MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

At a recent conference in Montréal (October 2016), the WFC (World Federation of Chiropractic) and the ACC (Association of Chiropractic Colleges) reached a consensus on education. Consequently, recommendations were produced that offer 12 key ‘take away messages’. I take the liberty of reproducing these statements entitled ‘Training Tomorrow’s Spine Care Experts’ (the square brackets were inserted by me and refer to brief comments I made below).

START OF QUOTE

1. Chiropractic educational institutions have a  responsibility to equip students with the skills and  attributes necessary to become future spinal health care experts. This includes a commitment to astute diagnostic ability, a comprehensive knowledge of spine-related disorders [1], appreciation for the contributions of other health professionals and a commitment to collaborative, patient-centered and evidence-informed care [2].

2. Technological advances [3] provide an opportunity for the chiropractic profession to enhance, evolve and standardize core education and practice. This is relevant to the teaching of chiropractic skills, sharing of learning resources and assessment of performance. Emerging technologies that support the development of clinically-competent practitioners should be embedded within chiropractic programs.

3. The teaching and learning of specialized manual assessment and treatment skills should remain a key distinguishing element of chiropractic curricula.

4. Surveys of the public have a demonstrated a desire for consistency in the provision of chiropractic services. Such consistency need not compromise the identities of individual institutions but will cultivate public trust and cultural authority [4].

5. Globally consistent educational and practice standards will facilitate international portability [5] and promote greater health equity in the delivery of spine care.

6. Chiropractic programs should espouse innovation and leadership in the context of ethical [6], sustainable business [7] practices.

7. Chiropractic educational curricula should reflect current evidence [8] and high quality guidelines [9], and be subjected to regular review to ensure that students are prepared to work in collaborative health care environments.

8. The training of tomorrow’ s spine care experts should incorporate current best practices in education.

9. Interdisciplinary collaboration and strategic partnerships present opportunities to position chiropractors as leaders [10] and integral team players in global spine care.

10. Chiropractic educational institutions should champion the integration of evidence informed clinical practice [11], including clinical practice guidelines, in order to optimize patient outcomes. This will in turn foster principles of lifelong learning and willingness to adapt practice methods in the light of emerging evidence [12].

11. Students, faculty, staff and administrators must all contribute to a learning environment that fosters cultural diversity, critical thinking [13], academic responsibility and scholarly activity.

12. Resources should be dedicated to embed and promote educational research activity in all chiropractic institutions.

END OF QUOTE

And here are my brief comments:

[1] Some chiropractors believe that all or most human conditions are ‘spine-related disorders’. We would need a clear statement here whether the WFC/ACC do support or reject this notion and what conditions we are actually talking about.

[2] ‘Evidence-informed’??? I have come across this term before; it is used more and more by quacks of all types. It is clearly not synonymous with ‘evidence-based’, but aims at providing a veneer of respectability by creation an association with EBM. In concrete terms, asthma, for instance, might, in the eyes of some chiropractors, be an evidence-informed indication for chiropractic. In other words, ‘evidence-informed’ is merely a card blanch for promoting all sorts of nonsense.

[3] It would be good to know which technical advances they are thinking of.

[4] Public trust is best cultivated by demonstrating that chiropractic is doing more good than harm; by itself, this point sounds a bit like PR for maximising income. Sorry, I am not sure what they mean by ‘cultural authority’ – chiropractic as a cult?

[5] ‘International portability’ – nice term, but what does it mean?

[6] I get the impression that many chiropractors do not know what is meant by the term ‘ethics’.

[7] But they certainly know much about business!

[8] That is, I think, the most relevant statement in the entire text – see below.

[9] Like those by NICE which no longer recommend chiropractic for back pain? No? They are not ‘high quality’? I see, only those that recommend chiropractic fulfil this criterion!

[10] Chiropractors as leaders? Really? With their (largely ineffective) manipulations as the main contribution to the field? You have to be a chiropractor to find this realistic, I guess.

[11] Again ‘evidence-informed’ instead of ‘evidence-based’ – who are they trying to kid?

[12] The evidence that has been emerging since many years is that chiropractic manipulations fail to generate more good than harm.

[13] In the past, I got the impression that critical thinking and chiropractic are a bit like fire and water.

MY CONCLUSION FROM ALL THIS

What we have here is, in my view, little more than a mixture between politically correct drivel and wishful thinking. If chiropractors truly want chiropractic educational curricula to “reflect current evidence”, they need to teach the following main tenets:

  • Chiropractic manipulations have not been shown to be effective for any of the conditions they are currently used for.
  • Other forms of treatment are invariably preferable.
  • Subluxation, as defined by chiropractors, is a myth.
  • Spine-related disorders, as taught in many chiropractic colleges, are a myth.
  • ‘Evidence-informed’ is a term that has no meaning; the proper word is ‘evidence-based’ – and evidence-based chiropractic is a contradiction in terms.

Finally, chiropractors need to be aware of the fact that any curriculum for future clinicians must include the core elements of critical assessment and medical ethics. The two combined would automatically discontinue the worst excesses of chiropractic abuse, such as the promotion of bogus claims or the financial exploitation of the public.

But, of course, none of this is ever going to happen! Why? Because it would mean teaching students that they need to find a different profession. And this is why I feel that statements like the above are politically correct drivel which can serve only one purpose: to distract everyone from the fundamental problems in that profession.

57 Responses to Educating chiros

  • I think I mentioned this before, but a friend told me of a Homeopathic ‘clinic’ in Glasgow that displays, or displayed, a sign boasting ‘ Informed by Science’.

  • If the WFC/AFC want to “train spinal specialists”, why do they not require students to qualify in medicine or physiotherapy before going on to specialise in spine-related disorders?

    Because they can’t? Because they have faith in a scheme of healthcare devised by DD Palmer as as a deliberate alternative to conventional systems? Because they reject the tenets of EBM? Because chiropractic schools would close if they did not conjure up their system as a rival to the discipline required of medical and physiotherapy schools?

    Just asking.

    • @Richard

      Mainstream chiropractic physicians in the US couldn’t care less about D.D. Palmer’s views of disease in the 1800’s. It’s unfortunate that Frank still hasn’t learned this despite my having informed him on this subject many times.

      “Chiropractic schools would close if they did not conjure up their system as a rival to the discipline required of medical and physiotherapy schools,” stated Frank. It’s difficult to address the plethora of misinformation contained in his rant….so I’ll simply note a couple of counter-examples to his mendacious post: 1. diagnosis is taught in accedited chiro colleges and proficiency must be evinced via national and state board exams, 2. “qualify in medicine” I take to mean having participated in a residency and having prescribing privileges; however, one need not have prescribing rights to be a skilled diagnostician/clinician, 3. it appears that PT’s are very interested in learning SMT considering the many seminars available which purportedly teach it to PT’s(and some dentists and M.D.’s) in weekend courses; does Richard wish to backtrack from his allegation that chiropractic colleges “conjured up their system” now that he has been made aware that his sacred PT affection has been hampered by the realization that PT’s appear to want to be like chiros?

      I can’t wait for Richard’s hopefully cogent reply!

      Be well

  • I find this conference consensus revealing.

    a) Among the comments on this blog we’ve recently rehearsed the ‘no true acupuncturist’ concept. But ‘no true chiropractor’ seems to be just as valid: consensus points 4 and 5, above, exemplify the variation. Chiros posting comments here range from the ‘subluxations are nonsense’, ‘reformer’ types to ‘straights’ who believe chiropractic covers most or all diseases. Several recipients of chiropractic ‘care’ have mentioned moving from chiro to chiro till they find one who does what they expect.

    b) Consensus point 1 essentially defines the objective of chiropractic as ‘spinal health’. But it doesn’t define what amounts to spinal ill-health. This allows chiros of any persuasion free to imagine any spine-related conditions they prefer. See my point (a) above: once again, there’s no true chiropractor. Every chiro is free to disagree with the practice of others.

    3) Consensus point 8 handily fails to define what kind of ‘current best practices in education’ it has in mind. Best practices in medical education (which would or should exclude chiropractic from consideration) or in chiropractic education? The latter may not be even ‘evidence informed’.

    4) Consensus point 12: what is ‘educational research activity’? From the chiropractic literature it seems as though most chiros haven’t the faintest clue about research.

    I searched Amazon books for ‘diseases of the spine’. The closest the first two pages of hits came to ‘chiropractic’ was just one book on ‘osteopathy’.

    • “Chiros posting comments here range from the ‘subluxations are nonsense’, ‘reformer’ types to ‘straights’ who believe chiropractic covers most or all diseases.”

