chiropractic confusion

[Fontwell]

Apologies for the length and rambling nature of this post and also using 'chiropractic' if it should have been chiropractice or chiropracticy but my spell checker just won't have it...

I know that there have been several threads about chiropractic here already and I have read them with interest but I have to say that I am still unclear on the subject. I'll try to do a bullet point list of my confusions. BTW I'm strictly an evidence based medicine person and have no time for woo but I have come across certain things recently (nothing stunning-see end of post) which have caused me to feel the need to re evaluate my stance on chiropractic, that stance being that it is all twaddle based on more twaddle.

* It has been stated here (jref forum) that there is a higher woo factor in US chiropractic than some other places (UK? Australia? I can't remember which) but is this just the chiropractors doing their own thing and peddling non chiropractic woo, or is it still embedded in the teaching?

* Are there any places that teach completely woo free chiropractic?

* Is that even possible? (See next point)

* What is chiropractic? I have looked it up in various places but I am still confused. What do they actually teach or do that conforms to, or flys in the face of conventional medical opinion. This may need some expanding so I'll split into sub confusions:

* What the heck do they do for the 3 (or whatever) years of training?
* Do they really teach that non spine related illnesses result from spinal misalignment?
* Do they in fact teach some things that are conventional medical opinion, in the way that, say, a physiotherapist learns a lot of medical stuff?
* If they do practice things that are conventional medicine, does that still count as chiropractic?
* The term subluxation seems to be used by some medical people to describe genuine misalignment of bones, such as might occur in a road accident. Is it a real term as well as a quack term in the way that 'energy' gets misused i.e. they mean something completely different?
* For the treatments were they are treating back related problems such as whiplash are their methods subject to something approaching scientific evaluation? (Although It's hard to imagine how a double blind test could be safely achieved.)

I'll stop with the list at this point.

For anyone interested, my state of confusion arose after talking to a chap from Australia who had some form of injury which caused chronic migraines. He also professed to run a mile at the first sign of anything new age, which he admitted would keep him away from the worst sort of chiropractor. So, his GP made pain killers available but obviously this was not a cure. Professional massages gave short term relief only. Chiropractic treatment (x-rays etc) fixed it. Now I know this is anecdotal and also subject to the placebo effect, spontaneous remission and lucky guessing etc. so I wasn't overly impressed. However, because I'm an open minded kind of chap I decided to do at little surfing to see what I could find. (My only previous exposure to chiropractic being its mentions here.)

Well, what surprised me was that a lot of the chiropractic web sites make no mention of blocked energy paths or holistic treatment or other rubbish and they only claimed to treat skeletal related disorders. Also there are what appear to be conventional medicine sites which use the term subluxation. To a non medical observer (me) there didn't appear to be any difference between them.

So this got me thinking, what exactly makes something chiropractic? If a chiropractor correctly fixes a dislocated shoulder in the same way as an MD (I've no idea if they do) is it chiropractic? If a chiropractor uses x-rays to spot a genuine problem and treats it like a physiotherapist would, is that chiropractic? If a chiropractor uses a unique but perfectly effective method it must be chiropractic. Is this what they do? Is it a bit of both? Has it moved on from its woo roots in the same way that medicine has left the quacks (blood letting etc) behind? Also, with the obviously fraudulent chiropractor is there a danger of assuming that because this person is a fraud then chiropractic is a fraud? Let's face it, there are enough loony MDs around to make us aware that we shouldn't necessarily blame a person's training for their faults.

On the other hand, anyone who thinks they can cure cancer by tweaking your back is clearly barking mad.

What's the real story?

 

[CurtC]

I can't answer all your questions, but "subluxation" is a term used by MDs to describe a partial dislocation of a joint. It's misused by chiros, to indicate what they think are vertebrae out of alignment. The trouble is, they can't agree when looking at the same x-ray about where subluxations are. As far as I'm aware, the medical community doesn't recognize spinal subluxations, since you don't really "dislocate" your vertebra. Medical people talk about pinched nerves, bulging disks, and other things that can be objectively observed.

 

[Eos of the Eons]

For anyone interested, my state of confusion arose after talking to a chap from Australia who had some form of injury which caused chronic migraines.

My doctor likes to remind me that most problems will resolve on their own. That said, what form of injury did your chap have? Did he see a physiotherapist at all?

