is a form of treatment that uses manipulative therapy
to correct subluxation
, which many chiropracters hold are 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.
Practictioners of chiropractic medicine generally hold themselves out as doctors of chiropratic (D.C.). The use of manipulative therapy by D.C.'s to treat back pain, headache, and other spinal and musculo-skeletal symptoms enjoys wide acceptance by government medical authorities in many nations, where 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.  (http://www.chiroweb.com/archives/ahcpr/foreword.htm) The studies have shown a high level of patient satisfaction with manipulative therapy by persons with back problems.  (http://www.chiroweb.com/archives/ahcpr/foreword.htm)
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.
Although chiropractic medicine has gained general acceptance in the last 20 years 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 termed "subluxation." Palmer, a layman with an interest in the metaphysical health philosophies of his day such as magnetic healing, phrenology, and spiritualism, embued the term "subluxation" with a metaphysical meaning holding that Palmer's "subluxations" interfered with the body's "Innate Intelligence" (spark of life or spirit).
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 Saskatewan, about one third of chiropracters still believe in Palmer's philosophy.  (http://www.canoe.ca/ChiroYork/chiro_philosophy)
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 See The Federation of Straight Chiropractors and Organizations (http://www.straightchiropractic.com/). The other school known as mixing chiropractic[?] mixes medical techniques with spinal and other joint manipulation. Mixing chiropractic is itself divided into conservative and liberal factions.  (http://www.chiroweb.com/archives/08/21/13)
The term straight chiropractic is used to more strictly associate with adherents of Daniel D. Palmer's chiropractic theory, and of those chiropractic schools who believe that subluxations are the cause of most or all diseases. 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.
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. (http://www.chirobase.org/15News/neurol)
Mainstream medical doctors and scientists reject the claims of most chiropractic associations and schools as pseudoscience; many refer to their claims as fraud. Recebtly, however, a chiropracter from the Canadian Memorial Chiropractic College, in Toronto, and two professors at Los Angeles College of Chiropractic also came to this position; they hold that all chiropractic organizations engage in and promote 'quackery".
Yor 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.
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 chiropracters 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."
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:
- The National Association for Chiropractic Medicine (NACM) 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. (Note that the bold-faced terms are in the original document.)
Material supportive of chiropractic:
- Chiropractic books, like other medical books are reviewed by Doody Review Services. If you select Barnes & Noble after clicking on the ISBN you will find the Doody review on the B&N page for the book.
- An Amazon list: "Top 15 Chiropractic Related Books For The Injury Practice" by Robert Zuniga, Chiropractor (http://www.amazon.com/exec/obidos/tg/listmania/list-browse/-/2RPA7OPQ5N8LC/ref%3Dcm%5Flm%5Fdp%5Fl%5F1/002-6959208-4588026)
- Activator Methods Chiropractic Technique, Arlan W. Fuhr (editor), with John R. Green, With Tony S. Keller, Mosby-Year Book, Inc., 1996, hardcover, 460 pages, ISBN 0815136846
- Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS, Gregory D. Cramer, Susan A. Darby, Mosby-Year Book, Inc., 1996, hardcover, 441 pages, ISBN 0801664675
- Best Practices in Clinical Chiropractic, author: Robert D. Mootz, edited by: Howard T. Vernon, Aspen Publishers, 1999 (or 2001), paperback, 200 pages, ISBN 0834213761, papers from the journal Topics on Clinical Chiropractic
- Chiropractic: A Philosophy for Alternative Health Care, Douglass D. Coulter, Science & Technology Books, 1999, paperback 117 pages, ISBN 0750640065
- Chiropractic: History and Evolution of a New Profession, Walter I. Wardwell, Mosby-Year Book, Inc., 1992, hardcover, 358 pages, ISBN 0801668832
- Chiropractic Management of Spine Related Disorders, Meridel I. Gatterman, Lippincott Williams & Wilkins, 1990 (there may be a new edition), hardcover, 437 pages, ISBN 0683034383
- Chiropractic Pediatrics: A Clinical Handbook, Neil J. Davies, Churchill Livingstone, Inc., 2001, hardcover, 475 pages, ISBN 0443062536
- Chiropractic Technique: Principles and Procedures, 2nd edition, Bergmann, Thomas F. Bergmann, David H. Peterson, Mosby-Year Book, Inc., 2002 hardcover, 880 pages, ISBN 032302016X
- Chiropractic Theories, 3rd edition, Robert A. Leach, with contributions by Charles A. Lantz, and Reed B. Phillips, illustrated by Robert S. Fritzius, Lippincott Williams and Wilkins, 1994, hardcover, 426 pages, ISBN 0683049046
- Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms, 2nd edition, Thomas A. Souza, Jones & Bartlett Publishers, Inc., 2001, hardcover, 959 pages, ISBN 0834217287
- Foundations of Chiropractic: Subluxation, Meridel I. Gatterman, Mosby-Year Book, Inc., 1995, hardcover textbook, 487 pages, ISBN 0815135432
