MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Low back pain (LBP) is a ‘minor complaint’ in the sense that it does not cost patients’ lives. At the same time, LBP is amongst the leading causes of disability and one of the most common reasons for patients to seek primary care. Chiropractors, osteopaths, physical therapists and general practitioners are among those treating LBP patients, but there is only limited evidence regarding the effectiveness offered by these provider groups.

The aim of this systematic review was to estimate the clinical effectiveness and to systematically review economic evaluations of chiropractic care compared to other commonly used approaches among adult patients with non-specific LBP.

A comprehensive search strategy was conducted to identify 1) pragmatic randomized clinical trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared to standard care delivered by other healthcare providers. Studies published between 1990 and 4th June 2015 were considered. The primary outcomes included pain, functional status and global improvement. Study selection, critical quality appraisal and data extraction were conducted by two independent reviewers. Data from RCTs with low risk of bias were included in a meta-analysis to determine estimates of effect sizes. Cost estimates of full economic evaluations were converted to 2015 USD and results summarized.

Six RCTs and three full economic evaluations were included. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1), physical therapy (n = 3) and medical care (n = 1). The authors found similar effects for chiropractic care and the other types of care. Three low to high quality full economic evaluations studies (one cost-effectiveness, one cost-minimization and one cost-benefit) compared chiropractic to medical care. Highly divergent conclusions (favours chiropractic, favours medical care, equivalent options) were noted for economic evaluations of chiropractic care compared to medical care.

The authors drew the following conclusions: moderate evidence suggests that chiropractic care for LBP appears to be equally effective as physical therapy. Limited evidence suggests the same conclusion when chiropractic care is compared to exercise therapy and medical care although no firm conclusion can be reached at this time. No serious adverse events were reported for any type of care. Our review was also unable to clarify whether chiropractic or medical care is more cost-effective. Given the limited available evidence, the decision to seek or to refer patients for chiropractic care should be based on patient preference and values. Future studies are likely to have an important impact on our estimates as these were based on only a few admissible studies.

This is a thorough and timely review. Its results are transparent and clear, however, its conclusions are, in my view, more than a little odd.

Let me try to re-formulate them such that they are better supported by the actual data: There is no good evidence to suggest that chiropractic care is better or worse that conventional therapeutic approaches currently used for LBP. The pooled sample size dimensions too small to allow any statements about the risks of the various approaches. The data are also too weak for any pronouncements on the relative cost-effectiveness of the various options. Given these limitations, the decision which approach to use should be based on a more comprehensive analysis of the therapeutic risks.

The point I am trying to make is quite simple:

  • The fact that RCTs fail to show adverse effects could be due to the small collective sample size and/or to the well-known phenomenon that, in well-controlled trials, adverse effects tend to be significantly rarer than in routine care.
  • Hundreds of serious adverse events have been reported after chiropractic spinal manipulations; to these we have to add the fact that ~50% of all chiropractic patients suffer from transient, mild to moderate adverse effects after spinal manipulations.
  • If we want to generate a realistic picture of the safety of a therapy, we need to include case-reports, case-series and other non-RCT evidence.
  • Conventional treatments of LBP may not be free of adverse effects, but some are relatively safe.
  • It seems reasonable, necessary and ethical to consider a realistic picture of the relative risks when deciding which therapy amongst equally (in)effective treatments might be best.

To me, all this seems almost painfully obvious, and I ask myself why the authors of this otherwise sound review failed to consider such thoughts. As one normally is obliged to, the authors included a section about the limitations of their review:

