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Chiropractic Vertebral Subluxations: Science vs. Pseudoscience

A 1997 publication by the Foundation for Chiropractic Education and Research, supporting the vertebral subluxation theory, noted that “…we [chiropractors] have successfully distanced the concept of a chiropractic subluxation from that of an orthopedic subluxation.”1 When discussing “subluxations” or misaligned vertebrae, however, chiropractors often fail to point out the difference between an orthopedic subluxation and a chiropractic subluxation. Reference to subluxations in medical literature is often presented as support for the practice of chiropractic as a method of adjusting vertebral subluxations to “restore and maintain health.”

In the eyes of the public, the chiropractic vertebral subluxation theory has confused the definition of the word “subluxation,” a common medical term. Unlike the mysterious, undetectable and asymptomatic chiropractic “vertebral subluxation complex” alleged to be a cause of disease, a real vertebral subluxation, that is, an orthopedic subluxation, can be a cause of mechanical and neuromusculoskeletal symptoms but has never been associated with organic disease.

Subluxations: Real and Imaginary

An orthopedic subluxation, recognized and named as such since the days of Hippocrates, is a painful partial dislocation. Simple misalignment of a vertebra, also referred to as a “subluxation,” is commonly caused by disc degeneration, curvatures, spondylolysis, and structural abnormalities. Such a subluxation may or may not be mechanically symptomatic and can be seen on a plain x-ray image. In the absence of pathology such as disc herniation or osteophyte formation, these common vertebral subluxations or misalignments rarely affect spinal nerves and have never been associated with organic disease. Spinal nerves supply musculoskeletal structures. The body’s organs are supplied primarily by autonomic nerve ganglia and plexuses located outside the spinal column and by cranial and sacral nerves that pass through solid bony openings, providing overlapping nerve supply independent of any one spinal nerve that passes between two vertebrae.

An orthopedic subluxation, a true vertebral misalignment, or a mechanical joint dysfunction that affects mobility in the spine is not the same as a “chiropractic subluxation” that is alleged to cause disease by interfering with nerve supply to organs. Such a subluxation has never been proven to exist. There is no plausible theory and no credible evidence to support the contention that “nerve interference” originating in a single spinal segment can cause an organic disease.

Unable to provide evidence that commonly occurring vertebral misalignment can cause organic disease, advocates of the subluxation theory have reasoned that there must be some other type of joint dysfunction that can affect general health. They have chosen, by consensus, to call this undetectable lesion a “vertebral subluxation complex,” which “embraces the holistic nature of the human body, including health, well-being, and the doctor/patient relationship as well as the changes in nerve, muscle, connective, and vascular tissues which are understood to accompany the kinesiologic aberrations of spinal articulations.”1

Some chiropractors claim to be able to locate these elusive subluxations by using surface electromyography, thermography, vibratory instruments, leg length checks, or by palpating the spine.

A largely ignored landmark review of the literature by a Ph.D. and a chiropractor (Nansel and Szlazak), published in 1995, concluded that there is not a single appropriately controlled study to indicate that any dysfunction in structures of the spinal column is a cause of organic disease.2 The review noted that pain and other symptoms referred from a spinal segment can “create overt signs and symptoms that can mimic, or simulate (rather than cause), internal organ disease,” lending no support to the vertebral subluxation theory. Spinal nerves are commonly irritated or compressed, causing pain and other symptoms in the musculoskeletal structures supplied by the affected nerve. But even the most severe compression of a spinal nerve does not cause organic disease.

A review of the current evidence on the epidemiology of the subluxation construct (Mirtz, et al, 2009) also failed to find any credible evidence supporting the chiropractic vertebral subluxation theory. This paper, authored by three chiropractors and a Ph.D., concluded that “No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.”3

While there is justification for use of the word “subluxation” when referring to a mechanical-type spinal problem, there appears to be no justification whatsoever for suggesting that a “chiropractic subluxation” can affect general health.

A Chiropractic Subluxation by Any Other Name…

If the chiropractic profession dumped the subluxation theory and took the steps needed to become a physical-treatment specialty in the care of mechanical-type neck and back problems, it could remain open to future research that might reveal evidence that spinal manipulation benefits general health─a finding that would be a bonus for use of manual therapy. Until then, the theory that adjusting a “vertebral subluxation complex” will restore and maintain health is too implausible to warrant support by the scientific community.

Unfortunately, the chiropractic profession in the United States continues to be defined by subluxation theory. Too few chiropractors are willing to “step out of line” and announce that the theory (more accurately defined as a belief) is scientifically indefensible and should be dumped. Failure of chiropractic associations to publicly disagree with subluxationists who identify chiropractic as a method of adjusting the vertebral subluxation complex keeps chiropractic marginalized and subject to ridicule by the scientific community. Without some identifying label or degree that distinguishes science-based chiropractors from subluxation-based chiropractors, medical physicians will continue to be reluctant to refer a patient to a chiropractor, lest they deliver a patient into the hands of a pseudoscientific practitioner whose philosophy embraces an anti-medical approach and endangers the patient. Science-based chiropractors who are properly specialized should openly announce their limitations if they are to earn the recognition and trust of medical professionals who can provide the referrals needed to sustain a specialized practice. 

