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A service of the U.S. National Library of Medicine
http://www.nlm.nih.gov/
and the National Institutes of Health
http://www.nih.gov/

What is Chiropractic?
http://www.consumersresearchcncl.org
What Does a Chiropractor Do?
http://www.consumersresearchcncl.org

Finding a Chiropractor
Chiropractic Education and Licensing
How Chiropractors Were Selected
Common Chiropractic Problems
Automobile Accident / Whiplash
Back Injuries and Pain
Subluxation
Sciatica
Scoliosis
Carpal Tunnel Syndrome
Neck Pain
Headaches
Sports

Directory of Chiropractors
The staff of the National Directory of Chiropractic is continuing in its eighteen-year tradition of quality and excellence by publishing the nation's leading printed directory of chiropractors. We are dedicated to maintaining the most up-to-date and accurate information regarding chiropractors and the chiropractic profession.

Chirodirectory.com serves as a resource for individuals seeking a chiropractor in their area. We provide details about each chiropractor we list including their chiropractic methods and practices, their education, and contact information to their clinic.

To find a chiropractic physician in your area, you have two options. You may enter your location details under the "Search Chirodirectory" title on the top right of this page. Or, if you would like to browse through specific states and cities, click on the "Browse Chiropractor by State and City" link under the "Browse Chirodirectory" title.

Over 65,000 Chiropractors listed.
Chiropractic methods and practices detailed.
Chiropractor contact information provided.
Profiled chiropractic doctors.

Patients using chiropractors in North America: who are they, and why are they in chiropractic care?

SUMMARY OF BACKGROUND DATA AND OBJECTIVES: Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. METHODS: The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient's reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. RESULTS: More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6-8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. CONCLUSION: These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.

How can chiropractic become a respected mainstream profession? The example of podiatry.
ABSTRACT: BACKGROUND: The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions which had their start at around the same time as chiropractic have disappeared. Despite chiropractic's longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society, and its market share is dwindling. In the meantime, the podiatric medical profession, during approximately the same time period, has been far more successful in developing itself into a respected profession that is well integrated into mainstream health care and society. OBJECTIVE: To present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority. DISCUSSION: There are several key areas in which the podiatric medical profession has succeeded and in which the chiropractic profession has not. The authors contend that it is in these key areas that changes must be made in order for our profession to overcome its shrinking market share and its present low status amongst healthcare professions. These areas include public health, education, identity and professionalism. CONCLUSION: The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise. Several lessons can be learned from the podiatric medical profession in this effort.

Chiropractic: a profession at the crossroads of mainstream and alternative medicine.

Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine. Chiropractic has taken on many of the attributes of an established profession, improving its educational and licensing systems and substantially increasing its market share in the past two decades. The public increasingly uses chiropractic largely for spinal pain syndromes and appears to be highly satisfied with the results. Of all the so-called alternative professions, chiropractic has made the largest inroads into private and public health care financing systems and is increasingly viewed as an effective specialty by many in the medical profession. Much of the positive evolution of chiropractic can be ascribed to a quarter century-long research effort focused on the core chiropractic procedure of spinal manipulation. This effort has helped bring spinal manipulation out of the investigational category to become one of the most studied forms of conservative treatment for spinal pain. Chiropractic theory is still controversial, but recent expansion in federal support of chiropractic research bodes well for further scientific development. The medical establishment has not yet fully accepted chiropractic as a mainstream form of care. The next decade should determine whether chiropractic maintains the trappings of an alternative health care profession or becomes fully integrated into all health care systems.

Chiropractic in the United States: trends and issues.

Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third-party payers. However, the profession's efforts to validate the effectiveness of spinal manipulative therapy, its principal modality, have yielded only modest and often contrary results. At the same time, reimbursement is shrinking, the number of practitioners is growing, and competition from other healing professions is increasing. The profession's efforts to establish a role in primary care are meeting resistance, and its attempts to broaden its activities in alternative medicine have inherent limitations. Although patients express a high level of satisfaction with chiropractic treatment and politicians are sympathetic to it, this may not be enough as our nation grapples to define the health care system that it can afford.

Economic case for the integration of chiropractic services into the health care system.

