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

The Canadian Chiropractic Association (CCA)… published a report to support clearer understanding of the chiropractic profession… Here are a few crucial quotes (in bold print) from this document (my are comments in normal print).

Put simply, chiropractors are spine, muscle and nervous system experts specifically trained to diagnose the underlying cause and recommend treatment options to relieve pain, restore mobility and prevent re occurrence without surgery or pharmaceuticals…

By this definition, I am a chiropractor! – and so are osteopaths, physiotherapists, several other SCAM practitioners, and most doctors.

… there is a concept in the pharmaceutical industry known as a risk-benefit analysis which is used to assess how much benefit a medication has compared to the potential risk. The riskier the medication, the less likely it will become mainstream.(2)

The concept of risk/benefit analysis applies to all medicine. It needs, of course, good knowledge of both the risks and the benefits. The second sentence of this paragraph is nonsense and suggests that the CCA fails to understand the concept.

Spinal manipulations should be recommended for patients when a similar risk-benefit assessment has been conducted. This assessment on the safety of chiropractic treatments is performed via the patient intake form and physical examination.

As there is no reporting system of adverse effects of spinal manipulations, a risk/benefit analysis is impossible. The second sentence of this paragraph is nonsense; there are no examinations that tell us about the risks of spinal manipulation.

Adverse reactions lasting less than 24 hours include headaches, stiffness, fatigue, local pain, prickling sensation, nausea, hot skin/flushing, and fainting. In up to 50% of patients, one or more of these have been reported over the span of a lifetime.(3, 4)

Perhaps adverse reactions last ON AVERAGE 24 hours; they can last up to 3 days.  About half of all patients experience such reactions.

Exact numbers on adverse events from chiropractic manipulation are difficult to extract due to variables such as research design, inclusion criteria and study selection. There is still a lot of research to be conducted on the role of spinal manipulation in individuals with serious adverse events.

The frequency of adverse events is unknown because there is no adequate reporting scheme.

Chiropractic treatment is a safe option for the prevention, assessment, diagnosis and management of musculoskeletal conditions and associated neurological system. Canadian chiropractors have over 4,200 hours of core competency training in the musculoskeletal system. It is up to each individual patient and their healthcare provider to assess the safety of chiropractic treatments and potential risks associated, and decide if spinal manipulation is right for them.

There is no good evidence that chiropractic treatment is safe.

There is no good evidence that chiropractic treatment is effective for disease prevention.

Chiropractic treatment is an option for assessment and diagnosis??? This is another nonsensical claim.

Chiropractic treatment is an option for associated neurological system??? Another nonsense!

Each individual patient and their healthcare provider assessing the safety is not an option.

References used in the quotes:

2 Risk: benefit analysis of drugs in practice Drug and Therapeutics Bulletin 1995;33:33-35.

3 Non-drug management of chronic low back pain Drug and Therapeutics Bulletin 2009;47:102-107.

4 Gibbons P, Tehan P. HVLA thrust techniques: what are the risks? International Journal of Osteopathic Medicine. 2006 Mar 1;9(1):4-12.

The references cited are pitiful!

In conclusion, I suggest the CCA re-read their statement and revise it according to the evidence, common sense and the rules of the English language. As it stands, it’s just too embarrassing – even for chiropractic standards!

30 Responses to A truly pitiful statement by the ‘Canadian Chiropractic Association’ about the safety of chiropractic

  • SMT might indeed “be right for them”, and can be offered by osteopaths, physiotherapists, doctors etc.
    But that begs the question: What is the added value of ‘chiropractic’? Why should ‘chiropractic’ be an ‘option’?

    If patients do want their ‘innate intellegence’ freed up, I guess they might ask a chiropractor to do the business (no other practitioner would claim to be able to do that) – but otherwise, what’s the point of chiropractic?

    Do we really have to go on asking these questions? Isn’t it time chiropractors moved on and qualified as physiotherapists or doctors? Or entered some other profession which values integrity more highly.

    • From what I’ve been told, here in the states DO and DPT programs will not put DCs on a fast track program. They would have to start a new from day one. So really what is the incentive…do go further in debt to earn about the same income as a DPT? To seperate themselves from the quacky side of the profession? To be able to use approaches to address nonspecific spine issues that have the same amount (sometimes less) evidence than what they currently do?

      I do know some who went on to become MDs and DPTs. They say the grass isn’t any greener.

    • Although I’m not a chiropractor, with reference to physiotherapists, most Physios have forgotten or are not trained to use there hands adequately .Exercise is there main skill,which is needed,but not on its own. Even doctors have very little training in the art of palpation.
      Regarding doctors; we all need them, but don’t think they are the only answer.Over 100,00 Americans died last year taking prescribed medications at there prescribed dosage. Regarding research and and evidence: unless you have vast amounts of money available to fund research projects which only mainstream medicine seems to have,including physiotherapy, “absence of evidence isn’t necessarily evidence of absence”.
      Mr Ernst is not the only authority worth considering on the subject of complimentary or alternative medicine and no one has all the answers.
      I

    • Knee surgeries and others do not do randomized controlled trials. They have little or no evidence..often make people worse. Very unsafe.
      Chiropractic is great..changes so many lives..and is safe. The professional indemnity insurance premiums prove this compared to physio ur surgery premiums.
      Silly opinions by Eddie the eagle…angry little man

  • Right on! I say add a six-week manipulation/spinal-adjusting class to barber-school. Problem solved. At least you’ll look good when they’re finished.