In May of 2010, the British General Chiropractic Council (GCC) advised members of the British Chiropractic Association (BCA) that “The chiropractic Vertebral Subluxation Complex…is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.”4 Chiropractors were advised to provide evidence-based care that “incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners including the individual chiropractor her/himself.”4 In response, the British Chiropractic Association advised its members to “refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access,” adding that “this advice has no bearing on scope of practice.”4

While the action of the GCC and the BCA in avoiding reference to the Vertebral Subluxation Complex is an important and unprecedented move in the right direction, it appears that the door was left open for British chiropractors to continue treating a broad scope of health problems. Such leniency would not restrict use of a variety of unproven treatment methods (originally based on the vertebral subluxation theory) promoted by individual chiropractors and preferred by indoctrinated patients.

Although many chiropractors are now backing away from the chiropractic vertebral subluxation theory, many continue to use the theory to justify treating a broad scope of health problems by “adjusting” the spine. They simply point to legal and dictionary definitions of chiropractic to support their claims. Some who do not use the word “subluxation” simply substitute another word or words, such as “joint dysfunction,” in support of their belief that some kind of segmental spinal “lesion” can affect overall health.

Spinal Manipulation Stigmatized by Subluxation Theory

The basic definition of chiropractic provides opportunity for pseudoscientific spinal manipulators who treat a broad scope of health problems with a myriad of implausible and unproven treatment methods, alienating an informed public along with the scientific community.

According to a study published in 2005, the percentage of the US population seeing chiropractors annually for various reasons decreased from 9.9% in 1997 to 7.4% in 2002.5 Using data from a 2002 National Health Interview Survey, a study published in a 2010 issue of The Journal of the American Board of Family Medicine reported that about 6% of the US population used complementary alternative medicine (CAM) to treat their back pain. About 74% of this 6% (about 4.4% of the population) went to chiropractors; 22% went to massage therapists.6 Since conventional medical practitioners traditionally refer back-pain patients to physical therapists, physiatrists, or orthopedic surgeons, physician referral to CAM practitioners remains low.

The chiropractic profession would be well advised to make the changes needed for recognition as specialists in the care of mechanical-type back pain, “the second leading reason for ambulatory office visits” and the most common reason for use of CAM in the United States.6

Science-based chiropractors who do not subscribe to the chiropractic vertebral subluxation theory, who specialize in the use of manipulation and other physical treatment methods in the care of mechanical-type neck and back problems, will use manipulation more appropriately. Unfortunately, there is no recognized label, degree, or association that distinguishes such chiropractors from subluxation-based chiropractors. Without a clear choice in selecting a good chiropractor, few physicians will risk referring their patients to a chiropractor, making survival difficult for properly specialized chiropractors.

As Sir James Frazer wrote in 1922, “The ablest man is dragged down by the weakest and dullest, who necessarily sets the standard, since he cannot rise, while the other can fall.”7

Belief System Perpetuates Status Quo

Since my graduation from a chiropractic college in 1956, arguments and opinions about chiropractic have changed very little. No one seems to know what chiropractic is or what it does. No two chiropractors can agree on how to treat a specific ailment or which vertebrae to adjust. There are at least 97 named antithetical adjustive techniques,8 all based on a nonsensical, nonfalsifiable chiropractic vertebral subluxation theory. The chiropractic profession as a whole has yet to be properly defined and specialized so that diagnosis and treatment methods are uniformly consistent and interchangeable among chiropractors. Subluxation-based chiropractic continues to be at odds with mainstream health care.

Although the public generally thinks of a chiropractor as a “back doctor,” societal suspicion keeps utilization of chiropractic low. In a cycle perpetuated by the definition of chiropractic, science takes a back seat to standards that allow some chiropractors to follow a 19th century philosophy formulated by a magnetic healer 115 years ago. So far, the chiropractic profession has failed to take a stand and draw a line that separates sense from nonsense in chiropractic care, keeping the profession on the fringe of health care and in the realm of alternative medicine. The Chiropractic Paradigm formulated by the Association of Chiropractic Colleges (ACC), representing North American Chiropractic Colleges, proposes that “Chiropractic is concerned with the preservation and restoration of health and focuses particular attention on the subluxation.”9,10 The purpose of chiropractic is to “optimize health.” This vague and untestable ACC paradigm has been endorsed by the American Chiropractic Association, the International Chiropractic Association, and the World Federation of Chiropractic. The ACC notes that “Because of the emphasis on holistic health care, chiropractic is associated with the field of complementary and alternative medicine.”11

Until chiropractic schools and associations draw a line (with the fanfare of a clarion call) and take a stand on the side of science as a properly limited specialty, uniformly defining and limiting chiropractic in state laws, the credibility and the status of chiropractors will remain low. Physicians will continue to refer their patients to physical therapists, physiatrists, and orthopedic surgeons rather than risk a bad outcome with inappropriate treatment provided by a chiropractor. With an increasing number of physical therapists and orthopedic manual therapists now including spinal manipulation in their treatment armamentarium, it may eventually become unnecessary to search for the manipulative services of individual science-based chiropractors who are “not like the other chiropractors.”

