . PMID 21885904 (https://pubmed.ncbi.nlm.nih.gov/21885904) .

119. Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL (August
2010). "Manipulation or mobilisation for neck pain: a Cochrane Review". Manual Therapy. 15 (4): 315–33.
doi:10.1016/j.math.2010.04.002 (https://doi.org/10.1016%2Fj.math.2010.04.002) . PMID 20510644 (htt
ps://pubmed.ncbi.nlm.nih.gov/20510644) .
120. Shaw L, Descarreaux M, Bryans R, Duranleau M, Marcoux H, Potter B, Ruegg R, Watkin R, White E (2010).
"A systematic review of chiropractic management of adults with Whiplash-Associated Disorders:
recommendations for advancing evidence-based practice and research". Work. 35 (3): 369–94.
doi:10.3233/WOR-2010-0996 (https://doi.org/10.3233%2FWOR-2010-0996) . PMID 20364057 (https://p
ubmed.ncbi.nlm.nih.gov/20364057) .

121. Chaibi A, Tuchin PJ, Russell MB (April 2011). "Manual therapies for migraine: a systematic review" (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072494) . The Journal of Headache and Pain. 12 (2):
127–33. doi:10.1007/s10194-011-0296-6 (https://doi.org/10.1007%2Fs10194-011-0296-6) .
PMC 3072494 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072494) . PMID 21298314 (https://pu
bmed.ncbi.nlm.nih.gov/21298314) .

122. Posadzki P, Ernst E (June 2011). "Spinal manipulations for the treatment of migraine: a systematic review
of randomized clinical trials". Cephalalgia. 31 (8): 964–70. doi:10.1177/0333102411405226 (https://doi.
org/10.1177%2F0333102411405226) . PMID 21511952
(https://pubmed.ncbi.nlm.nih.gov/21511952) . S2CID 31205541 (https://api.semanticscholar.org/Corpu
sID:31205541) .

123. Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006).
"Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". The
Clinical Journal of Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86 (https://doi.org/10.10
97%2F01.ajp.0000173017.64741.86) . PMID 16514329 (https://pubmed.ncbi.nlm.nih.gov/16514329) .
S2CID 23367185 (https://api.semanticscholar.org/CorpusID:23367185) .

124. Biondi DM (June 2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–
46. doi:10.1111/j.1526-4610.2005.05141.x (https://doi.org/10.1111%2Fj.1526-4610.2005.05141.x) .
PMID 15953306 (https://pubmed.ncbi.nlm.nih.gov/15953306) . S2CID 42640492 (https://api.semantics
cholar.org/CorpusID:42640492) .

125. Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA (2011). "Strength training alone, exercise
therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in
people with knee osteoarthritis: a systematic review" (https://doi.org/10.1016%2FS1836-9553%2811%29
70002-9) . Journal of Physiotherapy. 57 (1): 11–20. doi:10.1016/S1836-9553(11)70002-9 (https://doi.or
g/10.1016%2FS1836-9553%2811%2970002-9) . PMID 21402325 (https://pubmed.ncbi.nlm.nih.gov/214
02325) .

126. French HP, Brennan A, White B, Cusack T (April 2011). "Manual therapy for osteoarthritis of the hip or
knee - a systematic review". Manual Therapy. 16 (2): 109–17. doi:10.1016/j.math.2010.10.011 (https://do
i.org/10.1016%2Fj.math.2010.10.011) . PMID 21146444 (https://pubmed.ncbi.nlm.nih.gov/2114644
4) .
127. McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (February 2008). "Chiropractic treatment of upper
extremity conditions: a systematic review". Journal of Manipulative and Physiological Therapeutics. 31
(2): 146–59. doi:10.1016/j.jmpt.2007.12.004 (https://doi.org/10.1016%2Fj.jmpt.2007.12.004) .
PMID 18328941 (https://pubmed.ncbi.nlm.nih.gov/18328941) .

128. Pribicevic M, Pollard H, Bonello R, de Luca K (2010). "A systematic review of manipulative therapy for the
treatment of shoulder pain". Journal of Manipulative and Physiological Therapeutics. 33 (9): 679–89.
doi:10.1016/j.jmpt.2010.08.019 (https://doi.org/10.1016%2Fj.jmpt.2010.08.019) . PMID 21109059 (http
s://pubmed.ncbi.nlm.nih.gov/21109059) .

129. Brantingham, James W.; Bonnefin, Debra; Perle, Stephen M.; Cassa, Tammy Kay; Globe, Gary; Pribicevic,
Mario; Hicks, Marian; Korporaal, Charmaine (2012). "Manipulative Therapy for Lower Extremity
Conditions: Update of a Literature Review". Journal of Manipulative and Physiological Therapeutics. 35
(2): 127–66. doi:10.1016/j.jmpt.2012.01.001 (https://doi.org/10.1016%2Fj.jmpt.2012.01.001) .
PMID 22325966 (https://pubmed.ncbi.nlm.nih.gov/22325966) .

130. Mangum K, Partna L, Vavrek D (2012). "Spinal manipulation for the treatment of hypertension: a
systematic qualitative literature review". Journal of Manipulative and Physiological Therapeutics. 35 (3):
235–43. doi:10.1016/j.jmpt.2012.01.005 (https://doi.org/10.1016%2Fj.jmpt.2012.01.005) .
PMID 22341795 (https://pubmed.ncbi.nlm.nih.gov/22341795) .

131. Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV (2011). "Manual therapy with and without vestibular
rehabilitation for cervicogenic dizziness: a systematic review" (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC3182131) . Chiropractic & Manual Therapies. 19 (1): 21. doi:10.1186/2045-709X-19-21 (https://d
oi.org/10.1186%2F2045-709X-19-21) . PMC 3182131 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
3182131) . PMID 21923933 (https://pubmed.ncbi.nlm.nih.gov/21923933) .

132. Everett CR, Patel RK (September 2007). "A systematic literature review of nonsurgical treatment in adult
scoliosis". Spine. 32 (19 Suppl): S130–34. doi:10.1097/BRS.0b013e318134ea88 (https://doi.org/10.109
7%2FBRS.0b013e318134ea88) . PMID 17728680 (https://pubmed.ncbi.nlm.nih.gov/17728680) .
S2CID 9339782 (https://api.semanticscholar.org/CorpusID:9339782) .

133. Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic
scoliosis: a systematic review" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2262872) . Scoliosis.
3: 2. doi:10.1186/1748-7161-3-2 (https://doi.org/10.1186%2F1748-7161-3-2) . PMC 2262872 (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC2262872) . PMID 18211702 (https://pubmed.ncbi.nlm.nih.gov/1
8211702) .

134. Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (June 2007). "Chiropractic care for
nonmusculoskeletal conditions: a systematic review with implications for whole systems research". The
Journal of Alternative and Complementary Medicine. 13 (5): 491–512. doi:10.1089/acm.2007.7088 (http
s://doi.org/10.1089%2Facm.2007.7088) . PMID 17604553 (https://pubmed.ncbi.nlm.nih.gov/176045
53) .
135. Ernst E (December 2009). "Spinal manipulation for asthma: a systematic review of randomised clinical
trials" (https://doi.org/10.1016%2Fj.rmed.2009.06.017) . Respiratory Medicine. 103 (12): 1791–95.
doi:10.1016/j.rmed.2009.06.017 (https://doi.org/10.1016%2Fj.rmed.2009.06.017) . PMID 19646855 (htt
ps://pubmed.ncbi.nlm.nih.gov/19646855) .

136. Hondras MA, Linde K, Jones AP (2005). "Manual therapy for asthma". Cochrane Database of Systematic
Reviews (2): CD001002. doi:10.1002/14651858.CD001002.pub2 (https://doi.org/10.1002%2F14651858.
CD001002.pub2) . PMID 15846609 (https://pubmed.ncbi.nlm.nih.gov/15846609) .

137. Gotlib A, Rupert R (2008). "Chiropractic manipulation in pediatric health conditions--an updated
systematic review" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553791) . Chiropractic &
Osteopathy. 16: 11. doi:10.1186/1746-1340-16-11 (https://doi.org/10.1186%2F1746-1340-16-11) .
PMC 2553791 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553791) . PMID 18789139 (https://pu
bmed.ncbi.nlm.nih.gov/18789139) .

138. Baby colic:

Ernst E (2009). "Chiropractic spinal manipulation for infant colic: a systematic review of randomised
clinical trials" (https://doi.org/10.1111%2Fj.1742-1241.2009.02133.x) . International Journal of
Clinical Practice. 63 (9): 1351–53. doi:10.1111/j.1742-1241.2009.02133.x (https://doi.org/10.1111%
2Fj.1742-1241.2009.02133.x) . PMID 19691620 (https://pubmed.ncbi.nlm.nih.gov/19691620) .
S2CID 36131261 (https://api.semanticscholar.org/CorpusID:36131261) .

Husereau D, Clifford T, Aker P, Leduc D, Mensinkai S (2003). Spinal Manipulation for Infantile Colic (ht
tps://web.archive.org/web/20081217004845/http://cadth.ca/media/pdf/177_spinal_manipulation_tr
_e.pdf) (PDF). Technology report no. 42. Ottawa: Canadian Coordinating Office for Health
Technology Assessment. ISBN 978-1-894978-11-8. Archived from the original (http://cadth.ca/medi
a/pdf/177_spinal_manipulation_tr_e.pdf) (PDF) on 2008-12-17. Retrieved 2008-10-06.

139. Huang, Tao; Shu, Xu; Huang, Yu Shan; Cheuk, Daniel KL; Huang, Tao (2011). "Complementary and
miscellaneous interventions for nocturnal enuresis in children". Cochrane Database of Systematic
Reviews (12): CD005230. doi:10.1002/14651858.CD005230.pub2 (https://doi.org/10.1002%2F14651858.
CD005230.pub2) . PMID 22161390 (https://pubmed.ncbi.nlm.nih.gov/22161390) .

140. O'Connor D, Marshall S, Massy-Westropp N, Pitt V (2003). "Non-surgical treatment (other than steroid
injection) for carpal tunnel syndrome" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486195) .
Cochrane Database of Systematic Reviews (1): CD003219. doi:10.1002/14651858.CD003219 (https://do
i.org/10.1002%2F14651858.CD003219) . PMC 6486195 (https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC6486195) . PMID 12535461 (https://pubmed.ncbi.nlm.nih.gov/12535461) .
141. Fibromyalgia:
Sarac AJ, Gur A (2006). "Complementary and alternative medical therapies in fibromyalgia". Current
Pharmaceutical Design. 12 (1): 47–57. doi:10.2174/138161206775193262 (https://doi.org/10.217
4%2F138161206775193262) . PMID 16454724 (https://pubmed.ncbi.nlm.nih.gov/16454724) .

Schneider M, Vernon H, Ko G, Lawson G, Perera J (2009). "Chiropractic management of fibromyalgia

syndrome: a systematic review of the literature". Journal of Manipulative and Physiological
Therapeutics. 32 (1): 25–40. doi:10.1016/j.jmpt.2008.08.012 (https://doi.org/10.1016%2Fj.jmpt.200
8.08.012) . PMID 19121462 (https://pubmed.ncbi.nlm.nih.gov/19121462) .

Ernst E (2009). "Chiropractic treatment for fibromyalgia: a systematic review". Clinical

Rheumatology. 28 (10): 1175–78. doi:10.1007/s10067-009-1217-9 (https://doi.org/10.1007%2Fs100
67-009-1217-9) . PMID 19544042 (https://pubmed.ncbi.nlm.nih.gov/19544042) .
S2CID 25339207 (https://api.semanticscholar.org/CorpusID:25339207) .

142. Ernst E (2011). "Chiropractic treatment for gastrointestinal problems: A systematic review of clinical
trials" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027333) . Canadian Journal of
Gastroenterology. 25 (1): 39–49. doi:10.1155/2011/910469 (https://doi.org/10.1155%2F2011%2F9104
69) . PMC 3027333 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027333) . PMID 21258667 (htt
ps://pubmed.ncbi.nlm.nih.gov/21258667) .

