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There is no evidence chiropractors do more than placebos.

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Oh dear, I'm not going to make friends here. There is no evidence chiropractors do more than placebos. If you take a spine and look at it you can't even show where a nerve can be compressed unless you have disc material there. The bones themselves do not occlude the nerve passage.

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Roughly 3% to 11% of Americans visit a chiropractor every year. It has been estimated that by the end of this decade the United States will have approximately 100,000 chiropractors. The Institute for Social Research at Ohio Northern University performed a survey of North American chiropractors, which found that adjustments were believed to improve conditions such as tension headaches, migraines, otitis media, and asthma. Spinal manipulation is provided at every visit by 54.3% of chiropractors. The general perception is that spinal manipulations are believed to help visceral conditions by 62.1% of North American chiropractors. The inherent risk to providing spinal manipulation, such as stroke, paralysis, and death were not surveyed (McDonald, 2003). The therapeutic benefit of spinal manipulation compared to the risks involved remains controversial.

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I think its really hard to tell a chiroquack from a chiropractor. What exactly would be the difference?

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Tips on Choosing a Chiropractor

If you decide to consult a chiropractor, try to find one whose practice is limited to conservative treatment of musculoskeletal problems. Ask your family doctor for the names of chiropractors who fit this description and who appear to be competent and trustworthy. If your doctor cannot provide a name, ask other people and, if they recommend one, be sure to ask what conditions the chiropractor treats. If the chiropractor claims to treat infections or a wide range of other diseases, look elsewhere. But don't depend upon the Yellow Pages. You should avoid chiropractors who make extravagant claims or who advertise extensively.

When you have selected a chiropractor, go for a consultation or conduct a telephone interview to find out how he or she practices. If the chiropractor treats infants, offers spinal adjustments as a treatment for visceral disease or infection or as a method of preventing ill health, requires that every patient be x-rayed, or requires payments in advance for a long course of treatments, call another chiropractor. The Chirobase Guidelines provide additional tips about what to avoid. Chiropractors who follow these guidelines have been invited to post their names in the Chirobase Referral Directory.

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Originally posted by Dave W.

beskeptigal wrote:

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Oh dear, I'm not going to make friends here. There is no evidence chiropractors do more than placebos. If you take a spine and look at it you can't even show where a nerve can be compressed unless you have disc material there. The bones themselves do not occlude the nerve passage.

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No, apparently you're not going to make friends, since you seem to be ignoring what eklein is saying. Heck, even Dr. Stephen Barrett (of Quackwatch fame) recognizes that there are "rational" chiropractors who do, indeed, practice good physical therapy. Dr. Barrett's partnered chiropractor has even written "What a Rational Chiropractor Can Do for You," which includes a reference to a NEJM article which says your placebo comment is factually incorrect.

My sole problem with eklein's post is that he says that "[m]any chiropractors practice legitimate physical medicine," but my impression has been that "rational" chiropractors are actually a tiny minority of the whole group. While 'many' doesn't mean 'majority', I'd appreciate seeing some statistics on the quack-to-nonquack ratios in the field.

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In 1973, Stephen Barrett, M.D., sent a healthy four-year-old girl to five chiropractors for a"'check up.'"The first said the child's shoulder blades were "out of place" and found "pinched nerves to her stomach and gall bladder." The second said the child's pelvis was "twisted." The third said one hip was "elevated" and that spinal misalignments could cause "headaches, nervousness, equilibrium or digestive problems" in the future. The fourth predicted "bad periods and rough childbirth" if her "shorter left leg" were not treated. The fifth not only found hip and neck problems, but also "adjusted" them without bothering to ask permission. Several years later, 11 chiropractors who examined two adult women had similarly inconsistent findings (8).

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On the other hand, it is clear that chiropractors help people. I'm not quite sure how, and I'm not sure that you know either. But you are obviously doing something right. I am not sure who or what you should be treating. I'm not sure this is clear to you either -- and it won't be clear to me until it's clear to you. I would suggest that you make an attempt to define your scope. That won't be simple to do, but as long as your scope is undefined, you are going to be criticized for exceeding it.

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Originally posted by beskeptigal

Here's the main page with articles on all aspects of chiropractic 'science'. Barrett is the main author of the web site.

