MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

How often have we heard it on this blog and elsewhere?

  • chiropractic is progressing,
  • chiropractors are no longer adhering to their obsolete concepts and bizarre beliefs,
  • chiropractic is fast becoming evidence-based,
  • subluxation is a thing of the past.

American chiropractors wanted to find out to what extent these assumptions are true and collected data from chiropractic students enrolled in colleges throughout North America. The stated purpose of their study is to investigate North American chiropractic students’ opinions concerning professional identity, role and future.

A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analyses were performed.

A total of 1,243 questionnaires were electronically submitted. This means the response rate was 16.7%. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). About half of all respondents (46.8%) felt that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments.

The authors of this paper concluded that the chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.

What should we make of these findings? The answer clearly must be NOT A LOT.

  • the response rate was dismal,
  • the questionnaire was not validated
  • there seems to be little critical evaluation or discussion of the findings.

If anything, these findings seem to suggest that chiropractors want to join evidence based medicine, but on their own terms and without giving up their bogus beliefs, concept and practices. They seem to want the cake and eat it, in other words. The almost inevitable result of such a development would be that real medicine becomes diluted with quackery.

108 Responses to Subluxation, a myth that is deeply ingrained in the chiropractic mind-set

  • My biggest single problem with chiropractic is that the “discipline” or “profession” originated with Palmer’s concept of subluxations. A chiropracter who claims not to have anything to do with the subluxation concept is a bit like an astrologer who accepts that stars and planets have no influence on human behaviour etc.

    If the response is that chiropractic is purely the profession of spinal manipulation, then it needs a totally new underlying premise, preferably one based in something approaching good evidence, and a completely new name. Otherwise the expectation is for ridicule by association. Why would any thinking person even bother to associate him or herself with something as easily discredited as subluxation? One can only assume that subluxation non-believers who nevertheless call themselves chiropracters are unwilling to take the risk of establishing something novel and credible.

    • “One can only assume that subluxation non-believers who nevertheless call themselves chiropracters are unwilling to take the risk of establishing something novel and credible.”
      Such as joining a profession as registered medical practitioners or chartered physiotherapists.
      It is essential for chiropractors to ‘believe’ in subluxations – and that their adjustments affect specific systemic disease and illness.
      Otherwise their whole raison d’etre goes out of the window.
      They have nothing to sell.
      The emperors will be seen to have no clothes.
      The ‘profession’ ends in ignomy or moves even further down to path of CAM to join crystals, reiki and the like.

      Only this afternoon on ‘The Infinite Monkey Cage’ Brian Cox was pointing out that not onliy is science falsifiable, but that (real) scientists want to test their ideas and see if they can be falsified.
      Not so chiropractic.
      RIP.

      • Richard Rawlins: I wonder, what would be so credible about joining a profession(physiotherapy) which overtly practises Reiki, Craniosacral therapy and acupuncture amongst other in-credible alternative treatments? If you remove physiotherapy profession from the HPC list what makes it so different to chiropractic or osteopathy?

        • Very good point Bill.
          But if a patient has any evidence of a physiotherapist claiming to be able to conjure ‘Reiki energy’ and thereby cure a specific disease, or activate ch’i in a specific meridian to the same end – you can at least complain about them to the HPC.
          The HPC (like the GMC) does not accept complaints from ‘the public’ – only from patients who feel they have been deceived and defrauded by non evidence-based practice.
          I do not think this ‘light regulation’ is good enough – but it is better than the GCC which appears to have minimal ethical standards and indeed supports metaphysical constructs such as the ‘subluxation’ and the belief system in which this construct wallows.
          Faith cannot be regulated. Not even by Isil.

          The HPC is not ideal, but it is the best we have for regulating physical therapy.

          Of course, Chiropractic is not merely manipulation:
          D. D. Palmer moved from magnetic healing to hands-on vertebral adjustments. He felt the success he had with his new method was due to the effect of ‘vital forces’. He was able to detect ‘inflammations’ which he claimed caused “…an obstruction to the blood circulation and injury to certain nerves. It is this combination which causes cancers. Having found the cause of cancer it is an easy thing to relieve the pressure upon the blood vessel and nerve… in curing Lillard’s hearing I proved that disease does not originate outside the body – it is not the work of devils, for God created the universe. Drugs will not release pressure upon the spinal cord. It is the intelligence within – let us call it ‘innate’ – which transmits to every organ and cell the only real healing force. In other words, the power to heal is within us. Innate is an individualised portion of the All-Wise, usually known as the spirit.”

          Palmer went on to describe how the nervous system should have an optimal ‘tone’ – any alteration of tone caused disease: “Life is the expression of tone. Tone is the normal degree of nerve tension. Tone is expressed in functions by normal elasticity, activity, strength and excitability of the various organs. Consequently the cause of disease is any variation of tone – nerves in tension or slack. Life is the expression of tone. In that sentence is the basic principle of chiropractic. Innate directs its vital energy through the nervous system to specialize the coordination and sensation and volition through the cumulative vegetative functions. That I named ‘innate’ is the segment of that intelligence which fills the universe. Chiropractors correct abnormalities of the intellect as well as those of the body. Chiropractic is founded on different principles than those of medicine.” (D.D. Palmer The Chiropractor Adjustor 4. Portland Printing House. 1910.)

          Clearly, by Palmer’s own claim and intention, Chiropractic is an alternative to evidence based medicine.

    • Frank

      If chiros did give up the nonsense, what would they be left with? Osteopathy? Physiotherapy? But we never did get to the bottom of what the difference was between the chiro signature treatment, the HVLA thrust, as performed by a chiro, osteo, physio or a doctor.

      Frank said:

      Why would any thinking person even bother to associate him or herself with something as easily discredited as subluxation? One can only assume that subluxation non-believers who nevertheless call themselves chiropracters are unwilling to take the risk of establishing something novel and credible.

      Because they gain (unearned) legitimacy from being statutorily regulated by the General Chiropractic Council that they wouldn’t get otherwise, perhaps?

      • Hi Alan,

        I think I have said to you before that there is no difference between the professions in how they do a HVLA treatment and if there was does it matter, considering it is no more effective than any other treatment for low back pain.

        To look at it in a different way would be to say is there a difference between an exercise (the physio signature treatment) prescribed by an osteo, physio or chiro?

      • Does being registered with the HPC make physiotherapy entirely credible? If so that would suggest the HPC accepts the use of the alternative treatments used by physios, such as acupuncture and craniosacral therapy, the latter incidentally one of the therapies highlighted as bogus by the Nightingale Collaboration. Interesting too that physios attend manipulation courses provided by chiropractors. It seems that statutory regulation per se does not prevent the practice of quackery even by ‘credible’ professions.

    • When one tries to argue against a professional and their profession it is worth noting that correctly spelling said profession should be paramount. After reading your second line “chiropracter” gaffe I had an inkling of what was to come. After repeating the use of the neologism “chiropracter” in your final line I knew then that your argument went from misguided to foolish.

      To borrow one of your phrases, my single biggest problem with your piece is your problem with the concept of the subluxation. A subluxation is simply a name. It originated over a hundred years ago but has since undergone refinement to the term that my chiropractor (note the second “o”) colleagues and I use today. Medicine today is vastly different to medicine 200 years ago and just as medicine has changed, so has chiropractic.

      Much the same way that meat, cheese and tomato sauce on a piece of dough is simply called a pizza, a certain set of physiological signs and symptoms define a subluxation. These include pathophysiology, neuropathology, biochemistry and histopathology to name a few. Spinal subluxations involve displacement of the vertebrae which can be seen upon x-ray and detected by motion palpation. Much like the term pizza, subluxation is simply a noun.

      Unfortunately, there is a minority of chiropractors who claim to cure certain ailments however true chiropractors don’t cure anything. We simply adjust areas of dysfunction that we have termed subluxation (calm down, remember the pizza analogy) and generally the symptoms subside. We don’t cure, we simply try and restore the body’s normal function and allow the body to heal itself like it has been doing for millions of years.

      More research needs to be undertaken to ensure that the chiropractic profession is the best that it can be and this is happening, however this research happens a lot slower when we don’t have the backing of large pharmaceutical companies who bankroll medical research.

      You ask why any thinking person would even bother to associate him or herself with something as easily discredited as subluxation? I thought about this as I pondered why I’m engaging in a response to a “thinking person” who spells “chiropractor” with an “e”. I really must apologise for descending into critiques of your spelling. It’s almost as silly as critiquing a profession you don’t seem to understand. Back to the matter at hand though, how is it so easy to discredit the subluxation? You’re arguing against hard science, are you? Have you studied neurology, pathology, physiology? Spinal pain pathways? Nerve root pathology? Basic anatomy? Possibly, but I doubt you know even the basics of chiropractic. Please correct me if I’m wrong.

      Chiropractic certainly isn’t purely the profession of spinal manipulation as you suggest. Chiropractic is so much more. It’s about restoring life and maintaining function. You insist we need a completely new name. What do you suggest? Remember that correct spelling is important. How about “Quacky Back Crackers” or “Person Who Pushes On Spine And Secretly Pops Bubble-Wrap At The Same Time”? Any suggestions?

      As flippant as I’m being, I urge you to think twice before replying with more of the same. I trust that you’re not a chiropractor so it’s safe to say that I have the upper hand when it comes to chiropractic knowledge. You do however bring your unique brand of spelling.

      I’d hate to be ridiculed by association so I won’t get drawn into your last line about establishing something novel and credible. Oh, why the hell not!? Subluxation non-believers(?) don’t need to create something “novel and credible” because they understand the science, anatomy and dysfunction behind subluxations. They may choose to call it something else but the hard fact of the matter is a subluxation is a subluxation is a subluxation. Call it what you will, it is what I will continue to focus my professional energy on as I strive to safely and effectively improve the quality of life of the patients that I see.

      • Id rather have a few words spelled incorrectly than be riddled with logical fallacies. Maybe you should focus your professional “energy” on some critical thinking skills. A fallacy is a fallacy is a fallacy!