143. Brand PL, Engelbert RH, Helders PJ, Offringa M (2005). "[Systematic review of the effects of therapy in
infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain)]". Nederlands Tijdschrift
voor Geneeskunde (in Dutch). 149 (13): 703–07. PMID 15819137 (https://pubmed.ncbi.nlm.nih.gov/1581
9137) .

144. Proctor ML, Hing W, Johnson TC, Murphy PA, Brown J (2006). "Spinal manipulation for primary and
secondary dysmenorrhoea" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718213) . The Cochrane
Database of Systematic Reviews. 3 (3): CD002119. doi:10.1002/14651858.CD002119.pub3 (https://doi.o
rg/10.1002%2F14651858.CD002119.pub3) . PMC 6718213 (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC6718213) . PMID 16855988 (https://pubmed.ncbi.nlm.nih.gov/16855988) .

145. Goto, Viviane; Frange, Cristina; Andersen, Monica L.; Júnior, José M. S.; Tufik, Sergio; Hachul, Helena (May
2014). "Chiropractic intervention in the treatment of postmenopausal climacteric symptoms and
insomnia: A review". Maturitas. 78 (1): 3–7. doi:10.1016/j.maturitas.2014.02.004 (https://doi.org/10.101
6%2Fj.maturitas.2014.02.004) . PMID 24656717 (https://pubmed.ncbi.nlm.nih.gov/24656717) .

146. Liddle, Sarah D.; Pennick, Victoria (2015-09-30). "Interventions for preventing and treating low-back and
pelvic pain during pregnancy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053516) . Cochrane
Database of Systematic Reviews. 2015 (9): CD001139. doi:10.1002/14651858.CD001139.pub4 (https://d
oi.org/10.1002%2F14651858.CD001139.pub4) . PMC 7053516 (https://www.ncbi.nlm.nih.gov/pmc/arti
cles/PMC7053516) . PMID 26422811 (https://pubmed.ncbi.nlm.nih.gov/26422811) .
147. Camilleri M, Park SY, Scarpato E, Staiano A (2017). "Exploring hypotheses and rationale for causes of
infantile colic" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5276723) . Neurogastroenterology &
Motility (Review). 29 (2): e12943. doi:10.1111/nmo.12943 (https://doi.org/10.1111%2Fnmo.12943) .
PMC 5276723 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5276723) . PMID 27647578 (https://pu
bmed.ncbi.nlm.nih.gov/27647578) .

148. Anderson-Peacock E, Blouin JS, Bryans R, Danis N, Furlan A, Marcoux H, Potter B, Ruegg R, Stein JG,
White E (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not
due to whiplash" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839918) . The Journal of the
Canadian Chiropractic Association. 49 (3): 158–209. PMC 1839918 (https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC1839918) . PMID 17549134 (https://pubmed.ncbi.nlm.nih.gov/17549134) .

• Anderson-Peacock E, Bryans R, Descarreaux M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E

(2008). "A Clinical Practice Guideline Update from The CCA•CFCREAB-CPG" (https://www.webcitation.or
g/5sVyyGVET?url=http://jcca-online.org/ecms.ashx/PDF/2008/2008-1/ClinicalPracticeGuidelineUpdatefr
omTheCCACFCREABCPG.pdf) (PDF). The Journal of the Canadian Chiropractic Association. 52 (1): 7–
8. PMC 2258235 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258235) . PMID 18327295 (https://
pubmed.ncbi.nlm.nih.gov/18327295) . Archived from the original (http://jcca-online.org/ecms.ashx/PD
F/2008/2008-1/ClinicalPracticeGuidelineUpdatefromTheCCACFCREABCPG.pdf) (PDF) on 2010-09-05.

149. Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical
spine: a prospective national survey". Spine. 32 (21): 2375–78. doi:10.1097/BRS.0b013e3181557bb1 (htt
ps://doi.org/10.1097%2FBRS.0b013e3181557bb1) . PMID 17906581 (https://pubmed.ncbi.nlm.nih.gov/
17906581) . S2CID 42353750 (https://api.semanticscholar.org/CorpusID:42353750) .

150. Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM (July 2005). "Frequency and clinical predictors of
adverse reactions to chiropractic care in the UCLA neck pain study". Spine. 30 (13): 1477–84.
doi:10.1097/01.brs.0000167821.39373.c1 (https://doi.org/10.1097%2F01.brs.0000167821.39373.c1) .
PMID 15990659 (https://pubmed.ncbi.nlm.nih.gov/15990659) . S2CID 45678522 (https://api.semantics
cholar.org/CorpusID:45678522) .

151. "Safety and regulation of chiropractic" (http://www.nhs.uk/Conditions/chiropractic/Pages/Safetyandregul

ation.aspx) . NHS Choices. 20 August 2014. Retrieved 22 September 2016.

152. Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal
manipulation: a systematic review"
(http://pediatrics.aappublications.org/cgi/content/full/119/1/e275) . Pediatrics. 119 (1): e275–83.
doi:10.1542/peds.2006-1392 (https://doi.org/10.1542%2Fpeds.2006-1392) . PMID 17178922 (https://p
ubmed.ncbi.nlm.nih.gov/17178922) . S2CID 43683198 (https://api.semanticscholar.org/CorpusID:4368
3198) .

153. Ernst E, Posadzki P (2012). "Reporting of adverse effects in randomised clinical trials of chiropractic
manipulations: a systematic review". The New Zealand Medical Journal. 125 (1353): 87–140.
PMID 22522273 (https://pubmed.ncbi.nlm.nih.gov/22522273) .
154. Gorrell LM, Engel RM, Brown B, Lystad RP (2016). "The reporting of adverse events following spinal
manipulation in randomized clinical trials-a systematic review". The Spine Journal (Systematic Review).
16 (9): 1143–51. doi:10.1016/j.spinee.2016.05.018 (https://doi.org/10.1016%2Fj.spinee.2016.05.018) .
PMID 27241208 (https://pubmed.ncbi.nlm.nih.gov/27241208) .

155. Hebert JJ, Stomski NJ, French SD, Rubinstein SM (2013). "Serious Adverse Events and Spinal
Manipulative Therapy of the Low Back Region: A Systematic Review of Cases" (http://researchrepository.
murdoch.edu.au/id/eprint/15912/) . Journal of Manipulative and Physiological Therapeutics. 38 (9):
677–91. doi:10.1016/j.jmpt.2013.05.009 (https://doi.org/10.1016%2Fj.jmpt.2013.05.009) .
PMID 23787298 (https://pubmed.ncbi.nlm.nih.gov/23787298) .

156. Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Côté P,
Hogg-Johnson S, Cassidy JD, Haldeman S (2008). "Treatment of neck pain: noninvasive interventions:
results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders".
Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d (https://doi.org/10.1097%2FBRS.0b
013e3181644b1d) . PMID 18204386 (https://pubmed.ncbi.nlm.nih.gov/18204386) . S2CID 27261997
(https://api.semanticscholar.org/CorpusID:27261997) .

157. Paciaroni M, Bogousslavsky J (2009). "Cerebrovascular complications of neck manipulation" (https://doi.

org/10.1159%2F000180314) . European Neurology. 61 (2): 112–18. doi:10.1159/000180314 (https://do
i.org/10.1159%2F000180314) . PMID 19065058 (https://pubmed.ncbi.nlm.nih.gov/19065058) .

158. Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy
cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73.
doi:10.1097/NRL.0b013e318164e53d (https://doi.org/10.1097%2FNRL.0b013e318164e53d) .
PMID 18195663 (https://pubmed.ncbi.nlm.nih.gov/18195663) . S2CID 18062970 (https://api.semantics
cholar.org/CorpusID:18062970) .

159. Biller, J.; Sacco, R. L.; Albuquerque, F. C.; Demaerschalk, B. M.; Fayad, P.; Long, P. H.; Noorollah, L. D.;
Panagos, P. D.; Schievink, W. I.; Schwartz, N. E.; Shuaib, A.; Thaler, D. E.; Tirschwell, D. L. (2014). "Cervical
Arterial Dissections and Association With Cervical Manipulative Therapy: A Statement for Healthcare
Professionals From the American Heart Association/American Stroke Association" (https://doi.org/10.11
61%2FSTR.0000000000000016) . Stroke. 45 (10): 3155–74. doi:10.1161/STR.0000000000000016 (http
s://doi.org/10.1161%2FSTR.0000000000000016) . PMID 25104849 (https://pubmed.ncbi.nlm.nih.gov/2
5104849) .

160. Church, Ephraim W; Sieg, Emily P; Zalatimo, Omar; Hussain, Namath S; Glantz, Michael; Harbaugh, Robert
E (2016). "Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No
Evidence for Causation" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794386) . Cureus. 8 (2):
e498. doi:10.7759/cureus.498 (https://doi.org/10.7759%2Fcureus.498) . PMC 4794386 (https://www.nc
bi.nlm.nih.gov/pmc/articles/PMC4794386) . PMID 27014532 (https://pubmed.ncbi.nlm.nih.gov/2701
4532) .
161. Chung CL, Côté P, Stern P, L'espérance G (2014). "The Association Between Cervical Spine Manipulation
and Carotid Artery Dissection: A Systematic Review of the Literature". Journal of Manipulative and
Physiological Therapeutics. 38 (9): 672–6. doi:10.1016/j.jmpt.2013.09.005 (https://doi.org/10.1016%2Fj.j
mpt.2013.09.005) . PMID 24387889 (https://pubmed.ncbi.nlm.nih.gov/24387889) .

162. Wynd S, Westaway M, Vohra S, Kawchuk G (2013). "The quality of reports on cervical arterial dissection
following cervical spinal manipulation" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604043) .
PLOS ONE. 8 (3): e59170. Bibcode:2013PLoSO...859170W (https://ui.adsabs.harvard.edu/abs/2013PLoS
O...859170W) . doi:10.1371/journal.pone.0059170 (https://doi.org/10.1371%2Fjournal.pone.005917
0) . PMC 3604043 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604043) . PMID 23527121 (http
s://pubmed.ncbi.nlm.nih.gov/23527121) .

163. Tuchin, P. (2014). "A systematic literature review of intracranial hypotension following chiropractic".
International Journal of Clinical Practice. 68 (3): 396–402. doi:10.1111/ijcp.12247 (https://doi.org/10.11
11%2Fijcp.12247) . PMID 24372942 (https://pubmed.ncbi.nlm.nih.gov/24372942) . S2CID 5315779 (h
ttps://api.semanticscholar.org/CorpusID:5315779) .

164. Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil (2016). "Cervical Intradural Disc Herniation Causing
Progressive Quadriparesis After Spinal Manipulation Therapy" (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC4753938) . Medicine. 95 (6): e2797. doi:10.1097/MD.0000000000002797 (https://doi.org/10.109
7%2FMD.0000000000002797) . PMC 4753938 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC475
3938) . PMID 26871842 (https://pubmed.ncbi.nlm.nih.gov/26871842) .

165. Bussières AE, Taylor JA, Peterson C (2008). "Diagnostic imaging practice guidelines for musculoskeletal
complaints in adults – an evidence-based approach – part 3: spinal disorders" (http://jmptonline.org/arti
cle/S0161-4754(07)00314-4/fulltext) . Journal of Manipulative and Physiological Therapeutics. 31 (1):
33–88. doi:10.1016/j.jmpt.2007.11.003 (https://doi.org/10.1016%2Fj.jmpt.2007.11.003) .
PMID 18308153 (https://pubmed.ncbi.nlm.nih.gov/18308153) .

166. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on
Radiation Effects Research, US National Research Council (2006). Health Risks from Exposure to Low
Levels of Ionizing Radiation: BEIR VII Phase 2 (http://books.nap.edu/catalog.php?record_id=11340) .
Washington, DC: The National Academies Press. doi:10.17226/11340 (https://doi.org/10.17226%2F11
340) . ISBN 978-0-309-09156-5.

167. E Ernst (2011). "Response to critiques of deaths after chiropractic". International Journal of Clinical
Practice. 65 (1): 106. doi:10.1111/j.1742-1241.2010.02568.x (https://doi.org/10.1111%2Fj.1742-1241.20
10.02568.x) . S2CID 72845939 (https://api.semanticscholar.org/CorpusID:72845939) .
168. Di Fabio, Richard P (January 1, 1999). "Manipulation of the Cervical Spine: Risks and Benefits" (https://ac
ademic.oup.com/ptj/article/79/1/50/2857770) . Physical Therapy. Retrieved November 1, 2021.
"Although the risk of injury associated with MCS appears to be small, this type of therapy has the
potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization
(nonthrust passive movements). The literature does not demonstrate that the benefits of MCS outweigh
the risks. Several recommendations for future studies and for the practice of MCS are discussed."

