Position Statements

Chiropractors have the clinical training to assess, diagnose, and manage mild traumatic brain injury (mTBI)/concussion.

The diagnosis of mild traumatic brain injury (mTBI)/concussion is based on clinical criteria established with a health history, thorough physical examination, and exclusion of other serious injuries. Currently, there are no gold standard diagnostic tests.

According to the WHO Collaborating Center Task Force¹:

“Mild traumatic brain injury (mTBI) is an acute brain injury resulting from mechanical energy to the head from external physical forces. Operational criteria for clinical identification include:

• one or more of the following: confusion or disorientation, loss of consciousness for 30 minutes or less, post-traumatic amnesia for less than 24 hours, and/or other transient neurological abnormalities such as focal signs, seizure, and intracranial lesion not requiring surgery; and
• Glasgow Coma Scale score of 13-15 after 30 minutes post-injury or later upon presentation for healthcare.

These manifestations of mTBI must not be due to drugs, alcohol, medications, caused by other injuries or treatment for other injuries (e.g. systemic injuries, facial injuries or intubation), caused by other problems (e.g. psychological trauma, language barrier or coexisting medical conditions) or caused by penetrating craniocerebral injury.” (p. 115)

To diagnose, clinicians should rule out serious injuries to the head, neck and other bodily areas and differentiate signs or symptoms caused by other conditions (e.g., drugs, medications, other injuries) with a thorough health history and physical examination including a neurological examination. Once diagnosed, chiropractors should assess patients for associated conditions or comorbidities that may delay recovery (e.g., back pain, prior mental health issues, neck injury, learning disabilities, headache).²

Prompt referral for emergency medical attention may be required for persons with a suspected concussion. Chiropractors should monitor and educate patients about the associated signs and symptoms of serious pathology and refer to an appropriate diagnostic facility to investigate/confirm.

The pillars of concussion management once medical emergencies are ruled out are patient education, return to activity guidance, and symptom-targeted treatment.³ Given the wide variation of symptoms that patients may present with after concussion, a collaborative, multidisciplinary approach to care is recommended. Keeping this in mind, chiropractors are well-positioned to manage or co-manage patients, such as those presenting with the common complaints of headache, neck and back pain, upper extremity pain, and vestibulo-ocular symptoms. Chiropractors are also able to screen for other symptoms (e.g., psychological, cognitive), which may warrant prompt referral.

Reference:

1.Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004;36(43 Suppl):113-25.

2.Guideline for concussion/mild traumatic brain injury & persistent symptoms, 3^rd edition. Ontario Neurotrauma Foundation 2018.

3.Silverberg ND, Iaccarino MA, Panenka WJ, Iverson GL, McCulloch KL, Dams-O’Connor K, Reed N, McCrea M. Management of concussion and mild traumatic brain injury: A synthesis of practice guidelines. Arch Phys Med Rehabil 2020;101(2):382-93.

June 2022

Diversity encompasses, without limitation, race, colour, ethnicity, gender, sexual orientation, gender identity and expression, religion, nationality, age, disability, socioeconomic status, and marital or parental status.

A key component in addressing diversity, equity and inclusion is cultural agility. The CCA defines cultural agility as having enhanced skills and knowledge of the needs of a diverse society and requiring a commitment to inclusion that begins with broader concepts of diversity, equity and inclusion. The CCA acknowledges cultural agility as a foundation for competent healthcare delivery to improve patient outcomes and engage in healthcare initiatives.

November 2020

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The CCA’s DEI Statement is adapted and modelled after the American Chiropractic Association’s statement. Our statement establishes diversity, equity and inclusion as principles that must be woven into the fabric of our profession, the CCA, and in the profession’s approach to providing excellent patient care.

For more info, visit our Diversity, Equity and Inclusion page.

Vaccination is not within the scope of chiropractic practice in Canada. Notwithstanding, the Canadian Chiropractic Association recognizes that vaccination is a safe and effective public health practice for the prevention of infectious diseases. Members are encouraged to refer all patient questions, consultation and education regarding immunization and vaccinations to the appropriate public health authorities and/or health professional whose scope of practice includes vaccination.

December 2019

The delivery of healthcare in Canada is constantly evolving, driven by patient demands, fiscal influences, primary care reform, stakeholder demographics, and the integration of various healthcare practitioner groups into the formal healthcare system.

The chiropractic profession has also evolved and is defined by the following characteristics:

• Legislated regulatory bodies in every jurisdiction with the statutory authority to define scope of practice, impose standards of practice, and protect the public interest;
• Established efficacy for a range of clinical indications; Standardized national examinations;
• Inclusion in the limited group of regulated health professionals who deliver primary contact healthcare;
• Established legislation, wherein chiropractors are permitted to undertake the controlled act of adjustment/manipulation of the spine and extremity joints;
• An established and growing base of substantive evidence for neuromusculoskeletal conditions.

