extinction of chiropratic: subluxation construct

[TPT]

strength/conditioning athletes and bodybuilders widely use chiropractors for varied reasons including spinal 'adjustments' for 'subluxations.' we even see posts on this site that ellude to this and recommendations.

adjustments are commonly performed with the determination of some chiropratic or osteopathic subluxation of the vertebrae. historically, assumptions included that these subluxations caused neurological impairments and other organ dysfunciton systems wide. unfortunately, no evidence suggests these accounts and that chiropratic subluxations cause diseases.

the following paper illustrates much of the lack of validity in a subluxation contruct. the conclusions should inform consumers and provide concerns on whether treatment of subluxation even exists.

if it doesnt exist, why treat it?

http://www.chiroandosteo.com/content/pdf/1746-1340-17-13.pdf




Review
An epidemiological examination of the subluxation construct using Hill's criteria of causation

Timothy A Mirtz1 http://www.chiroandosteo.com/graphics/article/email-ca.gif (http://www.chiroandosteo.com/registration/technical.asp?process=default&msg=ce), Lon Morgan2 http://www.chiroandosteo.com/graphics/article/email.gif (http://www.chiroandosteo.com/registration/technical.asp?process=default&msg=ce), Lawrence H Wyatt3 http://www.chiroandosteo.com/graphics/article/email.gif (http://www.chiroandosteo.com/registration/technical.asp?process=default&msg=ce) and Leon Greene4 http://www.chiroandosteo.com/graphics/article/email.gif (http://www.chiroandosteo.com/registration/technical.asp?process=default&msg=ce)
1 University of South Dakota, Vermillion, South Dakota, USA
2 Retired, Meridian, Idaho, USA
3 Texas Chiropractic College, Pasadena, Texas, USA
4 University of Kansas, Lawrence, Kansas, USA

http://www.chiroandosteo.com/bmcimages/article/email.gif author emailhttp://www.chiroandosteo.com/bmcimages/article/email-ca.gif corresponding author email
Chiropractic & Osteopathy 2009, 17:13doi:10.1186/1746-1340-17-13
Published:2 December 2009
Abstract

Background

Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.
Aim

The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.
Methods

The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.
Results

The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.
Conclusion

There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.

[JamesWebb]

interesting. i am paying a ridiclous amount to see a chiro three times a week for adjustments but honestly after about 4 weeks i see no marked decrease in lower back pain.

[JamesWebb]

damn i feel like i am back in college reading this. lol

[TPT]

interesting. i am paying a ridiclous amount to see a chiro three times a week for adjustments but honestly after about 4 weeks i see no marked decrease in lower back pain.


what happened to your back? oh. wrong thread. lol.

anyway, watch this video called the kinsinger report. its speaks to much of the same as the referenced publication. http://www.ah.ouhsc.edu/rehab/continuing_education.asp

[big310]

I used to pop ribs out of place every couple of months before going to a chiro twice a week. Not once now in over a year.It took many different docs to find the right one for me. Lower back feels much better now too. If there wasn't any validity in it, why would the big health insurance companies cover it ?

[TPT]

I used to pop ribs out of place every couple of months before going to a chiro twice a week. Not once now in over a year.It took many different docs to find the right one for me. Lower back feels much better now too. If there wasn't any validity in it, why would the big health insurance companies cover it ?

now you know efficacy, evidence or effectiveness of an intervention doesnt matter in the history of insurance coverage. : )

great question that many health practitionars deal with everday.

and the answer is 'legislation.'

[ob205]

Great post as usual TPT, so in laymens terms you feel chiropractic care is more mysticism than science? I don't understand how the human body can get out of alignment so easily and that a mere adjustment corrects this. If this were true wouldn't we need an adjustment daily or hourly?

[thesamewords]

Didnt Flex get his neck broke by a Chiropractor... or was that some one else getting their neck broke....

