| Chiropractors, also known as doctors of | | | | Jersey, specify a severely narrowed scope.[45] |
| chiropractic or chiropractic physicians[38] in many | | | | States also differ over whether chiropractors |
| jurisdictions,[39] emphasize the conservative | | | | may conduct laboratory tests or diagnostic |
| management of the neuromusculoskeletal system | | | | procedures, dispense dietary supplements, or use |
| without the use of medicines or surgery,[22] with | | | | other therapies such as homeopathy and |
| special emphasis on the spine.[1] Chiropractic | | | | acupuncture; in Oregon they can become certified |
| combines aspects from mainstream and | | | | to perform minor surgery and to deliver children |
| alternative medicine, and there is no agreement | | | | via natural childbirth.[42] A 2003 survey of North |
| about how to define the profession: although | | | | American chiropractors found that a slight |
| chiropractors have many attributes of primary | | | | majority favored allowing them to write |
| care providers, chiropractic has more of the | | | | prescriptions for over-the-counter drugs.[35] A |
| attributes of a medical specialty like dentistry or | | | | related field, veterinary chiropractic, applies manual |
| podiatry.[4] It has been proposed that | | | | therapies to animals and is recognized in a few |
| chiropractors specialize in nonsurgical spine care, | | | | U.S. states,[46] but is not recognized by the |
| instead of attempting to also treat other | | | | American Chiropractic Association as being |
| problems,[25][4] but the more expansive view of | | | | chiropractic.[47] |
| chiropractic is still widespread.[40] Mainstream | | | | Chiropractic overlaps with several other |
| health care and governmental organizations such | | | | manual-therapy professions, including massage |
| as the World Health Organization consider | | | | therapy, osteopathy, and physical therapy.[48] |
| chiropractic to be complementary and alternative | | | | Chiropractic is autonomous and competitive with |
| medicine (CAM);[2] and a 2008 study reported | | | | mainstream medicine,[49] and osteopathy outside |
| that 31% of surveyed chiropractors categorized | | | | the U.S. remains primarily a manual medical |
| chiropractic as CAM, 27% as integrated medicine, | | | | system;[50] physical therapists work alongside and |
| and 12% as mainstream medicine.[3] Aligning with | | | | cooperate with mainstream medicine, and |
| conventional medicine could give chiropractors | | | | osteopathic medicine in the U.S. has merged with |
| more university affiliation and access to hospitals | | | | the medical profession.[49] Members distinguish |
| and long-term facilities; aligning with the CAM | | | | these competing professions with rhetorical |
| movement could bring more patients looking for | | | | strategies that include claims that, compared to |
| nonmedical approaches.[41] | | | | other professions, chiropractors heavily emphasize |
| The practice of chiropractic medicine involves a | | | | spinal manipulation, tend to use firmer manipulative |
| range of diagnostic methods including skeletal | | | | techniques, and promote maintenance care; that |
| imaging, observational and tactile assessments, | | | | osteopaths use a wider variety of treatment |
| and orthopedic and neurological evaluation.[22] A | | | | procedures; and that physical therapists |
| chiropractor may also refer a patient to an | | | | emphasize machinery and exercise.[48] |
| appropriate specialist, or co-manage with another | | | | No single profession "owns" spinal manipulation and |
| health care provider.[4] Common patient | | | | there is little consensus as to which profession |
| management involves spinal manipulation (SM) and | | | | should administer SM, raising concerns by |
| other manual therapies to the joints and soft | | | | chiropractors that orthodox medical physicians |
| tissues, rehabilitative exercises, health promotion, | | | | could "steal" SM procedures from chiropractors. A |
| electrical modalities, complementary procedures, | | | | focus on evidence-based SM research has also |
| and lifestyle counseling.[5] | | | | raised concerns that the resulting practice |
| Chiropractors are not licensed to write medical | | | | guidelines could limit the scope of chiropractic |
| prescriptions or perform major surgery in the | | | | practice to treating backs and necks.[18] Two U.S. |
| U.S.,[42] but that recently changed when New | | | | states (Washington and Arkansas) prohibit physical |
| Mexico became the first state to allow "advanced | | | | therapists from performing SM,[citation needed] |
| practice" trained chiropractors the ability to | | | | some states allow them to do it only if they have |
| prescribe certain medications.[43][44] Their scope | | | | completed advanced training in SM, and some |
| of practice varies by state, based on inconsistent | | | | states allow only chiropractors to perform SM, or |
| views of chiropractic care: some states, such as | | | | only chiropractors and physicians. Bills to further |
| Iowa, broadly allow treatment of "human | | | | prohibit non-chiropractors from performing SM are |
| ailments"; some, such as Delaware, use vague | | | | regularly introduced into state legislatures and are |
| concepts such as "transition of nerve energy" to | | | | opposed by physical therapist organizations. |
| define scope of practice; others, such as New | | | | |