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

Most chiropractors claim that their manipulations prevent illness, not just spinal but also non-spinal conditions. But is there any sound evidence for that assumption? A team of chiropractic researchers wanted to find out. Specifically, the objective of their systematic review was to investigate if there is any evidence that spinal manipulations/chiropractic care can be used in primary prevention (PP) and/or early secondary prevention in diseases other than musculoskeletal conditions.

Of the 13.099 titles scrutinized by the authors, 13 articles were included. These were

  • 8 clinical studies,
  • 5 population studies.

These studies dealt with various issues such as

  • diastolic blood pressure,
  • blood test immunological markers,
  • and mortality.

Only two clinical studies could be used for data synthesis. None showed any effect of spinal manipulation/chiropractic treatment.

The authors’ conclusions were straight forward: we found no evidence in the literature of an effect of chiropractic treatment in the scope of PP or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.

Many chiropractors have adopted the ‘dental model’ in their practice, proposing to prevent all sorts of conditions through treatment of spinal subluxations before symptoms arise. Some call this approach ‘maintenance care’ and liken it to the need for servicing a car. They tell their patients that regular consultations will prevent problems in the future. It seems obvious that this can be a nice little earner. In 2009, I reviewed the evidence on chiropractic maintenance treatment. Here is the abstract:

Most chiropractors advise patients to have regular maintenance treatments with spinal manipulation, even in the absence of any symptoms or diseases. This article evaluates the evidence for or against this approach. No compelling evidence was found to indicate that chiropractic maintenance therapy effectively prevents symptoms or diseases. As spinal manipulation has repeatedly been associated with considerable harm, the risk benefit balance of chiropractic maintenance care is not demonstrably positive. Therefore there are no good reasons to recommend it.

The new review confirms that this approach is useful only for filling the pockets of chiropractors.

The inevitable question arises: WHEN WILL CHIROPRACTORS STOP MISLEADING THE PUBLIC FOR THEIR PERSONAL GAIN?

32 Responses to Chiropractic manipulation and primary prevention. It’s time that chiropractors stop misleading the public in order to fill their pockets

  • a) Why do people feel Chiropractors are helping them long time?
    b) Why do people feel instantenuosly better after a simple chiropractic treatment?
    c) In Youtube Chiropractors make detailed explanations of bones, muscels, skeletal… their working field is much more fundamental, let’s say real, then artificial meridians, auras, chakren. What does orthopädists say to their comprehension? Are these explanations all bullshit – a wrong understanding of skeletal…?
    d) Victims of Chiro? Statistic?

    I had only one interaction with a chiro but it’s long ago (25 y) with two impressions afterwards:
    – the head-rotation “feels” better.
    – the master of chiropractic did’t look much intellectual.

    What I am interessted in: If I had the next Lumbago (Hexenschuss), what is the effect of chiropractic?
    Because I know the effect of conventional treatment (heat, Sirdalud 4 mg, muscle relaxation): after two weeks waiting the pain minimizes to 10%. When chiropractic reproduces this 10% in 2 or 20 minutes it would be a miracel.
    (sorry, I hope my english is understandable.)

  • a) Why do people feel Chiropractors are helping them long time?
    b) Why do people feel instantenuosly better after a simple chiropractic treatment?
    c) In Youtube Chiropractors make detailed explanations of bones, muscels, skeletal… their working field is much more fundamental, let’s say mor real then artificial meridians, auras, chakren. What does orthopädists say to their comprehension? Are these explanations all bullshit – a wrong understanding of skeletal…?
    d) Victims of Chiro? Statistic?

    I had only one interaction with a chiro but it’s long ago (25 y) with two impressions afterwards:
    – the head-rotation “feels” better (maybe an illusion).
    – the master of chiropractic did’t look very intellectual.

    What I am interessted in: If I had the next Lumbago (Hexenschuss), what is the effect of chiropractic?
    Because I know the effect of conventional treatment (heat, Sirdalud 4 mg, muscle relaxation): after two weeks waiting the pain minimizes to 10%. When chiropractic reproduces this 10% in 2 or 20 minutes it would be a miracel.
    (sorry, I hope my english is readable.)

