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Chiropractic

September 21, 2010

For the general entry on Alternative Medicine, click here

The Claims:

Chiropractic is an alternative medicine practice that is based on the theory that spinal misalignments, termed “subluxations”, interfere with the traveling of nerve signals to and from the brain. It is suggested that these subluxations are at the root of a variety of health problems, including many non-spinal syndromes.

According to traditional chiropractic theory, spinal adjustments (which are forceful thrusts applied to the spine by a chiropractor) can effectively “unblock” these nerve signals restoring the body’s “innate intelligence” and enabling the body to heal itself.

The Evidence:

Chiropractic is based on a philosophy of “vitalism” (the idea that health is determined by the flow of an innate energy) a doctrine that sharply contrasts with the tenets of modern science and medicine. Notably, no scientific evidence exists to validate the existence of spinal subluxations, as there is no way to detect, harness or measure so-called innate intelligence in any scientifically verifiable way. As chiropractic is based on unscientific premises, its doctrines are not amenable to empirical research or testing.

Chiropractic in the Treatment of Spinal Conditions:

The Canadian Chiropractic Association claims that there have been countless scientific clinical studies evaluating spinal manipulation as an appropriate and effective medical treatment. However, it is important to note that systematic reviews of the available research indicate that the majority of support for chiropractic comes from case studies focusing on unreliable testimonial evidence. Furthermore, few randomized controlled trials (RCTs), the gold-standard for efficacy research, have been conducted to date.

Scientific reviews of the evidence for chiropractic in the treatment of musculoskeletal conditions have been conflicting. A recent review of RCTs presented in the Chiropractic & Osteopathy “UK Evidence Report” indicates that when compared to sham treatment, spinal manipulation/mobilization can be effective in adults for the treatment of musculoskeletal conditions such as low back pain, migraine and cervicogenic headache, cervicogenic dizziness, several extremity joint conditions, and acute/subacute neck pain.

Notably, however, evidence from a previous systematic review of RCTs published in the New England Journal of Medicine concludes that “research shows that spinal manipulations ease back pain no better than specialised physiotherapy and only slightly better than doing nothing at all”.

Chiropractic in the Treatment of Non-spinal Conditions:

There has been a lack of empirically valid research conducted on the efficiency of chiropractic for non-spinal conditions. Research published in the New Zealand Medical Journal on the effectiveness of chiropractic for conditions including painful menstrual periods, carpal tunnel syndrome, fibromyalgia, ear infections, infantile colic, and gynaecological pelvic pain, concludes that the evidence for the effectiveness of chiropractic manipulation in the treatment of non-spinal syndromes are not based on data from well-designed clinical trials.

The researchers furthermore state that the notion for the treatment of chiropractic manipulation in such conditions is “scientifically implausible”. In addition, the “UK Evidence Report” has found moderate negative evidence (and not merely lack of evidence) for chiropractic in the treatment of asthma, hypertension, dysmenhorrea, ankle fracture and infantile cholic.

Conclusion:

Despite the widespread acceptance of chiropractic as a medical treatment, chiropractic is based on theories that have not been validated by modern science. Though some evidence exists to suggest that chiropractic may be effective in the treatment of musculoskeletal complaints such as low back pain, other research indicates that chiropractic may be no more effective than doing nothing.

While chiropractors commonly promote and practice manual therapy in the treatment of non-spinal ailments, it is important to note that the risks of chiropractic manipulation may be considerable, and currently no scientifically reliable study exist to show efficacy of such treatment in non-spinal conditions.

Links:

The Skeptic’s Dictionary Entry on Chiropractic

“The effectiveness of Chiropractic for Treatment of Low Back Pain: An Update and Attempt at Statistical Pooling” Assendelft, W.J., Koes, B.W., van der Heijen, G.J., & Bouter, L.M., 1996.

“Effectiveness of Manual Therapies: The UK Evidence Report” Bronfort, G., Haas, M., Evans, R., Leininger, B., & Triano, J., 2010.

“A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain” Cherkin, D.C., Deyo, R.A., Battie, M., Street, J., & Barlow, W., 1998.

“Chiropractic Manipulation for Non-Spinal Pain – A Systematic Review” Ernst, E., 2003.

“Deaths After Chiropractic: A Review of Published Cases” Ernst, E., 2010.

“Safety of Chiropractic Interventions: A Systematic Review” Gouveia, L.O., Castanho, P., & Ferreira, J.J., 2009.

“The Use of Expertise-Based Randomized Controlled Trials to Assess Spinal Manipulation and Acupuncture for Low Back Pain: A Systematic Review” Johnston, B.C., da Costa, B.R., Devereaux, P.J., Akl, E.A., & Busse, J.W., 2008.

“The Myth of Objectivity: Is Medicine Moving Towards a Social Constructivist Medical Paradigm” Wilson, H., 2000.

