chiropractic

See related entry on alternative health practices.

reader comments

28 Jun 1996
I've been skimming your dictionary, and it strikes me that you tar with a very wide brush, and sometimes (not always, just sometimes) substitute your own subjective impressions for a look at the actual evidence. In short, you're guilty of the same thing the creationists do. Demonstrating that SOME proponents of a system are making sloppy mistakes or exceeding their limitations or practicing magic doesn't invalidate the entire system; if it did then the creationists could easily invalidate evolution tomorrow and knock off for an early lunch. You're repressing Science; you should be held to a higher standard than that. So, on to Chiropractic:

Yes, "subluxation" is a wacky theory. But as for the practice of Chiropractic, a number of recent studies published in NEJM and elsewhere have demonstrated that chiropractic manipulation produces objectively better outcomes than traditional medicine when the condition being treated is lower back pain and the practitioner is seen within about a month of the injury/onset of pain. Sure, going to a chiropractor to heal your liver is stupid, but going for back pain is not a bad idea. And that is most of what chiropractors do these days.

Glen Raphael,

reply: Glen, I hope you will read the Consumer Reports (September 1995) article on back pain. Many studies have shown that most cases of acute lower back pain will get better all by themselves within about two weeks of occurring. However, lower back pain can also be a sign of other problems. If you have leg numbness, there could be spinal nerve compression. If the pain is intense and lasts for more than two weeks, it could be because of cancer or an aneurysm. If you've fallen or had an accident, you might have fractured your spine. If the pain is accompanied by fever or chills, you might have an infection. If you had one of these serious conditions, would you call a chiropracter?

It may be true that chiropractic produces "objectively better outcomes" (whatever that is) than traditional medicine when it comes to treating back pain (which is measured largely by subjective reports), but neither is very useful. Traditional medicine is changing its ways and most physicians now believe that for the sudden onset of acute lower back pain the best treatment is no treatment at all.

I read with interest your paragraph on Chiropractic. I also understand that some of what I read may be 4 years old? At any rate, check out some of the latest research available through any library on manipulation and Chiropractic. A theory initially will be spurned by those who are doubters. Secondly, it will be "accepted", but with limitations by those who are doubters. And finally, the same theory will be proven a glorious success by those same doubters, who will tell the world, the discovered it! Thanks for you ear. Hope you look deeper into Chiropractic!
Dr. Gary Rubenstein

reply: as manipulation is one of my favorite topics, I will check it out the next time I am at the library. Also, was it William James who made the claims about the history of theories?

Chiropractic: I read that there is no scientific research hat nerve interference can cause disease?....You need to look up a some of the greatest medical reaserchers. Henry Windsor "Windsor Autopsies"( this one goes back to the 1920's), Abraham Towbin M.D. In 1979 in the post-grad division of Harvard Medical School a medical reasercher by the name of Floyd Gilles an article titled " Infantile Atlantooccipital instability as a cause of crib death". C.H Suh's (head of ENG. at the U of Col) articles on the subluxation I. Korr. Ruth Jackson M.D.( Great Orthopedic Surg.)"The Cervical syndrome"...read about nerve interferance and problems in the eye, heart etc. Guytons Texbook of Medical Physiology. These are all medical doctors and reaserchers. I'll try to send you more information about subluxations would you like chiropractic or medical studies would you also like the names of medical doctors practicing chiropractic! please E-mail me.
Rick [C1@ix.netcom.com]

Wherever you read that there is no scientific research that nerve damage can cause disease, it wasn't here. What I say is that there is little scientific evidence to support Palmer's theory of subluxations, which, despite what any of your sources tell you, cannot cure cancer, heart disease, emphysema, dysentery, anemia, diabetes or crushed vertebrae. If you think a person with nerve damage will be helped by spinal manipulation, you are not only wrong but dangerous.

If anything is dangerous, Mr. Carroll, it is your erroneous opinions based solely on ignorance, and most likely, a lack of doing any valid research on the subject (Consumer Reports--give me a break).

reply: Do you know something about Consumer Reports that I don't? Please let me know, if you do. I consider it a basically reliable source of information. Why don't you?

First, your understanding of chiropractic philosophy is only partially correct. It is true that D.D. Palmer believed subluxations (vertebrae out of alignment or not showing proper biomechanical motion) could cause nervous "irritation", and that this, in turn, could cause a disturbance of normal physiologic function. This is only part of a bigger picture, however. The basic chiropractic philosophy is that the human body is inherently healthy and has the ability to heal itself when needed. This is apparent when you think about it--is it the band-aid that heals your finger when you cut it, or is it the cast that heals a fracture when you break a bone? Of course not, the body will heal itself--as long as there is nothing to interfere with the healing process.

reply: The human body is "inherently healthy?" You're kidding, right? Why do we get sick and die, then? Anyway, if by saying that the human body has the ability to heal itself you mean that healthy people have funtioning immune systems, etc., who could disagree with that?

