Chiropractic medicine

Chiropractic medicine is a form of treatment that uses manipulative therapy to correct subluxation, which many chiropractors hold is the cause of most disease. Although manipulative therapy has been shown to have some efficacy in treating back pain, headache, and other symptoms of spinal-related conditions, the application of chiropractic medicine as a cure or outside of this specific area is controversial and generally rejected by medical doctors in most countries. Chiropractic is an example of complementary and alternative medicine.

The use of manipulative therapy to treat back pain, headache, and other spinal and musculo-skeletal symptoms enjoys wide acceptance by medical authorities in many nations. It is covered by many health plans such as Medicare in the United States. Although some medical doctors (M.D.'s) and many doctors of osteopathy (D.O.'s) do perform manipulative therapy, more than 90% of the treatment of back pain by manipulative therapy is performed by D.C.'s (Doctors of Chiropractic). [1] The studies have shown a high level of patient satisfaction with manipulative therapy by persons with back problems. [1]

However chiropractic remains controversial. Classical chiropractic theory holds that the correction of subluxation can cure or treat of most disease. Although manipulative therapy has been shown to have some efficacy in treating back pain, headache, and other symptoms of spinal-related conditions, rigorous, medical studies have not supported the efficacy of chiropractic medicine as a cure outside of this specific area. Many people colloquially use the term chiropractic to refer to manipulative therapy of the spine, even by non-D.C.'s, and are unaware of existence of and controversy about the application of manipulative therapy to address medical problems outside of back pain.

Table of contents

1 History
2 Medical risks of spinal manipulation

2.1 Criticism of chiropractic claims

3 Misuse of science reports
4 Reformers
5 Further Reading

5.2 Bibliography of supporting material
5.3 Bibliography of critical material
5.4 External Links

6 Schools of Chiropractic United States
7 Schools of Chiropractic outside the United States
8 References

History

Although chiropractic medicine has gained general acceptance in the late 20th century as appropriate treatment for back and neck problems, medical doctors used to regard chiropractic as a form of quackery. In fact, until 1983 the American Medical Association made it unethical for M.D.'s to refer patients to chiropractors. The current ethical rules of the American Medical Association now permit M.D.'s to refer patients to D.C.'s for such manipulative therapy if the M.D. believes it is in the best interests of the patients. However, medical doctors continue to regard chiropractic as a form of quackery when used to treat other conditions such as e.g. asthma.

The term chiropractic literally means "done by hand" and was adopted by chiropractic's founder, Daniel D. Palmer, to describe a system of therapy that involved the physical manipulation to move joints and organs that are out of position, a condition Palmer coined "subluxation." Palmer was a layman with an interest in the metaphysical health philosophies of his day such as magnetic healing, phrenology, and spiritualism. He imbued the term "subluxation" with a metaphysical meaning, holding that subluxations interfered with the body's "innate intelligence", or spark of life.

In 1895, Palmer claimed to have restored the hearing of a nearly deaf janitor by manipulating his spine. Palmer believed that he had discovered the primary cause of disease and theorized that 95 percent of all disease was caused by spinal subluxation and the others by luxated bones elsewhere in the body. Accordingly to a survey of Canadian chiropractors conducted by the University of Saskatchewan, about one third of chiropractors still believe in Palmer's philosophy. [1]

Contemporary chiropractic is divided into two basic schools: The traditional approach is that followed by the faction of the chiropractive movement known as straight chiropractic [1]. The other school known as mixing chiropractic, combines medical techniques with spinal and other joint manipulation. Mixing chiropractic is itself divided into conservative and liberal factions. [1]

The term straight chiropractic is used to more strictly associate with adherents of Palmer's original theory, and of those chiropractic schools who believe that subluxations are the cause of most or all diseases (see alternative medicine). Outside of treatment (not cure) of a limited set of symptoms associated with the spine, there is no medical evidence supporting the efficacy of straight chiropractic, and some techniques in the past have not been safe. Doctors who have submitted research backing up the medical benefits of spinal manipulation have found their claims incorrectly applied to the entire field of chiropractic manipulation, including straight chiropractic.

Also note the reformer movement discussed below, The National Association for Chiropractic Medicine (NACM).

Medical risks of spinal manipulation

According to the National Council Against Health Fraud, the conviction held by chiropractic believers that every spine will benefit from an adjustment causes them to manipulate spines inappropriately. Among the concerns about chiropractic manipulation is the widespread use of the explosive "dynamic thrust" which takes the patient by surprise, as opposed to more conservative techniques. This maneuver has a greater potential for inflicting injury.