[TPT]

Great post as usual TPT, so in laymens terms you feel chiropractic care is more mysticism than science? I don't understand how the human body can get out of alignment so easily and that a mere adjustment corrects this. If this were true wouldn't we need an adjustment daily or hourly?


thanks, ob.

yes. historically, it is a fact that chiropractic is more mysticism than science. this is emphasized by the logic and reasoning behind the 'subluxation' being the determinant of disease. thus, fix the subluxation with a mere adjustment to fix the disease. we know that this is erroneous and many use this simplified construct in practice.

another link that speaks to the previous referenced paper.
http://www.sciencebasedmedicine.org/?p=3022#more-3022

[TPT]

Didnt Flex get his neck broke by a Chiropractor... or was that some one else getting their neck broke....


really?

tell us about it.

[drfunction]

Not all Chiro's are the same. Not all M.D.'s, D.D.S.'s, Nutritionist's etc. are the same.
Not all Chiro's practice the sublux theory. Research your Doc's.
Dr. Franco Columbo (Arnold's friend) is a chiro.
There are many body building friendly chiros that don't practice the sublux way.

[TPT]

Not all Chiro's are the same. Not all M.D.'s, D.D.S.'s, Nutritionist's etc. are the same.
Not all Chiro's practice the sublux theory. Research your Doc's.
Dr. Franco Columbo (Arnold's friend) is a chiro.
There are many body building friendly chiros that don't practice the sublux way.


yup. not all pts are the same as well.

of course some chiropractors dont follow the subluxation paradigm, but it is supported by the major chiropractic schools and inherently part of the history of chiropractic. Mirtz et al. (2009) referenced 98% of chiropractors reported that most or many diseases were determined by spinal mal alignments. also, over 75% of chiropractors reported that subluxation was significant to 50% or more of visceral disorders.

crazy shit...

[Colossal]

yup. not all pts are the same as well.

of course some chiropractors dont follow the subluxation paradigm, but it is supported by the major chiropractic schools and inherently part of the history of chiropractic. Mirtz et al. (2009) referenced 98% of chiropractors reported that most or many diseases were determined by spinal mal alignments. also, over 75% of chiropractors reported that subluxation was significant to 50% or more of visceral disorders.

crazy shit...

Unbelievable. And people buy it hook, line, and sinker.

Another profitable form of quackery is acupuncture. Topic for another thread, but a critical meta-analysis reveals essentially NO sound evidence that acupuncture is efficacious for the treatment of any disease or ailment.

P-L-A-C-E-B-O.

[TPT]

Unbelievable. And people buy it hook, line, and sinker.

Another profitable form of quackery is acupuncture. Topic for another thread, but a critical meta-analysis reveals essentially NO sound evidence that acupuncture is efficacious for the treatment of any disease or ailment.

P-L-A-C-E-B-O.


yeah. we can speak plenty to acupunture another time.

anyway, placebo is quite controlling for perceived effects. i suspect that many patients 'perceive' better feelings merely from an audible pop or cavitation from an adjustment/manipulation. in many instances the audible pop likely has psychological and social effects that are not readily discriminate.

vertebral manipulation may be helpful though confounding variables are quite controlling of effects as well. e.g., when spinal adjustments are performed in combination of other modalities including stretching, massage, etc. what actually had effects on perceived better feelings? it could be any of the parts of treatment,

consumers such as bodybuilders should choose the therapist, not the therapy. choose the practitioner, not the practice.

[drfunction]

"consumers such as bodybuilders should choose the therapist, not the therapy. choose the practitionar, not the practice."--good advice TPT and agreed....though you spelled practitioner wrong FWIW.

Many Pro Basketball, Football, Baseball, Hockey, and Olympic Teams.. from many countries have On Staff Chiros. I don't think these Professional Teams would waste money on Chiros if the athletes didn't see performance enhancement and speedy recovery from injuries. Chiro can be the right treatment for the right condition. Again, research your Chiro's my bodybuilding bro's.

