Is chiropractic for real or just quackery?

Cecil's Columns/Staff Reports
21

To start with, a little history:

When I was 11 years old, I feel off a 12 foot shelf and landed on my rear on a concrete floor. I broke my tail bone, compromised several disks, compressed my spine, and pinched a nerve.

Though the tail bone healed, the pinched never, which is trapped between my pelvic girdle and my spine, left me in pain. At first it was not bad. I couldn’t stay bent over for long periods of time, I couldn’t lay flat on my back, but it was manageable. But as the years wore on the mild radiating pain of the pinched nerve continued to get worse. It was a wearing, tedious kind of pain that I could ignore for the most part. But it was constant.

But the time I was in my mid twenties, I could not remember a time when I was not in pain. I had worse episodes and better ones. A few times I even woke up to realize that my legs were completely unresponsive. I could see them but I couldn’t make them move. To get them to move again was a slow process of stretching, a process that was agonizing.

Traditional doctors offered me pain medication and muscle relaxers, neither of which I can take due to allergies (I am severely allergic to aspirin and codeine). The other alternative was surgery. The surgery option would unpinch the nerve but at a potential cost of losing the use of my legs, bladder control, and sexual function.

I basically consigned myself to live in pain until I ended up going to a chiropractor for an entirely different matter. I explained to her what I had been experiencing, showed her my MRIs, X-Rays, and medical history. And she told me that she could help me. At first I didn’t believe her. But I figured it was worth trying.

So I started going to her three times a week for a month. Because of the length of time between injury and treatment and the contortions my body had to do to make up for the injury and misalignment, it took a long time to unscrew my back. Some days she actually made it worse, which she did warn me about.

But in the end, she found a way to align my back so that my pain virtually disappeared. Now, I need only go to the chiropractor once a month (a different one that was recommended to me by my orthopedic surgeon) to remain virtually pain free.

I won’t tell you that all chiropractors are good. Some simply don’t know what they are doing, but that goes for pretty much anyone in the medical profession. But chiropractic care is a godsend to anyone experiencing musculo-skeletal issues.

Finding the right one is hard. The best option is to seek an open minded doctor and get a referral.

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22

Cite?

Cite? And what is the relevance of quantum physics here?

That’s UL. The Master Speaks.

But I’m sure Einstein accepted Occam’s Razor as a sound principle, and would have been the first to agree with the dictum, “Extraordinary claims require extraordinary proof.” The existence of “vital energy” as something non-chemical is an extraordinary claim.

Cite?

And, more importantly, who got to make the tiebreaker diagnosis?

23

Oh, I see. You, the chiropractic expert, giving advice. Stephen Barrett M.D.?
Check the link:http://www.foundationforhealthchoice.com/victory_barett.html

Barrett is a hired gun. Seems you’re pretty good at slander but offer nothing, in the way of evidence to support any of the hot air you blow. Sorry.

24

I’m sorry Brian. I can’t find what I’m looking for. The testing was done on 4th med students and new DC graduates. the DC grads fares much better. I think it was 50% pass vs. 85% pass. There were a couple of different times it was done. No tiebreaker…

25

Dr. Bob, I’m afraid that your claims about chiropractors effectively treating ear infections in kids are not backed by solid evidence, your list not withstanding (although it’s entertaining to see that chiropractors put their faith in studies promoting homeopathy).

*"No randomized controlled trials of chiropractic treatment of middle ear infection were found (in a scientific literature search). 2 American studies published in 1996 and 1997 had significant design flaws that limited interpretation of results, which showed improvement of ear infection over several days. There were no comparison groups. Because most ear infections clear up without antibiotic treatment, it is not possible to conclude whether or not chiropractic manipulations had any effect on the natural course of the illness.

Safety of chiropractic
Safety of chiropractic therapy in children is not known due to limited research. Children’s bodies and spines are immature and they are more vulnerable to potential injury from rapid and forceful manipulations, especially young children and infants. Less forceful techniques may be less likely to cause spinal injuries. Serious events requiring hospitalization or resulting in permanent loss of function seem to be rare. Financial costs may be a barrier for some families."*

Here’s more on dubious chiropractic claims made for treating children.