There are studies done that point to chiros being able to help with lower back pain. They do learn something about the back afterall. It's just what they learn really is mixed with woo:

http://www.nycc.edu/acadaffairs/dc_curriculum.pdf

They learn philosophies, but learn nothing of the immune system. They learn of subluxation but can't point out one definitively.

It's woo mixed with physiology.

* Do they really teach that non spine related illnesses result from spinal misalignment?

Yes, or they will imply it causes subluxations that will exacerbate what caused the subluxation...your drug use will cause a subluxation and make you suffer even more and deteriorate faster:

Stress, anger and fear are examples of emotional causes of subluxations. Alcohol, drugs, pollution and poor diet can be chemical causes of subluxations.

http://www.relieveyourpain.com/subluxation.html

A subluxation is a complex of functional and/or structural and/or pathological changes that compromise neural integrity and may influence organ system function and general health.

http://www.kellychiropractic.com/back.html

You won't find any medical schools teaching these things. The lack of proof is too glaring.

* If they do practice things that are conventional medicine, does that still count as chiropractic?

I guess we need some examples here. Chiros are kept busy trying to treat imaginary subluxations. They don't do much else. Even whiplash will be treated as a subluxation. It's all taught with actual proper names for the vertebrae and such, so it sounds very serious and proper. You still can't reconcile it with reality when you try to though.

This experimental study demonstrates conclusively that the subluxation of a vertebra as defined by chiropractic-the exertion of pressure on a spinal nerve which by interfering with the planned expression of Innate Intelligence produces pathology-does not occur . This is what should be expected when one recognizes that the vertebral column has been evolving for over 400 million years to support the body and protect the central nervous system. By a process of natural selection the vertebral column of mammals has evolved into one in which the articulations allow an overall range of motion so that individuals may function well for survival within their environment.

http://www.chirobase.org/02Research/crelin.html

*Has it moved on from its woo roots in the same way that medicine has left the quacks (blood letting etc) behind?

No, and it can't. If it changes it will no longer be chiropractic. It will be conventional medicine, and conventional medicine has left non-evidence based things like bloodletting behind.

 

[Vitnir]

Are all chiropractics evil then? I'm a bit unsure about what to think of it since I have a friend who, if he wakes up in the morning and can hardly get out of bed because of back pain he doesnt bother with a MD. He gets an appointment with a chiropractioner as soon as possible and can get back to work the same day.
When I asked him how it was supposed to work he said the chiropractioner said that his manipulations caused the muscles to "reboot".

 

[steenkh]

As I have stated before, my own chiro is definitely non-woo, and the other one I have ever been to was the same. In fact, nobody I knows here in Denmark has heard their chiro preach woo-woo.

My chiro once told me that the Danish chiros had had a debate about whether they should change their name to distance themselves from the woo-types, but the brand "chiropractor" in Denmark is too strong, so nobody dared to make the move.

But I note that my chiro has his education from the U.S. so there must be some sensible chiros somewhere in that big country!

 

[Fontwell]

Thanks to everybody who has replied already, I need a bit more time to ponder the comments and follow through the various links posted. But I think that with these last two posts I do feel justified in raising the issue again. They seem to be doing something right some of the time as well as doing things badly wrong at others.

I would like to ask steenkh, what does your chiropractor actually do that is different to a regular physiotherapist? Is it the classic sudden jerk type of thing? And if your guys were considering a name change it does sound like there are probably two sorts of chiropractor around.

I can't help thinking that although chiropractic comes from an unscientific idea and much of it may still be nonsense, that they have probably discovered a few handy tricks along the way just by virtue of spending so much time fiddling with people's backs. If a chiropractor just sticks to these things then perhaps they may actually be of benefit. Don't worry though, I'm not going over to the Dark side just yet.

 

[steenkh]

My chiropractor does the traditional jerk-type manipulation plus some sort of massage. He has helped me with an acute cramp in the neck that was treatening a journey I was going at the next day. I arrived by taxi where we had to drive slowly because the slightest movement hurt my neck, and I was holding my head almost for fear that it would break off. After X-rays and treatment I was able to walk to the train by myself, and the journey was safe!

At the time he told me he could see from my X-rays that I also chest pains that I probably felt like heart pains, and I was really amazed because I had suffered from this for almost 20 years, and it was impossible for me to sleep on my left side because of the pains. After the journey, a month later he started treatment of that problem, and that night I fell asleep on my left side for the first time in many years. This last problem came back with time and I went regularly to keep it down, and over the years I have started feeling that the treatment is not really improving anything anymore, but on the other hand I have none of the two symptoms that caused me to start going to him in the first place. He has treated a number of minor problems over the years, but only rarely with the dramatic results that came with the first two visits.

