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PubMedDate not supplied

Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design.

BACKGROUND: Chiropractors have long claimed to affect scoliotic curves, and case studies abound reporting on successful outcomes. No clinical trials exist, however, that evaluate chiropractic's effectiveness in the management of scoliotic curves. OBJECTIVE: To assess the effectiveness of chiropractic intervention in the management of adolescent idiopathic scoliosis in curves less than 20 degrees. DESIGN: Cohort time-series trial with all subjects electing chiropractic care. Entry-level Cobb angle was compared with postmanagement curve. METHODS: Forty-two subjects completed the program of chiropractic intervention. Age range at entry was 6 to 12 years, and patients were included if their entry-level x-ray films revealed curves of 6 degrees to 20 degrees. Participants had adjustments performed for 1 year before follow-up. Full-spine osseous adjustments were the major form of intervention, but heel lifts and postural and lifestyle counseling were used as well. RESULTS: There was no discernable effect on the severity of the curves as a function of age, initial curve severity, frequency of care, or attending physician. CONCLUSION: Full-spine chiropractic adjustments with heel lifts and postural and lifestyle counseling are not effective in reducing the severity of scoliotic curves.

Adolescent↗
PubMedDate not supplied

Chiropractic technique procedures for specific low back conditions: characterizing the literature.

BACKGROUND: Many original clinical trials and several review papers have come to the conclusion that manipulation is safe and effective for the treatment of low back pain. However, it is necessary to determine which specific types of manipulation and nonmanipulative types of chiropractic adjustive care are most effective for particular types of low back pain across both tissue-specific and functional classifications. OBJECTIVE: To characterize the quantity and quality of literature gathered for an Expert Panel that was convened to rate various specific chiropractic adjustive procedures for the treatment of common types of low back pain, drawing on the clinical expertise of the panel members and the relevant literature. STUDY DESIGN: Systematic review of treatment-specific, condition-specific trials, studies, and case reports of chiropractic care for low back pain. METHODS: Computerized searching and hand searching were used to identify references in the medical and chiropractic literature pertaining to the chiropractic treatment of low back pain in which both the condition and specific treatment procedures were adequately described. This literature was then categorized according to a variety of characteristics and used by a panel to evaluate the specific procedures. RESULTS: The 3 most studied adjustive procedures are side-posture high-velocity, low-amplitude; distraction (mostly flexion distraction); and mobilization, respectively. The clinical condition most commonly addressed by the included studies is low back pain. The procedure with the widest base of evidence support is side posture manipulation for low back pain.

Chiropractic↗
PubMed2002

Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?

OBJECTIVE: To investigate whether 3 distinct patterns of reactions to chiropractic care predict early favorable treatment outcome in patients with persistent low back pain. DESIGN AND SETTING: Multicenter, clinic-based prospective outcome study with standardized interview questionnaires conducted in private chiropractic practices in Sweden. STUDY SUBJECTS: Previously compliant chiropractors were invited to participate in the study. A maximum of 20 consecutive patients (per chiropractor) who sought chiropractic care for low back pain with or without sciatica with a duration of more than 2 weeks at the time of consultation and for a minimum of 30 days total during the past year. INTERVENTION: Chiropractic management as decided by the treating chiropractor. OUTCOME AND PREDICTOR VARIABLES: Improvement was defined at the 4th visit as self-reported "definitely improved" (the best of 5 choices). The hypothesized most favorable prognostic group had immediate improvement reported on the 1st visit, reduced pain intensity reported on the 2nd visit, reduced disability reported on the 2nd visit, and a common reaction or no reaction reported on the 2nd visit. The hypothesized least favorable prognostic group had no immediate improvement on the 1st visit, no reduction of pain intensity on the 2nd visit, no reduced disability on the 2nd visit, and no reaction or an uncommon reaction reported on the 2nd visit. The hypothesized intermediate prognostic group included all patients who did not fit into the hypothesized most favorable or least favorable groups. COVARIABLES: Age, sex, pain intensity during past 24 hours, description of disability, duration and pattern of pain during present attack, duration and pattern of pain during past 12 months. ANALYSIS OF DATA: The 3 predictor-groups were cross-tabulated against the outcome variable and the other covariates. RESULTS: Of the 115 patients in the most favorable prognostic group, 84% (95% confidence interval, 77-91) reported to be "definitely improved" by the 4th visit versus 63% (59-67) of the 384 patients in the intermediate prognostic group, and 30% (22-38) of the 116 patients in the least favorable prognostic group. No major interactions from the covariates could explain these results. CONCLUSION: Among chiropractic patients with persistent low back pain, it is possible to predict which patients will report definite improvement early in the course of treatment.