      • David, please note Daniel David Palmer told us what chiropractic is:
        “The philosophy of chiropractic is founded upon the knowledge of the manner in which vital functions are performed by innate intelligence in health and disease. When the controlling intelligence is able to transmit mental impulses to all parts of the body, free and unobstructed – we have normal action which is health.
        Chiropractic is a science just so far as it is specific.
        Chiropractic is founded upon different principles than those of medicine.
        Chiropractic is an outgrowth of magnetic healing.
        That which I named innate (born with) is a segment of that Intelligence which fills the universe, a ‘part of the Creator.’
        Displacement, or ‘subluxation,’ of spinal vertebrae impedes the freedom of Innate to flow from the universe through the human body. ‘Adjustments’ restore Innate’s ability to care for and direct the functions of the body.”
        His son Bartlett Joseph Palmer added:
        “We chiropractors work with the subtle substance of the soul. We release the prisoned impulses, a tiny rivulet of force that emanates from the mind and flows over the nerves to the cells and stirs them to life. We deal with the magic power that transforms common food into living, loving, thinking clay; that robes the earth with beauty, and hues and scents the flowers with the glory of the air.”
        Quoted by World Chiropractic Alliance 2014.1.1

        Chiropractic is a belief system. It cannot be equated with ‘medicine’.
        Believe as you wish, but please stop contaminating the (slow) progress being made by medicine by seeking to insert your beliefs into scientific practice.

        Had you wanted to practice medicine, medicine is what you should have studied.
        And when qualified, manipulated however you liked to your heart’s desire.
        That is how the standards of professional medical practice are established, maintained and improved.
        Please join one of the conventional professions.
        Good luck, and may the innate be with you.

        • The cites from your quotes are missing. Will you please provide. Thank-you

          • D.D. Palmer. The Chiropractor. Los Angeles: Beacon Light Publishing Co.; 1914; 30.
            D.D. Palmer. The Chiropractor’s Adjuster: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland Printing House, Portland, 1910.
            B.J Palmer. Quoted in website of World Chiropractic Alliance. 2014.
            Joseph C. Keating. B.J. of Davenport: the early years of Chiropractic. The Association for the History of Chiropractic. Davenport. 1997.
            V. Gielow . Old Dad Chiro, Davenport, Bawden Bros. 59, 1981.
            D.D. Palmer, The Chiropractic Adjustor 111. Portland Printing House, 1910.
            D.D. Palmer The Chiropractor Adjustor 4. Portland Printing House. 1910.
            Google: D. D. Palmer quotes. Identified by Kurt Youngman.
            D. D. Palmer, letter to PW Johnson, Archives of David D. Palmer, Health Sciences Library, Davenport, Iowa, 1910.
            Davenport Leader, 1894, quoted in Vernon Gielow, Old Dad Chiro: A Biography of D. D. Palmer, Bawden Brothers, 1981.
            B. J. Palmer. Fight to Climb. Palmer School of Chiropody, Davenport. 1950 p. 58.
            David Daniel Palmer (son of B. J.) The Palmers. Bawden Bros. Davenport, p.76.

          • Are you seriously quoting sources from 1910 and 1894? Don’t you think the profession has evolved a little since then?

            Consider how different medicine was two hundred years ago compared with today. Should we list the barbaric, crude methods that medicine used back then? Should we discuss the early days of medicine? Blood-letting, mysticism and religion were highly prominent, were they not? Clearly modern medicine has progressed as has chiropractic from its earliest beginnings.

            Chiropractic isn’t “medicine”. It never has been and it has never strived to be. Chiropractic isn’t complementary medicine nor is it alternative medicine. It is an alternative to medicine just as it is alternative to dentistry, physiotherapy and osteopathy.

            What is your main concern with chiropractic? What really bothers you? Have you ever been to a chiropractor?

            Either way, the lovely thing is that chiropractic isn’t going anywhere and we’ll continue to help our patients live their best possible lives. It’s sad that you get so upset about us safely and effectively providing a service that helps so many people.

            Out of interest what would you do if you were suffering from acute lower back pain, say a facet joint? Or even a cervical nerve root pathology? Please don’t say anti-inflammatories and a good lie down. I know GP’s whom I no longer refer to who still suggest bed rest for lower back complaints, even though this has been scientifically shown to be the worst advice.

            My intention isn’t to change your mind about chiropractic, clearly you’ve made up your mind despite not fully understanding the profession. All I want to do is to enlighten you as to a few inaccuracies you have.

            I’m a normal, easy going chiropractor. I use traditional techniques, safety tests, care and empathy and as a result I get great results. All I ever wanted to do was to help people and I’m still amazed when a two year old who has never walked comes to see me and after two adjustments they begin walking or migraine sufferers with a ten year history never experience another crippling migraine after a handful of visits with me. I have hundreds of these stories and these are common to a lot of chiropractors.

            I truly have trouble understanding a lot of the negativity towards chiropractic on this thread. Chiropractic research is exploding all over the world, which is what we need to continue to validate what we do in the safest, most effective manner. As a profession we are only just over 100 years old, thus only in our infancy compared to some other professions. The research will continue, techniques will continue to be refined and above all chiropractic will continue to thrive.

            The American Medical Association tried to destroy chiropractic in the 70’s and were found to be guilty of trying to eliminate chiropractic as competition to medicine and guilty of concealing the effectiveness of chiropractic!! Their underhanded tactics didn’t work and never will.

            I don’t have an issue with medicine, despite the shockingly high rate of iatrogenic cases and the rampant over prescription of pharmaceuticals. I recognize it for what it is. Medicine isn’t perfect but it does still manage to help a lot of people. Ditto chiropractic.

            Don’t reply claiming inaccuracies and fallacies because that’s just wrong. We don’t need to make false claims, our record as a proven health care modality speaks for itself as it is safe, effective and growing. That’s right, chiropractic is getting stronger despite the naysayers who don’t understand it.

          • David, thank you for that but please advise your full name.
            You ask me: “Are you seriously quoting sources from 1910 and 1894? Don’t you think the profession has evolved a little since then?”
            Sadly, no.

            But much depends on what you mean by ‘the profession’. Chiropractic cannot evolve as it is not a profession (in the modern sense) but is a faith in the concepts and ideas of DD Palmer – as I have quoted.
            The only way there could be change is if practitioners gave up their beliefs, or were able to demonstrate that ‘adjustment of subluxation’ affected ‘innate’ which in turn affected somatic organs and associated diseases.
            If a practitioner does not believe that, in what way can they be said to be a chiropractor?

            As you so honestly say: ‘Chiropractic isn’t “medicine”… It is an alternative to medicine’.
            And that is my main concern.
            That’s what really bothers me.
            Not the practice of manipulation, but the pretence that chiropractic IS a reasonable alternative to medicine.
            The BCA claims it is a ‘primary healthcare profession’. What does that mean? Do chiropractors make diagnoses? If not, how do they know what they are doing? Do they know what they are doing? Just asking!
            Many chiropractors even style themselves ‘Dr.’ Why would they do that unless they wanted to mislead the public? Why not ‘Ch.’ For ‘Chiropractor’?

            I’m interested you think “the lovely thing is that chiropractic isn’t going anywhere”.
            So, no evolution then.
            I’m pleased you “get great results” but are they the result of your charisma and empathy, or the adjustment of a subluxation? How do you know?
            And why compare the ‘infant chiropractic’ with ‘other professions’?
            If, as you say, “All I ever wanted to do was to help people”, why did you not join one of those ‘other professions’?

            A “two year old that has never walked” who begins walking “after two adjustments” is not remarkable – it’s a miracle. Unless you bear in mind that children do (mostly) start walking at sometime. Funny that. What was the diagnosis? Did you report this in a Journal? If not, why not?

            Medicine needs committed enthusiasts like you to help it on its way. But DD Palmer decided from the outset that he wanted a system which was not ‘medicine’, and you have chosen to enter a profession which is not medicine. ‘Medicine’ became regulated (GMC 1858) precisely to ensure the public have a degree of protection from quacks and frauds. The GMC does that by setting standards of entry to the profession (with which not all can comply), standards for examination after training (which some fail) and standards for practicing medicine (for which some are not fit). These standards apply to all, including those doctors who wish to manipulate spines. (Or operate on them as I have done).

            Chiropractic does not comply with those standards, it is a faith, and nothing more needs to be said. Except that the doctrine of informed consent demands that you explain your faith to your patients before manipulating them, including the lack of evidence satisfactory to the general scientific and medical community for the existence of ‘subluxations’). Do you explain that?

            Medicine has faults. It continually tries to overcome them. Please help us. Setting off on a tangent does not help. In a free and liberal society I am not going to stop you, but I do ask you to practice with integrity and that you are honest with patients.

            Thank you.

          • As much as I enjoy your hilarious attempts to twist everything I say to fit your biased views, this will have to be my last post. I can’t discuss this with you rationally as you are so ardently against chiropractic and have resorted to silliness. Let’s go paragraph by paragraph for old time’s sake…

            Re: quoting sources from over one hundred years ago. The answer is yes you did. And chiropractic not evolving since then? You’re just being silly and you know it.

            All chiropractors adjust subluxations, whether they call them that or not. This allows the body to heal itself like it has been for millions of years. Some call this innate, others just understand that the body knows what to do after being adjusted. Again, innate is just a word.

            RE: chiropractic isn’t medicine. Everyone with a brain knows that the two are separate. Chiropractic is alternative to medicine just as it is alternative to a fry-cook or sports coach. Chiropractors don’t practice medicine or set out to practice medicine. I assume you know very little about chiropractic education but of course chiropractors make diagnoses. If we suspect something is out of our scope of practice we are trained to refer to the appropriate professional, be that a GP, physio etc. Many countries legally bestow the title Dr onto chiropractors at the completion of their training. You need to stop thinking that medical doctors are the only professionals who should be allowed to use this title. Chiro’s, dentists and those with PhDs are just some of the people who can legally call themselves Dr’s. It shouldn’t be an issue. I don’t see how it is misleading the public. If you go to a chiropractor expecting to see a medical doctor, then clearly you are in need of a psychologist, either that or you can’t read.

            RE: “the lovely thing is that chiropractic isn’t going anywhere”. Clearly you understood that to mean that chiropractors won’t be pushed around and our profession isn’t likely to disappear. However you tried to take a cheap shot and twist the words. Clever? No. Desperate? Yes.

            RE: ““get great results” but are they the result of your charisma and empathy, or the adjustment of the subluxation?” What do you think genius? When was the last time someone’s charisma and empathy helped with a lumbar disc bulge? Consider the following – I don’t advertise that I can treat colic nor do I tell parents that I can help with their child’s colic. However, I will then tell the parent of a colicky child that I will assess their spine and if I deem it necessary to adjust them I will. More often than not the colic symptoms resolve and the child returns to normal. How could you possibly take issue with that? I know the anatomy and physiology behind it. I know where to adjust, so I do. The child safely responds well and everyone is happy.

