Chiropractic Care: Global Recognition vs. Perceptions in Japan
Chiropractic care focuses on addressing imbalances observed in the joints and muscles. The goal is to enhance the inherent recuperative power (natural healing ability) of the individual, thereby improving the overall function of the body, including alleviating symptoms.
In Japan, there's a perception by some that chiropractic adjustments – often audibly recognized by joint "cracking" sounds – are daunting or even potentially dangerous. Yet, this viewpoint contrasts starkly with global attitudes. In North America, Australia, the UK, France, Scandinavia, New Zealand, and Hong Kong, among 45 countries in total, chiropractic is publicly recognized as a professional healthcare discipline, and its services are covered by insurance.
Furthermore, in nations like Switzerland and Denmark, chiropractic education is integrated into university medical programs. It's recognized not merely as complementary medicine but as a component of modern medical care.
So, why is there such ambiguity and lack of clarity surrounding chiropractic care in Japan, especially when it enjoys recognition and esteem overseas? Herein, we aim to elucidate this conundrum, shedding light on chiropractic care itself and, in conjunction, addressing perceptions in comparison to other similar professions.
1.What is Chiropractic Care?
Originating approximately 130 years ago in 1895 in the United States, chiropractic care emerged as a hands-on therapy. Subsequently, it evolved as an academic discipline overseas, with specialized universities being established. It's now taught in medical school faculties, and in certain countries, it's recognized as a national qualification, even qualifying for medical insurance coverage.
Chiropractic care zeroes in on the structure (primarily the spine) and function of the body. While the therapeutic methods in chiropractic can vary depending on the practitioner, the primary focus is on adjusting (correcting) the spine and other parts of the body. The objectives are to rectify misalignments, alleviate pain, enhance functionality, and bolster the body's innate healing capabilities. As stated by Japan's Ministry of Health, Labour, and Welfare in 2014, chiropractic care aims to harness this inherent recuperative power to guide the body towards an optimal state of health.
While the terminology can be a tad intricate, in essence, chiropractic care deals with correcting skeletal misalignments and imbalances using hands-on techniques. This, in turn, revives the body's impaired functions. One of the pivotal reasons chiropractors emphasize the spine is the belief that the central nervous system (the spinal cord) is safeguarded by the spine. If any issue arises with the spine, it could inhibit the function of the nerves.
2. The Primary Benefits of Chiropractic Care
According to the sole organization in Japan affiliated with the World Federation of Chiropractic (hereinafter referred to as "WFC"), the Japan Chiropractors' Association (hereinafter "JAC"), chiropractic care is particularly effective for conditions such as lower back pain, headaches, whiplash injuries, shoulder stiffness, and pain in the hip or knee joints, emphasizing its excellence in musculoskeletal disorders.
Furthermore, chiropractic treatments are utilized for fatigue recovery, posture correction, autonomic nervous system imbalance, improving organ function, stress relief, and routine health management for the elderly.
It should be noted that certain conditions, including but not limited to, cancer, diseases prone to bleeding, illnesses with high fevers, and infectious diseases, even if they might indirectly lead to symptoms like shoulder stiffness or back pain, are contraindications for chiropractic care. If there's even a slight suspicion of these during patient consultation, an immediate referral to specialized medical institutions is deemed necessary.
From a personal perspective, based on over 15 years of clinical involvement in chiropractic care, I believe that if we can gain patients' cooperation in making lifestyle adjustments (e.g., increasing physical activity, getting more rest, considering their daily posture, dietary habits, etc.), chiropractic can also be effective for headaches, numbness in the hands and feet, and other symptoms that may be difficult to articulate.
3. What Distinguishes Chiropractic from Osteopathy, Orthopedics, and Massage?
In many countries, chiropractic care is recognized as a national qualification and as a medical profession. However, this is not the case in Japan.
The reason lies in the fact that there is no law in Japan that specifically defines "chiropractic care." Hence, this absence of legal codification is a significant distinction between Japan and countries where it is recognized as a medical profession.
As a result, within Japan, the perceptions of chiropractic and manual therapy (often referred to as "seitai" in Japanese) are heavily influenced by the individual practitioner's approach and methodology. Patients who receive treatments often have varied impressions based on their unique experiences.
For instance, a patient whom I had the privilege to treat in the past once remarked, "So, your chiropractic approach doesn't use large crystals, does it?" It's important to note that even internationally recognized chiropractic methods do not involve the use of crystals.
Given the lack of a clear definition for chiropractic and manual therapy in Japan, making a comparative analysis becomes challenging. Hence, I've tried to explain by comparing it to chiropractic care as recognized in overseas healthcare systems.
In Japan, the term "seitai" (manual therapy) has broader recognition among the general populace compared to chiropractic. As a result, to enhance their visibility and outreach, many establishments use both terms, advertising as "Seitai & Chiropractic."
This undoubtedly has led to some confusion among Japanese consumers.
In our clinic, considering that many patients discover our facility through internet searches and that the search frequency for the term "chiropractic" is significantly lower than "seitai," we've chosen to utilize both terms.
