CHIROPRACTORS: MY THOUGHTS

MY THOUGHTS ON CHIROPRACTORS

Rivalries. They are everywhere.

Sports rivalries, sibling rivalries, company rivalries, and even rivalries between sororities at your local university.

These are all great rivalries, but all pale in comparison to the rivalry that is Physical Therapy vs. Chiropractic…

Ok, enough with the theatrics. There really is no bitter hatred or “rivalry” between the two professions, per say, I may have just exaggerated for enhanced effect.

However, with every decision made by the respective governing bodies for each profession throughout the years, there has been some what of a turf war in the back of their minds.

This turf war surrounds spinal manipulation…or as you may have seen it referred to on social media…”HUGE CRACKING ADJUSTMENTS”!

I’m an honest man. I will admit even I, on the physical therapy side, love a good chiropractic video full of backs “cracking” like popcorn.

As fun as those videos are, it is important to know the proper time and place when these manipulations, or adjustments, are to be used, as well as the actual physiological effect they carry.

Though I am very proud of how this blog sticks to purely research, facts, and evidence, I thought it would be OK to slightly (and only slightly) stray from a pure research focus and simply let you know of my opinion on chiropractors.

For you who love research, don’t worry, you will still find what you came here for. So, stay tuned. But the final take home of this post will be largely based on opinion.

NOTE: Many chiropractors are excellent professionals, knowing the appropriate time and place to implement their specific techniques. This post is not meant to lump all chiropractors into the same boat. It is simply to look at the questionable history of the profession itself and talk about how people may be too infatuated with the magical cure they believe to have received via a chiropractor. I know many chiropractors who are excellent professionals.

THE HISTORY OF CHIROPRACTIC

Before we get into my opinion, you need to understand fully what chiropractic care is and where it came from, for you to understand why I feel the way that I do.

Chiropractic care was started back in the 1890s by a man named Daniel David Palmer.

“How did he come to start this thing called ‘chiropractic’?”, you might ask. Well it really is just a great, great story (and by great, I mean completely laughable).

The story goes as such:

One day Palmer came across a janitor who had been deaf for nearly 17 years.

Upon further assessment of the gentleman, Palmer determined that a vertebra in the man’s spine was out of place, which would later be described as “subluxed vertebra”.

Now, why Palmer was doing a medical assessment on an individual when he had 0 medical training, I do not know (which, by the way, is the definition of malpractice).

Nonetheless, he reportedly adjusted this man’s spine, popped his vertebra back in, and magically the man regained his hearing over the next couple of minutes!

Wow! Aren’t you impressed?!

I’m not. Shortly, you’ll see why.

Palmer took this experience and turned it into what is known as chiropractic care today, with his principles and this very experience still being held as the foundational science of chiropractic care.

Interestingly enough, Palmer wasn’t the first person to use manual manipulation (i.e. getting your back “cracked”) for medical use.

There have been depictions and writings dating back to 400 BC that mention the use of such treatments to treat some spinal conditions (1).

Palmer wasn’t the first, but he certainly was the engine that made the train pick up speed…and pick up speed it did.

Chiropractic care has boomed into a $15 billion industry since its birth roughly 120 years ago.

After all this, the subluxation theory was started.

WHAT IS THE SUBLUXATION THEORY?

The subluxation theory, defined by the National Board of Chiropractic Examiners (NBCE), is stated as follows…

“A subluxation is a health concern that manifests in the skeletal joints, and,

through complex anatomical and physiologic relationships, affects the nervous

system and may lead to reduced function, disability, or illness” (2).

Simply stated, if a vertebra is out of place, or subluxed, then this can add undue pressure on nerves and the spinal cord, which can in turn lead to organic disease processes and pain.

In theory, anatomically and physiologically, this is not entirely untrue, however, it is not entirely rock solid in every medical circumstance, either.

Palmer claims that a manipulation to the spine healed this man’s inability to hear. Right off the bat, the red flags are popping up like groundhogs.

Let’s talk about anatomy real fast.

The nerves that control the body’s ability to hear (the vestibulocochlear nerves, to be exact), come off the brainstem, travel within the skull, and innervate the anatomical mechanism of the ear.

If the nerve controlling hearing stays entirely in the skull, how can a manipulation to the thoracic region of the spine effect its function?

Well, I have the answer for you…it CAN’T…

As you can see, the story that chiropractic uses as its very foundation is a complete hoax.

Strike 1.

