Most chiropractors claim they can effectively treat a wide range of conditions. I have looked far and wide but I fail to see sound evidence to show that this assumption is true. On a good day, I might agree that chiropractic works for back pain (but this would need to be a very good day and I would need to close at least one eye) – and that’s basically it! Unsurprisingly, chiropractors vehemently disagree with me. Yet, they have an all too obvious conflict of interest in that question and, therefore, they are unlikely to be objective.
One regular commentator of this blog recently reminded me that the UK ‘ADVERTISING STANDARDS AUTHORITY’ (ASA) state on their website that based on all evidence submitted and reviewed to date, the ASA and CAP accept that chiropractors may claim to treat the following conditions:
- Ankle sprain (short term management)
- Elbow pain and tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
- Headache arising from the neck (cervicogenic
- Joint pains
- Joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
- General, acute & chronic backache, back pain (not arising from injury or accident)
- Generalised aches and pains
- Mechanical neck pain (as opposed to neck pain following injury i.e. whiplash)
- Migraine prevention
- Minor sports injuries
- Muscle spasms
- Plantar fasciitis (short term management)
- Rotator cuff injuries, disease or disorders
- Shoulder complaints (dysfunction, disorders and pain)
- Soft tissue disorders of the shoulder
- Tension and inability to relax
This is an impressive yet very odd list:
- Why is ‘joint pain’ listed twice?
- Can lateral epicondylitis arise from musculoskeletal conditions of the back and neck?
- What exactly are ‘generalised aches and pains’?
- Isn’t lumbago and backache the same?
- Are ‘minor sports injuries’ (including a cut, bruise or haematoma?) a category that is well-defined?
- What is a ‘soft tissue disorders of the shoulder’
But let’s not be pedantic. Let’s assume these are all defined conditions that need to be treated. The problem still remains that there is hardly any good evidence that they can be effectively treated by chiropractic spinal manipulation (in case you disagree, please post the evidence in the comments section).
And here we come to the crux of the matter, I think.
Chiropractors would say that they use so much more than spinal manipulations.
- For a sport injury, they might apply an ice-pack.
- For the inability to relax, they might give a massage.
- For rotator cuff problems, they might administer exercises.
- For tennis elbow, they might recommend immobilizing the joint.
- Etc., etc.
But that’s not chiropractic!
Yes, it is what we do, insist the chiropractors.
I do not doubt it, but survey after survey shows that chiropractors treat almost all their patients with spinal manipulation. And the history of chiropractic is purely based on spinal manipulation. Yes, today they also use treatments borrowed from other disciplines, yet spinal manipulation is the treatment that defines them.
Let me try an example to make my point clear. Imagine a surgeon who specialises in an obsolete type of operation (e.g. ligation of the mammary artery as a treatment of coronary artery disease). Following the chiro-logic, he could claim that:
- my approach is not ineffective because I do so much more than just operate,
- I also prescribe medications,
- I give dietary advice,
- I give nutritional advice,
- I recommend relaxation,
- I suggest regular exercise.
And the results would, of course, show that many of his patients benefit from all this.
Does that mean our surgeon provides effective care for his patients?
Similarly, crystal healing could be seen as being effective, because some crystal healers tell their obese patients to eat less and exercise more?
So, the above-cited list of claims that the ASA now allows UK chiropractors to make is either way too long or much too short – in any case, it is nonsense. If we base it on the proven effectiveness of spinal manipulation, it must be very short indeed. If we base it on everything chiropractors might do in addition, it is far too short; in this case, it should include everything in the medical textbooks from AIDS to ZOSTER (I cannot imagine many conditions for which life-style advice, exercise or cryotherapy [for pain-control] etc. would not be helpful).
My conclusions from all this are as follows:
- Chiropractors have tried to reinvent themselves by borrowing some treatments from other healthcare professions.
- They have done this, I suspect, to avoid being judged by their largely ineffective hallmark intervention, spinal manipulation. The move may be commercially clever, but it is nevertheless transparently nonsensical and wholly unconvincing.
- Chiropractors must be judged not by the treatments they borrowed and might use occasionally, but by the only therapy that is inherent to chiropractic: spinal manipulation.
- And spinal manipulation is certainly not effective for a wide range of conditions.