osteopathy
So-called alternative medicine (SCAM) likes to present itself as a champion of disease prevention. Its advocates routinely claim to promote health before disease develops, to strengthen the body’s defences, and to address root causes rather than symptoms. This rhetoric is highly attractive, because prevention sounds proactive, humane, and economical. Crucially, it is also good for the SCAM practitioner’s bank account. Yet there is a snag: almost none of the preventive claims made for SCAM are supported by reliable evidence, whereas the prevention that works comes overwhelmingly from conventional medicine and science.
To show preventive benefit, an intervention must demonstrably reduce the incidence of symptom, disease, complication, or mortality in properly designed studies. That may require randomised trials, epidemiological studies, large cohorts, reproducible findings, and enough follow-up to show that fewer people actually experienced the given endpoint. Mainstream medicine has repeatedly met this standard. Immunization, blood pressure control, smoking cessation, lipid lowering, cancer screening, and risk-factor modification are all products of biomedical research, not of alternative healing traditions.
SCAM, by contrast, tends to use prevention in a loose, impressionistic, and unfalsifiable way. A practitioner may claim that a treatment “balances energy,” “supports immunity,” or “keeps the body in harmony,” but such phrases do not establish a preventive effect. They are placeholders for evidence, not evidence itself. In practice, the absence of disease after treatment is treated as proof that the treatment worked, even though the same outcome occurs every day without any intervention at all.
Acupuncture is a good example. Its defenders portray it as a preventive system capable of preserving general health or warding off illness, but the evidence base does not support that claim. Some reviews do suggest that acupuncture may help with some pain-related and symptom-focused conditions, yet its preventive value is largely unproven. I am not aware of solid evidence to show that acupuncture prevents anything – but, if I am wrong, please do correct me.
Chiropractic care is even more revealing because preventive claims are often tied to the doctrine of spinal “subluxation” and nervous system dysfunction. Yet the literature on prevention is thin and methodologically weak. I am not aware of solid evidence to show that chiropractic prevents anything – but, if I am wrong, please do correct me.
Herbalism benefits from the romantic appeal of “natural” remedies, but that appeal should not be confused with demonstrated preventive efficacy. Individual plant compounds have certainly inspired real drugs, yet that is a triumph of pharmacology, not of herbalism as a system. When herbal medicines are tested for prevention, results are usually weak, inconsistent, or insufficient to support recommendation. I am not aware of solid evidence to show that herbal medicine prevents anything – but, if I am wrong, please do correct me.
Homeopathy is one of the most extreme cases within SCAM. It is often sold as gentle, individualized, and even preventive, but its basic principles are scientifically implausible, and its clinical evidence is either flawed or negative. Preventive homeopathy, including ideas such as “homeoprophylaxis,” is particularly problematic because it can give people a false sense of security while displacing interventions that genuinely prevent disease, such as vaccination. I am not aware of solid evidence to show that homeopathy prevents anything – but, if I am wrong, please do correct me.
SCAM speaks almost constantly about prevention, but the evidence for actual preventive benefit is close to non-existent. What we know about prevention, what truly reduces disease incidence and improves population health, comes from conventional medicine, epidemiology, public health, and biological science. SCAM will no doubt continue to borrow the language of medicine and prevention, but – as far as I can see – it has failed to supply the proof.
Spinal manipulative therapies, including chiropractic and osteopathic maneuvers, are widely practiced for musculoskeletal complaints. However, serious complications such as cerebrospinal fluid (CSF) leak with subsequent intracranial hypotension (IH) have been described. The pathophysiological mechanism is presumed to involve mechanical stress on the spinal dura during high-velocity movements, leading to dural tears, particularly in the cervicothoracic region.
A team of Italian neuroscientists conducted a scoping review in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines, through a comprehensive search of PubMed and Scopus. They complemented the review with an illustrative case from their own institution.
The researchers identified 21 eligible papers, including 21 patients with IH following spinal manipulation. Most patients were women (81%), aged 29-54 years, and the majority underwent cervical maneuvers.