      The only convincing way for a chiropractor to ‘reform’ is by completely abandoning all that horseshit and retraining as a [hopefully competent] physiotherapist. That’s the only choice that does right by her patients. Anything else is like the battered wife who always stands by her man in Bill Hicks’ famous “Cops”, and while her funeral is her funeral, her choices and actions don’t only impact her; they damage other lives around her as well.

      • @has

        Nope! I had extensive training in PT by RPT’s back in the 80’s. I would have no need to “retrain” as a PT In fact, several PT’s graduated with DC degrees with me; they wished to become doctors! What do you say, has, to PT’s who practice SMT and who teach it to PT’s, dentists, and even MD’s at weekend seminars? Perhaps you would consider their actions a capitulation to having “retrained” as a chiropractor?

        Dentists are my number one referral source for TMJ pain and dysfunction, the cause of which is not uncommonly the dentist’s attempt to manipulate the TMJ based on what he/she learned at a weekend seminar.

    • Frank Odds wrote: “b) Consensus point 1 essentially defines the objective of chiropractic as ‘spinal health’. But it doesn’t define what amounts to spinal ill-health. This allows chiros of any persuasion free to imagine any spine-related conditions they prefer.”

      Indeed. Even chiropractors who like to sell themselves as ‘evidence-based’ will tolerate blatant quackery from other chiropractors. For example, in November 2016, the president of the British Chiropractic Association (BCA) praised the vitalistic UK McTimoney College of Chiropractic on its accreditation success with the ECCE (a chiropractor-established body with no statutory powers which exists to “assure the quality of chiropractic undergraduate education and training against a set of educational Standards”): https://www.facebook.com/748052515284118/photos/a.774373722651997.1073741828.748052515284118/1219069331515765/?type=3&theater

      Further, in December 2016, the BCA president, in a desperate bid to prevent deregulation, declared that “unity need not mean uniformity”:
      http://www.mccoypress.net/i/bca_bennett_letter_december_2016.jpg

      Frank Odds wrote: “3) Consensus point 8 handily fails to define what kind of ‘current best practices in education’ it has in mind. Best practices in medical education (which would or should exclude chiropractic from consideration) or in chiropractic education? The latter may not be even ‘evidence informed’. 4) Consensus point 12: what is ‘educational research activity’? From the chiropractic literature it seems as though most chiros haven’t the faintest clue about research.”

      I would venture that most chiropractors aren’t interested in robust research because they sense that it would produce undesired results, and that, in turn, would have a negative impact on their current (lucrative) business model. A good example of chiropractor heads being kept firmly in the DD Palmer sand can be seen in Scotland where a new vitalistic chiropractic college is set to open within the next two years:
      http://www.zenosblog.com/2016/02/the-scotland-college-of-chiropractic-out-of-kilter-with-science/

      Meanwhile, BCA members have cut their Research Levy from £2 to £1 a week:
      https://chiropractic-uk.co [DOT] uk/download/CONTACT_SUMMER2016_LR.pdf (see p10)

      As many readers will know, the situation appears to be just as bad internationally – as a scroll through these posts (and their comments) confirm: http://edzardernst.com/category/chiropractic/

  • @Richard Rawlins
    You were asking?
    http://vertebre.com/charte-pour-l-education-chiropratique-en-europe-8163
    @Blue Wode
    “I would venture that most chiropractors aren’t interested in robust research because they sense that it would produce undesired results, and that, in turn, would have a negative impact on their current (lucrative) business model”
    Some not all Blue and we have a very low threshold when it comes to the guru’s and BS merchants! Maybe I am biased as I circulate in groups that exchange the latest research on a daily basis! The vitalists as you say are terrified by any research that does not validate their religious beliefs! On the other hand I rather enjoy change!
    @has
    I work with and communicate with physio’s who passionate about research and they are annoyed with the bulk of their profession who are resistant to change! It seems that as chiro’s struggle to climb out of the rabbit hole while the subbies are holding us back there are physio’s happily jumping right down the hole! Dunning and his merry band of physio’s who call themselves “Osteopractors” is a good example! The osteopractor course is now the largest post graduate course for physio’s in North America!
    I would rather take the best from the physio’s and chiro’s and go where the evidence leads us! If you follow the evidence then we are essentially going down the same path!

  • The ‘argument’ between chiropractors reminds me of a few years ago when ‘genuine’ psychics either formed, or discussed forming, an Association which would vet entrants in an attempt to keep out the ‘bogus’ ones, who were in danger of giving the ‘profession’ a bad name.
    A safecrackers’ association would have made as much sense.

    • @Bar

      Your comparison of chiros and psychics represents an insult which I’m surprised passed Edzard’s scrutiny. Actually, the argument reminds me more of that between MD’s and DO’s in the early and middle of the 20th century. It was an interesting story in which MD’s in the late 50’s and in 1960 referred to DO’s as quacks, quacksters, rabid dogs, uneducated zealots, and killers; of course they claimed that such descriptors were based on science. Interestingly, the true political nature of organized medicine’s “turf protection” was exposed when the medical profession acquired the COP&S to benefit itself financially and, as a quid pro quo, offered DO’s the opportunity to simply exchange their DO degrees for MD degrees. Of course this blatantly hypocritical action exposed medicine as hypocritical, political, and self-serving. Think of it: medicine stated that osteopaths were quacks in 1960 but then conferred to osteopaths MD degrees in 1961 simply to advantage itself. Surely “modern medicine” must always be viewed as altruistic!

      Be well

  • I’ll go with that, but given SOFEC’s declaration that the ‘subluxation’ is of historic interest only, in what way does chiropractic differ from physiotherapy?

    Why do students who for some reason want to treat ‘musculo-skeletal’ disorders, not train as doctors (MD in US, GMC registered in UK) or as physiotherapists?
    What is it ‘chiropractic’ does that physiotherapy does not?

    Patients need to know.
    Chiropractors must make any distinction clear if they are to avoid suggestions they are quacks trying to fleece the gullible public.
    Do SOFEC accept that Palmer was misguided, deluded, or even a knowing quack?

    • @Richard Rawlins
      Good questions Richard!
      When it comes to following the evidence there should be little difference between chiro and physio. When it comes to patients some will respond no matter what approach, technique, advice or rehab exercise is used. For others it is no different to a doctor varying the dosage or changing a patients medication and that is how I explain it to patients and doctors who also ask “What is the difference”. Different approach/technique helps different patients and if I cannot help then I refer!

      “Do SOFEC accept that Palmer was misguided, deluded, or even a knowing quack?”
      We often refer to DD and BJ’s books as the “little green books” and that title is not a complement! They stood in the way of progress, actively hindered reform and attacked anyone who questioned their faith!

      “Chiropractors must make any distinction clear if they are to avoid suggestions they are quacks trying to fleece the gullible public.”
      Totally agree and Blue Wode has said the same thing! My referring doctors know how I practice and hold me accountable and the profession must hold the BS merchants accountable! Professional politics really pisses me off at times as institutions like the BCA try to make the vitalists see reason yet all the do is hinder, make demands and actively block anything that threatens their business model! Reform will ultimately have to be shoved down their throats and I think it will be the chiro reformers, insurers, third party payers and regulators who achieve this! Combined these forces make change inevitable! The accountants have moved in on medicine and chiropractic is not immune! If the vitalists do not change then they are in for a rude shock in the next few years!
      The reason I come on sites like Edzards is that I agree with so much of what is being said and it matches what many chiro’s are saying! Critics both within and without chiropractic are essential for reform and we should be helping each other to achieve this goal! Unfortunately the chiropractic reformers are all too often seen as acceptable collateral damage which is not helpful!

      • Critical_Chiro: The reason I come on sites like Edzards is that I agree with so much of what is being said and it matches what many chiro’s are saying! Critics both within and without chiropractic are essential for reform and we should be helping each other to achieve this goal! Unfortunately the chiropractic reformers are all too often seen as acceptable collateral damage which is not helpful!

        The late Bill Jarvis once told me, “You know what the problem with chiropractic is, don’t you … it’s chiropractic.” It doesn’t get more concise than this — except perhaps when the late Wally Sampson, who, during a TV interview was asked if he thought there was any merit to “chiropractic,” simply leaned back in his chair, pushed his outstretched palms with fingers interlocked toward the camera “cracking” his knuckles loudly, and with a broad grin answered, “Well, I’ll have to think about that.”