Our review has limitations. First, we did not search the grey literature for clinical effectiveness studies. McAuley et al. showed that the inclusion of results from the grey literature tend to decrease effectiveness estimates in meta-analyses because the unpublished studies tend to report smaller treatment effects. Second, critical appraisal requires scientific judgment that may vary among reviewers. This potential bias was minimized by training reviewers to use a standardized critical appraisal tool and using a consensus process among reviewers to reach decisions regarding scientific admissibility. Most of the original between-group differences and pooled estimates in our meta-analysis did not favour a specific provider group, and we believe it is unlikely that the inclusion of unpublished grey literature would change our conclusions. Third, the low number of clinical trials prevents us from conducting a meaningful investigation for publication bias. Fourth, the majority of the included clinical effectiveness studies (three out of five) and all three economic evaluations were conducted in the United States. Caution should therefore be used when generalizing our findings to other settings or jurisdictions. With respect to economic evaluations in particular, local healthcare systems and insurance plans may have a higher impact on cost than the type of healthcare provider.

Remarkably, this section does not mention their useless assessment of the risks with one word. Why? One answer might be found in the small-print of the paper:

The authors … have the following competing interests: MAB: Personal fees from Ordre des chiropraticiens du Québec for one teaching presentation, outside the submitted work. MJS: Position at the Nordic Institute of Chiropractic and Clinical Biomechanics is funded by the Danish Chiropractic Research Foundation. The Foundation had no role in the study design; in the design and conduct of the study, in the collection, management, analysis, and interpretation of data; in the preparation, review or approval of the manuscript; or in the decision to submit the article for publication. RBDS: Nothing to disclose. JB: Nothing to disclose. PH: Nothing to disclose. AB: Position at the School of Physical and Occupational Therapy at McGill University is funded by the Canadian Chiropractic Research Foundation. The Foundation had no role in the study design; in the design and conduct of the study, in the collection, management, analysis, and interpretation of data; in the preparation, review or approval of the manuscript; or in the decision to submit the article for publication.

34 Responses to A new systematic review of chiropractic for low back pain: far less encouraging than chiros make us believe

  • I’d be interested in more detail about the cost effectiveness question. The effectiveness may indeed be on a par with other forms of physical therapy (it would be odd if this were not so), but the costs of chiropractic appear to be very high, especially when one factors in the tendency of chiros never to discharge a patient. Indefinite courses of treatment for asymptomatic patients is a core part of most chiropractic marketing, as far as I can tell. This won’t be included in studies looking at treatment because typically only a limited number of sessions are reimbursed – after that, the patient has to pay out of their own pocket.

    • true!
      also a good physio can show LBP patients a programme of exercises that the patients would do at home; the costs of such an approach is minimal.

    • @Guy Chapman
      Good question! I keep practice statistics and my patient visit average is 6.8 visits. I also discharge patients though from what I see this as atypical! This is part of the medical referrals I get which have the initial report to the doctor and the final discharge letter!
      Some recent papers may be of help:
      The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.
      Weeks WB, Leininger B, Whedon JM, Lurie JD, Tosteson TD, Swenson R, O’Malley AJ, Goertz CM. J Manipulative Physiol Ther. 2016 Feb
      http://www.ncbi.nlm.nih.gov/pubmed/26907615
      A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States
      http://www.biomedcentral.com/1472-6963/15/474
      Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials.
      http://www.ncbi.nlm.nih.gov/pubmed/24986566
      Cost Analysis Related to Dose-Response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes From a Randomized Controlled Trial
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095804
      Spinal manipulation epidemiology: systematic review of cost effectiveness studies.
      http://www.ncbi.nlm.nih.gov/pubmed/22429823
      In response to Prof Ernst:
      “Hundreds of serious adverse events have been reported after chiropractic spinal manipulations; to these we have to add the fact that ~50% of all chiropractic patients suffer from transient, mild to moderate adverse effects after spinal manipulations.”
      This ~50% stat matches similar studies by the physio’s! It also forms part of my informed consent! Non-issue!
      This recent systematic review by Neurosurgeons is also interesting:
      Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation.
      Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Cureus. 2016 Feb
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794386
      I would have not selected that title but coming from neuro’s was definitely going to cause a stir!
      @GibleyGibley
      Criticism is necessary and part of the scientific method!
      @Alan Henness
      “No! Wait! That’s publicity! Or are they the same thing as far as quacks go?”
      Research that is a publicity stunt has the word “pragmatic” in the title! 😉

    • Guy opined-
      “I’d be interested in more detail about the cost effectiveness question”

      Glad you opined! HERE is a recent study that addresses your opine!
      ~~~~~~~~~~~~~~~

      J Occup Rehabil. 2016 Sep 17. [Epub ahead of print]

      Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain.

