Chiropractic – A Little PT, a Lot of Nonsense

What is chiropractic? Chiropractic means different things to different people. For some, it is a practical way to get quick relief from mechanical back pain. For others, it is a cult, a belief system based on demonstrably false ideas, a magnet for every kind of quackery, and a hoax that endangers our public health and sometimes even kills patients.

A science like chemistry develops gradually over many decades with input from many different scientists. A pseudoscience like chiropractic can be invented instantaneously by one person. D.D. Palmer, a grocer and magnetic healer, invented chiropractic on September 18, 1895. He did something to a deaf man’s back. The man said he could hear again. This is particularly ironic, because the nerves to the ear don’t go anywhere near the spine, and no chiropractor today claims to be able to cure deafness. D.D. immediately deduced that all disease was caused by bones out of place (95% in the spine and 5% in other bones). D.D. Palmer never tried to test his hypothesis in any way; he just forged ahead and treated thousands of patients.

1895 was also the year that Pasteur died. Most rational people accept the germ theory of disease, but chiropractic theory rejects it, and many chiropractors today continue to believe that germs can’t hurt you if your spine is in alignment.

1895 was also the year Roentgen discovered x-rays. D. D. Palmer thought he could feel bones out of place in the spine; he called them subluxations (partial dislocations). There are such things as true medical subluxations that show up clearly on x-ray. When they got around to documenting chiropractic “subluxations” with x-rays, nothing showed up.  But that didn’t matter. The belief system had already been established, and nothing was going to change their minds. They just changed their definition: instead of an actual subluxation, they were treating a “vertebral subluxation complex”: “A complex of functional and/or structural and or pathological articular changes that compromise neural integrity and may influence organ system and general health.” Translated, this means “We are going to call anything we want to manipulate a subluxation.”

Chiropractic theory is based on three principles:

  • bony displacement causes all disease
  • displacement interferes with nerve function
  • removing the interference allows Innate (a vitalistic force) to heal the body

All three are false.

  • Chiropractic subluxations have never been demonstrated
  • No impairment of nerve function has been documented
  • No such vitalistic force has been detected.

Palmer was under the misconception that all bodily functions are controlled by the nerves. He didn’t know about hormones. He didn’t know we would learn to transplant organs that would function in the new body with no nerve connections at all. He lived in a prescientific era, and his attitude was more that of a religious believer than a rationalist; he spoke of a God-given calling and seriously considered making chiropractic a religion. D. Palmer’s son B.J. was unscrupulous and a marketing genius. The success of chiropractic is largely due to his early efforts.

Spinal manipulation was nothing new. Others offered it, particularly osteopaths (they thought it restored blood flow rather than nerve function). During the course of the 20th century, osteopaths accepted scientific medicine. Today, American osteopaths take the same specialty training residencies and pass the same licensing exams as MDs. Chiropractic chose to remain in its own limbo. No school of chiropractic has ever been associated with a university, unless you count the University of Bridgeport, an institution closely associated with the Unification Church of Sun Myung Moon.

What does the evidence show? Spinal manipulation therapy (SMT) is as effective as other treatments for certain types of low back pain, and may offer superior early relief, but the long-term outcome is no better. That’s it. There is no good evidence that anything else about chiropractic is effective. It certainly is not effective for asthma, ear infections and other somatovisceral conditions that some chiropractors claim to benefit. So the one thing chiropractors do that works is something that is not uniquely chiropractic but is also used by physical therapists, physical medicine specialists, and osteopaths.

Chiropractors have accumulated over 200 different treatment methods. Instead of comparing two methods to see which works better and rejecting the other, they just keep adding new methods. I have only found one thing that chiropractic as whole has ever given up as ineffective: a nerve-tracing method invented by BJ Palmer who convinced himself he could feel nerves through the skin, nerves unknown to anatomists.

The Risk of Stroke

There is a very small but very real risk of stroke with neck manipulation. Because of the anatomy of the neck, a bone-tethered kink in the vertebral artery is stressed with high velocity neck manipulations and the artery can tear, causing immediate bleeding or sending delayed clots to the brain. Chiropractors try to deny this and say those patients probably went to the chiropractor because they had neck pain and were already starting to have a stroke. But we have plenty of “smoking gun” cases where healthy young people with no neck pain or stroke symptoms and no risk factors for stroke collapsed on the chiropractor’s table and were found to have tears in their vertebral arteries. In one study, patients under the age of 45 with a vertebral artery stroke were 5 times as likely as controls to have seen a chiropractor in the previous week.

