10.02.2020, Rīga, Latvia
Regarding: Chiropractic profession world wide and use of terminology within Latvia.
This letter is written in response to other health care providers (non-Chiropractors) who were unrightfully using Chiropractic terminology. Please consider the licenced status of the Chiropractic Profession, not to mislead the public.
To the Health Care Provider(s)/ Government Official(s) this might concern,
Definitions of Chiropractic by the World Health Organisation (WHO):
“Chiropractic is A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on subluxations”.
“Chiropractic is one of the most popularly used forms of manual therapy**. It is now practised worldwide and regulated by law in some 40 national jurisdictions”.
**With manual therapy there is reference made to therapy done by hand. NOT to the certification of “Manual therapy” as a profession, as it is known in certain countries. Rather, manual therapy is the accumulative term which covers professions like Chiropractic, Osteopathy, Manual therapy (profession), physiotherapy and so on in this context.
Please take reference to this document published by the WHO: https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf
“The quality of the practice depends mainly on the training performed by the practitioner. For this reason, the Regional Government of Lombardy supported the development of the WHO Guidelines on Basic Training and Safety in Chiropractic that aim at defining the requisites for chiropractic practitioners. The process of development of these Guidelines included the WHO Consultation meeting held in Milan in December 2004, which brought together experts, national authorities and professional organizations from all over the world. One of the conclusions of the Consultation was that these guidelines were appropriate as resources not only for the Lombardy Region, but also for various country situations worldwide. With this in mind, this document is to be considered an important reference point for those, among practitioners, political and administrative authorities, that want chiropractic to be a safe and efficacious aid for citizens’ health and for any regulatory and licensing act”.
Chiropractic is a licensed profession. In some countries it falls under Complementary Alternative Medicine (CAM). In other countries it is more part of primary Medicine and in one case fully and Chiropractors have the same status as Medical Doctors in the medical field (only example is Switzerland). Chiropractic being part of Complementary Alternative Medicine in some countries does not directly mean that is complementary to primary Medicine. It is merely a regulatory arrangement in the country for Chiropractors to work under a regulated profession. There is examples where most patients go to Chiropractors before they see regular Doctors regarding complaints of the Muscular, nervous and skeletal system (good example are countries like Denmark and Norway). Here and in many other countries Chiropractic is a big contributor to health in society.
In fact, it is two different matters. Rather, Complementary Alternative Medicine is the group into which different professions are grouped into -only in certain countries- in order to be regulated in the health care system of that country. But that does not make Chiropractic and CAM one and the same thing. Neither does it allow other healthcare providers to use the terminology of the Chiropractic profession. In the UK Chiropractic is part of CAM, so are Acupuncture and Homeopathy for example. It does not mean that they are the same professions. Somebody practising Chiropractic is a Chiropractor. Like Osteopathy is a profession and an Osteopath practises Osteopathy. In one country only; Chiropractors have the Medical Doctor title: Switzerland. In yet other countries Chiropractors cannot work because of legislation preventing them from practising their profession. That does not take away that Chiropractors everywhere in the world have the same Education standards. You can find Chiropractors anywhere in the world, like you can find Osteopaths and Doctors everywhere in the world.
For the benefit of the Professions licensing and in the interest of the public’s health -in my conclusion of the WHO guidelines and my conviction as an ‘European Council on Chiropractic Education accredited University’ graduate-:
Other Health care providers -whether they are part of CAM or not- should not refer to themselves as Chiropractors and should not give any signals out to the public that they are working in the Chiropractic area or Chiropractic profession (in any language). Neither should they be able to use similar derived terminology from the original professions name. Only healthcare providers who have gone through the Educational programs of Chiropractic as set out in the WHO guidelines for Chiropractic should have the right to do this.
In Chiropractic Education there are no osteopathic techniques taught, neither are manual therapy spinal manipulations originating from the Manual therapy profession integrated and neither are large parts of other techniques developed by other Professions included in the curriculum for that matter. Rather, the Profession has built and builds on its own discoveries, promoters, researchers and developers and well established Educational Chiropractic institutions and accreditation agents. In my own experience with some bone setters and Manual therapist professionals I see fundamental differences. Maybe some people from the outside might say: 'bone cracking is bone cracking' but I have to disagree as an insider. If you study Gonstead Chiropractic or some other Chiropractic techniques which are part of the basic Chiropractic curriculum you will know the difference. Furthermore the philosophy from the start is very different from that of Medicine and other healthcare professions and up until this day there is space for philosophical development within the Educational programs of Chiropractic. Philosophy very much influences how one practises. In case you have not studied the philosophy of Chiropractic and you are interested in the background of Chiropractic I would advise you to look into the 33 principles of Chiropractic and the Green books of Chiropractic. These days because of the requirements for the Chiropractic profession to exist in certain countries and their necessity to comply with modern evidence; Chiropractic is developing more in the direction of Evidence based practice and that is why they can be categorized into CAM in certain countries. As a result of the Evidence based practise; the Chiropractic Education can contain functional Rehabilitation as there is a lot of evidence to support the efficacy of rehab, and might contain minor aspects of other therapies also. That does not take away that the core of Chiropractic is the Chiropractic Adjustment and analysis methodology to determine where and how to adjust.