Adult↗
PubMed2003

Danish chiropractic patients then and now--a comparison between 1962 and 1999.

BACKGROUND: Little is known about changes in the chiropractic patient population over time. OBJECTIVE: To compare 2 surveys describing the Danish chiropractic patient population. DESIGN: Data concerning location of primary complaint and its duration for patients in Danish chiropractic offices between 1962 and 1999 were compared. SETTING: Private chiropractic practice and nonprofit research institution. OUTCOME MEASURES: Location of primary diagnosis/complaint, duration of complaint. RESULTS: In 1962, data for 1118 patients were collected, with a participation rate of 93%. In 1999, data for 1897 patients were collected. Of all Danish chiropractic clinics, 88% participated in the study, and 94% of all eligible patients filled out a questionnaire. In both 1962 and 1999, the most frequent complaints were pain in the lower back or neck either alone or with radiation to the extremities (roughly 70% of patients). In 1962, almost 4 times as many patients complained of headache as in 1999 (11% vs 4%). Although there were significant differences, less that 10% of patients presented with a nonmusculoskeletal disorder in both 1962 and 1999 (7% vs 3%). In 1962, almost half of the patients had had their complaint for more than 1 year; in 1999, approximately 80% of patients had had their complaint for less than 1 year. CONCLUSIONS: In both 1962 and 1999, Danish chiropractors primarily treated patients with pain syndromes related to the lower back and neck. Patients presenting with type O disorders comprised less than 10% of the total patient population in both surveys.

Adolescent↗
PubMed2003

Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures.

OBJECTIVE: To discuss a case involving a patient with chronic chest pain, dyspnea, and anxiety. Although resistant to previous treatment regimens, the condition responded favorably to chiropractic manipulation of the costosternal articulations. CLINICAL FEATURES: A 49-year-old man had chronic chest pain, dyspnea, and anxiety for over 4 months. The severity of the condition gradually progressed to the point of precluding the patient's active employment and most physical activity. Prior efforts to treat the condition had met with failure. INTERVENTION AND OUTCOME: The patient received mechanical force, manually assisted short-lever chiropractic adjustment of the thoracic spine and, in particular, the costosternal articulations. Adjustments were by means of an Activator Adjusting Instrument II. The patient responded favorably to the intervention, obtaining prompt relief from his symptoms. Sustained chiropractic care rendered over a 14-week period resulted in complete resolution of the patient's previously chronic condition, with recovery maintained at 9-month follow-up. CONCLUSIONS: Certain types of chest pain may have their etiology in a subluxation complex involving the costosternal articulation. Although the possibility of myocardial involvement must be considered with all patients whose symptoms include chest pain, a musculoskeletal involvement, including costosternal subluxation complex, may be the underlying cause of the symptoms in certain patients. When this is the case, chiropractic adjustment may provide an effective mode of treatment. Further study in an academic research venue is merited to investigate the role that conservative chiropractic care can provide for patients with chest pain.

Anxiety↗
PubMed2000

Chiropractic through the eyes of physiotherapists, manual therapists, and osteopaths in The Netherlands.

OBJECTIVES: To identify current perceptions and levels of awareness of chiropractic among physiotherapists, osteopaths, and manual therapists in The Netherlands. In addition, to investigate how future communication and interprofessional collaboration between the four professions may be improved in the interests of patient care as perceived by these groups. DESIGN: Four hundred and ninety-four (494) questionnaires were distributed to 100 manual therapists, 299 physiotherapists, and 95 osteopaths across The Netherlands. Questionnaires were identical for each profession. RESULTS: An overall response rate of 48% was achieved. The majority of practitioners reported limited knowledge of chiropractic. However, chiropractic was generally perceived as a primary health care profession most suited to extramural care. Sixty-seven percent (67%) of the manual therapists regarded it as direct competition, while 45% of the osteopaths and 48% of physiotherapists considered chiropractic complementary to their professions. While the majority of osteopaths felt that statutory self-regulation should be granted to chiropractors in The Netherlands, this was not supported by the manual therapists and physiotherapists. Moreover, there was only minimal (4%-11%) support for the availability of chiropractic treatment as part of the Dutch National Health Service. Although most respondents had never had contact with a local chiropractor, all osteopaths and 50% of the manual therapists and physiotherapists considered chiropractors to be skilled practitioners. However, this was more likely to be so if they had had contact with a chiropractor in the past. Current levels of communication and cooperation were thought to be poor to nonexistent although the majority welcomed closer links, particularly in relation to the treatment of spinal complaints. CONCLUSION: Greater awareness appears to be associated with increased levels of interprofessional acceptance and respect. The professions may wish to pursue areas of broad agreement identified by their practitioners in the interests of professional development and optimal standards of care for individuals in need of musculoskeletal services.