169. Michaleff ZA, Lin CW, Maher CG, van Tulder MW (2012). "Spinal manipulation epidemiology: Systematic
review of cost effectiveness studies". Journal of Electromyography and Kinesiology. 22 (5): 655–62.
doi:10.1016/j.jelekin.2012.02.011 (https://doi.org/10.1016%2Fj.jelekin.2012.02.011) . PMID 22429823
(https://pubmed.ncbi.nlm.nih.gov/22429823) .

170. Canter PH, Coon JT, Ernst E (2006). "Cost-Effectiveness of Complementary Therapies in the United
Kingdom – A Systematic Review†" (https://web.archive.org/web/20080511154423/http://ecam.oxfordjo
urnals.org/cgi/content/full/3/4/425) . Evidence-Based Complementary and Alternative Medicine. 3 (4):
425–32. doi:10.1093/ecam/nel044 (https://doi.org/10.1093%2Fecam%2Fnel044) . PMC 1697737 (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC1697737) . PMID 17173105 (https://pubmed.ncbi.nlm.nih.
gov/17173105) . Archived from the original (http://ecam.oxfordjournals.org/cgi/content/full/3/4/425)
on 2008-05-11.

171. van der Roer N, Goossens ME, Evers SM, van Tulder MW (2005). "What is the most cost-effective
treatment for patients with low back pain? a systematic review". Best Practice & Research Clinical
Rheumatology. 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007 (https://doi.org/10.1016%2Fj.berh.2005.
03.007) . PMID 15949783 (https://pubmed.ncbi.nlm.nih.gov/15949783) .

172. Sarnat RL, Winterstein J, Cambron JA (May 2007). "Clinical Utilization and Cost Outcomes From an
Integrative Medicine Independent Physician Association: An Additional 3-Year Update" (http://www.jmpto
nline.org/article/S0161-4754(07)00076-0/abstract) . Journal of Manipulative and Physiological
Therapeutics. 30 (4): 263–69. doi:10.1016/j.jmpt.2007.03.004 (https://doi.org/10.1016%2Fj.jmpt.2007.0
3.004) . PMID 17509435 (https://pubmed.ncbi.nlm.nih.gov/17509435) .

173. "Glossary" (http://nces.ed.gov/ipeds/glossary/?charindex=F) . National Center for Education Statistics,

U.S. Dept. of Education. Retrieved 2009-06-05.

174. Marcus DM, McCullough L (2009). "An evaluation of the evidence in 'evidence-based' integrative medicine
programs" (https://doi.org/10.1097%2FACM.0b013e3181b185f4) . Academic Medicine. 84 (9): 1229–
34. doi:10.1097/ACM.0b013e3181b185f4 (https://doi.org/10.1097%2FACM.0b013e3181b185f4) .
PMID 19707062 (https://pubmed.ncbi.nlm.nih.gov/19707062) .

175. Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M (September 1998). "A comparative study of
chiropractic and medical education". Alternative Therapies in Health and Medicine. 4 (5): 64–75.
PMID 9737032 (https://pubmed.ncbi.nlm.nih.gov/9737032) .
176. "Prospective students" (https://web.archive.org/web/20090814171533/http://www.chirocolleges.org/pro
spective_students.html) . Association of Chiropractic Colleges. Archived from the original (http://www.c
hirocolleges.org/prospective_students.html) on 2009-08-14. Retrieved 2009-07-23.

177. "Standards for Accreditation of Doctor of Chiropractic Programmes" (https://web.archive.org/web/20150

923202912/http://www.chirofed.ca/english/pdf/Standards-for-Accreditation-of-Doctor-of-Chiropractic-Pr
ogrammes.pdf) (PDF). Canadian Federation of Chiropractic Regulatory and Educational Accrediting
Boards. 2011-11-26. Archived from the original (http://www.chirofed.ca/english/pdf/Standards-for-Accre
ditation-of-Doctor-of-Chiropractic-Programmes.pdf) (PDF) on 2015-09-23. Retrieved 2014-08-02.

178. "CMCC Backgrounder 2015" (https://www.cmcc.ca/news/CMCC%20Backgrounder%202015.pdf) (PDF).

Canadian Memorial Chiropractic College. Retrieved 26 February 2019.

179. "Degree Authority in Ontario" (http://www.edu.gov.on.ca/eng/general/postsec/degreegr.html) . Ontario

Ministry of Training, Colleges and Universities. Retrieved 2010-12-14.

180. "State chiropractic licensure" (https://web.archive.org/web/20090801072938/http://www.life.edu/nod

e/94) . Life University. 2008. Archived from the original (http://life.edu/node/94) on 2009-08-01.
Retrieved 2009-06-05.

181. "Becoming a chiropractor" (https://web.archive.org/web/20090615181538/http://www.chirofed.ca/englis

h/becoming.html) . Canadian Federation of Chiropractic Regulatory and Educational Accrediting
Boards. Archived from the original (http://chirofed.ca/english/becoming.html) on 2009-06-15.
Retrieved 2009-06-05.

182. Grod JP (2006). "Continuing health education in Canada" (https://www.ncbi.nlm.nih.gov/pmc/articles/PM

C1839972) . The Journal of the Canadian Chiropractic Association. 50 (1): 14–17. PMC 1839972 (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839972) . PMID 17549163 (https://pubmed.ncbi.nlm.nih.
gov/17549163) .

183. Stuber KJ, Grod JP, Smith DL, Powers P (2005). "An online survey of chiropractors' opinions of Continuing
Education" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282582) . Chiropractic & Osteopathy. 13
(1): 22. doi:10.1186/1746-1340-13-22 (https://doi.org/10.1186%2F1746-1340-13-22) . PMC 1282582 (ht
tps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282582) . PMID 16242035 (https://pubmed.ncbi.nlm.ni
h.gov/16242035) .