The role and position of chiropractic care in the health care system must be transformed from being alternative and separate to alternative and mainstream. This transformation requires that chiropractic services become integrated in the many health care delivery organizations that collectively constitute the health care system. There is solid and impressive economic and related justification for the desired integration. Chiropractic care is a cost-effective alternative to the management of neuromusculoskeletal conditions by other professions. It is also safer and increasingly accepted by the public, as reflected in the growing use and high patient retention rates. There is much and repeated evidence that patients prefer chiropractic care over other forms of care for the more common musculoskeletal conditions. The public interest will be well served by this transformation. Musculoskeletal disorders and injuries are the second and third most costly categories of health problems in economic burden-of-illness studies. They rank first as a cause in the prevalence of chronic health problems and long-term disability and rank at the top for activity limitations and short-term disability. They rank first as a reason for consultation with a health professional and second as a reason for the use of prescription and nonprescription drugs. These conditions are more prevalent among the poor, lower-middle income groups, and the elderly, yet those are precisely the groups that make the least use of chiropractic care for reasons of inadequate insurance coverage. The integration of chiropractic care into the health care system should serve to reduce health care costs, improve accessibility to needed care, and improve health outcomes.

Health services research
Advances in rheumatologic arthritis health services research continue to be of interest to clinical rheumatologists and arthritis researchers interested in healthcare delivery and policy. Recent studies have shown that a higher incidence of osteoarthritis and functional disability among rural inhabitants influences delivery of arthritis care to rural areas and urban-rural variations in specialist distribution. In the United States, managed care organizations are increasingly dictating who delivers and who receives health care for arthritis. Provision of arthritis care by rheumatologists has become more discretionary and is strongly influenced by a patient's health insurance coverage. Coinciding with this trend, a higher percentage of arthritis care is being shifted to primary care providers. Based on prominent practice pattern variations, generalists have divergent knowledge and beliefs about the value of various arthritis treatments. New therapeutic programs have been proposed to better coordinate efforts between generalists and specialists. Many arthritis patients also seek alterative therapies. Of these, chiropractic care is one of the most common nontraditional therapies. Chiropractic management appears to be as cost-effective as traditional back care in certain settings.

Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis.

OBJECTIVE: To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services into managed care. DATA SOURCES: A literature review and information search were conducted to determine which new insurers had special policies for CAM from 1999 to 2000. Telephone interviews were conducted with a sample of 6 new managed care organizations (MCOs) or insurers identified in 2000 and a nonrepresentative cohort of 4 of the original 18 MCOs and insurers who responded both to the original survey in 1997 and again in 1998 to determine trends. STUDY SELECTION: This study constitutes the results of the third year of an ongoing annual survey. For the year 2000, a total of 14 new companies were identified as offering some CAM coverage. Survey results were analyzed for 6 of these who responded to the current survey as well as the results of the cohort mentioned above. DATA EXTRACTION AND SYNTHESIS: Most of the insurers interviewed offer some coverage for the following: nutrition counseling, biofeedback psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. All new companies indicated that market demand was a primary motivator for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness, consumer interest, and demonstrable clinical efficacy. Among the most common obstacles listed for incorporating CAM into mainstream healthcare were lack of research on clinical or cost-effectiveness, economics, ignorance about CAM, provider competition, and lack of standards of practice. CONCLUSION: Consumer demand for CAM is motivating more MCOs and insurance companies to assess the clinical and cost benefits of incorporating CAM. Outcomes studies for both conventional and CAM therapies are needed to help create a healthcare system based on treatments that work, whether they are conventional, complementary, alternative, or integrative medicine.

Are health services research methods a match for CAM?

BACKGROUND: Many complementary and alternative medicine (CAM) researchers believe that a new set of research methods is needed to study CAM. Health services research (HSR) is listed as a new research goal in the National Center for Complementary and Alternative Medicine 2005-2009 strategic plan. Does HSR offer solutions to the research needs of CAM? This article presents an overview of HSR, a summary of the HSR studies that have been published in CAM, and discussions of what HSR might offer CAM and what studies of CAM might offer conventional HSR. DISCUSSION: Our literature search, which was performed at the University of Arizona, found 84 published CAM HSR studies. A comparison of the search results-mostly surveys of CAM users or providers and economic outcome studies-with the breadth of topics that may be studied using HSR, showed that research in this field has not reached its potential. More work, including studies of interactions between patient, provider, and the system as well as patient-centered outcomes studies, is needed. Several areas in which CAM could benefit from HSR were identified and discussed. These included studies supporting the integration of CAM and conventional medicine, insurance coverage for CAM therapies, the development practice guidelines, and studies of the effectiveness and cost-effectiveness of CAM therapies and whole medical systems. The study of CAM, especially studies focusing on patients' attraction to CAM, may also help expand the topics and methods of conventional HSR. SUMMARY: HSR methods may address many of CAM's methodological challenges and improve clinical, patient-centered, and economic outcomes across all systems of care-both conventional and CAM.