The chiropractic profession adheres to a patient-centred, biopsychosocial approach to healthcare, encompassing examination, diagnosis and treatment, and utilizing conservative, safe approaches to healthcare, minimizing patients’ reliance on drugs and surgery when possible. Chiropractic care is included in insurance plans by both government and third-party payers.

While chiropractic care has been considered Complementary and Alternative Medicine (CAM), the chiropractic profession in Canada today is best described as a regulated, primary healthcare profession with particular expertise in the care of the spine and extremity articulations.

Published in 2005

Chiropractic is a regulated health profession with particular expertise in the care of the spine and extremity articulations. The legislated scope of practice of the profession includes the controlled act of spinal manipulation, a therapy that is central to the delivery of care by chiropractors.

Spinal manipulation requires a high degree of skill. The clinical decision to utilize manipulation is determined based on a thorough patient assessment and diagnosis requiring the clinical acumen to determine an appropriate course of treatment.

To ensure that the chiropractic profession is competent to assess, diagnose and provide spinal manipulation, the Council on Chiropractic Education of Canada (CCEC) requires that accredited chiropractic degree programs provide a minimum of 4,200 hours of education encompassing an approved curriculum. The World Health Organization (WHO) has also established 4,200 hours of training for chiropractic education in countries where  there is legislation governing the profession.

As well, the WHO has established a minimum of 2,200 hours of additional training for any other regulated healthcare professional, whose scope of practice includes the controlled act of manipulation, and who wishes to become proficient in the assessment and diagnosis of neuromusculoskeletal conditions and the application of spinal manipulation to address those conditions.

Therefore, it is the position of the Canadian Chiropractic Association (CCA), that chiropractors be educated in compliance with CCEC standards, and that other health professionals whose scope of practice includes the controlled act of spinal manipulation obtain a minimum of 2,200 hours of additional training that meets CCEC and WHO standards in order to be sufficiently qualified to assess and diagnose neuromusculoskeletal conditions and provide spinal manipulation.

The CCA cautions that public safety is at risk when spinal manipulation is performed by any health professional whose training and education do not meet CCEC and WHO standards.

The Canadian Chiropractic Association (CCA) supports public policies for improving the delivery of healthcare services that are integrative, patient-centred and reflective of outcomes. The CCA advocates that the Canada Health Act definition of “medically necessary” be revised to better reflect the needs of Canadians and the scientific evidence in order to:

1. Assure that patients receive the most appropriate care;
2. Assist in removing financial barriers which prevent patient access to the most efficacious, evidence-based treatment from the best qualified healthcare providers, and;
3. Facilitate inter-disciplinary patient care where indicated.

It is the position of the CCA that government health plans should include meaningful coverage for chiropractic care and that every Canadian should have full and equitable access to chiropractic care.

The CCA supports healthcare system reform based on a multi-disciplinary, primary healthcare model that recognizes the effectiveness and cost-saving value of evidence-based, regulated health services, such as chiropractic, in addition to medicine.

The CCA believes that sustainability of the Canadian healthcare system can only be achieved through greater inter-professional co-operation and an integrated approach to patient care that emphasizes health promotion and preventive care.

February 2005

The Canadian Chiropractic Association (CCA) believes that patient-centred interprofessional collaboration is critical to improving the quality of healthcare for Canadians. Interprofessional collaboration “strengthens health systems and improves health outcomes.” Patient satisfaction, quality of care, and the cost of care delivery can also be enhanced through a collaborative patient-centred approach.

Interprofessional collaboration happens when two or more healthcare professionals across different disciplines work together to achieve common patient goals. Team-based collaborative care facilitates access to a diverse range of disciplines to address the needs of patients and improve their health outcomes. Chiropractors, as musculoskeletal experts, are uniquely positioned to help strengthen the healthcare team by managing patients with underlying musculoskeletal conditions. Chiropractors can provide primary methods of treatment, or work collaboratively with other healthcare providers, while referring patients as needed.

Chiropractors offer their expertise of various musculoskeletal conditions, including pain, which is a key driver of costs and healthcare utilization in Canada. To appropriately manage pain, for example, a multi-modal, interprofessional approach is recommended. For musculoskeletal conditions, this collaborative approach should include chiropractic as an important conservative care option prior to considering medication or invasive interventions.

August 2018

Musculoskeletal injuries and disorders are a significant public health concern. Musculoskeletal conditions, including low-back and neck pain, are significant health issues and a leading reason for disability. Musculoskeletal conditions are also significant contributors to inactivity, which make it difficult to prevent and manage many chronic diseases. For Canadians with a lower socioeconomic status, the prevalence of musculoskeletal conditions is higher, disproportionately impacting the group’s health and well-being. This population may face additional barriers to accessing needed care and challenges in securing or holding employment.

Public health authorities play an essential role in educating the public and healthcare professionals on the impact of musculoskeletal conditions. Public health initiatives can also help to promote access to evidence-based approaches to prevention and treatment, including where socio-economic barriers exist.

