Chiropractic and chiropractors - does it work?
82Does chiropractic really work?
Talk to most people about going to a chiropractor and they immediately think you have something wrong with your back. Chiropractors made their name in the last fifteen years of so by providing a service for alleviating back and joint pain using techniques that include some that seem very similar to physiotherapy. On the basis of patient recommendations and very successful marketing they have become accepted as an effective means of getting treatment for back pain.
But the whole basis of chiropractic is a theory that makes some quite startling claims. Chiropractic started life back in the late 1890s when a spiritualist and salesman, Daniel David Palmer, in the US came across a deaf janitor who had lumps on his back. Associating the two, Palmer manipulated the man's back and claimed to have restore his hearing. From this basis, he developed the theory that underlies chiropractic, the belief that the spinal cord containing the nerves determines the whole of the body's health, and that misalignments could lead to medical problems. The cure would clearly then be correcting those misalignments, that he called subluxations.
Palmer had no medical training and his ideas were based on a spiritualist belief in vital forces. He explained the technique in terms of releasing nervous flow, and believed that the nervous system was the basis of very many illnesses. Indeed, he claimed that 95% of all illnesses were caused by his subluxations. This was, and remains, a non-scientific theory and no-one seems able to identify subluxations, with even chiropractors diagnosing very different misalignments when faced with the same X-rays. He seemed to ignore the overwhelming majority of illnesses that were caused by trauma, infection, congenital disease, degenerative conditions, and so on.
These days, the chiropractors have spread themselves out on a spectrum, with some more fundamentalist chiropractors stressing these mystical vital forces, and making outlandish claims to be able treat a wide range of illnesses including childhood colic, asthma, allergies, and even on occasions cancer.
More conventional chiropractors tend to focus on the mechanical manipulation of the musculo-skeletal structures to alleviate joint and back pain, using techniques very similar to physiotherapists. But there are many chiropractic clinics offering family chiropractic and other services, including treatments such as chiropractic adjustments and spinal decompression even for children. Such treatments are unproven and are in all probability quite unnecessary. If the diagnosis based on detecting subluxations is not reproducible and evidenced, any proposed treatment is questionable.
So what does the evidence say?
The call from the medical community for evidence to back up the claims made by chiropractors met with a mixed response. Some chiropractors were willing to undertake properly designed controlled, double-blind trials but in these cases, the results consistently showed that chiropractic did nothing. Gradually, the chiropractors established their own institutions and received funds to conduct their own research which started to produce positive research results. They appeared at first to be detecting the positive experimental results they were looking for, supporting the use of chiropractic.
However, when these studies were examined, they almost always lacked the essential elements of well-designed clinical trials. They relied on anecdotal accounts, they were lacking controls, they were not double-blinded, and so almost always, they contained significant bias tending towards positive results. It is still the case that, after every opportunity during decades, there remains no evidence that chiropractor has any influence on illnesses other than lower back pain. Even there, the evidence indicates that chiropractic is no better than a physiotherapist but costs a lot more.
So it remains the case that the claims made by chiropractors are unevidenced and don't stand up to scrutiny. The reports cited by chiropractors in defence of their techniques rely overwhelmingly on anecdotal case studies or else on methodologically poor trials. The research conducted by chiropractic institutes has been consistently low quality and has been heavily criticised by publications such as the BMJ for not meeting the standards of basic clinical research.
Some questionable techniques?
In some cases, chiropractors use a technique in which they move the head rapidly stressing the cervical vertebrae and this has been causally related to ruptures in the neck arteries and consequently with an increased risk of stroke. Although the actual incidence is very low, many medical practitioners regard this technique as dangerous and unnecessary.
Around half of the patients of chiropractors experience some pain and discomfort for a day or two following a session and there are some known complications but reports are patchy because of the low incidence of reporting. In clinical practice, all adverse effects must be reported but chiropractic is not clinical practice. There is a lower incidence of associated pain in the case of physiotherapists.
The bottom line?