Here's a quote from one page

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In 1973, Stephen Barrett, M.D., sent a healthy four-year-old girl to five chiropractors for a"'check up.'"The first said the child's shoulder blades were "out of place" and found "pinched nerves to her stomach and gall bladder." The second said the child's pelvis was "twisted." The third said one hip was "elevated" and that spinal misalignments could cause "headaches, nervousness, equilibrium or digestive problems" in the future. The fourth predicted "bad periods and rough childbirth" if her "shorter left leg" were not treated. The fifth not only found hip and neck problems, but also "adjusted" them without bothering to ask permission. Several years later, 11 chiropractors who examined two adult women had similarly inconsistent findings (8).

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And here's Dr Barrett's kindest statement on the matter:

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On the other hand, it is clear that chiropractors help people. I'm not quite sure how, and I'm not sure that you know either. But you are obviously doing something right. I am not sure who or what you should be treating. I'm not sure this is clear to you either -- and it won't be clear to me until it's clear to you. I would suggest that you make an attempt to define your scope. That won't be simple to do, but as long as your scope is undefined, you are going to be criticized for exceeding it.

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When I weigh all the material presented, I have a hard time coming to the conclusion there is strong evidence supporting spinal manipulation is the best option for back pain. The risk is too high of disruption of blood supply to the spinal cord to make chiropractic treatment a better choice than safer alternatives. The evidence there is more than placebo is slim.

There may very well be some types of back manipulation, massage, exercise, nerve stimulation or other actions that have a positive impact on back pain. I think the best approach would be to dump the whole chiropractic scheme and start from scratch evaluating what specific actions are beneficial and safe. The idea you are adjusting the spine to align it is nonsense.

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When I weigh all the material presented, I have a hard time coming to the conclusion there is strong evidence supporting spinal manipulation is the best option for back pain.

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The risk is too high of disruption of blood supply to the spinal cord to make chiropractic treatment a better choice than safer alternatives.

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The evidence there is more than placebo is slim.

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This article, from the quackwatch site, has a very thorough evaluation of the hazard. Read the article, read the links, decide for yourself. There is a discussion of whether proper techniques are the cause or improper techniques alone. The diagram on the first page explains the anatomical hazard. Any neck manipulation puts some patients at risk.

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Neck Manipulation

Manipulation may improve the mobility of a cervical spine that has been stiffened by osteoarthritis or by scar tissue from an old injury. Disc degeneration caused by wear and tear or by injury is a common cause of loss of range of motion in the cervical spine and can often benefit from manipulation. Neck manipulation or mobilization may improve range of motion and provide relief for neck pain and muscle-tension headache. But remember that benefit must be weighed against risk. Neck manipulation should not be used unless symptoms indicate a specific need for it. It should be done gently with care to avoid excessive rotation that could damage the patient's vertebral artery. Neck manipulation should not be done immediately after an injury that causes acute neck pain. When the acute pain subsides, usually after a few days, manipulation may be useful to relieve fixations and restore normal joint mobility. Once the patient is symptom-free, it should be discontinued. A small percentage of chiropractors advocate neck manipulation to "balance" or "realign" the spine no matter where the patient's problem is located. I recommend avoiding such chiropractors.

Neck manipulation is safest when neck rotation does not exceed 50 degrees. When rotation is not indicated or appropriate, special techniques can be used with the patient in a face-down position so that manipulative traction can be applied or there can be thumb contact with specific spinal segments.

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As to Dr. Barrett having confidence in chiropractors, we just have a professional disagreement on the evaluation of available evidence. I have read most of his site and some of the secondary links about chiropractors and I have just not come to the same conclusions as he has. Like I said, I even went so far as to discuss it with him by e-mail.

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The choice of using chiropractic treatment is essentially one which says the entire underlying premise on which the practice was built has been discredited. But perhaps by mere accident a technique has been discovered that relieves some forms of back pain. But if you examine the theory taught in chiropractic schools, you do not see a technique for relief of back pain taught.

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As Dr Barrett points out, the specific treatments and which types of injuries or pain is best suited for such treatments have not been defined. In essence, it's a crap shoot.

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a retired psychiatrist who resides in Allentown, Pennsylvania, has achieved national renown as an author, editor, and consumer advocate. In addition to heading Quackwatch, he is vice-president and a board member of the National Council Against Health Fraud (NCAHF), a Scientific Advisor to the American Council on Science and Health,, and a Fellow of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP).. In 1984, he received an FDA Commissioner's Special Citation Award for Public Service in fighting nutrition quackery. In 1986, he was awarded honorary membership in the American Dietetic Association. From 1987 through 1989, he taught health education at The Pennsylvania State University. He is listed in Marquis Who's Who in America and, in March 2001, will receive the Distinguished Service to Health Education Award from the American Association for Health Education.

