Resources and Strategies

The Evidence-Informed Chiropractor


An Overview Of Chiropractic Education, Guidelines, and Perceived Risks


Chiropractors are portal-of-entry (first-contact) health care providers. Referral is not a requirement. The result is that chiropractors see a wide variety of complaints.


The standard for chiropractic education is a 4 year program which prepares the chiropractic doctor for this role.


The first two years are comparable to medical education with regard to basic and clinical sciences.


Are all chiropractors alike?


Chiropractors divide themselves into two main camps. The traditional group focuses on the subluxation or subluxation-complex and do not view themselves as serving a diagnostic role or screening role for patients. Their assumption is that this is provided by their medical doctor.


The larger group, in addition to providing correction of biomechanical faults of the spine and extremities (i.e. subluxation/subluxation complex) also embraces the role of the portal-of-entry provider screening patients for potential public health concerns such as hypertension, vision, hearing, diabetes, depression, etc. and serving a role in counseling about recommendations for screenings such as for breast cancer, colon cancer, prostate cancer, advice regarding smoking cessation and exercise and diet, etc.


Patients often have difficulty in determining the high-quality chiropractor from those few who are questionable. The following link may be beneficial cross-referencing the behaviors of high-quality chiropractors


How to choose a chiropractor

Are there chiropractic guidelines that help direct their approach to patients?


The first guidelines for the profession were published in 1993 as the Guidelines for Chiropractic Quality Assurance and Practice Parameters also called The Mercy Guidelines. These were very general establishing recommendations for the use of history, examination, and imaging. For treatment, the recommendation was an initial treatment plan for two weeks which would then be modified if having no effect. Although most symptomatic problems would normally improve within an initial high-frequency approach for the first 2 weeks, complicating factors could extend that period of care.


Many other national and international guidelines have been developed that are quite similar to the Mercy document. In addition, specific radiological guidelines have recently been developed.


The most recent extensive review and best-practice collaboration is called the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) Best Practices document. These documents are regionally-based (e.g. low back, neck, upper extremity, etc.) and form chapters that are accessible on-line.

Following are links to a number of these documents:

Mercy Guidelines

Canadian Chiropractic Guidelines

Radiographic Guidelines
Upper Extremity
Lower Extremity

Risk of Chiropractic Care


Regarding risks and chiropractic care, a simple litmus test of safety is the cost of malpractice insurance. A quick search at NCMIC, the largest insurer of chiropractors, indirectly illustrates the safety record of the profession.

Chiropractors are often falsely accused of causing stroke in patients who have their cervical spine adjusted. Although it appears logical that "twisting" of the neck might cause damage, it is now clear that stroke associated with seeing a chiropractor is likely a "dissection" in progress. When the vertebral artery dissects, it most often causes signs of headache and neck pain. Patients then seek care for these symptoms.


In a groundbreaking study by Cassidy et al. it was clear that the association of having seen an M.D. prior to a VBA (vertebrobasilar accident) was equal to or greater than the association with seeing a chiropractor. These M.D.s did not manipulate their patients.

For more: Chiropractic care: The risks

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