            RE: “All I ever wanted to do was to help people”, why did you not join one of those ‘other professions’? I wanted to be a chiropractor, not one of those “other professions”. I wanted to help people using only my bare hands without the need for drugs or surgery. I’ve been trained to know when the need for drugs or surgery is appropriate and I refer accordingly.

            RE: A ““two year old that has never walked” who begins walking “after two adjustments” is not remarkable – it’s a miracle”. This isn’t a miracle, it’s fairly common in chiropractic offices. Most children walk a lot earlier than two years of age as you well know. If I can pick one of many cases like this, the diagnosis was an extension fixation of the right sacro-iliac joint and accompanying muscle tightness. Why would I report this in a journal? As I said, this isn’t miraculous, these results happen all the time. That’s chiropractic!

            Chiropractic absolutely complies with the standards set out by our professional governing bodies. Interestingly enough these bodies are designed to protect the public, not the chiropractors. Every single one of my patients has informed consent explained to them and discussed if necessary.

            RE: “Chiropractic is a faith”. Chiropractic isn’t a faith, it is a highly regulated, safe, effective and cost efficient profession that helps the public immeasurably. You need to get past the early beginnings of chiropractic. As you well know we have progressed immeasurably since then. I note you ignored my comments about the early days of medicine and how different that was back then. Same deal with chiropractic.

            I for one always practice with integrity and honesty, as do most chiropractors. Can the same be said for GP’s who push a certain drug depending on which pharmaceutical rep has taken them out for a nice lunch? Or the spinal surgeons who are too quick to want to fuse somebody’s lower back? Or the medical doctors who begin manipulating spines after undertaking a weekend course?

          • David said:

            …and guilty of concealing the effectiveness of chiropractic!!

            Seems like chiros are succeeding in that without the help of doctors.

    • I have collarbone subluxation. My tendons aren’t tight enough to hold my collarbone in it’s joint. It sometimes pops some of the way out and sometimes pops fully out I can feel and hear every time it pops, but I have no pain unless it gets popped too often, or stays out of socket for too long. For this reason I can say with 100% clarity you are wrong and I have the evidence to prove it.

      • @ME,
        Before you get too carried away with your outrage, read this;

        https://en.wikipedia.org/wiki/Subluxation

        “A subluxation may have different meanings, depending on the medical specialty involved. It implies the presence of an incomplete or partial dislocation of a joint or organ.[a] The World Health Organization (WHO) defines both the medical subluxation and the chiropractic subluxation. It contrasts the two and states in a footnote that a medical subluxation is a “significant structural displacement, and therefore visible on static imaging studies.”[2]”

        You had a real subluxation, not an imagined chiropractic one.

  • As a thinking chiropractor I have been working closely with doctors for 20+ years. I have established myself within the medical community and communicate constantly. I have the reputation for being the go to guy for difficult chronic backs that frustrate doctors. Doctors don’t refer lightly as it reflects straight back on them so they hold me to account and would cut me off at the knees instantly if I promoted any subluxation BS! This is the right path for chiropractors and the majority of chiropractors who I know have a medical referral base! Back pain is increasingly becoming a team based sport, practicing in blissful isolation is a thing of the past. Patients appreciate and frequently demang that their health care professionals communicate and coordinate their care.
    The doctors I work with are aware of the differences in chiropractic and refer accordingly. This is no different to any other referral and they know who is good and who is not for any given specialty. I have joined evidence based medicine and real medicine holds me to account!
    The skeptics focus on the BS merchants and that is fine as they need to be questioned! Though they do tend to asymmetrically sample the chiropractic profession repeatedly which does lead to a biased view! The skeptics also need to follow tup with support for the reformers within the chiropractic profession which ultimately moves the reform process forward!

    • Thinking_Chiro said:

      The skeptics focus on the BS merchants and that is fine as they need to be questioned! Though they do tend to asymmetrically sample the chiropractic profession repeatedly which does lead to a biased view! The skeptics also need to follow tup with support for the reformers within the chiropractic profession which ultimately moves the reform process forward!

      No they don’t. As long as there are those making bogus claims, skeptics are right to call them out, particularly when they infringe the laws and rules that are in place to protect the public from being misled or harmed. The fact that there may be chiros who don’t mislead isn’t the issue. It is up to the chiros – and more appropriately – their regulator. It’s up to them to get their house in order, but they do seem a tad reluctant: even after having to deal with 524 complaints about misleading claims a few years ago, although better, why are there still chiros claiming:

      Chiropractic care can also help children with: asthma, colic, prolonged crying, sleeping and feeding problems, breathing difficulties, hyperactivity, bedwetting and frequent infections especially in the ears

      Any reasonable person might think the regulator wasn’t really interested in protecting the public at all. If they’re not doing that, what are they there for?

      • @ Alan

        I agree with you when you say that it is important to point out professions when they are making bogus claims and i would say that it is important that this external pressure is applied to all professions making such bogus claims.

        It is a natural reaction for people to not accept criticism even if it is correct and a common reaction is to deflect i.e. they (another profession) are doing bad things too.

        But even after writing that i would still say it is important to mention all professions who are making bogus claims especially when you are highlighting a bogus claim that can be mentioned by a group of professions (chiro, osteo and physio) e.g. colic. Differentiation can be done by saying that only a certain number from each profession makes the bogus claim. I think that would look more even handed when applying criticism and would instantly prevent some peoples poor reaction to such criticism.

        • @AN Other

          There is no imperative to be ‘even-handed’: bogus claims are bogus claims and they are not ameliorated by pointing out whatever proportion of chiros make them and that others don’t. But that simply raises the question whether there is some proportion of bogus claims that would be acceptable? Equally irrelevant in this respect is whether other professions also make bogus claims, particularly if they are completely unrelated to the bogus claims chiros are making.

          This has just been published – you may find it interesting: Good Thinking Investigates: Chiropractic

          • @ Alan

            So, are saying you have to ‘biased’ when reviewing bogus claims because that would be the implication of having no imperative to be ‘even handed’.

            I agree with you that bogus claims are bogus claims. But all professions should be mentioned especially if they are making the same bogus claims as another profession

          • 1) read Alan’s comment again and try to understand what he actually wrote before you comment.
            2) please consider the fact that this blog is about alternative medicine only.

          • @ Edzard

            I do understand what Alan wrote – i am asking him to clarify his point of view because i feel that it is better to be even handed when discussing bogus claims rather than make out that one profession is guilty of making bogus claims and other professions are not guilty of making bogus claims by excluding them from the discussion.

            So do you feel it is irrelevant to mention other professions when discussing bogus claim? If so, why?

          • my expertise is in alt med; knowledge of conventional medicine is too rusty to make authoritative comments.

          • I’ts an old logical fallacy (red herring) to drag extraneous issues across the path to light and truth.
            Combined here with a second logical fallacy (straw man) to set up fall guys (‘other professions’) and criticise their performance.

            The only issue of concern in these posts should be the false or bogus claims made (if any) by chiropractors.
            In this respect theirs is not a ‘profession’ at all, any more than ‘Christian’ or ‘Scientologist’ is.
            Chiropractic is a belief, and can only be considered in that context.
            Subluxations do not exist. Neither do unicorns or the flying spaghetti monster.
            The issue is whether folks make money by charging others to view the unicorn.
            I remember a tent at a Boy Scout fete offering an entrant the sight of a ‘Water Otter’.
            On paying and entering a kettle could be examined! (Geddit?)
            Subluxations are in the same category.
            End of.

          • @ Edzard

            Ok. Alan’s link on one of his comments is to chiro and colic. Would you say it is irrelevant to say that some osteopaths claim to treat colic? If so why?

          • if the discussion and the post etc. are about chiro, why deviate from the original topic? some crystal healers might also pride themselves to cure colic.

          • AN Other said:

            @ Alan
            So, are saying you have to ‘biased’ when reviewing bogus claims because that would be the implication of having no imperative to be ‘even handed’.
            I agree with you that bogus claims are bogus claims. But all professions should be mentioned especially if they are making the same bogus claims as another profession

            So, would it be better to preface any discussion about bogus chiro claims with, say, “Other professions may make similar bogus claims, but let’s look at these chiro ones…”? What difference does that make the the chiro claims? Or do you think bogus claims by others mitigates those made by chiros?

            I’m having real difficulty understanding your position, which appears to me to be no more than an tu quoque fallacy.

          • it is always difficult to understand nonsensical positions, isn’t it?

          • AN Other said:

            @ Edzard
            Ok. Alan’s link on one of his comments is to chiro and colic. Would you say it is irrelevant to say that some osteopaths claim to treat colic? If so why?

            Because it is just that: irrelevant.

          • @ Edzard

            I would say that is not deviating from the topic – if the topic is the broader theme of bogus claims i.e. treating a condition without evidence, I would say that it is appropriate and vital to mention all professions.

            So if you want to inform people it is better to inform them of all the info rather than a fraction of it. So for example, if you stick to a single profession (in this case chiro) it could be lead to a person going to another profession that claims to cure colic because the other profession was not mentioned e.g osteo

          • that’s fine! then say it! and now try to convince someone else.

          • AN Other said:

            @ Edzard
            I would say that is not deviating from the topic – if the topic is the broader theme of bogus claims i.e. treating a condition without evidence, I would say that it is appropriate and vital to mention all professions.
            So if you want to inform people it is better to inform them of all the info rather than a fraction of it. So for example, if you stick to a single profession (in this case chiro) it could be lead to a person going to another profession that claims to cure colic because the other profession was not mentioned e.g osteo

            But the topic (here) isn’t the ‘broader theme of bogus claims’; it’s – specifically – the bogus claims of chiros.

            Now, it might make for an interesting topic to discuss, but that is a far bigger discussion – and not the topic being discussed here.

            But I will ask again: What difference does what others claim make to what chiros claim? Is the evidence – or lack thereof – changed because others make similar claims?