SMT techniques vary, most often involving high-velocity cervical maneuvers. The most frequent were axial tension with rotation in seven cases (33.3%), unspecified cervical manipulation in four cases (19%), and thoracic spinal manipulation in two cases (9.5%). Less common single-case techniques included rotation with hyperextension, combined cervical and thoracic mobilization, axial tension with lateral flexion, and occipital/shoulder tension technique (n = 1 case each).
Symptom onset was typically within the first week, and all presented with orthostatic headache, often accompanied by nausea, neck pain, tinnitus, or visual disturbances. Neuroimaging consistently revealed features of IH, with pachymeningeal enhancement and subdural collections as the most frequent findings; spinal imaging frequently demonstrated extradural CSF collections. Management was conservative in about one-third of cases, but most required epidural blood patching, which was effective in the majority. Surgical repair was necessary in rare, refractory cases, particularly in the presence of structural spinal abnormalities. Overall prognosis was favorable, with 95% of patients achieving full recovery.
The authors’ illustrative case highlights the potential for severe complications such as subdural hematomas and recurrence if the underlying leak is not addressed:
A 65-year-old patient without a previous history of headache presented with a progressively worsening headache, with orthostatic features, poorly responsive to medical therapy, that has lasted for the past 20 days. The patient denied any recent trauma. He reported having undergone cervical osteopathic manipulations within the past 3 months for recurrent cervicalgia. A brain MRI without contrast was performed, showing a large bilateral subdural hematoma with significant mass effect on the cortical gyri. The patient was admitted to the emergency department and underwent neurosurgical evacuation of a bilateral chronic subdural hematoma via burr holes. Subsequently, endovascular embolization of the middle meningeal arteries was performed as an adjunctive treatment to reduce the risk of recurrence. The surgical procedure was performed without complications. A cranial CT scan showed a reduction in the volume of the hematoma. Therefore, the patient was discharged. However, after a transient improvement in the symptoms, the patient continued to present a fluctuating headache without positional features, with four to five episodes per month. He was readmitted to our clinic and, upon arrival at the ER, a head CT scan showed an increase in pneumocephalus and a recurrence of the hematoma. The following day, an MRI of the neuraxis with contrast was performed, which revealed radiological findings suggestive of IH: pachimeningeal enhancement, subdural fluid collection, dural venous engorgement, cervical spinal longitudinal extradural collection, and effacement of the suprasellar cistern. The Bern score was 7. Given these findings, a surgical revision of the previous burr holes was performed without periprocedural complications. After the first day, a non-targeted epidural blood patch (EBP) was performed under local anesthesia by injecting 16 mL of autologous blood into the L3–L4 epidural space. The procedure was uneventful. A cranial CT scan showed satisfactory surgical outcomes, highlighting a reduction in the volume of the hematoma and of the pneumoencephalus. The patient was subsequently discharged with complete resolution of the headache.
The authors concluded that clinicians should recognize the possibility of CSF leaks after spinal manipulation, especially in patients with new-onset orthostatic headache.
I feel compelled to point out that, considering the multiple risks of upper spinal manipulations and the almost total lack of evidence of benefit from such treatments, the risk/benefit balance of spinal manipulation is clearly not positive. It follows, I think, that it would be wise for patients not to allow such therapies being carried out, and for healthcare professionals to discourage them.
The ‘Smallwood Report‘, entitled “The Role of Complementary and Alternative Medicine in the NHS” was published in October 2005. It recommended greater integration of so-called alternative medicine (SCAM) into the UK’s National Health Service and to address “effectiveness gaps” in treating chronic and psychosocial conditions, claiming potential cost savings.
Its core recommendations were:
- NICE assessment: Urged Health Ministers to task the National Institute for Health and Clinical Excellence (NICE) with a full review of the cost-effectiveness of therapies like acupuncture, chiropractic, osteopathy, herbal medicine, and homeopathy.
- Targeted applications: Suggested these SCAM options for lower back pain (manipulative therapies over conventional), asthma (homeopathy), common colds (echinacea), and other chronic issues where orthodox medicine falls short, potentially reducing absenteeism and NHS costs by hundreds of millions.
