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Laurance Johnston, Ph.D.

A number of years ago, I helped the then President of the Paralyzed Veterans of America (PVA) over a curb in the wheelchair-challenging French Quarter of New Orleans. It didn’t matter that I routinely worked out at the gym or had aided many wheelchair-using colleagues in the past; this time, I hurt my back. Due to the often awkward nature of such assistance, many caregivers and friends of wheelchair users have had similar experiences. This article provides an overview of chiropractic and its use by individuals with physical disabilities, including  spinal cord injury (SCI) and dysfunction.

Overall, back pain is a huge societal problem. For example, 85% of us will be disabled by it sometime, and, at any point in time, 7% of adults are suffering from a bout of back pain lasting more than two weeks. It is the second most frequent reason people use the healthcare system and the most common cause of work loss and disability.

“Get knowledge of the spine, for this is the requisite for many diseases,” - Hippocrates, the “Father of Medicine”

Experts have endorsed chiropractic as one of the most effective ways of treating such pain, discouraging traditional approaches of bed rest, medication, and surgery as counter productive. Most notably, a 1997 U.S. Agency for Health Care Policy (AHCP) report stated, “Chiropractic is now recognized as the principal source of one of the few treatments recommended by national evidence-based guidelines for the treatment of low-back pain, spinal manipulation.” 

With 35-million Americans visiting 60,000 chiropractors each year, chiropractic is the nation’s third-largest healthcare profession after medicine and dentistry. Of these people, 70% use chiropractic for back pain; 25% for head, neck and extremity pain; and 5% for other disorders.

Due to its popularity, including among individuals with physical disabilities, chiropractic should no longer be considered “alternative medicine” but a key component of our healthcare system that synergistically complements - not opposes - conventional medicine.

Chiropractic can help not only caregivers, who put their backs in harm’s way, but, as discussed below, also enhance the wellness of some people with spinal cord dysfunction and other disabilities, whose wheelchair living (e.g., transfers, bad posture, imbalanced muscle development, etc) aggravates physical problems amenable to chiropractic treatment.


Chiropractic focuses on diagnosing and treating musculoskeletal disorders that affect the nervous system and, as a consequence, general health. More specifically, the Association of Chiropractic Colleges defines chiropractic as “A healthcare discipline that emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery. The practice of chiropractic focuses on the relationship between structure (primarily spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. In addition, doctors of chiropractic recognize the value and responsibility of working in cooperation with other healthcare practitioners when in the best interest of the patients.”

Chiropractic’s core philosophy differs from conventional medicine, which believes we are the sum of our body parts (e.g., organs, cells, or molecules); if we fix the parts, the body will be repaired. In contrast, chiropractic grew out of a holistic vitalism philosophy, which says that the body has an innate life force (e.g., like qi or prana in Eastern-healing traditions) that flows down from the brain with the nervous system and out from the spine to the periphery. Like fixing a garden-hose kink, chiropractic adjusts musculoskeletal distortions that inhibit this flow and, by so doing, enhances wellness.


Chiropractic procedures have been a part of mankind’s healing armamentarium since time immemorial, including use by ancient Chinese, Egyptian, and Greek civilizations. Both Hippocrates (460-377 B.C.) and the influential Roman physician Galen (A.D. 129-199) recommended vertebral adjustments to relieve ailments.

 The founder of today’s chiropractic was Daniel David Palmer (1845 –1913), a self-educated man in medicine and science who practiced in Davenport, Iowa. In 1895, through vertebral manipulation, he restored the hearing of his building’s janitor, who had been deaf since a back accident 17 years earlier. This incident gave birth to chiropractic, the term coined from the Greek words praxis and cheir, meaning treatment by hand.

Much of the credit for chiropractic’s growth was due to the organizational leadership of Palmer’s son Bartlett Joshua (1881–1961), who at age 21 took over and built up the now well-known Palmer School of Chiropractic in Davenport. He was an innovator, who, for example, integrated nascent x-ray technology into the profession, and was an effective chiropractic promoter and defender. He cultivated and lobbied national figures and U.S. presidents, and even employed future President Ronald Reagan as a broadcaster at his World of Chiropractic (WOC) radio station.

Gradually, states approved chiropractic; Minnesota was the first (1905), and Louisiana the last (1974).

