Physio vs Chiro Part 2…let’s look at the literature

Posted: January 1, 2012 in Uncategorized

 

We'll see about that...

 

As some of my readers know, one of my blog posts has started a little bit of an argument over the philosophy some chiropractors abide by in their practice. Instead of responding to the chiropractors posts individually, I will try my best to show literature (no opinions) to explain why I have come to believe that subluxation theory has no place in today’s healthcare marketplace.

Before I start, I want to reiterate that I am a chiropractic supporter! I support any healthcare discipline regardless of the credential that incorporates current best practice evidence when treating their patients. For myself, as a physiotherapists who limits himself to the diagnosis and treatment of neuromusculoskeletal conditions, I feel I have a responsibility to my patients to seek out the best information I can on the most effective way to assesses and treat. I don’t rely on dogma or the thought processes of any one particular guru to guide my

The Guru...

clinical practice. I don’t subscribe to a single theory, or preach one entity as the cause of all (or most) disease. Like I said in my original post, I have many chiropractic friends who I look up to as colleagues and try to learn from. My father is a chiropractor in practice for 31 years and we are always learning from one another. I am not naïve to the profession as some of the chiropractors on my blog have inferred.

 For the rest of this post when I refer to chiropractic care I am referring solely to adjustments for subluxations. I am NOT referring to the other modalities evidenced informed chiropractors employ…so let’s look at the evidence:

There is questionable scientific evidence chiropractic works. Neither of two cochrane reviews support it, nor can the The National Center for Complementary and Alternative Medicine (the Federal Government’s lead agency for scientific research on complementary and alternative medicine) who state:

“Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain. Specifically, the 1996 systematic review reported that there were major quality problems in the studies analyzed; for example, statistics could not be effectively combined because of missing and poor-quality data. The review concludes that the data “did not provide convincing evidence for the effectiveness of chiropractic.” The 2003 general review states that since the 1996 systematic review, emerging trial data “have not tended to be encouraging…. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain.” The 2003 meta-analysis found spinal manipulation to be more effective than sham therapy but no more or no less effective than other treatments.” from: http://nccam.nih.gov/health/chiropractic/#9a

 The national center for complementary and alternative medicine, who’s purpose is to support CAM can’t in good conscious conclude that manipulation for “subluxations” works….interesting.

This review then necessitates to me that prudent healthcare practitioners use a multimodal treatment approach. No one therapy alone is sufficient! Just manipulating the spine without doing anything else will yield suboptimal results as stated in the literature.

The chiropractors that have commented on my blog have pretty much stated that the foundations for chiropractic are based on some of the most self evident truths of this universe and they fix subluxations because they feel universal intelligence clearly exists.

Now, no one is arguing against the existence of a supreme being. Nor are we suggesting that faith doesn’t play a role in health. What I do take issue with is the role of D.D. Palmer as high priest.

A quote from his 1910 book “The Chiropractor’s Adjuster” -

“I founded Chiropractic on Osteology, Neurology and Functions of bones, nerves and the manifestations of impulses. I originated the art of adjusting vertebrae and the knowledge of every principle which is included in the construction of the science of Chiropractic.”

and

“I am the originator, the Fountain Head of the essential principle that disease is the result of too much or not enough functionating. I created the art of adjusting vertebrae, using the spinous and transverse processes as levers, and named the mental act of accumulating knowledge, the cumulative function, corresponding to the physical vegetative function — growth of intellectual and physical — together, with the science, art and philosophy — Chiropractic. It is now being followed, more or less, by 2,000 Chiropractors, and its use is being attempted by several other methods. It was I who combined the science and art and developed the principles thereof. I have answered the time-worn question — what is life?”

Besides the obvious factual error (Palmer did not “create” SMT, it has existed in some form since before the time of Socrates), he claims to be the “fountainhead” of knowledge and to be able to answer to the question “what is life?”. There are others who have made similar claims over the years, including, but not limited to David Koresh, Rev. Jones, and General Idi Amin Dada…can you see why his god complex persona discredits him?