        As a so-called “critical chiro,” that sort of black-belt criticism is probably all ye need know. But, I’m wagering you still haven’t figured which way is “out” of Chiroville given your advocacy for some barely theoretical better, improved, reformed, modern, I-don’t-know-what “chiropractic” that still involves … ahem … “chiropractic.” Given what I would consider a baseless optimism about a bright chiropractic future, would YOU recommend “chiropractic” as a career in health care to your children — let’s say, over becoming a PT, a PA, or an MD? Why or why not … keeping in mind the criticism suggested by your anonymous mystery moniker, “Critical_chiro.” You still haven’t made it clear that you’re capable of criticizing chiropractors unless they’re fully naked doing any of the many chiropractic antler dances we see in the wild. Again, these antler dancers are only the identified patients in a sick chiropractic family.

        To help you along here and to provide a context for discussing what I’ve argued as your empty optimism, I’ll remind you and perhaps introduce readers to one of the more (if not one of the most) imbecilic conversations chiropractors have about their own education — to wit, the characterization of different chiropractic schools as being “more medical” and “less medical.” In other words, there’s a continuum between schools that embrace a MORE scientific appreciation (we’ll call it) of medicine and those which, despite any Med-Lite training they might endure for licensure, dismiss bioscience in favor of The Pure Chiropractic Stuff. In other words, chiropractic educational institutions range from the least medical (MOST “chiropractic”) schools to the most medical (LEAST “chiropractic”) institutions.

        Stop for a moment and consider the implications and meaning of the very concept itself. For example, given your finger-pointing at “the Vitalists” who are, in your opinion, spoiling your chiropractic party — they feel the same way about you, by the way — I’m guessing you would send your kid to the “more medical” school. Indeed, if you were recommending “chiropractic” as a career, you might even suggest seeking out the MOST medical chiropractic school.

        The “MOST medical chiropractic school,” Critical_Chiro? 🙂

        At this point, it should dawn on you that even the least medical, medical school is, by definition, more medical than the MOST medical chiropractic school. In fact, there is no “more medical,” medical school. It’s just medical school. And, this is the real hole in the bottom of the chiropractic bucket through which arguments for an oxymoronic scientific “chiropractic” eventually leak. If you go to a chiropractic school, you’re going to be a chiropractor when you grow up.

        Not that there’s anything wrong with it 🙂

        Still, this might be a good place to pause … to think about why any society with limited resources would need and support a separate and entire profession dedicated to, at a dubious BEST, the application a modality that duplicates the grade five mobilization of the PT and at worst, allows for a chiropractic free-for-all in which “anything can cause anything” and “anything can treat anything.”

        ~TEO.

        • @The Evil One
          The chiropractic free for all must come to an end! I am pessimistic about the vitalists ever willingly embracing reform! It will have to be imposed upon them and they are resisting and clumping together! Reducing their influence to the absolute minimum is my goal, unfortunately as one TORon guru like CJ Merts disappears to check his Swiss bank account another like Liam Schubel appears which is extremely frustrating! On the other hand I also see progress in Denmark, Australia and Switzerland and researchers like Jan Hartvigsen, Charlotte Leboeuf-Yde, Phillip Bolton, Martin Descarreaux etc. Are the TORon’s undermining these researchers work? Good question! I would have to say yes as the vitalists fear the research will damage their business model!

          Made some inquiries about you John and I have to admit that I am impressed! You are one of the original uber critics! Appreciate your work! I have also been advised not to get into a prolonged debate with you! Meh! Critics are a valuable resource and should be appreciated and engaged with as they drive reform! Critics also make us think and you are definitely doing that! 🙂

          • @CC

            I am impressed with your with your patience, perseverance, and tolerance of people who insult you, even though your thoughts largely agree with theirs, simply because you are part of a profession against which they’re biased and reductionist in thought. Simply put, you are a kind person to tolerate such abuse. You may wish to reference my previous post to Barrie regarding the transference of “inferior” DO degrees for MD degrees in 1961 for the financial benefit of “modern medicine,” which has as its “main purpose for existence”(haha) the betterment of human health; it frankly guts John’s claim that there is no “more medical” medical school. Obviously “modern medicine” didn’t believe that crap in 1960. Just sayin’…..

      • @Critical-Chiro referrring to DD and BJ Palmer, the inventors (not discoverers) of Chiropractic:

        They stood in the way of progress…

        Progress of what?
        How can make-believe healing “progress” to something useful? DD made it all up and his son BJ took over and made a business out of it. Should you not be saying they stood in the way of killing their gold-egg laying goose and replacing it with something useful?
        I agree with whoever said that the problem with chiropractic is chiropractic. Chiropractic is the correct term for the collection of deceptions DD Palmer invented. I asked you a while ago why you persevere at calling yourself a chiropractor when you maintain in effect that chiropractic should be abolished? Your previous reply to this did not really clarify the issue, at least as far as my understanding is concerned.

        • “Your previous reply to this did not really clarify the issue, at least as far as my understanding is concerned.”

          C-C seems to have a lacuna in his ‘critical’ faculties. He fails to grasp that chiropractic minus the bollocks becomes a minuscule, as-yet-unproven component of physiotherapy. I await the day he posts under the name ‘Self-critical Physio’, but I’m not holding my breath!

          • How quickly Frank forgets………chiropractic physicians diagnose; phisical therapists generally don’t! Frank posts as though someone has… [rest of comment SENSORED]

          • wrong: PTs do diagnose!

          • @Edzard

            Note the adverb “generally” in my post regarding PT’s and diagnosing; your inference from my post was erroneous. Though PT’s assess some neuromusculoskeletal disorders and arrive at clinical impressions, they don’t routinely diagnose and aren’t even responisble for diagnosing disorders which require labs or imaging.

          • I think you are mistaken

          • Why do you think I’m mistaken, Edzard? I have attended many PT seminars over the years and have many PT friends with whom I share referrals. Oh, and my wife is a senior PT at one of the largest hospitals in my area. I believe I know quite well what PT’s do and don’t do.

          • I am afraid mine is bigger than yours: I was head of PMR department in Vienna and had ~ 80 physios working for me.

          • (Adopts Alan Partridge voice)
            BACK OF THE NET!
            The Chiros are going to find it difficult to come back from this one. Have they flattered to deceive? And most of their substitutes have been used, or gone home in a sulk.
            Will they try to adopt a different shape? Their defence has looked leaky for some time now. More than 200 years in fact.

          • @Edzard

            What of yours exactly is bigger than mine?

            Perhaps you’re not familiar with US laws and state laws which regulate PT practice. I don’t know personally of any PT’s who have dxd breast or bone CA, or who have differentiated organic vs acquired arthropathy via lab analysis. For that matter, I don’t know any PT’s who have radiographic training to help differentiate new vs benign spinal compression fxs. PT’s work, for the most part, primarily with referrals from doctors(DO, DC, MD, DPM, etc) for already diagnosed NMS conditions.

          • 1) experience, of course!
            2) are you aware of the fact that the US is not the only country on the planet?

          • @Edzard

            You are right on that point. Are PT’s diagnosing organic disease in your part of the world? Are they performing or ordering labs, UA’s, EMG’s, CT’s, MRI’s, and the like in your area?

  • @Frank Odds & @Björn Geir
    “He fails to grasp that chiropractic minus the bollocks becomes a minuscule, as-yet-unproven component of physiotherapy.”
    I came to realize a long time ago that the vitalist BS represents a minuscule portion of the population that has not changed for many years while chronic back pain is huge and poorly managed by the health system? In the eyes of the public we already own one word “spine” (Not Subluxation) and the majority of new patients come in to see a chiro (even the vitalists) for back pain! Blue Wode likes to talk about the vitalists “bait and switch” of these patients and I agree with him!
    For low back pain 60% of patients see a doctor, 50% see a chiro and 28% see a physio (I will have to dig up that paper)! There are approximately 25 times more doctors and 4 times more physio’s than chiro’s yet we see 50%! So what is the chiropractic professions greatest strength? Conversely what is the chiropractic professions greatest weakness? Well we are in agreement on that and it has been discussed extensively on this site!

    • Critical_Chiro wrote: “I came to realize a long time ago that the vitalist BS represents a minuscule portion of the population”

      @ Critical_Chiro

      As you are aware from my previous comments, surveys from the US show that 65-90% of chiropractors are vitalist, and here in the UK, the figure is 65-75%.

      Ref: http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269

      How can such results be twisted to support your claim that the vitalists represent “a minuscule portion of the [chiropractor] popluation”?