The Canadian Chiropractic Association supports public health initiatives that recognize the burden of musculoskeletal conditions as a public health concern. Canada’s chiropractors are committed to improving the health of Canadians by promoting prevention, early intervention, and community-based programs that enhance the health of our population.

November 2016

Pain can be challenging to manage. Every year, more than 11 million Canadians suffer from pain directly related to back and other musculoskeletal conditions. According to the World Health Organization, musculoskeletal conditions are the second largest contributor to disability worldwide. Chronic pain is associated with the poorest quality of life as compared with other chronic diseases. Healthcare practitioners and Canada’s health system struggle with safe and effective pain management. And, there are significant gaps in accessing appropriate and effective pain management options within the current healthcare system in Canada. As the national association representing Canada’s chiropractors, the Canadian Chiropractic Association (CCA) supports a better approach to pain management. An approach that includes prompt access to and integration of chiropractic care across the country.

Too often, pharmacological and invasive treatments (including opioids) are the first-line of treatment used to manage acute and chronic non-cancer pain. Notably, low back pain is one of the primary causes for over-use of prescribed opioids. Greater access to non-pharmacological alternatives through prompt triage and referral would decrease invasive treatments and the pressure to prescribe opioids. Interprofessional collaboration that integrates chiropractors into innovative models of healthcare can lead to improved patient outcomes and satisfaction, and a reduced reliance on opioids by healthcare professionals for pain management.

Systematic reviews and clinical practice guidelines do not recommend the initiation of opioid therapy for chronic non-cancer pain. Rather, evidence supports use of self-management strategies and conservative care including chiropractic as first-line treatments to help manage pain and improve function.

The wait times for publicly-funded pain clinics in Canada can be up to or greater than one year, with the majority of Canadians having limited access to proper care. Yet, referrals to first-line treatment options for managing musculoskeletal conditions, such as community-based interprofessional primary care clinics, rarely include chiropractors. Incorporating chiropractors as part of the pain management team will improve health outcomes and overall quality of life, as well as reduce the burden on healthcare systems.

November 2018

1. Chiropractic care has been shown to be effective for a range of neuromusculoskeletal conditions for which there is credible research evidence. Communication of the benefits of care should be based on the best available literature and/or reasonable clinical experience.
2. The communication of a diagnosis following a comprehensive patient assessment is a fundamental element of clinical excellence.
3. The provision of a treatment plan with clear markers for evaluation of patient progress and improvement is essential to patient-centred care.
4. The provision of care should be preceded by a discussion of the benefits and risks of the proposed treatment. Patient consent should be documented in the patient’s file.
5. Ongoing treatment of a patient should be based on clinical findings and consideration of objective and subjective improvement. Re-evaluation of the need for care at regular intervals is essential. The absence of re-assessment renders long-term projections of care as conjecture.
6. Referral to or consultation with an appropriate health care provider is warranted when there is a lack of clinical improvement or a diagnosis for which chiropractic care is not indicated.
7. Patient care should not be contingent on conditions such as, but not limited to, requiring pre-payment, tying delivery of treatment to participation in a clinic activity, or requiring other family members to attend the clinic for treatment.
8. Privacy is a right of all patients. Options for privacy must be made available to all patients and the privacy of patients must be respected and accommodated at all times.

June 2008

The Canadian Chiropractic Association (CCA) supports the protection of the public interest through the legislated establishment of independent regulatory authorities in each province that have the power to grant or remove a practitioner’s license to practice. Each regulatory authority is charged with protecting the public interest by ensuring the competence of practitioners, establishing standards for the conduct of the profession, administering the scope of practice of the profession, and investigating complaints that may arise regarding the professional conduct of practitioners. The Board of each regulatory authority is comprised of individuals representing both the profession and the public.

The CCA’s Code of Ethics complements and supports the regulations of the provincial regulatory authorities by setting out the duties of members of the Association to their patients, to the profession and to society. All members of CCA are expected to conduct themselves in a manner consistent with the regulations of their provincial licensing body, as well as the CCA Code of Ethics and current Clinical Practice Guidelines approved by CCA.

February 2005

The chiropractic profession supports public health promotion and prevention efforts that are essential to the physical, mental health and well-being of Canadians.

As one of Canada’s largest primary contact healthcare professions, chiropractors are leading providers of care that directly contribute to many important public health goals. Chiropractors provide effective treatment when low back pain and other musculoskeletal conditions are limiting physical activity and mobility. Chiropractors are trained to take an active role in addressing risk factors related to preventing and managing a number of chronic diseases. Furtherto, they promote physical activity and educate patients on healthy eating.

The Canadian Chiropractic Association recognizes that good health requires more than good health care. The Canadian Chiropractic Association supports national public policies and initiatives that address the socio-economic determinants of health such as mental health programs, early childhood development, poverty, education, and safe affordable communities.

November 2016