Chiropractic Canada
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[edit] Canadian Chiropractic: Education, Philosophy, Scope of Practice
Chiropractic
The word "chiropractic" combines the Greek words cheir (hand) and praxis (action) and means "done by hand."
What is Chiropractic?
Chiropractic, also known as Chiropractic Medicine, is a primary care, complementary and alternative health profession, which primarily uses spinal manipulation and other non-invasive therapies for the correction of neuromusculoskeletal disorders. Additional therapeutic interventions that chiropractors commonly use includes electro-therapeutic modalities, corrective exercises, nutritional, dietary and lifestyle counseling to help Canadians lead healthier, more functional lives. The vast majority of patients who seek chiropractic health 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.[1]
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.[2] Spinal manipulation, is one of the oldest healing practices and was described by Hippocrates in ancient Greece.[3]. Chiropractors currently perform over 90% of all spinal/extremity manipulative procedures in Canada.
Origins of Modern Chiropractic
In 1895, Canadian born Daniel David Palmer founded the modern profession of chiropractic in Davenport, Iowa.[4] Although some countries still adhere Palmers' original premise of chiropractic based on the traditional premise of the verterbral subluxation and disease, Canada's chiropractic schools have abandoned this paradigm and modernized into a contemporary evidence-based medicine framework that positions chiropractic care primarily for neuromusculoskeletal conditions.
The 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[5] In particular chiropractors assess patients for disorders of the spine, pelvis, extremity joints and their effect on the nervous system. . [6] Chiropractors are regulated, primary care health providers. In cases such as low back pain, chiropractic care may be the preferred method of treatment. Where other medical conditions exist, chiropractic care may support medical treatment by relieving the musculoskeletal aspects associated with the condition. Chiropractic care may also be palliative, providing symptomatic relief of the musculoskeletal disorders associated with chronic conditions.[7]
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.[8]
Canadian Chiropractic Education
Chiropractic students undergo a rigorous course of study similar to that of other doctoral-level health care professionals such as medicine, optometry and dentistry. Entrance requirements are also similar. Students are required to complete a minimum of three years of university before they are eligible for admission to the CMCC accredited program. Approximately 90 per cent of students entering the CMCC program have completed a baccalaureate or graduate degree.The CMCC program requires four years of full-time study, including a 12-month internship in CMCC’s clinics. In Quebec, the UQTR has a five-year program following graduation from CÉGEP. 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. The CMCC program is a privately funded institution and requires four years of full-time study, including a 12-month clinical internship. In August 2005, CMCC became the first private institution in Ontario to be granted the privilege of offering a professional health care degree under the Post-secondary Education Choice and Excellence Act.[9] Canadian trained chiropractors have a minimum of seven years university-level education. 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.
Accreditation, Licensure
Canadian accrediting standards and admission requirements into the Doctorate of Chiropractic Degree programme are the strictest in North America. [10]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. [11]
[edit] Canadian Chiropractic 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.[12]
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.[13]
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.[14]
World Class Research
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.[15]
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.[16]
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. [17]
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