Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves, especially related to the spine.
Chiropractic treatment mainly involves safe, often gentle, specific spinal manipulation to free joints in the spine or other areas of the body that are not moving properly. Apart from manipulation, chiropractors may use a variety of techniques including ice, heat, ultrasound, massage, exercise and rehabilitation as well as advice about posture and lifestyle.
Although chiropractors are best known for treating back and neck pain, which they do very well, patients also consult chiropractors regarding a range of other, related conditions such as headaches, sports injuries, trapped nerves and limb pain.
Andrew Miles is registered with the General Chiropractic Council (GCC) and is a member of the British Chiropractic Association (BCA), which is the largest and longest-standing association for chiropractors in the UK. It was founded in 1925 and has a membership comprising over 50% of the UK’s registered chiropractors. The BCA only accepts members who have graduated from a nationally or internationally-recognised college of chiropractic education, after a minimum of four years full-time training and ensures its chiropractors maintain high standards of conduct, practice, education and training. He is also a member of the Royal College of Chiropractors, the European Chiropractors Union (ECU) and has been established as a chiropractor in Cardiff since 1997.
Treatment is covered by all major insurance providers including BUPA and PPP. Please contact us for further details.
The General Chiropractic Council says that the care provided by chiropractors should be "informed by the best available evidence, the preferences of the patient, and the expertise of practitioners".
What to expect on your first visit
Chiropractors are highly trained to provide an accurate diagnosis. Before any form of treatment is considered an initial consultation will include:
- A full health history
- A detailed physical examination including orthopaedic, neurological and chiropractic tests
- An explanation if further tests are required such as x-rays, MRI/ultrasound scans or a medical referral
- A detailed report of findings including an accurate diagnosis of your condition
- A full explanation of the most effective type of treatment recommended for your particular case (this could involve treatment by another practitioner)
- Treatment (if you and the chiropractor are happy to proceed)
Chiropractic is a package of care rather than any one specific type of manipulation or treatment. Chiropractors are trained in a range of therapeutic techniques, many involve a specific manipulative technique to restore movement to a restricted joint. These techniques are currently recommended by the National Institute for Clinical Excellence (NICE) as highly effective in treating back pain. The treatment will vary depending on the condition and will be tailored to the individual.
At The Llandaff Clinic we not only offer an experienced chiropractor in Cardiff but we are fortunate to have a wide range of experienced therapists and we will ensure that each patient has access to the best possible care for their specific needs.
Evidence for chiropractic
There is a range of evidence to indicate that chiropractic care is safe and effective. This evidence includes:
This recent MRC-funded study estimated the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. All groups improved over time. Exercise improved disability more than "best care" at three months. For manipulation there was an additional improvement at three months and at 12 months. For manipulation followed by exercise there was an additional improvement at three months and at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.
Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.
Summary of recommendations for treatment of acute non-specific low back pain:
Give adequate information and reassure the patient
Do not prescribe bed rest as a treatment
Advise patients to stay active and continue normal daily activities including work if possible
Prescribe medication, if necessary for pain relief; preferably to be taken at regular intervals; first choice paracetamol, second choice NSAIDs
Consider adding a short course of muscle relaxants on its own or added to NSAIDs, if paracetamol or NSAIDs have failed to reduce pain
Consider (referral for) spinal manipulation for patients who are failing to return to normal activities
Multidisciplinary treatment programmes in occupational settings may be an option for workers with sub-acute low back pain and sick leave for more than 4 - 8 weeks
Manipulation/mobilisation - Summary of the evidence:
There is moderate evidence that manipulation is superior to sham manipulation for improving short-term pain and function in chronic low back pain (CLBP)
There is strong evidence that manipulation and GP care/analgesics are similarly effective in the treatment of CLBP
There is moderate evidence that spinal manipulation in addition to GP care is more effective than GP care alone in the treatment of CLBP
There is moderate evidence that spinal manipulation is no less and no more effective than physiotherapy/exercise therapy in the treatment of CLBP
There is moderate evidence that spinal manipulation is no less and no more effective than back-schools in the treatment of CLBP
Recommendation: Consider a short course of spinal manipulation/mobilisation as a treatment option for CLBP.
NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Its guideline on the acute management of patients with chronic low back pain was published in May 2009.
The evidence-based recommendations include the following:
Provide people with advice and information to promote self-management of their low back pain.
Consider offering a course of manual therapy including spinal manipulation of up to 9 sessions over up to 12 weeks
Consider offering a course of acupuncture needling comprising up to 10 sessions over a period of up to 12 weeks
Consider offering a structured exercise programme tailored to the individual.
This review, by Gert Bronfort et al, was published in the journal Chiropractic & Osteopathy in 2010. Commentaries by Professor Scott Haldeman and Professor Martin Underwood accompany the report. In summary, the report demonstrates robust randomised controlled trial (RCT) evidence that the care offered by chiropractors is effective for a wide range of conditions including neck pain, pain associated with hip and knee osteoarthritis and some types of headache.