- Implementation steps: Promote GP referrals to SCAM, target deprived communities, prioritize research on cost-effectiveness/safety, address regulatory barriers, and use case studies showing reduced GP visits and secondary care savings.
At the time, I called its evidence “grossly misleading,” citing ignored Cochrane reviews showing no superiority for most of the claims. Many critics agreed with me, and the Lancet editor Richard Horton famoulsy called it “dangerous nonsense”.
As the recommendations were pure BS, it is comforting to note that – 20 years later – they have been largely ignored.
NICE assessments:
NICE has issued selective endorsements—e.g., acupuncture and manipulative therapies for low back pain—but stopped short of broad SCAM evaluations, often citing “insufficient evidence” or requiring further trials, directly countering the report’s call for comprehensive cost-effectiveness reviews. No large-scale NICE program emerged to validate the report’s claimed savings (hundreds of millions annually), and guidelines frequently dismiss or deprioritize unproven modalities like homeopathy.
NHS integration status:
- Limited GP referrals: Sporadic pilots exist (e.g., acupuncture in some pain clinics, osteopathy/chiropractic for musculoskeletal issues), often GP-led and adjunctive, but not systematic; social prescribing now favors mindfulness over traditional SCAM.
- Funding barriers: Most Integrated Care Boards (ICBs) classify SCAM as “low priority” absent robust evidence, funding only exceptional cases in palliative or pain management pathways; many services closed due to austerity post-2010.
- No deprived-community focus: The report’s equity push for high-need areas saw negligible uptake, with barriers like clinician resistance and regulatory hurdles persisting.
The report’s optimistic case studies (e.g., Glastonbury) proved anecdotal and unscaled, undermined by critiques highlighting flawed evidence (e.g., ignored Cochrane reviews). Today, NHS policy emphasizes evidence-based conventional care, with SCAM relegated to private or niche settings – realization sits at ~10-20% for endorsed therapies, 0% for broader vision.
In other words, ignoring the report has saved the NHS many millions. More importantly, it has prevented UK evidence-based healthcare from getting watered down by ineffective therapies.
Could that also have happened without my loud protests (e.g. here and here) at the time?
Nobody can know for sure?
But when I feel a little bit down, I tell myself that I had an important role in saving the UK millions!
The aim of this study was to determine the effectiveness of spinal manipulation and clinician-supported biopsychosocial self-management vs medical care for adults with increased risk of chronic disabling LBP.
This 2 × 2 factorial randomized clinical trial enrolled participants in 3 research clinics at the Universities of Minnesota and Pittsburgh from November 2018 to May 2023; final follow-up was in June 2024. Adults with acute or subacute LBP at moderate to high risk of chronicity based on the STarT Back tool were randomized to 1 of 4 groups, with interventions lasting up to 8 weeks. Statistical analysis was conducted from November 2024 to June 2025.
These interventions were:
- Spinal manipulation therapy (n = 201),
- supported self-management (n = 305),
- combined supported self-management with spinal manipulation (n = 193),
- guideline-based medical care (n = 301).
Physical therapists and chiropractors provided spinal manipulation and supported self-management.
The 2 primary outcomes averaged over a follow-up of 1 year were monthly low back disability (Roland-Morris Disability Questionnaire) and weekly pain intensity (numerical rating scale). Secondary analysis examined the proportion of participants achieving a 50% or higher reduction in the primary outcome measures.
Among the 1000 participants randomized (mean [SD] age, 47 [16] years; 58% female), 93% completed the trial. The omnibus test for differences across the 4 treatment groups was statistically significant for disability (P = .001; supported self-management, 4.7; spinal manipulation, 5.5; combined supported self-management with spinal manipulation, 4.8; medical care, 5.9) but not pain intensity (P = .16; supported self-management, 2.8; spinal manipulation, 3.0; combined supported self-management with spinal manipulation, 2.8; medical care, 3.0). Averaged over 12 months, LBP disability was significantly lower compared with medical care for supported self-management (mean difference, −1.2 [95% CI, −1.9 to −0.5]) and supported self-management with spinal manipulation (mean difference, −1.1 [95% CI, −1.9 to −0.3]) but not spinal manipulation alone (mean difference, −0.4 [95% CI, −1.2 to 0.4]). Group differences in pain intensity were not statistically significant; point estimates ranged from −0.2 to 0. Both supported self-management groups had higher proportions of patients achieving a 50% or greater reduction in disability (supported self-management, 67%; spinal manipulation, 54%; combined supported self-management with spinal manipulation, 65%; medical care, 54%).