  • EE…The second sentence of this paragraph is nonsense; there are no examinations that tell us about the risks of spinal manipulation.

    True as stated (albeit a silly worded retort). However, there are examinations which can indicate a potential increase risk of an AE.

    Example…

    https://jaoa.org/article.aspx?articleid=2093276

  • “to put it simply”….oh, thank you, thank you so much….

  • The college is a joke. So are a lot of chirpractors. But so are a lot of physios and more then alot of socialist medical doctors. Sometime even internet blog posts sound like a Hilary trump conversation by Cleetus and Igor. There should be adjusting standards… I have no clue where that data comes from that they mention. 22 ish years and practice and yes some people get worse before they get better. So e people I can’t help. No I don’t use the word inatte or subluxation. I wish there was massive studies on things. Like proof of narcotics for chronic pain management. Or proof u should be giving clients core exercises before u correct the biomechanical abnormalities of their back/pelvis. You know what…. I would love a study that showed how bad parenting and grand parenting are ruining children’s spines by giving them too much cell phone and tablet time… Sometimes people’s version of common sense is different. MPGA….

  • No one is forcing Chiropractic on the world. Those if us who see bennefit can choose it and those who dont can reflect it. Just because you dont understand it, doesnt mean it is ineffective. In truth, science has only the sketchiest idea of how the body works and all forms of medicine are based more on trial and error than on true engineering.

  • In not a fan of chiro, and I believe that more work is needed to establish its risks, but I do object to the ‘no good evidence’ argument. The absence of evidence is not evidence,in either direction. It is merely the absence of research and effort. If you are going to critique on scientific grounds, you weaken your argument when you use rhetorical instruments that defy scientific principles. If your thesis is that chiro is unsafe, then provide the evidence for that.

    • Well stated. For the record, there is lots of Chiro evidence. Doing double blind testing is difficult because doing a placebo adjustment.is impossible.
      A former prime Minister if Canada once told me “Chiropractic … I dont understand it but I know that it works”. My experience has been the same.

    • But Chiropractic claim evidence – they use all the scientific/medical jargon to justify themselves and their claims- calling themselves doctors is just a small example.

  • Here is on from the JAMA
    https://jamanetwork.com/journals/jama/fullarticle/2616395

    Here are two from NCBI
    https://www.ncbi.nlm.nih.gov/pubmed/20184717
    https://www.ncbi.nlm.nih.gov/pubmed/15556955
    I am wasting my time posting these, however, you are going to RIP them apart and criticize them. Let’s just remember that the standard of acceptance for medications is often only a 1% improvement in absolute terms.

    I am a professional Engineer. I cant fix a machine I dont understand. I can tinker with it and over time I can record what actions have what effects and side effects. That does not mean I understand how it works.
    The human body is that machine. No one knows how it works, we just create and update simplistic models based on evidence. Even germ theory is flawed. If exposure to gems was the cause of disease, it stands to reason that doctors and nurses would be sick all the time. We are just guessing.

    • 1) https://edzardernst.com/2017/04/spinal-manipulation-for-acute-low-back-pain-a-new-meta-analysis-is-damning-it-with-faint-praise/
      2) https://edzardernst.com/2014/02/the-alchemists-of-alternative-medicine-part-5-pseudo-systematic-reviews/
      3) has been criticised by others many times;
      interesting comment about the ‘germ theory’. only chiros call it thus these days, I think.
      are you a ‘germ theory denier’?

    • @Scott Dalrymple

      If exposure to gems was the cause of disease, it stands to reason that doctors and nurses would be sick all the time. We are just guessing.

      This has to be one of the dumbest comments I’ve ever seen on this blog. Microbes (parasites, fungi, bacteria and viruses) cover a wide spectrum of virulence, from almost inevitably causing disease (e.g. smallpox virus) to living as human commensals (e.g. the gut microbiota). Humans individually represent an equally wide spectrum of resistance to infection, from being very seldom infected (intact epithelial barriers, nonspecific antimicrobial substances, innate immune responses based on dendritic cells, macrophages, monocytes and neutrophils) to being infected even by the mildest commensal microbes (people with major deficits in any or all of those antimicrobial defence mechanisms).

      Your comment is not just totally ignorant: it is a vicious insult to the people who’ve been researching infectious diseases for more than a century and have already explained in great detail many of the the complex interactions of individual microbial virulence factors with individual components of human antimicrobial defences.

      • Well that is certainly a stretch. You have an interesting method of debate.
        Since you have taken the gloves off an made this a personal attack, I will join in.
        I know many well educated people with lots of degrees. One in particular has multiple doctorates and recently shared the Nobel prize for Physics. NONE OF THEM USE ALL THEIR POST-NOMINAL LETTERS. THE FACT THAT YOU DO IS EITHER SNOBBERY OR INSECURITY. IT IS THE ACADEMIC WORLD’S EQUIVALENT TO SMALL PENIS SYNDROME (URBAN DEFINITION).

        • “NONE OF THEM USE ALL THEIR POST-NOMINAL LETTERS. THE FACT THAT YOU DO IS EITHER SNOBBERY OR INSECURITY.” Huhh? When have I ever used my post-nominal letters on this blog? Since I retired 10 years ago I don’t use them at all!

          How about giving a reasoned response to the points I raised?

    • I managed to omit to mention after ‘innate immune responses’ the specific immune responses based on T- and B-lymphocytes, which create long(er)-lived immunity to reinfection by the same microbe.

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