Authorized reprint 2005 WHO guidelines on basic training and safety in chiropractic 2005 WORLD FEDERATION OF CHIROPRACTIC

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1 Authorized reprint Pars sacralis Pars lumbalis Pars thoracalis Pars cervicalis WORLD FEDERATION OF CHIROPRACTIC

2 Authorized reprint 2005 WHO guidelines on basic training and safety in chiropractic 2005 WORLD FEDERATION OF CHIROPRACTIC

3 CIP ISBN NLMWB905.7 ISBN ISBN WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland bookorders@who.int permissions@who.int Issued as a publication by the World Health Organization in 2005 under the title World Health Organization 2005 The Director-General of the World Health Organization has granted reproduction rights to World Federation of Chiropractic World Federation of Chiropractic 1246 Yonge Street, #203, Toronto, Ontario, M4T 1W5, Canada

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7 Mark Griffin David Chapman-Smith Life University of Marietta, Georgia, USA ii

8 New LambtonDr John A Sweaney Umberto SolimeneMiss Elisabetta Minelli iii

9 TM/CAM Alessandro Cè Regional Minister of Health Regional Government of Lombardy Giancarlo Abelli Regional Minister of Family and Social Solidarity Regional Government of Lombardy iv

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11 CCEIwww.cceintl.org 2

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14 4 D.D. Palmer Palmer Chiropractic PalmerReverand Samuel H. Weed

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36 Dr. Abdullah Al Bedah, Supervisor, Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia Dr. Maurizio Amigoni, Deputy Director-General, Directorate-General of Health, Lombardy Region, Milan, Italy Dr. Sassan Behjat, Coordinator, Office of Complementary and Alternative Medicine, Ministry of Health, Abu Dhabi, United Arab Emirates Ms Anna Caizzi, Director of Consumer Protection and Support to the Commercial System Structure, Directorate- General of Markets, Fairs and Congresses, Lombardy Region, Milan, Italy Dr. Martin Camara, Board Member, Philippine Institute of Traditional and Alternative Health Care (PITAHC), Makati City, Philippines (Co-Rapporteur) Dr. Margaret Coats, Chief Executive & Registrar, General Chiropractic Council, London, England Dr. Alessandro Discalzi, Directorate-General of Family and Social Solidarity, Lombardy Region, Milan, Italy Mr. Igwe Lawrence Eleke, Assistant Director, National Traditional Medicine Development Programme, Federal Ministry of Health, Abuja, Nigeria 1 Mr. Michael Fox, Chief Executive, Prince of Wales s Foundation for Integrated Health, London, England Dr. Ricardo Fujikawa, Centro Universitario Feevale, Novo Hamburgo, Brazil Novo Hamburgo Feevale Dr. Edward Tin-tak Lee, Chairman, Chiropractors Council, Hong Kong SAR, People s Republic of China (Co-chairperson) Professor Jean-Pierre Meersseman, Chiropractor, Italian Chiropractic Association, Genova, Italy 27

37 Professor Emilio Minelli, WHO Collaborating Center for Traditional Medicine, Center of Research in Bioclimatology, Biotechnologies and Natural Medicine, State University of Milan, Milan, Italy Dr. Koichi Nakagaki, Kokusai Chiropractic School, Osaka, Japan Kokusai Dr. Susanne Nordling, Chairman, Nordic Co-operation Committee for Non-conventional Medicine (NSK), Committee for Alternative Medicine, Sollentuna, Sweden Ms Lucia Scrabbi, Planning Unit, Directorate-General of Health, Lombardy Region, Milan, Italy Professor Vladimir S. Shoukhov, Health officer, International Federation of Red Cross and Red Crescent Societies (IFRCRC), Moscow, Russian Federation Professor Umberto Solimene, Director, WHO Collaborating Center for Traditional Medicine, Centre of Research in Bioclimatology, Biotechnologies and Natural Medicine, State University of Milan, Milan, Italy Dr. John Sweaney, New Lambton, Australia (Co-Rapporteur) Dr. U Sein Win, Director, Department of Traditional Medicine, Ministry of Health, Yangon, Myanmar (Co-Chairperson) World Chiropractic Alliance (WCA) Dr. Asher Nadler, Member of the International Board, Israel Doctors of Chiropractic, Jerusalem, Israel Dr. Yannick Pauli, WCA Liaison to WHO, Lausanne, Switzerland World Federation of Chiropractic (WFC) Dr. David Chapman-Smith, Secretary-General, Toronto, Ontario, Canada Dr. Anthony Metcalfe, President, Teddington, Middlesex, England 28