There are numerous case reports and studies in the medical literature on strokes caused by cervical manipulation (neck cracking). The existence of one report to a chiropractors’ meeting questioning this link is not very meaningful, especially as the authors apparently follow the belief that patients are prone to rupture their vertebral arteries by simply turning their heads or through other activities of daily living, and that the fact that their necks were forcefully adjusted by chiropractors just before their strokes began is mere coincidence or somehow not the chiropractors’ fault.
It’s possible that in a few cases people have presented to chiropractors with symptoms including neck discomfort which chiros failed to recognize as early warning signs of transient ischemic attacks or stroke, and went ahead and cracked their necks, precipitating a full-blown stroke. That would be further evidence that some chiros’ diagnostic skills are drastically in need of improvement.

I’ll respond to more of your post at another time (it’s late, and your embedding responses in the body of a quote makes for confusing reading). I have to say, though, that I’m disappointed in your use of ad hominem attacks, first on Dr. Ernst, now on Dr. Barrett (one of the directors of the National Council Against Health Fraud and me. Similarly, tu quoque attacks on the medical profession are not only irrelevant to the current discussion but illustrate another bankrupt tactic that is frowned on at this board.

26

This is what i don’t get: chiropractic says you become ill because your spine is misaligned. How are violent neck-twisting movements (adjustments) supposed to re-align the spine?
The whole thing is illogical.
I went to a chiro once-no positive results. I went to a physical therapist three times-complete relief, and no vilent neck-cracking stuff! (It was for lower back pain).

27

The few studies I’ve heard of that claim a positive result for chiropractic therapy are limited to lower back pain. All the stuff about curing bedwetting and so forth are unsubstantiated insofar as I know. I, however, am skeptical about the relief form lower back pain as well. Wouldn’t just about any deep massage provide some relief from back pain? A painful rub should release endorphins that would mask a condition for a while. How do they conduct these experiments anyway? Is there a placebo group that has improperly executed techniques performed on their backs? Even that wouldn’t be double blind. And what about damage done to people by violent chiropractic techniques? How many people are being hurt? To the best of my knowledge, no one is keeping count. And what of the claim that lies at the heart of the practice, namely that chiropractors realign the skeletal system? Is there evidence that the spine is really being realigned by these procedures?

My wife injured her back a few weeks ago. She could barely even stand up. “Get thee to a chiropractor” we were told. “No” said she because she had no faith in them. “you’re making a big mistake” we were told. My wife took it easy and she is much, much better now. If she had gone gone to a chiropractor she would presumably have improved at the same rate (unless they screwed her up somehow.) I can see where someone with the same problem as she would be convinced that the chiropractor helped her after experiencing the same recovery as my wife.

28

REREAD “NECK CRACKING”, YOUR PHRASE THAT IS DEMEANING, ASSIGNING IT TO LITTLE MORE THAN RUBBISH. I’M SURE YOU RECOGNIZE WHEN YOU’RE INSULTING. THERE WERE OTHER EXAMPLES.

29

Captain,

Many people suffer from swelling and spasm and pain when they injure their backs and many people, with a little rest and early, gentle movement, can pull out of it in 3-10 days. The issue that I see, is that these episodes can become chronic and recurrent and the deep, intrinsic muscles that support the spine during movement, will atrophy, losing not only muscle mass but also speed of contraction, thereby not adequately stabilizing the joints as they attempt to move, exposing the skeletal and soft tissue structures to further insult and accelerated degenerative arthritic changes, as the condition perpetuates. Specific spinal stabilization exercises are important and many people will benefit from an experienced DC who can not only provide you with the appropriate exercise regimen but also restore proper motion to the offending dysfunctional joint complex that is frequently a key part of the chronic problem.

30

(I’m pretty sure this quote was actually intended to be your own, and not Jackmannii’s…)

I read the link. Can you point out where Barrett was “completely discredited”? I see a lot of vague claims, such as

“Also, Barrett had said that he was a “legal expert” even though he had no formal legal training.”

What’s a “legal expert”? Are those who give expert testimony (as Barrett has done) required to study law?

And also:

“During the course of his examination, Barrett also had to concede his ties to the AMA, Federal Trade Commission (FTC) and Food & Drug Administration (FDA).”