Is health services research the Holy Grail of complementary and alternative medicine research?
In a 2006 article in Alternative Therapies in Health and Medicine, Herman et al argued cogently that adopting a health services research (HSR) paradigm would help resolve some of the issues that the complementary and alternative medicine (CAM) community and those researching CAM face with randomized controlled trials. Although the article makes a strong case for HSR and CAM, it fails to discuss some of the work in HSR that is uniquely relevant to CAM or to provide a critique of the view one gets from HSR about CAM. There is within the studies of chiropractic a sufficient body of HSR, which can help to assess what the contribution of HSR has been in the past and also what its limitations are today. It provides a cautionary tale for CAM. This article looks at HSR in relationship to evidence-based practice and will discuss the limitations and dangers of the view of CAM from the perspective of HSR using chiropractic studies as an exemplar.

Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice.

Complementary and alternative medicine (CAM) is growing in popularity among patients traditionally seen in an allopathic setting. A literature review and information search was conducted to determine the trend in demand for and the availability of CAM in the United States. The results of major surveys show that there is an increase in the use of CAM in the United States. The best predictor of CAM use is higher level of education. In addition, findings reveal that the field of CAM is poorly researched. Many studies in CAM therapies have flaws, such as insufficient statistical power, poor controls, inconsistent treatment, and lack of comparisons. The National Center for Complementary and Alternative Medicine of the National Institutes of Health, has declared their top strategic priority to be investing in research. Currently, more than 70 medical schools offer some type of training in alternative medicine, although there are few guidelines for curriculum and there is considerable heterogeneity in content, format, and requirements among CAM courses. As patients have greater access to information, their needs and values change. They become more involved in their overall health care and are taking a more natural and holistic approach to achieving well-being. Health care practitioners, both allopathic and alternative, must be well informed. There is an imperative to make CAM research a high priority. Valid and reliable empirical data must document the clinical efficacy and safety of CAM practices. In order to integrate CAM into the mainstream, there must be a coordinated effort among all the entities involved. Physicians need to be familiar with proven CAM therapies in order to advise patients about these modalities and the potential benefits and limitations. CAM practitioners should be licensed and regulated in scope of practice to provide a high standard of care, and be sufficiently educated in conventional medical science(s) in order to recognize how, where, and why their respective complementary practice is most effective for integration.

Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis.

OBJECTIVE: To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services into managed care. DATA SOURCES: A literature review and information search were conducted to determine which new insurers had special policies for CAM from 1999 to 2000. Telephone interviews were conducted with a sample of 6 new managed care organizations (MCOs) or insurers identified in 2000 and a nonrepresentative cohort of 4 of the original 18 MCOs and insurers who responded both to the original survey in 1997 and again in 1998 to determine trends. STUDY SELECTION: This study constitutes the results of the third year of an ongoing annual survey. For the year 2000, a total of 14 new companies were identified as offering some CAM coverage. Survey results were analyzed for 6 of these who responded to the current survey as well as the results of the cohort mentioned above. DATA EXTRACTION AND SYNTHESIS: Most of the insurers interviewed offer some coverage for the following: nutrition counseling, biofeedback psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. All new companies indicated that market demand was a primary motivator for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness, consumer interest, and demonstrable clinical efficacy. Among the most common obstacles listed for incorporating CAM into mainstream healthcare were lack of research on clinical or cost-effectiveness, economics, ignorance about CAM, provider competition, and lack of standards of practice.

CONCLUSION: Consumer demand for CAM is motivating more MCOs and insurance companies to assess the clinical and cost benefits of incorporating CAM. Outcomes studies for both conventional and CAM therapies are needed to help create a healthcare system based on treatments that work, whether they are conventional, complementary, alternative, or integrative medicine.