The second issue, how does a grocer (Palmer’s career in 1895) instantly become so well versed in “Osteology, Neurology, and the Fuctions of bones, nerves, and the manifestations of impulses” to found anything?

Third, how does Palmer so easily dismiss the thousands of years of evolution in medical knowledge that came before him? Peracles, Hippocrates, Socrates, Virchow, and Lister mean nothing? Palmer was smarter than the thousands of healers who came before him. He alone is the “Fountainhead”. Please.

Lastly, look at Palmer’s motivation (again from his book):

“One question was always uppermost in my mind in my search for the cause of disease. I desired to know why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench, was not. Why? What difference was there in the two persons that caused one to have pneumonia, catarrh, typhoid or rheumatism, while his partner, similarly situated, escaped? Why? This question had worried thousands for centuries and was answered in September, 1895.”

Actually, we now have the answer to this worrisome question, and it isn’t chiropractic. Our modern understanding of the immune system, down to the protein synthesis level, has specifically determined the answers in a very provable manner.

Very interesting book!

 More on subluxation theory:

Other chiropractors have declared its unproven status as an area that needs reform:

“Some may suggest that chiropractors should promote themselves as the experts in “correcting vertebral subluxation.” However, the scientific literature has failed to demonstrate the very existence of the subluxation. Until and unless sound research published in credible journals demonstrates the existence and reliable identification of vertebral subluxation, and vertebral subluxation is found to be an important public health problem, society at large will not care about its correction. Thus, “subluxation correction” alone is not a viable option for chiropractic’s future.”

(Murphy, et al.Bringing Chiropractic Into the Mainstream in the 21st Century – Part II“, Dynamic Chiropractic, September 1, 2005, Vol. 23, Issue 18)

 A Beth Israel Deaconess Medical Center article describes the mainstream understanding of vertebral subluxationheory:

Since its origin, chiropractic theory has based itself on “subluxations,” or vertebrae that have shifted position in the spine. These subluxations are said to impede nerve outflow and cause disease in various organs. A chiropractic treatment is supposed to “put back in” these “popped out” vertebrae. For this reason, it is called an “adjustment.”

However, no real evidence has ever been presented showing that a given chiropractic treatment alters the position of any vertebrae. In addition, there is as yet no real evidence that impairment of nerve outflow is a major contributor to common illnesses, or that spinal manipulation changes nerve outflow in such a way as to affect organ function.[32]

 (Robin Brett Parnes, MS, MPH, “Chiropractic Treatment: What You Should Know“, Beth Israel Deaconess Medical Center.)

And finally:

In 2009, four scholarly chiropractors (yes, chiropractors did this study!) concluded that epidemiologic evidence does not support chiropractic’s most fundamental theory. Since its inception, chiropractors have postulated that “subluxations” (misalignments) are the cause or underlying cause of ill health and can be corrected with spinal “adjustments.” After searching the scientific literature, the chiropractic authors concluded:

“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.”

 (Mirtz TA et al. An epidemiological examination of the subluxation construct using Hill’s criteria of causation.Chiropractic & Osteopathy 2009, 17:13, 2009)

 With this in mind, it is laughable to me that some chiropractors claim that through the removal of subluxations they have prevented heart surgeries, helped with ADHD or colitis…among other conditions. HOW can any rational healthcare practitioner espouse this? I mean, ca’mon! Let’s be real here.

Another great read

Instead of debating the chiropractors on my site point by point I have taken the time to find my sources. It was said that I am an “unarmed man” when it comes to research. I have just posted excerpts of studies showing you WHY I believe your theory for why you say you do what you do just doesn’t hold water. If anyone has any credible sources to prove subluxaions A) Exist and B) cause the problems some have said they create then please share. I am always up for learning and always ready to change my mind if presented with compelling information.

