Health Studies 301 Complementary and Alternative Therapies

Study Guide: Unit 8

Chiropractic

A chiropractic session in progress. Jim Dubel Chiropractic, 2010, CC BY-SA 2.0.

The aim of chiropractic treatment is to diagnose alterations in the spine and other bony articulations and to restore normal function. It is both an art and a science.

Learning Objectives

Upon completion of Unit 8, you should be able to

• discuss the theory of chiropractic and the nature of this therapy.
• identify situations where chiropractic is commonly used.
• determine the effectiveness of chiropractic by analyzing the available research.
• identify trends and issues related to the use of chiropractic.

Learning Activities

Study Questions

As you complete the activities for Unit 8, keep the following questions in mind. You may want to use the Personal Learning Space wiki on the course home page and answer these questions as a way of keeping notes to focus your learning.

1. What are the conditions most commonly treated by chiropractors?
2. The traditional bone-out-of-place model used to explain the mechanism for chiropractic’s beneficial effects has been replaced by what contemporary model?
3. What term has been used historically by chiropractors as a synonym for spinal joint dysfunction?
4. What do the preponderance of research studies show about the most effective and cost-effective approaches for relieving pain and restoring function for both acute and chronic low-back pain?

Unit 8 Discussion Forum

When you have completed the other activities for this unit, answer at least one of the questions in the Unit 8 Discussion Forum and respond to at least one post by a fellow learner.

The more questions you answer, the better prepared you will be for the final exam!

Read

In addition to the notes provided here, read in the textbook:

Micozzi, M. (2019). Fundamentals of Complementary, Alternative, and Integrative Medicine. Pages 241–257.

Chiropractic and Chiropractors

The textbook provides a detailed history of chiropractic. It also describes how the theory and practice of chiropractic have evolved.

Chiropractic straddles a fine line between conventional medical practice and CAM. Traditionally in North America, chiropractors have not had hospital privileges. However, the American Medical Association, the Canadian Medical Association, governments, health-funding agencies, and insurance plans recognize chiropractic therapy and treatment, and therefore include practitioners’ fees in their payment schedules. Most provinces in Canada changed their policy on this in recent years and have ceased covering chiropractic treatment through healthcare plans. However, many private insurance plans do cover the treatment. Chiropractors have successfully lobbied for both the profession and the field of therapy.

Chiropractic is regulated and taught through accredited programs and colleges in Canada, the United States, and other countries. Its 5-year educational program curriculum covers a broad spectrum of study areas. Provincially, chiropractors are regulated under the Health Professions Act with protection of title for Chiropractor, Doctor of Chiropractic, and the abbreviation D.C.

Chiropractic shares some common ground with osteopathy, which also practises manipulation of the spine and other body parts. Osteopathy emphasizes the manipulation of bones and joints to increase blood circulation in order to maintain or restore health. By contrast, chiropractic focuses on spinal vertebrae adjustments to allow uninterrupted neural transmission to all parts of the body. Osteopathy is not included in this course.

In their practice, chiropractors can examine, diagnose, and treat through chiropractic adjustment and other means to maintain and promote health and wellness. They can use X-ray, massage, heat, ultrasound, and electrotherapy to diagnose, analyze, and treat clients. However, they cannot prescribe or administer medications or anesthetics, and they cannot perform internal examinations or surgery, or treat infectious diseases. Chiropractic treatment stresses the development and refinement of manual therapies and promotes total body health and individual responsibility for health. To this end, some chiropractors will also provide lifestyle recommendations such as exercise and nutrition.

As you read the textbook, pay special attention to the description of current thinking by chiropractors regarding the rationale for their treatment and their methods of practice. The history of chiropractic is intimately bound up with the concept of subluxation. This concept has evolved into segmental dysfunction.

The textbook reviews the research evidence concerning the value of chiropractic treatment (pages 247–257). Much attention is given to lower back pain, which is the condition that practitioners of chiropractic spend much of their time treating. The author provides an impressive weight of evidence from published research that indicates a major benefit from chiropractic treatment. However, a systematic review came to a much more negative conclusion (Walker, French, Grant, & Green, 2011):

Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute lower back pain. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with lower back pain when compared to other interventions.

But in stark contrast, a more recent systematic review came out in favour of chiropractic; the authors concluded, much like the author of the textbook reading, that the therapy is indeed effective for lower back pain (Lorenc et al., 2018).

With respect to several other conditions discussed in the textbook, the evidence that chiropractic is of value is rather weak. Others who have reviewed trials of chiropractic for various conditions have come to negative conclusions regarding the value of the treatment.

Despite the lack of supporting evidence for the value of chiropractic in areas beyond back pain, many practitioners use the therapy for the treatment of patients with a variety of assorted conditions including ADHD, autism, and asthma (Benedetti & MacPhail, 2018). They claim that this is justified because subluxations (supposedly) cause a wide variety of health disorders. Many practitioners of chiropractic have expressed anti-vaccination views.

The textbook discusses the challenge of designing research studies in this area (page 248). The discussion raises issues that appear in other units concerning the most appropriate design of research investigations into CAM therapies.

There are several possible risks associated with chiropractic treatment. For several years, there has been controversy regarding the possible risk of stroke that has been linked to chiropractic treatment of the neck. The author of the textbook chapter (pages 256–257) argues that, first, the risk is extremely low, and, second, that the problem may, in reality, be that people experiencing the early stage of a stroke are seeking chiropractic treatment rather than that chiropractic treatment is causing a stroke. However, Ernst (2010) came to an altogether different conclusion:

[N]umerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly.

We have just seen two examples of people looking at an issue and coming to very different conclusions. The author of the textbook chapter, argues that the research evidence clearly shows that chiropractic treatment is of much benefit for patients suffering from lower back pain (see the final paragraph on textbook page 257). He also argues that chiropractic treatment of the neck can be disregarded as a cause of stroke. But others have looked at the available evidence and have come to conclusions on both issues that are unfavourable to chiropractic. Such contradictory opinions are a perennial problem when assessing CAM therapies. The one definitive conclusion we can make is that more high-quality research is needed.

Summary

Despite a great deal of careful research, chiropractic treatment is of uncertain value. By far the strongest body of evidence supporting its benefit is in the area of lower back pain. However, even here some experts have found the supporting evidence to be less than convincing. Chiropractic treatment of the neck cannot be recommended, as there may be some risk of stroke (even though this risk is probably very low), while there is little or no benefit.

Learning Activity

Self-test Quiz

Do the self-test quiz for Unit 8 as many times as you wish to check your recall of the unit’s main points. You will get a slightly different version of the quiz each time you try it. (This quiz does not count toward your final grade).

If you have trouble understanding the material, please contact your Academic Expert.

References