Chiropractic Woo?

[Kahalachan]

This is just in regards to lower back pain and stuff like that.

I'm not talking about children or many of the other woo claims chiropractors make.

Wolff's Law seems to support the idea of re-alignment. In fact, I know that's how martial artists get the bone strength to break bricks and ice and stuff like that.

So if a chiropractor works only with lower back pain and muscle stresses and attempt to re-shape lower back structure is that woo?

What's medical science's stance on just this alone?

Wikipedia has an external link saying this.

"Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints"

Here's the source

http://www.ama-assn.org/ama/pub/category/13638.html

 

[blutoski]

Chiropractic has nothing to do with Wolff's Law.

The other problem is that 'chiropractor' is a vague and practically meaningless term. You'll have to be more specific.

Are you talking about Activator spinal adjustment? Manual torsion? HVLA or LVLA? &c.

The medical consensus is that the best chiro treatments are roughly equal to treatment with rest. Just more expensive.

Try Chirowatch.

 

[JJM]

A Scientific Test of Chiropractic's Subluxation Theory
http://www.chirobase.org/02Research/crelin.html

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.

If you read through the whole thing, he shows that if the chiropractic mis-alignments did exist, the force needed to re-align the spine would actually break it.

Chirobase http://www.chirobase.org/index.html has a wealth of authoritative information. It is a subsite of www.quackwatch.org which is great for all sorts of critical information on quackery.

 

[JJM]

This is just in regards to lower back pain and stuff like that.

{snip}

So if a chiropractor works only with lower back pain and muscle stresses and attempt to re-shape lower back structure is that woo?

I have cited the research that shows chiros do not re-shape the back.

{snip} "Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints" {snip}

"Manipulation" is a bit vague. Chiros call their spinal treatments "adjustments" and hope that will be confused with massage, and evidence-based "manipulation" applied by physicians and physical therapists (PTs).

The bottom line- chiros charge a premium for a massage that may make you feel better. Why not just get a massage from someone who does not pretend to medical knowledge?

If you need PT (beyond massage), it is difficult to know if a particular chiro is sufficiently educated to provide it. Some may be, some definitely aren't; there is no quality control on their "education."

 

[Kahalachan]

OK thanks everyone. The AMA's stance on it left open some questions for me that are answered. Alleviating back pain doesn't = fixing it for good. The AMA noted that back pains and headaches were helped but it didn't say for how long.

 

[Miss Anthrope]

It's merely anecdotal, but seeing a chiropractor after a car accident caused more pain, not less. My lower back kept "going out" after adjustments, to the point where I could barely walk. As soon as I stopped seeing the quack, my back felt fine.

 

[JJM]

It's merely anecdotal, but seeing a chiropractor after a car accident caused more pain, not less. My lower back kept "going out" after adjustments, to the point where I could barely walk. As soon as I stopped seeing the quack, my back felt fine.

Miss A, your experience is not unusual- a lot of people don't realize:

Current chiropractic practice seems to take little account of these problems. Either the fact that about 50% of patients will experience mild adverse events is completely ignored or these events are labelled as necessary experiences on the patient's path to clinical improvement.

http://www.cmaj.ca/cgi/content/full/166/1/40

More than that, there is a rule of thumb that if you need more than two visits to a chiro to obtain relief, it is wiser to seek medical advice. And, if you are symptom-free- "maintenance adjustments' only maintain the chiro's bank account.

 

[blutoski]

OK thanks everyone. The AMA's stance on it left open some questions for me that are answered. Alleviating back pain doesn't = fixing it for good. The AMA noted that back pains and headaches were helped but it didn't say for how long.

The document you read was not an AMA "position paper" - it was the report of one of their sub-committees ten years ago.

The AMA is expressly prohibited against having an official opinion on chiropractic. This is because their official position was very negative when published, and chiropractors sued. The government felt it was antitrust, and laid down a law that practicing doctors could not publish an opinion about chiropractic.

This is why the quackbusters who go after chiropractic are retired - they are not at risk of breaking the gag law.