  • A couple of comments.

    1. This paper didn’t access motives. (WHEN WILL CHIROPRACTORS STOP MISLEADING THE PUBLIC FOR THEIR PERSONAL GAIN?)

    2. Most of those papers were low quality and published in a silly journal.

    3. Evidence based chiropractors agree with their conclusion.

    “Chiropractors should therefore assume their responsibilities as an evidence-based, mature health care profession and seize such activities until, if ever, new evidence emerges.“

    4. Most serious chiropractic researchers aren’t currently interested in spending precious and limited time and money on the topic.

  • What else would be expected from the D(umb) & C(onfused).
    These “spine-experts blather on about evidence-based care yet wouldn’t an unbiased observer be led to believe that IF there was striking “evidence” for a 120 year old healthcare miracle (err, delusion, stolen en mass from Andrew Still), systematic-reviews, time and time again would demonstrate that exemplary research and it would stand as a stunning and overwhelming testament to THAT efficacy? Certainly it shouldn’t just be equivocal when such a capacious number of these spine and pain-management “experts” are all running such evidence-based practices?
    But alas all that can be proven now is 50% or more can feel worse post the “miraculous-intervention”. Just like after visiting a Catholic priest.
    In my ex-wife’s practice EVERYONE came in for a “spinal-adjustment”….”evidence” other than her telling them they were “out” (and the far-reaching consequences THAT had to their “wellness”) never entered into the conversation. How could it? People go to DCs for spinal-adjustments….which are pre-scientific farce…irrespective of what evidence they may conjure up after the fact.
    Adjusting-a-malaligned spine and lying about its importance is the schtick of the chiropractic profession. If it’s something ELSE, then it AIN’T Chiropractic.

    • Really? Considering one of the papers was mainly a PT approach?

      “Techniques employed included 1) muscle and joint mobilisation techniques, for example Maitland mobilisations [25], muscle energy techniques, trigger point therapy, myofascial and positional release techniques [26]; 2) diaphragm doming [27]; 3) rib raising [28].

      Does Manual Therapy Provide Additional Benefit To Breathing Retraining In The Management Of Dysfunctional Breathing? A Randomised Controlled Trial

      Another a pilot and another preliminary study.

      • @EE
        “Most chiropractors”.
        Priceless.
        Time to stop carpet bombing the profession with generalizations and supporting the researchers.
        Good article from Charlotte Leboeuf-Yde.

        • @uncritcal_chirper: I’m still trying to understand this. “You” possess insights and understandings of “chiroquackery” and it’s lofty practice, of which your lowly brethren simply can’t, or won’t absorb. You can see the real “big idea” since you have extensive alternate-knowledge and training the low-level, run-of-the-mill quack simply refuses to avail themselves to? Is that it? Or are you running an alternative Chiroquackery college where the 120 year old professional basis: malalignment of the spine has far reaching health consequences AND whimsical, arcane chiroquactic interventions can “restore” innate and heal all manner of dis-ease has been discounted? (A fake-doctorate profession of 100 entrepreneurial-techniques, of which queen-quack Dr. Goertz points out: “there are over 100 techniques and only 2 have shown to be more effective than a placebo or sham” (and even those don’t show squat)). And in “your” professions magazines “subluxation” is discussed and assumed to be alive-and-well virtually every month e.g. Am Chiro Dec 2018: “At last: the hidden factor that causes vertebral subluxations to occur and reoccur”. I think you need to review “analogies” and find something more appropriate than “carpet-bombing”. Are you familiar with the term “lying to myself”?

  • Hi Ezard been a while.

    As you know I find the evidence based model of care interesting in so far as practitioners lacking experience need some information to guide them..

    I have often said to you “absence of evidence is not evidence something does not work” and all the recent anecdotal evidence of cannabis oil helping a whole range of conditions and it being legalised for medical use would be a case in point.

    We know an active livestyle benefits people who have sedentary lives. We know joints stiffen upfor a variety of reasons, so common sense tells us that maintaining Spinal Joint movement whether done by a physiotherapist, an osteopath a chiropractor a bone setter or a Turkish barber might be of benefit and if people feel the benefit they will return just as they would go to the gym and do exercise.

