Let’s say your back hurts. You go to a chiropractor, over a few visits they crack a few joints, and that’s all she wrote, right? That’s certainly what I used to think about chiropractic. It turns out, though, that quackery has been around from the very beginning of chiropractic. The modern back-cracking that most of us are familiar with has been built on some rather out-there origins.
Traditional/straight chiropractic
the mid-1890s by D.D. Palmer founded chiropractic in the mid-1890s. According to Wikipedia, he claimed that the idea came to him from “the other world.” Which other world, you might ask? Apparently, whatever world was the home to a doctor who had died 50 years prior. So yeah, we’re not starting off well.
Old-school chiropractic types, also known “straight” chiropractors, believe in vitalism, which is the notion that there’s some sort of life energy that distinguishes living from non-living things. Ah, non-measurable life force energy, a popular favourite in many different forms of quackery (e.g. reiki). Straight chiropractors also reject scientific principles.
In traditional chiropractic, all health problems are seen as stemming from vertebral subluxation. This is thought to interfere with the “innate intelligence” expressed through the nervous system, which, in turn, impairs the body’s natural healing abilities. These so-called subluxations aren’t actually visible on X-ray, though, so it’s not clear that they are literally real.
According to an editorial by Johnson and colleagues, the American Medical Association put up a fight against chiropractic, even creating a “Committee on Quackery” to “contain and eliminate chiropractic.” In 1966, the AMA adopted a policy that described chiropractic as an “unscientific cult” with a “rigid adherence to an irrational, unscientific approach to disease causation.”
Modern “mixer” chiropractic
“Mixers” take a more modern approach that retains some of the old beliefs but also incorporates science. They accept the idea that vertebral subluxation is not the sole cause of disease.
Websites of modern chiropractic organizations mostly focus on the back/joint pain that you might expect. That’s what they do, they know how to do it, no problem. However, there’s a bit of quackery mixed in here and there, as the original beliefs associated with chiropractic haven’t entirely gone away.
The website of the Association of Chiropractic Colleges says this about vertebral subluxation:
“Chiropractic is Concerned [sic] with the preservation and restoration of health, and focuses particular attention on the subluxation.
A subluxation 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.”
Sounds a bit different from the “straight” perspective, but a subtle flavour is still there.
The National Center for Complementary and Integrative Health says this about chiropractic:
“… [It] emphasizes the body’s ability to heal itself. Treatment typically involves manual therapy, often including spinal manipulation. Other forms of treatment, such as exercise and nutritional counseling, may be used as well.”
It adds that the purpose of joint manipulations is to improve joint motion and function. That sounds quite reasonable. Nutritional counselling seems like a bit of a random add-on, but I didn’t see an explanation of the reasoning behind that.
Side effects
Side effects of spinal manipulations are common; it’s estimated that up to 61% of people experience a short-term worsening of pain and stiffness. In some cases, manipulation of the upper spine can lead to permanent disability or even death.
Strokes occur as an adverse event in an estimated 5 out of 100,000 manipulations; note that this is the number of manipulations, not the number of patients.
Still quacking
In my neck of the woods, chiropractors have been in the news in recent years for taking an anti-vaccination stance. The original chiropractor, D.D. Palmer, described vaccines as “filthy animal poisons,” and the basis for this was his rejection of the medical field as a whole. Modern anti-vax chiropractors focus heavily on what they see as downsides to the vaccine without acknowledging any public health benefits. “Straight” chiropractors are also against water fluoridation.
In my province (British Columbia, Canada), the regulatory body for chiropractors has recently issued a directive that chiropractors are not to make claims that they can reposition fetuses in utero, including turning them from the breech position. They’re also not allowed to claim that they can make labour shorter, easier, and less traumatic, or that they can treat postpartum depression. The regulator cites a lack of evidence as the reason for its directive. The fact that this is even an issue at all clearly implies that some chiropractors were making these unsupported claims in the first place.
If you’d like to see some straight chiropractic quacky fun, you can check out the video here (there’s no hyperlink because I’d rather not give them a backlink): http://www.straightchiro.com/resources/videos/spinal-hygiene-video/
So what does this mean?
Overall, it sounds like chiropractic started with a foundation of quackery, and then most chiropractors (although not all, like the guy in the video) built some much more reasonable layers over top. The problem with shaky foundations, though, is how do you trust what you’re walking on?
Were you aware of chiropractic’s quacky past (and present)?
References
- Association of Chiropractic Colleges: Chiropractic paradigm: Scope & practice
- Busse, J.W., et al. (2005). Chiropractic antivaccination arguments. Journal of Manipulative and Physiological Therapeutics, 28(5), 367-373.
- College of Chiropractors of British Columbia. (2019). Public notice – amendments to the professional conduct handbook and efficacy claims policy: Webster technique and pregnancy related conditions.
- Johnson, C., et al. (2008). Chiropractic and public health: Current state and future vision. Journal of Manipulative and Physiological Therapeutics, 31(6), 397-410.
- National Center for Complementary and Integrative Health. (2019). Chiropractic: In depth.
- Wikipedia: Chiropractic
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