 

[JJM]

{snip} The AMA is expressly prohibited against having an official opinion on chiropractic. This is because their official position was very negative when published, and chiropractors sued. The government felt it was antitrust, and laid down a law that practicing doctors could not publish an opinion about chiropractic.

The AMA (and members) can have a position on the unreality of chiro- the legal decision was that the AMA cannot prohibit collaboration between chiros and MD/DOs. That was dependent on a law concerning "restraint of trade." The judge noted that the AMA made a strong case that chiro was scientifically illegitimate.

This is why the quackbusters who go after chiropractic are retired - they are not at risk of breaking the gag law.

There is no "gag-law" on MDs speaking against chiros; medical associations simply cannot sanction members who associate with chiros.

If you are thinking of Dr. Stephen Barrett (of quackwatch), he retired early because anti-psychotic drugs reduced the demand for psychiatrists, and his interest had turned to consumer health- protection and education.

I find it amusing that the case (Wilk v AMA, 1987) is often cited by chiros as establishing the legitimacy of chiro. When I point out that it was decided strictly on the basis of anti-trust law, and the judge commented that the AMA made a good case that chiro is nonsense; the chiros suddenly dismiss the judge's opinion concerning the science.

 

[Kahalachan]

The AMA (and members) can have a position on the unreality of chiro- the legal decision was that the AMA cannot prohibit collaboration between chiros and MD/DOs. That was dependent on a law concerning "restraint of trade." The judge noted that the AMA made a strong case that chiro was scientifically illegitimate.
There is no "gag-law" on MDs speaking against chiros; medical associations simply cannot sanction members who associate with chiros.

This sounds good. I think collaboration between chiros and MDs sounds like a good practice. A chiropractor might be skilled in anatomy and be able to find muscular or joint problems, from which they would state there is an abnormal pressure on a specific bone or joint.

From what I've read in this thread, a good chiropractor could be a precursor to an MD. Someone might complain about back pains, the chiropractor might suggest a specific posture while sitting at work on a computer, for example, and do a little massage type therapy.

If the pain continues, of course, or is unbearable they should recommend to an MD.

 

[JJM]

This sounds good. I think collaboration between chiros and MDs sounds like a good practice. A chiropractor might be skilled in anatomy and be able to find muscular or joint problems, from which they would state there is an abnormal pressure on a specific bone or joint.

From what I've read in this thread, a good chiropractor could be a precursor to an MD. Someone might complain about back pains, the chiropractor might suggest a specific posture while sitting at work on a computer, for example, and do a little massage type therapy.

If the pain continues, of course, or is unbearable they should recommend to an MD.

I am afraid you are mistaken. I don't know how you arrived at your conclusion. Plainly stated, chiro is no more effective for back pain or headache than, less expensive, conventional treatment.

There is no quality control for chiro education. Therefore, one must assume the lowest common denominator- which is a fool who believes all your illnesses derive from a "chiropractic subluxation" in your spine.

Moreover, you must ask what a chiro could know that a health professional can't know. The answer is nothing.

The chiro can give give an over-priced massage, or dubious "physical therapy." It is faster and cheaper to seek mainstream therapy.

 

[Blue Wode]

From what I've read in this thread, a good chiropractor could be a precursor to an MD.

And therein lies the main problem with chiropractic. How do you find a “good” chiropractor? And perhaps more importantly, do most people know enough about chiropractic to take the time to look for one?

There is no quality control for chiro education. Therefore, one must assume the lowest common denominator- which is a fool who believes all your illnesses derive from a "chiropractic subluxation" in your spine.

JJM doesn’t seem to be too far off the mark with this. Apparently 89.8% of chiropractors in the USA feel that spinal manipulation should not be limited to musculoskeletal conditions (McDonald W, Durkin K, Iseman S, et al, How Chiropractors Think and Practice. Ada: Institute for Social Research, Ohio University, 2003) – something which appears to be supported by this 2004 survey of chiropractors in Portland, Oregon...