The authors concluded that for patients with acute or subacute LBP at increased risk of chronic disabling LBP, clinician-supported biopsychosocial self-management showed statistically significant but small reductions in disability, but not pain, vs medical care over 1-year follow-up, and spinal manipulation alone showed no significant difference for either outcome.
These findings are very bad news for chiropractors (the profession that uses spinal manipulations more than any other): spinal manipulation does not generate effects that are in the least convincing. This is particularly remarkable, since the study was not blinded. It means that, even the undoubtedly powerful placebo effect associated with spinal manipulation did not render the outcome more favourable.
I said it many times, and I will say it again: For LBP, many therapies generate similarly marginally positive effects but no treatment is truly convincing. In this situation, we should choose one that is at least inexpensive and free of severe adverse effects. And that evidently cannot be spinal manipulation!
Von Willebrand disease (VWD) is the most common inherited bleeding disorder and predisposes patients to hemorrhagic complications following trauma or invasive procedures. Chiropractic spinal manipulation is widely used for musculoskeletal pain; however, serious complications have been reported, particularly in patients with underlying coagulopathies.
Iliopsoas hematoma with secondary femoral neuropathy is an uncommon but potentially disabling condition. A team of US doctors present a clinical case highlighting this rare complication following chiropractic manipulation in a patient with VWD and review the relevant literature. They describe the clinical course and follow-up of a 32-year-old female patient with known VWD who developed acute neurological deficits after chiropractic manipulation. Imaging findings were analyzed using radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). Hematoma volume was calculated using the ABC/2 formula, which has been well validated and shows a high correlation with volumes calculated using planimetric techniques.
After chiropractic manipulation, the patient developed severe lumbar and inguinal pain, followed by progressive weakness and sensory impairment of the left lower limb. Imaging revealed a large left iliopsoas hematoma measuring approximately 896 cc, causing femoral nerve compression. Management included coagulation factor replacement, pain control, and interventional radiology-guided drainage, resulting in significant hematoma reduction and neurological improvement. At the six-month follow-up, residual neuropathy and muscle atrophy persisted, although functional recovery was evident.
The uthors concluded that patients with VWD are at high risk for severe hemorrhagic complications even after seemingly minor manipulative therapies. Chiropractic spinal manipulation may precipitate life-threatening or disabling bleeding events in this population. Early recognition, appropriate imaging, correction of the coagulopathy, and multidisciplinary management are crucial to optimize outcomes. This case highlights the importance of patient counseling, risk stratification, and caution when considering alternative therapies in individuals with inherited bleeding disorders.
The list of complications, including fatal ones, after chiropractic manipulations is long – very long. That they can cause iliopsoas hematoma with secondary femoral neuropathy was new to me. The lesson here seems relatively simple: if you have a bleeding abnormality, avoid chiropractic manipulations at all costs!
This, of course, raises an interesting question:
Considering that ~25% of the general population have some sort of clotting abnormality, do chiropractors routinely check whether their pations have normal blood clotting?
Somehow, I doubt it.
The authors found very low‐certainty evidence (downgraded for study limitations, inconsistency, and imprecision) that SMT may result in a medium reduction in pain compared to no treatment at one month (MD ‐13.99, 95% CI ‐27.33 to ‐0.66; I2 = 89%; 4 studies, 325 participants), but the evidence is very uncertain. They found low‐certainty evidence (downgraded for study limitations and imprecision) that SMT may result in a large improvement in functional status compared to no treatment at one month (SMD ‐0.84, 95% CI ‐1.32 to ‐0.35; I2 = 71%; 4 studies, 312 participants).
