Chiropractic

Chiropractic
Alternative medicine
Chiropractor performing adjustment
A chiropractor performing a vertebral adjustment
ClaimsVertebral subluxation, spinal adjustment, Innate Intelligence
RisksVertebral artery dissection (stroke), compression fracture, death
Related fieldsOsteopathy, vitalism
Original proponentsD. D. Palmer
Subsequent proponentsB. J. Palmer
MeSHD002684
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Chiropractic (/ˌkaɪroʊˈpræktɪk/) is a form of alternative medicine[1] concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine.[2] It is based on several pseudoscientific ideas.[3]

Many chiropractors (often known informally as chiros), especially those in the field's early history, have proposed that mechanical disorders of the joints, especially of the spine, affect general health,[2] and that regular manipulation of the spine (spinal adjustment) improves general health. The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.[4] A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as "doctor" but is not a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.).[5][6] While many chiropractors view themselves as primary care providers,[7][8] chiropractic clinical training does not meet the requirements for that designation.[2]

Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.[7] A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study "fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition."[9] Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient.[10] No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases.[11]

There is not sufficient data to establish the safety of chiropractic manipulations.[12] It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[13] There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation.[14] Several deaths have been associated with this technique[13] and it has been suggested that the relationship is causative,[15][16] a claim which is disputed by many chiropractors.[16]

Chiropractic is well established in the United States, Canada, and Australia.[17] It overlaps with other manual-therapy professions such as osteopathy and physical therapy.[18] Most who seek chiropractic care do so for low back pain.[19] Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues.[7] Chiropractic has two main groups: "straights", now the minority, emphasize vitalism, "Innate Intelligence", and consider vertebral subluxations to be the cause of all disease; and "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[20]

D. D. Palmer founded chiropractic in the 1890s,[21] claiming that he had received it from "the other world".[22] Palmer maintained that the tenets of chiropractic were passed along to him by a doctor who had died 50 years previously.[23] His son B. J. Palmer helped to expand chiropractic in the early 20th century.[21] Throughout its history, chiropractic has been controversial.[24][25] Its foundation is at odds with evidence-based medicine, and is underpinned by pseudoscientific ideas such as vertebral subluxation and Innate Intelligence.[26] Despite the overwhelming evidence that vaccination is an effective public health intervention, there are significant disagreements among chiropractors over the subject,[27] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[28] The American Medical Association called chiropractic an "unscientific cult" in 1966[29] and boycotted it until losing an antitrust case in 1987.[8] Chiropractic has had a strong political base and sustained demand for services. In the last decades of the twentieth century, it gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.[8] During the COVID-19 pandemic, chiropractic professional associations advised chiropractors to adhere to CDC, WHO, and local health department guidance.[30][31] Despite these recommendations, a small but vocal and influential number of chiropractors spread vaccine misinformation.[32]