Now, how does our body interact or communicate with itself and with the environment. Guess what, 100% through the nervous system. By manipulation of the articulations of the spinal column the interference is removed and the body is let to heal on its own. We as chiropractors are not healing the body, but letting the body heal on its own.

reply: If the body can heal on its own, why does it need your manipulations of articulations? The idea that without your manipulations, the body would not heal on its own, does not seem to be supported by the empirical evidence of most people's lower back pain going away on its own. Comparing your manipulations with putting a cast on a broken arm is misleading. We know what function the cast plays; you are assuming the role played by manipulation.

Palmer did suggest that nerve irritation was mostly due to a subluxation impinging on a nerve, and this would then lead to nerve dysfunction. This bone pinching nerve theory has been proven to be a factor only under certain circumstances such as when there are advanced degenerative changes. There have been numerous studies, however, that found many indirect pathways for subluxation to cause nerve irritation. These are too complex and technical to discuss here but can be made available.

reply: Very interesting, but if nerves are "irritated" or damaged and this irritation causes pain, why wouldn't manipulation cause further irritation and damage and, therefore, more pain?

Remember also that this is only a philosophy, and as such should be changing as new data support some ideas and refute others. The philosophy of today is different although core components still remain. I also know that the accredited colleges or American Chiropractic Association would not endorse chiropractic treating heart disease, diabetes, cancer, and other serious and life-threatening situations--these are beyond our scope of practice. But who is to say these conditions and others such as asthma, ulcers and other GI troubles to name a few, could not be helped by chiropractic--at least in the beginning stages, or even prevented.

reply: Sounds like wishful thinking to me.

Yes, I admit, the research in this area is just beginning, but also remember, the chiropractic profession is only 100 years old and it's not like we had the government and other funding money we do today. Also, let me remind you about a recent New England Journal of Medicine article that stated only 15% of medical practices are validated by double-blinded, controlled clinical trials. Am I saying because the medical profession doesn't have the research that chiropractic does not need it either? Of course not. What I am relating is that in order to do research you must first have an idea to study. Also remember that research in not everything, clinical results are just as important. What is probably going to end up happening is that chiropractic will be used in conjunction with other therapies in a "multidisciplinary" approach for these visceral conditions. A typical chiropractic practice is made up of only a few percentage (five or less) of these "organic" conditions.

reply: I'm not one for trying to predict the future of such things as chiropractic, but I do have some opinions about spending our tax dollars testing metaphysical hypotheses and empirical possibilities. The government should stay out of metaphysics and before spending money on a possible cure for cancer by meditating underwater while injecting bee pollen there should be some solid empirical or theoretical evidence that such a practice is likely to prove beneficial. I'm not opposed to "pure" research, or experiment by trial and error, but with limited resources to spend, decisions on how to spend it should be based on some sort of merit system. The minimal requirement of such a system should be the ability to establish empirical or theoretical probability that a medical intervention will be effective. I don't say that this minimal probability be as high a standard as "beyond a reasonable doubt." Such a high standard would end all funding. But some proof beyond mere possibility should be required.

Now for your comment about low back pain. Apparently you have absolutely no idea what you are talking about here because an overwhelming body of evidence supports the superior outcomes (subjective, objective, clinical, whatever you want) of manipulation for low back pain. Perhaps you fail to understand the scope of low back pain in the United States and around the world. About 80% of adults will experience disabling low back pain at some point in their lives. While it is true that low back complaints are generally self-limiting, I would like you to name the majority of conditions seen in clinic or hospitals that are not. That is not even relevant whatsoever as to whether a condition should be treated or not. What determines a treatments effectiveness is if it can effect the condition in less time than that condition's natural history. The natural history for low back complaints is four weeks (not 2 as you stated). Now can you imagine having low back complaints for four weeks--or even two. Remember low back complaints affect PEOPLE. These people have lives, jobs, kids, hobbies. What happens to a person when they are not able to do these things.

reply: Well, it depends on the person. Some people have chronic back pain and are also employed as roofers or in jobs requiring a lot of lifting. They may have to find another line of employment or make sure they wear a back support and take care in how they bend to lift things (learn to squat instead of bending over with the legs stiff). Getting "cranked", as one of my friends calls it when he goes to his chiropractor, provides little more than temporary relief. This friend used to be a roofer. He once called me at about 5:30 in the morning to help him. His back pain was so great he couldn't even get out of bed to go to the bathroom. He was lying on the floor when I came over and he was still there in the afternoon when I returned after work. He was taken by ambulance to the hospital. He's been going to a chiropractor for years but this time he consulted a surgeon. The thought of going under the knife was so unpleasant that he eventually changed professions rather than deal with another potential paralysis episode. He took so long to decide what to do that eventually he healed on his own. He wears a back brace whenever he does lifting and has a job which puts very little strain on his lower back. As far as I know, he hasn't needed to go to his chiropractor since he changed jobs. I think it was changing jobs, not the years of "cranking" that relieved him of his pain.

