Chiropractic
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Revision as of 04:04, 5 November 2010
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Chiropractic is the theory and practice of correction of "vertebral subluxation processes" to treat and cure disease. Basically, this means cracking the spine in several places because the spine, being the centre of all nerves in the body, is connected to everything; this somehow enables the body to magically heal itself. It was developed in the late 19th century by D.D. Palmer, just before the development of modern medical education in the United States and the shift towards evidence-based medical practice.
The public has many different perceptions of chiropractic medicine, as there are few unified standards of practice for it. Most patients seek out chiropractors because they are suffering from back pain; there is some evidence that spinal manipulation is effective for short term pain control.[1] However patients also may be drawn toward the pseudoscience end of chiropractic medicine, which has numerous claims of being able to cure childhood colic (noting that legitimate chiropractors don't operate on minors because they have insufficiently developed bone structure to take the manipulation) or even serious illnesses in extreme circumstances. This is attractive to patients for the same reasons as other forms of alternative medicine, such as perceived failures or side-effects of mainstream medicine or attraction to the "natural" aspects of the treatment. The more esoteric claims of chiropractors are perhaps bolstered by the common perception of spinal manipulation being effective for back pain and the studies that support this.
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Chiropractic theory
Most chiropractors subscribe to the theory of "vertebral subluxation".[2] This differs from the medical definition considerably. An "orthopaedic subluxation" is a painful partial dislocation of a vertebral body. A "chiropractic subluxation" is an asymptomatic misalignment or a "vertebral subluxation complex" thought to be a cause of disease. Such a subluxation has never been proven to exist.[3]
In July 1996, the Association of Chiropractic Colleges issued a consensus statement that "Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health." This hypothesis has never been tested, and ignores significant anatomical reality, such as the fact that much of the nervous system does not pass through "subluxations" in any way. This especially applies to the autonomic nervous system that "influences organ system function".
Effectiveness of chiropractic
There is evidence that chiropractic therapy is as effective as usual medical therapy in treating acute low back pain. Usual medical therapy includes back exercises and anti-inflammatory medications. Chiropractic was also found to be slightly more effective than simply handing a patient a book about back care. In some studies, chiropractic did cost more overall.[4] Specifically, a study comparing outcomes of acute low back pain treated by orthopedic surgeons, primary care physicians (PCP), and chiropractors found similar outcomes, but less cost from PCPs.[5]
While 50-60% of patients who seek chiropractic care do so for back or neck pain, a significant number are treated for other problems. There is no evidence to support the use of chiropractic in general medical conditions.[6]
Potential harms
There are many potential harms associated with chiropractic. These fall into three main categories:
- Cost: chiropractic care costs more than usual care for low back pain
- Overreach: many chiropractors claim to treat conditions for which they have no evidence of effectiveness. They may discourage conventional medical care as it is out of line with subluxation theory (and it would cut into their profits). Also, national health systems may route people to chiropractors to delay more effective, but expensive therapy that could more appropriately be rendered by physicians.
- Danger: rarely, chiropractic care can be actively dangerous, including causing stroke, carotid artery dissection, and vertebral artery dissection.[7][8][9][10]
Summary
There is evidence that chiropractic can help alleviate symptoms of low back pain. There is no evidence that it can help with any other medical problems and may in fact cause harm. The theory behind chiropractic, specifically subluxation theory, is scientifically unsound. It seems likely that much of the benefit of chiropractic comes from the "laying on of hands" and listening to the patient. There is no reason to believe this is any better than standard massage therapy, which may be considerably safer.
Given the non-scientific theories underlying chiropractic, and its poor results, it should be classified as a pseudoscience.
Footnotes
- ↑ "Combined chiropractic interventions for low-back pain." Walker B.F.; French S.D.; Grant W.; Green S., Cochrane Database Syst. Rev. (2010)
- ↑ McDonald W (2003) How Chiropractors Think and Practice: The Survey of North American Chiropractors. Institute for Social Research, Ohio Northern University
- ↑ Samuel Homola, DC,Chiropractic: History and Overview of Theories and Methods, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Number 444, pp. 236-242,2006.
- ↑ Shekelle PG, What Role for Chiropractic in Health Care? N Engl J Med 339:1074, October 8, 1998 Editorial
- ↑ Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. The Outcomes and Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons, N Engl J Med 333:913, October 5, 1995 Special Article.
- ↑ Balon J, Aker PD, Crowther ER, Danielson C, Cox PG, O'Shaughnessy D, Walker C, Goldsmith CH, Duku E, Sears MR A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma. N Engl J Med 339:1013, October 8, 1998 Original Article.
- ↑ Hufnagel A, Hammers A, Schonle P-W, Bohm K-D, Leonhardt G. Stroke following chiropractic manipulation of the cervical spine. J Neurol 1999;246:683-688.
- ↑ Vickers A, Zollman C. The manipulative therapies: osteopathy and chiropractic. BMJ 1999;319:1176-1179.
- ↑ Schievink WI, Mokri B, Piepgras D, Parisi J, Silbert P. Cervical artery dissections associated with chiropractic manipulation of the neck: the importance of preexisting arterial disease and injury. J Neurol 1996;243:Suppl 2:S92-S92.
- ↑ Stroke caused by chiropractor. (MSNBC)