Chiropractic

Chiropractic was “discovered” in 1895 by Daniel David Palmer, a self-styled “magnetic healer” who claimed he found a misplaced vertebrae in the spine of a deaf janitor. According to Palmer, he “racked’ the vertebrae back into position, thereby curing the janitor’s deafness. Palmer called these supposedly misaligned vertebrae “subluxations,” which he claimed interfered with nerve flow, thereby causing disease. Palmer opened a school in Davenport, Iowa to train others in chiropractic. Not surprisingly, Palmer and his disciples were arrested for practicing medicine without a license. To solve this problem, chiropractors sought passage of state practice acts defining chiropractic as a separate healing profession and allowing them the use of the honorific “doctor.” Over a sixty year period chiropractors were successful in getting such legislation passed in each state, Louisiana being the last state to legalize chiropractic, in 1974.

Chiropractors today still claim the ability to detect subluxations of the spinal vertebrae, sometimes referred to as spinal “misalignments,” which, they say, interfere with the normal generation, transmission, and expression of nerve impulse between the brain, organs, and tissue cells of the body, thereby causing disease. Chiropractors further claim that they adjust, or manipulate, these subluxations to restore the normal flow of nerve impulse which, in turn, produces normal function and consequent health. This is as much of a fabrication today as it was when Palmer invented it. It is rank pseudoscience.

Although more recently some chiropractors have tried to come up with a more “scientific” explanation for the subluxation, they have never been able to demonstrate that subluxations exist, that they can detect subluxations with any reliability, that these subluxations affect human health, and that chiropractic adjustments, or manipulations, can correct subluxations. Chiropractors cannot agree on a definition of the chiropractic subluxation, nor on whether evidence exists that there is such a thing. This has caused something of an intramural war within chiropractic between those who still adhere faithfully to Palmer’s philosophy and those who plainly admit there is no such thing as a subluxation and who would prefer to see chiropractors limit their practice to evidence-based treatment of musculoskeletal problems, mainly back pain.

Unfortunately, the state of Florida has sided with pseudoscience. The state defines chiropractic scope of practice as: “the science, philosophy, and art of the adjustment, manipulation, and treatment of the human body in which vertebral subluxations and other malpositioned articulations and structures that are interfering with the normal generation, transmission, and expression of nerve impulse between the brain, organs, and tissue cells of the body, thereby causing disease, are adjusted, manipulated or treated thus restoring the normal flow of nerve impulse which produces normal function and consequent health.” Sec. 460.403(9)(a), Fla. Stat. (2008). This means Florida’s chiropractors can legally diagnose their patients as having subluxations, claim the subluxations affect one’s health, and adjust the supposed subluxations, even though none of this is based on generally accepted scientific principles of human physiology or anatomy. It is, in fact, contrary to what we know about how the human body functions.

Diagrams such as this one are used by some chiropractors to imply that "subluxations" can interfere with nerve flow to the organs causing them to become diseased. While these diagrams may accurately show innervation of the bodily organs by spinal nerves, there is no evidence that subluxations exist or, even if they did, that they would interfere with the flow of nerve signals to and from the organs. Even if the nerve is actually damaged by, for example, trauma, that does not mean the organs it innervates will malfunction. If that were true, all people with spinal cord injuries would suffer multiple organ failure which, of course, they do not.

Chiropractors use some terms differently than conventional medical practitioners, which can be confusing to the patient. The term “subluxation” is one of these terms. To a nurse, medical doctor or physical therapist, a subluxation is a partially dislocated joint, such as a dislocated shoulder. Another term is “manipulation.” Physical therapists, D.O.s, and some M.D.s use a therapy called manipulation, which moves a joint beyond its normal range of motion, to treat joint problems such as decreased mobility. Chiropractors also use manipulation in this manner, and some chiropractors limit themselves to the treatment of musculoskeletal problems, such as back pain. There is evidence that this kind of manipulation is effective for certain types of low back pain of mechanical origin, but there is no evidence that manipulation by a chiropractor is any more effective than manipulation by other practitioners. Unlike chiropractors, M.D.s, D.O.s and physical therapists do not use manipulation to treat the chiropractic subluxation, because they do not believe such subluxations exist. Chiropractors also use the word adjustment when describing manipulation. To further confuse things, chiropractors do not always call the subluxation by that name. It is also called the vertebral subluxation complex, spinal misalignment, and spinal lesion, to name a few.