          • @ Edzard

            Does that mean i have managed to convince you 🙂

            @ Alan

            If the point of what you want to do is to inform people the why not give them the full picture. How does stating another profession is making a bogus claim mitigate a bogus claim made by another profession? They are all making a bogus claim
            So, if you want to inform people it is better to inform them of all the info rather than a fraction of it. So for example, if you stick to a single profession (in this case chiro) it could be lead to a person going to another profession that claims to cure colic because the other profession was not mentioned e.g osteo

          • I always suspected that WISHFUL THINKING was endemic in chiro circles.

          • @ Alan

            My comment above was written before you your comment timed at 17:23, so it may not answer you question.

            you said – What difference does what others claim make to what chiros claim? Is the evidence – or lack thereof – changed because others make similar claims?

            The level of evidence does not change because others are making the same claims. Either the evidence is there or it isn’t. However, as I said by not mentioning other professions (who are making similar bogus claims) you could be misleading others.

          • @ Edzard

            Who said i was a chiro – just because i don’t agree with you doesn’t make me a chiropractor

          • I didn’t – lean to read!

          • @ Edzard

            Well you certainly implied that i was by you last comment of “I always suspected that WISHFUL THINKING was endemic in chiro circles.”

          • AN Other said:

            So, if you want to inform people it is better to inform them of all the info rather than a fraction of it.

            Should I also inform them of the failings of Big Pharma; the lies homeopaths tell; that crystal healing is also bogus; that faith healing doesn’t work; the problems with breast implants… Or should we try to focus on one issue at a time so that we can get to the bottom of that first?

            So for example, if you stick to a single profession (in this case chiro) it could be lead to a person going to another profession that claims to cure colic because the other profession was not mentioned e.g osteo

            This is a blog that discusses altmed, not a place where you should expect medical advice.

          • @ Alan

            Yes i do think we should focus on one issue at a time. So for me in this case the issue is claiming to be able to treat colic when you have no evidence for it. Therefore in this situation i feel it would be helpful to discuss all professions who are making such a bogus claim (they can treat colic without the evidence) because then the general public would be more informed.

            I also feel that the more important issue is the making claims without evidence (whoever does it) rather than a single profession making a claim without evidence.

            Finally, if this blog is not informing people to make better choices about healthcare then what is it here for?

          • … to provide a [much-needed] critical analysis of all aspects related to alt med.

          • AN Other said:

            @ Alan

            Yes i do think we should focus on one issue at a time. So for me in this case the issue is claiming to be able to treat colic when you have no evidence for it.

            Sadly, in this case, the topic isn’t that: it’s chiros, their beliefs and subluxations and bogus claims made by chiros that arise from those beliefs.

            Therefore in this situation i feel it would be helpful to discuss all professions who are making such a bogus claim (they can treat colic without the evidence) because then the general public would be more informed.

            I can fully understand why you might want to talk about others making bogus claims. That really is veering way off topic, but it’s not clear why you seem to demand that Prof Ernst follows you on that diversion.

            I also feel that the more important issue is the making claims without evidence (whoever does it) rather than a single profession making a claim without evidence.

            That certainly is a good topic for discussion, but it is a vast area; hence the need to focus on one issue at a time. I’m sure it won’t have escaped your notice that Prof Ernst has written on this blog about the bogus claims being made by several professions, including osteos. Why are you insisting they are all discussed together on this one page?

            But let’s say you started your own blog and wrote about the issue of all the bogus claims made by everyone. That would probably be a very long post – and perhaps more suited to a book!

            Finally, if this blog is not informing people to make better choices about healthcare then what is it here for?

            See prof Ernst’s reply.

      • In reply to Alan Henness:
        “The fact that there may be chiros who don’t mislead isn’t the issue. It is up to the chiros – and more appropriately – their regulator. It’s up to them to get their house in order, but they do seem a tad reluctant: even after having to deal with 524 complaints about misleading claims a few years ago, although better, why are there still chiros claiming:”
        Yep, I agree totally that we must get our house in order, unfortunately blanket statement in regards to the profession does leave the vital cleaners as unacceptable collateral damage!

        • Thinking_Chiro said:

          Yep, I agree totally that we must get our house in order, unfortunately blanket statement in regards to the profession does leave the vital cleaners as unacceptable collateral damage!

          If a chiro isn’t making claims about the likes of colic, etc, then how could they be collateral damage – surely they couldn’t be touched by the GCC or the ASA? But that still doesn’t excuse nor explain the fact that many are still making claims about colic (although far fewer than six years ago). Why is that? Is it because they were taught they could or is the GCC doing nothing about them. Or worse, does the GCC not even know what their charges are up to?

    • No doubt many of the anonymous ‘Thinking_Chiro’ patients benefit from the care they receive. And no doubt many doctors are grateful to be able to unload their problem patients.
      But as TC is now aligned with evidence-based medicine will he (she?) please tell us
      i) What is his (her) name?
      ii) If TC wishes to remain anonymous can he (she) explain why that is?
      Ernst is Ernst, Henness – Henness and I am who I say I am.
      iii) in the last year (or any defined period) how many patients treated by him (her) benefitted?
      iv) How does he (she) know? How were they assessed?
      v) How many patients did not have benefit?
      vi) Was the benefit due to the contructive therapeutic relationship with an empathic practitioner, or to the manipulations?
      vii) Whatever the answer – how does TC know?
      viii) In the event TC cannot or will not answer, will TC accept that claims to have ‘joined with EBM’ are hogwash and designed to mislead? Does that make TC a quack and fraud?
      Thank you.

    • In reply to David who posted on 17th February:
      “As much as I enjoy your hilarious attempts to twist everything I say to fit your biased views, this will have to be my last post”
      David, I am sorry to learn this was your last post, but if you let me have your email perhaps we can continue off line?
      I have never expressed any bias towards chiropractic. I have simply asked questions to get to the bottom of what exactly ‘chiropractic’ is and why folks practice it. Sorry if my inquiries have put you on the spot.
      You comment: “Re: quoting sources from over one hundred years ago. The answer is yes you did”
      Yes, I did. But in what way since then has chiropractic evolved? Which of Palmer’s ideas should we set aside?
      You said: “All chiropractors adjust subluxations, whether they call them that or not. This allows the body to heal itself like it has been for millions of years. Some call this innate, others just understand that the body knows what to do after being adjusted. Again, innate is just a word”.
      But words have to mean something or the ideas expressed by them are meaningless. What do you mean by ‘…the body knows what to do’? We are back to the central issue – what evidence do you have that adjustment of subluxations (by whatever terminology used) has any greater effect on health than manipulation by an osteopath, doctor or physiotherapist? What is the USP of chiropractic?
      “RE: chiropractic isn’t medicine. Everyone with a brain knows that the two are separate. Chiropractic is alternative to medicine just as it is alternative to a fry-cook or sports coach. Chiropractors don’t practice medicine or set out to practice medicine.”
      Agreed! But then you go on to claim “chiropractors make diagnoses”. Given Medicine is “The science or practice of the diagnosis, treatment, and prevention of disease.” (Oxford Dictionaries) how can you claim not to be practicing medicine?
      You remind us: “Many countries legally bestow the title Dr onto chiropractors at the completion of their training.”
      But not in the UK. And I am unclear how a country ‘bestows’ the title anywhere else.
      You advise me: “You need to stop thinking that medical doctors are the only professionals who should be allowed to use this title”.
      I have never thought that. Anyone, I repeat, anyone, in the UK can legally style themselves as ‘Dr.’ But unless they are medically registered or have PhDs – why would they? And in the context of the healthcare environment – why would they if it was not their intention patients would be mislead? What other motive can there be?
      In respect of your ‘great results’ I did indeed ask: “ Are they the result of your charisma and empathy, or the adjustment of the subluxation?”
      Your answer implies you do not know. Why not find out?

      On what basis do you ever assess that a child with colic needs their spine adjusted? How do you know adjustment has any effect? Babies do recover from colic without intervention as you know only too well (I suspect you have had control patients who have not been adjusted).
      “RE: “All I ever wanted to do was to help people”, why did you not join one of those ‘other professions’?”, you answer:
      “I wanted to be a chiropractor, not one of those “other professions”. I wanted to help people using only my bare hands without the need for drugs or surgery.”
      This is no answer. Doctors are not obliged to use drugs or surgery – unless they determine it is in the patient’s best interest. You could have learned to manipulate as a postgraduate.
      “RE: A ““two year old that has never walked” who begins walking “after two adjustments” is not remarkable – it’s a miracle”.
      You reply: “This isn’t a miracle, it’s fairly common in chiropractic offices. Most children walk a lot earlier than two years of age as you well know. If I can pick one of many cases like this, the diagnosis was an extension fixation of the right sacro-iliac joint and accompanying muscle tightness.”
      But surely you know that the sacroiliac joint is a virtually immovable unless fractured. Most children do indeed walk by two – but of those who do not, how many have ‘extension fixation’ of their SI joints? The only references to such a condition I can find on Google is in the chiropractic literature! And chiropractic isn’t medicine as you have pointed out.

      “Every single one of my patients has informed consent explained to them and discussed if necessary”.
      But it appears you do not discuss with them that chiropractic is not medicine and relies of a belief in ‘innate’ (by whatever name known) which is an entity unrecognised by medical scientists.

      “RE: “Chiropractic is a faith”. Chiropractic isn’t a faith; it is a highly regulated, safe, effective and cost efficient profession that helps the public immeasurably.”
      This is a false dichotomy. And chiropractic remains based on groundless belief (and therefore a faith) that adjusting subluxations can help in the management of somatic conditions. Charisma, yes. Chiroshoving, no (until plausible evidence is adduced).
      “We have progressed immeasurably since then. I note you ignored my comments about the early days of medicine and how different that was back then. Same deal with chiropractic.”
      Not so. Medicine has indeed progressed. In what way has chiropractic progressed?
      “ Can the same be said for GP’s who push a certain drug depending on which pharmaceutical rep has taken them out for a nice lunch?”
      A fallacy – Tu quoque. But if you have evidence this happens, report the practitioner to the GMC. You will have my support.
      Many thanks for your stimulating contributions to this thread.

  • As I am not competent with the modality, No comment

    • len said:

      As I am not competent with the modality, No comment

      You don’t have to be a chiro to be able comment on the evidence for chiro. Also, reiki, homeopathy, crystal healing, dowsing, etc, etc, etc.

      • Furthermore, one doesn’t need to be a chef to justifiably complain when a restaurant serves undercooked chicken; one doesn’t need to competent in Internet service provisioning to report a service fault.