[TPT]

"consumers such as bodybuilders should choose the therapist, not the therapy. choose the practitionar, not the practice."--good advice TPT and agreed....though you spelled practitioner wrong FWIW.

lmao @ teh irony of u spell checkin me ova an internet forum. take yo 2 posts and gtfo. fwiw. : )


Many Pro Basketball, Football, Baseball, Hockey, and Olympic Teams.. from many countries have On Staff Chiros. I don't think these Professional Teams would waste money on Chiros if the athletes didn't see performance enhancement and speedy recovery from injuries. Chiro can be the right treatment for the right condition. Again, research your Chiro's my bodybuilding bro's.

this logic and reasoning might be common sense and intuitive. however, it does not hold up to further scrutiny. just because professional athletes might employ chiroprators, does not mean others should employ them nor is chiropractic somehow a valid practice.

[Colossal]

Many Pro Basketball, Football, Baseball, Hockey, and Olympic Teams.. from many countries have On Staff Chiros. I don't think these Professional Teams would waste money on Chiros if the athletes didn't see performance enhancement and speedy recovery from injuries. Chiro can be the right treatment for the right condition. Again, research your Chiro's my bodybuilding bro's.

Great broscience example of "well THESE people use it, therefore it must be good."

If millions of people are spending money on a product like Airborne every cold season, does that in itself mean it's efficacious? To my knowledge there is no evidence it has any measurable benefit. People expect it to work.

I think chiropractic has it's place, although much of it is quackery (meaning there is little to no verifiable data to back up claims of efficacy), and many chiropractors work outside their scope of practice; promoting holistic nutritional therapies and trying to treat systemic disease based on the unsubstantiated subluxation construct.

[drfunction]

The world has much bigger problems than to pick on Chiros. For example: U.S. News & World Report 9/03/07 page 24-By Randall Larsen, retired US Air Force Colonel and the Director of the Institute for Homeland Security in Alexandria, VA. and Author of “Our Own Worse Enemy”
In the last 6 years :
Nearly 3,000 Americans have died from Terrorism
30,000 Americans have died from food poisoning
240,000 Americans have died on our highways
600,000 Americans have died from medical mistakes

I think the above are much bigger concerns in life.

I hear what you guys are saying and thought the Medical Journal articles below are worth knowing.Continue to educate yourselves and stay fit. Move well, eat well, think well.

Journal of the American Medical Association 5/20/98: the study's author, Stanford University researcher John A. Astin, Ph.D., surveyed more than 1,000 randomly selected people throughout the United States and found that 40% of the respondents reported using some form of alternative health care during the past year, including chiropractic. Those using alternative medicine were no more dissatisfied with or distrustful of conventional medicine than nonusers. Among all respondents who reported being highly satisfied with their conventional practitioners, more than one-third also used alternative therapies. He also reported that users of alternative medicine tend to be better educated and have a more holistic approach to health than those who use only conventional medicine.

New England Journal of Medicine 1993;328(4):246-52: the study's author, Eisenberg, M.D., surveyed 1539 people with medical problems occurring in the previous year and found that there were more visits to unconventional providers than to general practice MD's in the year of 1990. For 5 of the 10 most commonly cited medical conditions, they were more likely to seek unconventional care than just traditional medical care. There were more visits to unconventional providers (such as chiropractors) in the entire year: 425 million vs 388 million. 1 out of 3 Americans used some unconventional care and spent $14 billion on it. (The highest use was by non-African-American persons aged 25 to 49 with college educations and incomes greater than $35,000 per year).

Annals of Internal Medicine 1997;127(1):61-69: the study's author, Eisenberg, M.D., noted that more than 70% of the patients who use alternative treatments never mention them to their medical doctors. He goes on say to his medical colleagues that they must address the challenge of discussing alternative treatments with patients because patients are using alternative treatments whether traditional medicine likes it or not.