What does that mean, exactly? I’m sure quite a number of doctors could be said to have “ties to the AMA,” and the article says Barrett himself testified that he was “called upon by the FDA, FTC and other governmental agencies for his purported expertise.”

I see the same article cited gleefully on dozens of other chiropractic/alternative medicine sites like it’s the discovery of the Rosetta Stone, but frankly I’m not seeing what the big “gotcha” is, here. Barrett’s defamation lawsuit being dismissed doesn’t discredit the man or his opinions, despite how much it may please you personally.

31

Sorry, Dr. Bob, but the ample evidence in the medical literature linking cervical manipulation to strokes cannot be handwaved away based on a single set of findings by a chiropractic group. For instance, there’s this study (note that WebMD itself refers to “neck cracking”, a common term for forceful neck manipulation by chiropractors, and obviously one I did not invent):

*"(Dr. Smith’s) team looked at all patients under the age of 60 who from 1995-2000 visited two large medical centers for cervical dissections resulting in strokes or the passing stroke-like episodes called transient ischemic attacks. They found 151 such patients; 51 were available for study. The patients were compared with 100 age-matched patients whose strokes were not due to arterial dissection. All were asked a battery of questions – including whether they had head or neck pain in the 30 days before their stroke, and whether they got a spinal manipulation during that time.

Of the 51 patients, seven (14%) remembered getting their necks cracked before their stroke. Only 3% of the control patients remembered seeing a chiropractor in the month before their stroke. After controlling for all other factors, getting a spinal adjustment upped the risk of stroke 6.62-fold…

“If a person has any of the symptoms of stroke, he or she should bypass the chiropractor and go directly to the hospital,” Smith says.

These red flags are:

One side of the body becomes weak, numb, or paralyzed.
Double vision, blurry vision, or loss of sight.
Trouble speaking or difficulty understanding speech.
Loss of balance or coordination; dizziness.
Sudden severe headache.

“Neck cracking,” or cervical spinal manipulation, is the chiropractic technique that most concerns neurologists. To make this adjustment, the practitioner often gives the neck a high velocity twist. Chiropractors are trained to know the anatomy of the neck. Other kinds of practitioners, Smith says, may not be so well aware of the risks. He notes that many chiropractors already are adopting a less forceful technique for cracking necks."*

Chiropractors continue to be in severe denial about the potential consequences of neck cracking. Some analysts think the true incidene of strokes related to chiropractic manipulation is considerably higher than reported, because 1) such strokes don’t have to be reported to health authorities, and 2) due to delayed bleeding and clot formation from arterial tears, which patients don’t connect with their earlier visit to the chiropractor. Here’s the latest case to make the news.

A suggestion for you - lay off the references to “slander” and “defamation”. They sound odd (to say the least) coming from a poster who accuses others without foundation of being paid to criticize chiropractic (i.e. charging Dr. Stephen Barrett of chirobase.org/Quackwatch with being a “hired gun”). As for me, I’m a physician who doesn’t require payment from whatever shadowy sources you imagine, in order to be concerned about chiropractic quackery and other excesses.

32

No, it isn’t. There was energy in the universe long, long before there was life.

33

Buzzzz. Game over. Thanks for playing.

I suppose we never should have expected much of someone who can continually call BrainGlutton “Brian.”

34

Probably not an unreasonable occurrence in limited cases (not using muscles can lead to atrophy).

You’re on a lot shakier ground here with these speculations.

Proper exercises are dandy - in fact they’re a common part of medical/rehab programs designed to help people recover from back injuries, and are not something exclusive to chiropractors.

Still, it’s good to see you recognize the value of exercise, rather than simply calling on patients to come in every month or more often for lifelong “maintenance” manipulation.

What is this “good advice” and what methodologies do you employ to treat patients with type II diabetes? Do you “adjust” them? And did your training (or the American Chiropractic Association) encourage you to attempt to treat diabetic patients?

35

Here is Haldeman’s quote, on the next page:

Scott Haldeman, DC, PhD, MD, is a chiropractor as well as a neurologist. As clinical professor of neurology at the University of California, Irvine, he’s studied many cases of arterial dissection in chiropractic patients.

