Is chiropractic for real or just quackery?

Cecil's Columns/Staff Reports
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Regarding this article: Is chiropractic for real or just quackery?
Anecdotes follow.

In 1988 I injured my back - I didn’t know how to lift things properly at the time, and had a 3-day project where I screwed my back up bad.

After 6 or 8 weeks of physical therapy, my back was in excruciating pain daily. My only relief was seeing a chiropractor. After a 1 hour session, which would include moist heat, a TENS machine, vigorous manipulation of the muscles, deep rubbing of the tendons, and some minor spinal manipulation, I would feel good for some time. It might be a few days, or a few weeks, but I would feel little to no pain from the injury.

The chiropracty session would leave my back a little sore for a few hours (especially from the deep rubbing of the tendons), but that was a welcome sensation when compared to the pain from the injury.

Now’s the good part of the story: Several years ago, someone recommended I try Yoga to make my back feel better. I rented a bunch of Yoga DVDs until I found a favorite few, then practiced with those. After a few weeks of Yoga, my back pain slowly diminished, until it was completely gone.

I guess I would attribute it to the stretching of the muscles that gave me the eventual benefit. I went through about 17 years of back pain and chiropracty visits, when a little Yoga might have solved it !

Nowadays I don’t need to practice Yoga daily - a session every few weeks, with some short stretching exercises every few days, and my back is great. No more chiropracty visits.

By the way, at one point I changed my primary care physician, and I could no longer get chiropracty appointments covered by insurance. I guess some PCPs reason it is too quack-like for insurance.

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Some things they do seem to help. But, during my personal training course I read that 80% of all back pains are unable to be diagnosed, AND 80% of all back pain whether correctly diagnosed or not, start to disappear within 6-8 weeks. Seems like a lot of successful treatment can be chalked up to just waiting.

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And then, there are the guys who claim to cure cancer with back rubs.

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And the people who die or are paralysed by manipulation of the neck.

J R Soc Med 2007;100:330-338
Adverse effects of spinal manipulation: a systematic review

E Ernst

Objective: To identify adverse effects of spinal manipulation.

Design: Systematic review of papers published since 2001.

Setting: Six electronic databases.

Main outcome measures: Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports.

Results: The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature.

**Conclusions: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation. **

Source

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When I saw the headline for this discussion it made me think of something my father told me. See, my dad is a Chiropractor and has been for over 30 years. He has taught at one of the most prominent Chiropractic colleges in CA and is one of few Doctors certified in the highly specialized Mckenzie method of Chiropractic.

One day, after he had finished adjusting my back, I asked my father if Chiropractic really works.

He laughed and then surprised me by saying “Well, here’s the thing. I have been through years of schooling, taught numerous courses on the subject, seen thousands of patients and spent years in the field and I have come to the conclusion that we actually have no idea what we are doing. I have seen many a Chiropractor get up in arms about how beneficial this field is that we work in and how it has changed peoples lives. While I do believe all of that, all the anatomy, physiology, and procedure jargon they like to spit out actually never answers why what we do helps people. But that is just it, what we do helps people. I don’t really know why (even though I could tell you which vertebrae is being affected by this adjustment) when I push you like this and make that popping sound it really helps, but for whatever reason, it does. That is why I like working with people as a Chiropractor. If someone wants to hear all the medical terms for what we do so they can feel better about what we do, then fine. But when everything is said and done if it makes you feel better than why not?”

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If you were a REAL student of the literature, you would know that Edzcar Ernst has compromised his professional integrity by publishing “clear” hit pieces on Chiropractic care. This article was summarily ridiculed for its lack of accuracy, distortion of the facts and demonstration of pronounced bias, by researchers around the world for its poorly supported and lopsided representation of Dr. Ernst’s “data”. Your presentation of this paper either demonstrates that you are iignorant of of this Dr.'s reputation OR you, too have an agenda that is not one of providing clarification of the issues, but more of a malicious nature.

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This is actually inaccurate. Chronic lower back pain (CLBP) is one of the most prevalent chronic recurrent conditions in our society. It is the 2nd or 3rd most common ailment ranked as a reason people see a doctor. The intensity of the symptoms may minimize over time but the condition doesn’t “disappear”. While I’m sure you had good training in your course, the information you were given was wrong. If you would like better data about this, let me know.

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Are you by chance a chiropractor?

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I am. I AM a student of the literature and have been in practice for 26 years.

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I think it’s also worthwhile to point out that pain is often a symptom of something, a sign to you that you’re doing something wrong. You can either treat the pain or treat the symptom.

I’ve taken ergonomics classes, perform on a safety committee, talk to a lot of fitness coaches, and participate in coaching the health of employees who ask for it at my company. IANAD, but I’ve noticed several correlations with back pain, and the cures are often in your lifestyle.

