Subluxation-based chiropractic care is sustained more by faith than by facts
Much of what is discussed in this article has been said before in previous articles I have written for Science-Based Medicine. But since the audience for SBM has greatly increased over the past few years, some subject matter should be repeated for the new readers and researchers coming to this site for reliable information on health care.
Many consumers now search SBM for articles dealing with controversial alternative treatment methods that have been shown to be ineffective or to be loaded with fraud and quackery. Chiropractic in particular continues to be problematic for its failure to renounce the scientifically indefensible, nonfalsifiable subluxation theory that defines the profession as a whole. A review of chiropractic web sites reveals that many chiropractors continue to base their treatment methods on subluxation theory, encompassing a broad scope of health problems. Some chiropractors are now including use of “functional medicine” which uses “natural tools” to treat diabetes, thyroid disease, neuropathy, and other diseases best treated by conventional medical care. Most alarming of all is the treatment of infants and children by “pediatric chiropractors.” Chiropractors are being certified in 10 different specialties, including a diplomate in Diagnosis and Internal Disorders.
As long as chiropractic is licensed as a health-care profession based on subluxation theory or some other unscientific approach, it will continue to be subjected to scrutiny and criticism by the science-based community. It is, in fact, the moral and ethical responsibility of science-based practitioners to oppose any form of unscientific health care, wherever it might exist, separating sense from nonsense without being influenced by politics, special interest, pseudoscience, or belief systems.
Chiropractors often deny that neck manipulation can be a primary cause of stroke by injuring vertebral arteries. But according to Jean-Yves Maigne, M.D., head of the Department of Physical Medicine at the Hôtel-Dieu Hospital in Paris, France:
It is now a well established fact that cervical thrust manipulation can harm the vertebral artery. This accident was formerly regarded as very rare, although severe, and related to atherosclerosis. Clinical tests were proposed to detect patients at risk. The problem is now better known. It is no longer attributed to atherosclerosis…but to a dissection of a vertebral artery, a clinical entity observed in younger patients (20-45 years). It remains very rare, but mild symptoms appear to be not so infrequent. Finally, the predicting tests seem to be deprived of any value.1
In 1997, the French Society of Orthopaedic and Osteopathic Manual Medicine (SOFMMOO), following presentations by anatomists, neurologists, radiologists, and practitioners in the field of French Manual Medicine, adopted the neck-manipulation proposals made by Dr. Maigne.1 “Acknowledging the fact that prevention is out of reach,” said Dr. Maigne, “the aim of these recommendations is to reduce the number of (not to say to suppress) rotational cervical thrust manipulations in a targeted population. This population consists mainly in females of less than 50 years old. Five recommendations were developed, in addition to classic contraindications of spinal manipulative therapy.”
The recommendations of the SOFMMOO, dealing with cervical manipulation in general and allowing the use of neck manipulation in special cases, are worth considering since they were reviewed by medical specialists in different disciplines and approved by licensed practitioners who use manual therapy, long before the stroke-neck-manipulation furor reached its peak in the United States.
Although obscured by controversy, there is evidence to indicate that spinal manipulation can be as effective as conventional treatment methods in relieving low-back pain.1,2,3,4 This grain of truth mixed with chiropractic vertebral subluxation theory that encompasses a broad scope of ailments makes it difficult for the average person to distinguish between appropriate and inappropriate use of manipulation by chiropractors. A person who is satisfied with chiropractic manipulative treatment for back pain might be led to believe that the same treatment can be used to treat a variety of organic ailments by correcting “vertebral subluxations.” Such treatment is usually described as a “chiropractic adjustment.”
A manual chiropractic adjustment
Although chiropractic care based on subluxation theory has been rejected by the scientific community, spinal manipulation used in the treatment of mechanical-type back pain has a plausible basis that makes it acceptable in mainstream healthcare. A good back-cracking back rub provided by a chiropractor or some other manual therapist can be a pleasurable, pain-relieving experience, and this can be a preferred method of treatment for some types of back pain. But you should be well-informed enough to know where to draw the line in separating subluxation-based chiropractic adjustments from appropriate use of generic spinal manipulation if you should consider treatment by a chiropractor. Otherwise, you might become the victim of the bait-and-switch tactics of chiropractors who offer you treatment for back pain and then attempt to indoctrinate you in subluxation theory.
Much of what follows in this article has been said before in other articles of mine posted on this site. An up-to-date summary of basic concerns about chiropractic care, however, might be useful for new readers and others, including professionals, who want a brief overview for quick reference in seeking answers to questions about the problematic aspects of chiropractic use of spinal manipulation.