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Who Should Manipulate The Spine?

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Who Should Manipulate The Spine?

The Chiro.Org Blog

SOURCE:   World Health Organization

The World Health Organization (WHO) recently crafted and published the WHO Guidelines on Basic Training and Safety in Chiropractic (FULL TEXT Adobe Acrobat 512KB) in consultation with the World Federation of Chiropractic, the Association of Chiropractic Colleges, and various other chiropractic, medical, and osteopathic groups.

The Guidelines clarify that chiropractic is a separate profession rather than a set of techniques that can be learned in short courses by other health professionals. They also make it clear that medical doctors and other health professionals, in countries where the practice of chiropractic is not regulated by law, should undergo extensive training to re-qualify as chiropractors before claiming to offer chiropractic services. In some countries there have been recent efforts by medical groups to provide short courses of approximately 200 hours in chiropractic technique. The WHO feels this is a bad decision.

The World Health Organization guidelines indicate that a medical graduate should a require an additional minimum of 1800 class hours, including 1000 hours of supervised clinical training, before claiming to offer chiropractic services. [2]


1.   World Health Organization Guidelines on Basic Training and Safety in Chiropractic (Adobe Acrobat file)

2.   An Announcement About the Guideline’s Publication

By |December 27, 2010|News|14 Comments

About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.


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  3. peoria chiropractor December 28, 2010 at 11:13 am

    Who’d have thought we’d have to rely on the WHO to protect our profession? Thanks, WHO!

    RESPONSE from Frank:

    Actually, David Chapman-Smith (the lawyer involved in the Chiropractic In New Zealand Report) has been working tirelessly behind the scenes, after helping to form the World Federation of Chiropractic. A review of their website is most interesting.

  4. Derek @ ACC Chiro December 28, 2010 at 11:30 am

    I always think it’s funny when another profession, like medical doctors or physical therapists, try to put down chiropractic, but then say they want to learn and be licensed to perform chiropractic adjustments.

  5. Maine Chiropractor December 28, 2010 at 11:52 am

    It may be the first time I’ve been on board with a WHO recommendation since I graduated chiro school!

  6. seattle chiropractor December 28, 2010 at 3:33 pm

    Just another sign that times are changing! Thanks WHO!

  7. Hexham Family Chiropractic December 29, 2010 at 11:10 am

    Yes, I agree Derek, you don’t see chiropractors attending weekend courses on how to do knee replacements. Nice work WHO!

  8. Nick Karapasas December 29, 2010 at 3:11 pm

    Luckily, chiropractic is much more than spinal manipulation.

    Sadly, we have done such a good job educating people that they believe that chiropractic IS spinal manipulation as performed by chiropractors.

    The key is in educating the public, medical professionals, and chiropractic physicians about the issues involved. While the WHO recommendation precludes people saying they offer chiropractic services, it says nothing about spinal manipulation. Truth is, spinal manipulation is a horse that has left the barn. PTs, DOs, and a number of indiginous systems offer spinal, extremity, and visceral manipulation. We would like to think that all of those providers learned those skills in a weekend course, but many have spent hundreds if not thousands of hours learning those skills (some even doing so in hospitals and clinics where they see the worst pathology.)
    many in our profession are technique centered and use a technique of spinal manipulation that they themselves learned in a set of weekend courses…)

    I do not say this lightly…to be critical, or to imply that we are not highly skilled and qualified physicians. It is intended as a point of order and as a reminder that we have a higher goal and a “big idea” that we need to remember… DCs deserve the cultural authority and responsibility that comes with being a physician level provider. It is our responsibility to do whatever is necessary to further that end, even if it doesn’t result in short term gain.

    It is a double edged sword…

  9. Maine Chiropractor December 29, 2010 at 9:14 pm

    Exactly right Nick. One can be very skilled at manipulation without any understanding of diagnosis, physiology, etc… (many are in this category) Being good at manipulation is not what makes us doctors. Manipulation of the spine and extremities had been around for thousands of years, and probably far longer. Soft tissue work has been used throughout human history as well. We need to hold ourselves to the highest standard and be the absolute best at what we do if we are to stand out as a profession.

  10. karl December 29, 2010 at 10:28 pm

    in order to manipulate the spine/osseous joints you should have to meet the training a doctor of chiropractic. i believe the law in minnesota is that in order for practitioners to manipulate the spine they must meet the same educational standards as chiropractors.

  11. Frank December 29, 2010 at 10:41 pm

    Perhaps you all noticed that the WHO advised an additional 1800 hours of training at a chiropractic school…and that requirement includes 1000 hours of superrvised clinical experience on top of their pre-existing doctor degree?

    Yes, the adjustment is a mechanical trick, composed of speed, certainty, will, and focus. Applying it in the wrong location, or in the wrong direction will lead to injury.

    Please folks, read the whole document before you write it off, or minimize it’s importance and scope.

  12. Maine Chiropractor December 30, 2010 at 8:43 am

    I was just agreeing with Nick’s observation that chiropractic and manipulation are not synonymous. I do feel that the WHO made the right call on this one.

  13. Frank December 30, 2010 at 11:06 am


    My school instilled a dislike of the word “manipulate”, in favor of the traditional term “adjust”. Whatever. Semantics. I still agree. Unfortunately, our researchers stuck with the word “manipulate” because that’s the MESH term everyone else used. Good move? Bad move? Who cares, because the horse is already out of the barn.

    I don’t believe much research has been devoted to *how* the chiropractic adjustment differs from a manipulation applied by a PT or a DO. There are some studies distinguishing mobilization from manipulation, but that’s about it. There’s certainly minimal research distinguishing one chiropractic technique from another, although Palmer is in the midst of comparing 3 different upper cervical techniques in a blood pressure trial.

    We all *know* that chiropractic is *different*. At the same time, we don’t have much evidence distinguishing what we do from the rest of the herd. It’s really a crying shame that we were forced into the periphery by organized medicine, because up until very recently we had no access to Federal dollars to fund research. Before that, funds had to come from our own schools or the FCER/NCMIC/ICPA/FACE axis, all of whom had their own predilictions and agendas. We’ll never know what could have been funded.

    Even so, (as old Prez Bush said) there’s already a thousand points of light that shine on the safety, effectiveness, and cost-effectiveness of chiropractic care compared with standard medical management of NMS complaints. We do have that going for us.

    Sadly, there’s also been some serious flaws in the visceral trials of the last 20 years (asthma, colic) because the *sham* treatments also evidenced clinical benefits, making it *look* as though the active treatment provided no benefit, when IN FACT both active and sham treatments achieved results, compared with either no treatment, or medical management. Unfortunately, all the *science-based* nay-sayers (you know who I mean) have had plenty of time to undermine, deride, and minimize us from every angle.

    My hope and wish is that EVERY practicing DC joints a National Association (you can pick…ICA or ACA) so that these groups will finally have the funds necessary to continue to push on all fronts. If we can’t match the firepower of the AMA and the million other splinter groups who’d prefer to eat our slice of the pie, who’s to say where we will end up in the future?

  14. Maine Chiropractor December 30, 2010 at 11:18 am

    Funny you mentioned the “*science-based* nay-sayers”. I just had a discussion with an allopath about how most of the negative literature out there bashing chiropractic is done by the same handful of authors (Barrett, Ernst etc.). He was blown away. Most MDs have no idea that the lions share of the anti-chiro studies out there are done by a few crusaders with an ax to grind (for whatever reason). We do such a good job educating our patients and such a poor job educating local PCPs where we practice. In my experience (admittedly brief) they are very receptive, if only we’d take the time to seek them out and start a dialogue.

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