Chiropractic Canada

Canadian Chiropractic Association

Chiropractic

The word "chiropractic" combines the Greek words cheir (hand) and praxis (action) and means "done by hand."

"Doctor of Chiropractic(DC)"

Chiropractors, also known as Doctors of Chiropractic, practice a drug-free, manual approach to health care that includes patient assessment, diagnosis and treatment. The doctor of chiropractic is practitioner concerned with, as the member of the healing arts, the health needs of the public. The chiropractor gives particular attention to the structural and neurological relationships of the body in health and disease. He/she is educated in the biological and clinical sciences as well as health related subjects [http://cmcc.ca/PDF/2006/CMCC_Calendar06to07.pdf] In particular chiropractors assess patients for disorders of the spine, pelvis, extremity joints and their effect on the nervous system. . [http://registrar.cmcc.ca/NewCmcc/pdf2005/2005099.pdf]

What is chiropractic care?

One of the largest primary-contact health care professions in Canada, chiropractic is a non-invasive, hands-on health care discipline that focuses on the neuromusculoskeletal system.

Chiropractors practice a manual approach, providing diagnosis, treatment and preventative care for disorders related to the spine, pelvis, nervous system and joints. The vast majority of patients who seek chiropractic care do so for complaints of the musculoskeletal system, most often for conditions affecting the spine such as back pain, neck pain and headaches. Research studies have demonstrated that chiropractic treatment is effective for these conditions. [http://www.ccachiro.org/Client/cca/cca.nsf/web/Facts%20%26%20FAQs?OpenDocument Facts & FAQs ] ]

Chiropractors use a combination of treatments, all of which are predicated on the specific needs of the individual patient. After taking a complete history and diagnosing a patient, a chiropractor can develop and carry out a comprehensive treatment/management plan, recommend therapeutic exercise and other non-invasive therapies, and provide nutritional, dietary and lifestyle counselling counseling to help Canadians lead healthier, more functional lives.

For many conditions, such as lower back pain, chiropractic care is frequently the primary method of treatment. Where other conditions exist, chiropractic care may complement or support medical treatment by relieving the neuromusculoskeletal aspects associated with the condition.

Chiropractic care may also be used to provide symptomatic relief for patients with chronic conditions. According to patient surveys, by treating the neuromusculoskeletal elements of such disorders, chiropractic treatment has been shown to improve the general well-being of the patient.

There are many reasons to seek chiropractic care:

Back pain, Neck pain, Headache, Whiplash, Strains and sprains, Repetitive strain injury (RSI), Work and sports injuries, Arthritis, Limited range of motion in the back, shoulder, neck or limbs, General health and well-being

Treatment modalities

Chiropractic treatment plans can include any of the following natural therapies: spinal manipulation, soft tissue therapy, exercise rehabilitation, electrotherapies, acupuncture, health and lifestyle promotion, nutritional counseling and other holistic, conservative therapies.

Spinal manipulation/adjustment

Adjustment is the most common form of treatment utilized by chiropractors in clinical practice. Also known as spinal manipulative therapy, adjustment is a non-invasive, manual procedure that utilizes the highly refined skills developed through four years of intensive chiropractic education. Adjustment/manipulation is a carefully controlled high velocity low ampltitude (HVLA) thrust delivered by a skilled practitioner to dysfunctional spinal or extremity joints. The primary goal is to decrease pain and restore function by improving areas of reduced movement in the joints and supporting tissues, and decreasing muscle tightness or spasm. Spinal manipulation, is one of the oldest healing practices and was described by Hippocrates in ancient Greece. [ [http://nccam.nih.gov/health/chiropractic/ An Introduction to Chiropractic [NCCAM Backgrounder ] ] . Chiropractors currently perform over 90% of all spinal/extremity manipulative procedures in Canada.

Education

Chiropractic education in Canada is offered at the Canadian Memorial Chiropractic College (CMCC) in Toronto, and at l’Université du Québec à Trois-Rivières (UQTR). Both programs are fully accredited by the Council on Chiropractic Education of Canada. Canadian Chiropractic students undergo a course of study similar to that of other doctoral-level health care professionals, including medicine, optometry and dentistry and have similar entrance requirements. Students are required to complete a minimum of three years of university before they are eligible for admission to the CMCC Doctorate of Chiropractic Degree program and have a minimum of 7 years combined prior to graduation and licensure.

The CMCC program requires four years of full-time study, including a 12-month internship in the College’s internal and external clinics including St-Josephs Rehabilitaion Hospital . In Quebec, the UQTR has a five-year program following graduation from CÉGEP. CMCC also offers chiropractic graduate studies in sport sciences, clinical sciences, rehabilitation sciences and radiology following the 4 year Doctor of Chiropractic Degree. A one year continuing education programme in acupuncture is also offered.

Multidisciplinary faculty

In addition to the academic program, chiropractic education requires hands-on clinical experience under the supervision of highly-qualified chiropractic faculty. This experience includes clinical assessment, diagnosis, treatment, and referral protocols. The faculty at both CMCC and UQTR have diverse backgrounds and offer students a wide range of expertise. Faculty come from such disciplines as biological sciences, pathology, medicine and psychology, as well as chiropractic.