It seems likely that subluxation-based chiropractic, like homeopathy and other belief systems, will be perpetuated to some degree by true believers. It remains to be seen whether chiropractic will eventually split into two camps─one for science-based chiropractors and one for subluxation-based chiropractors. Hopefully, the science-based camp will eventually prevail as a majority in defining chiropractic in state laws, forcing subluxation-based chiropractors to practice surreptitiously. This may never happen. But in the archives of science, the “chiropractic subluxation” will be filed away under the label of dogma.

Nonfalsifiable Subluxation Theory Still Alive

Despite the general consensus of scientific and academic groups that the chiropractic vertebral subluxation theory is not a viable construct, the National Board of Chiropractic Examiners continues to define chiropractic as subluxation-based: “The specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction. A subluxation is a health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability, or illness.”9

Such a definition continues to allow routine manipulation of vertebrae anywhere in the spine to “restore and maintain health” by correcting “subluxations” or “joint dysfunction.” This approach allows frequent manipulation of the cervical spine, a treatment that has been associated with stroke caused by dissection of vertebrobasilar arteries. It’s important to remember that the chances of injury are multiplied when chiropractic neck manipulation is routinely used many times on every patient in a misguided attempt to improve health, as opposed to occasional use of neck manipulation by physical therapists and other manual therapists who are concerned only about restoring mobility in a stiff spine.

In June of 2010, the Connecticut Chiropractic Board, denying that neck manipulation can be a cause of stroke, issued this statement: “After a careful and thorough review of all the testimony and documentary evidence admitted at the hearing [January 2010], the Board concludes that there is sufficient evidence to establish that a stroke or a cervical arterial dissection is not a risk or side effect of joint mobilization, manipulation or adjustment of the cervical spine.”12 It seems unlikely that any group or organization outside of chiropractic will agree with this observation.

Because of apparent concerns that chiropractic neck manipulation based on subluxation theory involves more risk than benefit, the Kaiser Permanente Mid Atlantic States and Mid-Atlantic Permanente Medical Group recently revised their Chiropractic Manipulation Medical Coverage Policy to exclude cervical Chiropractic Manipulative Treatment (CMT). The revised policy states: “Given the paucity of data related to beneficial effects of chiropractic manipulation of the cervical spine and the real potential for catastrophic adverse effects, it was decided to exclude chiropractic manipulation of the cervical spine from coverage.”13 In response, the American Chiropractic Association “…sent a letter to Kaiser outlining the extensive data that supports cervical spine manipulation as both beneficial and safe.”14

Until the schools and associations of the chiropractic profession totally abandon the vertebral subluxation theory, and state and federal laws defining chiropractic are changed, it is not difficult to understand why there might be some justification for blanket condemnation of chiropractic, despite evidence that spinal manipulation can be useful in the treatment of uncomplicated mechanical-type back problems. It does not appear, however, that the chiropractic profession might be willing to voluntarily reduce its scope of practice by renouncing the vertebral subluxation theory. At the present time, “…the 50 state chiropractic practice acts essentially define chiropractic as the detection and correction of subluxations and assume their significance to human health, allowing a broad scope of practice. Because the chiropractic profession seems unwilling to abandon these discredited concepts, reform of the state chiropractic practice acts to eliminate subluxation-based chiropractic practice may be the only viable solution to the perpetration of unscientific and unproved healthcare practices.”15

The subluxation is the yoke of the chiropractic profession. The “chiropractic subluxation,” under one name or another, continues to find shelter under the umbrella of chiropractic. Good science-based chiropractors who do not subscribe to the vertebral subluxation theory and who use manipulation appropriately can offer a service of value. Unfortunately, such chiropractors are not easy to find.

References

  1. Rosner A. The Role of Subluxation in Chiropractic. Des Moines, IA: Foundation for Chiropractic Education and Research; 1997.
  2. Nansel D, Szlazak M. Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease. J Manipulative Physiol Ther. 1995;18:379-397.
  3. Mirtz TA, Morgan L, Wyatt LH, Greene L. An epidemiological examination of the subluxation construct using Hill’s criteria of causation. Chiropractic & Osteopathy. 2009;17:13. http://www.chiroandosteo.com/content/17/1/13 (Accessed August 24, 2010).
  4. Brown R. President, British Chiropractic Association. BCA Statement on Vertebral Subluxation Complex. May 24, 2010. General Chiropractic Council Guidance on Claims Made for the Chiropractic Vertebral Subluxation Complex. http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf (Accessed August 24, 2010.)
  5. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005;11:42-49.
  6. Kanodia AK, Legedza AT, Davis RB, Eisenberg DM, Phillips RS. Perceived benefit of complementary and alternative medicine (CAM) for back pain: a national survey. The Journal of the American Board of Family Medicine. 2010;23(3):354-362.
  7. Frazer J. The Golden Bough. New York, NY: The Macmillan Company; 1956.
  8. Peterson D, Wiese G. Chiropractic: An Illustrated History. St. Louis, MO: Mosby; 1995:260-261.
  9. Christensen M, et al. Practice Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners; 2010.
  10. Chiropractic Paradigm. Association of Chiropractic Colleges, 2010. http://www.chirocolleges.org/paradigm_scope_practice.html (Accessed August 24, 2010.)
  11. What Is Chiropractic? Association of Chiropractic Colleges. 2010 http://www.chirocolleges.org/whatis.html (Accessed August 24, 2010.)
  12. Connecticut Chiropractors’ Informed Consent Standard Upheld. American Chiropractic Association. June 11, 2010. http://www.acatoday.org/content_css.cfm?CID=3978. (Accessed August 28, 2010.)
  13. No Evidence of Benefits, Health Insurer Excludes Neck Manipulations. PR Web. August 28, 2010. http://www.prweb.com/pdfdownload/4432714.pdf (Accessed Aug 28, 2010.)
  14. American Chiropractic Association responds to new Kaiser policy excluding cervical manipulation. Chiropractic Economics. August 20, 2010. http://www.chiroeco.com/news/print-this.php?id=10075. (Accessed August 28, 2010.)
  15. Bellamy JJ. Legislative alchemy: the US state chiropractic practice acts. FACT. 2010;15(3):214-222.

