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117 thoughts on “Science and Chiropractic

  1. zager says:

    [...abstract refers to cervical “manipulation,” not “chiro adjustment.”]

    They explain that chiropractic adjustment is used.

    Subluxation theory is disproven and no longer worth arguing about. The theory under scientific investigation is that intervertebral joints become hypo-mobile, and adjustment restores mobility in the resricted segments.

    I don’t know offhand if and how “Innate Intelligence” could be tested, so yes, it is an embarassing fairy-tale. Many chiropractors don’t subscribe to this. Even if they do, the science has to deal with analysis of objective measurements. Health care, in practice, is an art, and I am sure some PTs (and some MDs) have their fairy tales. And, I am sure some PT have cause strokes. I bet one could find some chiropractors that have performed >100,000 adjustments in a 10-year period without any stroke incidents resulting from the adjustments.

    “…the first 12 volunteers that fit the inclu-sion/exclusion criteria for the study would become the manipulation group as this would enable the next 12 subjects to be age matched…
    … no subject knew which group they were taking part in prior to their experimental session taking place…”

    Subject selection was randomized.
    The physical measures were not subject to concious influences, so it was not necessary to blind the therapist (chiropractor) or the subjects.
    Two groups of twelve subjects will often have sufficient power to determine a statistical difference. It was sufficient for these scientific findings.

  2. Joe says:

    Zager wrote “They explain that chiropractic adjustment is used.”

    So adjustment = manipulation; except PTs do it more safely.

    Zager wrote “Subluxation theory is disproven” and “I don’t know offhand if and how “Innate Intelligence” could be tested, so yes, it is an embarassing fairy-tale.”

    So, you acknowledge that the basis for the chiro cult is nonsense.

    Zager wrote “I am sure some PT have cause strokes.”

    So, cite your evidence.

    Zager wrote “…the first 12 volunteers that fit the inclusion/exclusion criteria for the study would become the manipulation group as this would enable the next 12 subjects to be age matched…”

    That is not radomization. Randomization means you identify a population and assign them “randomly” to each arm of the study.

    Zager wrote “… no subject knew which group they were taking part in prior to their experimental session taking place…”

    So, it was ‘single’ blind. That may be a landmark in chiro “research.”

  3. zager says:

    Again, I would urge administrators at this site to read the scientific article suggested and discuss the findings based on scientific merit. It certainly fits the theme, “Science-Based Medicine”.

    I don’t know if the authors are chiropractors, but they are scientific researchers, as evidenced by their paper published in a legitimate, refereed journal. They used a licensed chiropractor to provide the “adjustments”.

    Let’s call short, high-velocity manipulations (chiropractic) “adjustments”. And, we might call slow, full-range manipulations (one PT technique) “joint mobilizations”. We can all agree that they are different.

  4. zager says:

    Is there a forum here to start a new thread? The following is a completely different issue to the one I raised above.

    Symons BP, Leonard T, Herzog W (2002) Internal forces sustained by the vertebral artery during spinal manipulative therapy. Journal Of Manipulative And Physiological Therapeutics 25: 504-510

    “SMT resulted in strains to the VA that were almost an order of magnitude lower than the strains required to mechanically disrupt it. We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA.”

    I think the epidemiological studies can only associate ~1 in 150,000 chiro adjustments with stroke.

  5. Harriet Hall says:

    When I looked up the Haavik-Taylor article in PubMed I found a similar article by the same author on “Altered cortical integration of dual somatosensory input following the cessation of a 20 min period of repetitive muscle activity.”

    Evoked potentials and cortical integration are not my area of expertise – Steve Novella would be far more qualified to comment – but it seems at first glance that if the phenomenon can be elicited by stopping repetitive muscle activity as well as by spinal adjustment, it probably has little to tell us about chiropractic. And the changes they measured only lasted 20 minutes.

    Chiropractic researchers have developed at least 3 reasonable hypotheses about possible mechanisms by which spinal manipulation therapies might relieve pain, but none is supported by enough evidence to raise it out of the realm of simple conjecture.

    As to chiropractic and stroke, I’m planning to write about that subject in the near future.

  6. zager says:

    “…seems at first glance that if the phenomenon can be elicited by stopping repetitive muscle activity as well as by spinal adjustment, it probably has little to tell us about chiropractic. ”

    Maybe. I will try to read through that article.

    They have since used a different neurophysiological technique (TMS):

    Taylor HH, Murphy B (2008) Altered sensorimotor integration with cervical spine manipulation. Journal of Manipulative and Physiological Therapeutics 31: 115-126

    I think there is mounting evidence, beyond simple conjecture.

    How about a forum where we can discuss in focused thread topics?

  7. Joe says:

    Zager wrote “Subluxation theory is disproven and no longer worth arguing about.”

    You are right; but, not for chiros. According to a survey of and by chiros (William P. McDonald et al in “Seminars in Integrative Medicine” 2:3, 2004, pp. 92-8) 88.1% believe in subluxation.

    In addition, in 2005 the Association of Chiropractic Colleges wrote “Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.”
    Source: http://www.chirocolleges.org/paradigm_scopet.html

    As for your reference to JMPT, that is a CAM (specifically, chiro) publication. I learned long ago not to waste time looking at such “literature.” Think about this, if you made a valuable discovery in health-care, why would you publish in a magazine of no repute? The fact that the authors chose that outlet for their work suggests that even ‘they’ don’t take it seriously.