I appreciate healthcare professionals regardless of which methods they use, as long as they have the right intentions, educational background and clinical experience to act in the patients best interest. I believe though that a full time study and proper technique training and safety consideration are needed to be able to do safe and effective spinal corrections. I will describe a scenario under which circumstances in many countries Healthcare providers can do spinal manipulations on the public. The requirement in most countries to be able to do spinal manipulations is that you are a health care provider and you do a very limited amount of hours of training (compared to the Chiropractic Adjustive technique training) in spinal manipulative therapy, mainly over weekend or evening courses after which you can apply spinal manipulative therapy in practise. In practise they might do something like this on patients; ‘pushing back the shoulders from the side posture position and kicking down the leg; cracking everything from mid-back until the low back’ -to put it in that metaphoric description-. This is very contrary to the specific Adjustments Chiropractors dedicate much of their Education and career to mastering. This described scenario does not imply to everyone doing spinal manipulations, as I am sure many non-Chiropractors doing spinal manipulations are doing good but it goes to show some of the differences which can be expected according to which professional you go to.
I do not judge people by their title or profession and there are many routes to become a good clinician and to be in a position to help people. But that does not take away that up until this moment the Chiropractic Education according to the WHO standards, in my understanding is the best basis to shape good spinal correction specialists. Therefore, there has to be licensing and copyright legislation for the terminology of Chiropractic in every country. Because patients who are in the expectation that they see a licensed Chiropractor and might have been fooled or confused as to which Professional they go to, are being done injustice (i.e. it could be a safe and good experience but it might also not be, hence the licensing) if the person they undergo healthcare services from does not meet up to the same level of Education and accreditation as the person they expected to entrust their health with. If there is clarity and transparency about the health care provider they go to; for example they know that they visit an Osteopath or a Manual therapist professional, then they have a chance to orientate themselves in regard to the regulations and education standards of the profession in the country in question. The licensing provides confirmation about the educational background and this is greatly linked to safety of practise.
In Latvia there are no regulations in regard to Chiropractic. This is why it is crucial that we keep the name separate otherwise a similar situation might develop as is the case in Germany.
The story in Germany regarding Chiropractors vs. Healthcare providers trained to do spinal manipulations will be described: Orthopaedic Doctors, Physiotherapists as well as Heilpraktiker (basic medical certificated) can do weekend courses of spinal manipulation. Then they become 'Chirotherapeuten' (note that they use the name Chiropractors use, more or less) and insurance covers for it! The Orthopaedic Doctor groups consequently downgraded Chiropractic by doing publications stating that "Chirotherapeuten do the same as Chiropractors ; but without the risk factors involved". And they lobbied that Chiropractors cannot work in Germany unless they have the 'Heilpraktikers license'. I am convinced however that with a more solid base of learning spinal corrections, which the 5 to 6 years Chiropractic educational program (or the shortened course of 4 years which for certain existing healthcare providers is available) offers, that this lowers the risk factors. As a consequence of the legislation it is very hard for Chiropractors to work in Germany and they often refer to ‘American Chiropractic’ to show the difference. This goes to say that it is important not to mix into different professions terminology, otherwise the blossom of that profession can be affected. Of course the more you practise, the better you become.. But it is in most cases a logarithmic learning curve. If the foundation is not properly laid, the quality and efficacy of the end ‘product’ can certainly be less.
I like the idea that we should get together as health care professionals and learn from each other and work together. Part of that is learning and recognising the differences of each other. If there would be a way in the system that people can change profession easier or that everybody can have a basic education to make what you are doing safe and consequently you can share techniques and so on easier that would be great. But now in many countries the situation is such for Chiropractors that it is actually not fair the way the regulations are being laid down and that’s why it is needed to stand up for the differences, so Chiropractic does not get ‘washed away’ in certain countries. Licensing and protecting our name is the only way to do this. Given the previously described scenarios and background of Chiropractic we hope for your understanding and your professional actions as a Health care provider or consideration as a government official.
Pascal Sanderse, Anglo European College of Chiropractic Graduate, Master of Chiropractic