      Blanchette MA1, Rivard M2,3, Dionne CE4,5, Hogg-Johnson S6,7, Steenstra I6,7.

      Abstract

      Objective To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers. Methods We analyzed data from a cohort of 5511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period. Results Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10-1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71-0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02-2.19], P value = 0.040) rather than a physician (reference). Conclusion The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker's compensation system. Further investigation is required to understand the between-provider differences.

    • Prof Ernst, You lament the lack of research by the chiropractic profession, yet when research is done, you criticise it. You cannot have it both ways. Research like this allows all practitioners of neuro-musculo-skeletal heath care to review their methods and change accordingly, (irrespective of their profession).
      You and your supporters appear to have a fascination with the use of physiotherapy as a valid method of treatment. However, the research into this profession interesting as they have an identity crisis. They, themselves do not know what they do, and when they do it, there is a significant amount of inconsistencies in what they do. They cannot agree on treatment methods and a lot of the methods of treatment have been seriously discredited in the literature. Exercises, TENS, Ultra-sound, trigger point therapy, massage , corsets, biofeedback are just a few used by physiotherapists in the treatment of their patients, yet these methods are known to be either unproven, or yet to be proven. See NZ ACC Clinical Practice Guidelines into the treatment of Low Back Pain, Page 13. The neurophysiological mechanism for back pain is the same as neck, knee, thoracic, ankle etc. pain. If a method of treatment e.g. spinal manual therapy works for low back pain, it is also going to work for neck, thoracic, hip knee etc. pain. So, if physiotherapy modalities, e.g. exercises, TENS, ultrasound etc. do not work for low back pain, they are not going to work for anything else.
      http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/guide/prd_ctrb112930.pdf
      So, if the ethical and valid management options for physiotherapists to use are extremely limited, if not non-existent, what have they got to offer? ….Nothing, but “hands-on homeopathy”, known also as “shake; bake and fake”.

      • “Prof Ernst, You lament the lack of research by the chiropractic profession, yet when research is done, you criticise it. You cannot have it both ways.”
        WHY NOT?
        this may be new to you: one can have large quantities of high quality research!!!
        anyway, I did commend this review; it is thorough! but it’s conclusions are wrong as they are not based on the available data.

      • GibleyGibley said:

        You lament the lack of research by the chiropractic profession, yet when research is done, you criticise it. You cannot have it both ways.

        Your (mistaken) assumption would appear to be that research done by chiros is all high quality…

      • @GibleyGibley on Wednesday 14 September 2016 at 21:58

        “Prof Ernst, You lament the lack of research by the chiropractic profession, yet when research is done, you criticise it. ”

        Are you saying that any research is good even if it it is garbage? The point of research is that it can be criticised and, if found wanting, discarded. I can do research outside the local post office by a hasty questionnaire, so is that acceptable?

        “You cannot have it both ways.”

        That would be the Logical Fallacy, False Dichotomy.

        “Research like this allows all practitioners of neuro-musculo-skeletal heath care to review their methods and change accordingly, (irrespective of their profession).”

        Research like this shows how far some are removed from neutrality and/or reality.

        “You and your supporters appear to have a fascination with the use of physiotherapy as a valid method of treatment. However, the research into this profession interesting as they have an identity crisis. They, themselves do not know what they do, and when they do it, there is a significant amount of inconsistencies in what they do.”

        Putting aside the Tu Quoque, of which your cohort is particularly fond, physiotherapy didn’t start with the basis of a supernatural premise. It is also under scrutiny as a part of medical science and, despite some cowboys, has not splintered into disparate camps without a commonality.