Posted in: Chiropractic

Leave a Comment (29) ↓

29 thoughts on “Chiropractic Vertebral Subluxations: Science vs. Pseudoscience

  1. mdcatdad says:

    And I have recently seen two commercials on Washington, D.C. TV stations in the past 10 days featuring staged “interviews” with “doctors” offering to treat diabets (and even women’s thyroid conditions). The “doctors” turn out to be chiropractors

  2. Joe says:

    According to this http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54917 the Council on Chiropractic Education is poised to remove references to subluxation from its position papers. He is hot about some other changes as well.

    The problem with the notion of a rational chiropractor is that they have no place to learn this. Self-educated people in critical situations (such as health care) are not trustworthy. Certainly, there are exceptions; but why take a chance?

    Asking chiro to become evidence-based is like asking a mechanic to rebuild a car from just the hood ornament. If all chiros suddenly became rational, there would be massive unemployment in the trade. (It is a ‘trade,’ not a ‘profession’ except in the way garbage-collection or dog-walking may be termed ‘professions.’)

    Our elected representatives have inflicted us with chiropractic and it is here to stay. And, it has no compelling reason to change; after all, they are making money. It would be simple for a school to hire properly educated faculty and adopt a PT curriculum. Simple; but not easy since it would be expensive and it would rankle a lot of people in the trade. So, without any impetus to change, why should they bother?

  3. Zetetic says:

    Seems they’re backing away from “Subluxation” and even “Chiropractor” around here! Chiropractic clinics in this area are named things like “Back & Spine Clinic” and make liberal use terms like “Wellness.” Full page ads recently in the Seattle Times tout new machines to de-compress the spine. Reading them through is interesting, the word “Chiropractic” or “Chiropractor” or “Subluxation” is nowhere to be found in the ad texts. “Doctor” or “Dr.” is used freely but I saw there was only one use of “D.C.” anywhere. Research was cited – but all done by medical doctors and perhaps not even applicable.

  4. squirrelelite says:

    @Zetetic,

    I got a card in the mail last week for a Health Fair coming up in a couple of weeks. They are offering the following “Services & Screenings”:

    – Flu Shots
    – Body Fat
    – Blood Pressure
    – Free Massage
    – Heart Screenings
    – Fitness Testing
    – Bone Density
    – Spinal Screenings
    – Hearing Test
    – Microderm Abrasion
    – Reflexology

    It’s being put on by a local chiropractic business.

    Their yellow pages ad mentions

    – X-Ray Facility On-Site
    – Knee, Shoulder, Wrist Problems
    – Massage Therapy Available
    – Pre-Natal & Pediatric Care
    – Emergency Care
    – Nutrition / Orthotics

    I noticed they are listed under Physicians! This is probably common, but does Dex know the difference?

  5. windriven says:

    First, I would like to know whether the new health care system is going to pay to have subluxations unluxated?

    Is it not in the interest of serious and dedicated chiropractors to ensure that high professional standards of practice are defined and enforced?

    CPAs, to choose a profession, have quite specific standards of practice beyond which licensure is revoked. My CPA cannot, say, decide that I needn’t report according to generally accepted accounting practices and instead make up inventory and revenue numbers that look good on my balance sheet. I’m not sure why practice that involves money should be more tightly regulated than practice that involves life and death.

  6. Blue Wode says:

    Thank you for another great post, Dr Homola, and for highlighting the problem here in the UK – i.e. the GCC ruling that no claims can be made for treating ‘subluxations’, but (under its loose definition of evidence based care) still allowing chiropractors to supposedly detect and correct them in unwitting patients once they are inside their clinics.

    Joe wrote: “If all chiros suddenly became rational, there would be massive unemployment in the trade.”

    Well, it certainly doesn’t look like chiropractors in the U.S. are going to become rational any time soon if the American Chiropractic Association is anything to go by:

    Quote:
    “Wide acceptance and a rapidly increasing population make the future of chiropractic a boundless one.”

    More…
    http://www.acatoday.org/content_css.cfm?CID=747

    Although its assertion seems to be very much at odds with the content of this new thread at Chirotalk:
    http://tinyurl.com/32jpq9d

  7. Jann Bellamy says:

    I agree – an excellent post.