184. Coulter ID, Adams AH, Sandefur R (1997). "Chiropractic training" (https://web.archive.org/web/20080625
173624/http://curziechiropractic.com/forms/ahcpr/uschiros.pdf) (PDF). In Cherkin DC, Mootz RD
(eds.). Chiropractic in the United States: Training, Practice, and Research (http://curziechiropractic.com/f
orms/ahcpr/uschiros.pdf) (PDF). Rockville, MD: Agency for Health Care Policy and Research. pp. 17–
28. OCLC 39856366 (https://www.worldcat.org/oclc/39856366) . Archived from the original (http://chir
oweb.com/archives/ahcpr/chapter3.htm) on 2008-06-25. Retrieved 2008-05-11. AHCPR Pub No. 98-
N002.
185. "The Council on Chiropractic Education (CCE)" (http://cce-usa.org/) . The Council on Chiropractic
Education. Retrieved 2008-07-05.

186. "The General Chiropractic Council" (http://www.gcc-uk.org/) . Retrieved 2020-05-02.

187. "About Us" (https://web.archive.org/web/20101118013746/http://www.cceintl.org/About_Us.html) .

Councils on Chiropractic Education International. Archived from the original (http://www.cceintl.org/Abou
t_Us.html) on 2010-11-18. Retrieved 2010-09-30.

188. "Accredited Doctor of Chiropractic programs" (https://web.archive.org/web/20080214031937/http://ww

w.cce-usa.org/adcp.php) . The Council on Chiropractic Education. Archived from the original (http://cce-
usa.org/adcp.php) on 2008-02-14. Retrieved 2008-02-22.

189. "Accreditation of educational programmes" (https://web.archive.org/web/20090518022905/http://www.c

hirofed.ca/english/accreditation.html) . Canadian Federation of Chiropractic Regulatory and
Educational Accrediting Boards. Archived from the original (http://chirofed.ca/english/accreditation.ht
ml) on 2009-05-18. Retrieved 2009-06-05.

190. "Program Accreditation Status" (https://web.archive.org/web/20110217092348/http://ccea.com.au/Accr

editation/Program%20Accreditation%20Status.htm) . Council on Chiropractic Education Australasia.
Archived from the original (http://www.ccea.com.au/Accreditation/Program%20Accreditation%20Statu
s.htm) on 2011-02-17. Retrieved 2010-09-30.

191. "Institutions holding Accredited Status with the ECCE" (https://web.archive.org/web/20140722063913/ht

tp://www.cce-europe.com/accredited-institutions.html) . European Council On Chiropractic Education.
2010-11-01. Archived from the original (http://www.cce-europe.com/accredited-institutions.html) on
2014-07-22. Retrieved 2014-08-02.

192. "Canadian Chiropractic Association FAQs" (https://web.archive.org/web/20090817225255/http://www.ch

iropracticcanada.ca/en-us/FactsFAQs.aspx) . Canadian Chiropractic Association. Archived from the
original (http://www.chiropracticcanada.ca/en-us/FactsFAQs.aspx) on 2009-08-17. Retrieved
2010-10-02.

193. "Federation of Chiropractic Licensing Boards FAQ" (http://pacex.fclb.org/Information/FAQ/tabid/364/Def

ault.aspx) . Federation of Chiropractic Licensing Boards. Retrieved 2010-10-02.

194. "Chiropractors" (http://www.bls.gov/oco/ocos071.htm) . U.S. Bureau of Labor Statistics. 2007.

Retrieved 2008-07-05.

195. "Canadian Chiropractic Association: Chiropractic in Canada" (https://web.archive.org/web/20100527103

605/http://www.chiropracticcanada.ca/en-us/AboutUs/ChiropracticInCanada.aspx) . Canadian
Chiropractic Association. Archived from the original (http://www.chiropracticcanada.ca/en-us/AboutUs/C
hiropracticInCanada.aspx) on 2010-05-27. Retrieved 2010-10-02.

196. Chapman-Smith D (2000). "Current status of the profession". The Chiropractic Profession: Its Education,
Practice, Research and Future Directions. West Des Moines, IA: NCMIC. ISBN 978-1-892734-02-0.
197. Hester H, Cunliffe C, Hunnisett A (2013). "Stress in chiropractic education: a student survey of a five-year
course" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791907) . Journal of Chiropractic Education.
27 (2): 147–51. doi:10.7899/JCE-13-4 (https://doi.org/10.7899%2FJCE-13-4) . PMC 3791907 (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC3791907) . PMID 23957319 (https://pubmed.ncbi.nlm.nih.gov/2
3957319) .

198. Johnson C (December 2010). "Reflecting on 115 years: the chiropractic profession's philosophical path"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342796) . Journal of Chiropractic Humanities. 17 (1):
1–5. doi:10.1016/j.echu.2010.11.001 (https://doi.org/10.1016%2Fj.echu.2010.11.001) . PMC 3342796
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342796) . PMID 22693471 (https://pubmed.ncbi.nl
m.nih.gov/22693471) .

199. Simpson JK, Losco B, Young KJ (2010). "Development of the murdoch chiropractic graduate pledge" (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967342) . Journal of Chiropractic Education. 24 (2): 175–
86. doi:10.7899/1042-5055-24.2.175 (https://doi.org/10.7899%2F1042-5055-24.2.175) . PMC 2967342
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967342) . PMID 21048880 (https://pubmed.ncbi.nl
m.nih.gov/21048880) .

200. Staff. "Code of Ethics" (https://web.archive.org/web/20140222140728/http://www.acatoday.org/content

_css.cfm?CID=719) . American Chiropractic Association. Archived from the original (http://www.acatod
ay.org/content_css.cfm?CID=719) on 2014-02-22. Retrieved 2014-02-11.

201. Staff. "ICA code of Ethics" (https://web.archive.org/web/20140405120410/http://www.chiropractic.org/ic

a/ethics.htm) . International Chiropractor's Association. Archived from the original (http://www.chiropra
ctic.org/ica/ethics.htm) on 2014-04-05.

202. Inc., Gallup (8 September 2015). "Majority in U.S. Say Chiropractic Works for Neck, Back Pain" (http://ww
w.gallup.com/poll/184910/majority-say-chiropractic-works-neck-back-pain.aspx) . Retrieved
2015-09-13.