Chiropractic is based on an unscientific and unevidenced theory that the spinal cord affects all aspects of health, and uses supposed misalignments of the spine to provide a diagnosis for a range of conditions. Subluxations cannot be identified even by specialists such as orthopaedic surgeons and so their very existence is in doubt. There is no evidence to support the contention that the spine influences all aspects of health.
Some chiropractors restrict their practise to treating lower back and joint pain using techniques very similar to physiotherapy, a mixture of stretching and exercise. Understandably, these have success rates lower or equal to physiotherapy.
There is no evidence to support their claims to be able to treat conditions such as asthma, childhood colic, and other conditions. So whatever may be the claims, you will not get effective treatment for these conditions from a chiropractor. If you have back pain, you will get similar relief by going to a qualified physiotherapist and using a mixture of gentle stretching and exercise.
Chiropractic is a pop-therapy, based on unscientific beliefs, supported by extensive marketing and anecdotal evidence. Those chiropractors who say chiropractic can treat anything other than lower back and joint pain, are making unjustified claims and you are much better off consulting someone who is medically trained. You might also want to report them to their professional associations since making unsubstantiated claims is generally against their code of practice.
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Pure Chiropractic:
Thanks for your comments.
No-one would argue that because something originates in a non-scientific way, that therefore there is something wrong with it. The point however, is that if it cannot be shown objectively to be effective, then it should not be claimed to be so. Blood-letting was indeed a medical treatment but the reason it was dropped wasn't because suddenly people lost faith, but because a physician accumulated clinical evidence that it was doing more harm than good. He measured the rates associated with patients who had been bled and compared it to those who hadn't.
That principle of the clinical trial was fundamental in determining which treatments are effective and those which are not. They are based on three principles. They are controlled, which means only a single treatment is different between two groups, i.e. one group gets the treatment and one does not. If there is any statistically significant difference, it can then reasonably be attributed to the treatment. If the sample size is too small, then the results won't be statistically significant and no conclusion can be drawn.
Secondly, the trial has to be double-blind which means that neither the patient nor the practitioner knows whether or not the treatment is real or not. Sometimes that is difficult to organise but far from impossible. The principle here is to avoid confirmation bias in which appropriate evidence is sought, rather than objective evidence measured. Very many published trials of chiropractic show this type of confirmation bias.
The third principle is that the trials have to be randomised meaning that no-one can predict the pairing of patient with practitioner in the trial.
When judged against these standards, the research papers claiming to support chiropractic are very poor. It is common to rely on anecdotal evidence, trials with insufficient numbers of patients, trials in which the blinding hasn't taken place, non-randomised trials, and so on.
In 2006, Ernst and Canter published in the Journal of the Royal Society of Medicine a paper called "A systematic review of systematic reviews of spinal manipulation" which studied both the content and quality of the research published on chiropractic. They came to the conclusion that the evidence was that in treating neck pain, chiropractic was ineffective. In treating back pain, it was as effective as normal physiotherapy. Other claims of pain reduction were the same as physiotherapy, i.e. chiropractic was no better.
The research from the University of Chicago was very widely reported in the alt-med press but details of the trial itself were not. The results apparently depended on the "skills of one chiropractic practitioner" but crucially, the patients were all also following a diet and exercise regime which would inevitably impact on blood pressure. That means that the trial was NOT controlled. In fact, it turns out that these patients were also on a drug regime prior to the trial which was stopped just before. Methodologically, there are major problems with this research.
But the answer is that the research just needs to be repeated with better controls so that the results can be checked. We're still waiting for any confirmation. So as it stands, it's poor research with no confirmation of the results.
But one thing I really must take issue with because it is an error on your part of fundamental human biology:
"even a basic high school student knows that the brain communicates with and controls the body through the spinal cord and spinal nerves. If there is significant pressure placed on these nerves, such as in sciatica, then it stands to reason that the nerves ability to to control the target organ will be compromised. "
A school child will realise that organs are not simply controlled by nerves. You can replace a kidney without any link to the spinal cord and it will function perfectly. The same is true of the liver. And no-one can seriously suggest that by putting pressure on a nerve, you can change the biochemistry of an organ of the body. That is simply rubbish. What is true is that if nerves are trapped, then there will be symptoms and loss of functionality of the target TISSUE, i.e. the muscle. That's everyday commonplace knowledge that physiotherapists employ.