“Evidence-based medicine and its implications for the profession of chiropractic. Social Science & Medicine” Villanueva-Russell, Y., 2005.

12 Comments leave one →
  1. Will Martin permalink
    July 5, 2013 1:15 AM

    Firstly. People seem to think that when Chiroprators mention “innate” they mean “magic” just because there is “no way to detect, harness or measure so-called innate intelligence in any scientifically verifiable way”. This is ridiculous. If you cut your finger, it will stop bleeding then heal by itself. That is innate. When it’s hot, the blood vessels near the surface of the skin dilate to allow heat diffusion. That is innate. When you were and embryo developing in the womb no outside force told your cells how they should divide and arrange themselves, they did it effectively by themselves. That is innate. Just because Chiropractors are the only group that talks about “innate” doesn’t mean that it doesn’t exist.

    Secondly. Randomized control trials are the gold standard WHEN IT COMES TO TESTING MEDICATIONS, but for larger things such as Chiropratic, they make no sense. For a Chiropractic RCT the practitioner would have to be unaware if they had or had not actually delivered an adjustment, and the patient would have to be unaware if they had or had not actually been adjusted. Neither of which are logical, as Chiropractors know what is and is not an adjustment, and patients can feel the difference. RCTs are impractical for anything but trials of medications. It’s like saying “there have been zero RCTs into the effectiveness of using a parachute when jumping out of a plane, therefore, parachutes don’t work.”

  2. Zach permalink
    May 25, 2011 5:04 PM

    Seriously, Im a chiro, I practice Evidence based medicine. I routinely co-manage patients with MDs. Its the dumbest 5% of chiros that make the rest of us look like fools. I routinely fight with them, I promise. In many setting the practice habits and techniques of a chiro could be indistinguishable from a PTs

  3. Simon permalink
    May 17, 2011 9:10 AM

    I have sciatica. My right leg is prone to becoming up to 1cm shorter than my left leg due to the ‘S’ shape in my scoliosis affected spine. My chiro is employed once every three months to adjust my back/hips into correct alignment and relieve pain, aches and tension associated with my condition. It works…if you dislocate your finger, you’re gonna pop it back in, aren’t you…or just exercise it and treat it with drugs? HOWEVER….as soon as he tries to sell me on some idea that he can cure the pain in my elbow with a spinal adjustment, I’ll find another chiro. The scope of their efficacy is indeed limited.

  4. BPM permalink
    December 13, 2010 9:26 PM

    “But then again, would you call podiatry quack medicine just because there’s no evidence that it can cure acne?”

    I would if my podiatrist claimed he could cure acne by readjusting my instep.

  5. BPM permalink
    December 13, 2010 9:24 PM

    “cookoo chiropractors out there giving us all a bad name”

    “I think it depends on who your chiropractor is. Some guys think they can cure anything with a back adjustment”

    Seems to me that you can’t call yourself any kind of a coherent science or even medical profession with that kind of variation in the theory behind the practice, and the types of treatments provided.

    Imagine the field of say, oncology where the whole thing is built on the theory of bodily essences. The chemical and radio treatments are directed at ‘bad essences’, of course some oncologists reject the mysticism, while others also offer leeches and blood letting to get at those bad essences.

    Now some of those treatments work, but would we accept a field where you had to avoid the ‘cookoo oncologists’? One where the basic theory behind those treatments was demonstrably false? One where those who are not cookoo are the ones rejecting some basic tenets of the field?

    If there is anything real behind Chiropractic, why isn’t it a normal science with independent and peer reviewed studies? Why aren’t the crazy underpinnings revised to agree with reality?

  6. humesghost permalink
    December 10, 2010 5:05 PM

    Joe,
    I understand your frustration at the quacks who give chiropractic a bad name. Unfortunately, they are not the “outliers” you claim. Simon Singh was sued by the British Chiropractic Association for denouncing just the claims you call “cuckoo”. And a quick search shows both the Canadian Chiropractic Association and Canadian Chiropractor Magazine making claims supportive of chiropractic treatment for infant cholic, to pick just one example. The reason why chiropractic stands alone from the medical mainstream is its commitment to vitalism as a “core principle” – despite vitalism having been discredited for centuries. And chiropractors are notoriously behind much of the anti-vaccine rhetoric that is leading to fresh outbreaks of once eradicated diseases like whooping cough.
    If, as you claim, most chiropractors do not believe this nonsense, then it is up to you to forcefully say so, and reveal the bad apples for the quacks they are. Only by firmly standing behind evidence-based medicine and rejecting magical nonsense can you hope to distance yourselves from the ranks of homeopaths, faith healers and other pseudoscientific quacks.
    Of course, even limiting itself to neck and back pain, chiropractic still has a lot to prove: despite your claims, meta-analyses suggest that chiropractic is no better than ordinary physiotherapy or massage.