Low back complaints are the second largest reason for a visit to a primary care physician. Low back complaints cost more than AIDS, heart disease, and cancer combined in terms of cost of medical treatment and indirect costs from work loss/decrease in productivity. Low back complaints are the leading cause of disability in Americans ages 25-45. Low back complaints are the number one reason for medical discharge from the military. Low back complaints are the number one reason for claims to worker's compensation, and these claims (30% of total claims) make up 80% of worker's compensation costs, again, because of high cost of medical treatment and work loss. In short, low back pain is a MAJOR, BIG-TIME problem in America and around the world. For you to make it sound as if low back pain is no big deal and will disappear without a problem is a gigantic mistake and just goes to prove your lack of understanding or research on the subject. By effecting the complaint in a faster time period than natural history you get that person back on the job faster, you take that person out of pain and suffering, you decrease the chance of that condition becoming chronic, and overall, you increase that person's quality of life. Apparently you have dealt with little or no people who experience chronic low back pain, or increased pain because of failed back surgery. These people's entire lives are affected.

reply: I'm sorry if you took my meaning to be that lower back pain "is no big deal." I did not intend to imply that nor did I intend to imply that no one ever benefits from treatment by chirpopractors, physicians, massage therapists, exercise class, etc. If you want to bring in worker's compensation complaints, however, then we'll have to discuss fraud, which is beyond the scope of this article or these comments. Anyway, I have known people who've had successful back surgery. It changed their lives---for the better.

They are depressed, some cannot work, some can barely walk, and some have lost their families because of it. Even if you can reduce that person's pain by two weeks you have done a great service. Also by getting treatment instead of just leaving it, other more dangerous causes of low back pain (cancer, organ disease, etc.) can be ruled out, and healing can be supervised to ensure a more complete job with less chance of chronicity or repeat back complaint.

reply: The question is, though, if someone is seriously disabled, would they get equal or better results elsewhere. You haven't convinced me that if I ever find myself in such a condition I would be better off consulting a chiropractor than an M.D.

You also made reference to some of the above conditions as other causes of back pain (cancer, etc.) as a reason people should not go to a chiropractor. This is absolutely ridiculous. Chiropractors are trained to diagnose and rule-out other causes of back pain such as these. If the diagnosis falls outside of our scope of practice we make the appropriate referral. This is no different than the general MD who make the referral to the heart surgeon or other specialist.

reply: There is one difference between a general M.D. and a chiropractor, and it is that difference which leads many people to seek the services of the latter: the M.D. sees back pain as a sign that something is wrong with the body and it is possible that the M.D. will recommend drugs or surgery to relieve the pain. The chiropractor is likely to see back pain as a sign that something is out of alignment and is unlikely to recommend surgery.

Anyway, who do you think is more likely to know that a back complaint may have a more serious cause. An MD who sees a few back cases a week, or a chiropractor who sees a hundred backs a week. To become a chiropractor it takes at least 7 years of schooling. We are DOCTORS, Doctors of Chiropractic, and we are recognized with all the other powers and rights of other physicians. While you're at it I think you need some work on the chiropractic education.

reply: I don't say that "it is more likely" that back complaints have a serious cause. I just say that the cause may be serious. And, I'm sure you've come a long way from the days of Dr. Palmer.

Back to chiropractic documentation for low back pain. Recently the Department of Health's Agency for Health Care Policy and Research released a guideline entitled "Understanding Acute Low Back Pain in Adults". This is a major guideline with the purpose of defining what treatment(s) should be used for certain conditions. These guidelines are used by our government as well as in other countries, by health care professionals around the world, and by third-party payers. These guidelines are made by gathering a multidisciplinary panel of experts in that particular field and then finding and evaluating all the research for a particular topic. For low back pain the panel said that spinal manipulation is the best early treatment. What do you mean there are no reports on chiropractic and back pain--they reviewed all the valid studies from every discipline in the world!!!

reply: I don't mean anything by "there are no reports on chiropractic and back pain," because I never said such a thing.