SMT versus other conservative interventions
Low‐certainty evidence (downgraded for inconsistency) indicated that SMT may result in little to no difference in pain (MD ‐4.72, 95% CI ‐8.26 to ‐1.17; I2 = 89%; 31 studies, 4109 participants) and may result in a small improvement in functional status (SMD ‐0.25, 95% CI ‐0.38 to ‐0.11; I2 = 73%; 28 studies, 3940 participants) compared to other conservative interventions at one month.
These effects, however, should be interpreted with caution due to the substantial statistical heterogeneity for which there is no clear explanation.
Less than half of the studies (47%) reported on adverse events, of which 12 studies reported these systematically. Adverse events in the SMT group were limited to muscle soreness, stiffness, and/or transient increase in pain. None of the studies registered any serious complications related to either the experimental or control group treatment. The evidence is very uncertain about the adverse effects of SMT.
Authors’ conclusions: When SMT is compared to sham SMT/placebo, it may result in a small improvement in pain and medium improvement in functional status in adults with chronic low back pain. When compared to no treatment, SMT may result in a medium improvement in pain and a large improvement in functional status. When compared to other conservative interventions, SMT may result in little to no difference in pain and a small improvement in functional status. The evidence is of low to very low certainty, largely due to the fact that the effects of SMT were examined in trials conducted in different settings and populations, with different types of SMT technique, dosage, and frequency of treatment. Continuing to conduct RCTs in the same manner will neither strengthen the evidence nor our confidence in it.
Once again, it has been confirmed that most trials of SMT are, because of their failure to report adverse effects, in violation of ethical standards. But the importance of this excellent review lies elsewhere. Despite 76 published RCTs, there is huge uncertainty about the benefits of SAM. What should we make of this fact?
In my view, it highlights that:
- the studies are often of poor quality;
- the effect of SMT are so small that they are negligibel;
- patients with back pain should look for treatments that are safe and effective;
- the choice can therefore not be SMT.
In the UK, honours for so-called alternative medicine (SCAM) are relatively rare and unsurprisingly controversial. Recently, I reported that Robin Daly, has been awarded an MBE in recognition of his outstanding contributions to the field of integrative cancer care and his tireless work through ‘Yes to Life’.
Since the 2026 New Year’s honours list is just out, I thought it would be interesting to see who else has been given a ‘gong’.
There seems to be nobody in the current list – so, let’s see who in the realm of SCAM has been honoured previously. Here is what I found:
Christina Cunliffe received an OBE in the 2025 ‘King’s Birthday Honours List’ for her 25-year career in developing chiropractic education in the UK and internationally.
Richard Brown got an MBE in 2021 for services to disability and a Lifetime Achievement Award in 2025 for his global impact on the chiropractic profession.
The late George Lewith was given a CBE in 2017 for “Services to Health Research and Complementary Medicine.”
Michael Dixon was honoured twice (2015 and 2024) for his personal service to the Royal Family and his work with the College of Medicine promoting holistic care.
Peter Fisher received an CVO in 2018 for personal service to the Queen as her homeopathic physician.
Christopher Hedley received an MBE in 2015 for services to the profession of herbalists and herbal education.
Simon Fielding was awarded his OBE in the 1998 for his services to osteopathy.
As we see several of these people have also received another honour: they are in my ‘ALTERNATIVE MEDICINE HALL OF FAME’!
Coincidence?
Who knows?!
The above list is surprisingly short, and I am almost certain that it is woefully incomplete. Since it would be nice to have a more complete list, I ask my readers to name other SCAM professionals who have received a gong in the past.
The objective of this systematic review was to investigate trustworthiness, i.e. the methodological rigor, transparency, good governance, research integrity, and absence of misconduct, of randomized clinical trials (RCTs) of osteopathic manual therapy.
The team searched MEDLINE, EMBASE, CINAHL, AMED, PEDro, ostmed.dr, and Chiroindex for RCTs evaluating osteopathic treatments (January 2021-June 2024). Risk of bias (RoB) was assessed using Cochrane tool 2, while trustworthiness was assessed with the Cochrane Pregnancy and Childbirth Screening Tool and the REAPPRAISED checklist. Journal trustworthiness, misleading representations in abstracts (“spin”), and results plausibility (via meta-analysis) were also assessed. Findings were synthesized descriptively.