        Len to ISP: My Internet connection has stopped working.
        ISP to Len: You are not competent in this type of provisioning, so don’t comment on it.

  • Quite a few questions to answer above so:
    In reply to Richard Rawlings
    “Why remain anonymous?”
    I remain anonymous as the vocal subluxation based chiropractors frequently resort to personal attack. In the US they have even sent their lawyers after the critical chiropractors, Simon Singh is not alone!
    “How do I know if patients benefitted, don’t benefitted and how are they assessed?” Good question!
    I utilise outcome based measures, questionnaires, regular reviews, functional measures relevant to that patient and tag tests. Any treatment is graded and incremetal as I transition the patient from passive care to active care. If the patient feels better or worse I want to know why and what part of the treatment needs to be reviewed or changed. I set treatment goals and time frames to achieve them and I discuss all this with the patient and I send a detailed report to the referring doctor. The doctor also gets follow up reports and I frequently call the doctor as well. If we don’t achieve the goals in the agreed time frame then I refer the patient back to their doctor with another report detailing what we did and recommendations on further referral options. Both the patient and the doctor hold me accountable! This generates more referrals as doctors appreciate the clear communication and the fact that if I cannot help the patient I refer them back. I am not a cure all! If the patient was not referred by a doctor then I use this as an opportunity to open lines of communication. I get the patients consent. then send a report and follow it up with a phone call where I address any concerns the doctor may have with one of their patients seeing a chiro!
    “Was the benefit due to the contructive therapeutic relationship with an empathic practitioner, or to the manipulations?”
    I specialise in chronic back conditions. Acute pain will resolve no matter what the patient does or doesn’t do! The graded incremental approach to care which includes manipulation, lifestyle and ergonomic advice, exercises etc allows us to assess if any one step didn’t help or made things worse. Placebo and Nocebo are well documented and the psychosocial model of back pain is important. Discussing everything with the patient, the reasons for any treatment modality, treatment goals, measures and time frames for achieving those goals puts the patient in control. Empathy is important, chronic patients often feel helpless and frustrated so addressing these concerns and de-catastrophising is a major part of their care.
    Joining evidence based care and working with doctors is not hogwash, it makes me accountable!

    The physio’s are adopting some of chiropractics bad habits like practice management guru’s promoting how to create lifetime wellness patients, activators, blocking using SOT protocols, calling themselves Osteopractors (now one of the largest courses in North America) without serious criticism. An even handed approach if the blog is applicable to physio’s as well would be to put “physiotherapy” into the “Tagged” and “Posted in” at the end of the article. This has been lacking in previous blogs! BS is BS no matter who makes the claim and it should be labelled appropriately.

    • We must thank Thinking Chiro for his/her reply but to clarify the answers to my inquiries:
      i) and (ii) Why is TC anonymous? A: Because he/she fears retribution from other chiropractors.
      This site does not invite whistleblowing of specified unacceptable practice, but a discourse on what that practice is.
      If TC is so afraid of his/her fellow professionals (fundementalists) he/she really should bail out and join another.
      And inform the GCC.
      And surely there is no reason not to clarify whether TC is male or female?
      iii) and (v) We are still not told how many patients benefitted, and how many did not. The answer is…?
      iv) We still don’t know how they were assesed. Where are these ‘assessment’ methods published?
      vi) and (vii). Still no answer to the question as to whether any perceived benefit was due to the very conscientious supportive care TC obviously offers or due to the release of ‘innate intellegence’ from TC’s manipulation.
      Does TC manipulate or not?
      Does it make (a statistical) difference if he/she does not?
      Thank you. Slow progress with this issue.

      • I am not afraid of the subbies, it’s just that they refuse to listen or participate in a reasoned debate and take personal offence if you question their dogma. Where it counts I use my own name and I also directly communicate with critics if I deem it appropriate. Additionally, I am based in Australia so the COCA and AHPRA is who I deal with not the GCC. I keep statistics on all my practice and approximately 1 in 8 chronic pain patients referred by a doctor get referred back with recommendations. The remaining patients are co-managed.
        The patients are assessed with standardised patient outcome based questionnaires like the Oswestry, neck disability index etc. They are not published as I am in private practice but are invaluable when dealing with third party insurers, workers compensation etc.
        “Inate Intelligence?” Facepalm!
        I use a multimodal approach as I explained above that includes manipulation where clinically appropriate!

        • Thank you for that, but the words ‘stone, blood, a, from’ spring to mind.
          We still don’t even know your gender.
          We still don’t know which methods of assessment you use – simply that you uses some methods.
          Where are these methods published? Not your results, the methodology.
          How many patients have had chiropractic treatment? How many have not benefitted?
          (Percentage will do, we do not need you to reveal confidential details of your practice).
          In how many (percentage) patients is manipulation not ‘appropriate’?
          Why not?
          What I am trying to get to the bottom of is just what difference chiropractic manipulation makes to a population of patients who have chronic back pain.
          It may be ‘none’.
          In which case, these patients do not need to see a chiropractort but a placebist (one who utilises the effects of placebos, having gained informed consent to do so).
          Am I right in thinking you no longer believe your work releases ‘innate intellegence’?
          If so, why are you a chiropractor at all?
          Indeed, are you really a chiropractor?
          Thank you.
          Richard Rawlins.
          aka (for entertainment purposes) Professor Riccardo, Consultant Charlatan, Specialist in the Care of the Gullible.

  • The link I posted — Adjusting the Joints — is a segment from the PBS Scientific American Frontiers episode called, A Different Way to Heal? It aired nationally (in the U.S., that is) in June 2002, in case you think chiropractors have put all their subluxation baloney behind them in 2015. Those are all faculty in the video explaining what they’re thinking and doing when they diagnose and treat patients. And, college president at that time, Gerry Clum, offers a “no bones about it” explanation of the subluxation approach and mind-set that has underpinned the Chiropractic Enterprise since its beginning.

    The Vertebral Subluxation informs what a chiropractor thinks, says, and does. This is typically true EVEN when a chiropractor says they use Spinal Manipulative Therapy (SMT) and insists they are treating musculoskeletal complaints only. That’s because SMT (generic manual therapy used by PTs, MDs, DOs) and The Chiropractic Adjustment are not the same as most chiropractors think. These descriptor terms shouldn’t be substituted one for the other as though they were the same. We can talk about that difference but for now, it’s useful to know that at some fundamental non-verbal level of their chiropractic being and training, chiropractors “Look to the spine” — the straightest chiropractors as though it held the Secret of Health and Disease; but, even the musculoskeletal practitioner is infected with chiropractic spinalism since The Spine is the focus of all their diagnosis and therapy. It’s what they do. They’re chiropractors, after all. The customer is going to get some way, shape, and form of “chiropractic,” no matter.

    Notably, a Chiropractic Subluxation can be whatever a chiropractor says it is. At this point (2015), it is safest to define the Chiropractic Subluxation as “something treated by a chiropractor.” Watch the video again. There are three Chiropractic Technics featured — all of them treating THEIR version of “subluxation” as defined by the chirodigm they would apply to ANY patient, regardless of the patient’s entering complaint. In fact, the patient of the Brand Technic practitioner barely enters into the chiropractic equation except as the vehicle for the chiropractor to get whatever “chiropractic” they’re doing all over the consumer. A chiropractor using any chirodigm is using its algorithm to find and fix a Chiropractic Subluxation … which, in turn, they would maintain, when fixed will remedy the patient complaint.

    Now, are these three Subluxation based chirodigms featured in the video a thing of the past — like blood letting, let’s say — found to be empty therapeutically by chiropractors since the 2002 video was made? Or are these and other chirodigms not featured in the video no longer taught and practiced in 2015? They are alive and well in Chiroville. See for yourself. Take a look.

  • In reply to Richard Rawlins:
    Yes I am a chiropractor for 25+ years.
    Some recent research from my library answering some of your questions. The first two are older and the rest are all from 2014.
    Neuromechanical characterization of in vivo lumbar spinal manipulation. Part I. Vertebral motion.
    http://www.ncbi.nlm.nih.gov/pubmed/14673406
    Neuromechanical characterization of in vivo lumbar spinal manipulation. Part II. Neurophysiological response.
    http://www.ncbi.nlm.nih.gov/pubmed/14673407
    Mechanical versus manual manipulation for low back pain: An observational cohort study
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850274/?tool=pmcentrez
    Effects of Cervical Spine Manual Therapy on Range of Motion, Head Repositioning, and Balance in Participants With Cervicogenic Dizziness: A Randomized Controlled Trial
    http://www.archives-pmr.org/article/S0003-9993%2814%2900310-4/fulltext
    Three-dimensional chiropractor-patient contact loads during side posture lumbar spinal manipulation: a pilot study
    http://www.chiromt.com/content/22/1/29/abstract
    Changes in Biochemical Markers of Pain Perception and Stress Response After Spinal Manipulation.
    http://www.jospt.org/doi/abs/10.2519/jospt.2014.4996?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed&
    Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise: a parallel-group randomized clinical trial evaluating relative effectiveness and harms
    http://www.chiromt.com/content/22/1/26
    Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial
    http://www.thespinejournalonline.com/article/S1529-9430%2813%2901390-9/abstract?cc=y
    Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study
    http://www.chiromt.com/content/22/1/24
    Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial.
    http://www.ncbi.nlm.nih.gov/pubmed/24862763
    Effect of spinal manipulation on the development of history-dependent responsiveness of lumbar paraspinal muscle spindles in the cat
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045034/?tool=pmcentrez
    Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non-thrust mobilization.
    http://www.ncbi.nlm.nih.gov/pubmed/24880778
    Instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations.
    http://www.ncbi.nlm.nih.gov/pubmed/24928638
    The role of preload forces in spinal manipulation: experimental investigation of kinematic and electromyographic responses in healthy adults.
    http://www.ncbi.nlm.nih.gov/pubmed/24928637
    Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging–Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up
    http://www.jmptonline.org/article/S0161-4754%2814%2900034-7/abstract
    Immediate effects of spinal manipulation on nitric oxide, substance P and pain perception.
    http://www.ncbi.nlm.nih.gov/pubmed/24674816
    Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report
    http://www.chiromt.com/content/22/1/12/abstract
    Spinal Manipulative Therapy–Specific Changes in Pain Sensitivity in Individuals With Low Back Pain (NCT01168999)
    http://www.jpain.org/article/S1526-5900%2813%2901300-X/abstract
    Do manual therapies help low back pain? A comparative effectiveness meta-analysis.
    http://www.ncbi.nlm.nih.gov/pubmed/24480940
    Neural Responses to the Mechanical Parameters of a High-Velocity, Low-Amplitude Spinal Manipulation: Effect of Preload Parameters
    http://www.jmptonline.org/article/S0161-4754%2813%2900271-6/abstract
    Spinal manipulative therapy and exercise for seniors with chronic neck pain.
    http://www.ncbi.nlm.nih.gov/pubmed/24225010
    Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation.
    http://www.ncbi.nlm.nih.gov/pubmed/25222385
    Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262810/?tool=pmcentrez
    Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial.
    http://www.ncbi.nlm.nih.gov/pubmed/25454683