Most organs of the body are controlled through the changing equilibrium of chemical reactions controlled by hormones. Many chiropractors live in a fictitious world where the spinal cord somehow magically communicates with all regions and organs of the body but it simply isn't true. They think motor control means that everything is controlled by the spine. It's nonsense. Do the research, learn the physiology, check the biochemistry, do the science.
Before claiming these things, you need to really study the science and not just use the vocabulary. If you think the whole body is controlled by the spinal cord, explain how transplanted kidneys can still work perfectly well.
Chiropractors have shown an atrocious lack of understanding of the importance of scientific evidence in establishing the effectiveness of treatments. They even tried to sue Dr Simon Singh for questioning them about it. Time they joined the real world.
An interesting hub. Personally I have had great success with chiropractic treatment in the past, reducing trapped nerve problems in my neck, and the associated migraines that went with it. Of course, physio may well have been just as effective had I chosen that route instead. I'm going to be starting a course of treatment soon for rotated vertebrae and a twisted hip, which I'm hoping will be just as successful...
I realise that different chiropractors have different beliefs about what they can do, but the basic concept of restoring joints to where they're supposed to be seems uncontroversial.
I know that many medical folk doubt the existence of subluxations as, like you say, they cannot often be captured on x-rays, (although I thought that some subluxations could be captured in scans?). However, as a subluxation is simply a partial dislocation, and nobody doubts the existence of dislocation, I am confused about this apparent controversy. (Please excuse my ignorance if I have got this wrong. Perhaps it's specifically subluxations of the spine that are controversial?)
As someone who suffers from hypermobility syndrome (aka EDS hypermobility type), I am someone who experiences subluxations on a daily basis. From when I was very young I've felt joints go out of place, and pushed or clicked them back in again. This has been confirmed by several consultant rheumatologists and physios who specialist in hypermobility syndrome.
Moon Daisy,
Thanks for your comment. Often what is claimed as success for chiropractic is nothing more than the result of some gently joint or muscle massage and as you say, pretty much the same as physiotherapy. But what distinguishes chiropractic is that it claims much more. The subluxations cannot be identified, not even consistently identified by chiropractors themselves. When they were tested with X-rays and scans, they couldn't even agree amongst themselves and when orthopaedic surgeons viewed them, they could not detect anything either.
The idea that dislocations of joints can affect all of the organs of the body is a central idea of chiropractic and is utterly without foundation. Most people go to a chiropractic for some form of physiotherapy but they're sold some hocus pocus as well. Instead of talk about spirits and magic though, they are given nonsense words like subluxations.
Those who go with musculo-skeletal problems, such as back pain will get some physiotherapy, if the practitioner knows how to do it. Some though will get dodgy treatments like partial controlled dislocations. A general rule is that at the very least you shouldn't come out of the session with any pain that you didn't have when you went in. If they are pulling your joints about and hurting you, you should go to someone else.
Incidentally, trapped nerves do actually cure themselves over time - an effect often claimed as a success by chiropractors. The bottom line is that the rational part of chiropractic is just physiotherapy but the expensive mystical nonsense that goes with it has no basis in reality.
I respect your right to your opinion, but I will choose chiropractic care any day over 'traditional' medicine for health maintenance and non-acute injures based on the simple fact that I hope to prevent death as long as possible. And the number of deaths related to surgery complications, prescription drugs, diseases caught in doctor offices and hospitals, and so on far far exceed any small complications that are claimed to be linked to chiropractic. When I go to my chiropractor for head or back pain she doesn't have to spend 30 seconds listing all the possible side-effects and complications like heart-attack, blood clots, death and so on that pain medication has to.
As for it's effectiveness, well if it didn't work, people wouldn't go. Simple as that. I go because it works and don't need some double-blind study to tell me the pain is gone, my energy is increased and I can sleep better.