      Further, the President of the British Chiropractic Association declared last month – in a letter openly embracing the several hundred strong vitalist element of UK chiropractors – that “unity need not mean uniformity”: http://www.mccoypress.net/i/bca_bennett_letter_december_2016.jpg

      How can there possibly be any meaningful chiropractic reform taking place when such desperate measures are being proposed?

      Björn Geir wrote: “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”

      Beautifully put.

      • “Surveys from the US show that 65-90% of chiropractors are vitalist….,” stated Wode, who apparently based the statement on a question in an Oregon survey which asked if chiros treated vertebral subluxation complex. This is a fine example of Wode’s parroting faux reality because of his ignorance of the veridical reality of Medicare reimbursement in the US. Medicare reimburses ONLY for treatment of the chiropractic VSC and DC’s must use the term by law in order to receive remuneration for their services. Thus, Wode’s specious, “definitive” claim that up to 90% of US DC’s are vitalist is demonstrably weak and reeks of a lack of education relative to the topic he is trying to discuss.

        • Logos-Bios commented: ” “Surveys from the US show that 65-90% of chiropractors are vitalist….,” stated Wode, who apparently based the statement on a question in an Oregon survey which asked if chiros treated vertebral subluxation complex. This is a fine example of Wode’s parroting faux reality because of his ignorance of the veridical reality of Medicare reimbursement in the US.”

          @ Logos-Bios

          The following is lifted from the text of the link I provided:

          [QUOTE]
          “A large survey of (and by) chiropractors which was carried out in 2003 (McDonald W, Durkin K, Iseman S, et al, ‘How Chiropractors Think and Practice’, Seminars in Integrative Medicine, 2004 V.2 No.3 92-98, Institute for Social Research, Ohio University) revealed that 89.8% of chiropractors in the USA (where well over 50% of chiropractors practice) felt that spinal manipulation should not be limited to musculoskeletal conditions – a figure which appears to be supported by this 2004 survey of chiropractors in Portland, Oregon…
          http://www.chirobase.org/02Research/laidler.html
          …which found a 100% incidence of beliefs and practices that were unsubstantiated or clashed with established scientific knowledge. Interestingly, the McDonald et al survey also revealed that 9 in 10 chiropractors believed in (fictitious) subluxations, 4 in 5 thought they were involved in visceral illness, and 2 in 10 thought they explain all of illness (so-called straight chiros).
          A further indication that the majority of chiropractors are using spinal manipulation as a panacea can be found in research which the World Federation of Chiropractic (WFC – an association of chiropractic organisations in 85 countries) gathered during its 2004-2005 consultation on ‘The Identity of the Chiropractic Profession’. It gives valuable insight into the chiropractic profession’s perceptions of itself on an international scale. For example, not only did the consultation result in the participating chiropractors’ unanimous agreement that the most appropriate public identity for the profession within health care was “The spinal health care experts in the health care system” – a definition which clearly allows pseudoscientific chiropractic practices to continue to flourish – it also produced a document entitled “Abstracts of Previous Relevant Research” which cited 2003 McDonald et al study, and specifically mentioned the following in section E, #6:Quote:
          “Approximately 9 in 10 [USA chiropractors] confirmed that the profession should retain the term “vertebral subluxation complex” (88.1%) and that the adjustment should not be limited to musculoskeletal conditions (89.8%). Subluxation is rated as a significant contributing factor in 62.1% of visceral ailments.”
          In addition to that, the results of the WFC consultation produced a chart called “Perceptions of How the General Public Perceives the Chiropractic Profession”. It illustrates the percentage of chiropractors who said that the following phrases described the profession “perfectly” (7 on a scale of 1 to 7) or almost perfectly (6):Quote:
          “Management of vertebral subluxation an its impact on general health”
          – 65% of chiropractors said that the general public should perceive chiropractic that way
          “Management of vertebral subluxation”
          – 57% of chiropractors said that the public should perceive chiropractic that way.
          Those figures are supported by a 2007 survey of UK chiropractors which revealed that traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of respondents, with 63% considering the subluxation to be central to chiropractic intervention:
          http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1188-the-scope-of-chiropractic-practice-a-survey-of-chiropractors-in-the-uk.html
          Indeed, in 2010, the vitalistic Alliance of UK Chiropractors (which claims to be the largest of the four UK chiropractic associations), pressured the UK regulator, the General Chiropractic Council (GCC), into changing its former stance about there being no evidence to link imaginary chiropractic subluxations to “health concerns”. Shockingly, when the GCC caved in it apparently provided no evidence to support its U-turn. See:
          http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1827-alliance-of-uk-chiropractors-october-2010-newsletter.html

          [/QUOTE]

          @ Logos-Bios

          Note that the text above says “a large survey of (and by) chiropractors which was carried out in 2003 (McDonald W, Durkin K, Iseman S, et al, ‘How Chiropractors Think and Practice’, Seminars in Integrative Medicine, 2004 V.2 No.3 92-98, Institute for Social Research, Ohio University) revealed that 89.8% of chiropractors in the USA (where well over 50% of chiropractors practice) felt that spinal manipulation should not be limited to musculoskeletal conditions”

          Bearing in mind that there is no evidence that chiropractic spinal manipulation can treat non-MSK conditions, the McDonald survey’s findings fit in well with DD Palmer’s erroneous theory [based on vitalism which chiropractors call Innate Intelligence] that spinal misalignments…

          QUOTE
          “cause abnormal tension (“tone”) in the nearby nerves and that disturbed nerve tone causes 95% of all diseases. Later he elaborated a biotheology holding that: (1) “Innate Intelligence,” or “nerve energy,” flows throughout the nervous system and controls every bodily activity not under voluntary control, (2) even slight spinal misalignments hinder this flow, causing people to become ill, and (3) manual manipulation (“adjustment”) of the spine is the remedy.”

          Ref: http://www.chirobase.org/05RB/AHCPR/10.html

          Logos-Bios wrote: “Medicare reimburses ONLY for treatment of the chiropractic VSC and DC’s must use the term by law in order to receive remuneration for their services.”

          @ Logos-Bios

          So, most U.S. chiropractors either believe in chiropractic pseudoscience or don’t care that they are conning people? Is that correct?

          • Blue Wode,

            Thank you for your posted citations. I do hope you took the time to read the material you posted and didn’t simply on Prof. Edzard’s “conclusions” relative to it.

            You likely know that I view the chiro subluxation as mythical. Note also that my post to which you have commented dealt with US, not global, chiropractice. I did not address world chiro practice patterns therefore your mention of same was non-contributory to the subject at hand. Consider my comments relative to the US situation, please.

            Please re-read my comments relative to Medicare reimbursement for chiro subluxation. Of course DC’s are going to endorse their treatment of subluxation even though most view the term as synonymous with segmental dysfunction, fixation, and intersegmental hypomobility, none of which is payable as a primary dx for DC’s in the US.

            Regarding chiros’ majority stance(per you citation)that subluxation(dysfunction) is contributory to patients’ suffering in visceral ailments, note that the survey question did not evince that subluxation was believed to have been causative to the visceral condition. Ergo, treatment of patients with pancreatic or bone cancer for viscerosomatic pain would just as likely represent the scenario in which surveyed chiros would view subluxation as contributory to the patient’s condition.

            Why do you continue to mention 19th century-originated terms like “innate intelligence”? You should know by now that I don’t ascribe to such nonsense, yet you continue to throw it into our conversations as though it were relevant to chiropractice today. Why? To make yourself feel warm and fuzzy, or simply to attempt to insult?

            “So, most U.S. chiropractors either believe in chiropractic pseudoscience or don’t care that they are conning people? Is that correct?” you sarcastically stated. Your misunderstanding of subluxation terminology as demonstrated by these questions hopefully will have been made clear to you via your having assimilated my above comments. I will try to further clarify the matter for you, however. Subluxation=fixation=segmental dysfunction=intersegmental hypomobility————–all must be billed to Medicare as subluxation per federal law which was enacted 45 years ago. I would prefer that Medicare were to accept more accurate dxs from DC’s, but it doesn’t.

          • Blue Wode asks Logos-Bios: So, most U.S. chiropractors either believe in chiropractic pseudoscience or don’t care that they are conning people? Is that correct?

            Oops 🙂

            I was a little surprised to see Chiropractic Advocate, Logos-Bios walk into this particular hole. Really, Doctor. By arguing that chiropractors must submit bills to third party payers with diagnoses of “Subluxation” … JUST to get paid … that might be viewed as a kind of insurance fraud IF their real chiropractic or medical judgment was something other than “Vertebral Subluxation” and they were lying to the insurance company. On the other hand, if chiropractors did believe in their own advertising that they could “find and fix” these Vertebral Subluxations, that would add weight to the argument that the Chiropractic Subluxation is not simply a matter of history, an argument I’ve seen floated here by so-called reformers. Either way, if you know what I mean.