THE FALL OF THE SUBLUXATION THEORY

In 2012, the Council on Chiropractic Education (CCE) omitted the word “subluxation” from their publication when they posed their accreditation standards for chiropractic colleges around the country.

Naturally, you can understand why the American Chiropractic Association (ACA) was not happy with this publication.

The entire foundation of the chiropractic profession was based on this subluxation theory, so when the accrediting body removed the word sublux, the ACA was very worried that in the long term this would undermine their strength and historical identity of the profession.

Well, when your own accrediting body essentially disproved the foundational model of which you stand on, you can see how that would weaken the teachings of chiropractic care…with good reason.

Even the recent research is debating the subluxation theory.

In 2009, Mirtz et al published an article stating that there is a significant lack of evidence to conclude that subluxations are associated with any disease process or suboptimal health condition (3).

To combat this, the association has come up with terms such as “joint dysfunction”, “vertebral subluxation complex”, and “sublaxation/neurobiomechanical dysfunction”.

However, this is not fooling anyone.

It doesn’t matter what they call it if they continue to imply that it can cause disturbances to the nervous system resulting in illnesses.

Not only does the CCE want to get rid of the subluxation theory, it has effectively been disproven by research.

Strike 2.

CHIROPRACTIC vs. PHYSICAL THERAPY

There is one simple difference between the two professions.

Chiropractors are the only ones that have adopted this subluxation model, and thus, it has become unique to them.

If they were to drop the subluxation model and become professionals who specialize in the care of back pain and other general musculoskeletal problems, then there is worry in the chiropractic community that they will be unable to compete with physical therapists, or even osteopathic doctors, for that matter, as the musculoskeletal experts.

Essentially, the foundational concept that chiropractic was founded upon seems to also be the very issue that limits the profession and could potentially become its undoing.

One thing that is key to note, from the stand point of physical therapy, is that spinal manipulation is not performed under the belief of the subluxation theory.

In physical therapy, spinal manipulation generally is used for short term reduction of acute (sometimes chronic) back pain and must (let me repeat, MUST) be used in combination with a comprehensive physical therapy program, including exercise, movement mechanic re-education, etc.

The pain-relieving effects of spinal manipulation have been proven by research to be effective only in the short term.

This is why, when you get an “adjustment” at the chiropractor, your relief only lasts a few days to weeks, and your chiropractor may recommend you come back in and be adjusted once or twice a month...for the rest of your life…

OK OK, that’s obviously an exaggeration, they don't say that...but there is some truth to that.

I have heard many a chiropractor, especially on YouTube, recommend monthly adjustments for their patients.

For chiropractic care to be effective in the long term you will be going to the office essentially twice per month for a long, long, long time. That's a lot of $$$.

Strike 3.

In physical therapy, a spinal manipulation is (or at least should be) immediately followed by specific exercise to retrain the neuromuscular system in hopes to restore pain free functional movement.

In whole, there is no significant difference in the actions of a chiropractor and a physical therapist when it comes to spinal manipulation.

The true difference lies in the frequency with which spinal manipulation is used, the purpose for which spinal manipulation is used, and the lowered level of which physical therapists believe in its “curative” powers.

WHAT IS MY OPINION?

As I mentioned above, there are many excellent chiropractors, who practice their craft appropriately and safely.

Many chiropractors understand the questionable nature of the subluxation theory, and they change their practice to only provide effective spinal manipulations when appropriate, using safe practice when doing so.

The mark of a good professional is their ability to know the limitations and inadequacies of their own profession, and to tailor their care around effective treatments only.

With that being said, unfortunately, I have to develop my opinion based on the profession as a whole.

Thus, if you are looking for the major takeaway from this post, I would say it has to be this:

Chiropractic care would not be my first suggestion if you are wanting significant, long term relief from any kind of back pain or other musculoskeletal pain you may be experiencing.

Quite frankly (admitting my bias to physical therapy), I wouldn’t recommend chiropractic care to anyone.

I just don’t believe that, with the highly questionable history and with the tendency for the profession to almost not even believe in itself, chiropractic care is never really the answer to short-term or long-term musculoskeletal pain.

Now, do you feel relief immediately after a chiropractic session? ABSOLUTELY.

Is that relief going to last long enough for you to stay out of the office twice per month? Probably not.

If you have tried everything and nothing is working, then yes, chiropractic care may be a successful adjunct therapy to use in combination with other types of treatments.

However, as I always say, be skeptical of any chiropractor that promises an immediate return to function or promises curative powers for certain organic illnesses, like nausea, heartburn, etc.