- Functional Soft-Tissue Examination and Treatment by Manual Methods: New Perspectives, Revised edition, Warren I. Hammer, Aspen Publishers, Inc., hardcover, 625 pages, ISBN 0834206307
- Guidelines for Chiropractic Quality Assurance and Practice Parameters, editors: Scott Haldeman, David Chapman-Smith and Donald M. Petersen, Aspen Publishers, 1992, paperback, 264 pages ISBN 083420388X
- Positional Release Techniques (Book for Windows and MacIntosh) with Cdrom, Leon Chaitow, Elsevier Science, 2002, paperback, 350 pages, ISBN 0443070814
- Principles and Practices of Chiropractic Techniques, Scott Haldeman, Appleton & Lange, 1992, hardcover, 641 pages, ISBN 0838563600
- Rehabilitation of the Spine: A Practitioner's Manual, editor Craig Liebenson, Lippincott Williams & Wilkins, 1996, hardcover, 432 pages, ISBN 068305032X
- Text-Book of the Science, Art and Philosophy of Chiropractic For Students and Practitioners, D. D. Palmer, Portland Printing House, 1966 reprint of 1910 edition, hardcover, 1007 pages
Bibliography of critical materials:
- Chiropractic: The Victim's Perspective, George Magner, edited by Stephen Barrett, forward by William T. Jarvis, Prometheus Books, 1995, hardcover, 252 pages, ISBN 157392041X forward and table of contents (http://www.quackwatch.org/04ConsumerEducation/BookContents/cv)
- Concerns about Chiropractic at York University (http://www.ndir.com/chiro/scientific)
- Assendelft WJJ, Bouter LM, Knipschild PG. Complications of spinal manipulation - a comprehensive review of the literature. J Fam Pract 1996; 42: 475-480
- Beatty, R. "Dissecting hematoma of the internal carotid artery following chiropractic cervical manipulation" J Trauma, 17:248-249, 1977
- Benassy, J. and Wolinetz, E., "Quadraplegia after chiropractic manipulation," RHUM, 24:555- 556, 1957
- A. Breen, E. Leerberg, M. D Pedigo, G. Waddell, L. G F Giles, E Ernst, and W J J Assendelft Chiropractic for low back pain BMJ, January 23, 1999; 318(7178): 261a - 261.
- Chiropractic for low back pain: We don't know whether it does more good than harm, The British Medical Journal, 1998; 317:160-160 (18 July)
- Davidson, K., et al, "Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation" NEURORADIOLOGY, 115:651-652, 1975
- Ernst E. Chiropractors use of X-rays Br J Radiol
- E. Ernst Spinal manipulation: Its safety is uncertain Can. Med. Assoc. J., January 1, 2002; 166(1): 40 - 41
- Harrison, J. Strokes ICA Malpractice Alert, 2:1-2, 1981
- Krueger, B. and Okazakl, H. "Vertebral-basilar distribuation infarction following chiropractic cervical manipulation", Mayo Clin Pros. 55:322-332, 1980
- Levine, J., Howe, J., and Rolofson, J., "Radiation exposure to a phantom patient during simulated chiropractic spinal radiography", Radiol Health Data Reports, 12:245-251, 1971
- Miller, R. and Bunon, R. "Stroke following chiropractic manipulation of the spine" JAMA, 229:189-190, 1974
- Modde, P. "Malpractice as an inevitable result of chiropractic philosophy and training" Legal Aspects of Med Practice, Feb:20-23, 1979
- Rinsky. L, et al, "A cervical spinal cord injury following chiropractic manipulation" Paraplegia, 13:223-22, 1976
- Schelihas, K., et al, "Vertebrobasilar injuries following cervical manipulation" Am Med Assoc, 244:1450-1453, 1980
- Smith, P and Doll, R., "Mortality among patients with ankylosing spondylitis after a single treatment course with x-rays", Brit Med J, 284:449-460, 1982 Abrams, H., "The overutilization of x-rays", New England J MED, 300:1213-1216, 1979
- Stano M, Smith M. Chiropractic and medical costs of low back care. Medical Care 1996; 34: 191-204
- Zak, S. and Carmody, R . "Cerebellar infarction from chiropractic neck manipulation" Ariz Med, 41:333-337, 1984
- Zauel, D., and Carlow, T., "Internuclear Ophthalmalegia following cervical manipulation" Annals of Neurol, l:308, 1977
Critical of Chiropractic
- Alphabetical list by country with links to Chiropractic Colleges (http://www.fcer.org/html/Links/educ.htm)
- Cleveland Chiropractic College, Kansas City, Missouri and Los Angeles, California (http://www.clevelandchiropractic.edu/)
- Life Chiropractic College West in Hayward, California (Bay area) (http://www.lifewest.edu/)
- Life Chiropractic College in Marietta, Geogia (http://www.life.edu/newlife/admissions/programs/collegechiro)
- Logan College of Chiropractic in Chesterfield, Missouri (http://www.logan.edu/)
- National University of Health Sciences in Lombard, Illinois near Chicago (http://www.nuhs.edu/)
- New York Chiropractic College in Seneca Falls, New York (http://www.nycc.edu/)
- Northwestern Health Sciences University in Bloomington, Minnesota (http://www.nwhealth.edu/)
- Palmer College of Chiropractic in Davenport, Iowa (http://www.palmer.edu/PCC/PCCmain.htm)
- Palmer College of Chiropactic Florida in Port Orange, Florida (http://www.palmer.edu/pccf/default.htm)
- Palmer College of Chiropractic West in San Jose, California (http://www.palmer.edu/PCCW/PCWmain.htm)
- Parker College of Chiropractic in Dallas, Texas (http://www.parkercc.edu/)
- Sherman College of Straight Chiropractic in Spartanberg, South Carolina (http://www.sherman.edu/)
- Los Angeles College of Chiropractic of the Southern California University of Health Sciences (http://www.lacc.edu/lacc/index.php)
- Texas Chiropractic College in Pasadena, Texas near Houston (http://www.txchiro.edu/)
- Western States Chiropractic College in Portland, Oregon (http://www.wschiro.edu/)
- New Zealand
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