            The history of chiropractic participation in Medicare and the 1972 Houston Conference Subluxation listings offer a useful window into understanding much of The Chiropractic Enterprise and the Chiropractic Predicament. In order to bill Medicare, chiropractors were — rather cynically — challenged to demonstrate the Chiropractic Subluxation(s) they had been Selling and Serving since 1895 … IF they wanted to be reimbursed for any and all of their extensive repertoire of Chiropractic Spinalisms, that is. Just like you said, Doctor Bios. Chiropractors complied since participation in Medicare was all part of their “Hey, we’re doctors too ya-know” effort and to be taken seriously as providers and players in the health care marketplace.

            Is there a doctor in the house? 🙂

            Had chiropractors decided they wanted to remain hands-on healers working out of their homes instead of wanting to be “Doctors,” billing insurance for their “chiropractic,” I doubt too many would notice or care. Cash practice, all the way home and no one knows the difference. I mean, you would always have conversations here about medical quackery and credulous consumers of “chiropractic” (including chiropractors themselves, let’s not forget), but it’s really the advertisement of chiropractor as a “doctor” — even a doctor of the spine — that many critics find troubling and should, in my opinion, challenge any society with limited health care resources to think more than twice about.

            I mean, what’s all this “Spine” stuff, anyways? What’s that all about do you suppose? 🙂

            My chiropractic students frequently asked why they had to take “all this medical stuff” when, in the end, they all KNEW — in their Heart of Chiropractic Hearts — they were just going to “adjust” people and “check the legs,” no matter. A perfectly legitimate question, incidentally, and one — for those who were paying attention — that offered insight into the schizoid conundrum that a few encountered in the student clinic when their Med-Lite “push” came to chiropractic “shove,” if you’ll pardon the expression.

            Even the student question itself, “Why does a chiropractor have to learn medicine” describes the situation and tells a story. To wit, the more science and medicine to which the aspiring chiropractic student gets exposed, the more ridiculous and impossible their empty chiropractisms might seem in the face of the medical and pathophysiogic complexities frequently encountered in practice. The fact is, many, if not most students’ understanding of their Med-Lite program was that they were only learning an abbreviated CliffsNotes “medicine” in order to make sure the coast was clear to provide this other stuff they had studied called “chiropractic” — or, as Doctor Stephen Rowe, DC so concisely summarized the whole of what I’m talking about in Adjusting the joints: “Let’s take a look at your Spine and see how you’re really doing.”

            Thanks, Doctor Rowe. That was quite perfect! 🙂

            So, returning to dialing for chiropractic dollars, chiropractors — by their own hand, if you will — chose to submit x-rays supposedly demonstrating the Vertebral Subluxation(s) they were billing for — even when an acceptable Medicare “listing” like “lateral flexion subluxation of C5,” let’s say, was not a version of the Subluxation in which they personally and professionally believed and/or “treated.” So, while I wouldn’t say that pointing to a pencil-marked x-ray and exclaiming, “Look, a Subluxation” and billing for whatever “chiropractic” you render is chiropractic’s greatest sin — it’s what a chiropractor does, after all. What you might not notice is that medicine has itself to blame for VALIDATING the Chiropractic Subluxation by ACCEPTING the very notion of “misaligned vertebra” (a Subluxation) that chiropractors sell AND a formalized acknowledgment that chiropractors are the ones who treat these “misalignments.” After all, Medicare REIMBURSES chiropractors FOR treatments directed at fixing the Subluxations chiropractors point to on the x-rays they use to document them!

            Oops.

            The irony is thick since “medicine” dared chiropractors to put up or shut up with this x-ray requirement. But, the “victory” and irony cuts both ways when chiropractors realize that their success with Medicare slits their own chiropractic throats as well by having the weakest part of THEIR argument for existence — the Chiropractic Subluxation and “Thuh” Adjustment — validated by Medicare. How? Because at some point in whatever development chiropractors might imagine for themselves, chiropractors are going to have to admit that they were only kidding about all that Subluxation Stuff — especially the part about misaligned bones and chiropractors being able to “correct” those “pesky” malpositions. Getting paid for chiropractic quackery only digs a deeper hole from which the rumored more rational chiropractor must climb and worse, raises the noise level of rabid Subluxationists who tell their patients, “See…? INSURANCE covers chiropractic treatment of the Vertebral Subluxation!”

            In other words, everyone loses.

            The fact is that a Chiropractic Subluxation remains whatever a chiropractor says it is or wants it to be and is nothing more nor less than “something diagnosed and treated by a chiropractor.” That would include all this “joint dysfunction” and “joint fixation” chiropractors pretend are not a Chiropractic Rose by another name. I mean, these chiropractic diagnoses aren’t like a diagnosis of glaucoma, let’s say, which hinge on how it’s defined and measured depending on which doctor you consult. Chiropractic Subluxations, by comparison, vary from office to office and from chiropractor to chiropractor. Indeed, ONLY your chiropractic doctor can tell you if you’re Suffering Needlessly from any of their spinal fictions. Just take a look or just ask one.

            Incidentally, some readers might be interested in Some Notes on Subluxations and Medicare.

            ~TEO.

          • @John

            Your recent post was a big “yawner.” It was based on a blatant misinterpretation of my statements regarding the dx of subluxation and Medicare. I walked into no hole; you simply arbitrarily contorted my statements….very WEAK of you!

            Perhaps as a Life graduate you had/have little diagnostic competence. Many Life grads I know felt the need to improve their diagnostic skills via numerous post-grad seminars. Perhaps you believe(or want others to believe) that “diagnosing” refers only to deciding what level of the spine to code for “adjustment”? Pathetic!

            I’ve listed a number of examination procedures I have used for years to diagnose patients; no “subluxation assessments” are included. Unlike some DC’s in the past, when I refer a patient to a specialist I assign the patient a diagnosis which has been worked up via imaging, labs, or clinical findings. I don’t routinely push off a patient onto a specialist only after a patient fails to improve with conservative care. If a patient has a disorder which is not amenable to SMT/PT rehab, he is referred. None of the work-ups involve searching for mythical subluxations!

            Perhaps you have little experience with diagnosing now that you earn your living, I asume, dispensing little blue pills to aging men. Perhaps you choose to not assimilate the fact that mainstream US chiropractic physicians do diagnose, and are required to do so per the laws in most states. It’s difficult to separate the wheat from the snarky chaff in your posts, but you do seem to by puffing your cheeks when blowing off steam against “subluxationists.” BTW, I assume you graduated as a “subluxationist.” Am I correct? Ol’ Sid, after all, was as big on philosophy as he was on using make-up to make himself appear more presentable during photo shoots. Please do enlighten us!

            Be well, TEO (BTW, what does the E represent…emetic?) Please advise

    • @Blue Wode
      Minuscule portion of the “general” population Blue! The public see chiropractors as spine and back pain experts and primarily consult us for these conditions. If a patient comes to me who has been brainwashed by a subbie then I “Bait and Switch” away from the BS and educate them! I also do not actively attack their previous chiropractor I just say “that is not how I practice” and explain why! Majority of those patients then come to the right conclusion on their own! Similar with Orthopods and Neuro’s some celebrity ones I wouldn’t allow near my spine with a 50 foot barge pole while the ones I refer to are superb!
      As for the chiropractic population we have had this discussion before and studies in the US, Canada, Europe and Australia put the subluxationists at 15-18% of the profession! This is way too many and my goal is to actively reduce their numbers to the absolute minimum! Will we ever be rid of them? Unfortunately not and even 1% would not be minuscule or acceptable!

      • Critical_Chiro wrote: “we have had this discussion before and studies in the US, Canada, Europe and Australia put the subluxationists at 15-18% of the profession!”

        @ Critical_Chiro

        One of the most recent studies giving that approximate figure, and which was hailed by chiropractic Professor, Stephen Perle, as “one of the most rigorous studies of the profession”, was wholly misleading.

        For example, the study https://www.ncbi.nlm.nih.gov/pubmed/24512507 stated: “As with any investigation, this study has limitations. First, although the response rate was good at 68%, it remains unclear what practice perspectives and behaviours are associated with non-participants. Also, although the sample was randomly selected and stratified according to the number of licensed practitioners in each province, the sample represented only approximately 12 percent of practitioners from each province. As always, there is the possibility that despite the randomization scheme, a unique sample was selected, and generalizability is a possible concern.”