Ann, I'm glad you think it works for you. Physiotherapy can be very effective and in most cases, that's what chiropractors provide for muscle pain, back problems, etc. The trials show it to be no more effective than physio and most patients who go to chiropractors get physiotherapy and call it chiropractic. The difference though is that many chiropractors claim to be diagnosing "subluxations", mislalignments, which cannot be detected by any known means other than some mystical awareness which is apparently the preserve of the chiropractors themselves. In some cases, they then use this non-existent subluxation as a justification for all kinds of manipulation, some of which is benign.
But if they cannot reliably diagnose these "subluxations", and they can't, then the very basis of the diagnosis is suspect. Better surely that they call themselves physiotherapists, make sure they are properly trained, and offer patients a reliable and honest service.
I'm sure you'd get just as effective treatment from a trained physiotherapist without the hocus pocus nonsense theories from the chiropractor and at a very much lower cost. The trials are there to test claims and to make sure people can't pretend to know things they don't. Recently in the UK chiropractors were making claims to be able to treat childhood colic and asthma and ended up suing Simon Singh, a science journalist, for questioning it. Their case collapsed and now it seems they have to produce evidence which they don't have. These clinical trials are important because they stop quack theories turning into exploitative businesses. As for the warnings of side effects, I wonder how many chiropractors explain that "cranial therapy" involves a risk of rupturing arteries in the neck. If they were regulated in the same way doctors are, they'd have to disclose this. They don't warn you because they are not required to.
Nice information is given on this hub.
chiropractic is a cure for all ails, but even a basic high school student knows that the brain communicates with and controls the body through the spinal cord and spinal nerves.
restrelax: two mistakes in one sentence. Chiropractic isn't a cure for all ills and even the most arrogant of practitioners wouldn't claim that. But the second mistake is one of simple biology. It isn't true that the brain communicates with and controls the body through the spinal cord and spinal nerves. Some of the control of the body is exercised that way, for example motor control of the muscles, but other aspects are not. Very many functions of the human body are controlled chemically through hormones and others by maintenance of a balance between various biological chemicals. The brain contains an endocrine gland called the pituitary gland that secretes hormones which in turn control the production of other hormones and these are circulated through the blood stream. Many are very specific to certain organs so don't affect their non-targets, but once at the target they bring about chemical changes. This doesn't involve the spinal cord or the spinal nerves.
A really clear example is the case of the kidneys which don't have any connection with the spinal cord. When a kidney is transplanted, again there is no connection with the spinal cord and yet they function perfectly well. Another very good example is the immune system which operates independent of the spinal cord. The digestive system too will operate perfectly well without control from the spinal cord. It is simply biologically incorrect to claim that the spinal cord and spinal nerves are central to our health. For motor control, of course these nerves are important as every physiotherapist knows very well, but human biology includes many other systems which are not dependent on the spinal cord.
Chiropractic theory is based on a very old belief system which has since been shown to be quite wrong. But they still pump out the same beliefs as if they were right. They're not and the evidence is very clear about that, so the chiropractors should stop misleading people.
Very interesting hub. Sure to be a sensitive topic for some. But now I'm confused. I have heard that subluxations cause an interference and stop the flow of communication between the spinal cord and spinal nerves and the brain.
And that once subluxations are corrected that no matter what disease you have the potential for healing would be the result. As subluxations weaken the system from proper communication.
wwolfs, there are two kinds of subluxations. The ones you're talking about are when the joints and vertebrae come slightly out of place from where they're supposed to be, and they trap nerves and cause pain and discomfort. In chiropractic, the therapist uses deliberate subluxations to try to encourage your vertebrae to go back into their proper alignment.
The fact is that no-one, not chiropractors nor orthopaedic surgeons, have been able to identify what they claim are subluxations. Even when trialled, the same chiropractors looking at the same x-rays without realising it diagnosed different "subluxations". What they claimed were misalignments weren't. Subluxations are made up and don't exist. Of course, there are real clinical cases of spinal misalignment and these are very well researched and documented, and treatable with clinical medicine.
But the idea that such misalignments might affect the general metabolism of the body is a nonsense theory. It is contradicted by the evidence, by clinical trials, by observation, by the structure of the human body, and by clinical knowledge we already have. The points I made above, for example about transplanted kidneys, need to be answered by anyone making these chiropractic claims.