    Here’s a chiropractic ad I saw just today:

    “Brain-to-Stomach
    Stomach-to-Brain
    Controlling and regulating nerve impulses leave your brain, travel down your spinal cord to pairs of nerve roots exiting from between each pair of spinal bones and out to every cell, tissue, organ and system of your body. Simultaneously, messages from the body are constantly sent back to the brain. Even the slightest distortion or disturbance of these vital messages to or from the brain can produce malfunctioning organs or tissues.
    This is why a stomach problem may not be a stomach problem! Instead, it might be a brain-to-stomach or stomach-to-brain communication problem.
    Locating and reducing these communication impairments with safe and natural chiropractic care help restore proper function and good health.”

  8. red rabbit says:

    My beef with the chiropractors locally is multifactorial:

    They tell my patients nonsensical stuff about their pelvis being tilted or their legs being different lengths, and then have them come back and pay for hundreds of treatments for a non-condition.

    They tell my patients to call me and DEMAND an MRI. No, sorry, I need to examine you and decide whether this is warranted. Usually, it isn’t. It’s usually straighforward MSK or sciatic pain that a non-quack reassures people and gives them some exercises for.

    They do these full-length x-rays which impress the hell out of people (how come my doctor just does little x-rays? this guy’s obviously better) and then don’t know how to read them. I had a guy freak my patient out by pointing out an “abnormality” and telling her she had to get in to see me “right away.” The abnormality he’d indicated: perfectly normal bowel gas.

    The real abnormality was elsewhere.

    It breaks my fucking heart. I hope he was just incompetent, because otherwise he is one hell of a heartless crook.

  9. sailwave says:

    In the UK the two major colleges (AECC and WIC) both teach science-based chiropractic but it’s clear that many graduates ‘drift’ into traditional subluxation-based chiropractic post graduation – even if they don’t use “subluxation”.

  10. Blue Wode says:

    sailwave wrote: “In the UK the two major colleges (AECC and WIC) both teach science-based chiropractic but it’s clear that many graduates ‘drift’ into traditional subluxation-based chiropractic post graduation – even if they don’t use ‘subluxation’.”

    FYI, a British scientist recently wrote to the Welsh Institute of Chiropractic (WIC), University of Glamorgan, to express his concerns about the claims and information available (or not, in some cases) on its official website. He requested clarification as to the website’s accuracy/intent. You can read his letter here:
    http://sciencedigestive.blogspot.com/2010/06/email-to-university-of-glamorgan.html

    Apparently the WIC’s reply, which hasn’t been published, was wholly evasive in that it sent a run down of the modules taught, but not what was actually in them.

    One wonders if the WIC has something to hide.

  11. Blue Wode says:

    Samuel Homola wrote: “In June of 2010, the Connecticut Chiropractic Board, denying that neck manipulation can be a cause of stroke, issued this statement: “After a careful and thorough review of all the testimony and documentary evidence admitted at the hearing [January 2010], the Board concludes that there is sufficient evidence to establish that a stroke or a cervical arterial dissection is not a risk or side effect of joint mobilization, manipulation or adjustment of the cervical spine.”

    That is a very disappointing conclusion considering that there have been dozens of reports of serious injury and death following manipulation over the years. Indeed, if you scroll down to the May 2004 news item in the following link, you can find many of the cases referenced:
    http://tinyurl.com/257vhkf

    Also, readers might like to take a look at the death certificate of 39-year-old John Hoffman (may be slow to load): http://www.chiropracticstroke.com/pdf/Hoffman%20Death%20Certificate.pdf

    It confirms that he died as a consequence of having his neck manipulated. His stroke occurred around 3 hours after having a neck adjustment at his chiropractor’s office and he died 6 days later.

  12. zeno says:

    Sallwave

    Following on from Blue Wode’s comments, in July, I wrote about what the UK training establishments and the trade associations are still saying about subluxations: The Cracklash begins.

  13. Cowy1 says:

    I figure most of you already know but for those that don’t, the best place for reliable, correct information about chiropractic on the web is http://www.chiroweb.org

  14. Cowy1 says:

    Ugh, ignore last link, it will just suck you into a pile of chiro-woo.

    Correct link is http://www.chirobase.org

  15. Joe says:

    @sailwave on 02 Oct 2010 at 3:36 am wrote “In the UK the two major colleges (AECC and WIC) both teach science-based chiropractic”

    Well, continuing what blue wode and zeno posted, “science based chiropractic” is an oxymoron. There is no scientific basis for anything that is truly chiropractic. Sometimes, they offer stuff that is rational; but it does not derive from chiro. There is nothing in real medicine that is derived from chiro.

    That brings up a problem with any sCAM practitioner. How is the ordinary customer to separate the good stuff (promoted by health professionals) from the garbage unique to the quack?

    To return to the topic of subluxations, they have never been demonstrated- either in fact or in hypothesis. They remain a notion of the fevered imagination of a 19th-century grocer.

    Do we need an intact spinal process to function properly? For the most part, no, transplanted organs work fine without any connection to our nervous systems. After spinal cord damage, most organs work normally without any connection to the CNS. The fairy tale that “chiro subluxations” cause problems could not have less support. That is not a controversial conclusion among scientists.