Sixty-one RCTs were included (median sample size 45, interquartile range (IQR) 30-76), largely studying healthy volunteers (29%). The findings are sobering:
- Most had high RoB (74%).
- Only 7% acknowledged potential conflicts from authors’ professional ties.
- Only 27% of contactable authors engaged with reviewers.
- Only 7 abstracts (12%) were free of spin.
- Methodological concerns included poor missing data handling (31%), selective analyses (38%), unacknowledged multiple testing (36%), and outcome switching (12%).
- Meta-analysis found two outliers and 5 further with very large effects.
- 19% of the studies provided inadequate data for pooling.
- Limitations included incomplete reports and lack of validated trustworthiness assessment tools.
The authors concluded that adherence to best practices in osteopathic RCTs needs improvement to enhance evidence-based decision-making, reduce research waste, and enhance reproducibility. Further research should explore whether these findings apply to other small, under-resourced fields.
Considering that many of the authors are affiliated to osteopathic institutes, this is a remarkably critical review. Its results cannot surprise anyone who regularly studies the literature in this field. What is surprising, however, is the conclusion: ADHERENCE TO BEST PRACTICES NEEDS IMPROVEMENT. This is undoubtedly true, but it is not the most direct conclusion of what the data show. In my mind, it should be something more akin to this:
MOST OSTEOPATHIC RCTs ARE OF POOR QUALITY AND THEIR FINDINGS ARE THUS UNRELIABLE.
Colic in infants causes excessive crying in an otherwise healthy and thriving baby. Colic is a common but poorly understood and often frustrating problem for caregivers. The objective of this trial was to study whether osteopathic treatments of infants with infantile colic / excessive crying (IC/EC) have an impact on the subjectively perceived psychological stress of caregivers compared to usual care.
The study was designed as a prospective, multicenter, randomized controlled trial. Infants aged 1 week to 3 months and who met Rome IV criteria for IC/EC were included. By means of external randomization, infants were allocated to an intervention group or a control group. Infants in the intervention group received three osteopathic treatments at intervals of one week. The treatments were custom-tailored and based on osteopathic principles. Controls received their osteopathic treatment after a 3 week untreated period. The primary outcome parameter was the assessment of parental psychological stress (three questions), measured using a numeric rating scale (NRS; 0-10). Furthermore, the average daily crying time (measured using the Likert scale), the crying intensity (measured using the NRS) and the parents’ self-confidence (measured using the Karitane Parenting Confidence Scale) were assessed.
A total of 103 infants (average age 39.4 ±19.2 days) were included, 52 in the intervention group and 51 in the control group. An inter-group comparison of changes revealed clinically relevant improvements in favor of the intervention group for the main outcome – parameter psychological stress – for all 3 questions (e.g., for question 2 respectively 3, NRS: between group difference of means 3.5; 95% CI: 2.6 to 4.4; p < 0.001). For the secondary outcome parameters of crying intensity and crying time/day, the changes were of similar magnitude.
The authors concluded that three osteopathic treatments given over a period of two weeks led to statistically significant and clinically relevant positive changes of parental psychological stress.
This is a cleverly designed study. I say ‘cleverly’ because the casual reader might not even notice that it compared osteopathic treatments with doing nothing. It is well-documented that just hadling babies with IC/EC has an effect on outcomes. Thus the positive effect may not have anything to do with osteopathy and be due simply to the extra attention given to the child. In other words, the positive result of the study was sure even before the 1st baby was entered into the trial.
I am impressed!
Perhaps this study should be in the textbook entitled:
HOW TO CHEAT WITH SEEMINGLY RIGOROUS CLINICAL TRIALS?
Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological condition. The efficacy of medical treatments such as nonsteroidal anti-inflammatories (NSAIDs) or oral contraceptive pills (OCPs) is considerable. However the failure rate can still be as high as 20-25% and there are also a number of associated adverse effects. Many women are thus seeking alternatives to conventional medicine. One popular treatment modality is spinal manipulation.