In addition, if someone is claiming some form of "interference", then they have to demonstrate it, identify it and characterise it, and show HOW it works. No-one has done that because it doesn't happen. If someone told you that your car needs expensive repairs because its energy channels were out of alignment, you'd laugh them out of the room and yet if someone says that about the human body, somehow gullible people think "it might be true..." and go along with it. Chiropractic is a very old wrong theory exploited by practitioners to mystify physiotherapy treatment to make more money. We should wise up and demand they produce demonstrable and reproducible evidence of their claims - or they should stop making them.
Chiropractic is a very old wrong theory exploited by practitioners to mystify physiotherapy treatment to make more money.
Having read lots of Mr Boyds comments, I am astounded he can say the things he does.
With all due respect, physiotherapy moves the vertebrae and other joints BEFORE they are aligned correctly as a general rule...they do not address the issue of joint alignment, so any wear and tear diagnosed by doctors will be being exacerbated and I never found physiotherapy to work at all for me.
I had a whiplash injury in 1988 and screaming headaches every single day for 5 and 1/2 years. physiotherapy couldnt help me one bit. One visit to a chiropractor and hey presto, no more pain either in the neck or head!
I have never had a return to the pain I had, never had another headache like that, and I didnt get regular treatment from a chiropractor for years after that. I now do and feel wonderful as a result. The comments you made here about the nerve impulses and the target tissue being affected...well what would you expect? The target tissue is FED BY THOSE VERY NERVES coming from the spinal cord. so the end result is no different to the chiropractic belief...it's just that your emphasis is placed in a different location.
stormeelaydee: You grasp of human biology is very weak indeed. For anyone to say things like "The target tissue is FED BY THOSE VERY NERVES coming from the spinal cord." shows you have virtually no understanding of human anatomy. The point I made, and repeat, is that a transplanted kidney has NO connection with the spinal cord but functions perfectly well.
You clearly don't understand what physiotherapy does either: "physiotherapy moves the vertebrae and other joints BEFORE they are aligned correctly as a general rule". This is nonsense and whoever told you it is making it up. The point I made, which you seemed to miss, was that chiropractors claim misalignments are the cause of clinical conditions when those claimed misalignments DON'T EXIST. It's not that chiropractors are "realigning" the vertebrae - the very misalignments they claim to exist cannot be found. Chiropractors themselves cannot identify them - they claim different misalignments even when shown the same X-rays - and orthopaedic surgeons cannot detect them. Since they cannot demonstrate any reproducible evidence, these misalignments are nothing more than hocus pocus. Not only that, but using these would-be misalignments as an attempted diagnostic method completely fails to identify real clinical conditions. You ignorance of anatomy and physiology plays into the hands of unscrupulous practitioners who can get away with telling you stories to justify what they are doing. A more informed person would be less easily convinced. Check up the anatomy of the spinal cord and you will see that it doesn't "feed" anything. It's not helpful to anyone to repeat the stories that chiropractors tell when mystifying their business practice.
Pure Chiropractic 21 months ago
I any profession you will find people out in left field, and chiropractic and conventional medicine are not excluded from this. I do however, take issue with some of the statements in your hub. Admittedly, chiropractic did have it's beginning from non-science, but that does not discredit it's value. Native American Indians chewed willow bark to releive pain, not knowing the scientific reason for their relief (it contains ASA). Likewise, many things in medicine also have had no scientific merit. Blood letting was used up until the time that chiropractic originated.
You also state that research shows not benefit for anything other than backpain. This is simply not true and I'd advise you to actaully review the research yourself, rather than rely on information you read on the net or simply made up. A recent double blind study conducted by medical researchers at the University of Chicago recently found that chiropractic resulted in a significant decrease in blood pressure.
You would be hard pressed to find a chiropractor today that states that chiropractic is a cure for all ails, but even a basic high school student knows that the brain communicates with and controls the body through the spinal cord and spinal nerves. If there is significant pressure placed on these nerves, such as in sciatica, then it stands to reason that the nerves ability to to control the target organ will be compromised.
I would have considered a more objective article coming from someone with a scientific background.