Chiropractors are everywhere. They are ferociously marketing themselves to my Dear Reader, nagging passers-by near a mall kiosk, and fishing (phishing?) their way into the offices of medical doctors. In all of these facets, they are relaying a message stating a comprehensive healing ability by musculoskeletal, specifically spinal, manipulations to fix vertebral subluxations. One could simply read the Wikipedia page to learn how it’s fraudulent since this is well-trodden, but reading my cool swear words and fantastical wit is infinitely more entertaining. Plus, new chiropractic operations continue to open all the time and I’m going to learn from doing this.
What It Is
Chiropractic is a form of alternative medicine concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine, under the belief that such a disorder affects general health via the nervous system.
History or HIS STORY – Cue Beethoven’s Fifth
Chiropractic was created by a Canadian chap named Daniel David Palmer, or the original DDP, who got his start in alternative medicine with magnetic healing and spiritualism. While he was working as a magnetic healer (an exceedingly pseudo-scientific alternative medicine) in Davenport, IA, a janitor stopped in to tell DDP about how he became hard of hearing years ago while picking something up and DDP felt the urge to molest a lump in the janitor’s back. Soon after the janitor claimed to be able to hear again, as the legend is told in his book. However, the janitor’s daughter says her father informed her of the story quite differently, saying DDP hopped into a group of men being told a joke by the janitor and when the punchline landed, DDP slapped the janitor on the back in hilarious exclamation and the janitor’s hearing was restored. If only one of them had put the joke on their Snapchat story, then we’d know the truth. However, this was in the Year of Our Lord, 1895.
A student in chiropractic school should start to shift in his or her chair after being informed of this story. Does the tale, told either way, not immediately cast doubt into the mind of a rational person? Better yet, should a rational person not be equally skeptical of chiropractic intervention even before this story is put forth? That is supposed to be the scientific mindset. Moreover, DDP’s son, BJ Palmer, put forth the idea that chiropractic was founded on “…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it.” Also, there is a bizarre patricide story that BJP angrily ran his father over with his car at a parade and DDP died soon after, but it was officially called death by typhoid. Not joking. I just wish a disgruntled client of DDP’s had run him over before he had the chance to further contaminate the world with his gene pool.
Anyway, this “discovery” DDP had made led him down a rabbit hole and soon he was claiming phantasmagorical abilities of his hands, even claiming he “received chiropractic from the other world”. What he believed to have stumbled upon was a phenomenon called vertebral subluxation, a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. In laymen’s terms, the vertebrae and other joints are misaligned and it’s fucking all kinds of shit up.
“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.” – DDP, from his book, The Science, Art and Philosophy of Chiropractic
Childhood leukemia? No problem, I’ll just crack the kid’s neck! AIDS? That’s probably just a low-back tweak. The bubonic plague? Nothing a quick snap, crackle, and pop can’t fix.
Subluxinate Me, Batman!
Here’s the thing, long before Christopher Nolan took Batman way too seriously, scientists and doctors were having trouble finding literally any statistically significant basis for vertebral subluxations and the Innate Intelligence, i.e. the force in one’s body that governs all of its function, it supposedly restores. II is a shockingly mystical leap of faith and a complete diversion from the actual definition of human intelligence, a phenomenon that has tomes of evidence to back it up. I was, surprisingly, unable to find a Bell Curve equivalent for Innate Intelligence.
However, the semi-ethereal claims about subluxations made by DDP over a century ago can be turned into a valid hypothesis and rigorously examined with a scientific lens. The good news for us is that it has been, and the bad news for chiropractors is that it has been. Before we get into the literature, listen to what some progressive chiropractors have to say:
Samuel Homola, DC
“Chiropractic, which celebrated its centennial in 1995, is a curious mixture of science and pseudoscience, sense and nonsense. Much of it is based on the theory that misaligned spinal bones produce nerve interference that causes disease. Many chiropractors claim that correcting these misalignments (“subluxations”) can restore health and that regular spinal adjustments are essential to maintain it.
Neither logic nor scientific evidence supports such a belief. Although spinal manipulation can relieve certain types of back pain, neck pain, and other musculoskeletal symptoms, there is no scientific evidence that it can restore or maintain health. As a result of expressing my opinion on this subject, I have been called a chiropractic heretic.
The chiropractic profession has little tolerance for dissension. Its nonsense remains unchallenged by its leaders and has not been denounced in its journals. In fact, many chiropractic journals continue to publish articles that attempt to justify subluxation theory. Although progress has been made, the profession still has one foot lightly planted in science and the other firmly rooted in cultism. Without appropriate criticism, the good in chiropractic will never be sifted out, and competent chiropractors will not receive the recognition they deserve.
This book denounces the cultism in chiropractic but supports the appropriate use of spinal manipulation and the research efforts required to solidify its scientific basis. If you are contemplating or receiving chiropractic care, it might help protect both your pocketbook and your health.” – an excerpt from Inside Chiropractic: A Patient’s Guide by Samuel Homola, DC
Preston Long, DC, PhD
“The fact that patients swear by us does not mean we are actually helping them. Satisfaction is not the same thing as effectiveness… Many chiropractors actually take courses on how to trick patients to believe in them (see Chapter 8 of his book).” – Preston Long, DC, PhD is author of Chiropractic Abuse: An Insider’s Lament
Lon Morgan, DC
“Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity.” – Lon Morgan, DC
The overwhelming majority of chiropractors and the American Chiropractic Association continue to peddle subluxation as an a priori axiom of health and purpose for musculoskeletal manipulations. Subluxations are the pillar of the profession and still the most contentious aspect of their practice. It’s hard to think of another medical practice that sits on a complete foundation of sand. The authors of a comprehensive review of the existence of subluxations say the term is perhaps currently more a political assertion than a scientific theory. Moreover, Craig Nelson, DC, said this, “clinical studies of the effectiveness of spinal manipulation are conducted and reported without reference to the presence or absence or even the existence of subluxations.” I added the italics and bolding because Beethoven is playing and I want to provoke the crowd. Remember that throwaway joke I wrote earlier? Of course not. Waste some time by scrolling up to look for it.