  16. marcus welby says:

    Homola’s post is welcome and honest. A little appreciated aspect of chiropractic is that a considerable amount of income to chiropractors comes from treatment of personal injury victims who are often conflicted about their desire for full recovery. Alliance of chiropractors and attorneys (some MDs prey on litigants and align with attorneys also) is a win/win for the DC or MD and the attorney. In Florida, there are Personal Injury Protection (PIP) clinics which take advantage of the 10,000 dollars of medical payments for no-fault treatment after an auto accident, then when that money is used up, the treating practitioner declares a permanent physical impairment which is lucrative to the attorney and claimant. Since pain cannot be measured, only reported, and most adults will have spinal imaging MRI abnormalities, this is a common occurrence. Plaintiffs have learned from their attorneys that permanent injury is necessary for significant financial recovery with their lawsuit, thus are discouraged consciously or subconsciously from returning to health. Guilt, depression, drug and substance abuse, joblessness and loss of employment skills, perhaps further application for SSDI status may be the result.
    The 1-800-ASKGARY network of PIP clinics owned by a chiropractor in the Tampa area who is now attempting to advance his antivaccination agenda via political connections to the Governor has earned enough for Gary that the large St. Petersburg, Fla. performing arts center has now been purchased and renamed the 1-800 ASKGARY arts center or something along those lines.
    The recent SBM post “When (Anti-Vax) Politics Intrudes” discusses in more detail some of chiropractor Gary’s activities.

  17. Jurjen S. says:

    I have an issue with a sentence like “…we [chiropractors] have successfully distanced the concept of a chiropractic subluxation from that of an orthopedic subluxation,” because it seems to me that Palmer latched onto the established concept of the subluxation, and then attributed a bunch of stuff to it that has since been established to be a load of hooey.

    So the chiropractic and orthopedic subluxations are not two different critters; rather, the difference as akin to that between wolves as presented in “Little Red Riding Hood,” “The Wolf and the Seven Little Goats” etc. on the one hand, and real-life wolves on the other. They’re both called “wolf” and share a number of basic characteristics (both are canine carnivorous quadrupeds), but the behavior of one is a complete fabrication, whereas the other has been empirically observed. Similarly, we have the “chiropractic subluxation,” which exists only in fairy tales, and the orthopedic subluxation, which exists in real life.

  18. Blue Wode says:

    Readers might be interested to know that here in the UK many skeptics are keenly awaiting the General Chiropractic Council’s reply to the following concerns:

    QUOTE
    “On 17 Aug 2010 representatives of the Alliance of UK Chiropractors (AUKC) comprised of members of the MCA (McTimoney Chiropractic Assocation), SCA (Scottish Chiropractic Assocation) and UCA (United Chiropractic Association) met with the GCC (General Chiropractic Council), the main subject of this meeting seems to have been the subluxation. At the meeting the AUKC presented what they describe as ‘a substantial 120 page dossier entitled The Vertebral Subluxation Complex – The History, Science, Evolution and Current Quantum Thinking on a Chiropractic Tenet’. (This document does not appear to be publically available via the internet.)
    This dossier was commissioned by the AUKC and includes contributions from Christopher Kent D.C a confirmed anti-vax campaigner, and Bruce Lipton, a supporter of chiropractic with some ‘fringe’ ideas on genetics. So I have sent a letter to the GCC and asked them for a copy of the 120 page dossier and their view as to the quality of dossier as a basis for evidence.
    I have also asked for details of exactly why they felt compelled to issue updated guidance. If this is based on the availability of new evidence then I have asked them to supply copies. They state that the VSC is the basis for health concerns and I have asked them to list these health conditions (along with supporting evidence).”

    More:

    GCC under pressure over subluxations…
    http://tinyurl.com/34st584

  19. William says:

    Good news is that government-run healthcare (e.g., Medicare) does not authorize use of a Chiropractor, so there is not need to worry about what happens in 2014.

    Bad news is that government-run healthcare does not authorize use of a Chiropractor, so seeing a legitimate DC isn’t going to be covered.

    Strangely, though, a spine center that does injections (an intrusive and dangerous procedure) IS covered.

  20. Blue Wode says:

    Further to my previous comment above, the UK General Chiropractic Council has now responded to concerns regarding its guidance on the Vertebral Subluxation Complex:
    http://skepticbarista.wordpress.com/2010/10/17/subluxations-still-no-evidence/

    Readers might also be interested in this new press release in which two New Zealand medical researchers warn parents against taking children to chiropractors:
    http://www.infonews.co.nz/news.cfm?id=59215

  21. Blue Wode says:

    Some further excellent investigative work on the chiropractic subluxation has just been published at Skeptic Barista’s blog:
    http://skepticbarista.wordpress.com/2010/10/24/subluxations-who-said-what/

    It specifically looks at the World Health Organisation’s view of chiropractic which is frequently referenced by chiropractors in support of their services.

  22. Sam Homola says:

    Thank you, Blue Wode, for your interesting updates from the United Kingdom.