Adult↗
PubMedDate not supplied

Manual therapies for pain control: chiropractic and massage.

OBJECTIVES: To evaluate the effectiveness of chiropractic and massage therapy for the reduction of any type of pain. METHODS: Systematic reviews of chiropractic and massage as a means of pain control were located and evaluated. RESULTS: Six systematic reviews were found, 4 of chiropractic and 2 of massage therapy. Promising evidence emerged from some of these reviews but neither for chiropractic nor for massage was there fully convincing evidence for effectiveness in controlling musculoskeletal or other pain. DISCUSSION: The notion that chiropractic or massage are effective interventions for pain control has not been demonstrated convincingly through rigorous clinical trials.

Back Pain↗
PubMed1996

Chiropractic and medical costs of low back care.

This study compares health insurance payments and patient utilization patterns for episodes of care for common lumbar and low back conditions treated by chiropractic and medical providers. Using 2 years of insurance claims data, this study examines 6,183 patients who had episodes with medical or chiropractic first-contact providers. Multiple regression analysis, to control for differences in patient, clinical, and insurance characteristics, indicates that total insurance payments were substantially greater for episodes with a medical first-contact provider. Most of the cost differences were because of higher inpatient payments for such cases. Analysis of recurrent episodes indicates that chiropractic providers retain more patients for subsequent episodes and that patient exposure to a different provider type during early episodes significantly affects retention rates for later episodes. Patients choosing chiropractic and medical care were comparable on measures of severity and in lapse time between episodes. The lower costs for episodes in which chiropractors serve as initial contact providers along with the favorable satisfaction and quality indicators for patients suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending. More research is needed, especially in developing alternative measures of health status and outcomes.

Adult↗
PubMed1997

The effects of comorbidity and other factors on medical versus chiropractic care for back problems.

STUDY DESIGN: This study is a cross-sectional analysis of adults in the United States who reported at least one back-related visit to a health care professional during a 2-week reference period. OBJECTIVES: To estimate and compare the effects of comorbidity and other factors on self-reported use of medical and chiropractic care for back problems in the United States. SUMMARY OF BACKGROUND DATA: Although back pain is the second most frequent primary symptom reported by patients seeking medical care and the most frequent primary symptom among chiropractic patients, there is a dearth of research on the predictors of chiropractic and medical care among back pain patients. METHODS: Data from the 1989 National Health Interview Survey were used to perform a cross-sectional analysis of adults who sought care for a back-related condition. The primary predictor variables included comorbidity and associated disability, sociodemographic variables, and back-problem-related variables. Weighted logistic regression modeling was performed to estimate odds ratios adjusted for the effects of covariates. RESULTS: Of the 4790 adults with reported back problems, 931 sought health care for their back condition during the 2-week reference period. Adults with disabling comorbidities and back-related restricted-activity days were relatively less likely to use chiropractic care than primary medical care. Those who were male, high-school educated, single, employed, and with more than nine doctor visits during the previous 12 months were relatively more likely to use chiropractic care than primary medical care. CONCLUSIONS: The presence of comorbidity-related or back-related disability, as well as other factors, affect the type of care sought for back conditions among adults in the United States.

Adolescent↗
PubMed1998

One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.

STUDY DESIGN: A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy. OBJECTIVES: To compare outcome and costs of chiropractic and physiotherapy as primary treatment for patients with back and neck pain, with special reference to subgroups, recurrence rate, and additional health care use at follow-up evaluation 12 months after treatment. SUMMARY OF BACKGROUND DATA: Earlier studies on the effect of spinal manipulation have shown inconsistent results. Mostly they include only short-term follow-up periods, and few cost-effectiveness analyses have been made. METHODS: A group of 323 patients aged 18-60 years who had no contraindications to manipulation and who had not been treated within the previous month were included. Outcome measures were changes in Oswestry scores, pain intensity, and general health; recurrence rate; and direct and indirect costs. RESULTS: No differences were detected in health improvement, costs, or recurrence rate between the two groups. According to Oswestry score, chiropractic was more favorable for patients with a current pain episode of less than 1 week (5%) and physiotherapy for patients with a current pain episode of greater than 1 month (6.8%). Nearly 60% of the patients reported two or more recurrences. More patients in the chiropractic group (59%) than in the physiotherapy group (41%) sought additional health care. Costs varied considerably among individuals and subgroups; the direct costs were lower for physiotherapy in a few subgroups. CONCLUSIONS: Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.