There is moderate evidence that spinal manipulation therapy (SMT) can be similarly effective for low-back pain as physical therapy (PT), but what I’ve seen of PT is almost entirely tomfoolery so I remain skeptical. I’ll probably touch PT in another post, but suffice it to say that external rotation of the shoulder joint with a band or 2 lb dumbbell is improving only the PT’s wallet. The study last linked goes on to say that limited evidence proves it is more or similarly effective to exercise therapy or medical care, but no firm conclusions can be made right now. Much of the aforementioned improvement in pain could be placebo. Moreover, this 2012 review from a PhD with a hyper-Polish last name found no statistically significant reduction in pain from SMT. This 2011 Cochrane review said SMT has no current clinical evidence that it is superior to any other modality for decreasing pain and/or function in the spine, and we should pay attention to our wallet when seeking help. Thanks for the tip, guys. Same thing here. Another one said it’s similar to other interventions and might be superior to some stuff but couldn’t make a definitive conclusion. Please, my Dear Reader, put the gun down. I’m only trying to be thorough.
A meta-analysis found that SMT can be a valid approach for slightly improving sciatica radiculopathy, i.e. pain from compression or inflammation of the sciatic nerve. It might help lumbar (low-back) radiculopathy a bit, but it will not help chronic lumbar and/or cervical (neck) pain symptoms or thoracic (mid-back) radiculopathy. Currently, there is no consensus on whether cervical pain can be improved at all by SMT and it might be the same as PT. Doesn’t really help whiplash. There is weak evidence that thoracic manipulations might help cervical pain in some cases, but certainly can’t be generalizable. Evidence does not support the claim that it helps migraines.
Headaches begin to enter the area of overreach practiced by many chiropractors. At this point, we’re beyond the idea of spine pain and moving into nonmusculoskeletal issues. If chiropractic doesn’t seriously improve pain or function related directly to the spine, how can it heal or even improve nonmusculoskeletal issues that are completely unrelated to the spine? This is what Kenny Loggins meant by the Danger Zone. Also, Top Gun is shit, there’s no way Tom Cruise could spike a volleyball.
Despite the scientific uncertainty, many chiropractors won’t hesitate to suggest improvements of hypertension, gastrointestinal disorders, learning disabilities, fibromyalgia (a bizarre phenomenon to begin with, much less treat), carpal tunnel, asthma, allergies of all kinds, insomnia, menstrual cramps, and many other issues. One can simply browse the Internet for a few minutes to find these claims, and, as my Dear Reader has guessed, none of it has any clinical evidence for support.
This study proves what we intuitively understand, if we tell patients they are going to feel pain or not, their perception of pain will change accordingly. The patients told that SMT would positively affect their pain experienced hypoalgesia, i.e. reduction of sensitivity to painful stimuli, and the ones told SMT would negatively affect their pain experienced hyperalgesia, i.e. increased sensitivity. Is it possible all of the evidence, as weak as it is, pointing toward SMT’s effect is related to placebo or hypoalgesia?
I’ll Just Conclude This Thing
So, to quickly recap, vertebral subluxations, the foundation of chiropractic assertions, are a scientific conclusion made before any science was performed and when chiropractic adjustment was turned into a hypothesis with an a priori presupposition of it as an already relevant tool of medical intervention, it provides little to no evidence to back its claims. In other words, not only have we not proved subluxations, chiropractic has asserted into the mainstream its intervention for subluxations as valid, and even the interventions themselves have weak support. A house of sand made on a foundation of sand. THE LEVEL OF QUACKERY BAFFLES MY FEEBLE MIND. Furthermore, the Innate Intelligence peddled by the uniquely Deepak Chopra-esque chiropractors has no basis in reality, as it is mired in redefining words that have been used scientifically for decades, and cannot be currently tested, or even solidly hypothesized, in a clinical setting.
If you happen to enjoy having your back cracked, keep paying your chiropractor. I certainly won’t stop you. However, a 2007 review found serious adverse effects of spinal manipulation, stating, “dissection of the vertebral arteries was the most common problem; other complications included dural tear, oedema, nerve injury, disc herniation, haematoma and bone fracture. The symptoms were frequently life-threatening, though in most cases the patient made a full recovery. In the majority of cases, spinal manipulation was deemed to be the probable cause of the adverse effect.” You can read more on the risks at the bottom of this article by Pain Science, a source I wholeheartedly endorse. So, if you find yourself seeking the help of a chiropractor, briefly consider the risk-to-reward ratio and the fact that YOUR DUMB.
“Well, that about does her, wraps her all up… I guess that’s the way the whole darned human comedy keeps perpetuatin’ itself, down through the generations, westward the wagons, across the sands of time until we– aw, look at me, I’m ramblin’ again. Well, I hope you folks enjoyed yourselves. Catch ya later on down the trail.” – The Stranger