The practice of greatest concern is the rotary neck movement (sometimes called "Vaster cervical'' or "rotary break"). This type of manipulation has led to trauma, paralysis, strokes, and death among patents. Even chiropractic's legal advisors have warned against its use.

The overuse of x-ray by chiropractors poses potential patient harm. Of primary concern is the 24' x 36' full spine x-ray. This technique exposes patients to a substantial amount of radiation. Exposing the body trunk to x-rays can have serious long-range consequences and should be avoided. Further, according to NCAHF's chiropractic advisors, such radiographs have little or no diagnostic value.

Criticism of chiropractic claims

The National Council Against Health Fraud, an American private, non-profit health care organization issued a report in 1985 critical of chiropractic medicine.

Sixty-two clinical neurologists from across Canada, all certified members of the Royal College of Physicians and Surgeons, have issued a warning to the Canadian public and provincial governments about the dangers of neck manipulation. [1]

Mainstream medical doctors and scientists reject the claims of most chiropractic associations and schools as pseudoscience; many refer to their claims as fraud. Recently, however, a chiropracter from the Canadian Memorial Chiropractic College, in Toronto, and two professors at the Los Angeles College of Chiropractic also came to this position; they hold that all chiropractic organizations engage in and promote "quackery".

York University at one point attempted to affiliate with a chiropractic school. The scientists and medical doctors at this school rebelled against the plan, and even created their own website explaining why this would be a bad idea. They enlisted the help of Nobel prize-winning scientists to explain to the school's administration, and public-at-large, why chiropractice is unscientific. [1]

There are many investigations and lawsuits underway in Canada for false advertising, deceptive practices and claims, injuries and deaths.

Misuse of science reports

Some doctors who have submitted research backing up the medical benefits of limited forms of spinal maipulation have found their claims incorrectly applied to the entire field of chiropractic manipulation. Perhaps the most well-known case of this occurred in response to The RAND report on The Appropriateness of Spinal Manipulation for Lower-Back Pain. This scientific study was a meta-analysis of 22 controlled experiments; the conclusion was that certain forms of spinal manipulation were successful in treating certain types of lower-back pain. Many chiropractors seized upon these results as proof that chiropractic theory was sound and that chiropractic medicine had reliable results; in fact, the authors of the report had said no such thing. Misuse of this report reached such an extent that the RAND report authors were forced to issue a public statement. In 1993 Dr. Paul Shekelle rebuked the chiropractic industry for making false claims about RAND's research:

"...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....RAND's studies were about spinal manipulation, not chiropractic, and dealt with appropriateness, which is a measure of net benefit and harms. Comparative efficacy of chiropractic and other treatments was not explicitly dealt with."

Reformers

A small percent of chiropracters have rejected the metaphysical beliefs of mainstream chiropracters. They view the beliefs of mainstream chiropractic medicine as metaphysical and religious, and having no scientific validity, and as a profession which may be danergous. In contrast, the hold that there are scientifically defensible uses of spinal manipulation for medical benefits. According to their website (boldface preserved from the original):

The National Association for Chiropractic Medicine (NACM, [1]) is a consumer advocacy association of chiropractors who confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery. The NACM offers consumer assistance in finding member practitioners. The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based. The original chiropractic hypothesis, stated simply, is that "subluxation is the cause of dis-ease." Modern day chiropractic associations may have expanded and changed this simple statement for the public, but the reality is that this remains the backbone of chiropractic education and practice to this day. In clarification, the term "subluxation" has never been defined by the profession in a way as to have universal acceptance within the chiropractic profession. Chiropractic "subluxation" is not the same as medical subluxation, which represents a partial dislocation of joint structure and would be a contraindication to "adjusting" or "manipulating" the joint structures. Chiropractic "subluxation," not having universal definition, and, thereby, not having received universal scientific status of existence, has evolved into a metaphysical status. Further, the profession has neither defined nor outlined what disease or "dis-ease" that the correction of the "subluxation" might cure or affect. Because the hypothesis has found no validity in universally accepted, peer-reviewed, published scientific journals, belief in the hypothesis, then, is essentially a theosophy. Science has not found any organ system pathology which "adjustment" or "manipulation" of spinal joint structures has effect; that is, no disease or "dis-ease" process is affected.