    Just because I don’t understand why people like jumping in the sea on New Years and there is no “scientific evidence” to support the activity does not make it wrong or of no benefit. The evidence as you know is not always right it is only a guide. The evidence stated “incurable”and offered me 22 months in 2013 with chemotherapy. I declined and tried cannabis oil and dare I say chiropractic instead. Not only am I alive, as of 4 months ago I was still cancer free. We can only speculate as to why??

    “Evidence” does not have all the answers ,clinical science is far more complex than physical science

    • good to hear from you.
      “absence of evidence is not evidence something does not work”
      I also quote this a lot – but next I stress that as responsible healthcare professionals, we try to stick with stuff where there is a presence OF evidence.
      all the very best to you. edzard

    • @Richard Lanigan

      Maybe I am misunderstanding something here?

      In your comment above you claim that in 2013 you were given an estimate of 22 months survival for your recurrent rectal cancer so you refused and tried cannabis oil instead… and chiropractic:

      The evidence stated “incurable”and offered me 22 months in 2013 with chemotherapy. I declined and tried cannabis oil and dare I say chiropractic instead. Not only am I alive, as of 4 months ago I was still cancer free. We can only speculate as to why??

      Yes one can certainly speculate but I think it is obvious why you are still alive, and it is not because doctors don’t know how to fix, as you put it.

      In this blog-post, which seems to be written by a Richard Lanigan, it says (my emphases):

      I started Chemo in October 2013, after four cycles, I was experiencing the peripheral neuropathy again and told the consultant I did not want to continue the treatment, she was surprised, said I might only live 6 months if I stopped. I told her I was not afraid of dying I was afraid of living with no life. In my head was the definition of insanity, doing the same thing again and again, expecting a different outcome, there had to be something else. A fortune teller had recently told me I would live to 85 and although I am not into that sort of stuff, bizarrely it had given me a lift, better than being told not to make any long term plans haha. I had had a wonderful life, few regrets. The day I told Isabelle Isabelle I was dying, she said; “I would rather have a Daddy like you for ten years, than a boring one for twenty”; I felt my life was complete, my children were strong individuals, who would succeed in life despite the adversity they would encounter.

      The CT scan in December 2013, revealed the metastasis had not progressed so the chemo had done something; (perhaps the five day fasts I had done prior to each session had made a difference, it had in mice in a study haha). I was a good candidate for targeted radiation and again as in 2011, twenty sessions of radiation fried the tumours in the Lymph nodes around the Aorta. Preventing cancer cells spreading was the concern, and again chemo therapy was suggested and I refused.

      I read that you had at least four rounds of chemotherapy and a good helping of radiation.
      So how come you go on about cannabis oil and chiropractic having saved your life after refusing chemotherapy when you only refused the last round? That is simply untrue.
      You had surgery, radiation and chemotherapy for your tumour when first treated and you had chemotherapy and radiation for your recurrence. You are still alive, but you go on belittling your doctors and modern medicine and claim boastfully that something else saved your life?
      I see no reason to attribute your happy outcome to anything other than modern medicine, the proverbial “cut, poison and burn treatment”, if you will. It saved your life.

      Neither cannabis oil nor chiropractic are likely to have contributed to you being alive.
      If I am reading this right, you are being both dishonest and ungrateful.

      • if you are correct, he would also be DANGEROUS!
        other cancer patients will read his comments on this blog and elsewhere and conclude that they can forfeit conventional treatments in favour of cannabis oil. this would shorten the lives of many.

      • The link from Bjorn leads to a website that my anti-Virus software flashes up as dangerous in a manner I have never seen before. When I try to override the anti-virus software it won’t let me!!

      • @Frank Odds
        Try this (without adding a prefix):

        http://www.rectalcancer.me

        and then have a look at his blog post about turning sixty. The link in my comment somehow adopted an https-prefix so it became misconfigured.
        If that doesn´t do the trick, try lowering the protection level of your anti-virus. Mr. Lannigan hasn´t bothered to remove spam comments so there´s a drove of spam links in the comments section below his post, which might be arousing your watchdog. They should be OK as long as you don´t click them. I´ll make some screenshots of the blogpost later this norning and send you, in case your anti-virus software doesn´t allow you access anyway.