38 Ms Elisabetta Minelli, International Relations Office, WHO Collaborating Center for Traditional Medicine, State University of Milan, Liaison with Planning Unit, Directorate-General of Health, Lombardy Region, Milan, Italy Dr. Samvel Azatyan, Technical Officer, Traditional Medicine, Department of Technical Cooperation for Essential Drugs and Traditional Medicine, World Health Organization, Geneva, Switzerland Dr. Xiaorui Zhang, Coordinator, Traditional Medicine, Department of Technical Cooperation for Essential Drugs and Traditional Medicine, World Health Organization, Geneva, Switzerland 29

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44 1. Meade TW et al. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. British Medical Journal, 1990, 300(6737): Meade TW et al. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. British Medical Journal, 1995, 311(7001): Baldwin ML et al. Cost-effectiveness studies of medical and chiropractic care for occupational low back pain: A critical review of the literature. Spine, 2001, 1(2): Withington BT. Hippocrates, with an English translation. Cambridge, MA, Harvard University Press, Palmer DD. The chiropractor s adjustor. Portland, OR, Portland Printing House, Gibbons RW. Medical and social protest as part of hidden American history. In: Haldeman S, ed. Principles and practice of chiropractic. East Norwalk, CT, Appleton Lang, 1992: Palmer DD. Three generations: a history of chiropractic. Davenport, Iowa, Palmer College of Chiropractic, 1967: Ehrenreich B, English E. For her own good. New York, Anchor/Doubleday, 1978: Coulter ID. What is chiropractic? In: McNamee KP. The chiropractic college directory, , 5th ed. Los Angeles, CA, KM Enterprises, World Federation of Chiropractic. Consensus statements and the ACC position paper on chiropractic: The chiropractic paradigm (Proceedings of the conference on Philosophy in Chiropractic Education). Fort Lauderdale, FL, World Federation of Chiropractic Toronto, Gatterman MI, Hansen DT. Development of chiropractic nomenclature through consensus. Journal of Manipulative and Physiological Therapeutics, 1974, 17(5): Guthrie HN. Report of the Honorary Royal Commission to Inquire into Provisions of the Natural Therapists Bill in Western Australia. Perth, Western Australian Government Printer, Lacroix G. Report of the Royal Commission on Chiropraxy and Osteopathy. Quebec, Government of Quebec,

45 14. Teece J. Report of the New South Wales Health Commission Inquiry into the Question of Registration of Chiropractors. Sydney, New South Wales Government Printer, Webb EC. Report of the Committee of Inquiry into Chiropractic, Osteopathy, Homeopathy and Naturopathy. Canberra, Australian Government Publishing Service, Inglis BD, Fraser B, Penfold BR. Chiropractic in New Zealand report: Commission of Inquiry into Chiropractic. Wellington, New Zealand Printer, 1979: Bingham T. Report of the Kings Fund Working Party on Chiropractic. London, King s Fund, Vindigni D, Perkins J. Identifying musculoskeletal conditions among rural indigenous peoples. Australian Journal of Rural Health, 2003, 11(4): Gatterman M. Standards for contraindications to spinal manipulative therapy. In: Vear HJ, ed. Chiropractic standards of practice and quality of care. Gaithersburg, MD, Aspen Publishers Inc, Vear HJ. Standards of chiropractic practice. Journal of Manipulative and Physiological Therapeutics, 1985, 8(1): Gatterman MI. Indications for spinal manipulation in the treatment of back pain. Journal of the American Chiropractic Association, 1982, 19(10): Haldeman S. Spinal manipulative therapy in the management of low back pain. In: Finneson GE, ed. Low back pain, 2nd ed. Philadelphia, PA, JB Lippincott, 1980: Gatterman MI. Contraindications and complications of spinal manipulation therapy. Journal of the American Chiropractic Association, 1981, 15: Palmer DD. The science, art and philosophy of chiropractic. Portland, OR, Portland Printing House, 1910: Gatterman MI. Chiropractic management of spine related disorders. Baltimore, MD, Lippincott, Williams & Wilkins, Cassidy JD, Potter GE. Motion examination of the lumbar spine. Journal of Manipulative and Physiological Therapeutics, 1979, 2(3): Haldeman S, Chapman-Smith D, Petersen DM, eds. Guidelines for chiropractic quality assurance and practice parameters. Gaithersburg, MD, Aspen Publishers, Henderson DJ et al., eds. Clinical guidelines for chiropractic practice in Canada. Journal of the Canadian Chiropractic Association, 1994 (Suppl.), 38(1). 36

