Chiropractic is often called an ‘alternative medicine’ that focuses on the diagnosis and treatment of musculoskeletal disorders, especially those of the spine. Most chiropractors will tell you that it is so much more - it is a way of life, and lifestyle medicine.

Watch this interview clip with Dr. Kyle Worrell, DC - he has a large toolbox full of different techniques, and chooses his techniques based on the specific needs of his clients. As an Ironman, he has personal experience of how exercise and optimal movement are central to a long and fulfilling life, and are a core part of his chiropractic practise.

Joe Public sees chiropractors using manual techniques, such as spinal manipulation, to adjust the alignment of the spine and other joints, and to restore normal function and mobility.

Chiropractors are embracing movement assessment and exercise prescription as part of their holistic approach to patient care. Chiropractors use movement assessment and exercise prescription to identify and correct movement dysfunctions, optimize performance, prevent injuries, and enhance health and well-being [1].

Movement assessment is the process of evaluating the quality, quantity, and efficiency of human movement, while exercise prescription is the design and implementation of individualized exercise programs based on the results of the assessment.

Some of the tools and methods that chiropractors use for movement assessment and exercise prescription include functional movement screens, postural analysis, gait analysis, range of motion testing, muscle strength testing, balance testing, and aerobic capacity testing [2]. Chiropractors also follow the principles of exercise prescription based on the type, duration, frequency, intensity, and volume of exercise [3]. Chiropractors tailor the exercise prescription to the specific needs and goals of each patient, taking into account their health status, baseline fitness, preferences, and contraindications [3].

By incorporating movement assessment and exercise prescription into their practice, chiropractors can provide more comprehensive and evidence-based care to their patients. Movement assessment and exercise prescription can help chiropractors address the underlying causes of musculoskeletal pain and dysfunction, improve functional outcomes, and promote physical activity and exercise as a vital component of health [1].

So how many chiropractors are there?

According to the latest estimates from the U.S. Bureau of Labor Statistics (BLS), there were about 37,740 chiropractors employed in the USA as of May 2022 [4]. However, this number does not include self-employed chiropractors, who may account for a significant portion of the profession. According to another source, more than 70,000 chiropractors are registered and licensed in the USA [5].

The number of chiropractors varies widely by state, ranging from around 80 in West Virginia to around 3,050 in Florida [6]. The states with the highest concentration of chiropractors per capita are Georgia, Minnesota, Wisconsin, South Dakota, and Colorado [6]. The states with the highest average annual wage for chiropractors are New York, Alaska, Connecticut, New Jersey, and Massachusetts [6].

The chiropractic profession is often considered to be fragmented because of the lack of consensus and standardization among its practitioners. There are different schools of thought and practice within chiropractic, such as straight, mixer, reform, evidence-based, and subluxation-based. These approaches differ in their philosophy, scope of practice, diagnostic methods, treatment techniques, and scientific evidence.

Some of the factors that contribute to the fragmentation of chiropractic are:

1. The historical conflict between chiropractors and the medical establishment, which led to legal battles, professional isolation, and persecution in some states [7](Keating et al., 2005).

2. The diversity of educational programs and accreditation standards for chiropractic colleges, which result in different levels of training and competency among graduates [8] (Gleberzon et al., 2014).

3. The lack of a unified national licensing exam and continuing education requirements for chiropractors, which allow for variation in state regulations and practice standards [8] (Gleberzon et al., 2014).

4. The influence of personal beliefs, values, preferences, and experiences on chiropractic practice, which may affect the choice of methods and outcomes [9](Leboeuf-Yde et al., 2009).

- The competition and rivalry among different chiropractic associations, organizations, journals, and media outlets, which may promote conflicting agendas and interests [10](McGregor et al., 2014).

Despite these challenges, there are also some efforts to unify and advance the chiropractic profession. For example:

1. The World Federation of Chiropractic (WFC) is an international organization that represents national associations of chiropractors from 92 countries. The WFC promotes cooperation and collaboration among its members and advocates for the recognition and integration of chiropractic in health systems worldwide [11] (WFC website).

2. The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is a U.S.-based organization that develops evidence-based clinical practice guidelines for chiropractic care. The CCGPP aims to improve the quality and consistency of chiropractic practice and to enhance patient outcomes and satisfaction [12] (CCGPP website).

3. The National Center for Complementary and Integrative Health (NCCIH) is a federal agency that supports research on complementary and integrative health approaches, including chiropractic. The NCCIH funds studies on the safety, effectiveness, mechanisms, and cost-effectiveness of chiropractic interventions for various health conditions [12] (NCCIH website).

In conclusion, chiropractic is a diverse and dynamic profession that offers a range of services to patients with musculoskeletal problems. There are many factors that influence the number and distribution of chiropractors in the USA and the degree of fragmentation within the profession. However, there are also some initiatives that aim to foster unity and progress among chiropractors and to improve their integration into mainstream health care. One thing is for sure, it is no longer just hands-on profession. Movement assessment and exercise prescription are here to stay.

References:

[1] Physical Activity and Exercise Prescription - Physiopedia. https://www.physio-pedia.com/Physical_Activity_and_Exercise_Prescription

[2] ACSM’s Guidelines for Exercise Testing and Prescription 9th Ed. 2014. https://europepmc.org/article/PMC/4139760

[3] ACSM’s Guidelines for Exercise Testing and Prescription, 11th edition | Q&A With Senior Editor Dr. Gary Liguori. https://www.acsm.org/blog-detail/acsm-blog/2021/01/12/acsm-guidelines-for-exercise-testing-and-prescription-11th-edition-qa-senior-editor-gary-liguori

[4] BLS (May 2022) Occupational Employment Statistics: Chiropractors.

[5] BLS (May 2022) Occupational Employment Statistics: Chiropractors.

[6] BLS. (2023). Occupational Employment Statistics: Chiropractors. Retrieved from https://www.bls.gov/oes/current/oes291011.htm

[7] Keating JC Jr et al. (2005). A history of the legal status of professional licensure for US chiropractors. J Manipulative Physiol Ther. 28(1):16-25.

[8]Gleberzon BJ et al. (2014). A scoping review of comparisons between different types or philosophies of chiropractic education. J Chiropr Educ. 28(2):115-25.

[9] Leboeuf-Yde C et al. (2009). The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors. Chiropr Osteopat. 17:1.

[10] McGregor M et al. (2014). Differentiating intra professional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey. BMC Complement Altern Med. 14:51.

[11] WFC website. (n.d.). About the WFC. Retrieved from https://www.wfc.org/website/index.php?option=com_content&view=article&id=95&Itemid=110&lang=en

[12] NCCIH website. (n.d.). Chiropractic: In Depth. Retrieved from https://www.nccih.nih.gov/health/chiropractic-in-depth