        “They cannot agree on treatment methods and a lot of the methods of treatment have been seriously discredited in the literature. Exercises, TENS, Ultra-sound, trigger point therapy, massage , corsets, biofeedback are just a few used by physiotherapists in the treatment of their patients, yet these methods are known to be either unproven, or yet to be proven. See NZ ACC Clinical Practice Guidelines into the treatment of Low Back Pain, Page 13. The neurophysiological mechanism for back pain is the same as neck, knee, thoracic, ankle etc. pain. If a method of treatment e.g. spinal manual therapy works for low back pain, it is also going to work for neck, thoracic, hip knee etc. pain. So, if physiotherapy modalities, e.g. exercises, TENS, ultrasound etc. do not work for low back pain, they are not going to work for anything else.”

        Non-sequitur.

        “http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/guide/prd_ctrb112930.pdf
        So, if the ethical and valid management options for physiotherapists to use are extremely limited, if not non-existent, what have they got to offer? ….Nothing, but “hands-on homeopathy”, known also as “shake; bake and fake”.”

        If you are going to use references, please ensure they make sense?

        • Frank Collins said:

          Are you saying that any research is good even if it it is garbage?

          Yep. that’s how the old saying goes.

          No! Wait! That’s publicity! Or are they the same thing as far as quacks go?

        • Frankster is at it again..he simply cannot comprehend that chiros perform physiotherapy and PT’s are now performing manipulation when he criticizes chiro for its origins. The profession of leeches and bloodletting has had a dubious history, but Frankster ignores it while claiming that modern medicine is research and science-based and chiro was born out of mysticism. Frankster is a hypocrite of the highest order…and a blatantly biased one at that! His thoughts regarding chiro are saturated with disdain so consistently that it is obvious he knows little of how it’s practiced by the majority of Chiropractic physicians in the US.

          One simply has to marvel at the chiro haters on this site who wail on about the lack of science in chiro yet regale “modern medicine” as a scientific altar at which to worship. What a joke! It’s interesting to read of the off-label prescribing practices of many pediatric MD’s. While such practices do sometimes help patients, they come at great risk.

          Off-label prescribing can also harm patients, however. According to a report in Archives of Internal Medicine 2006; 166(9): 1021-1026, the potential for harm is greatest when an off-label use lacks a solid evidentiary basis. A 2006 study examining prescribing practices for 169 commonly prescribed drugs found high rates of off-label use with little or no scientific support. Researchers examining off-label use in U.S. children’s hospitals concluded, “[W]e still have incomplete knowledge about the safety and efficacy of many medications commonly used to treat children across a range of drug classes and clinical diagnoses.” More than half the respondents in a survey of academic medical centers reported that innovative off-label prescribing raised concerns in their institutions, such as lack of data, costs, and unfavorable risk-benefit ratios. When substantial uncertainty exists about off-label applications, patients are at risk of receiving harmful or ineffective treatments.

          It seems our medical brethren are quite guility of “hocus pocus” practices when it suits them…or when their drug reps buy them expensive lunches while extolling the virtues of their peddled products for off-label use. Never mind the lack of large-scale RCT’s, or even small RCT’s; somethimes even a decent cohort study is lacking in support of “physician judgment” sans evidence-based criteria for treatment. I can’t wait for Frankster’s claim of tu quoque, a practice of which he is often guilty even though he selectively forgets his own use of it.

          I must say I find it entertaining to read the many twisted comments of chiro haters on this site. They cling to their biases so steadfastly that they fail to realize that their criticisms of chiro can be found in their own “scientific” profession. Make no mistake, I respect the medical profession and not simply because my daughter is a Med-peds resident. Unfortunately, most of the medical professionals on this site are spinsters and chiro antagonists; and they are grossly uninformed relative to the conditions which US chiropractic physicians diagnose and manage, let alone how they manage them. Earth to Frankster: US chiros’ integration into what some would refer to as mainstream healthcare has progressed markedly over the last 30 years. However, Frankster doesn’t care about chiropractic’s progress. He would rather simply insult out of ignorance; he’s quite good at this.