  7. Joe permalink
    December 8, 2010 9:24 AM

    It’s things like this that are so frustrating for a smart, logical practicing chiropractor like myself. Much of your critique of the profession is based upon old teachings or from some in the profession giving us a bad name. Just like any profession, there will be bad chiropractors out there! The ones that preach chiropractic for “everything”, that it is the be-all end-all, that you should never use regular medicine! Like you I think that is all crap! All the innate talk and mystical stuff annoys me aswell! I believe in chiropractic as the best first choice for mechanical neck pain, back pain, and headache. Studies have consistently shown the efficacy and cost efficiency of utilizing chiropractic for these conditions. Again, the problem is NOT with chiropractic, but cookoo chiropractors out there giving us all a bad name! Let me explain about what I do in practice, first the adjustment, which is more than just a “forceful thrust applied to the spine by a chiropractor” as you explained, the exact definition of the chiropractic adjustment is this, “The chiropractic adjustment is a controled input of force on a specific contact point of the spine or other articulation, given in a specific line of correction, in order to overcome abnormal restrictive barriers in or around a joint that is limiting or confining its range of motion. The very specific adjustive thrust stimulates many populations of neurologic receptors, which initiate protective muscular reflexes important in preventing joint degeneration and instability. The biochemical and neurological effects of the adjustment help restore normal function, range of motion, sensorimotor coordination and control, pattern or motion, biomechanics, load distribution and joint neurology.” Now you must agree, that sounds nothing like “letting your innate” flow or any of that garbage! Second, why use chiropractic for injuries of the spine? Well, “The deep, short muscles that are solely for the purpose of spinal movement consist of a complex group of muscles extending from the pelvis to the head; these muscles collectively control the spine. These muscles are not under our voluntary control as they steady adjoining vertebrae of the spine and control spinal movements during the postures of standing, sitting, walking, etc.. These muscles are under the control of the autonomic nervous system as is the heart, liver and other internal organs.
    Injuries to the ligaments and discs of the spine cause the postural muscles of the spine to contract locking spinal bones in abnormal positions preventing healthy movement. A self-directed home exercise for an injured spinal joint is not possible because the muscles that move the individual spinal bones are not under our control. Since the nerves that control these muscles are not under our voluntary control a precise chiropractic adjustment has the ability to inhibit the contraction of these muscles and thereby restore healthy motion enhancing the healing process. The best treatment, therefore, is early, persistent controlled motion of the injured tissues. Chiropractic adjustments are the method of choice for controlled motion.
    Another reason for chiropractic adjustments. Stretched and torn tissue causes a production of chemicals that are released from the damaged cells. These chemicals cause local pain receptors to send impulses to the brain and the muscles in the area of injury. The result of these pain impulses to muscles is muscle spasm. The indirect result of these muscle contractions is many and compounding. One indirect result is a restricted movement of the spine, which causes a decreased blood flow to the area resulting in cell damage and more chemical debris. These chemical debris, in turn, cause more pain impulses to be sent and produce more muscle spasms, more damage to the tissue and the cycle renews itself. The more freedom the joint has to move the more neurological stimuli from joints and muscles enter the spinal cord and block the transmission of pain stimuli that causes less pain to be sensed and less muscle spasm to be experienced. By reducing pain we reduce muscle spasm, which reduces the chemical production of inflammation, and we enhance the healing process.
    Chiropractic adjustments administered throughout the course of healing provides for proper alignment of new collagen, less scarring, improved ligament strength, less pain and inflammation.” Many chiropractors like myself practice based upon science, not on the originally teachings proposed in 1895! Please try not to crush a whole profession based upon the outliers, investigate further!

  8. Steve permalink
    December 6, 2010 12:32 PM

    I think there are some misunderstandings about the efficacy and scope of chiropractic treatment. I’ve been to a chiropractor. She was not a miracle worker and she charged way too much for her services. She also pressured me to keep coming to see her for more than a year after my initial complaint had been resolved. Having said that, however, she did make my back feel much better when I had injured it. The misunderstanding is the idea that chiropractic services can have a positive effect on unrelated parts of the body. There is no evidence to support this. But then again, would you call podiatry quack medicine just because there’s no evidence that it can cure acne?

  9. November 23, 2010 12:24 PM

    Chiropractic treatment is a rip-off. The manipulations these people do only release small amounts of nitrogen into the joints, which provides some temporary relief. But then the “patient” becomes addicted to this. One is far, far better off simply doing yoga and, if possible, more strenuous exercise. The biggest problem “patients” have is laziness to do strenuous exercise 4 times a week! Health is free and one shouldn’t have to pay $50 an hour for it!

  10. Marty M permalink
    November 22, 2010 1:38 PM

    My quack keeps my back happy. He also suggests exercise and diet to keep healthy. No Psudoscience going on here. I think it depends on who your chirpractor is. Some guys think they can cure anything with a back adjustment.

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