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

...which found a 100% incidence of beliefs and practices that were unsubstantiated or clashed with established scientific knowledge.

 

[Kahalachan]

JJM doesn’t seem to be too far off the mark with this. Apparently 89.8% of chiropractors in the USA feel that spinal manipulation should not be limited to musculoskeletal conditions (McDonald W, Durkin K, Iseman S, et al, How Chiropractors Think and Practice. Ada: Institute for Social Research, Ohio University, 2003) – something which appears to be supported by this 2004 survey of chiropractors in Portland, Oregon...

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

...which found a 100% incidence of beliefs and practices that were unsubstantiated or clashed with established scientific knowledge.

This is interesting. I doubt the people who have told me about chiropractors would be that lucky 10% who didn't associate with a more extreme woo practitioner.

Of course I never heard about them going in for repeated examinations.

I would venture to say a lot of it sounds like a "foot in the door" technique. You went in for a nice massage and their knowledge of anatomy may make it sound reasonable that they know what they're doing. After that they try and make it sound like they can cure more ailments.

It's also probably a tempting decision for some to make as long as the chiropractors undercut the costs to see a medical doctor. Especially if someone's insurance company won't pay for a more expensive doctor's visit.

 

[Rodney]

I am afraid you are mistaken. I don't know how you arrived at your conclusion. Plainly stated, chiro is no more effective for back pain or headache than, less expensive, conventional treatment.

There is no quality control for chiro education. Therefore, one must assume the lowest common denominator- which is a fool who believes all your illnesses derive from a "chiropractic subluxation" in your spine.

Moreover, you must ask what a chiro could know that a health professional can't know. The answer is nothing.

The chiro can give give an over-priced massage, or dubious "physical therapy." It is faster and cheaper to seek mainstream therapy.

"For decades, anyone who wanted chiropractic treatments for backaches or other ailments had to find them on his own and pay for them out of pocket. But times are changing. While the medical profession remains deeply skeptical of chiropractic as a comprehensive health-care approach, more doctors are referring patients to chiropractors to treat lower-back and other musculoskeletal pain.

'I'm an orthopedic spine surgeon, so I treat all sorts of back problems, and I'm a big believer in chiropractic,' says William Lauerman, chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital. 'I'm more of a believer for acute problems like short-term back pain, although I know [chiropractic] can be helpful for some cases of more-chronic conditions.'"

See http://www.washingtonpost.com/wp-dy...7/07/13/AR2007071301836.html?hpid=smartliving

 

[Blue Wode]

From the Washington Post article:

'I'm an orthopedic spine surgeon, so I treat all sorts of back problems, and I'm a big believer in chiropractic,' says William Lauerman, chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital.

That’s hardly surprising since true chiropractic is based on a belief system:
http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

Rather than being an endorsement of chiropractic, the article seems to be more an indication of the ignorance of some medical doctors of the rampant quackery that continues to pervade the chiropractic profession.

more doctors are referring patients to chiropractors to treat lower-back and other musculoskeletal pain

But do we know if these MDs are being responsible and referring patients to (the tiny percentage of) evidence-based chiropractors? It would be interesting to know what evidence supports the “more doctors” claim. Interestingly, a recent survey on the use of CAM by US adults noted this:

'The greatest relative increase in CAM use between 1997 and 2002 was seen for herbal medicine (12.1% vs.18.6%, respectively), and yoga (3.7% vs. 5.1%, respectively), while the largest relative decrease occurred for chiropractic (9.9% to 7.4%, respectively).'

Davis, R. B., Phillips, R. S., Eisenberg, D. M., Tindle, H. A. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005 Jan-Feb; 11(1):42-9.

http://www.cababstractsplus.org/google/abstract.asp?AcNo=20053046923

[My bold]

 

[JJM]

"For decades, anyone who wanted chiropractic treatments for backaches or other ailments had to find them on his own and pay for them out of pocket. But times are changing. While the medical profession remains deeply skeptical of chiropractic as a comprehensive health-care approach, more doctors are referring patients to chiropractors to treat lower-back and other musculoskeletal pain.