When patients visit us and express interest in the difference between chiropractic and seitai, we make it a point to provide a comprehensive explanation.
If you are interested in understanding the nuanced differences, I highly recommend referring to the comparison of musculoskeletal (locomotor) medical professions compiled by the JAC in 2019. This table is presented in an easily understandable format.
*Please note that the chiropractic section of this table describes chiropractic care as it's recognized overseas as a medical profession. Therefore, there might be differences from the perception of chiropractic care within Japan.
Furthermore, bone-setting (often referred to as "sekkotsu" or "jikotsu" in Japanese) and massage have national qualifications in Japan, such as massage therapists and judo orthopedic therapists. These professions significantly differ from chiropractic and manual therapy (seitai) within the domestic context.
I've briefly summarized the distinctions among chiropractic, seitai (manual therapy), and bone-setting for your reference. It's crucial to remember that the content of each treatment can vary greatly from one establishment or company to another. As such, my explanation provides a general overview. I appreciate your understanding in advance.
Not recognized as a national qualification within Japan (In other countries, it is often a national qualification, and may come with academic degrees and diagnostic privileges).
Health insurance cannot be used in Japan (However, there are countries where it can be used).
Anyone can claim to be a chiropractor without regulations.
Neither in Japan nor abroad is it recognized as a national qualification.
Health insurance cannot be used.
Anyone can claim to be a practitioner without regulations.
Osteopathy (Official title: Judo Orthopedic Therapist＊Required qualification to work in a bone-setting clinic with insurance coverage)
Recognized as a national qualification in Japan.
If treatment is required for an injured part of the body, it's covered by health insurance.
Not everyone can claim this title.
Originating from judo, it deals with external injuries such as fractures, sprains, and dislocations.
Massage (Official title: Anma-Massage Therapist)
Recognized as a national qualification in Japan.
Health insurance can be used only when deemed necessary by a physician.
Not everyone can claim this title (In reality, some unqualified individuals use the term "massage" for their services).
Shiatsu focuses on soft tissue and muscles using thumb pressure.
4.The Misconception of "Cracking Sounds Seem Painful..."
During the adjustment of joints such as the spine or pelvis, one might often hear a "crack" sound. However, if the practitioner understands the appropriate amount of force, speed, and the patient's comfortable position, there's no reason for it to be "painful" or "dangerous."
Nonetheless, if the practitioner lacks the proper skills, the patient may experience "unnecessary pain or fear" after the procedure.
There are also patients who have previously undergone such treatments and experienced pain afterward. Some may be fearful and not want to undergo the technique at all. At our clinic, before making any adjustments, we always discuss with the patient the most suitable method for them or if there's any technique they're particularly uncomfortable with. For those who are inexperienced, we first adjust areas far from the neck, such as the pelvis, and monitor their reactions.
The sound from the joint is akin to flipping a bathtub filled with air in water, where air is released onto the water's surface.
It's understood that this "crack" sound is due to the release of "nitrogen gas" within the joint, often seen as evidence that a previously stiff joint has moved.
You can see the condition of a joint being captured on an MRI during this "cracking" process in this YouTube video.
5. About AC Chiropractic Treatments
All the chiropractors in charge of chiropractic treatments at our clinic have undergone specialized education for 4-5 years, amounting to 4,200 hours, in line with the educational standards listed in the WHO guidelines.
As of November 2019, 561 individuals who have cleared this educational standard and the certification exam are registered with the Japan Chiropractic Registry (JCR). The list of JCR registrants is submitted to the Ministry of Health, Labor, and Welfare twice a year and is stored.
Our clinic, having been established in Nakameguro, is celebrating its 11th year in 2022. Our highly experienced clinical staff takes the time to understand and then clearly explain the patient's physical symptoms based on their consultation and examinations.
The reason for this is to ensure that by understanding the current situation, the progress and reactions of future treatments proceed more smoothly.
While the specific treatment approach varies based on individual needs, our general treatment involves addressing muscular issues (too tense, too lax, injured) and joint problems (misaligned movement, excessive movement, surrounding ligament stiffness, injuries). Treatments are applied individually to achieve an overall balanced body condition.
1. Muscle Issues
For muscle stiffness, we perform manipulations to relax the muscle. If the muscle is overly soft, we introduce stimuli similar to training to activate it. For injuries, measures such as icing and taping are used to reduce strain.
2. Joint Issues
To adjust joint movements, manual or tool-based adjustments are performed (you can choose between techniques that produce a "cracking" sound and those that don't). If the movement is excessively large, treatment is directed at the part believed to be under strain (sometimes including immobilization with taping). Other issues with surrounding tissues might be addressed with icing, immobilization, and gradually introducing movement as deemed appropriate.
The name of the clinic, "AC," stands for "Active Care." This embodies the idea that patients should actively engage with their own bodies, integrating proper body usage, rehabilitation, and exercise into their daily lives.
The primary reason for this is that individuals can control and improve their own bodily conditions. This aligns perfectly with our clinic's concept: "Heal your own body by yourself."
Thus, at the end of each treatment session, we provide simple exercises that patients can perform on their own, aiming for quick recovery and sustained improvement (prevention).