MD, PhD, FMedSci, FSB, FRCP, FRCPEd

At first, I thought this survey would be yet another of those useless and boring articles that currently seem to litter the literature of alternative medicine. It’s abstract seemed to confirm my suspicion: “Fifty-two chiropractors in Victoria, Australia, provided information for up to 100 consecutive encounters. If patients attended more than once during the 100 encounters, only data from their first encounter were included in this study. Where possible patient characteristics were compared with the general Australian population…” But then I saw that the chiropractors were also asked to record their patients’ main complaints. That, I thought, was much more interesting, and I decided to do a post that focusses on this particular point.

The article informs us that 72 chiropractors agreed to participate (46 % response rate of eligible chiropractors approached). During the study, 20 (28 %) of these chiropractors withdrew and did not provide any data. Fifty two chiropractors (72 % of those enrolled) completed the study, providing information for 4464 chiropractor-patient encounters. Of these, 1123 (25 %) encounters were identified as repeat patient encounters during the recording period and were removed from further analyses, leaving 3287 unique patients.

The results that I want to focus on indicated that chiropractors give the following reasons for treating patients:

  • maintenance: 39%
  • spinal problems: 33%
  • neck problems: 18%
  • shoulder problems: 6%
  • headache: 6%
  • hip problems: 3%
  • leg problems: 3%
  • muscle problems: 3%
  • knee problems: 2%

(the percentage figures refer to the percentages of patients with the indicated problem)

Yes, I know, there is lots to be criticised about the methodology used for this survey. But let’s forget about this for the moment and focus on the list of reasons or indications which these chiropractors give for treating patients. For which of these is there enough evidence to justify this decision and the fees asked for the interventions? Here is my very quick run-down of the evidence:

  • maintenance: no good evidence.
  • spinal problems: if they mean back pain by this nebulous term, an optimist might grant that there is some promising but by no means conclusive evidence.
  • neck problems: again some promising but by no means conclusive evidence.
  • shoulder problems: no good evidence.
  • headache: again some promising but by no means conclusive evidence
  • hip problems: no good evidence.
  • leg problems: no good evidence.
  • muscle problems: no good evidence.
  • knee problems: no good evidence.

As I said, this is merely a very quick assessment. I imagine that many chiropractors will disagree with it – and I invite them to present their evidence in the comments section below. However, if I am correct (or at least not totally off the mark), this new survey seems to show that most of the things these chiropractors do is not supported by good evidence. One could be more blunt and phrase this differently:

  • these chiropractors are misleading their patients;
  • they are not behaving ethically;
  • they are not adhering to EBP.

Yes, we (I mean rationalists who know about EBM) did suspect this all along – but now we can back it up with quite nice data from a recent survey done by chiropractors themselves.

14 Responses to What conditions do chiropractors really treat?

  • before some chiro is tempted to say BUT WE DON’T DO SPINAL MANIPULATION ON ALL PATIENTS, let me remind you of this (http://circleofdocs.com/global-chiropractic-adjustment-survey-results/):

    Question 3: Is the adjustment the primary service you offer in your office?

    Yes: 92.58%

    No: 7.42%

  • Hip, leg, muscle, and knee problems were mentioned as having been treated by chiros. Unfortunately, there was no mention of how these inexplicitly described disorders were treated or managed by the chiros. Any clarifications as to the specific treatment approaches would be welcome and necessary in order for any intelligent conversation on this topic to occur. Hip, leg, muscle, and knee problems could very well be overlapping conditions in this survey; we can’t know because of the generalized, vague nature of the questions. The injection of the “93% response” canard regarding manipulation’s being the primary service in the chiros’ offices irrespective of the condition which is being treated means absolutely nothing if, for example, the chiros’ patient bases consisted of 93% mechancial spinal disorders.

    BTW, maintenance care is by definition elective; it’s not medically necessary care. It’s something that some patients desire but for which insurance doesn’t reimburse. Ergo the numbers in the survey depict roughly up to 85-90% of medically/chiropractically necessary treatments are directed towards spinal and spinal-related disorders.

    The extrapolation, and attendant spurious implications, proffered by Edzard regarding chiropractice has no logical link to the pith of the survey as he here presented it.

  • “What conditions do chiropractors really treat?”

    Lower back discomfort due to a painfully heavy wallet.

  • It must gall the chiro cynics on this site that the “chief medical officer” for the dominant Team USA at the Rio Olympic Games was/is a chiropractic physician. Dr. Moreau is also managing director for sports medicine for the US Olympic Committee. Good day to all.

    • @ Logos-Bios

      I wonder what guidance ‘Dr’ Moreau issued to Team USA on cupping…
      http://scienceblogs.com/insolence/2016/08/09/thanks-michael-phelps-for-glamorizing-cupping-quackery/

      …but perhaps the inclusion of such quackery in the Olympics is only to be expected in view of chiropractic being a pseudo-medical system based on the mystical teachings of a 19th Century magnetic healer:
      https://www.sciencebasedmedicine.org/subluxation-theory-a-belief-system-that-continues-to-define-the-practice-of-chiropractic/

      Clearly, though, in choosing a chiropractor as Chief Medical Officer and Managing Director for Sports Medicine, Team USA and the US Olympic Committee lose most credibility for taking a reckless gamble on the unknown – i.e. a recent systematic review of controlled clinical trials of chiropractic for the prevention and/or treatment of sports injuries revealed that:

      “Few rigorous trials have tested the effectiveness of chiropractic manipulation for the treatment and/or prevention of sports injuries. Thus, the therapeutic value of this approach for athletes remains uncertain.”