          • @ Logos-Bios on Tuesday 20 September 2016 at 20:44

            Ad Hominem
            Tu Quoque
            Red Herring
            Strawman
            Fallacy Fallacy
            When will they end?

            Do you have anything other than Logical Fallacies and childish rants? It is no wonder you are a chiro.

          • Of course Frankster would not(likely could not for fear of self-embarrassment) intelligently respond to well deserved criticism of his cherished notion that “modern medicine” is free of hocum. His blatant retreat from this discussion is on full display as he can dish out incessant spin regarding the practice of a profession about which he is largely ignorant, but he runs and hides when confronted with criticism of his brethren. Frankster states my post was an Ad Hominem attack, as though such was new to him, the “professional” who has previsously referred to this poster as “detestable scum.” Frankster is a real hoot and a joy to watch as he recoils from justified criticism. At least he is entertaining, in a “cretinesque” sort of way.

          • @ Logos-Bios on Thursday 22 September 2016 at 00:56

            “Of course Frankster would not(likely could not for fear of self-embarrassment) intelligently respond to well deserved criticism of his cherished notion that “modern medicine” is free of hocum. His blatant retreat from this discussion is on full display as he can dish out incessant spin regarding the practice of a profession about which he is largely ignorant, but he runs and hides when confronted with criticism of his brethren. Frankster states my post was an Ad Hominem attack, as though such was new to him, the “professional” who has previsously referred to this poster as “detestable scum.” Frankster is a real hoot and a joy to watch as he recoils from justified criticism. At least he is entertaining, in a “cretinesque” sort of way.”

            Sadly, you think these rants are damaging me. I am glad the prof rarely, if ever, censors; it allows all to see such posts “in all of their glory”.

          • Poor Frank…again he is unable to understand that I don’t seek to damage him in any way. I simply point out his hypocrisy which is quite evident in most of his mind-numbingly repetitive posts. I note that Frank has again deflected from addressing the pith of my 9/20/16 post regarding unscientific prescribing practices by many physicians. He is quick to discuss the primitive beginnings of chiropractic and to suggest that today’s chiropractic is the same profession as that in 1895. Yet he glosses over his own profession’s dubious beginnings(bloodletting, leeches, etc) and proclaims “modern medicine” as somehow divorced from its inauspicious genesis. Open-minded(i.e. NOT Geir, Barrie, Bart, and the other dogmatic chiro-haters) readers can easily see through the propagandist, self-agrandizing veneer of “scientific medicine” that he imagines and about which he comments.

            It’s quite telling that Frank seldom injects many of his own thoughts, or justifications of same, in his comments. He cuts and pastes others’ thoughts in most of his posts and inserts an occasional dull-minded or sarcastic morsel of his own in his attempts to seek relevance in a conversation. His comments typically aren’t relevant; but they are often quite humorous. I really enjoy reading his “LMAO” comments. I hope he keeps them coming.

          • fallacy: problems in the aviation industry are not an argument for flying carpets.

          • If chiros have evolved so much as you suggest then why do so many use bogus claims like diagnosing multiple symptoms and ailments with unproven tests(hair analysis for one), or claim to cure multiple symptoms with unrelated manipulations(like renal colic,etc,etc.) or claim to have equivalent training as MD’s who have 4 years of medical school(and do not try to equate chiro curricula) and a minimum of 3 years of Residency in hospitals with the sickest of the sick? Most PT’s are not glorified chiropractors but perform legitimate “physical therapy” and rehab. Conversely chiros are glorified PT’s with much added anti scientific witch craft.