The objectives of this Cochrane review were to determine the safety and efficacy of spinal manipulations for the treatment of primary or secondary dysmenorrhoea when compared to:
- each other,
- placebo,
- no treatment,
- or other medical treatments.
Electronic searches of the Cochrane Menstrual Disorders and Subfertility Group specialised register of controlled trials, CCTR, MEDLINE, EMBASE, CINAHL, Bio extracts, Psyclit and SPORTDiscus were performed to identify relevant randomised controlled trials (RCTs). The Cochrane Complementary Medicine Field’s Register of controlled trials (CISCOM) was also searched. Attempts were also made to identify trials from the National Research Register, the Clinical Trial Register and the citation lists of review articles and included trials. In most cases, the first or corresponding author of each included trial was contacted for additional information.
Included were any RCTs including spinal manipulative interventions (e.g. chiropractic, osteopathy or manipulative physiotherapy) vs each other, placebo, no treatment, or other medical treatment were considered. Exclusion criteria were: mild or infrequent dysmenorrhoea or dysmenorrhoea from an IUD.
Five RCTs were identified that fulfilled the inclusion criteria for this review. Four trials involving high velocity, low amplitude manipulation (HVLA), and one involving the Toftness manipulation technique were included. Quality assessment and data extraction were performed independently by two reviewers. Meta analysis was performed using odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes. Data unsuitable for meta-analysis were reported as descriptive data and were also included for discussion. The outcome measures were pain relief or pain intensity (dichotomous, visual analogue scales, descriptive) and adverse effects.
Results from the four trials of high velocity, low amplitude manipulation suggest that the technique was no more effective than sham manipulation for the treatment of dysmenorrhoea, although it was possibly more effective than no treatment. Three of the smaller trials indicated a difference in favour of HVLA, however, the only trial with an adequate sample size found no difference between HVLA and sham treatment. There was no difference in adverse effects experienced by participants in the HVLA or sham treatment. The Toftness technique was shown to be more effective than sham treatment by one small trial, but no strong conclusions could be made due to the small size of the trial and other methodological considerations.
The authors concluded that overall there is no evidence to suggest that spinal manipulation is effective in the treatment of primary and secondary dysmenorrhoea. There is no greater risk of adverse effects with spinal manipulation than there is with sham manipulation.
Probably the first question that springs in one’s mind is, WHY ON EARTH COULD SPINAL MANIPULATIONS BE EFFECTIVE FOR THIS CONDITION? Unsurprisingly, the proponents of this approach have come up with several rationales:
- The parasympathetic and sympathetic pelvic nerve pathways are closely associated with the spinal vertebrae, in particular the 2nd-4th sacral segments and the 10th thoracic to the 2nd lumbar segments. One hypothesis is that mechanical dysfunction in these vertebrae causes decreased spinal mobility. This could affect the sympathetic nerve supply to the blood vessels supplying the pelvic viscera, leading to dysmenorrhoea as a result of vasoconstriction. Manipulation of these vertebrae increases spinal mobility and may improve pelvic blood supply through an influence on the autonomic nerve supply to the blood vessels.
- Another hypothesis is that dysmenorrhoea is referred pain arising from musculoskeletal structures that share the same pelvic nerve pathways. The character of pain from musculoskeletal dysfunction can be very similar to gynecological pain and can present as cyclic pain as it can also be altered by hormonal influences associated with menstruation.
I think we can all agree that these theories are very long shots! As it stands, we also do not need to shoot long at all. There is simply no good evidence that spinal manipulations work for dysmenorrhoea. There is thus no need to embark on implausible explanations to justify the notions of Palmer and Still claiming that spinal manipulation is a panacea. The idiocy of this claim has long been established.
The only question that does remain, in my view, is this:
WHEN WILL CHIROPRACTORS AND OSTEOPATHS FINALLY GIVE UP THEIR OUTLANDISHLY WISHFUL THINKING OF THEIR FOUNDING FATHERS?