I realize that this post may have offended some and I’m sorry for that. I started my original post praising where chiropractic is going and by the comments of a few, I am sadly reminded that there is still so far for your profession to go. I find it funny how subluxation based chiropractors tell me that other chiros who do more than fix subluxations are “fake chiros”. These are the chiropractors that have taken it upon themselves to constantly learn more and demand the most from their profession. Are they doing exactly what Palmer said they should do? NO! And I commend them for it!

For a much better author on this topic please visit: http://www.sciencebasedmedicine.org/index.php/subluxation-theory-a-belief-system-that-continues-to-define-the-practice-of-chiropractic/

 Thanks for reading,

Jesse Awenus B.A (Hons) Kin, MSc.PT
Registered Physiotherapist

 

 

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Comments
  1. Oscar M says:

    1. You’re a physiotherapist. You did not learn the science, art, and philosophy of Chiropractic by attending four years of Chiropractic school. I find it wild that you feel the need to write a blog about subluxation. You’re a physiotherapist. Why would you write a blog about a seperate and distinct health care profession? You’re a physiotherapist. It would be crazy for a Chiropractor to write a blog discrediting physiotherapy, acupuncture, internal medicine, podiatry, or any other health care field that he is not educated about. You’re a physiotherapist. If you want to write about subluxation and Chiropractic, learn about subluxation and Chiropractic.

    2. “Lets look at the literature”. By literature did you mean finding an article in a trade journal, medical centers website, or reading some quacks blog? Seriously, this type of lunacy makes me want to ram my head into the computer. Dynamic Chiropractic is a trade magazine – not a peer-reviewed research journal. The Beth Israel Medical Centers website is just that – a medical centers website, not a credible peer-reviewed journal. Also, Sam Homola’s blog is not “literature”. C’mon, man! At least find some credible sources next time.

    3. Speaking of review of literature… “Upper Cervical Subluxation Complex: A Review of the Chiropracitc and Medical Literature” by Dr. Kirk Eriksen. Before you write another blog about Chiropractic, do your homework. Dr. Eriksen wrote an entire freakin textbook about the upper cervical subluxation citing over 1200 research papers. And thats just for the upper cervical spine! For more research you can visit vertebralsubluxationresearch.com, where you will find access to Chiropractic journals. By the way, you should read Dr. Dickholtz study published in the Journal of Human Hypertension regarding the upper cervical correction and normalized blood pressure. Fantastic stuff. I expect you to refer all you’re hypertensive patients to an upper cervical chiropractor.
    http://www.ncbi.nlm.nih.gov/pubmed?term=bakris%20AND%20atlas

    4. Yes, Chiropractic, like every other health care profession, needs to continue to publish research. Chiropractic is just scratching the surface when it comes to published research. Unfortunately, this wonderful profession does not receive the same research budgets that other health care professions receive and does not have the infrastructure in place to perform massive research projects. However, times are changing.

    5. Get your entire family checked for subluxation. Subluxations kill. You can even sign up your whole family for a prepaid care plan. :)

  2. Marc says:

    Oscar

    Don’t be a fool. I’m a DC and subluxations do not kill. It’s that kind of dogma and BS that discredits us all. Same goes for you’re cook book “prepaid care plan”. I can run circles around when it comes to evidence-informed chiropractic practice, but that would be like beating up a wet paper bag. True some of your statements have merit, but they were completely obscured with oyur point #5.

    • Giovanni Barricelli says:

      Marc,
      Subluxations do not KILL? I believe what Oscar was referring to was: A subluxation can lead to disease (dis-ease) , disorder of the spine or cancerous activity….which can eventually lead to death Granted that may take YEARS and YEARS to occur, but it does diminish a person’s health.

    • Oscar M says:

      #1. Get over it. Subluxations kill. I find it crazy that the American Heart Association can claim that hypertension is deadly and no one (maybe yourself included) has any issues with that. MDs scare the hell out of their patients everyday telling them if they don’t get on anti-hypertension medications they will die of a heart attack or stroke. Talk to any lay person and they are terrified of the hypertension boogyman because it will kill them.