Both the CMCC and the UQTR programs include courses in anatomy, biochemistry, physiology, neurology, embryology, principles of chiropractic, radiology, immunology, microbiology, pathology, nutrition, and clinical sciences specifically relating to diagnosis with emphasis on the neuromusculoskeletal system.

In particular, chiropractors receive training in radiology that covers a range of topics from radiation biophysics and protection to clinical X-ray interpretation and diagnosis. Radiology training consists of more than 360 contact hours followed by application during clinical internship.

CMCC and UQTR have also developed relationships – both formal and informal – with other universities in Canada. For example, faculty and students of CMCC are currently conducting research with fellow scientists at the University of Alberta, University of Calgary, University of Saskatchewan, University of Toronto and Ryerson University. UQTR has collaborations with l’Université du Québec à Montréal and Laval University. [ [http://www.chiropractic.on.ca/ChiropracticCare/WhatisChiropractic.aspx What Is Chiropractic? ] ]

Licensure

Canadian Chiropractic Examining Board requires all candidates to complete a 12 month clinical intership to obtain licensure, as well as write a total of 3 exams in their 4th year of study. Candidates must successfully pass Components A and B (Written Cognitive Skills Examination) to be eligible for the Clinical Skills Examination. [ http://cceb.ca/english/exam/index.htm] ] Canadian accrediting standards are higher than the United States, and admission requirements into the Doctorate of Chiropractic Degree programme are the strictest in North America. [ [http://72.14.205.104/search?q=cache:T3ZpTWx44MYJ:www.ontla.on.ca/hansard/37_parl/session1/Committees/gengov/g037.htm+jean+moss+meet+and+exceed+standards+chiropractic&hl=en&ct=clnk&cd=2&gl=ca 403 Forbidden ] ]

Regulation & standards

Chiropractic is regulated by provincial statute in all 10 Canadian provinces. Chiropractors along with medical doctors, dentists, psychologists, and optometrists have the legislated right and obligation to communicate a diagnosis and to use the title doctor. Each province has a regulatory college established by legislation in the same manner, and with the same structure and similar regulations, as the regulatory bodies for other health care professions. The regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.

Hospital and public health integration

Dr. Deborah Kopansky-Giles, DC, FCCS(C) the principal investigator for a large demonstration project at St. Michael’s Hospital, Integrating Chiropractic Health Care in a Primary Care, Hospital-Based Setting, received a $600,000 grant from the Ministry of Health and Long Term Care in Ontario. The two-year project evaluated a new model of health service delivery where chiropractors are integrated as staff practitioners into a teaching hospital. [ [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1839937 Dr. Deborah Kopansky-Giles, DC, FCCS(C), FICC ] ] The project was deemed a success and as of June 2007 Dr. Kopansky-Giles and Dr. Igor Steinman, DC, FCCS(C) have both been given permanent funding and have been integrated into the primary care staff at the hospital.

Furthermore, chiropractic doctors are now working on Family Health Teams and Community Health Centres as interdisciplinary models of care and an increased focus on wellness and preventative health evolve as the new paradigm. [http://www.health.gov.on.ca/transformation/fht/guides/fht_inter_provider.pdf]

Research: Academic integration

Consortium of University-Based Research Centres

The Consortium of Canadian Chiropractic Research Centres (CCCRC), established in 1998 by The Canadian Chiropractic Association (The CCA) represents research collaborations with many universities and institutions across the country. The CCCRC currently comprises the Canadian Memorial Chiropractic College and twelve university-based research sites where chiropractic researchers either hold faculty appointments or are taking advanced research training. The CCCRC facilitates inter-disciplinary research and has sponsored four significant research symposia since its inception.

The CCRC, partnered with the Canadian Institute of Health Research (CIHR) have successly developed the University Chiropractic Research Chairs where chiropractic scientists study manual medicine and public health measures. [http://www.ccachiro.org/Client/cca/cca.nsf/web/Chiropractic%20Research?OpenDocument Chiropractic Research ] ]

International collaboration

The Canadian Chiropractic Association is an affiliate member of the Canadian Cochrane Network and Centre and a representative of the chiropractic profession serves on the Executive Committee of the Network. The Cochrane Collaboration, established in the United Kingdom in 1993, is an international organization whose mission is to prepare, maintain and promote the accessibility of systematic reviews of the effects of health care interventions. The CCA also participates in international projects such as the World Health Organization’s Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders which is conducting multi-disciplinary, international studies.

The Canadian Memorial Chiropractic College

The Canadian Memorial Chiropractic College (CMCC) has been recognized as an international leader in chiropractic research for more than five decades. Over the years, members of CMCC’s faculty have developed collaborative research relationships with faculty at many academic institutions in North America. CMCC and the profession also participate in inter-professional health policy development. An example of this is the 2003 award of almost $2 million by the Ontario Ministry of Health and Long-Term Care to faculty at CMCC for a primary care project to develop a model of collaborative, inter-disciplinary practice.