203. Weeks, William B; Goertz, Christine M; Meeker, William C; Marchiori, Dennis M (2015-01-01). "Public
Perceptions of Doctors of Chiropractic: Results of a National Survey and Examination of Variation
According to Respondents' Likelihood to Use Chiropractic, Experience With Chiropractic, and Chiropractic
Supply in Local Health Care Markets" (https://doi.org/10.1016%2Fj.jmpt.2015.08.001) . Journal of
Manipulative and Physiological Therapeutics. 38 (8): 533–44. doi:10.1016/j.jmpt.2015.08.001 (https://do
i.org/10.1016%2Fj.jmpt.2015.08.001) . PMID 26362263
(https://pubmed.ncbi.nlm.nih.gov/26362263) .

204. "A pivotal moment for free speech in Britain" (https://www.theguardian.com/science/blog/2010/apr/15/s

imon-singh-libel-reform) . The Guardian. April 15, 2010.

205. "The BHA re-publishes Simon Singh's article on chiropractic therapy" (https://humanism.org.uk/2009/07/
29/news-331/) . British Humanist Association. July 29, 2009.
206. Ernst E, Gilbey A (2010). "Chiropractic claims in the English-speaking world". The New Zealand Medical
Journal. 123 (1312): 36–44. PMID 20389316 (https://pubmed.ncbi.nlm.nih.gov/20389316) .

207. Stephen Barrett (2017-01-02). "Medicare Overpayments to Chiropractors Are Widespread" (http://acsh.or
g/news/2017/01/02/medicare-overpayments-chiropractors-are-widespread-10670) . American Council
on Science and Health.

208. Lucas Laursen. "The Great Beyond: Chiropractic group advises members to 'withdraw from the
battleground' " (http://blogs.nature.com/news/thegreatbeyond/2009/06/chiropractic_group_advises_me
m_1.html) . Nature.com. Retrieved 20 June 2009.

209. Lucas Laursen. "The Great Beyond: Complaints converge on chiropractors" (http://blogs.nature.com/new
s/thegreatbeyond/2009/06/chiropractic_complainers_ident.html) . Nature.com. Retrieved 20 June
2009.

210. "Unjust burdens of proof" (https://doi.org/10.1038%2F459751a) . Nature. 459 (7248): 751. June 2009.
Bibcode:2009Natur.459Q.751. (https://ui.adsabs.harvard.edu/abs/2009Natur.459Q.751.) .
doi:10.1038/459751a (https://doi.org/10.1038%2F459751a) . PMID 19516290 (https://pubmed.ncbi.nl
m.nih.gov/19516290) .

211. Pallab Ghosh (2010-04-15). "Case dropped against Simon Singh" (http://news.bbc.co.uk/1/hi/sci/tech/86
21880.stm) . BBC News.

212. Mark Henderson (2010-04-16). "Science writer Simon Singh wins bitter libel battle" (http://business.times
online.co.uk/tol/business/law/article7098157.ece) . Times Online. London.

213. Leach, Matthew J. (2013-08-01). "Profile of the complementary and alternative medicine workforce
across Australia, New Zealand, Canada, United States and United Kingdom". Complementary Therapies in
Medicine. 21 (4): 364–378. doi:10.1016/j.ctim.2013.04.004 (https://doi.org/10.1016%2Fj.ctim.2013.04.
004) . ISSN 0965-2299 (https://www.worldcat.org/issn/0965-2299) . PMID 23876568 (https://pubme
d.ncbi.nlm.nih.gov/23876568) .

214. Xue CC, Zhang AL, Lin V, Myers R, Polus B, Story DF (2008). "Acupuncture, chiropractic and osteopathy
use in Australia: a national population survey" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC23229
80) . BMC Public Health. 8: 105. doi:10.1186/1471-2458-8-105 (https://doi.org/10.1186%2F1471-2458-
8-105) . PMC 2322980 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322980) . PMID 18377663
(https://pubmed.ncbi.nlm.nih.gov/18377663) .
215. Adams, Jon; Lauche, Romy; Peng, Wenbo; Steel, Amie; Moore, Craig; Amorin-Woods, Lyndon G.; Sibbritt,
David (2017). "A workforce survey of Australian chiropractic: the profile and practice features of a
nationally representative sample of 2,005 chiropractors" (https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5217252) . BMC Complementary and Alternative Medicine. 17 (1): 14. doi:10.1186/s12906-016-1542-x
(https://doi.org/10.1186%2Fs12906-016-1542-x) . ISSN 1472-6882 (https://www.worldcat.org/issn/147
2-6882) . PMC 5217252 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217252) . PMID 28056964
(https://pubmed.ncbi.nlm.nih.gov/28056964) .  This article incorporates text (https://bmcc
omplementalternmed.biomedcentral.com/articles/10.1186/s12906-016-1542-x) by Jon Adams, Romy
Lauche, Wenbo Peng, Amie Steel, Craig Moore, Lyndon G. Amorin-Woods, and David Sibbritt available
under the CC BY 4.0 license.

216. "Chiropractic treatment available on NHS in Cornwall" (https://www.bbc.co.uk/news/uk-england-cornwall-

23669971) . BBC. August 13, 2013. Retrieved August 18, 2013.

217. Langworthy JM, Forrest L (2010). "Withdrawal rates as a consequence of disclosure of risk associated
with manipulation of the cervical spine" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161389) .
Chiropractic & Osteopathy. 18: 27. doi:10.1186/1746-1340-18-27 (https://doi.org/10.1186%2F1746-1340-
18-27) . PMC 3161389 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161389) . PMID 20977721
(https://pubmed.ncbi.nlm.nih.gov/20977721) .

218. Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review" (https://www.nc
bi.nlm.nih.gov/pmc/articles/PMC1784103) . Chiropractic & Osteopathy. 15: 2. doi:10.1186/1746-1340-
15-2 (https://doi.org/10.1186%2F1746-1340-15-2) . PMC 1784103 (https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC1784103) . PMID 17241465 (https://pubmed.ncbi.nlm.nih.gov/17241465) .