I have of course often wondered if I am paying for a liberal dose of placebo, but I will not be the best judge of that. I am a satisfied customer at my chiropractor's clinic, and that is enough for me.

I have never visited a physiotherapist, so I cannot compare the two treatments. My wife, on the other hand, has suffered from far more problems than I have had, and many years at a number of physiotherapists did never ever bring any improvements. She also experienced some improvements when she visited a chiropractor, though never anything as dramatic as I have. She persuaded me to go the chiropractor in the first place, but hers was closed at the time, so I have another chiro.

Over the years my wife has found a better physiotherapist, and gradually she is visiting that person more often than her chiro. It seems that the physiotherapist is giving more massage than the chiro, and since her back problems do not really go away, a massage is probably more soothing than a jerk!

About the proposed name change, I have also wondered why the Danish chiro would want that. Apparently, woo chiros do exist in Denmark, but I have just never encountered one.

Some years ago the state issued a report about the effectiveness of various treatments that is paid for by the public health insurance, and it was clear that for back problems, the chiros were the only ones for which an improvement in the overall condition for their patients could be measured. The chiros were of course delighted, but full subsidies for their treatments did not materialise at the time, and most doctors still preferred to refer their patients to physiotherapists.

It seems that many physiotherapists in Denmark have adopted the chiropractic trademark manipulations in their repertoire, so what the difference really is, I do not know. There is no doubt that there is a war between the two groups of practicians, but how much substance there is to it, I do not know.

Come to think of it, I have once been at a physiotherapist paid by my work, and this lady prescribed some very sensible things I should do to prevent the worst effects of stress, and then she also tried to refer me to a reflexologist, which is a woo practice that many here think is based on science. I protested strongly and she said something like, "Oh, you are one of the scientific types, that is OK, you do not have to go". So going to a physiotherapist does not shield you from encountering the occasional woo-woo.

 

[Mojo]

In the UK chiropractors are regulated by legislation. The Chiropractors Act 1994 set up the General Chiropractic Council, with which anyone calling themselves a chiropractor has to be registered. Their website includes this definition of chiropractic:

Chiropractic is concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal manipulation or adjustment (World Federation of Chiropractic, 1999).

It looks from this as if they're mostly concerned with "mechanical disorders of the musculoskeletal system," but I'm not entirely sure what they include under the effects on general health. I haven't yet found anything detailing what sort of disorders they feel it is appropriate or inappropriate for a chiropractor to claim to be able to treat.

 

[Eos of the Eons]

What really gets me is that they are so misinformed about the human body that they become part of the largest group of anti-vaccinators out there. Just look up Tim Bolen, Tedd Koren, Martha Collins, etc. etc.

I urge you to ask any chiro to name EVERY white blood cell in the human body. If they don't come up with 16 names and classifications, then run away screaming for your life. Hey, I'm serious!

They prefer to view the human immune system as some kind of energy flow system, and if the back has "subluxations" then that can cause disease, deafness, etc. You therefore don't need vaccination, you only need your back cracked!

To determine the prevalence of antivaccination attitudes within the chiropractic community, Colley and Haas29 conducted a mail survey of ~1% of randomly selected US chiropractors
...approximately one third of the 171 respondents believed there is no scientific proof that immunization prevents disease, that immunization has not substantially changed the incidence of any major infectious disease in this century, that immunizations cause more disease than they prevent, and that contracting an infectious disease is safer than immunization. Over two thirds of the respondents concurred that high standards of nutrition and sanitation are more important than immunization in preventing infectious disease. More than half believed that the risks of pertussis vaccination outweigh its benefits.

http://pediatrics.aappublications.org/cgi/content/full/105/4/e43

For this reason alone chiropractic needs an overhaul. They are clearly miseducated. The whole lot of them in chiro schools should be made to take some years of medical school as well (heck, just do away with chiro schools and allow med students to specialize in areas relating to the back and spinal column-don't some do that already? Wouldn't this encompass neurologists?). Also, a large part of the chiro "philosophy" needs revision and updating!

Read why:

http://www.chirowatch.com/Chiro-pediatrics/ch000212levant.html