'I'm an orthopedic spine surgeon, so I treat all sorts of back problems, and I'm a big believer in chiropractic,' says William Lauerman, chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital. 'I'm more of a believer for acute problems like short-term back pain, although I know [chiropractic] can be helpful for some cases of more-chronic conditions.'"

See http://www.washingtonpost.com/wp-dyn/content/article/2007/07/13/AR2007071301836.html?hpid=smartliving

Georgetown U is rife with quackery: http://scienceblogs.com/insolence/2006/11/not_so_stealthily_sneaking_cam_into_the_1.php

It is true that chiropracty seems to be as effective as physical therapy (PT) (or massage) for acute low back pain. (The only other thing for which there is evidence is some headaches. However, there is the possibility the chiro will deliver a deadly neck-snap.) Why would a doctor refer to a chiro instead of a PT?

At another venue, a retired doctor anonymously admitted that it gets rid of the patient. A PT works off a doctor's prescription, a chiro goes it alone.

Blue Wode is right to wonder about the quality of the chiro to which the patient is being referred. The referring doctor may be unaware of what other nonsense his patient may fall victim to.

 

[Rodney]

From the Washington Post article:

That’s hardly surprising since true chiropractic is based on a belief system:

And skepticism isn't?

http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

Even that source is forced to concede: "The one area that there is evidence that Chiropractic can be beneficial is in treating lower-back pain." And what is the skeptical explanation for that inconvenient fact? Further, what about a recent study showing that chiropractic care is beneficial for chronic neck pain? See http://www.chiropracticresearch.com/News_chiropractic_care_beneficial.htm

Rather than being an endorsement of chiropractic, the article seems to be more an indication of the ignorance of some medical doctors of the rampant quackery that continues to pervade the chiropractic profession.

Let's consider what the author of the Washington Post article has to say about his treatment by medical doctors: "After three spinal surgeries since 2002, two lumbar and 2004's brutally intrusive cervical fusion, which put a piece of cadaver bone in my neck in a procedure that was supposed to correct chronic shoulder and arm pain -- and didn't -- I'm hoping to minimize my time under the knife."

If you had your way, would you ban the author from seeking chiropractic treatment after conventional treatment had failed?

 

[JJM]

{snip} Even that source is forced to concede: "The one area that there is evidence that Chiropractic can be beneficial is in treating lower-back pain." And what is the skeptical explanation for that inconvenient fact?

No need to explain, the studies show that physical therapy, chiropracty and massage are about the same in that case. Chiros like to overemphasize their role.

Further, what about a recent study showing that chiropractic care is beneficial for chronic neck pain? See http://www.chiropracticresearch.com/News_chiropractic_care_beneficial.htm

That article refers to a non-medical magazine (JMPT); which is "refereed" by fellow quacks. I doubt the authors could have this accepted in a good, medical journal; or they would have done so.

Let's consider what the author of the Washington Post article has to say about his treatment by medical doctors: "After three spinal surgeries since 2002, two lumbar and 2004's brutally intrusive cervical fusion, which put a piece of cadaver bone in my neck in a procedure that was supposed to correct chronic shoulder and arm pain -- and didn't -- I'm hoping to minimize my time under the knife."

"Hoping" is the key word, if the author thinks there is any reliable evidence that chiro will help him: like Rick in Casablanca, he is misinformed. Many problems (even, longstanding ones) resolve themselves without treatment. If the author's problems go away with the "help" of a chiro- the author doesn't know if it would have gone away without such "help."

If you had your way, would you ban the author from seeking chiropractic treatment after conventional treatment had failed?

Failures of medicine don't validate quackery. (Write that on a post-it and put it someplace handy.) Actually, I would ban the quacks who prey on the misinformed.

 

[Blue Wode]

[I wrote: "That’s hardly surprising since true chiropractic is based on a belief system"] And skepticism isn't?

I was being a little clumsy there. I should have said that chiropractic is based on a false belief system (insofar as that’s what the science tells us).