    In reply to John Badanes:
    Subluxation is only taught here in the history class. Research in Europe, North America and Australia consistently put the subbies at 15-18% of the population. The subluxation based chiropractors here are frustrated at the lack of their dogma in the curriculum and have tried to set up their own college in Adelaide based on the Barcelona College Model. The recent failure of Barcelona to gain accreditation may have derailed their plans and now they have shown their hand publically there is mounting organised opposition.
    The skeptics repeatedly asymmetrically sample from the bottom of the chiropractic bell curve that does tend reinforce their perspective. That they do this is to be expected, but to further reform they need to support the reformers at the other end of that curve. When it comes to the dogma and BS of the subbies I agree with the critics and skeptics. Support for thr reformers is also an important part of the equation!
    As a critical chiropractor it is very frustrating to be attacked by the subbies on one side (which I enjoy responding to) and the external critics on the other for not being critical enough and/or their making blanket statement in regards to my profession! Any criticism needs to be targeted!

    • Thank you very much for that comprehensive reply.
      At a brief glance the papers quoted did not indicate in what way chiropractic manipulation was different from osteopathic or physiotherapeutic manipulation.
      Any chance of letting us know why you trained as a chiropractor and not osteopath, physiotherapist or doctor?
      Just what is the USP of chiropractic if not ‘adjustment of a subluxation’ or ‘release of innate intellegence’?
      Have you ever thought of changing your profession?
      I know a musician who switched to medicine!
      (And come to that, many medics who have switched to music and the arts).

      • In reply to Richard Rawlins:
        “why you trained as a chiropractor and not osteopath, physiotherapist or doctor?”
        12 years prop forward rugby union. Chiropractor helped me with resultant chronic LBP. Why not Dr or physio? 5 doctors in family and was never interested. Grew up immersed in medicine!
        In reply to Björn Geir:
        The papers I cited are all relevant from 2014. There are positive, negative, chiro, physio and medical relating to SMT and exercise. As you noted some are negative. Both sides of the chiropractic debate often accuse each other of cherry picking so a more balanced list is appropriate. I checked the links and they worked!

        • @Thinking_Chiro
           
          Oh Dear!
          There must have been either a DNS or server error at nih.gov. I did check for other pubmed resources that worked.
          Now I can see the ncbi.nlm.h-nih.gov links again.
          OK, I should have suspected something technical as it was three links to the same domain that did not work.
           
          BUT!! after examining what the links show, I find they do not affect my argumentation at all, which you seem to have missed completely.
          Two of the papers are behind paywalls and the abstracts do not impress at all. One is another irrelevant cat-experiment.
           
          To feed my message to you with a spoon:
           
          This is not the first time Thinking_Chiro dumps a cut-paste heap of links from his/her notebook into a comment on this forum. This time I actually bothered to look at some of the twenty five (!!!) links and found the sample irrelevant or inadmissible. Expecting us to accept overzealous scores of links as reference or even as an argument by itself and expecting us to retrieve and make sense of the whole bunch is impolite.
           
          We do know there are sh*loads of chiropractic associated references to be harvested. All with sciency and suggestive titles and even catchy conclusions. Alas, the number of papers associated with a discipline (e.g. chiropractic) has absolutely no relation to the discipline’s value.
          That is where careful reviews and analyses come in.
           
          I believe this kind of obfuscation would sort under “contextomy” or the fallacy of quoting out of context.
           
          I propose we call it “argumentum ad link-dumpum”

    • @ Thinking_Chiro

      In your comment you copy-pasted a list of 25 links to what you state would, at least partially, answer RR’s questions.
      I find his questions adequate and important so I had a look at several of the links in your long list.
      Recognising your apparent ambitions and integrity I expected to see relevant, interesting, scientifically sound material and perhaps even something of your own.
      Of course I could have started at the top but I clicked at random and made note of the findings.
      I managed to examine 8 (32%) of them before I gave up.
       
      Here is a full list of those that I looked at, with my comments:
       
      http://www.chiromt.com/content/22/1/29
      Not a study, only a description of a method of measuring applied forces. Not even a proper pilot study. This is a paper that might have been admissible in High school physics class, not a study of chiropractic outcomes or applicability.
      No relevance to answering RR’s questions
       
      http://www.chiromt.com/content/22/1/26
      Not a study, only a long winded article describing a trial with multiple ambitious endpoints but no results given and no conclusion
      This article has no relevance to the question of chiropractic utility or applicability and no relevance to answering any of RR’s questions
       
      http://www.ncbi.nlm.nih.gov/pubmed/24862763
      Link does not work
       
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045034/?tool=pmcentrez
      Link does not work
       
      http://www.archives-pmr.org/article/S0003-9993%2814%2900310-4/fulltext
      Link to a real trial but…
      It is trial of metods developed by physiotherapist. Nothing to do with chiropractic methods. No chiropractors seem involved. Does not contribute to answer any of RR’s questions.
       
      http://www.chiromt.com/content/22/1/12/abstract
      A systematic review. The conclusion copy-pasted from the full text:

      Conclusions
      Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.

      Do I need to say more?
      No relevance to answering RR’s questions other than perhaps negatively as regards the value of chiropractic.
       
      http://www.jmptonline.org/article/S0161-4754%2813%2900271-6/abstract
      An experimentell study of muscular behaviour/responses in anesthetized cats[sic]. May have interest as basic research in muscular physiology. Far fetched relation to chiropractic clinical reality. Has no relevance to RR’s questions.
       
      http://www.ncbi.nlm.nih.gov/pubmed/24225010
      Link not working
       
      By now I gave up.
       
      Thinking Chiro.
      In the future, if you wish to support your arguments with lists of links.
      Please make sure that…
        
      a. The list is concise. Long lists tend to get ignored completely as has been the effect on me with your previous list-dumps. I hope that is not your intended purpose?
      b. The links are up to date and lead somewhere (by testing them yourself just before submitting)
      c. The links lead to material that is relevant to the issue.
      d. The links are to real papers, not make-believe articles mostly intended as fillers of impressive looking reference-list sh*loads so large that few will bother to start looking into them.

      • Dear TC,

        I am grateful to Bjorn for having analysed your reply.
        Frankly, I was too polite to do so. The very first reference used transducers fixed to spinous processes. Was that the method you have used?
        If not, why offer this reference?

        Look, all I want is NOT for you to offer justification for chiropractic, but to tell us what methods of assessment you used/use to answer (for yourself) the most simple questions of all:
        “Did my patient improve/have benefit?”
        “Was any benefit due to my charisma or to my chiropodial manipulation (adjustment of a subluxation)?”
        “If both, to what extent did each apply?”
        “How many (as a percentage) of all patients treated with manipulation had benefit (as determined by the assesment methods used) and how many did not?”

        Simple.That’s all folks.
        In the absence of a rational reply we will be obliged to assume you have indeed adopted the persona of TC the TV cartoon cat whose bluster was funny but not edifying.
        Thank you.

        • In reply to Richard Rawlins:
          I use tag tests (positive tests that reproduced the pain), functional measures, pain scales and outcome based questionnaires. Functional measures relevant to that patient like activities of daily living, Eg being able to walk more than 5 minutes without experiencing pain, a golfer who wants to play 18 holes but can currently only play 9, getting a good nights sleep etc. Your questions are ones I ask with every patient on every visit. What treatment modality worked, if it didn’t work then I use another modality, what exercises are relevant to that patient, are they doing them, are they helping, is the patient benefiting. Approximately 1 in 8 patients do not benefit and are referred back to the doctor for referral up the medical food chain.
          With chronic pain patients it is about pain management, setting goals for treatment, time frames for achieving those goals, functional measures for that patient, counselling the patient on what is pain, giving the patient tools to actively manage the pain themselves and keeping the patient active, mobile and as pain free as possible. I have not adjusted a “subluxation” in practice ever! Even in my day at Uni it was only taught in its historical context! I am well aware of the placebo and nocebo effect and that is why I utilise functional measures and not just subjective pain scales and how the patient is feeling.

          In reply to Björn Geir:
          I have listed the latest research, if you find it impolite then I apologise. I wish to convey the current state of the research and where it is heading. I have critically read the full articles both pro and con and there has been an explosion in research from chiro’s, physio’s and doctors over the last few years. The above cited articles are from 2014 only as I wished to keep the list as short as possible. I agree with the critics when they say “if you want to make a claim, prove it!” That is why I cite relevant and related papers. If the subbies proved what they claim I would adopt it. Unfortunately the plural of anecdote is not evidence, so I have never gone down that path.
          As for the research there have been papers comparing chiro and physio to medical approaches and between different exercises, but few comparing specific physio to chiro approaches! Only generic manipulation to mobilization, which is not very specific and they usually don’t give details of the actual technique used!
          I hope this answers your questions!

          • Still no reference to what tests are used to assess the outcome of TCs ministrations.
            And if TC has never adjusted a subluxation, on what basis does he claim to be a ‘chiropractor’.
            Is he trying to mislead patients by claiming he is?

  • Is Osteopathy somatic dysfunction a subluxation?

    • [quote]Is Osteopathy somatic dysfunction a subluxation?[/quote]
      Well yes, inasmuch as the Osteopathic Lesion and the Chiropractic Subluxation are both empty faith-based pseudo-medical diagnostic constructs that define professionally proprietary “problems” such that the osteopath and chiropractor, respectively, can sell themselves and their arbitrary ministrations as solutions to those invented problems as each has defined them. Touching your own nose at its finest.

      Why do you ask?