        Certainly, the results do seem somewhat inconsistent with the other available data:
        http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269

        Most significantly, McGregor’s 1st, 3rd, 4th, 5th, and 6th subgroup descriptions don’t seem to exclude the unethical chiropractor element. IOW, 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.

        Also, according to Science Based Medicine author, Jann Bellamy: “The survey was of Canadian chiropractors, most of whom graduated from Canadian Memorial Chiropractic College, which appears to have a more orthodox orientation than, for example, Life or Palmer…the groups not included in the unorthodox category doesn’t mean the others are necessarily free of unorthodox views.”

        ___________________________________________________________

        “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”

        Björn Geir Leifsson, MD

        • @Blue Wode
          If you look at that study the pure subluxationist % also aligns with the anti-vaccination %. As for other subgroups I am wellness orientated as I try to build the patients resilience and ability to help themselves and help them to reduce occurrence and better self manage! I am wellness and prevention oriented yet anti-subluxation!

          • Critical_Chiro wrote: “As for other subgroups I am wellness orientated as I try to build the patients resilience and ability to help themselves and help them to reduce occurrence and better self manage! I am wellness and prevention oriented yet anti-subluxation!”

            The manner in which you practice is irrelevant. The fact remains that we do not know for certain that the chiropractors in the following subgroups have moved on from DD Palmer’s quackery:

            QUOTE
            “McGregor’s 1st, 3rd, 4th, 5th, and 6th subgroup descriptions don’t seem to exclude the unethical chiropractor element. IOW, 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.”

            ___________________________________________________________

            “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”

            Björn Geir Leifsson, MD

  • 12 very good goals were proferred by the WFC, and Edzard lobbed his inimical “spin” into his discussion of them. Imagine that! It’s great to know that that there are predictable events(Edzard’s bias against chiropractice) in the universe other than the accuracy of atomic clocks and the speed of light.

  • Another-completely idiotic comment by Logos- Bios, complaining about imaginary impoliteness and insults .
    Perhaps chinos could branch out- a lot of their promo material seems to be concerned as much with ‘expanding their practice’ as with their magic- and start offering to cure thin skin or hallucinatory states. Maybe using some kind of ‘Wellness Solution’ hammer, as was mentioned a few weeks ago..
    By the way, since imagined impoliteness seems to be of such concern to him, and since he’s hinted that a ban on my posts might be considered as a result of hurt feelings that he’s managed to whip up out of nowhere- kind of ‘sub-luxation equivalents- perhaps he might consider a little more carefully EE’s stricture about using the names that people employ in their posts.
    Not that I could care tuppence, since I occasionally glance at his nonsense but have no intention of engaging with him further than that, but it would be gratifying to see him apply a little consistency and rationality SOMEWHERE in his life.

    • I note that Barrie again deflected from addressing the pith of my comments regarding DO and MD relationships in the past; not surprising as it is apparent he is unwilling or unable to discuss matters about “modern medicine” which he finds uncomfortable. It would be nice if he could occasionally “up his intellectual game” and post cogently. Note that he injected irrelevant canards regarding practice expansion and “subluxation equivalents” into his most recent post when even he should be able to recall that I have never used “subluxation” in my practice and consider chiro subluxation to be mythical. Unfortunately. Barrie only enjoys discussing issues about which he knows little but which allow him to have fun at another profession’s expense.

      Be well

    • @Bar

      It’s interesting that Barrie has run away from addressing the DO-for-MD degree scheme I mentioned earlier. Interesting, but not at all surprising.

      Be well

      • off topic!

        • How is the comparison of DO-MD quarrels “off topic” when they are quite analogous to the “straight-mixer” quarrels within chiropractic, especially when one reads the totally off-topic post (not criticized as off-topic) on 1/10/17 of Barrie regarding homeopathy, which has nothing to do with the title of your post? I wonder if it’s because the MD-for-DO degree scheme I brought up is an inconvenient truth for you? How convenient!

  • I laughed out loud reading Wode’s L-B quote:

    Logos-Bios commented: …” This is a fine example of Wode’s parroting faux reality because of his ignorance of the veridical reality of Medicare reimbursement in the US.”

    The Logos-Bios accusing others of parroting faux reality That’s nothing short of hilarious. 😀 Maybe I should stop ignoring the L-B rants? Nah, it’s probably as boring as before.

  • Logos-Bios wrote on Sunday 15 January 2017 at 20:32: “I did not address world chiro practice patterns therefore your mention of same was non-contributory to the subject at hand.”

    @ Logos-Bios

    I merely referenced the up-to-date data on the global chiropractic picture in the hope that readers would find it a useful comparison when examining the current U.S data.

    Logos-Bios wrote: “Of course DC’s are going to endorse their treatment of subluxation even though most view the term as synonymous with segmental dysfunction, fixation, and intersegmental hypomobility, none of which is payable as a primary dx for DC’s in the US.”

    …”most view the term”? Given that there are 329 terms that either relate to, are synonyms for, or have been used or cited in connection with describing a subluxation or aspects of a VSC, it follows that the chiropractic subluxation in the U.S. can be anything a chiropractor needs it to be. For example, the following terms are lifted from Rome PL. Usage of chiropractic terminology in the literature — 296 ways to say “subluxation.” Chiropractic Technique 1996;8:1-12.