Chiropractors claim that spinal adjustments are helpful in treating a wide variety of conditions and diseases. (Actually, they use the verbal dodge that they don’t “treat” anything, but are merely removing interference to “nerve flow,” which, once eliminated, allows the body to heal itself.) Among these are allergies, asthma, ear infections, painful periods, bedwetting, colic, AD/HD and autism. Not surprisingly, there is no good scientific evidence that the detection and correction of so-called subluxations is effective for any condition or disease. Many chiropractors also tell patients they need regular spinal checkups to detect and correct any subluxations as these regularly occur and may interfere with good health. They even claim that infants are born with their spines already subluxated and it is important to bring infants into the chiropractors office as soon as possible after birth for treatment. All of this is, of course, nonsense. Interestingly, and tellingly, chiropractic “adjustments” are not on the list of recommended clinical preventive services issued by the U.S. Preventive Services Task Force. The task force is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services, such as physical exams and immunization schedules, that are science-based and cost-effective. The on-line version of the task force’s pocket guide, which covers about 100 interventions, is at http://www.ahrq.gov/clinic/pocketgd.htm.

There is an unquantified but very real risk of vertebral artery dissection from cervical (neck) manipulation. Dissection can lead to stroke and its serious consequences, including death. Any risk-benefit analysis will likely lead a patient to conclude the benefit of neck manipulation is not worth the risk. In scientific studies, neck manipulation for neck pain or headache is no more beneficial than other treatments, such as NSAIDS and mobilization, a much gentler procedure. Neck manipulation to eliminate so-called “subluxations” or “spinal misalignment” should not be performed as the total lack of benefit means the risk is never worth the treatment.

Chiropractors who claim the ability to detect subluxations sometimes use x-rays to locate these subluxations. X-rays have never been validated as a means of subluxation detection, for the obvious reason that chiropractors cannot agree what a subluxation is or how to find one. Therefore, there is no reason to subject oneself to radiation for this purpose.

Craig Nelson and other, more progressive, chiropractors have called the profession to task for its unremitting belief in chiropractic “philosophy” and its attendant “subluxations.” They argue that such unscientific beliefs must be abandoned if chiropractic is to gain respectability and urge the creation of a specialty profession limited to musculoskeletal conditions, such as back pain. However this argument resolves itselfs within chiropractic, it is clear that Florida’s chiropractic practice act should not be based on notions invented by a “magnetic healer” in 1895.

Because chiropractic is a regulated profession, complaints against chiropractors can be filed with the Florida Department of Health. For more information, see “Your rights as a healthcare consumer under Florida law.”

References:

Craig F. Nelson, Dana J. Lawrence, et al, “Chiropractic as Spine Care: A Model for the Profession,” Chiropractic & Osteopathy 13, no. 9 (2005). http://www.chiroandosteo.com/content/13/1/9.

Donald R. Murphy, et al, “How Can Chiropractic Become a Respected Mainstream Profession? The Example of Podiatry,” Chiropractic & Osteopathy 16, no. 10 (2008).  http://www.chiroandosteo.com/content/16/1/10.

Samuel Homola: “Chiropractic: History and Overview of Theories and Methods,” Clinical  Orthopedics &  Related  Research 444( 2006). 

Samual Homola : Inside Chiropractic  (New York:  Prometheus Books, 1999)

Edzard Ernst: “Chiropractic: A Critical Evaluation,” Journal of Pain & Symptom Management 35 (2008).

Edzard Ernst, P.H. Canter: “A Systematic Review of Systematic Reviews of Spinal Manipulation,” Journal of the Royal Society of Medicine 99 (2006). 

E. L. Hurwitz  et al: “Treatment of Neck Pain: Noninvasive Interventions,” Spine  33 no. 4S (2008).

Edzard Ernst, "Chiropractic Maintenance Treatment: A Useful Approach?,” Preventive Medicine (2009) (article in press). 

Autonomic Nervous System illustration from LifeART (and/or) MediClip image copyright (2009) Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. For viewing purposes only. All rights reserved.

Edzard Ernst:  “Chiropractic Treatment for Asthma?” Journal of Asthma, 46 (2009).

Edzard Ernst: “Chiropractic Spinal Manipulation for Infant Colic: A Systematic Review of Randomised Clinical Trials, International Journal of Clinical Practice, 63(9).

Sam Homola: “Neck Manipulation: Risk vs. Benefit, Science-Based Medicine, http://www.sciencebasedmedicine.org/?p=1037 (accessed 9-4-09).

Mark Crislip: “Chiropractic and Stroke: Evaluation of One Paper, Science-Based Medicine, http://www.sciencebasedmedicine.org/?p=170 (accessed 9-4-09).