Now why should chiropractic be the first method of therapy for low back pain? There are basically 3 reasons:

1. Chiropractic specifically, and spinal manipulation generally, has been proven to be the most effective early treatment. This fact can simply not be refuted, period.

reply: Well, since it can't be refuted there is no need to try. But some people believe that to exclude contrary evidence a priori is not good scientific technique. I believe that taking all the evidence, including the reports you cite, the case is not as strong as you think and it certainly isn't irrefutable.

2. Chiropractic is very safe. There have been no reports of complications from low back manipulation by chiropractors in the literature, although the risk has been estimated as a complication per 200 million manipulations. That would make chiropractic 10,000 times safer than anesthesia alone. Even taking aspirin is far more dangerous than having spinal manipulation. Now why would surgery or medications be indicated for a condition that you call self-limiting. In this case medical treatment is much more dangerous than no treatment alone. Now please don't get me wrong, medical and surgical treatment is necessary sometimes, but only in very specific and well-defined circumstances.

reply: I can't argue with you here. (Except for your reference to me claiming something about a condition being "self-limiting;" I don't say that. In fact, I don't even know what you are talking about.) The dangers from drug reactions or potential addictions, anesthesia, surgical misadventures of high magnitude (euphemism for "killed the patient") are greater than the dangers of chiropractic. This is one of the main attractions of chiropractic and other alternative health practices. Unfortunately, being safer does not equate with being better. It would, if you were talking about comparing two interventions used for exactly the same conditions which produce very similar results. Then, the safer would be the wiser choice.

3. Chiropractic is without a doubt less costly than medical treatment. It is true that we have a larger number of visits or treatments per condition, but that does not matter one bit. The name of the game is COST-EFFECTIVENESS.

reply: I'll take your word for it. Again, though, being cheaper would be better only if we were comparing interventions for the same conditions which produce the same results.

Now let's hear you respond to this. If you refute anything I say all I ask is that you SHOW ME YOUR DATA. If you want any information from me I will gladly get it to you.
Brian V. Jongeward, D.C.

reply: You have already claimed that you can't be refuted. So, I won't try to refute you, but thanks for the offer.

20 Nov 96
Would it be fair to say that some alternative therapies are "marginal" therapies - acknowledged to have favourable effects, but also steeped in nonsense? Shouldn't the skeptical community hold two views on these therapies, not just one all-encompassing negative view, and acknowledge that they possibly do have some value?

reply: I think it's fair to say that some alternative or complementary therapies are "marginal" but I can't speak for the skeptical community, if there is such a thing. I don't know how other skeptics feel, but I think anybody should be able to offer and receive not only "marginal" but "non-sensical" therapies as well...as long as they don't endanger anybody's life but their own and as long as they don't expect the taxpayer or insurance company to foot the bill.

Chiropractic and Acupuncture spring to mind, but because I know more about chiropractic I will concentrate on that. The view that correction of subluxations can correct a wide range of diseases, including what might be called "non-mechanical" - ear infection for instance - is patently ludicrous. Nevertheless, apparently intelligent people, qualified chiropractors, will diligently represent these views if you ask them. I know, because I have asked, and I have been given these ludicrous answers.

(I am reminded of mentioning to my chiropractor that I had a heavy cold, and it might be fairer on his other patients if I avoided breathing directly on his HiLo treatment table. He explained that it wasn't a problem if you didn't believe in the "Germ Theory.")

But chiropractic therapies most certainly do create a sense of well-being, relaxation, cessation of muscle tension, correction of mechanical injury like whiplash, and relief of muscle spasm like a "crick in the neck." Anecdotal evidence suggests that chiropractic therapy really is good for lower back pain. I don't expect chiropractic to correct my back problems, but I do expect and I do receive significant symptomatic relief from manipulation. Pretty much the same effect as a good sports massage, but in different areas:

a) There seems to be genuine benefit - beyond the placebo effect.
b) Correction of subluxation to relieve muscle spasm doesn't intuitively seem unreasonable.
c) Chiropractic (by trained practitioners) seems not to be inherently risky.

I guess it comes back to the old skeptical quandry - where do you draw the line between "Prove it to me" and "Don't waste my time trying to prove it to me." I'm happy to place Iridology in the "Don't waste my time" basket, but let's be a little more generous to Chiropractic.
Mark Roberts, Auckland, New Zealand

reply: I don't think I've been that unkind to Chiropractic, but then I'm not a chiropractor. In any case, I'm sure the iridologists and aromatherapists would disagree with your assessment of their arts. And I guarantee that when I get around to writing entries in the Skeptic's Dictionary for those subjects I will get some unfriendly mail blasting me for criticizing what I haven't tried and extolling the virtues of their sciences whose proof is in their many success stories.