          • @S. Cox, MD It’s actually getting more and more rare to find those methods being used by Chiropractors. Many old timers are still in the profession, and they have already been sold on their old methods. It makes others in the profession look bad, but you’ll have that in any profession. Not all Chiropractors are equal. With each generation, there will be better understanding, education and patient care. Not everyone can be logical and reasonable.
            When I was taking an “Applied Kinesiology” class in a massage school (it’s the one where you do muscle tests and hair tests that you mention in your comment), the instructor told us to practice on each other pulling a hair on their classmate’s head or body and doing a deltoid muscle test to determine if the person is dehydrated or not. We had an odd number of students, so I was luckily paired up with the instructor. He tested me and said that I was dehydrated and that I should go to the water fountain, drink a glass of water and return to him. I went to the bathroom area where the water fountain was, but didn’t drink. Instead I went to the restroom and took a leak. When I came back, he retested me, and said that now my muscle was strong, and that I am well hydrated. I was already very skeptical, but this convinced me.
            Same with Chiropractic. I was very skeptical of the profession and a lot of things in it didn’t make sense and still don’t. Keeping that in mind, I try to apply only the treatments for my patients that are consistently efficient, consistent with physiology and consistent with physics.
            Maybe it’s a Dunning-Kruger effect, and I am giving too much credit to other Chiropractors based on the way I do things, but it’s also consistent with the continuing education classes I attend annually. They reject the subluxation, foot-on hose and bone-out-of-place models, and they reject using techniques such as Applied Kinesiology and Network Chiropractic (these techniques are not taught at Chiropractic schools as part of the curriculum). So I think Chiropractic is heading in the right direction.

          • @Aleksey Z

            All very fine, but what exactly is it you do practise that marks out chiropractic as a separate ‘profession’ from medicine or physiotherapy?

            Unlike physio and other subdisciplines of medicine such as pharmacology, psychiatry, paediatrics and the rest, chiropractic did not arise from growth and progress in medical knowledge and biomedical science, but from unscientific theories pulled out of their backsides by a father and son pair of con men. So what progress in our understanding of medicine underpins your version of chiropractic?

          • @ Frank Odds
            In my experience, Chiropractic is a unique, non-invasive skill/art in alternative medicine that helps with mechanical musculo-skeletal problems.
            When a person overworks a muscle or pulls a muscle, the muscle tightens up. This prevents or lessens joint movement where the muscle crosses. Now do this: try to sit completely still for 5 minutes. It’s very difficult and uncomfortable. Your joints need motion in order for the structures within the joint to get proper lubrication and nutrition via synovial fluid. My goal is to reduce the myospasms and to re-introduce motion to the joint. How do I do this?
            Before I answer that, I have to mention that I disagree with the Chiropractic “HVLA (high velocity low amplitude)” phrasing when it comes to adjustments, because it doesn’t make sense to me from laws of physics perspective. It should be called “HALM (High Acceleration Low Mass)”. Force = mass times acceleration. We want to get enough force without applying much mass, thus being less invasive and pushing less deeply into the patient’s soft tissues.
            Okay, so what I do is, I bring the joint as far as the tight muscle allows me. During this time, I’m also trying to prevent muscle guarding of the joint by using distractors, verbal cues, breathing instructions, etc. The moment I feel that the patient’s muscles are gonna let me move that joint, I have to be super quick and deliver my HALM adjustment, before the patient has time to react, otherwise they’ll muscle-guard, and I won’t get the desired effect, plus their muscles are gonna be sore later. The second reason that the acceleration is important is because the golgi tendon organs have a reflex response to quick change in length, in order to prevent being torn: Golgi tendon to spinal cord to muscle spindles. Muscle lengthens, joint gets cavitated, patient feels relief.
            Even though this response is a bit lengthy, it’s still oversimplified, but I hope it gives you the idea of the skill. There is the art component of being able to feel for and to recognize myospams and to decreased joint motion, along with the ability to get your patient to cooperate and relax, and to be able to deliver a timely, quick yet shallow thrust. Because of the art component, it’s very difficult to get scientific data on a profession that is still fairly new.
            Am I sure that’s how this works? No. But this is the best explanation I have right now, and it is consistent with results of my patients.
            Typical patient: comes in with low back or neck pain. i’m anywhere from 3rd to 5th person they came to for help. I test their range of motion, do some orthopedic tests, palpate their muscles and then adjust them accordingly. Then I don’t see them until a new problem arises. But I see their friends, co-workers, family members because now they’re calling me with “this so and so referred you because they spent weeks/months with pain that no one seemed to be able to help with and you made it go away in 3 minutes.” This is not a one time occasion. I get this most weeks, and I’m sure there are lots of other Chiropractors who get same.
            Once again, I know this is anecdotal. I know where you’re coming from. I appreciate the scrutiny Chiropractic gets, because it helps the profession evolve into something that helps patients. There will always be con artists who just want to make a quick easy buck, and Chiropractic has a lot of cleaning up and improving to do. But please understand and accept that there is a lot of bias from other health professions, which is based on outdated sources, exaggerations and even myths. So give us a little break. 🙂 Hope this helps or at least makes some sense. Thanks for the time you took to read.