Even that source is forced to concede: "The one area that there is evidence that Chiropractic can be beneficial is in treating lower-back pain." And what is the skeptical explanation for that inconvenient fact?

It’s true that spinal manipulation can be beneficial in treating low back pain. However, the real inconvenient fact (especially for chiropractors) is that exercise and analgesics are just as effective, as well as being convenient, cheap, and probably safer - and quackery usually doesn’t get a look in:

There was little or no difference in pain reduction or the ability to perform everyday activities between people with low-back pain who received spinal manipulation and those who received other advocated therapies..... it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.

Spinal manipulative therapy for low-back pain
http://www.cochrane.org/reviews/en/ab000447.html

Do you think chiropractors always tell patients that? Apparently, they don’t always do so in the UK:

over one-third do not advise patients of alternative available treatments

Consent or submission? The practice of consent within UK chiropractic
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15726031

Further, what about a recent study showing that chiropractic care is beneficial for chronic neck pain? See http://www.chiropracticresearch.com/News_chiropractic_care_beneficial.htm

That might be, but it must be weighed against the risks involved:

Spinal manipulation for neck pain is a treatment with unknown benefits and unknown harm. Because of this and the fact that serious risks are on record, a responsible risk–benefit assessment cannot ignore the risks and cannot come out in favour of spinal manipulation. Remember the supreme law in medicine: first do no harm. Other therapies for neck pain exist, e.g. exercise, which are supported by at least as good evidence for benefit and which are at the same time free of significant risks. The inescapable recommendation based on the best evidence available today is to use exercise rather than spinal manipulation as a treatment for neck pain.

See second section here:

Spinal manipulation for neck pain – more good than harm?
http://journals.medicinescomplete.com/journals/fact/current/fact0902a06d01.htm

Let's consider what the author of the Washington Post article has to say about his treatment by medical doctors: "After three spinal surgeries since 2002, two lumbar and 2004's brutally intrusive cervical fusion, which put a piece of cadaver bone in my neck in a procedure that was supposed to correct chronic shoulder and arm pain -- and didn't -- I'm hoping to minimize my time under the knife."

If you had your way, would you ban the author from seeking chiropractic treatment after conventional treatment had failed?

No, it would be his choice, but I would warn him that chiropractic/spinal manipulative treatment is known to be associated with serious risks. He might want to minimize his time under the knife, but I’m sure that he wouldn’t want to spend the rest of his life in a wheelchair, or worse...

Collectively, these data suggest that spinal manipulation is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death.

Adverse effects of spinal manipulation: a systematic review
http://www.jrsm.org/cgi/content/full/100/7/330

 

[Rodney]

No need to explain, the studies show that physical therapy, chiropracty and massage are about the same in that case. Chiros like to overemphasize their role.

So, I take it that you disagree with this statement by William Lauerman, chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital, about chiropractic treatment for short-term back pain:

"Three or four days, can't get out of bed, that sort of thing" -- Lauerman says, "is one of the few things that has been demonstrated to significantly alter the natural history of acute back pain. . . . People get better quicker if they go to a chiropractor for a few visits."

That article refers to a non-medical magazine (JMPT); which is "refereed" by fellow quacks. I doubt the authors could have this accepted in a good, medical journal; or they would have done so.

Has the study been refuted?

"Hoping" is the key word, if the author thinks there is any reliable evidence that chiro will help him: like Rick in Casablanca, he is misinformed. Many problems (even, longstanding ones) resolve themselves without treatment. If the author's problems go away with the "help" of a chiro- the author doesn't know if it would have gone away without such "help."

But he sure knows that the conventional treatment he tried before turning to a chiropractor was a complete failure. And, I would venture to say, that treatment was also far more expensive than what the chiropractor is charging.

Failures of medicine don't validate quackery. (Write that on a post-it and put it someplace handy.)

Would you ever consider faulty conventional treatment to be quackery?

Actually, I would ban the quacks who prey on the misinformed.

Would that include the author's chiropractor?