Dr Steven SmilksteinCayla Urdang

What is Chiropractic?

What Chiropractors do, how they train in South Africa, who regulates them, and what to expect at a first visit.

Most people walk into a Chiropractor's rooms with a sore back and only a rough idea of what is about to happen. That's reasonable. The name doesn't give much away: it comes from two Greek words that mean "done by hand".

A profession of its own

The World Health Organization describes Chiropractic as 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 health1. Take that long word apart and you get nerves, muscles and the skeleton, which are the parts that hold you up and move you around. The spine gets most of a Chiropractor's attention, but shoulders, hips, knees and ankles are part of the job too.

Chiropractic began in the United States in 18951. The first Chiropractors reached South Africa in 1926 and set up in Adderley Street, Cape Town2.

Six years of study

In South Africa you can study Chiropractic at two places: the University of Johannesburg and the Durban University of Technology. The course is a four-year bachelor's degree followed by a master's degree, about six years in all, and the master's is the minimum needed to register3. Graduates then go through an internship programme that falls under the profession's regulator.

That regulator is the Allied Health Professions Council of South Africa, the AHPCSA. Every practising Chiropractor in the country has to be registered with it under the Allied Health Professions Act 63 of 1982, and has to keep studying each year to stay registered3. You are welcome to ask any Chiropractor for their registration number. Dr Steven Smilkstein's is A10995.

What happens at a first visit

Expect more talking and testing than treatment to begin with.

In 2020 the British Journal of Sports Medicine published a review of clinical guidelines for muscle and joint pain. The good guidelines agreed on the basics: listen to the patient, examine them physically, check for signs of anything serious, use scans only when there is a reason to, and explain what is going on4. A careful Chiropractor works the same way. You will be asked about the pain and about your general health. Your posture and movement will be checked, usually with some joint and nerve tests. You should leave knowing what the Chiropractor thinks is wrong and what they suggest doing about it.

You don't need a doctor's referral to book.

The treatment itself

The best-known treatment is the adjustment, also called spinal manipulation. It is a quick, controlled push on a joint that isn't moving as well as it should, and it often comes with a pop. In 2015 researchers in Canada filmed finger joints inside an MRI scanner while they were pulled until they cracked. At the moment of the sound, a small gas cavity formed in the fluid inside the joint5. So the pop is gas. Bones are not grinding against each other.

Manipulation is one tool among several. At The World Games in 2017 a team of Sports Chiropractors recorded what they did for the athletes and officials who came to them. Manipulation was used in 82% of visits, muscle and soft tissue work in 80%, gentler joint mobilisation in 32% and taping in 20%6. Most people got a combination. Exercises to do at home and advice about work, sleep or training are usually part of it as well.

What people come in for

Mostly backs and necks. Low back pain affected about 619 million people around the world in 2020, and the WHO calls it the leading cause of disability worldwide7. It is also where the research on Chiropractic treatment is strongest. The WHO's 2023 guideline on long-lasting low back pain lists spinal manipulative therapy among the treatments it recommends, next to exercise and education8. There is more on that research in Does Chiropractic work?

What a Chiropractor is not

A Chiropractor doesn't prescribe medicine and doesn't operate. If your problem needs a GP, a specialist or a scan, a good Chiropractor will say so and send you on.

This article is general information and not a diagnosis. If you are in pain, come in for an assessment.

References

  1. World Health Organization. WHO guidelines on basic training and safety in Chiropractic. Geneva: WHO; 2005. iris.who.int
  2. Chiropractic Association of South Africa. History. chiropractic.co.za
  3. Chiropractic Association of South Africa. Studying Chiropractic. chiropractic.co.za
  4. Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. bjsm.bmj.com
  5. Kawchuk GN, Fryer J, Jaremko JL, Zeng H, Rowe L, Thompson R. Real-time visualization of joint cavitation. PLoS One. 2015;10(4):e0119470. pmc.ncbi.nlm.nih.gov
  6. Nook DD, Nook EC, Nook BC. Utilization of Chiropractic care at The World Games 2017: a retrospective descriptive study. J Manipulative Physiol Ther. 2023;46:271-279. doi.org
  7. World Health Organization. Low back pain (fact sheet). 19 June 2023. who.int
  8. World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: WHO; 2023. who.int

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