Whacking, Cracking, and Chiropracting

by Brian Dunning
May 1, 2007

Today we're going to lay down on the table, hold tight and grit our teeth, and receive what a chiropractor once eloquently described to me as the "Whack & Crack," and have the flow of New Age energy improved through our bodies and spirits. For today's topic is chiropractic.

Like so many non-evidence based alternative medicine systems, chiropractic was established and defined by a non-scientist during a time when almost nothing useful or true was known about medicine. In this case, our inventor was Daniel D. Palmer, a practitioner of New Age healing with magnets, when medicine was in the Dark Ages of 1895. Palmer believed that his magnets could manipulate a type of immaterial spiritual essence which he believed exists in the body, and which he called "innate intelligence." Palmer reasoned that innate intelligence flows through the body through the nervous system, and that whenever an illness exists, it must be due to a nerve blockage preventing the flow of innate intelligence. It seemed reasonable to Palmer that straightening the spine through manual manipulation would relieve any crimps, thus curing virtually any disease and restoring health. Palmer called his new invention chiropractic, from the Greek for "done by hand."

Chiropractic's entire history has been quite stormy, and the early days were no exception. Palmer was soon arrested and convicted of practicing medicine without a license. His son, BJ Palmer, formed the first professional chiropractic association to cover legal expenses of the students he and his father trained.

Chiropractic is relatively unique among alternative medicine systems because, although it was originally developed based on the purely mythical and supernatural conjecture of innate intelligence, the profession as a whole has evolved and generally accepted most anatomical discoveries of modern medicine. Most (though certainly not all) modern chiropractors do accept many of the fundamentals of orthopedics and physical therapy. This has inevitably resulted in several different branches of chiropractic, with different sets of beliefs, and we'll talk more about those in a moment.

The cornerstone of chiropractic is something they call a subluxation. The first and most important thing to understand is that a chiropractic subluxation is a completely different phenomenon from an orthopedic subluxation, which is a real medical condition, and is unrelated. An orthopedic subluxation is a partial dislocation of a joint. They are significant physical displacements, and as such, they can and do appear on images such as X-rays, MRI's, and CAT scans. A chiropractic subluxation, on the other hand, is theoretic and is not visible on an imaging study or otherwise verifiable through conventional medicine. The chiropractic profession has repeatedly redefined a subluxation over the years, and the current definition is "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." As you can see, it's quite a vague definition and leaves plenty of room for individual interpretation. In practice, it usually refers to an alleged misalignment of adjacent vertebrae. According to the medical profession, such a misalignment would not have any of the detrimental effects on organs or general health claimed by chiropractors. Additionally, were there an actual nerve impingement in the spine, it would absolutely be visible on an imaging study and would absolutely not be treated through manipulation, which could easily result in irreparable injury. Therein lies the essential conflict between conventional medicine and chiropractic. Chiropractic treats imaginary conditions, that could not possibly cause the reported symptoms even if they did exist, using methods that would be highly detrimental on an actual impingement.

With such necessarily vague definitions, there are about as many different types of chiropractic as there are chiropractors; and indeed, most chiropractors do not belong to any sort of professional chiropractic association. However, most do fall into one of three main groups: Straights, Reforms, and Mixers. Straights are those who stick firmly with Palmer's original concepts of innate intelligence, tend to reject modern medicine, and honestly believe that spinal manipulation can cure most any disease. Significantly, no evidence has ever shown that straight chiropractors have a lower incidence of any given disease, or of disease in general, which kind of makes you wonder. Reforms are the opposite. They accept that innate intelligence is not a real phenomenon and tend to restrict their treatment to types of manipulation that correspond with conventional physical therapy. Those few chiropractors who are also MD's are usually Reforms. The largest group of chiropractors are the Mixers, who, as their name suggests, attempt to marry some of Palmer's original ideas of subluxations with modern anatomical knowledge and treatments. Mixers often offer various other alternative medicine systems and often take a holistic approach to health. After many decades of controversy and licensing debates, there are now accredited colleges through which chiropractors can become licensed to practice. A Doctor of Chiropractic is not a medical doctor, and is not licensed to prescribe drugs or to perform surgery in the United States. They can be listed as primary care providers, which seems surprising given they are not trained or allowed to do something as simple as prescribe an antibiotic or set a broken bone.

I have some volleyball friends who see chiropractors regularly, and swear by them. Like some other sports, volleyball is one that keeps its elder players fairly constantly in the offices of orthopedic surgeons and physical therapists. Athletic massage and physical therapy are often essential parts of injury recovery, but if improperly performed, they absolutely have potential to cause more damage and make a bad situation worse. That's why we have certification boards for massage therapists and Doctors of Physical Therapy — top physical therapists should have a DPT after their name on the door. Physical therapists who are not doctors still must have taken an accredited four-to-six-year college program and must pass a national physical therapy examination and an examination on the laws and regulations governing the practice of physical therapy. Physical therapy assistants must take an accredited two-year college program and must pass the national physical therapist assistant examination, and they may only work under the supervision of a licensed physical therapist. A physical therapy aide is not licensed and is not required to meet any education requirements and has no formal training. However, they are required to work only under the direct physical supervision of a licensed physical therapist. When my volleyball friends report back about what their chiropractor did for them today, guess what? It's often exactly the same treatment I've received from my DPT. Some of these chiropractors are doing conventional physical therapy but without having taken the training and passed the tests, and they're getting away with it because they're calling it chiropractic. Not only is that untrue, it's illegal, unless that chiropractor also happens to be a licensed physical therapist. If you have a painful sports injury, you should be going to an orthopedist anyway, who is licensed to provide medical care and can do things like order an MRI to properly assess an injury.

Many chiropractors are rational people and are knowledgeable about sports medicine or back pain, and do provide good physical therapy. The best will often be openly critical of Straight chiropractors and advise you to avoid any practitioner who follows the subluxation philosophy. This is good, but it's not as good as receiving the same advice from someone who went to medical school and whose practice is built on medical science. My question to these Reform chiropractors is: If you are so critical of the chiropractic arts, then why are you a chiropractor yourself? If you want to be a doctor and help people, fine; go to medical school, and become a doctor. Yes, it's easier, cheaper, and faster to go to chiropractor school, and there isn't so much pesky "anatomy" to learn, but if you believe medical services should be based on medical science, then you should go all the way. I'm tired of hearing chiropractors be critical of chiropractic. It's the pinnacle of hypocrisy.

There's one criticism of chiropractic that I'm not going to urge, and that's the fact that these spinal manipulations can be extremely dangerous and can cause spinal injuries that have resulted in paralysis and deaths. The most common injury is a stroke following neck manipulation. The reason I'm not going to urge this criticism is that mistakes can be made in every type of medicine, whether it's alternative or conventional. A pharmacist friend of a friend once made a mistake, filling a prescription with the wrong medication, and a child died as a result. During the ensuing lawsuit, the pharmacist took her own life. No type of treatment is free of the risk of accidental error. Fortunately, they're extremely rare.

If you have some medical condition that you've been treating with chiropractic, consider going to a medical doctor for a proper diagnosis. If an athletic massage or physical therapy are prescribed by your doctor, go to a proper physical therapist or licensed massage therapist, who are able to give you better treatment, legally and with the proper training under their belt, and who understand the medical basis for their treatment. You can only do better than with a chiropractor whose training is founded upon Palmer's 1895 conjecture of innate intelligence.

By Brian Dunning
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