American Family Physician 1996; Nov 15: 2205-2212: the study's author, Gordon, M.D., reports that since Eisenberg's landmark article, the use of alternative medicine has... increased to more than 40% of the US population... It's important to integrate aspects of alternative medicine into family practice... in less than a generation the approach and techniques currently called "alternative" will be an integral part of practice of all family physicians.

American Medical News 1997; April 7: 13-18: the author, Shelton D., reports that the AMA recognizes the demand for alternative health care. This has been forced on them by the public's growing demand for access to alternative care options and the health care market's search for ways to reduce costs. This mainstreaming trend has allowed alternative medicine to lose much of its cult-fad status and forced the medical establishment to take it seriously. Chiropractic is the largest category of alternative care with 50,000 D.C.s in the US. The health care system of the 21st century will have conventional and alternative providers working side by side.

Fundamentals of Complementary & Alternative Medicine: editor Micozzi, M.D., Ph.D. says "It's a tremendous consumer movement, a social phenomenon & a reality in health care today."

In other words it has reached critical mass. It has become a tremendous consumer movement. The public's mind over what health care should be has been changing over the past five decades; people have realized that they can ask questions and demand answers, and that they can and should make their own health care choices.

[Cogrick2]

What an important post. Thank you, TPT! I am glad I stopped going to a chiropractor after experiencing no benefit and significant inconvenience, and spending $800. :(

[TPT]

What an important post. Thank you, TPT! I am glad I stopped going to a chiropractor after experiencing no benefit and significant inconvenience, and spending $800. :(



good, cogrick. i assume we all would rethink using any practitioner who provided no benefit for us.

for those interested in reading more editorial on the topic. http://www.sciencebasedmedicine.org/?p=4068

[tribal]

but doesnt it feel fuking good? thats more then enough benefit for me to get it done

[TPT]

but doesnt it feel fuking good? thats more then enough benefit for me to get it done


lots of people do report that.

[ob205]

lots of people do report that.


Yes they do, but I think you feel great after doing some Yoga and Foam rolling as well! Hope that foam roller doesn't knock me out of alignment! :yep:

[TPT]

an article by a chiro on 'how chiropractic subluxation model threatens public health.'

http://www.chirobase.org/01General/risk.html

[ThePoser]

Good read, but all I can say is that I have walked into a chiro's with so much (lower back) pain that I couldn't even sit or stand up straight. Walked out fine and thanked him!

Same thing has happened with my neck and even my jaw!

[chucksm00th]

Good read, but all I can say is that I have walked into a chiro's with so much (lower back) pain that I couldn't even sit or stand up straight. Walked out fine and thanked him!

Same thing has happened with my neck and even my jaw!

I have to agree on back pain. Ive been regularly seening a chiroprator sine my back went out 3 times in 2 weeks. I didnt even work out the day prior and I woke up in agony not being able to even put my shoes on. I got a consult they took xrays and my spine was semi curved at the base (making my right hip higher thanmy left). After a few visits I felt much more mobile and my lifts have even improved in the gym.
Alot of people think they are a waste but they do help some people. Im a firm believer that it helps and works.

[Curt James]

thanks, ob.

yes. historically, it is a fact that chiropractic is more mysticism than science. this is emphasized by the logic and reasoning behind the 'subluxation' being the determinant of disease. thus, fix the subluxation with a mere adjustment to fix the disease. we know that this is erroneous and many use this simplified construct in practice. (snip)

Then pass the mysticism, bruddah!

I had incredible neck pain that radiated to my right shoulder years back. Saw a free visit coupon to Becker Chiropractic in Lemoyne, PA. Visited his shop. Got an adjustment and it was as if someone had flicked a light switch. The pain stopped immediately.

No push for follow-up visits. No pressure of any kind. I visit occasionally for a $20 co-pay.

Placebo or reality, the pain is gone!


Im a firm believer that it helps and works.

Amen. :bowdown:


"consumers such as bodybuilders should choose the therapist, not the therapy. choose the practitionar, not the practice."--good advice TPT and agreed....though you spelled practitioner wrong FWIW.