  8. Harriet Hall says:

    zager said. “I think there is mounting evidence”

    Mounting evidence for what? For the fact that manipulating the spine is felt by the patient? When you adjust the spine, you would expect the sensory nerves to take messages to the brain and for the brain to process those messages. When you hit your foot with a hammer you might expect something similar to happen.

    How can there be mounting evidence of “how” chiropractic works when there is no convincing evidence “that” it works?

  9. zager says:

    How about a forum where we can discuss in focused thread topics?

  10. zager says:

    JMPT is peer reviewed and indexed. The journal impact factor is just under 1.0, which is not great, but it is far better than the the lay conjecture spouted here. The Clin Neurophys journal impact factor is ~2.5, which is pretty good.

    PTs, Massage therapists, Chiropractors, and others can detect rigid spine segments. There are hundreds of thousands of patients who have experienced the different clinical results available from different professionals. Chiropractic does work, and it is perfectly valid to investigate the mechanisms scientifically.

  11. Joe says:

    Zager wrote “JMPT is peer reviewed and indexed.”

    When your peers are quacks, it doesn’t mean much.

    Indexed? If you mean in PubMed, PubMed has been forced to index quackery by our legislators, not by scientists.

    Zager wrote “Chiropractic does work …”

    Great, cite the evidence; but, don’t include “manipulation” (or chiro fanzines). We need to see chiro subluxations in action. Absent that, you are merely a massager. Don’t fret, that has its place for people who can tolerate it.

  12. Harriet Hall says:

    Zager asked, “How about a forum where we can discuss in focused thread topics?”

    This is a blog, not a forum. There are plenty of other forums available. For chiropractic, I’d recommend http://chirotalk.proboards3.com/index.cgi

  13. Harriet Hall says:

    Zager wrote “PTs, Massage therapists, Chiropractors, and others can detect rigid spine segments. There are hundreds of thousands of patients who have experienced the different clinical results available from different professionals. Chiropractic does work.”

    You seem to be confusing spinal manipulation therapy with chiropractic. They are not the same thing.

    SMT works to some extent for a few specific musculoskeletal conditions, mainly low back pain, but it is not superior to other treatments. SMT is a modality used by various practitioners. It is not specific to chiropractic. Most of what chiropractors do has not been shown to work, and SMT has not been shown to work for most of the things chiropractors claim. “Hundreds of thousands” of testimonials don’t add up to evidence.

  14. AndyB says:

    hahahaha…wow, what a conversation!

    Harriet, I apologize for the chiropractor who created an arguably controversial statement and then would not allow himself the opportunity to respond to your questions/comments. If I may give it a shot in the next few days, I can hopefully at least give you some sort of a idea where he may have been coming from, although I cannot speak for him directly.

    But just a couple of things off the cuff…

    1) The Chiropractic course of study is based on what is often called the “3-legged stool” of “science, art, and philosophy”. Or you may say science, technique, and theory in most cases. So perhaps this is the science of which he is speaking. Science is science- The science classes from a Chiropractic school are the same as those in a medical school. The scientific information that is out there is equal for everyone and the textbooks are the same. The science on which Chiropractic is based is the same science on which medical care is based. No school is calling Chiropractic a science, they are saying that the program is science classes, which it is… at the vast majority of schools the pre-med program and the pre-chiropractic program is identical.

    2) The major difference however is that medical has approached disease or “dis-ease” from a deductive standpoint (which is how modern science operates as you were alluding to earlier) with a hypothesis of what’s going on and experiments to prove/disprove the hypothesis… Chiropractic was formed and operates largely via an inductive approach to disease. Things were seen that created results, and then more tests were carried out. From these were generated theories about what was going on in the human body. Osteopathy was created in much the same way. except that they originally thought that impingement of blood vessels was the cause of all major diseases, which inherantly proved to be a flawed theory/hypothesis. This is a fundamental difference between the two and hopefully helps to explain a little of the confusion/debate. Is is at times ridiculous to compare two disciplines which operate through different types of scientific reasoning.

    3) PT and yoga do not really belong in this thread. Yoga is not a healthcare modality in the scientific sense, and does not really compare to Chiropractic in any sense relative to this post. I’m not really sure where that one went wrong except that someone wanted to voice their opinions about how great they think Yoga is, but I’m not sure why they chose to drop that here. And PT is a wonderful artform with amazing results. But a chiropractor takes many more graduate level courses than a medical doctor, let alone a PT practitioner. And chiropractors “adjust” rather than “manipulate” the spine. The difference in my opinion is merely a matter of specificity. An adjustment is specific, a manipulation is general.

    4) An entire group cannot be judged by the words of a few. There are many, many unspecific chiropractors out there, and many chiropractors claiming to practice things that are not chiropractic. I apologize for that, but this is true in any profession, and the more you have, the more of them there will be. Let’s not begin to number the MD’s that caused hundreds of thousands of unnecessary deaths last year as a result of medical errors. How many deaths were there last year as a result of chiropractic error… zero, I believe

    5) The research relating to vertebral artery/stroke cases which have been attributed to Chiropractic is largely b.s. The studies that have been done highlight manipulations not conducted by chiropractors, but done, in fact, by PT practitioners, a barber, a massage therapist, among others. I’m not sure if any of the studies actually highlight a chiropractic adjustment, but I will look in to that for sure.

    Harriet, I will try to get you a response to your initial posting in the next couple of days. If you have any specific questions, I will be glad to give them my best shot.

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