Researchers

The profession’s researchers are funded by many premier agencies such as the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Health Canada, Ontario Ministry of Health and Long-Term Care, Industry Canada, Alberta Provincial CIHR Training Program in Bone and Joint Health, and the Canada Primary Care Transition Fund, to name a few. The profession’s researchers undertake broad-based, substantive research in biomedical and clinical sciences, health systems and services, and in social cultural areas, and they are widely published in both chiropractic and non-chiropractic peer-reviewed journals. Some of these journals include the New England Journal of Medicine, the Lancet, Annals of Internal Medicine, Arthritis and Rheumatism, British Medical Journal, Canadian Medical Association Journal, Spine, Archives of Physical Medicine and Rehabilitation, the Clinical Journal of Pain, the Journal of the Canadian Chiropractic Association and the Journal of Manipulative and Physiological Therapeutics.

Building a research culture

One of the primary goals of the Canadian Chiropractic Research Foundation (CCRF) is to support chiropractors to obtain their Masters and PhD degrees and support their research projects. This is one of the ways in which the profession continually nurtures a chiropractic research culture that will inform the quality of care. The Canadian Institutes for Health Research (CIHR) has also partnered with the profession to fund doctoral and fellowship awards. The training of chiropractic researchers through sponsored PhD programs will enable the profession to further develop the research leadership to ensure continued research into chiropractic health care. A national community of fulltime research scholars in chiropractic will ensure that Canadians benefit from high quality, evidence-based care.

Chiropractic research agenda

In 2000, The Canadian Chiropractic Association began a complex process to establish a national chiropractic research agenda in Canada. This process is funded in part by four CIHR Institutes: the Institute of Musculoskeletal Health and Arthritis, the Institute of Aging, the Institute of Neuroscience, Mental Health and Addiction, and the Institute of Population and Public Health.

University chairs in chiropractic

The chiropractic profession has also established a university Research Chair program jointly funded with CIHR. Dr. Greg Kawchuk was the first member of the profession to be awarded a university-based Chiropractic Research Chair. He was subsequently awarded a Canada Research Chair at the University of Alberta, one of the federal government’s highest research awards.

Dr. Mark Erwin was awarded the profession’s second Research Chair in 2003 at the University of Toronto where he is investigating degenerative disc disease, the most common cause of lower back pain and associated disability. Dr. Jean-Sébastien Blouin DC, PhD has been named to the Canadian Chiropractic Research Foundation (CCRF) Professorship in Spine Biomechanics and Neurophysiology at the University of British Columbia (UBC). This five-year, full-time tenure tracked position for a DC, PhD begins with an initial investment of $500,000 and is funded by the CCRF, UBC, the British Columbia Chiropractic Association (BCCA) and the British Columbia College of Chiropractors (BCCC). Dr. Martin Descarreaux has been named to the Chiropractic Research Chair at the Université du Québec a Trois Rivières. The Fondation de Recherche Chiropratique du Québec and Platinum Systems, a firm specializing in clinical management software, are both contributing to finance the Chair. Dr. Descarreaux is a full-time professor at UQTR teaching clinical biomechanics. In collaboration with the Department of Kinesiology, he is currently studying the effect of muscular fatigue and pain on the control of head and neck movements. Dr. Descarreaux is also pursuing research on low back pain and is conducting a study on low back muscle fatigue and neuromuscular control of lumbar stability. The profession’s Research Chair program will significantly build the profession’s intellectual research capacity and help Canadians live healthier lives.

In June 2007, Dr. Jill Hayden DC, PhD became the profession’s newest Chiropractic Research Chair and will take up the CCRF/CIHR Chair at the Toronto Western Research Institute. She is currently a Scientist at the Centre for Research Expertise in Improved Disability Outcomes (CREIDO) at University Health Network Rehabilitation Solutions located at the Toronto Western Hospital. In addition, Dr. Hayden is a Scientific Associate in the Division of Health Care and Outcomes Research at the Toronto Western Research Institute. Dr. Hayden’s research experience and expertise includes prognostic research, systematic review methods and musculoskeletal health, specifically low back pain. Her current work at CREIDO focuses on prognosis research and the development of prognostic models for disability outcomes in low back pain.

Current university-based research chairs now include:

Dr. Greg Kawchuk DC, PhD at the University of Alberta,Dr. Mark Erwin DC, PhD at the University of Toronto,Dr. Jean-Sébastien Blouin DC, PhD at the University of British Columbia,Dr. Martin Descarreaux DC, PhD at Université du Québec à Trois-Rivières, andDr. Jill Hayden DC, PhD at the Toronto Western Research Institute, University Health Network. [ [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1924669 Canadian Chiropractic Research Bulletin #12 ] ]

http://www.ccachiro.org/client/cca/cca.nsf/web/Home?OpenDocument

http://registrar.cmcc.ca/NewCmcc/pdf2005/2005099.pdf

References