        • The new link works fine, Bjorn, thank you. And your comments on 22 December are spot on. A classic example of someone almost certainly fooling himself, sad to say.

    • @RL: “Lack of evidence doesn’t prove evidence of lack..” No, actually it generally does…especially when the scams have had generations to prove themselves, and can’t. What else can scammers fall back on? “Oh, science just hasn’t caught up with my keen insights and experiences yet…but eventually really smart people will do the correct research and Bazinga, it will be proven” (like Noah’s ark and L. Ron Hubbard’s reincarnation?).
      As arcane and asinine as chiropractic is (100 techniques, ALL made up by entrepreneurs) there are innumerable “terminal” patients, having placed a prayer request on a piece of paper under a saucer of milk, which if slurped up by a rat in a particular Hindu temple found their malady miraculously cured.
      Testimonials are the most cruel, exploitative and detrimental form of “marketing”….but of course the most capacious and successful. They are what affords scammers, frauds and religions the ability to make bank-deposits. Best to just stick to “residual effects of previous medical interventions” or coincidence. The ominous reality is that neither coincidence OR sCAM can ever be relied on when you really need them.

  • EE: No compelling evidence was found to indicate that chiropractic maintenance therapy effectively prevents symptoms or diseases.

    If would help if people understood the difference between maintenance care and preventative care.

    Maintenance care, as one group defines it, is, “…care in which the clinical intent or treatment goal is prevention of deterioration in the functional and current health status of a patient with a disability or severe level of functional impairment.” https://meteor.aihw.gov.au/content/index.phtml/itemId/462100

    Preventative care, as one groups defines it, is, “Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.” https://www.healthcare.gov/glossary/preventive-services/

  • @numb & contused: are you expecting some future patients may read this blog and that differentiation may persuade them to give you a call? Just to be clear: the “thing” you intend to prevent should actually be a real-thing AND be preventable based on a consistently provable intervention. 2 attributes missing in the Chiroquackery bag-of-tricks. Perhaps you should read Hills criteria and apply it to subluxation (or whatever it is you are “treating”, “preventing” or “maintaining”….If NOT subluxation). Perhaps you’ll continue to suggest, as the other “reformers” are proposing that you don’t actually hunt-and-kill subluxations. But if you don’t then it seems you’d just be running a gym, and that doesn’t require healthcare hacks with pseudo-doctor degrees. Does it?

    • I don’t expect any new patients from this blog, that would be silly.

      • yes, but your last comment strongly implies that you are silly, doesn’t it?

        • A couple of folks here are capable of a serious and informed discussion, others like MK, not so much.

          • A couple of folks here are capable of a serious and informed discussion; unfortunately, you do not seem to be one of them.

          • No problem, you didn’t make my list either.

          • @dumb/contused: interesting how your ability to dismiss “serious and informed discussion” is in direct proportion to your inability to ably interject an actual answer to said discussion.
            Hills-criteria is considered a serious counter to the subluxation-construct. As you and other hubris-filled faux-doctor-renegades are want to suggest, subluxation is NOT part of your “modern, reformed” chiroquacker purview. Yet none of you will actually tell us how YOU practice, WHY anyone would bother spending their money on your escapades (vs a PT or exercise physiologist etc).
            And why whatever the hell you do DO, required a 4 year, non-transferable $200K “education” vs opening a gym and selling fitness-memberships? If chiroquackery IS NOT hunting-and-killing subluxations (fixations, blockages, impaired motion etc etc) then WTF is it really? Clearly you don’t know.

          • I don’t recall dismissing serious and informed discussions.

            The public is free to choose who they see for their problems. If they want to see a PT, sobeit…they can help some people.

            However, “In 2011, only about 11.7 million adults took advantage of outpatient physical therapy services (according to this resource), which means only 9.58% of the people who could have benefited from our services ever received them.“. https://www.webpt.com/blog/post/7-thought-provoking-facts-about-physical-therapy-you-cant-ignore

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