An expert in medical communications, Dr. Barrett operates five Web sites; edits Consumer Health Digest (a weekly electronic newsletter) writes weekly columns for Canoe.ca and Health Scout; is medical editor of Prometheus Books; and is a peer-review panelist for several top medical journals. His 47 books include The Health Robbers: A Close Look at Quackery in America and five editions of the college textbook Consumer Health: A Guide to Intelligent Decisions. One book he edited, Vitamins and Minerals: Help or Harm?, by Charles Marshall, Ph.D., won the American Medical Writers Association award for best book of 1983 for the general public and became a special publication of Consumer Reports Books. His other classics include Dubious Cancer Treatment, published by the Florida Division of the American Cancer Society; Health Schemes, Scams, and Frauds, published by Consumer Reports Books; The Vitamin Pushers: How the "Health Food" Industry Is Selling America a Bill of Goods, published by Prometheus Books; and Reader's Guide to "Alternative" Health Methods, published by the American Medical Association.

Dr. Barrett has been studying the chiropractic marketplace since 1968. His chiropractic source collection includes more than 200 books, several thousand journals, 200 audio and videotapes, and more than 20,000 miscellaneous documents. He has visited a chiropractor as a patient, attended classes at a chiropractic college, watched students working in the college clinic, attended the 1995 Chiropractic Centennial Celebration, and conversed with or written to thousands of chiropractors. In 1990, the ACA Journal of Chiropractic published an adaptation of his 1987 speech to the American Chiropractic Association's House of Delegates.

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Carey, T.S., Garrett, J.M., Jackman, A., and Hadler, N. (1999). "Recurrence and care seeking after acute back pain: Results of a long-term follow-up study."

This study found that adults seeing different types of providers for acute back pain had similar back pain recurrence rates and functional status during recovery. This was true despite very different philosophies of care and practice patterns among primary care physicians (PCPs), chiropractors, orthopedic surgeons, and health maintenance organization PCPs. However, patients who had originally sought care from a chiropractor were two to three times more likely to seek care for modest recurrences of low back pain. Although chiropractic care was associated with excellent patient satisfaction, it did not improve functional status, and therefore, it was somewhat more expensive, according to the researchers.

Based on periodic interviews with 921 patients from their initial back pain visit until 22 months later, the researchers found that back pain recurred in over half of patients seen for low back pain. Yet despite recurrences, almost all of these patients were reasonably functional, and work disability was rare. The likelihood of any recurrence of back pain increased with the number of back pain episodes experienced prior to the current episode of pain. For instance, 15 percent of those with no previous episodes had a severe recurrence compared with 35 percent of those with more than five lifetime episodes of low back pain.

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Press Release Date: October 3, 1995

A study supported by the Agency for Health Care Policy and Research (AHCPR), published in the October 5 issue of The New England Journal of Medicine (NEJM), concludes that outcomes of patients with acute low back pain are similar regardless of the type of practitioner initially seen.

The study, entitled "The Outcomes and Costs of Care for Acute Low Back Pain Patients Seen by Primary Care Practitioners, Chiropractors and Orthopedic Surgeons," was conducted by Timothy S. Carey, MD, at the University of North Carolina at Chapel Hill. The study enrolled, and followed for up to six months, a total of 1,633 patients from the practices of 208 North Carolina practitioners. The participating practitioners were randomly selected from six strata: urban and rural primary care medical doctors, urban and rural chiropractors, orthopedic surgeons, and practitioners in a group-model health maintenance organization. Researchers found tha

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On September 18, 1895, in Davenport, Iowa, Daniel D. Palmer, inquired about the history of a deaf janitor, named Harvey Lillard. Lillard informed Palmer that while working in a cramp area 17 years ago he felt a pop in his back and had been nearly deaf ever since. Upon examination Daniel D. Palmer found what he described as a lump that was sore to the touch. He concluded that it was possible this lump was a misalignment, that was later to be called a subluxation, was the cause of Harvey Lillards deafness. After correcting this misalignment in the janitor's spine his hearing was restored. Harvey was reported to have noted that he could now hear the wheels of the horse drawn carts in the street below. Danial D. Palmer began further investigation into the phenomena and believed to have discovered that a major source of interference to the nervous system, the vertebral subluxation, interfered with the body's regulatory mechanism, causing what he termed dis-ease or loss of ease

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