  23. Blue Wode says:

    Dr Homola and readers might find the following two very recent posts from bloggers in the UK to be of particular relevance to the above discussions:

    Chiropractors at War with their Regulator, the GCC
    http://www.quackometer.net/blog/2010/11/chiropractors-at-war-with-their-regulator-the-gcc.html

    Where the evidence leads (the GCC caught out)
    http://www.zenosblog.com/2010/11/where-the-evidence-leads/

  24. Joe says:

    Here is another thread, much of it by Blue Wode, that reviews evidence for chiro in low back pain: http://forums.randi.org/showthread.php?t=99523

  25. nobs says:

    “# Joe on 20 Nov 2010 at 5:39 am
    Here is another thread, much of it by Blue Wode, that reviews evidence for chiro in low back pain: http://forums.randi.org/showthread.php?t=99523

    WOW!?? Really? REALLY??

    This “study” has NOTHING to do with “chiropractic”! and (giving you the benefit of the doubt, Joe,) why would anyone claiming to be “science-based” be so hood-winked into believing so?

    Directly from the study cited by Blue Wode/Joe:

    “The randomisation
    envelope also contained a second envelope with the
    participant’s allocation to active or placebo spinal
    manipulative therapy. This envelope was given to the
    treating physiotherapist to open in private…….Spinal manipulative therapy was done by
    15 physiotherapists, in 13 private clinics in Sydney, who
    had a minimum qualification of a graduate diploma in
    manipulative therapy,…”

    What is your agenda? Why would you deliberately misrepresent yourself and the study you cite? I cannot think of any honest reason.

    Clearly, DCs were NOT a part of this study. PTs were the manipulation providers…> NOT DCs. Why would you intentionally repeat such dishonest nonsense? Are you so gullible? or just dishonestly manipulative?

    SOOO YES! – the claims cited below ARE very much indeed “misleading. inaccurate, and distortion”…..and I will add- dishonest.

    Per Joes’s cite:

    “According to the GCC the offending newspapers are:

    Chiropractors ‘are a waste of money’, Daily Telegraph, Rebecca Smith
    Chiropractors ‘are a waste of time’, Daily Mail, Jenny Hope
    ‘Chiropractors may be no use in treating back pain, study says’, The Guardian, Alok Jha”

    Yes they ARE indeed “offending” and This is just ANOTHER example of the egregious misuse of “chiropractic” for dishonest purposes. See:

    Inappropriate/Misuse of “chiropractic”
    http://www.ncbi.nlm.nih.gov/pubmed/7636409?dopt=Abstract&holding=f1000,f1000m,isrctn

    AND:

    http://www.ncbi.nlm.nih.gov/pubmed/16925822

    A professing “science-based”, “critical thinker” would/should have spotted this full on. It is truely disappointing to witness the selective, convienient “science sometimes”(http://smperle.blogspot.com/2010/04/science-sometimes-stroke-and.html) displayed here.

    Let me enlighten you as to a few recent studies that actually incorporated DCs:

    Spine J. 2010 Oct 2.

    ‘The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.’
    http://www.ncbi.nlm.nih.gov/pubmed/20889389

    AND:

    ‘Study: Starting with Chiropractic Saves 40% on Low Back Pain Care’
    http://insurancenewsnet.com/article.aspx?id=236234

    This IS the evidence. …. Spinal manipulation is indeed effective when it is incorporating the skills of DCs. I can’t speak for PTs. However your ahem..”evidence” has nothing to do with DCs.

    Shame on you for dishonest misrepresentation of the “evidence”!!

  26. nobs says:

    # nobson 20 Nov 2010 at 2:04 pm
    Your comment is awaiting moderation.
    Reposting

    “# Joe on 20 Nov 2010 at 5:39 am
    Here is another thread, much of it by Blue Wode, that reviews evidence for chiro in low back pain: http://forums.randi.org/showthread.php?t=99523”

    WOW!?? Really? REALLY??

    This “study” has NOTHING to do with “chiropractic”! and (giving you the benefit of the doubt, Joe,) why would anyone claiming to be “science-based” be so hood-winked into believing so?

    Directly from the study cited by Blue Wode/Joe:

    “The randomisation
    envelope also contained a second envelope with the
    participant’s allocation to active or placebo spinal
    manipulative therapy. This envelope was given to the
    treating physiotherapist to open in private…….Spinal manipulative therapy was done by
    15 physiotherapists, in 13 private clinics in Sydney, who
    had a minimum qualification of a graduate diploma in
    manipulative therapy,…”

    What is your agenda? Why would you deliberately misrepresent yourself and the study you cite? I cannot think of any honest reason.

    Clearly, DCs were NOT a part of this study. PTs were the manipulation providers…> NOT DCs. Why would you intentionally repeat such dishonest nonsense? Are you so gullible? or just dishonestly manipulative?

    SOOO YES! – the claims cited below ARE very much indeed “misleading. inaccurate, and distortion”…..and I will add- dishonest.