46 29. Singer KP. Contraindications to spinal manipulation. In: Giles LGF, Singer KP, eds. The clinical anatomy and management of low-back pain. Oxford, Butterworth-Heinemann, 1997: Giles LGF. Diagnosis of thoracic spine pain and contraindications to spinal mobilization and manipulation. In: Giles LGF, Singer KP, eds. The clinical anatomy and management of low-back pain. Oxford, Butterworth-Heinemann, 1997: Terrett AGJ. Contraindications to cervical spine manipulation. In: Giles LGF, Singer KP, eds. The clinical anatomy and management of low-back pain. Oxford, Butterworth-Heinemann, 1997: Stoddard A. Manual of osteopathic medicine, 2nd ed. London, Hutchinson, Haynes-Mazion LM. Contraindications to chiropractic manipulation with specific technique alternatives. Phoenix, AZ, K & M Printing, Stoddard A. Manual of osteopathic practice. London, Hutchinson, 1969: Maitland GD. Vertebral manipulation, 3rd ed. London, Butterworth, 1973: Bohannon AD, Lyles KW. Drug-induced bone disease. Clinics in geriatric medicine, 1994, 10(4): Walker B, ed. Risk Management Continuing Education Module. Chapter 1 Neck manipulation and vertebrobasilar stroke, Chapter 5 Musculoskeletal complications of spinal manipulation. Chiropractic and Osteopath College Australasia, Ringwood, Victoria, Belanger A. Evidence-based guide to therapeutic physical agents. Baltimore, MD, Lippincott, Williams & Wilkins, Low J, Reed A. Electrotherapy explained, 3rd ed. Oxford, Butterworth-Heinemann Ltd, Robertson V et al. Guidelines for the clinical use of electro-physical agents. Melbourne, Australian Physiotherapy Association, Kleynhans AM. Complications and contraindications to spinal manipulative therapy. In: Haldeman S, ed. Modern developments in the principles and practice of chiropractic. New York, NY, Appleton-Century-Crofts, 1980: Henderson DJ. Vertebral artery syndrome. In: Vear HJ, ed. Chiropractic standards of practice and quality of care. Gaithersburg, MD, Aspen Publishers, 1992: Kleynhans AM, Terrett AG. Cerebrovascular complications of manipulation. In: Haldeman S, ed. Principles and practice of chiropractic, 2nd ed. East Norwalk, CT, Appleton Lang, Grayson MF. Horner s syndrome after manipulation of the neck. British Medical Journal, 1987, 295: Heffner JE. Diaphragmatic paralysis following chiropractic manipulation of the cervical spine. Archives of Internal Medicine, 1985, 145: Kewalramani LS et al. Myelopathy following cervical spine manipulation. American Journal of 37

47 Physical Medicine, 1982, 61: Mann T, Refshauge K. Causes of complication from cervical spine manipulation. Australian Journal of Physiotherapy, 2001, 47(4): Brynin R, Yomtob C. Missed cervical spine fracture: chiropractic implications. Journal of Manipulative and Physiological Therapeutics, 1999, 22(9): Grieve GP. Incidents and accidents of manipulation. In: Grieve GP, ed. Modern manual therapy. New York, NY, Churchill Livingston, 1986: Bromley W. National Chiropractic Mutual Insurance Company: stronger than ever. Journal of the American Chiropractic Association, 1989, 26: Laderman JP. Accidents of spinal manipulation. Annals of the Swiss Chiropractors Association, 1981, 7: Gallinaro P, Cartesegna M. Three cases of lumbar disc rupture and one of cauda equina associated with spinal manipulation (chiropraxis). Lancet, 1983, 1(8321): Kornberg E. Lumbar artery aneurysm with acute aortic occlusion resulting from chiropractic manipulation a case report. Surgery, 1988, 103(1): Haldeman S, Kohlbeck F, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine, 2002, 27(1): Rothwell D, Bondy S, Williams J. Chiropractic manipulation and stroke: a population-based casecontrolled study. Stroke, 2001, 32: Haldeman, S et al. Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias. Spine, 2002, 2(5): Haldeman S et al. Arterial dissections following cervical manipulation: the chiropractic experience. Journal of the Canadian Medical Association, 2001, 2, 165(7): Jaskoviak PA. Complications arising from manipulation of the cervical spine, manipulation and head/neck movement. Journal of the Canadian Chiropractic Association, 1985, 29: Maigne R. Manipulations vertebrales et les thromboses vertebrobasilares [Vertebral manipulations and vertebrobasilar thromboses]. Angéiologie, 1996, 21: Haldeman S. Testimony, Mason H v Forgie D, Judicial district of Saint John, New Brunswick, December 1984 (S/C1569/82). 61. Gutmann G. Verletzungen der arteria vertebralis durch manuelle Therapie [Injuries to the arteria vertebralis from manual therapy]. Manuelle Medizin, 1985, 2: Dvorak J, Orelli F. How dangerous is manipulation of the cervical spine? Manuelle Medizin, 1982, 20:

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