    Aberrant motion
    (Ab)normal articular sensory input
    Abnormal dysfunction
    Abnormal fixation
    Abnormal instantaneous axis of rotation
    Abnormal mechanics
    Abnormal motion or position
    Abnormal muscle function
    Abnormal nervous system function
    Abnormal spinal function
    Altered intervertebral mechanics
    Altered joint structure and function
    Altered nociceptive and proprioceptive input
    Altered regional mechanics
    Arthropathic
    Abnormal function
    (Ab)normal joint mechanics
    Abnormal joint motion
    Abnormal motion or position
    Abnormal muscle function
    Abnormalities of range of motion or coupling
    Abnormal nervous system function
    (Ab)normal regional sympathetic tone
    Abnormal restrictive barrier in or around joints
    Abnormal spinal function
    (Ab)normal structural relationship
    Acute joint locking
    Acute locking
    Adverse mechanical tension of the nervous system
    Altered alignment
    Altered joint motion
    Altered nervous system movement
    Altered physiological function
    Apophyseal subluxation
    Arthron (extremity joint subluxation — see also “vertebron”)
    Articular derangement
    Articular dyskinesia
    Articular juxtaposition
    Biomechanical distortion
    Biomechanical impropriety
    Biomechanical insult
    Biomechanical stress
    Blockage
    Blocking
    Bony displacement
    Bony maladjustment
    Bony lesion
    Cervical joint dysfunction
    Changes of the dynamic segment
    “Changes of thoracic segments”
    Chiropractic lesion
    Compensatory structural subluxations
    Comprehensive lesion
    ” … compromise proper function”
    Deconditioned syndromes
    Deviation of the bodies
    Errors of static or motor mechanics
    Facet joint syndrome
    Facet synovial impingement
    Facilitated spinal system
    Facilitated subluxation*
    Functional pathology
    Functional subluxation*
    Chiropractic subluxation
    Chiropractic subluxation complex
    Comprehensive lesion
    ” … compromise proper function.”
    Delayed instability
    Deformation behaviour
    Degenerative dynamic segment
    Derangement
    Derangement of the opposing joint surfaces
    Discoradicular conflict
    Disorder of the disc
    Disrelationship of the facets
    Displacement
    Disturbance in the mechanico-dynamics
    “(vertebrae) … don’t move enough, or they move too much.”
    Dynamic forceps
    Dynamic segment
    Dysarthric lesion
    Dysarthrosis
    Dysfunctional joint
    Dysponesis
    Dystopia
    Dysfunctional segments
    Engagement of the spinal segment in a pathologic reflex chain
    Erratic movement of spinal articulations
    Excursion (Conley) = (“Wandering from the usual path.” — Taber’s)
    Facet imbrication
    Facet joint dysfunction
    Facet syndrome
    Facilitated segment
    Facilitative lesion
    Fanning of interspinous space
    Fixation
    Fixed vertebra
    Focal tenderness
    ” … force other joints to move too much.”
    Functional block
    “(subluxations) … force other joints to move too much.”
    Functional compromise
    Functional deficit
    Functional defects
    Functional derangement
    Functional and structural changes in the three joint complex
    Functional disturbance
    Functional impairments of motion
    Functional spinal lesion
    Functional subluxation*
    Gravitational (im)balance of joints (with) reduced chronic, asymmetrical forces
    Harmful dysfunction of the neuromusculoskeletal system
    Hyperaemic subluxation
    Hyperanteflexion sprain
    Hypermobility
    Hypopmobility
    Hypokinetic aberration*
    Impairment
    (Im)properly direct(ed) coordinated, (in)harmonious motor programming
    Inability of the segment to articulate about its new axis
    Incomplete luxation
    Incomprehensible pattern of symptoms and clinical findings when compared to with examination of mechanical lesions in the extremities
    Instability of the posterior ligament complex
    Interdiscal block
    Internal joint derangement
    Internal vertebral syndrome
    Intersegmental instability
    Intersegmental subluxation
    Intervertebral blocking
    Intervertebral disrelationship
    Intervertebral dysfunction of the mobile segment
    Intervertebral joint subluxation
    Intervertebral obturations
    Intervertebral subluxation
    Joint bind
    Joint disturbances
    Joint dysfunction
    Joint immobilization
    Joint “instability”
    Joint movement restriction
    “Just short of a dislocation”
    Kinesiopathology
    Kinetic intersegmental subluxation
    Kinetic subluxation
    Lesion
    Less than a locked dislocation
    Ligatights
    Localised/referred pain
    Locked
    Locking
    Locked subluxation
    Locks up and restricts motion
    Lose their normal motion or position
    Loss of elasticity
    Loss of joint movement
    Loss of juxtaposition
    Loss of segmental mobility
    Low back dysfunction
    Malalignment
    Maladjustment (of a vertebra)
    Malposed vertebra
    Mechanical interferences
    Mechanical malfunctioning
    Mechanically infringe
    Manipulatable joint lesion
    Manipulatable lesion (adjustable subluxation!)
    Mechanical derangement
    Mechanical disorder
    Mechanical dysfunction
    Mechanical instability
    Mechanical irritation of the sympathetic ganglionic chain
    Mechanical musculoskeletal dysfunction
    Mechanico-neural interaction
    Metameric dysfunction
    Mild pubic diastasis
    Minor derangement
    Misalignment
    Misalignment of the fibrocartilaginous joint
    Motor unit derangement complex
    Motion restriction
    Movement restriction
    Multisegmental spinal distortion
    Musculoskeletal dysfunction
    Myopathology
    Nervous system impairment by the spine
    Neuro-articular dysfunction*
    Neuro-articular subluxation*
    Neuro-articular syndrome*
    Neurobiomechanical
    Neuro-dysarthric
    Neuro-dysarthrodynic
    Neurological dysfunction
    Neurodystrophy
    Neurofunctional subluxation*
    Neuro-mechanical lesion*
    Neuromuscular unit
    Neuromuscular dysfacilitation
    Neuromuscular dysfunction
    Neuropathology
    Neuropathophysiology
    Neurospinal condition
    Neurospinal distortions
    Neurostasis (Wilson)
    Occult subluxation
    Offset
    Orthokinetics
    Ortho-spondylo-dysarthrics
    Osteological lesion
    Osteopathic lesion
    Osteopathic spinal lesion
    Osteopathic spinal joint lesion
    Pain and debility without recognisable pathology
    Painful intervertebral dysfunction (“PID”)
    Painful minor intervertebral dysfunction (“PMID”)
    Palpable changes
    Paravertebral subluxation
    Partial dislocation
    Partial or incomplete separation
    Partial fixation
    Partial luxation
    Pathogenic interaction of spine and nervous system
    Pathophysiological mechanics
    Pathologically altered bradytrophic tissue
    Pathologically altered dynamic segment
    Pathomechanics
    Pathophysiology
    Perverted function
    Physiologic displacement
    Physiologic lock the motion segment
    Positional dyskineria
    Posterior facet dysfunction
    Posterior joint dysfunction (“PJD” — see “three-joint complex”!)
    Posterior joint syndrome
    Post-traumatic dysautonomic
    Prespondylosis
    Primary dysfunction
    Primary fibromyalgic syndrome
    Pseudosubluxation
    Putative segmental instantaneous axis of rotation
    Reflex dysfunction
    Reduced mobility
    Regional dysfunction
    “Relative as absolute lack of space within the intervertebral foramen”
    Residual displacement
    Restricted motion
    Restriction
    Restriction of unisegmental mobility
    Reversible with adjustment/manipulation
    Sagittal translation (Conley)
    Sectional subluxation
    Segmental dysfunction
    Segmental instability
    Segmental movement restriction
    Segmental vertebral hypomobility
    Semiluxation
    Simple joint and muscle dysfunction without tissue damage
    Shear strain distribution
    Slight luxation
    Slightly luxated
    Slightly misaligned vertebra
    Soft tissue ankylosis
    Somatic dysfunction
    Spinal dysfunction
    Spinal fixation
    Spinal hypomobilities
    Spinal irritation
    Spinal joint blocking
    Spinal joint complex
    Spinal joint dysfunction
    Spinal joint malfunction
    Spinal kinesiology
    Spinal lesion
    Spinal mechanical dysfunction
    Spinal pathophysiology
    Spinal segmental facilitation
    Spinal segmental instability
    Spinal subluxation
    Spine restriction
    Spino-neural conflict
    Spinostasis (Wilson)
    Spondylodysarthric lesions
    Sprain
    Stable cervical injury of the spine (see also “instability” above)
    Static intersegmental subluxation
    Static subluxation
    Strain
    Strain distribution
    Structural abnormalities
    Structural derangement
    Structural disrelationship
    Structural intersegmental distortion
    Structural lesions
    “Stuck”
    Subtle instability
    Sub-luxation
    Subluxation
    Subluxation complex
    Subluxation complex myopathy
    Subluxation syndrome
    Subluxes
    Three joint complex
    Tilting of the vertebral body
    Tightened, deep, joint related structures
    Total fixation
    Translation
    Unresolved mechanical tension or torsion
    Unstable lumbar spine
    Unstable subluxation
    Vertebragenous syndromes
    Vertebral derangement
    Vertebral displacement
    Vertebral dysfunction
    Vertebral dyskinesia
    Vertebral factor
    Vertebral genesis
    Vertebral induction
    Vertebral lesion*
    Vertebral pathology
    Vertebral subluxation
    Vertebral subluxation complex
    Vertebral subluxation syndrome
    Vertebrally diseased
    Vertebroligamentous sprain strain
    Vertebron (see also “arthron”)
    Wedged disc
    Zygopophyseal pathophysiology

    42 Terms for a Sacroiliac Subluxation:

    Abnormal pelvis biomechanics
    Altered sacroiliac mechanics
    Changed motor pattern (in muscles)
    Change in relation
    Displacement
    Disturbed normal relationship
    Distorting the normal mechanics
    Downslips (see also “upslips”)
    Dysarthria
    Dysarthric syndrome
    ” … effect on body mechanics”
    Instability of the pelvic joints
    ” … irritation of the nerves is possible … ”
    Joint binding
    Joint dysfunction
    Joint lesion
    Joint motion restriction
    Joint slip
    Joint syndrome
    Limitation of motion
    Malposition
    Malrotation
    Mechanical dysfunction
    Misplaced
    Misplacement
    Motions are restricted
    Partial luxation
    Primary dysfunction
    Restrictions
    Rotatory slips
    Shear dysfunction
    Shear mechanism
    Slight luxation
    Slip
    Slipping sacroiliac joints
    ” … stick at the limit of normal motion …”
    Strain
    Strain and laxity
    Tilts (anterior, posterior)
    Upslips (see also “downslips”)
    Vertical slipping of the innominate on the sacrum

    Synonyms:

    59 Synonyms or Metaphors for the “Spinal Adjustment”
    Arthral alignment
    Atlas therapy
    Biokinetic remediation
    Bone setting
    Chiropractic manipulation
    Chiropractic manipulative therapy
    Corrective spinal care
    Disengage
    Diversified-type force application to release the segment at its articulation
    Facet adjusting
    Fix
    Flexion distraction manipulation
    Functional restoration
    Gentle adjusting
    Gently relieve the locked subluxation
    High velocity facet adjusting
    Human readjustments
    Joint manipulation
    Low force/amplitude manipulation
    Manipulation
    Manipulative surgery
    Manipulative therapy
    Manipulatory
    Manual adjustment
    Manual cavitation
    Manual medicine
    Manual reflex neurotherapy
    Manual therapy
    Manual treatment
    Mechanical treatment of the nerve centres.
    Mobilisation
    Neuro-mechanical spinal chiropractic management
    Neuromechanical correction*
    Neurotherapeutic
    Neurotherapy
    Orthokinetics
    Orthopedic orthokinetics
    Osteopathic manipulative therapy
    Osteopathic osteological adjustment
    Physiatry
    Physical medicine
    Readjustment
    Reconstructive measure
    Reduced
    Reduction
    Reduction of dislocation
    Release of intraarticular pressure
    Replacement
    Repositioning
    Restoration of mobility
    Slipped into place
    Specific mobilization
    Spinal adjustment
    Spinal manipulative therapy
    Spinal manual therapy
    Spondylotherapy
    “Springing the spine”
    Vertebral adjustment*
    Vertebral medicine

    * Unreferenced

    Logos-Bios wrote: “Regarding chiros’ majority stance(per you citation)that subluxation(dysfunction) is contributory to patients’ suffering in visceral ailments, note that the survey question did not evince that subluxation was believed to have been causative to the visceral condition. Ergo, treatment of patients with pancreatic or bone cancer for viscerosomatic pain would just as likely represent the scenario in which surveyed chiros would view subluxation as contributory to the patient’s condition.”

