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Chiropractor – The A to Z of Allied Health

The chiropractic profession is well-established, having had an international association for almost 100 years, with 5,836 chiropractors registered in Australia alone. Chiropractors are popular and busy, with an estimated 300,000 people seeking chiropractic services in Australia every week.

What does a chiropractor do?

The chiropractic profession is one of several healthcare professions involved in the assessment, diagnosis, treatment, and prevention of musculoskeletal problems. Chiropractic care centres on the relationship between the spine and the nervous system.

A chiropractor works with people who present with a range of conditions including acute back, neck, knee, or shoulder pain, chronic musculoskeletal pain due to injury and osteoarthritis, difficulty walking or mobilising, poor posture, migraine headaches, chronic obstructive airways disease, and sleeping problems related to pain.

Chiropractors use a combination of approaches, including evidence-based advice and exercise prescription to rehabilitate deconditioned body structures, as well as offering hands-on manual therapy that can include muscle and joint mobilisations, massage, and gentle joint manipulation if required. Outcome measures of treatment success include increased patient self-efficacy, pain reduction and improved functional work capacity. Chiropractors also provide lifestyle education to promote optimal musculoskeletal health, for example, lifting and carrying safely, general ergonomics advice, and safe exercise techniques.

Where do chiropractors work?

Chiropractors work in at least 45 countries including Australia, United Kingdom, Canada, New Zealand, the Netherlands, Italy and the USA.

Chiropractors mainly work in private practice settings in Australia, Canada, and the UK. In the USA, chiropractors work in a wider range of settings, including multidisciplinary clinics, primary care clinics, hospitals, Veterans Affairs Medical Centres, in fitness centres, with sports teams, and in corporate settings.

What types of patients to chiropractors treat?

When patients present with a musculoskeletal condition, a chiropractic treatment may not be dissimilar to that of an evidence-based musculoskeletal physiotherapist. A chiropractic treatment plan is developed with the patient goals of care in mind—i.e., a whole-of-patient approach. Chiropractic care follows guideline-based care (international clinical practice guidelines for acute and chronic musculoskeletal conditions), which takes into account the patient’s risk profile including pain chronicity, catastrophising, psychosocial factors and lifestyle elements.

Depending on the chiropractor’s clinical focus and level of expertise, a typical treatment plan for some acute or chronic back pain presentations may involve a short course of manual therapies, including hands-on mobilisation and massage with or without gentle spinal manipulative therapy of stiffened back and pelvic joints, aimed to reduce pain and improve work capacity.

Patients are encouraged to remain active and avoid bed rest and engage in a variety of exercise to improve back and pelvic muscle conditioning and strength. Patient recovery may be supported by helping the patient to reduce any background emotional stress and improve social connections with mindfulness meditation, stress-reduction techniques, as well as other social prescriptions that encourage activity and social connection. Nutritional advice may be made to support the healing process which may also help with pain levels.

In Australia, when a GP refers a patient to a chiropractor within Medicare Chronic Disease Management plans, patients are able to receive a Medicare rebate for up to 5 chiropractic visits. As a result of these GP referral the chiropractor will write a medical report at the first and last visit within the Medicare funded plan to enhance interdisciplinary communication and improve patient health outcomes.

What are the professional, educational and regulatory frameworks for chiropractors?

Chiropractors in Australia are required to complete a  five-year university degree comprised of a bachelor of science and masters of chiropractic which includes working in an outpatient clinic during the final year of university study. Chiropractors are also trained and licenced to take x-rays of spine and pelvic structures.

In the USA, the length of chiropractic education programs varies, but requires a minimum of three years’ undergraduate study, followed by a Doctor of Chiropractic degree which can take up to five years to complete.

Those looking to qualify as a chiropractor in Canada complete up to seven years of education including two years of studying social sciences and sciences at university, followed by up to five years of specialised chiropractic study.

To qualify as a chiropractor in the UK, students undertake a Master’s level degree which takes between four and five years to complete.

It takes five years to become a qualified Chiropractor in New Zealand with one year of general health science followed by a Bachelor of Chiropractic degree.

There are several educational programs across Europe, which typically entail five years of university study.

There are no local chiropractic education programs in Singapore.

Chiropractors are nationally regulated in Australia through the Australian Health Practitioner Regulation Agency (AHPRA). In the UK, Canada, and New Zealand, the chiropractic profession is self-regulated. In the USA, the chiropractic profession is licenced and regulated in all 50 states, however there are significant state-based differences in the role and scope of practice of chiropractors.

Workforce considerations for chiropractors

The chiropractic profession is well-established, having had an international association for almost 100 years, with 5,836 chiropractors registered in Australia alone. Chiropractors are popular and busy, with an estimated 300,000 people seeking chiropractic services in Australia every week. Chiropractors almost always work in private settings, with very few funded to work in public health settings, for example in the National Health Service in the UK.

The COVID pandemic and the chiropractic workforce

We discussed with Dr John Petrozzi (PhD), of  Body Mind Central clinic in Sydney, the impact of COVID-19 on the chiropractic profession. His research with allied health professionals found that while telehealth was beneficial for the talking therapies (psychologists and mental health care workers) during the COVID-19  pandemic, telehealth was not as well accepted by chiropractic, physiotherapy and osteopathic patients as an alternative to usual face-to-face care. While some chiropractors were able to use telehealth with patients to check how they were doing their exercises and provide injury management advice, overall chiropractors and their patients’ access to care were substantially affected by the pandemic. Some practices were forced to take out loans to cover ongoing costs while others were forced to downsize and furlough staff. Post-COVID has seen a resumption of practice, though it may take some time until practice viability recovers to pre-pandemic levels. Follow John Petrozzi on LinkedIn.

Find out more about Chiropractors

Here are some links to websites and resources for and about Chiropractors:

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