Chiropractic faced vociferous opposition from organized medicine, which essentially viewed it as a threat to its healthcare monopoly. Because medicine did not include a spinal-manipulation focus - preferring its pharmaceutical and surgical approaches - it minimized the benefits that could accrue from this focus emphasized by a competing discipline.

In defense of organized medicine, which had made huge healthcare advancements as it transitioned into the 20th century and cleaned up its own house by imposing rigorous professional standards, many of the early chiropractic profession’s actions, infighting, lax standards fueled criticism. Chiropractic emergence was also handicapped, however, because it did not advocate drugs, and, as such, could not cultivate strong financial, pharmaceutical-industry allies. (e.g., on average, every U.S. physician receives >$14,000 each year from the pharmaceutical industry’s marketing and promotional campaigns.)

Organized medicine was forced to back down when a landmark, 1987 federal anti-trust ruling found the American Medical Association (AMA) guilty of a prolonged and systematic attempt to completely undermine the chiropractic profession, often using highly dishonest methods. By stopping the major source of organized resistance, this case ushered in a new era of cooperation between physicians and chiropractors.

In recent decades, Federal actions have increasingly supported chiropractic, including: the 1974 authorization to the Council of Chiropractic Education to accredit schools, the aforementioned AHCP endorsement of chiropractic to treat lower back pain, the 1996 decision by the National Institutes of Health to fund chiropractic research, and President Clinton’s 2000 mandate that chiropractic be made available to all active-duty military personnel.


Facilitating its current acceptance, the chiropractic profession has adopted strict educational standards, comparable in rigor but different in focus from medical education. Although both professions’ basic-science components are equivalent in study time, chiropractic emphasizes musculoskeletal and neuroanatomical systems over medicine’s pharmacological and surgical priorities. Furthermore, in contrast to medicine’s broad clinical preparation, chiropractic clinical training is specialized, focusing on the profession’s unique diagnostic and treatment methods, which can only be mastered through extensive, hands-on practice.


Chiropractors focus on correcting disordered vertebral joints, which include vertebrae and their boney projections (called facet joints and spinous or transverse processes), shock-absorbing cartilage discs, muscles, ligaments, and nervous tissue. Subluxations - abnormalities of this vertebral complex - affect health by impinging on nerve roots as they exit the complex through channels called intervertebral foramen.

Because of the complex’s inherent intricacy, subluxations can result from numerous, interacting factors that upset the complex’s homeostatic equilibrium, e.g., from unbalanced muscle tension that pulls a vertebra out of alignment with neighbors. In turn, a specific subluxation can create a chain reaction affecting other parts of the spinal column. For example, neck pain may be the secondary consequence of a pelvic misalignment.

Chiropractic emphasizes non-invasive therapies, such as manual treatments, physical therapy, exercise programs, nutritional advice, orthotics, and lifestyle modification.

The most common procedure is the spinal adjustment, accomplished through diverse techniques. For example, with spinal manipulation, using the vertebral projections as levers, a carefully measured force is rapidly applied to the joint that carries it past its voluntary range of motion but still well within the range permitted by nature. The commonly heard “crack” is actually a vacuum-created, nitrogen bubble bursting within the joint. In contrast, with spinal mobilization procedures, the joint remains within its passive range of movement.

Depending upon the problem’s acute or chronic nature, often multiple treatment sessions are needed, 6-10 being the average.

Studies show that the chiropractic risks are minimal. For example, a 1996 RAND Corporation study concluded that 1.5 serious complications occur from every million cervical manipulations. For comparison sake, there are 1,000 serious complications per million from taking over-the-counter painkillers. 

Chiropractic & Physical Disabilities:

People with disabilities frequently use chiropractic. For example, a Kessler Institute (N.J.) study indicated 23% of people with SCI with chronic pain had used chiropractic (Nayak et al, J. Spinal Cord Medicine, Spring, 2001).

Dr. Julet Hutchens, a chiropractor (photo) who practices with medical doctors and physical therapists, discusses potential SCD benefits: 

“I have treated patients with spinal cord dysfunction for four years, the first of which was my husband Eddy, a wheelchair athlete and Mountain States PVA associate member. When I met him, he had been paralyzed 16 years due to an automobile accident, in which he sustained a complete T-10 spinal-cord transection.

