Chiropractic (therapeutic) manipulation, commonly referred to as spinal and extraspinal adjustment, manual adjustment, vertebral adjustment, or spinal manipulative therapy (SMT), is the treatment of the articulations of the spine and musculoskeletal structures, including the extremities, for the purpose of relieving discomfort resulting from impingement of associated nerves or other structures (e.g., joints, tissues, muscles). In spinal manipulation, manual or mechanical means may be used to correct a structural imbalance or subluxation related to distortion or misalignment of the vertebral column.
Subluxation is an alteration in alignment, movement integrity, and/or physiologic function of the spine in which contact between the surfaces of the joints remains intact. Subluxation may be acute or chronic. Acute subluxation is defined as a new injury in which manipulation may result in an improvement. Chronic subluxation is defined as an existing injury that is not expected to completely resolve with manipulation. Once an individual's condition becomes chronic, ongoing manipulation is considered maintenance therapy.
Extraspinal manipulation, also known as extraspinal manipulative therapy (EMT), is used to treat joint dysfunction outside of the vertebral column. Extraspinal regions are the following: head (excluding atlanto-occipital, including temporomandibular joint), lower extremities, upper extremities, rib cage (excluding costotransverse and costovertebral joints), and abdomen.
Maintenance therapy is a continuation of care and management of the individual when the therapeutic goals of a treatment plan have been achieved, no additional functional improvement is apparent or expected to occur, the provision of services for a condition ceases to be of therapeutic value, and the therapy is no longer considered medically appropriate or medically necessary. This includes maintenance services that seek to prevent disease, promote health, and prolong and enhance the quality of life.
Chiropractic spinal manipulation under anesthesia (MUA) may be performed as a closed treatment for vertebral fracture or dislocation. In the absence of vertebral fracture or dislocation, MUA, performed either with the individual sedated or under general anesthesia, is intended to overcome an individual's conscious protective reflex mechanism that may limit the success of chiropractic spinal manipulation or adjustment. Controlled clinical trials are considered particularly important to isolate the contribution of this intervention and to assess the extent of the expected placebo effect. The available published medical literature does not currently provide evidence to support the safety and/or effectiveness of chiropractic spinal manipulation under anesthesia.