      Maybe these links will help — at least on the chiropractic side of stupid:

      [url=http://www.youtube.com/watch?v=tQb8FK2PM6Y]Adjusting the Joints[/url]

      [url=http://pages.citebite.com/h1n5l6v9j1niv]Responses to viewer mail[/url]

      ~TEO.

  • In reply to Richard Rawlins:
    Orthopedic and neurological tests which are standard to chiro’s, physio’s and doctors. I do not use SOT, AK or any other weird and wonderful test you may be thinking of! When I write a full narrative report to a referring doctor containing all those positive tests with a diagnosis, treatment plan, active care plan and prognosis they have no difficulty understanding it!
    “And if TC has never adjusted a subluxation, on what basis does he claim to be a ‘chiropractor’.”
    Subbies are a minority! I work with doctors in a medical centre and the majority of my new patients are from medical referrals. They are well aware of the differences in chiropractic and are not being mislead. Same with their patients! It is a collaborative environment where I am held accountable and we communicate constantly! The skeptics do tend to repeatedly sample chiropractic from the subluxation tail of the bell curve and think we are all the same, this does lead to a biased view! Pointing out the BS within the chiropractic profession is necessary, but this needs to be balanced with support for the chiropractic reformers/house cleaners/evidence based practitioners which ultimately pushes reform!

  • Communicating with doctors, nothing! Similar problems, different approach, helps different patients. If I cannot help I will refer to the physio and vice versa. I get that question from patients and doctors!

    • So, you claim to be a chiropractor who has never adjusted a subluxation, and you communicate with doctors.
      Just what is your ‘different approach’?
      Are you sure you are not a physiotherapist fraudulently claiming to be a chiropractor?
      Do you style yourself ‘Doctor’?
      (In the UK a number of chiropractors do – as do all in the US. This is misleading).
      I’m not surprised you persist in remaining annonymous.
      But, being annonymous, at least I cannot libel you!

  • “Are you sure you are not a physiotherapist fraudulently claiming to be a chiropractor?”
    http://www.spinalmanipulation.org/
    Interesting wouldn’t you say?
    “Do you style yourself ‘Doctor’?”
    Don’t use the title, have not earned it, causes confusion with patients, have actively campaigned against it! I work with doctors and have 5 doctors in my family. Abuse of the title doctor is just plain wrong! At least we agree 100% on one topic! Amazing! There is hope! 😉
    “I’m not surprised you persist in remaining annonymous. But, being annonymous, at least I cannot libel you!”
    HaHa! I may out myself, we’ll see! I do communicate directly with the critics (here and overseas) both internal and external regularly!

  • “But, being annonymous, at least I cannot libel you!”
    🙂 That should never be a problem, I m always polite and being an evidence based chiropractor, I am by default courageous and thick skinned so your safe as well!

  • Excellent point on the cognitive dissonance. After all if you are teaching students to practice ineffective systems based on the idea that manipulation corrects biomechanical problems instead of simply releasing gas in joints and even worse is a panacea for human diseases then you must have cognitive dissonance and poor quality education to pull it off. This means that in order to maintain intraprofessional harmony chiropractic will never critically analyze itself and maintains techniques used in the real horse and buggy days of the late 1800s because of their hero worship of the palmers (Hole in One technique aka “Toggle”, 1950s Sacro Occipital Technique, Applied Kinesiology). Orthopedic physiotherapy/physical therapy has surpassed it in every way and is the best choice in every case.

  • Just read this discussion from Mr Ernst website as he had quoted the WCA at some point (a self appointed bunch of chiropractic nutjobs doing nothing for the profession except keeping it in the dark ages). this as I stumbled across it when one of my patients came across this article “Chiropractic correction may help reverse multiple sclerosis and Parkinson’s disease” and asked my opinion. Politely explaining how this was total B.S. and having to make excuses for my profession is difficult. How do you explain that some Chiropractors are so delusional they see this a reasoned hypothesis, and give false hope to those with two serious and totally unrelated conditions.

    But during a week when a local Physio has spent 4 weeks exercising and performing cross friction and acupuncture a 15 year old boy with a calcified periosteal tear to the back of his distal Tibia because he didn’t bother to perform a tap test or use a tuning fork on a traumatic injury, so didn’t even know when to refer for X-ray, I find the statement suggested by Prof Ernst “Subluxation, a myth that is deeply ingrained in the chiropractic mind-set” really trivial. When I then X-ray and see a solid 5cm long Periosteal response write to the GP suggesting perhaps discontinuing exercise and Orthopaedic referral for a possible cortisone injection, I am still performing my duties as a Chiropractor. When a 17 year old girl has the posterior arch of C2 removed because I have referred an aneurysmal bone cyst to the hospital missed on 14 visits to the GP, Type 2 dens fracture sent home from the hospital with whiplash and exercises (that would possibly killed or paralysed her had she done them) referred to me for X-rays by an observant Osteopath, I believe I am performing my duties as a Chiropractor.

    I don’t give a toss what model someone chooses to use for treating back pain, which in the most part is self limiting anyway. Whether they call it stiff back or Subluxated back really doesn’t matter. Whether they give exercises only (and if this is the case Physio’s are just glorified personal trainers so whats the point of them?) whether treatment is manipulation alone, or whether they use manipulation or hands on treatment in some for to ease pain, then exercise to prevent recurrent pain which to me seems sensible. Manipulation and exercise are not mutually exclusive, the difference between Physiotherapy Chiropractic and Osteopathy is simply emphasis.

    But having had my rant, I just can’t defend my profession when I come across rubbish like this “” http://www.news-medical.net/news/2004/09/10/4689.aspx “Chiropractic correction may help reverse multiple sclerosis and Parkinson’s disease”. It just makes me think maybe Edzard has a point.

    • Eugene, what a fine doctor you would have made.
      But given that, for whatever reason you did not qualify in medicine, just what attracted you to join the ‘chiropractic profession’?
      You know chiropractors profess to practice in a manner different from that of medicine (DD Palmer said so) and have faith that there is a ‘innate intellegence’ which will cause pathological problems if not released by chiropractic manoeuverings.

      I’m so glad you had the sense to refer the patients you cite onto regular healthcare professionals – but why did they come to you in the first place?

      The girl with an aneuysmal bone cyst must have had symptoms or she would not have been to her GP once, never mind ’17 times’. And as she was clearly not getting anywhere, why on earth did she (or her parents) not move to a specialist after a couple of visits – without passing ‘go’ and without turining to a system of treatment defined by its founnder as alternative to medicine?

      Sigh.

      (PS I know of no cases reported in the literature where a patient with a stable dens fracture has died or been paralysed after excercises. Do you? If so, no patients with ‘whiplash’ should ever see a chiropractor, as all could have dens fractures).

  • As a student currently enrolled in chiropractic college, I’ll do my best to add some current perspective to this issue. The word “subluxation” is not used, and actually ridiculed at our school. Our professors are strong proponents of evidence based care, and many openly denounce the ridiculous notion that a dysfunctional joint in your spine can cause any kind of disease. We are taught that manipulation is a method of restoring normal function to joints, in the spine or otherwise. We are also taught not to be so naive that we think manipulating joints is all we can offer. Rehabilitative exercise, patient education, as well as soft tissue therapy, and contemporary medical acupuncture are all tools that new graduates have in their tool belt. Manipulation certainly is not being taught as the be-all-end-all, not all patients require it, and it is simply another tool (along with the aforementioned) that we have to help patients feel and move better. I think our profession has more similarities to physiotherapy than it does differences. This is obviously not the case for all colleges, which is unfortunate, but hopefully the power of the internet will lead patients to make an informed choice and not choose subluxation based care. Subluxation based chiropractors, please read a science textbook, or retire. Thank you.

    • @Student

      “Our professors are strong proponents of evidence based care”

      Unlikely: the serious evidence base for the efficacy of chiropractic is non-existent.

      “I think our profession has more similarities to physiotherapy than it does differences.”

      I can appreciate that line of thought. So why on earth don’t you switch to physiotherapy and remove yourself from the tarnished name of a crackpot, bogus medical cult that was originated by a person who pulled ideas out of his backside and whose practitioners include a huge proportion of numbskulls who continue to talk about subluxation and who maintain that manipulating the spine can cure every kind of disease?
       
      Seriously, Student. Please enlighten us what makes you think chiropractic is in some way superior to physiotherapy which, for all its many faults, has grown up with medicine and is much more free of snakeoil associations.

      • The studies generally focus on purely using manipulation, which by itself, hasn’t consistently been demonstrated to be any better than rehabilitative exercise. There would never be a patient whose condition requires purely SMT and nothing else. Some patients will benefit more from manipulation, others will benefits more stabilization exercises, some may need soft tissue therapy, no two patients are the same (check out Flynn et al, 2002). The point I am trying to make is that I agree with you. If you simply use SMT on all of your patients, you’re doing them a disservice. We use many different forms of manual therapy to help patients. I never said I believe our profession is better than physiotherapy, I think physiotherapy is amazing. My reason for being in chiropractic school is that the manual skills (joint manipulation) are built into the curriculum. Physiotherapy requires part time postgraduate study in manual therapy in order to learn these skills. I’d rather do the extra 2 years full time up front. With regards to your snake oil salesman comment, you hit the nail on the head. There’s a portion of (generally older) practitioners who adhere to an extremely outdated way of thinking without any scientific rationale behind what they are doing. This is certainly an issue, but the tides are turning. If you have an MSK issue, we can help by using a variety of tools; not simply manipulation. You may be interested in a position statement signed by several colleges worldwide last year that rejects subluxation theory and advocates against several issues which are deemed to be negatively impacting the profession. Google “European-South African chiropractic position statement”. As for your kind words about the “founders” of the profession, I wrote a paper last year that I swear you must have plagiarized.

        • it’s not enough to say ‘every patient is different’ – we all know that and it does not free you from the obligation to use interventions based on sound evidence. where is the evidence for the new chiropractic approach? are you perhaps merely exchanging an old quackery for a new one?

        • @Student
          I never knowingly plagiarize. Please supply a reference to the paper you suggest I’ve copied.

  • I wouldn’t really call it a “new chiropractic approach”. We don’t have some secret tests we perform that nobody else knows about. We use orthopedic testing to determine an issue and correct it using whichever tools we believe best suit the injury. (If those tests are bogus then I guess sports med physicians and ortho surgeons are quacks too?) There could very well be a patient who we never use manipulation on at all. I obviously would not treat a sprained ankle the same was I would treat acute back pain. As for evidence, Flynn et al., 2002 has some interesting clinical prediction rules for when manipulation may be beneficial.