Risks should be weighed against benefits, but there don’t seem to be any clear benefits of neck manipulation. A recent Cochrane review showed that gentle mobilization worked just as well as high-velocity manipulation, and in fact neither of them worked alone, but only in conjunction with exercise. The real tragedy is that chiropractors are manipulating necks for “health maintenance” and low back pain and other conditions where there is no evidence of benefit and no plausible rationale. 20 year old Laurie Jean Matthiason saw her chiropractor for low back pain; she had 186 neck manipulations over a 6 month period and the last one killed her. Sandra Nette had a neck manipulation only because she thought it would help maintain her already good health; she suffered a severe stroke and has filed a class action suit asking the government of Canada for $525 million dollars for failure to regulate a dangerous practice.

Other Risks

Half of all chiropractic patients report mild to moderate side effects, from local discomfort to headache. Manipulations have caused broken bones and herniated discs. Chiropractors expose patients to radiation from unnecessary x-rays. Some discourage patients from taking medications or having needed surgery, some want to serve as the initial point of contact for all health care.  Chiropractors are notorious for adopting all kinds of quackery from applied kinesiology to colonic irrigation. My biggest concern is that over half of chiropractors don’t support immunizations, thereby endangering everyone’s public health.

Just a few examples of chiropractic insanity from my local community:

  1. A chiropractor says a baby’s neck is stretched 2 ½ times normal length by childbirth [an anatomical impossibility] and should have neck adjustments starting in the delivery room.
  2. A chiropractor treated his own son’s meningitis with manipulations only; the child died.
  3. A chiropractor diagnoses allergies by having a patient hold a sealed vial of allergen in one hand while he judges the muscle strength in the patient’s other arm. He suspected one patient of being allergic to something at work, and since he didn’t have a vial of Boeing, he had the patient just think about Boeing and that worked just as well.
  4. A morbidly obese chiropractor informed me that if germs caused disease we’d all be dead; he insists you can’t become ill if your spine is properly aligned.
  5. A chiropractor offers to tell if you have a good brain or a bad brain on the basis of a paper and pencil measurement of the normal blind spots in your eyes, and then offers to fix it with manipulation.
  6. Several chiropractors offer $5000 series of spinal decompression treatments with a computerized machine that has not been shown to offer any benefit.
  7. A chiropractor in nearby Seattle adjusts her patients’ necks without even touching them, and when shown a video of her procedure said, “My whole thing is that I’m touching.”

How to Choose a Safe Chiropractor

Some chiropractors have become very skilled at SMT and at treating low back pain. You can look for one who rejects the subluxation myth and limits his practice to short-term treatment of mechanical back pain and doesn’t use any quack treatments. But then you’re not getting chiropractic treatment, you’re getting physical therapy from a chiropractor. Edzard Ernst, the world’s first professor of complementary and alternative medicine, has reviewed the scientific evidence for chiropractic and concluded “Chiropractors… might compete with physiotherapists in terms of treating some back problems, but all their other claims are beyond belief and can carry a range of significant risks.”

A friend of mine had a narrow escape. He had back pain that just wouldn’t quit, and he finally decided to try a chiropractor. He called on a Friday and made an appointment for the following Monday. Over the weekend, his pain stopped and it never came back. If he had seen the chiropractor on Friday, he would have been convinced the chiropractor had cured him, and probably would have spent the rest of his life faithfully getting useless maintenance adjustments.

For further reading:

The best book on chiropractic is Inside Chiropractic by Samuel Homola, D.C.

The best website is http://www.chirobase.org/

This article was originally published as a SkepDoc column in Skeptic magazine.

 

Dr. Hall is a contributing editor to both Skeptic magazine and the Skeptical Inquirer. She is a weekly contributor to the Science-Based Medicine Blog and is one of its editors. She has also contributed to Quackwatch and to a number of other respected journals and publications. She is the author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon and co-author of the textbook, Consumer Health: A Guide to Intelligent Decisions.