  1. ^ Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B, et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 978-0-07-137534-4.
  2. ^ a b c Nelson CF, Lawrence DJ, Triano JJ, Bronfort G, Perle SM, Metz RD, Hegetschweiler K, LaBrot T (2005). "Chiropractic as spine care: a model for the profession". Chiropractic & Osteopathy. 13 (1): 9. doi:10.1186/1746-1340-13-9. PMC 1185558. PMID 16000175.
  3. ^ For an explanation regarding the description of chiropractic as a pseudoscience, see:
  4. ^ Mootz RD, Shekelle PG (1997). "Content of practice". In Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366. AHCPR Pub No. 98-N002.
  5. ^ "The DC as PCP? Drug Wars Resume – Science-Based Medicine". sciencebasedmedicine.org. 2019-12-18. Archived from the original on 2019-12-18. Retrieved 2020-03-27.
  6. ^ Bellamy, Jann (December 20, 2018). "Legislative Alchemy 2018: Chiropractors rebranding as primary care physicians continues". sciencebasedmedicine.org. Archived from the original on December 19, 2019. Retrieved 2019-12-18.
  7. ^ a b c Ernst E (May 2008). "Chiropractic: a critical evaluation". Journal of Pain and Symptom Management. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
  8. ^ a b c Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues". Milbank Quarterly. 81 (1): 107–38, table of contents. doi:10.1111/1468-0009.00040. PMC 2690192. PMID 12669653.
  9. ^ Posadzki P, Ernst E (2011). "Spinal manipulation: an update of a systematic review of systematic reviews". The New Zealand Medical Journal. 124 (1340): 55–71. PMID 21952385.
  10. ^ Cite error: The named reference Lin2011 was invoked but never defined (see the help page).
  11. ^ Cite error: The named reference ErnstMaintenance2009 was invoked but never defined (see the help page).
  12. ^ Cite error: The named reference Gouveia was invoked but never defined (see the help page).
  13. ^ a b Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". Journal of the Royal Society of Medicine. 100 (7): 330–38. doi:10.1177/014107680710000716. PMC 1905885. PMID 17606755. Archived from the original on 2010-05-16.
  14. ^ Cite error: The named reference Haynes was invoked but never defined (see the help page).
  15. ^ Cite error: The named reference Ernst-2010 was invoked but never defined (see the help page).
  16. ^ a b Ernst E (2010). "Deaths after chiropractic: a review of published cases". International Journal of Clinical Practice. 64 (8): 1162–65. doi:10.1111/j.1742-1241.2010.02352.x. PMID 20642715. S2CID 45225661.
  17. ^ Cite error: The named reference global-strategy was invoked but never defined (see the help page).
  18. ^ Cite error: The named reference Norris was invoked but never defined (see the help page).
  19. ^ Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002-03". BMC Health Services Research. 6: 49. doi:10.1186/1472-6963-6-49. PMC 1458338. PMID 16600038.
  20. ^ Cite error: The named reference Kaptchuk-Eisenberg was invoked but never defined (see the help page).
  21. ^ a b Martin SC (October 1993). "Chiropractic and the social context of medical technology, 1895-1925". Technology and Culture. 34 (4): 808–34. doi:10.2307/3106416. JSTOR 3106416. PMID 11623404. S2CID 23423922.
  22. ^ Cite error: The named reference Religion was invoked but never defined (see the help page).
  23. ^ Lazarus, David (June 30, 2017). Column: Chiropractic treatment, a $15-billion industry, has its roots in a ghost story. Archived July 19, 2020, at the Wayback Machine --- "Daniel David Palmer, the 'father' of chiropractic who performed the first chiropractic adjustment in 1895, was an avid spiritualist. He maintained that the notion and basic principles of chiropractic treatment were passed along to him during a seance by a long-dead doctor. 'The knowledge and philosophy given me by Dr. Jim Atkinson, an intelligent spiritual being ... appealed to my reason,' Palmer wrote in his memoir The Chiropractor, which was published in 1914 after his death in Los Angeles. Atkinson had died 50 years prior to Palmer's epiphany." Los Angeles Times. Retrieved: September 25, 2019.
  24. ^ DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clinical Orthopaedics and Related Research. 444: 243–49. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145. S2CID 35775630.
  25. ^ Homola S (2006). "Chiropractic: history and overview of theories and methods". Clinical Orthopaedics and Related Research. 444: 236–42. doi:10.1097/01.blo.0000200258.95865.87. PMID 16446588.
  26. ^ Cite error: The named reference History-Primer2 was invoked but never defined (see the help page).
  27. ^ Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". Journal of Manipulative and Physiological Therapeutics. 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414.
  28. ^ Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics. 105 (4): e43. doi:10.1542/peds.105.4.e43. PMID 10742364.
  29. ^ Cite error: The named reference Chiro-PH was invoked but never defined (see the help page).
  30. ^ WFC Public Health Committee and WFC Research Committee (March 17, 2020). COVID-19 Advice for Chiropractors World Federation of Chiropractic.
  31. ^ Robert C. Jones, et al. Not Business as Usual: A Safe, Responsible Response to COVID-19 American Chiropractic Association
  32. ^ MICHELLE R. SMITH, SCOTT BAUER and MIKE CATALINI (October 8, 2021). Anti-vaccine chiropractors rising force of misinformation. Associated Press.