  • But Mr Student, what convinced you that learning ‘manual skills’ would be of any value in the first place?
    Medical and physiotherapy students start by learning how disease and illness may affect a patient, how to establish a diagnosis, and only then go on to consider what treatment options might be best.

    You (and DD Palmer) put a very large cart before the horse – you declaim manipulation is the answer and then attempt to justify your poor career and life decisions.
    Why did you not add ‘manual skills’ to postgraduate studies of medicine or physiotherapy?
    Because, to a chiropractor, manipulation is the only answer needed. Palmer said so.
    Medicine is not a faith – it is a profession which relies on evidence, and demands high levels of critical thinking skills from those who seek to join it.

    Palmer said ‘chiropractic is founded on different principles from medicine’.
    Fair enough, but time to move on.

    • Richard Rawlins,

      I think I’ve made it quite clear that traditional chiropractic philosophy is not taught and is 100% accepted as quackery. We agree on this. Palmer was a fool. The spine does not causes disease. We agree on these points as well. The reason I chose the manual therapy route was because I’ve had great results through seeking care from physiotherapists and chiropractors to deal with a variety of injuries. I think medicine, physio, and modern chiropractic all have value and should be working together rather than against each other to best serve patient needs. Believe me, I understand your distaste and criticism of the profession, I often go on similar rants myself. The fact is, there is a portion of the profession who are great manual therapists with beliefs grounded in anatomy, biomechanics, and orthopedics, rather than fairy dust and snake oil. Please do not paint us all with the same brush and judge each practitioner on their own merit is all I ask.

      • @Student
        I sympathize entirely. I practice astrology, and I just can’t comprehend why so many people think I’m all about birth signs and horoscopes. I only ever use proper telescopes and even collaborate with a group of X-ray astronomers. Some of them say I should study proper astronomy and call myself an astronomer, but what do they know? I find lots of people have sincere trust in astrologers and never go near astronomers, and I get a lot of business from such folk.
         
        Did you never hear of guilt by association?

      • And the answer to my question as to why you did not first study medicine or physiotherapy before moving on to ‘manual skills’ such as chiropractic is…?

      • @Student

        If the school you currently attend denounces – if I understand your statements right – the delusional doctrine of DD Palmer and his disciples, then why does it hold on to the designation “Chiropractic”?

      • Student: Please do not paint us all with the same brush and judge each practitioner on their own merit is all I ask.

        Kind of a pointless request in any discussion of “chiropractic” and chiropractors. To wit — and pay close attention here, Student — the answer to the question of quackery in “chiropractic” is NOT that “student” is no quack. The fact that you even ask for the broad-brush exemption suggests the very problem with “chiropractic” from which you yourself are seeking relief. After all, it’s not YOU who is being painted with the broad brush, but a chiropractic profession that continues to insist on a “chiropractic” — the notion that it’s the Chiropractic Spine that holds the secrets of Health and Disease — or the fervent but untested belief in a “Healthy Chiropractic Spine” or “Spinal Health,” if you like.

        For now, it would be helpful for you to explain why it is that chirodigms like Gonstead, Activator Methods, BioPhysics, NUCCA (or any of the other HIO upper cervical Technics) are not artifacts of medical history and no longer part of what chiropractors do in 2016. These are but a few chirodigms that characterize what it is that chiropractors _actually_ think, say and do. Not YOU, of course; but so what “not you” when voices like yours can’t be heard above the background chiropractic din of faith-based subluxationism.

        There are simply too many chiropractors who DO “Adjust” patients and their Vertebral Subluxations using arbitrary diagnostic and therapeutic proprietary methods that are unique to “chiropractic.” There’s nothing “broad brush” about it. Add in those NON-Proprietary Technic chiropractors who adjust what they’ve diagnosed as “spinal dysfunction” or “joint dysfunction” and a broad brush is precisely what’s required to paint a realistic portrait of downtown Chiroville. Its not uncommon for these generic (non-Technic) spinal “adjusters” to point to their more full-fledged chiropractic enthusiast claiming they are “fringe.” It would be considerably more accurate and insightful to call these Chiropractic Purists the identified patient in a sick chiropractic family … or, the “canaries” in the The Chiropractic Mindset.

        My advice to you having read the few things you’ve written here (and assuming you really are a chiropractic student) is that you should run for your life. If you’re on the eve of graduating, finish up and look for another career — in or out of health care — but first-thing on diploma day. Anything up to and including midway through your training, hit the trail, even if you’re at one of those so-called “more medical” chiropractic schools that’s promising you a more modern version of “chiropractic.”

        By definition and at best, you will always be a “more medical” chiropractor rationalizing the “more medical” (and “less chiropractic”) practice possibility just as you’re already doing here, even as a student. Worse and most importantly, once you DO get your chiropractic antlers, you will never really be able to grow professionally because you will always sink into the vast chiropractic oobleck that surrounds you — the same chiropractism that has informed the chiropractic enterprise since its inception. That’s the broad brush from which you’re already trying to extricate yourself.

        Don’t you even recognize the professional implications of aspiring to be a reasonable chiropractor? Think about it. You would do well to ask yourself, “reasonable as compared with what and whom?” 🙂

        ~TEO.

        • Dr. Manohar M. Panjabi, one of the leading researchers in spinal biomechanics from Yale University knows what a subluxation is. He co-wrote the seminal text Spinal Biomechanics.

          http://cdn2.perfectpatients.com/childsites/uploads/219/files/ligament-subfailure.pdf

          Please note the 8 references where chiropractic proved superior to exercise, medication and accupuncture in treatment of chronic spinal pain. In one study, the side effects of medication % was greater than the pain relief %.

          You idiots who don’t read research, should crawl into a deep hole and drop dead.
          You obviously are being paid by someone to publish your slanderous dribble.

  • Here’s a couple:

    Exercise for back pain.
    Searle, A. et al. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation Dec2015, Vol. 29 Issue 12, p1155 13p.

    Manipulation vs exercise (we use both).
    Merepeza, A. Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review. Journal of the Canadian Chiropractic Association (J CAN CHIROPRACT ASSOC), Dec2014; 58(4): 456-466. (11p)

    Acupuncture for lateral epicondylitis.
    Waseem, M. et al. Lateral epicondylitis: A review of the literature. Journal of Back & Musculoskeletal Rehabilitation 2012, Vol. 25 Issue 2, p131 12p.

    Soft tissue therapy and education for MSK injuries.
    Piper, S. et al. Systematic review: The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review by the Ontario Protocol for Traffic Injury management (OPTIMa) collaboration. Manual Therapy Nov 2014

    Patient education and McKenzie protocols for back pain.
    Narciso, G. Effectiveness of Back School Versus McKenzie Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Physical Therapy (PHYS THER), Jun2013; 93(6): 729-747. (19p)

    Exercise for back pain.
    Salavati, M. et al. Comparative study: Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain. Journal of Bodywork & Movement Therapies Apr 2015

    Edzard, I’ll obviously defer to you as the expert on efficacy of conservative/alternative therapies. That being said, I’m curious as to what the evidence DOES say is effective in treatment of MSK issues, other than surgery and medication, as those are outside of our scope. Appreciate it.

    • @Student
       
      One thing that always irritates readers of this blog is when people dump a pile of references in a comment with no clear indication of the point they’re supposed to make. We know there are all sorts of publications on all sorts of management approaches for all sorts of diseases. Despite the irritation I took a look at your six references.
       
      Searle et al. 2015. A meta-analysis of exercises for back pain. Shows some types of exercise more effective than others. This is physiotherapy.
       
      Merepeza, 2014. A literature review with some elements of a meta-analysis. Ends up with just three papers that match quality criteria and concludes: “The results included a mix of effects with one study finding spinal manipulation as more effective and another finding the exercises more so. The third study found both interventions offering equal effects in the long term.” Which proves what?
       
      Waseem et al., 2012. Three lines about acupuncture, misspelled as ‘accupuncture’, refer to a useless paper from 1983.
       
      Piper et al., 2014. There is no November issue of Manual Therapy. Please supply full details (volume and page) when you cite references.
       
      Narciso Garcia et al., 2013. Another comparison of exercise methods. Physiotherapy.
       
      Salavati et al. 2015. No such paper in the April 2015 issue of Journal of Bodywork & Movement Therapies. Please supply full details (volume and page) when you cite references.
       
      So, what have you given us? Only four of your six references are correct: not a great start. One doesn’t cover the acupuncture you claim it does. (“DNA molecules are based on a double helix”: reference is Watson & Crick, 1953, not somebody else who cited them in a review. That leaves us with three papers assessing various forms of exercise, which is fine, but not the raison d’etre for chiropractic. (“The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,” also called “chiropractic adjustment.” Website of the American Chiropractic Association.)
       
      “I’m curious as to what the evidence DOES say is effective in treatment of MSK issues, other than surgery and medication…”. Nowhere near my own field, but a fair question. From the discussions I’ve read on this blog, physiotherapy is in serious need of some good research to support the techniques it uses. Moreover, it seems some physios embrace acupuncture, chiropractic and other unproven woo. The smart choice for someone like you who wants to be a practitioner for musculo-skeletal stuff is, nevertheless, physiotherapy, because it doesn’t come with the baggage of nonsense that remains the basis of chiropractic.

  • Frank, I appreciate the criticism. I guess the point I was attempting to make is that there is a lot of overlap with physiotherapy in the way that we treat. We are now using mehods typically reserved for physiotherapists, and more frequently seeing them use manipulations. I think we are in agreement that there is a need for further research into all methods of manual therapy. I enjoyed your astrology reference, though I would say that we are now being educated in astronomy and chuckling at the old astrologers along with you. The unfortunate truth is that there are some practitioners (and schools, regrettably) that live and die by the Zodiac and are doing their best to keep the profession in the dark ages. I think we have kicked a dead horse enough, and I have enjoyed our exchange. Edzard, I would still appreciate your input with regards to the most efficacious treatments for MSK issues.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you want to be able to edit your comment for five minutes after you first submit it, you will need to tick the box: “Save my name, email, and website in this browser for the next time I comment.”
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”


Click here for a comprehensive list of recent comments.

Categories