      Yet, we know that Chiropractic care normalizes blood pressure. The Dickholtz study clearly stated that an upper cervical ADJUSTMENT that removes the SUBLUXATION is more effective than TWO anti-hypertension medications combined. The patients were followed for 8-weeks and 80% of them received only ONE adjustment, and there blood pressure remained normalized after the trial. Therefore, the correction of the upper cervical SUBLUXATION got rid of deadly hypertension – which the AHA says kills people everyday.

      By the way, just in case you didn’t know, the lead author of the study was Dr. Bakris. Dr. Bakris is probably the worlds leading authority on hypertension. If hypertension had a face, it would be Dr. Bakris on the cover. This wasn’t some rinky-dinky study authored by a rogue MD. And yes, I know it was a small sample size, and a larger study is currently under way.

      And thats just for hypertension. You should read the Chiropractic care and HRV studies. Poor Heart Rate Variability results have been called an indicator for all-cause mortality (not just heart disease). Look at the research my friend. Subluxations kill. I hope you emphasize the importance of getting checked to all of your patients.

      #2. Whats wrong with a patient that understands the risks of the vertebral subluxation and the benefits of Chiropractic care and chooses to save some money by paying for their care upfront? Please explain why prepaid care plans are bad. Thanks in advance.

  3. Jesse A says:

    This sums it up well:
    “Put simply, if we ignore the need for research and partnership
    with others in mainstream healthcare, and fail to challenge
    the charismatic evangelists among us who are often heard to
    be the voice of the profession, chiropractic will remain on the
    periphery and will be considered but a fringe player in the
    musculoskeletal healthcare community.” – Dr. Richard Brown, British Chiropractic Association (BCA) and European Chiropractors’ Union (ECU)

    –if you are unclear, this CHIROPRACTOR is stating that subluxation based chiropractors are keeping the professions down.

    This blog was never meant to debate the professions. It was meant to simply give all therapists info they could use in their clinical practice. I didn’t want to start this “argument” but I was forced into it. I professionaly bow out.

    All the best,

    Jesse

  4. Interesting post Jesse – seems you’ve aroused some angst. In my experience, those who are aggressively defensive in a forum like this always have something to hide…normally extreme insecurity in the ‘facts’ they preach. Clinical practice is about adaptation and integration of emerging information and research in a patient-centered manner, not hopelessly clinging to a historical (and extremely unbelievable) construct that minimally shrouds a purely financially-driven, doctor-centered ‘treatment’ model. I will say that it does make all of their (counter-)arguments very simple – just shut off your brain and repeat: “one cause, one cure…”

    I like these quotes from Dr. Richard Brown, President of the British Chiro Association and Secretary of the European Chiropractors’ Union:

    “Put simply, if we ignore the need for research and partnership with others in mainstream healthcare, and fail to challenge the charismatic evangelists among us who are often heard to
    be the voice of the profession, chiropractic will remain on the periphery and will be considered but a fringe player in the musculoskeletal healthcare community.”

    “Chiropractic, when compared to medicine and dentistry, remains in a period of teenage angst. It demands to be listened to, yet at times struggles to articulate itself in a way that mainstream
    healthcare will tolerate. It speaks in its own language, yet often fails to realise that others in healthcare may not comprehend. It insists on acceptance, yet sometimes displays an
    inflexibility that seemingly shuns the notion of true integration.”

    Our profession needs to clean up our act or we will be abolished…

    Cheers,

    Shawn

    • Oscar M says:

      My bad, fellas. I thought we were having a conversation about subluxation, science, research, and literature. I thought you guys might appreciate the resources I provided you with.

      However, it seems like you guys are interested in talking about evangelists, “preaching”, and “one-cause, one-cure”. Maybe you should change the title of your blog if those are the topics you wish to discuss.

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