Understanding Complementary and Alternative Medicine
Many people with musculoskeletal problems use complementary and alternative medicine (CAM) in addition to traditional medical care. CAM providers have varied backgrounds and training. Professional licensing and the regulation of CAM providers vary from state to state. Some states require that certain CAM professionals be licensed, certified or registered to practice. These requirements may include:
- Graduating from an accredited training school with a minimum number of hours of training
- Passing an examination that assesses knowledge and practice techniques
- Knowledge of ethical and professional standards
Professional boards and organizations often assist in the licensing process. A licensing board, for example, may include professionals in the field, legal advisors and government representatives. These boards create licensing regulations, collect licensing and application fees and determine policies for suspension, renewal and professional behavior. In addition, national professional organizations may set standards for training, curriculum hours and professional conduct, as well as offer examinations to those preparing to enter practice. Acupuncturists, nutritional counselors, massage therapists, naturopaths, and homeopaths are the professions most commonly regulated by the states.
Acupuncture originated in ancient China. It is based on the theory that an essential life energy called "qi" flows through the body along invisible lines. Stimulating points along these lines corrects the flow of qi to optimize health or block pain.
Acupuncturists can be certified in two ways. They can complete a formal, full-time educational program that includes both classroom and clinical hours or they can participate in an apprenticeship program. Acupuncturists must also complete a "Clean Needle Technique" approved course. Medical doctors with training in acupuncture also can obtain board certification.
Certification for formally trained acupuncturists is through the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). Medical doctors are certified through the American Academy of Medical Acupuncture and must possess a valid medical license.
As of January 2009, 39 of the 42 states that regulate acupuncturists required NCCAOM certification. Organizations representing the profession are the American Association of Oriental Medicine and the American Academy of Medical Acupuncture.
Ayurveda is a form of health care developed in ancient India. The focus is on wellness and healthy living through diet, exercise, moderation and meditation. The practitioner is an advisor who suggests lifestyle and health practices to restore or optimize mental, physical and spiritual well-being. There are few ayurvedic practitioners in the United States. There is no U.S. national standard for certifying ayurvedic practitioners. Graduates of an Indian ayurvedic medical program will have a degree of BAMS (Bachelor of Ayurvedic Medicine and Surgery) or DAMS (Doctor of Ayurvedic Medicine and Surgery).
Chiropractic is based on the theory that vertebral misalignment causes most neuromuscular and related functional diseases and disorders. It was developed in the United States in 1885. Chiropractors complete a four-year program at one of 18 accredited chiropractic colleges. Although they mainly focus on musculoskeletal issues, chiropractors are also trained in general diagnostics and health promotion. Many use nutrition, exercise and lifestyle modification in their practices. Chiropractors are certified through the National Board of Chiropractic Examiners and must complete a two-part board exam. Chiropractors are licensed in all 50 states and many foreign countries. The initials DC (Doctor of Chiropractic) identify a licensed chiropractor. Chiropractors are not licensed to perform surgery or to prescribe drugs. Their national professional organization is the American Chiropractic Association.
The practice of Chinese medicine involves restoring balance to the body. Herbs are prepared as pills, potions and liniments and are "prescribed" by herbalists. Chinese herbalists may complete either formal schooling from an accredited Oriental Medicine education program or an apprenticeship program.
Certification is through the National Certification Commission for Acupuncture and Oriental Medicine. Currently, Chinese herbalists do not have to be licensed to practice in the United States. The national organization of Chinese Medicine is the American Association of Oriental Medicine.
Homeopathy (homeo- in Greek means similar; pathy means suffering) was developed in the 18th century in Germany. Tiny amounts of natural substances such as herbs, minerals and animal products are diluted and administered to a sick person to induce healing. In larger quantities, these same remedies would produce effects similar to those of the disease being treated, hence the theory that "like cures like."
Only three states (Arizona, Connecticut and Nevada) license homeopaths. These states require a DO or MD degree as well as certification in the study of homeopathy. Minnesota's Complementary and Alternative Health Care Bill allows practitioners of complementary and alternative modalities to practice in the state with protective jurisdictions in place in case of harm and imminent risk of harm. The National Board of Homeopathic Examiners offers a board exam, but it is not required for licensing. Certification is offered through the Council for Homeopathic Certification. The national organization for homeopaths is the North American Society for Homeopathy. Members of the American Institute of Homeopathy are medical personnel and health profession students interested in or currently practicing homeopathy.
Massage is one of the most-used complementary therapies in the United States. To become certified, massage therapists must complete a formal therapeutic massage bodywork program. They may also be considered for certification if they have training in anatomy, physiology and kinesiology, as well as formal education and professional experience in bodywork and/or massage. Board certification is through the National Certification Board for Therapeutic Massage and Bodywork and is required in 33 of the 39 states that regulate massage therapists. The professional organization for massage therapists is the American Massage Therapy Association.
Naturopathy began in European spas in the 19th century. The underlying principles of naturopathy are to encourage healthy living habits and to allow the body to heal itself. Naturopathic physicians are noted for their expertise in nutrition. They frequently work with a physician or other health care provider. They can treat wounds and are trained in minor surgery.
Naturopathic physicians (ND) undergo a four-year training program that includes nontoxic therapies such as homeopathy, clinical nutrition, manipulation, herbal medicine and hydrotherapy. They often may have additional training in Chinese medicine (acupuncture and herbs). Naturopaths are licensed in 14 states. Their certification exam is administered by the North American Board of Naturopathic Examiners. Their professional organization is the American Association of Naturopathic Physicians.
The professional/occupational office of your state's government should have credentialing information regarding each occupation it regulates. Most states offer this information on their Web sites. It's worth a visit before you decide to consult a provider of complementary or alternative medicine. If you do decide to see a CAM provider, be sure to let your primary care physician know about your decision, and about any treatments the CAM provider suggests. Some herbs can have deadly interactions with your current medications.
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.