219. Crownfield PW (2007). "Chiropractic in Alberta: a model of consumer utilization and satisfaction" (http://c
hiroweb.com/archives/25/06/02.html) . Dynamic Chiropractic. 25 (6).

220. Kemper KJ, Vohra S, Walls R (December 2008). "American Academy of Pediatrics. The use of
complementary and alternative medicine in pediatrics" (https://doi.org/10.1542%2Fpeds.2008-2173) .
Pediatrics. 122 (6): 1374–86. doi:10.1542/peds.2008-2173 (https://doi.org/10.1542%2Fpeds.2008-217
3) . PMID 19047261 (https://pubmed.ncbi.nlm.nih.gov/19047261) .

221. Daniel C. Cherkin; Robert D. Mootz (2010). "Chiropractic in the United States:Training, Practice, and
Research" (http://www.chirobase.org/05RB/AHCPR/12.html) . Chirobase. Retrieved 2010-10-01.

222. Gaumer G (2006). "Factors associated with patient satisfaction with chiropractic care: survey and review
of the literature". Journal of Manipulative and Physiological Therapeutics. 29 (6): 455–62.
doi:10.1016/j.jmpt.2006.06.013 (https://doi.org/10.1016%2Fj.jmpt.2006.06.013) . PMID 16904491 (http
s://pubmed.ncbi.nlm.nih.gov/16904491) .

223. Tindle HA, Davis RB, Phillips RS, Eisenberg DM (2005). "Trends in use of complementary and alternative
medicine by US adults: 1997-2002". Alternative Therapies in Health and Medicine. 11 (1): 42–9.
PMID 15712765 (https://pubmed.ncbi.nlm.nih.gov/15712765) .
224. Stanley, G. (2007). "The Sustainability of Chiropractic" (http://www.dynamicchiropractic.com/mpacms/d
c/article.php?id=52341) . Dynamic Chiropractic. 25 (19).

225. Eric J. Bailey (2002). African American Alternative Medicine: Using Alternative Medicine to Prevent and
Control Chronic Diseases (https://books.google.com/books?id=g83lie1RiUMC&pg=PA26) . Greenwood
Publishing Group. pp. 26–. ISBN 978-0-89789-747-1.

226. Baer HA (1987). "Divergence and convergence in two systems of manual medicine: osteopathy and
chiropractic in the United States". Medical Anthropology Quarterly. 1 (2): 176–93.
doi:10.1525/maq.1987.1.2.02a00030 (https://doi.org/10.1525%2Fmaq.1987.1.2.02a00030) .

227. "Definition of chiropractic in English" (http://www.oxforddictionaries.com/us/definition/american_englis

h/chiropractic) . Oxford English Dictionary. Oxford University Press. 2014.

228. "Definition of chiro- in English" (http://www.oxforddictionaries.com/us/definition/american_english/chir

o-) . Oxford English Dictionary. Oxford University Press. 2014.

229. [1] (http://www.chiro.org/Plus/History/Persons/PalmerDD/Gregory,Alva-chrono.pdf) — Chiro.org

230. Cherkin D (November 1989). "AMA policy on chiropractic" (https://www.ncbi.nlm.nih.gov/pmc/articles/P

MC1349822) . American Journal of Public Health. 79 (11): 1569–70. doi:10.2105/AJPH.79.11.1569-a
(https://doi.org/10.2105%2FAJPH.79.11.1569-a) . PMC 1349822 (https://www.ncbi.nlm.nih.gov/pmc/ar
ticles/PMC1349822) . PMID 2817179 (https://pubmed.ncbi.nlm.nih.gov/2817179) .

231. Wardle, Jon; Frawley, Jane; Steel, Amie; Sullivan, Elizabeth (2016). "Complementary medicine and
childhood immunisation: A critical review". Vaccine. 34 (38): 4484–4500.
doi:10.1016/j.vaccine.2016.07.026 (https://doi.org/10.1016%2Fj.vaccine.2016.07.026) .
PMID 27475472 (https://pubmed.ncbi.nlm.nih.gov/27475472) .

232. Russell ML, Injeyan HS, Verhoef MJ, Eliasziw M (2004). "Beliefs and behaviours: understanding
chiropractors and immunization". Vaccine. 23 (3): 372–79. doi:10.1016/j.vaccine.2004.05.027 (https://do
i.org/10.1016%2Fj.vaccine.2004.05.027) . PMID 15530683 (https://pubmed.ncbi.nlm.nih.gov/155306
83) .

233. Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin:
contributing factors to success" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1350185) . American
Journal of Public Health. 79 (10): 1405–08. doi:10.2105/AJPH.79.10.1405 (https://doi.org/10.2105%2FA
JPH.79.10.1405) . PMC 1350185 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1350185) .
PMID 2782512 (https://pubmed.ncbi.nlm.nih.gov/2782512) .

234. Jaroff, Leon (27 February 2002). "Back Off, Chiropractors!" (http://content.time.com/time/health/article/
0,8599,213482,00.html) . Time. Retrieved 7 June 2009.

235. Gunther Brown, Candy (July 7, 2014). "Chiropractic: Is it Nature, Medicine or Religion?" (http://www.huffin
gtonpost.com/candy-gunther-brown-phd/chiropractic-is-it-nature_b_5559654.html) . HuffPost.
 Further reading

Long PH (2013). Barrett S (ed.). Chiropractic Abuse: An Insider's Lament. American Council on
Science & Health. ISBN 978-0-9727094-9-1.

Homola S (2002). "Chiropractic: Conventional or Alternative Healing?" (https://books.google.c

om/books?id=Gr4snwg7iaEC&pg=PA308) . In Shermer M (ed.). The Skeptic Encyclopedia of
Pseudoscience. 1. ABC-CLIO. pp. 308–. ISBN 978-1-57607-653-8.

Menke JM (January 2014). "Do Manual Therapies Help Low Back Pain?: A Comparative
Effectiveness Meta-Analysis". Spine (Meta-analysis). 39 (7): E463–72.
doi:10.1097/BRS.0000000000000230 (https://doi.org/10.1097%2FBRS.000000000000023
0) . PMID 24480940 (https://pubmed.ncbi.nlm.nih.gov/24480940) . S2CID 25497624 (http
s://api.semanticscholar.org/CorpusID:25497624) .

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