Adolescent↗
PubMed2002

A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study.

STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. SUMMARY OF BACKGROUND DATA: Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown. METHODS: Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. RESULTS: Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32-0.86; average pain, 0.22, -0.25-0.69; and disability, 0.75, -0.29-1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20-2.32). CONCLUSIONS: After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small.

Analgesics↗
PubMed1986

Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study. Report of a working group.

This is the report of a feasibility study of a randomised controlled trial of chiropractic and hospital outpatient management for low back pain of mechanical origin. Preparations for the study included an approach to the General Medical Council for guidance about the intended collaboration between medically qualified and heterodox practitioners, detailed communication with local general practitioners, and the provision of a Medical Research Council (MRC) grant to cover payments to the chiropractors for work carried out in the course of the study. A total of 238 patients were considered, 197 of whom had initially presented to Northwick Park Hospital and the remaining 41 to the chiropractic clinic in Harrow. Only 6% of the patients presenting to the hospital refused to enter. The single most frequent reason for ineligibility in the hospital patients was freedom from pain at the time of the first hospital visit (23%). A variety of medical contraindications accounted for the exclusion of a further 24% of hospital patients. Patients presenting to the chiropractic group tended to have had shorter current episodes of back pain but to have had more NHS treatment in the past than those presenting to hospital. The commonest reason for exclusion among those presenting to the chiropractic clinic was refusal to enter (34%). Only 5% of the chiropractic patients were ineligible for medical reasons. Overall, 16% of those presenting to hospital and 44% of those presenting to the chiropractors were eligible and willing to enter the randomised treatment phase of the study. Of the 50 patients who entered the treatment phase, all but seven completed treatment and the six weekly self-completed assessments of progress. Patients whose current episodes had lasted less than a month progressed significantly more rapidly than those with longer current episodes. It is likely that sufficient numbers of patients with low back pain are prepared to take part in a formal randomized controlled trial. The organization and working methods for such a trial appear to be feasible. A full scale multicentre trial should aim to include about 2000 patients.

Back Pain↗
PubMed1999

Chiropractic intervention in the treatment of joint and soft tissue disorders.

The concept of manual therapy, specifically manipulation of the bodily joints as in the practice of chiropractic, can no longer be deemed an invalid system of health care. Practiced for over 2,000 years by a variety of ancient civilizations, the art of manipulation for the purpose of correcting and restoring joint function has continued to flourish, despite opposition. The climate, however, is changing. The art of chiropractic is increasingly being seen as a uniquely devised and administered technique whereby high velocity, low amplitude thrusting maneuvers are specifically directed by the skilled practitioner toward spinal segments and peripheral articulations in an effort to correct aberrant mechanical function. The corrections are effected while utilizing the transverse and spinal processes of individual vertebrae as contacting levers. Hippocrates is credited with the advice to, "look well to the spine for the cause of disease," as displaced or degenerative vertebrae m! ! ay irritate spinal nerve roots while exiting the intervertebral foramina and, consequently, interfere with normal nerve function. Similarly, it is a fundamental precept of chiropractic philosophy that irritation of the nervous system by mechanical, chemical, or psychogenic means is considered as causative in the development of disease. The scientific evidence associated with chiropractic intervention in the treatment and management of musculoskeletal disorders and visceral diseases is growing. This paper discusses the history, philosophy, and efficacy of joint manipulation and its influence on the development of chiropractic treatment.

Chiropractic↗
PubMed2002

Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study.

OBJECTIVES: This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. METHODS: Satisfaction scores (on a 10-50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. RESULTS: The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients' satisfaction. CONCLUSIONS: Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction.

Adolescent↗
PubMed1999

[Chiropractic in general and in low back pain].

The practice of chiropractic was for many years regulated by "The Quack Act" in Norway, and the numbers of chiropractors decreased year by year. They are now authorized health care practitioners with academic training; most Norwegian students attending courses in chiropractic or clinical biomechanics go to European universities. An international council ensures reciprocity and a quality assured academic programme in all recognized colleges of chiropractic. Recent research have broadened our understanding of the biomechanical interrelationship between the nervous system, the musculature and the skeletal articulations. In the early 1990s, several studies documented favourable effect of chiropractic treatment of low back disorders. These studies are now substantiated by new studies, especially concerning cost-effectiveness. Several reports also give evidence that chiropractic manipulation is beneficial especially in combination with light exercise. There are conflicting results concerning the efficacy of varying types of exercise programmes. Patients may benefit from increased cooperation between medical doctors and chiropractors. Most acute low back syndromes should be assessed by the chiropractor in order to prevent chronic illness.

