In the comments to a previous blog entry, a chiropractor made the following statements:
1. Chiropractic is a science.
2. Chiropractic is based on neurology, anatomy and physiology.
3. Chiropractors are doctors of the nervous system.
4. Chiropractic improves health and quality of life.
I offered to write a blog entry on the “science” of chiropractic, and I asked him, both in the comments section and by personal e-mail, to educate me first by providing me whatever evidence he could find to support those claims. I never heard back from him, so I was left to do my own research as best I could. Here’s what I found.
Is chiropractic a science? No.
In 1895, a magnetic healer named D. D. Palmer adjusted a deaf man’s back and allegedly restored his hearing. Generalizing from this one case, he reasoned that “A subluxated vertebra… is the cause of 95 percent of all diseases. …The other five percent is caused by displaced joints other than those of the vertebral column”
He decided that when a bone was out of place, it pressed on a nerve and impaired the flow of Innate (always capitalized), his word for a mythical vitalistic force that allowed the body to heal itself. At one point he talked of establishing chiropractic as a religion.
Once he had decided what he wanted to believe, he never put his beliefs to any kind of a test. He simply proceeded to treat as many patients as possible as quickly as possible. His son B.J. was a marketing genius who established the first chiropractic school and sold chiropractic to the American public. Ironically, chiropractic no longer claims to be able to treat deafness, the condition that got it started.
This describes a cult, not a science. Sciences are not invented in a day by an individual. Sciences are based on research, testing, and verification, not on contemplation, belief, and practice. Sciences progress as new knowledge builds on old and disproven ideas are discarded. Chiropractic keeps adding new techniques (over 200 now) but never discards one. As far as I’ve been able to determine, chiropractic has never discarded anything except “nerve tracing,” the palpation of nerves unknown to anatomy. Chiropractic tries to “do” science, but even its best journals publish articles of poor quality, and in over 100 years it has made precious little progress in understanding what actually happens when they “pop” a back, which techniques are better than others, or how to predict who is likely to benefit.
Is chiropractic based on neurology, anatomy and physiology? No.
It was based on a misunderstanding of those very disciplines. Palmer didn’t understand the germ theory of disease and he didn’t have the advantage of x-rays. He thought bones were actually out of place and thought he was putting them back: x-rays eventually showed this to be false. He thought the spinal nerves controlled every function of the body: he didn’t know about hormones, and he presumed connections that anatomy has never demonstrated. He thought of nerve impulses as flowing like water through a hose, and thought pinching a nerve would impair nerve conduction downstream rather than just at the point of constriction. He got almost all the basics wrong.
Chiropractic was finally forced to admit that the BOOP (bone out of place) theory was wrong. In 1996 the Association of Chiropractic Colleges redefined the subluxation as “…a complex of functional and/or structural and or pathological articular changes that compromise neural integrity and may influence organ system and general health.”
This is not a definition a scientist could grab hold of to do research. It’s a useful fiction that allows chiropractors to treat anything they choose to treat by saying there is a subluxation.
Are chiropractors doctors of the nervous system? No.
A neurologist is a doctor of the nervous system. Chiropractors can’t do most of the things neurologists do, like prescribing anticholinesterase agents for myasthenia gravis, treating seizure disorders, or hospitalizing patients. Chiropractors really don’t have anything much to do with the nervous system: they work on the musculoskeletal system with manual adjustment techniques. If they are “straights” manipulation is all they do. If they are “mixers” they use a variety of other treatments like heat and massage.
Does chiropractic improve health and quality of life? No.
There’s no published evidence to support that idea. In fact, I found one study suggesting that chiropractors don’t live as long as other people. Despite enthusiastic claims, there is no evidence that preventive or maintenance adjustments do anyone any good.
Chiropractic is not a science, but that doesn’t mean that nothing they do is based on science. There is evidence that spinal manipulation therapy is effective for some kinds of low back pain. It is no more effective than other treatments for low back pain, but is a viable option for patients who prefer it. It is not exclusive to chiropractors, but is also used by physical therapists, physiatrists and doctors of osteopathy. In essence, the one “claim to fame” that chiropractors have is not really anything uniquely chiropractic but is a manual therapy shared with other disciplines.
There are a few chiropractors like Samuel Homola, author of Inside Chiropractic, who limit their practice to short-term treatment of musculoskeletal problems, who reject the subluxation myth, and who try to provide rational, evidence-based care. I respect them, especially the ones who have been attacked by their colleagues for speaking out in favor of science and reason.
Unfortunately the majority of chiropractors still believe the subluxation myth. Many of them aspire to be family doctors, discourage immunizations, and think they can help patients with somatovisceral problems – everything from ear infections to stomach ulcers. Some of them want to adjust your baby’s spine in the delivery room and sign you up for lifetime care. A large percentage of them practice applied kinesiology, a bogus muscle testing technique relying on the ideomotor illusion. If a new quackery comes along, you can be sure chiropractors will be among the first to jump on the bandwagon. And once in a while a patient dies of a stroke after a chiropractor applies a rapid twisting thrust to his neck and tears his vertebral artery.
Click on this link for an excellent article by a chiropractor describing what a rational chiropractor can do for you and offering tips on how to choose a chiropractor. There is also a wealth of information on the Chirobase website.
This article was originally published in the Science-Based Medicine Blog.