Obviously if you have a hernia or slipped disc, nerve, tendon, ligament, bone, or muscle damage, or some other medical issue - your doctor is the best person to help you with it. What Dr. Bob is referring to is conditions where you either can’t treat the cause, or the cause is unknown. That’s in a surprising amount of cases I think.

In my case, as I changed jobs over 17 years, I changed doctors 3 times, and none of them could find a “cure” for my back pain - all they could do was treat the pain. Ibuprofen from one, short-term Vicodin from another, and short-term Codeine from another, none of which did much to help the pain. So what to do?

As I stated in my OP, chiropractic helped in short-term cases, and wouldn’t make me drowsy or addicted. I was glad to find the cure to the symptoms was better stretching and fitness for my body – my life is radically improved ever since the back pain went away.

In addition to Yoga and stretching, I also discovered that sleeping on my side is much better than sleeping on my back or my belly. Also, don’t sleep (or lay down) for more than 8 hours, as the extra time lying down will just make your back hurt the next day.

For a lot of people, it can be caused by weight. Especially in men, where even just a little bit of weight will form in the belly, which changes the shape of your torso in a way that is unnatural to the spine. If your BMI is over 25, drop it to 24.9 or lower, stretch your back and legs (I recommend Yoga), and sleep on your side. There’s a huge chance your back pain will go away. In my experience with coaching other people on back pain relief, this advice has yet to fail, when it’s followed.

In the meantime, a skilled therapeutic masseuse, or a trustworthy chiropractor who doesn’t rely on crystals and magnets, might be able to help your back feel good enough to attend those Yoga classes.

The chiropractors I’ve been to are skilled masseuses with very strong hands who manipulate the spine, ribs, arms, and legs to stretch and massage all of the joints and muscles. At the very least, this is relaxing and restores blood flow to the muscles and ligaments, and is good for muscles that are swollen.

They not only do the physical hands-on thing, but also talk the entire time. In my experience, they asked questions about when my back started hurting, if I got into an accident, when I first noticed it, if it hurts more when I bend over or when I turn my head.

They also spend some time giving advice on how to help my body. They might suggest finding a time of the day that I can stretch – they’ll ask when I have ten or fifteen minutes to spend calmly alone that you can bend down and touch your toes, stretch from left to right, reach over my head and stretch back, etc. They will show me the exercise and help me through the motions until I have it down. The stretching helped, and had I done it more regularly and for longer periods, my back probably would have gotten better earlier.

That’s another advantage to chiropractic that people might not think about – the person giving me this advice probably knows more about my back and joints than I do, and by asking the right questions and learning about my particular body, they can give me advice to help it out.

As Bosda Di’Chi of Tricor stated, there are guys who claim to cure cancer with back rubs. I found that an approach of calming therapeutic massage and good advice helped my back, which was the result I was looking for.

Here’s a great site on Chronic Low Back Pain:

Very heartwarming first sentence to the article: “Low back pain is a condition that affects 80% of the general United States population at some point in life, often to the point of missing work because of it.”

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I look at chiropractic the same way I look at the alignment on the wheels of my car. If the wheels on my car don’t point in the correct direction with the correct angles, the car won’t drive right.
Just like my car, if my spine gets out of alignment I won’t drive right.
I have had my spine adjusted when it was out of place (I saw the x-rays) and the effect was almost magic. When I walked in, I could not turn my head. Period. When I walked out, I had some residual muscle soreness, but my head turned just fine.

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I hope you would agree that the original theory of chiropractic is bogus. Nerves transmit only information to and from the limbs, not “life force” or “energy.” Your tissue gets “energy” via the blood, in the form of oxygen and burnable food. As for non-chemical biological “energy,” whatever you call it – “chi,” “kundalini,” “prana,” “odyllic force” – there is no scientific evidence whatsoever that it exists.

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Brian, What is your understanding of chiropractic theory?

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Dr Bob–how would you treat diabetes?

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It would depend upon many things. Which type, other co-morbidities, who is in charge of the case. Type I or juvenile onset is managed quite differently,at least in the early stages, than type II, which CAN be managed conservatively, without medication. There are many other potential issues around causation that could influence algorithmic decision-making, here. If you’re asking to test my competence, that’s fine. I may return the favor and ask what are your qualifications to judge my response?

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Free Will.

Also, a college degree, & a skeptical, but not cynical, mind.

And please–pharmaceuticals or other?

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I am NOT a historian of the genesis of the profession. DD Palmer WAS an innovator and like many great things, it was a serendipitous chain of events that led to the discovery of chiropractic. In the context of the times, his construct was quite remarkable and not too far off the mark, in a number of ways. His concept that it was the nervous system that connects the brain to the body and that was how the body talked back with the brain, was a revolutionary concept, that is generally how it works. Remember, we only discovered that the immune system was run by the central nervous system, less than 30 years ago. Palmer had that one nailed.