Chiropractic↗
PubMedDate not supplied

Prevalence of nonmusculoskeletal complaints in chiropractic practice: report from a practice-based research program.

OBJECTIVE: To identify patient and practice characteristics that might contribute to people's seeking chiropractic care for nonmusculoskeletal complaints. DESIGN: This was a cross-sectional study conducted through the methods of practice-based research. SETTING: Data were collected in 1998--1999 in chiropractic offices in the United States, Canada, and Australia; data were managed by a practice-based research office operating in a chiropractic research center. POPULATION: The subjects were new and established patients of all ages who visited the participating offices during a designated data collection week. DATA ANALYSIS: Multiple logistic regression was used to examine factors associated with patients' presenting for nonmusculoskeletal chief complaints. Pearson's chi(2) test was used to examine associations among practice variables and the proportion of patients with nonmusculoskeletal chief complaints. RESULTS: A total of 7651 patients of 161 chiropractors in 110 practices in 32 states and 2 Canadian provinces participated; data from 2 Australian practices were included in the totals but not in the analysis. Nonmusculoskeletal complaints accounted for 10.3% of the chief complaints. The following characteristics made patients more likely to present with nonmusculoskeletal chief complaints: being less than 14 years of age (adjusted odds ratio [AOR], 6.9; 95% CI, 5.2--9.1); being female (AOR, 1.5; CI, 1.3--1.8); presenting in a small town/rural location (AOR, 1.9; CI, 1.3--2.7); reporting more than 1 complaint, especially nonmusculoskeletal complaints (AOR, 4.9; CI, 3.9--6.0); having received medical care for the chief complaint (AOR, 3.4; CI, 2.9--4.1); and having first received chiropractic care before 1960 (AOR, 1.7; CI, 1.1--2.4). Practices with the highest proportion of patients with nonmusculoskeletal chief complaints (>17%) were less likely to accept insurance and more likely to be in locations with populations greater than 100,000. They used the most common chiropractic adjustive techniques less frequently and used more nonadjustive procedures, especially diet/nutrition counseling, nutritional supplementation, herbal preparations, naturopathy, and homeopathy. CONCLUSIONS: Drawing on practices with the patient and practice characteristics identified in this study to conduct outcomes studies on nonmusculoskeletal conditions is a possible direction for future research.

Adolescent↗
PubMedDate not supplied

The effect of chiropractic care on jet lag of Finnish junior elite athletes.

OBJECTIVE: To determine the effect of chiropractic care on jet lag in Finnish junior elite athletes. SUBJECTS: Fifteen Finnish junior elite athletes. METHODS: Through use of a table of random numbers, each athlete was assigned by sex to one of 3 groups: chiropractic adjustment, sham adjustment, or control. As needed, the chiropractic adjustment group athletes (n = 5) were adjusted on a daily basis by licensed chiropractors using a toggle/recoil procedure. The sham adjustment group athletes (n = 5) received sham adjustments on a daily basis by licensed chiropractors. The control group athletes (n = 5) were not adjusted or sham-adjusted but participated in all test protocols. Sleep, jet lag, chiropractic, and mood data (the last acquired through use of the Profile of Mood States) were collected on a daily basis for 18 consecutive days. RESULTS: Repeated-measures analyses of variance (3 x 2) of total mood disturbance scores and heart rate variables indicated that there were no significant (.05 level) between-group differences. Sleep data were analyzed through use of a 3 x 2, repeated-measures multivariate analysis of variance. Pillai's trace indicated that there were no between-group differences. Self-assessment of jet lag by participants after traveling to Georgia and after returning to Finland showed no between-group differences. CONCLUSIONS: It was concluded that chiropractic care did not reduce the effects of jet lag.

Adolescent↗
PubMed1994

Beyond the "Jim Crow" experience: blacks in chiropractic education.

Although the first chiropractic adjustment was given by D.D. Palmer to a black man in 1895, within two decades attendance at the Palmer School of Chiropractic was forbidden to blacks. Not until mid-century were blacks allowed entrance into the oldest and largest chiropractic college in the United states. Denied entry at the Palmer School, most blacks who entered chirporactic studied in "Jim Crow" schools run by white practitioners in the North. This paper explores the social, historicl and economic factors influencing the exclusion of blacks from medical education, and concludes that chirpractic education is at the stage medical education was twenty-five years ago in its attempts to recruit black students. The author recommends that the Association of Chiropractic Colleges establish a task force on minoritiy recruitment to expand the educational opportunities in chiropractic for blacks and other minorities.

Black or African American↗