    Even if your opinion was correct, chiropractic would have nothing to offer. The fact remains that chiropractic spinal manipulation has been shown to be effective for nothing other than short-lived pain relief for people suffering from uncomplicated low back pain, and even then it is no better than sham:
    http://www.ebm-first.com/chiropractic/research-and-efficacy.html

    Logos-Bios wrote: “Why do you continue to mention 19th century-originated terms like “innate intelligence”?”

    To inform readers that a religious concept underpins subluxation-based chiropractic philosophy to which many chiropractors still adhere.

    Logos-Bios wrote: “Subluxation=fixation=segmental dysfunction=intersegmental hypomobility————–all must be billed to Medicare as subluxation per federal law which was enacted 45 years ago. I would prefer that Medicare were to accept more accurate dxs from DC’s, but it doesn’t.”

    So, chiropractors in the U.S. are free to charge for any condition they can get away with ‘treating’ as long as it’s billed to Medicare as a diagnosis using the word ‘subluxation’? Is that correct?

    ___________________________________________________________

    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”

    Björn Geir Leifsson, MD

    • @Blue

      You, as usual, are wrong.

      It is entertaining to read your linguistic contortions and informational distortions as you try to prove your typically baseless opinions: your list of “subluxation equivalents” was quite amusing.

      “So, chiropractors in the U.S. are free to charge for any condition they can get away with ‘treating’ as long as it’s billed to Medicare as a diagnosis using the word ‘subluxation’? Is that correct?” stated Blue. This has to be as ignorant a statement as I’ve read from him, and there have been many. Medicare has strict standards which require documentation of the medical necessity of treatments of conditions amenable to chiropractic treatment. So, NO! DC’s are NOT free to charge for “any condition” as long as there is a subluxation diagnosis. Inform yourself before you post drivel!

      Trepanation, leeches for UTI’s, and bloodletting are all historical treatments of medical doctors. However, we have been informed that “medicine has changed and evolved with new research” by several folks on this site….uh huh! It’s hypocritical of Blue to impute mainstream chiropractice to the profession’s beginnings and yet not admit that medicine’s founding and evolution was inbued with consistently scientific rigor.

      There is nothing religious about mainstream chiropractice.

      Blue thinks viscerosomatic spinal pain represents uncomplicated spinal pain?!? He is uninformed as per usual.

      Try harder, Blue, and be well

      • Logos-Bios wrote: “Medicare has strict standards which require documentation of the medical necessity of treatments of conditions amenable to chiropractic treatment. So, NO! DC’s are NOT free to charge for “any condition” as long as there is a subluxation diagnosis. Inform yourself before you post drivel!”

        So, what diagnostic word do the many vitalist U.S. chiropractors use in order to adhere to Medicare’s “strict standards which require documentation of the medical necessity of treatments of conditions amenable to chiropractic treatment”?

        Logos-Bios wrote: “Trepanation, leeches for UTI’s, and bloodletting are all historical treatments of medical doctors…It’s hypocritical of Blue to impute mainstream chiropractice to the profession’s beginnings and yet not admit that medicine’s founding and evolution was inbued with consistently scientific rigor.”

        The difference is that the medical profession has *completely* discarded trepanation and bloodletting, etc., whereas chiropractors haven’t discarded anything in their dubious tool bag.

        Logos-Bios wrote: “There is nothing religious about mainstream chiropractice.”

        That might be true with regard to “mainstream” practice, but since there are no universal standards in chiropractic, many chiropractors still believe in its religious foundations. For example:
        http://avonchiropractor.com/the-tic-and-the-tor/

        Logos-Bios wrote: “Blue thinks viscerosomatic spinal pain represents uncomplicated spinal pain?!?”

        No, I don’t. Re-read what I said.

        John Badanes, DC, wrote on Monday 16 January 2017 at 22:25: “My chiropractic students frequently asked why they had to take “all this medical stuff” when, in the end, they all KNEW — in their Heart of Chiropractic Hearts — they were just going to “adjust” people and “check the legs,” no matter. A perfectly legitimate question, incidentally, and one — for those who were paying attention — that offered insight into the schizoid conundrum that a few encountered in the student clinic when their Med-Lite “push” came to chiropractic “shove,” if you’ll pardon the expression…Even the student question itself, “Why does a chiropractor have to learn medicine” describes the situation and tells a story. To wit, the more science and medicine to which the aspiring chiropractic student gets exposed, the more ridiculous and impossible their empty chiropractisms might seem in the face of the medical and pathophysiogic complexities frequently encountered in practice. The fact is, many, if not most students’ understanding of their Med-Lite program was that they were only learning an abbreviated CliffsNotes “medicine” in order to make sure the coast was clear to provide this other stuff they had studied called “chiropractic”…medicine has itself to blame for VALIDATING the Chiropractic Subluxation by ACCEPTING the very notion of “misaligned vertebra” (a Subluxation) that chiropractors sell AND a formalized acknowledgment that chiropractors are the ones who treat these “misalignments.” After all, Medicare REIMBURSES chiropractors FOR treatments directed at fixing the Subluxations chiropractors point to on the x-rays they use to document them!…at some point in whatever development chiropractors might imagine for themselves, chiropractors are going to have to admit that they were only kidding about all that Subluxation Stuff — especially the part about misaligned bones and chiropractors being able to “correct” those “pesky” malpositions. Getting paid for chiropractic quackery only digs a deeper hole from which the rumored more rational chiropractor must climb and worse, raises the noise level of rabid Subluxationists who tell their patients, “See…? INSURANCE covers chiropractic treatment of the Vertebral Subluxation!” In other words, everyone loses.”

        @ John Badanes

        Thanks for telling it how it really is.

        _________________________________________________________

        “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
        Björn Geir Leifsson, MD

        • LOL….the quote of Geir at the end of this post is as hilarious as it is bogus.

          • LOL….the quote of Geir at the end of this post is as hilarious as it is bogus.

            I can confirm that the quote is not at all bogus. I wrote every one of these words.

            Now, go play doctor or something…

          • I’m happy to re-phrase my recent comment for the non-perspicatious(Geir) among us: the authorship of Blue’s quote of Geir was not bogus. The content within the quote or Geir was both hilarious AND bogus.

            You’re welcome!

          • “LOSE WEIGHT WITH THE LAP-BAND! SAFE 1 HOUR, FDA APPROVED; 1-800-GET-THIN; 1-800-953-5000; PPO INSURANCE; FREE INSURANCE VERIFICATION”

            It’s astounding to consider the lengths that some physicians will traverse to enrich themselves at the expense of people who have a poor self-image and are psychologically vulnerable, but who are otherwise physically healthy. $33K is a lot of motivation for some, I suppose.

  • PLEASE don’t block Logos-Bios’ comments, as you did those of another fellow a few months ago.
    Every day, I get up-time difference, late riser- and look forward to the comments that have come through in the night.
    He’s like an out-of/control clockwork mouse with a firework up its bum.
    Sorry- didn’t mean to be impolite.
    I meant ‘hedgehog”.

    • Barrie….lol

      I certainly mean no disrespect to you or to anyone on this site. While I don’t agree with Edzard’s negative spin regarding the research in and the practice of most non-medical disciplines, I get the feeling that he would not ban a poster for simply responding in kind to other posters’ opinions with which he disagrees. If there were no disagreement on his blog, it would not be fulfilling its purpose the the fullest.

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