No one cares about spelling. Trust me, I checked. ;)

[Anthony]

I've also had good success with chiros - key is to find the right one. Bad back/hip pain was quickly relieved, numbness from apparent nerve impingement fixed in one visit. The mechanics with those issues seem simple enough - nerve is squeezed between bones - adjustment takes the pressure off the nerve.

[towtheline]

Have any of you out there noticed how PT's are seemingly wannabe chiro's? They try to manipulate, educate on posture and spinal mechanics, try to teach home stretching and core strengthening...All stuff my chiro was doing 20 years ago. There wasnt a PT around back then. Now the PT's bash chiro and try to do exactly the same thing. You will find some quacks out there, much like MDs, we can start all whole new thread on ADD, Depression and so on. Big Pharma owns those bastards. Had to vent, long post.

[s2h]

i go to a chiro once a week that uses active release method...i find this to be a big help compared to the "quacky" chiros that think they can cure cancer by manipulation of the upper back..

[GeminiJedi]

I do have to say that I LOVE my chiro!! Besides fixing some posture, and fixing the curvature of my cervical spine (it was curved the wrong way!), I notice that I can breathe better when I'm aligned properly. I was never a believer in chiropractic practice until last year when I started seeing mine, and I have to say that I can definitely tell when it's time to get adjusted again.

[chiropractor]

this is an interesting read! im getting ready to go to chiro school and have seen many different chiros work and not all are the same. some dont really care and some really do and you can tell by the ones that do when they ask you about the pain instead of rushing you out. i bend over to pick up a basketball and both my legs went numb and i couldnt even walk i had to very slowly tip toe and after 4 weeks of stetching and trying to get it to go away, i went to my chiro and within a week i started to walk noemal again without a limp. i say every medical profession has its place and they are in out toolbelts and we need to use which ever for whatever situation were in.

[GirlyMuscle]

My chiro helped me get through 2 herniated discs without surgery. Thirty yrs ago my Dad was out of work for a back problem (can't remember the details) and every MD he went to wanted to operate. A chiro helped him heal without surgery. I think a good chiropractor is invaluable.

[ob205]

GM, Can you describe the process that helped you rehabilitate the discs? did the chiro discover these thru MRI's?

Thanks

[GirlyMuscle]

Yes. X-rays and MRIs. Two herniated discs in the lower back. I can't remember the numbers.

I don't know what caused them. Not like I was deadlifting or anything. I just got up one day and couldn't move. I could sit or lay down but I could not stand or walk farther than 20 feet, literally. I had to have people drive me around and drop me at the front door. After 5 steps I'd have to stop to sit down. Because of where the discs were all the swelling in the area was squeezing the hell out of my sciatic nerve and I had constant pain shooting down my left leg as well. It was really bad.

First, he did a thorough adjustment. I went in three times a week. He had this traction contraption that went around my ribcage and my hip bones with metal bands in between. Once in it, I had to turn a knob which expanded the distance between ribcage and hips. This would stretch me and separate the vertabrae a little. Then I'd walk around. Maybe 10 steps, sit down, 10 steps, sit down. Little by little I increased the distance walked. This traction therapy helped the discs to kinda suck back in to where they were supposed to be. I also took msm, condroitin, glucosamine and another natural anti-inflammatory whose name I can't remember, all fort he swelling. It took about a month before the pain subsided and I was able to walk from my car across a parking lot to work. After the 1st month is got better even faster. The more I could walk in the brace/traction thing the faster I healed.

He told me that once your disc is herniated it will always be herniated. But there's no swelling, no pain and no limitations. he also said it could flare up again in the future but it's been 10 yrs and I've not had any issues with it since.

side note...although my chiro is pretty anti-drugs he did tell me that if I could get pain killers I could take them. I had a friend with a stockpile. Neither Vicodin nor Darvacet put a dent in the pain.