Haldeman says the Smith study has a major weakness: It relies on patients’ memories of events years in the past. Also, he notes that even though the study took place in California – where people do more spinal manipulations than anywhere else – only seven cases of stroke could be linked in any way to neck cracking.

“I think the basic information in the Smith study is very important. It does confirm that there is a temporal relationship between stroke and spinal manipulation that we cannot rule out,” Haldeman tells WebMD. “But their evidence that spinal manipulation is a major cause of stroke is weak. The risk is not zero, and none of us is suggesting there isn’t some risk. What we have basically got here is a situation we have to put into perspective.”

Remember this article was posted 5 years ago. Much has happened since then. The Bone and Joint Task Force put the largest study to look at any of this, yet you continue to belittle it. Rather curious…

36

Hey, the important thing is to get the marks to accept that sympathetic magick works; the rest is details.

37

With that kind of specious technobabble you could be a writer for the next Star Trek series. I stopped counting the number of scientific errors in the above paragraph once I ran out of fingers, but just as an example, your understanding of the role of mitochondria, ATP, and the Krebs cycle leaves much to be desired. ATP is not “carried by the blood” to other cells; ATP is produced by and used in intercellular processes. I’m not clear what “quantum physics, quarks, string theory, and the beyond,” have anything to do with the theory of chiropractic medicine, but the not even the most feveret gene-centrist is going to support the idea that “the body adapts, in real time, to changes, at a genetic level, in response to PERCEPTIONS of the cells…”, et cetera. Epigenetics is the action of change of gene expression in individual cells governed by a variety of mechanisms which activate or deactivate areas for transcription. It’s not some kind of inexplicable magic voodoo where cells “perceive” or organize to an unexplained result. Slinging around pop-sci terms in an uneducated, pseudoscientific fashion does not bolster your claims.

As for chiropractic as physical therapy, I rate it up with theraputic massage, except that if a massage therapist grabbed my neck and suddenly jerked it, I wouldn’t consider going back. It is clear that some back pain is due to misalignment of the spine and/or twitching or bruising of the muscles, and can be treated by chiropractic adjustment, but that doesn’t make it a cure-all for pathogenic illness or general medical trauma. A lot of back pain and injury can be avoided by exercising good posture and keeping the multifidus spinae and ntertransversarii flexible and strong by exercise like yoga, pilates, ballroom dancing, low impact martial arts, or any activity that encourages stretching and upright posture, and otherwise avoiding activities that strain the muscles of the back non-uniformly, i.e. lifting from the waist and high spinal impact activities.

Stranger

38

What a classic strawman.

Nowhere in Smith et al’s study in Neurology, or in any of the other studies and case reviews supporting its findings, will you find the claim that spinal manipulation is a major cause of stroke. It is relatively rare (incidence has been estimated at anywhere between one in 40,000 to over one in a million neck crackings, but is thought by numerous observers to be an underreported complication).

Where chiropractic really gets in trouble on this issue, is that there is poor evidence that neck manipulation does much good in the first place. A comprehensive Cochrane review of the medical literature concluded that:

“Done alone, manipulation and/or mobilization were not beneficial (for treating neck pain); when compared to one another, neither was superior.”

Given the dubious rewards of having your neck cracked by a chiropractor, should even a small risk of stroke and death be tolerated? Shouldn’t patients be properly informed of the risk-benefit ratio of this procedure?

Here are a couple of additional articles on the hazards of neck manipulation - important reading for anyone seeing a chiropractor.

By the way, I note that you’re a believer in the foundational fantasy of chiropractic’s beginnings - that D.D. Palmer cured janitor Harvey Lillard’s deafness though spinal manipulation:

It may be bass of me (sorry) to mention this, but the cranial nerve that controls our ability to hear (the 8th cranial nerve) doesn’t run through the spine. It comes off the brain stem and passes through the skull. So no manipulation of alleged spinal abnormalities is going to affect it.

When you and all the other non-evidence based chiros abandon this fairy tale, you’ll have a slightly better chance at being taken seriously. :dubious:

39

Dr Bob–how would you treat a parasitic tapeworm infection?

40

WAG-by grabbing the tapeworm by the shoulders and giving the head a sharp twist to the side?