I adjust Eddy usually 1-2 times per month depending on his activity and discomfort level. I keep the majority of my adjustments to him and other paralyzed patients above the injury level. However, occasionally, I will perform more passive types of mobilization to the pelvis, low back, and lower extremities. Eddy says the adjustments give him instant relief to shoulder problems, upper/mid-back and rib pain, and neck pain.  A Denver Rolling Nuggets basketball player, he recommends chiropractic treatments to his teammates to ensure their continued full range of movement above and below the injury site. 

I often treat shoulder and rib-related injuries in individuals with paralysis that result from their excessive shoulder and arm use associated with frequent wheelchair transfers. Often, a repetitive-use injury occurs, which, if not taken care of, can lead to more severe shoulder problems, even requiring surgery. Chiropractic treats the shoulders and ribs, giving the patient relief. And with any repetitive-use injury, strengthening exercises reinforce adjustments, preventing future injuries.

As with any person sitting for long time periods, posture becomes an issue in wheelchair users. Most end up with neck and upper-back pain due to bad posture. When we sit for a long time, we tend to slump forward, placing extra stress on the neck and upper back. When I observe wheelchair athletes, I see them leaning forward, resting their arms on their legs, or leaning slightly forward and to the side, resting on a wheel. Such posture places extra stress on the neck and upper back, and, as a result, the muscles around the spine become weak and those in the chest become tighter. These changes cause an imbalance between front and back muscles, which can lead to pain. I work with the patient to rebuild muscle balance, and restore motion in the spine that is restricted from such imbalance.  Teaching patients the difference between good and bad posture is especially important so that they become aware of the small changes they can make to alleviate some of their neck and back issues. 

Active individuals with paralysis will develop a strong upper body to compensate for their inability to balance themselves through the use of abdominal, leg, and lower-back muscles as an able-bodied person would.  Because of this upper-body reliance, we want to keep it in good working order, which is accomplished through a strong chiropractic and stretching and strengthening programs. Shoulder or neck pain can impair one’s ability to not only transfer in or out of a wheelchair but also to push it, limiting overall mobility.  

Adjustments, muscle work, and exercises keep the spine, shoulders, ribs, and shoulder blades moving as they should in a painless, full range of motion.  These methods keep the joints lubricated, discs between the vertebrae from deteriorating, and muscles and ligaments strong and balanced. At the same time, it loosens muscles.

Overall, because they will be healthier, feel better, and have more energy, all wheelchair users should receive regular bodywork.

When I treat patients with SCI, arthritis that causes joint fusing, post-polio, or cerebral palsy, I adapt my treatment to accommodate the patient.  Depending on their disability, I treat patients in their wheelchair, or if comfortable, I will help them transfer to a treatment table. 

I try to choose the optimal treatment for the specific patient, some of which are more passive or aggressive than others. I also x-ray all patients with SCI to see exactly what is going on in their spine, shoulders, etc.  With SCI, the body compensates in one area for the lack of motion in another.  Because such compensation can be observed through x-rays, the patient can be more effectively treated.”

Chiropractic Restoration of Function?

Dr. Dudley Delany, a chiropractor, relates an anecdotal case suggesting that chiropractic therapy may have the potential to restore some function after SCI. Specifically, when Delany was a freshman chiropractic student, the school's president indicated that he had became a paraplegic after a football injury but was able to regain full recovery through chiropractic spinal manipulations. For further specifics, see


Most healing traditions have something valuable to offer yet, at the same time, have limitations in scope. Allopathic medicine emphasizes valuable pharmaceutical and surgical interventions, chiropractic focuses on musculoskeletal system mechanisms that medicine has ignored, and other traditions stress different therapeutic concepts and modalities that also have great validity.  It is as if medicine looks at the world through red-tinted lenses, chiropractic blue lenses, and other disciplines green or other colored lenses.

Unless we work together more in unity than opposition, each discipline’s vision will remain inherently limited to the detriment of all. However, if we open-mindedly accommodate divergent views of what is possible, we create an expanded healing spectrum that will benefit all, including those with spinal cord dysfunction.

Contact:  Dr. Julet Hutchens, CLINIX, 7030 S. Yosemite, Centennial, CO 80116 (303-721-9984).

Adapted from a two-part article appearing in Paraplegia News, October & November, 2003 (For subscriptions, contact