      • All research is not created equal. For example, the findings of a case study do not carry the same weight as the findings of a high quality RCT.

        Another thing, at least in NZ, research published by chiropractors form the College of Chiropractic does not appear to be of a particularly good quality (or quantity). Why do I think this? Well I simply checked the ratings of chiropractic researchers in the 2012 PBRF results for the NZ College of Chiropractic: two researchers achieved a C rank.

        • @ Andrew Gilbey on Thursday 15 September 2016 at 23:12

          There are many laughs on these pages and you provided a good one. Thanks.

          “two researchers achieved a C rank.”
          At first glance, I read that as “Crank” and had a real lol.

          • Frankster seems to have a predilection for cranks….not surprising!

          • Irony is lost on you.

          • I bet Frankster doesn’t know that “crank” is slang for many things. Connotation is foreign to him.

          • Good ‘Ol Frankster is at a loss of (coherent) words when it is his profession which is being criticized. Nothing new here! Frankster is deliciously humorous even when he is trying to be serious. The progeny(Frankster) of the profession of bloodletting and leeches has forgotten that every profession has grown from sometimes dubious beginnings; of course he only comments on the early beliefs of CAM and other paramedical professions. The descendent(Frankster) of the medical profession and its culpability in the Thalidomide debacle which killed or deformed more humans in a few years than chiropractic allegedly has since 1895, simply can’t wrap his mind(?) around those deaths from a medically countenanced product to treat the life-threatening condition of “morning sickness.” Instead he and his bros in this forum lament chiropractic’s treatment of “minor problems like neck and LBP” as being too deleterious to justify. Frankster is indeed a legend in his own mind, at least when he tries to discuss chiropractic practice.

          • @ Logos-Bios on Thursday 22 September 2016 at 00:59

            “I bet Frankster doesn’t know that “crank” is slang for many things. Connotation is foreign to him.”

            I am familiar with most slang terms, however, your references are tawdry, ill-conceived and embarrassing. Even I feel embarrassed for you. And you think chiros have high standards?

          • Frankster, the purveyor of the “detestable scum” descriptor, is one of the last people who should criticize anyone’s standards. He comments in a reductionist manner regarding chiropractice about which he is largely ignorant. Good ‘ol Frankster is always good for a couple of giggles.

        • Andrew Gilbey, your reluctance to mention some of the spurious research published in the New Zealand Medical Journal by yourself, Prof. Ernst, Sean Holt and David Colquhoun is palpable. The research done by the four of you has been eviscerated by all commentators involved, to the extent that your research was described as being of “poor” quality
          http://www.nzma.org.nz/journal/121-1280/3222/
          and Shaun Holts as being “deceitful”.

  • Any feelings on this group Edzard, mostly physical therapists from what I can tell.

    http://www.spinalmanipulation.org/

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