      – and concluded that

      “Future studies of chiropractic should adhere to accepted standards of trial design and reporting (e.g. CONSORT guidelines). In particular, studies should be adequately powered, use validated outcome measures, control for non-specific effects and minimise other sources of bias. Reporting of these studies should be such that results can be independently replicated.”

      Ref: http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2011.01111.x/full

      Then, of course, there are those pesky risks that still have to be factored in…

      THOSE OLYMPIC RESULTS IN FULL

      MEDAL EVENT WINNER

      Gold – Vertebral Arterial Dissection Chiropractic
      Gold – Needless Irradiation Chiropractic
      Gold – Fractures In Osteoporotics Chiropractic
      Gold – Restoration of Innate Intelligence Chiropractic
      Silver – Advising Against Vaccination (Gold = Homeopaths)

      http://www.quackometer.net/blog/2012/04/chiropractors-cash-in-on-olympics.html#comment-9725

      • Silly Blue Wode…..does he really think that manipulation is the only procedure that chiropractic physicians utilize in treating sports injuries? Get with the times, Bluesy!

        I’m not sure what advice, if any, Dr. Moreau gave regarding cupping.

        I did appreciate the humor from Has(been) about the heavey wallet….well done! It’s an old joke but a good one. I first heard it regarding plastic surgeons’ use of botox to “cure” the condition of “crows feet.” Do enjoy!

        Your jealousy is showing, Bluesy. It must really irk you that a chiropractic physician headed the sports medicine unit for the uber-successful Team USA. lmao

        • Logos-Bios wrote: “Silly Blue Wode…..does he really think that manipulation is the only procedure that chiropractic physicians utilize in treating sports injuries? Get with the times, Bluesy!”

          @ Logos_Bios

          In that case, if Moreau is an ‘evidence based’ chiropractor (an oxymoron if ever there was one), then he is essentially a physiotherapist who is doing healthcare no favours…

          QUOTE
          “A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are ‘chiropractic’. Using techniques like massage, range of motion exercises, strength-building exercises, and mobilization of joints are all legitimate science-based techniques used by physical therapists and physicians with specialties in physiatry, orthopedics, and sports medicine. Some chiropractors also use similar techniques – and with good results. But by doing so and calling it ‘chiropractic’ it legitimizes the pseudoscientific practices that are very common within the profession – like treating non-existent ‘subluxations’ in order to free up the flow of innate intelligence.”

          Ref: https://www.sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

          • Bluesy obviously is a blissful fellow(ignorance is bliss, you know). Chriopractic physicians have been performing physiotherapy for decades, as well as other effective services. You’re not so deluded as to think that manipulation comprises all of chiropractic, are you? Likely you simply choose to believe otherwise. rest assured that the US Olympic team will continue to advantage itself via chiropractic management of appropriate conditions as it has for the last 30 years.

            I note you like to cut and paste. Ae you too lazy to type your own responses? Perhaps you’re so apoplectic at discovering the success of Dr. Moreau that you are at a loss of words? Do enjoy!

          • “ignorance is bliss”
            there is someone (LB) who knows it well!

          • @ Edzard

            Of course I have on this site empirically observed “blissful ignorance” in many of the comments proffered by self-absorbed, chiro-antagonist zealots who so often post with one hand while doing who knows what with the other; you guys are absolutely entertaining in displaying your ignorance of chiropractice in the USA. Priceless you are!

        • What legitimate medical services do chiropractors offer patients that a Physical Therapist cannot perform?

          • Diagnosis, SMT, imaging services and interpretation, a license which classifies them as chiropractic physicians, etc, are but a few services performed by chiros and which are, for the most part, not offerred by PT’s.

            With all due respect to PT’s(my wife is a PT in her fourth decade of experience), a better question would be relative to what services can’t PT’s provide that chiros can.

          • Pts do a lot of things that are not based on sound evidence.
            Chiros do practically nothing that is based on sound evidence.
            PTs are mostly rational.
            Chiros are the followers of an irrational cult.
            WITH SOME DEGREE OF SIMPLIFICATION, THIS DESCRIBES THE MAIN DIFFERENCES BETWEEN THE TWO PROFESSIONS, I THINK.

          • I LMAO when I read Edzard’s ramblings about chiropractice. Note he didn’t discuss my specific comments, instead injecting more of his “Don Rickles” humor into the conversation. Unfortunately, the humor in his posts is not generated by his posts’ content, but from the ridiculousness and ignorance of that content. Please, please…..keep on entertaining the forum, Edzard. You make me “belly laugh.”

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