The saga of chiropractic began in 1895 when D.D. Palmer, a magnetic healer, announced that “95 percent of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints.” Palmer opened the first chiropractic school in Davenport, Iowa, offering a three-week course of study at the Palmer School and Cure, subsequently renamed the Palmer School of Chiropractic. The school was taken over by B.J. Palmer, the son of D.D. Palmer, in 1906. In 1910, the course of instruction was six months. Kansas and North Dakota were the first states to pass laws legalizing the practice of chiropractic (in 1913 and 1915). By 1921, the Palmer School of Chiropractic, requiring 18 months of study, had 2,000 students, reaching a peak enrollment of 3,600 in 1922. By 1923, 27 states had chiropractic licensing boards. Hundreds of chiropractic schools sprang up, some offering correspondence courses. There were no entrance requirements, anyone could become a chiropractor. H.L. Mencken wrote in the December 11th, 1924, issue of the Baltimore Evening Sun:
Today the backwoods swarm with chiropractors, and in most States they have been able to exert enough pressure on the rural politicians to get themselves licensed. Any lout with strong hands and arms is perfectly equipped to become a chiropractor. No education beyond the elements is necessary.1
Although Palmer’s subluxation theory was contrary to all known laws of anatomy and physiology, the theory was appealing to the general public. Medical science was in its infancy, struggling to find effective and safe remedies for disease and infection. There was no known cure for many common ailments, and many of the medicines used by physicians were ineffective or harmful. In the public marketplace, the door was wide open for snake oil salesmen, entrepreneurs, and opportunists who could mix a concoction or fabricate a new treatment guaranteed to work. With growing numbers of chiropractors treating disease and infection by adjusting the spine to relieve alleged pressure on spinal nerves, offering treatment claimed to be superior to medical care, members of the medical community felt an obligation to oppose what they viewed to be blatant, unbridled quackery.
An old Palmer illustration showing how a displaced vertebra could cause disease by pinching a spinal nerve.
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.
ChiroNexus recently listed the top 10 chiropractic studies of 2013. In my experience, chiropractic studies tend to be of poor quality. A media report says “study shows chiropractic works for X,” and when I look for the study it turns out to be a single case report or an uncontrolled study. When Simon Singh was sued by the British Chiropractic Association for saying chiropractic treatment for certain childhood ailments was bogus, the BCA responded with a list of 29 studies they said provided evidence for their claims. Steven Novella showed that out of 29 studies on the list, only 17 actually constituted evidence for 4 clinical claims, and those 17 were poor quality, cherry-picked, and too weak to support the claims. I have a copy of a chiropractic textbook entitled Somatovisceral Aspects of Chiropractic: An Evidence-Based Approach and there is nothing in it that would qualify as credible evidence to a science-based thinker. Chiropractic commenters on SBM have told us that modern chiropractic rejects the “subluxation” paradigm and relies on evidence, and I am always willing to look at new evidence and give chiropractors another chance to convince me that a reform movement is really underway, so I looked up the top 10 studies and read them. I was not impressed.
Note: This is a long article with mind-numbing details that will not be of interest to most readers. Feel free to scroll down to the Summary section. You can just read the bold-faced headings describing the claims of each study on the way down.
Also note: For those who want more detail, the “Study #” headings are links to the full text when available online, or to the PubMed citation.
Chiropractic originated in 1895 when D.D. Palmer claimed to have restored deaf janitor Harvey Lillard’s hearing by manipulating his spine. This makes no anatomical sense, and few if any chiropractors claim to be able to reverse deafness today. But now a chiropractic website is attempting to vindicate D. D. Palmer. They list deafness among a long (wrong) list of “Conditions That Respond Well to Chiropractic”
They list 6 supporting studies. Three are case reports, two are case series, and one is a review of the literature that is labeled in its title as “A Search to Validate” D.D. Palmer. (more…)