    Per Joes’s cite:

    “According to the GCC the offending newspapers are:

    Chiropractors ‘are a waste of money’, Daily Telegraph, Rebecca Smith
    Chiropractors ‘are a waste of time’, Daily Mail, Jenny Hope
    ‘Chiropractors may be no use in treating back pain, study says’, The Guardian, Alok Jha”

    Yes they ARE indeed “offending” and This is just ANOTHER example of the egregious misuse of “chiropractic” for dishonest purposes. See:

    Inappropriate/Misuse of “chiropractic”
    http://www.ncbi.nlm.nih.gov/pubmed/7636409?dopt=Abstract&holding=f1000,f1000m,isrctn

    AND:

    http://www.ncbi.nlm.nih.gov/pubmed/16925822

    A professing “science-based”, “critical thinker” would/should have spotted this full on. It is truely disappointing to witness the selective, convienient “science sometimes”(http://smperle.blogspot.com/2010/04/science-sometimes-stroke-and.html) displayed here.

    Let me enlighten you as to a few recent studies that actually incorporated DCs:

    Spine J. 2010 Oct 2.

    ‘The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.’
    http://www.ncbi.nlm.nih.gov/pubmed/20889389

    AND:

    ‘Study: Starting with Chiropractic Saves 40% on Low Back Pain Care’
    http://insurancenewsnet.com/article.aspx?id=236234

    This IS the evidence. …. Spinal manipulation is indeed effective when it is incorporating the skills of DCs. I can’t speak for PTs. However your ahem..”evidence” has nothing to do with DCs.

    Shame on you for dishonest misrepresentation of the “evidence”!!

  27. nobs says:

    Third posting

    # nobson 20 Nov 2010 at 4:58 pm
    Your comment is awaiting moderation.
    # nobson 20 Nov 2010 at 2:04 pm
    Your comment is awaiting moderation.
    Reposting

    “# Joe on 20 Nov 2010 at 5:39 am
    Here is another thread, much of it by Blue Wode, that reviews evidence for chiro in low back pain: http://forums.randi.org/showthread.php?t=99523”

    WOW!?? Really? REALLY??

    This “study” has NOTHING to do with “chiropractic”! and (giving you the benefit of the doubt, Joe,) why would anyone claiming to be “science-based” be so hood-winked into believing so?

    Directly from the study cited by Blue Wode/Joe:

    “The randomisation
    envelope also contained a second envelope with the
    participant’s allocation to active or placebo spinal
    manipulative therapy. This envelope was given to the
    treating physiotherapist to open in private…….Spinal manipulative therapy was done by
    15 physiotherapists, in 13 private clinics in Sydney, who
    had a minimum qualification of a graduate diploma in
    manipulative therapy,…”

    What is your agenda? Why would you deliberately misrepresent yourself and the study you cite? I cannot think of any honest reason.

    Clearly, DCs were NOT a part of this study. PTs were the manipulation providers…> NOT DCs. Why would you intentionally repeat such dishonest nonsense? Are you so gullible? or just dishonestly manipulative?

    SOOO YES! – the claims cited below ARE very much indeed “misleading. inaccurate, and distortion”…..and I will add- dishonest.

    Per Joes’s cite:

    “According to the GCC the offending newspapers are:

    Chiropractors ‘are a waste of money’, Daily Telegraph, Rebecca Smith
    Chiropractors ‘are a waste of time’, Daily Mail, Jenny Hope
    ‘Chiropractors may be no use in treating back pain, study says’, The Guardian, Alok Jha”

    Yes they ARE indeed “offending” and This is just ANOTHER example of the egregious misuse of “chiropractic” for dishonest purposes. See:

    Inappropriate/Misuse of “chiropractic”
    http://www.ncbi.nlm.nih.gov/pubmed/7636409?dopt=Abstract&holding=f1000,f1000m,isrctn

    AND:

    http://www.ncbi.nlm.nih.gov/pubmed/16925822

    A professing “science-based”, “critical thinker” would/should have spotted this full on. It is truely disappointing to witness the selective, convienient “science sometimes”(http://smperle.blogspot.com/2010/04/science-sometimes-stroke-and.html) displayed here.

    Let me enlighten you as to a few recent studies that actually incorporated DCs:

    Spine J. 2010 Oct 2.

    ‘The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.’
    http://www.ncbi.nlm.nih.gov/pubmed/20889389

    AND:

    ‘Study: Starting with Chiropractic Saves 40% on Low Back Pain Care’
    http://insurancenewsnet.com/article.aspx?id=236234

    This IS the evidence. …. Spinal manipulation is indeed effective when it is incorporating the skills of DCs. I can’t speak for PTs. However your ahem..”evidence” has nothing to do with DCs.

    Shame on you for dishonest misrepresentation of the “evidence”!!

  28. Blue Wode says:

    nobs wrote: “This “study” has NOTHING to do with “chiropractic”!…Clearly, DCs were NOT a part of this study. PTs were the manipulation providers… NOT DCs.”

    Exactly. Haven’t you read the link in my last comment which preceded Joe’s comment? Here it is again:

    Where the evidence leads (the GCC caught out)
    http://www.zenosblog.com/2010/11/where-the-evidence-leads/

  29. Joe says:

    In a recent thread, a chiro demanded a new report of vertebral artery dissection following chiro. It seems we have two: http://www.myfoxny.com/dpp/news/local_news/091123- “mom-dies-after-a-chiropractic-adjustment” and J Neurol DOI 10.1007/s00415-006-0099-x

    I guess they will want yet another report before they consider it.

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