Is subluxation the cause of all disease? Of course not! Can acute or chronic spinal injury affect autonomic nervous system function and health expression. Certainly! We are receptor driven organisms, with both feedforward and feedback mechanisms at play. Motion drives the brain and nervous system and disturbed feedback from the system lends faulty motor programs that cause corrupted transduction and can spill over into other systems a la software problems. Studies support functional autonomic imbalance in spinal trauma which frequently becomes chronic.

Regarding the “information” that nerves transmit, your portrayal of these events, suggests you have something of a mechanistic view of things and while I respect your right to have an opinion, I believe your view discounts many other things that are going on when it comes to transmission of “information”. Our understanding of many things involving the brain and how it works, are lacking. Energy is precisely what the nerves transmit to tissue, whether is be afferent (brain to tissue) or efferent (tissue to brain) impulses. Energy IS Ball Game. It doesn’t come from the blood but gets transported from the mitochondria in the cells as the result of the Krebs cycle or other metabolic cycles which produces ATP which is THEN carried by the blood. Quantum physics, quarks, string theory and beyond, takes one on quite a journey but what is more pertinent is that epigenetics plays a pivotal role when the body adapts, real time, to changes, at a genetic level, in response to PERCEPTIONS of the cells as to what is occurring in the environment. I wouldn’t get too invested in what science can or cannot prove because according to science, bumblebees can’t fly! Because science doesn’t have answers for things doesn’t mean that things don’t exist. I believe it was Einstein who was quoted as saying: “Imagination is more important than knowledge”. There are a couple of places you can go. The link I provided below is good place to start
http://www.brucelipton.com/article/the-wisdom-of-your-cellspart-2-how-your-beliefs-control-your-biology

Another book that will get you really thinking about your world around you is by Lynn McTaggert entitled “The Intention Experiment”. Check it out of your library or buy it online; a worthwhile read.
The reason I came to this site, in the first place, was because of the gross misrepresentations of the profession that Cecil Adams made. It is irresponsible and misleading to the public. There is good data on otitis media (ear infections) in children being very well managed and infections greatly reduced or completely eliminated with cervical spine adjustments. More effective than meds. Did you know know that we are the only nation in the world that treats otitis media with drugs and we have the worst outcomes?
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Doctors of Chiropractic were put up against medical doctors in several different studies and each time DCs came out on top of MDs when it came to differentially diagnosing pts in the neuromusculoskeletal arena…every time! Cecil’s advice to get to an MD to rule out serious pathology, before you embark on a visit to a chiropractor, is inaccurate and misleading.

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What’s the mechanism of action?

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Oh, my. We’ve got a live one here.

This of course is complete nonsense, unsupported by any rigorous evidence, which is not surprising as there is no anatomic foundation whatever for such claims. Dr. Bob also says when asked how he’d treat diabetes:

That’s an awful lot of flailing about, when the correct response should be “I don’t treat diabetes. That’s outside the expertise of a chiropractor.”

Dr. Bob, you’ll find that your profession will get a certain amount of respect on this board when it comes to treating chronic musculoskeletal aches and pains, for which there’s evidence in some cases that chiropractic manipulation works about as well as physical therapy, massage and other “hands-on” modalities.

Where you’ll have a hard time is in convincing us that chiropractic has any place in treating infections and various internal disorders which have nothing to do with back cracking. It’s sad that while reform elements exist in chiropractic, so many practitioners still try to falsely promote themselves as comprehensive healers and do damage, mostly by delaying proper treatment and by attacking vital facets of evidence-based medicine, such as vaccination.

There is in addition the harm done through the largely useless practice of neck cracking, which can cause strokes and death through forcible tearing of the vertebral arteries in the neck.

It is also revealing, Dr. Bob, that while you snipe at the reputation of Dr. Edzard Ernst (the highly respected director of the Department of Complementary Medicine at the University of Exeter), you claim that D.D. Palmer, who founded chiropractic was a “revolutionary” innovator.

Palmer was actually an uneducated quack who claimed that he healed a janitor’s deafness by manipulating his back. He and his son (before they had a falling out which culminated in the son running over Dad with his car) were successful in marketing chiropractic, but the only real innovation they came up with was a new way to make money.

Good information on chiropractic and how to find a responsible, evidence-based chiropractor can be found here

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A great site, and quite helpful in sorting out various claims.

I actually shared an office with a chiropractor for a while (I’m an MD), and he was an evidence-based guy (a la Ron Slaughter, DC) who had no tolerance for the claims of most of his fellow DCs.

He told me in no uncertain terms that if a DC offered me manipulation for anything beyond musculoskeletal complaints relating to the back, neck, shoulders, and hips, that I should firmly decline said offer.

He understood the scientific method better than most MDs, frankly. Of course, the mainstream chiropractors considered his ideas to be poison.