Whacking, Cracking, and Chiropracting

Defined in 1895, chiropractic treats imaginary conditions with dangerous manipulations.

by Brian Dunning

Filed under Alternative Medicine

Skeptoid #42
May 1, 2007
Podcast transcript | Listen | Subscribe
 

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.

Tip Skeptoid $2/mo $5/mo $10/mo One time

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.

Brian Dunning

© 2007 Skeptoid Media, Inc. Copyright information

References & Further Reading

Balon, J.W., Mior, S.A. "Chiropractic care in asthma and allergy." Annals of Allergy, Asthma & Immunology. 1 Aug. 2004, Volume 93, Number 2,: S55-S60.

Barrett, Stephen. "Don't Let Chiropractors Fool You." Quackwatch. Quackwatch, 17 Sep. 1999. Web. 3 Oct. 2009. <http://www.quackwatch.com/01QuackeryRelatedTopics/chiro.html>

Collinge, W. The American Holistic Health Association Complete Guide to Alternative Medicine. Boston: Hachette Digital, Inc., 1996. 6-9.

Ernst, E. "Chiropractic: a critical evaluation." Journal of Pain and Symptom Management. 1 May 2008, Volume 35, Number 5: 544-562.

Gouveia, L.O., Castanho, P., Ferreira, J.J. "Safety of chiropractic interventions: a systematic review." Spine. 15 May 2009, Volume 34, Number 11: E405-E413.

Leach, R. The Chiropractic Theories: a Textbook of Scientific Research. Philadelphia: Lippincott Williams & Wilkins, 2004. 14-17.

Mirtz, T., Morgan, L., Wyatt, L., Greene, L. "An epidemiological examination of the subluxation construct using Hill's criteria of causation." Chiropractic & Osteopathy. 1 Jan. 2009, Volume 17:13.

Reference this article:
Dunning, B. "Whacking, Cracking, and Chiropracting." Skeptoid Podcast. Skeptoid Media, Inc., 1 May 2007. Web. 23 Nov 2014. <http://skeptoid.com/episodes/4042>

Discuss!

10 most recent comments | Show all 221 comments

I am very analytical and through the critical thinking process, I conclude that though chiropractic still today leaves a bit to be desired regarding research and development but look at pharmacology, oncology, surgery etc … so much of that is experimental. A lot of it kills people. Chiropractic risk is very minimal. There are some that state it causes stroke but come on … what do they pay yearly for malpractice? National average: $2,100. Compare to MD primary: $35,000. People allow themselves to be so dissuaded by ignorance and prejudice. It's a shame; not only is it counterproductive, it is against the best interest of the healthcare needs of our population.

Robert, Washington
April 3, 2013 2:25pm

"Garavito, that's perhaps the silliest and least logical argument I've ever seen on this forum. The AMA incorporates all legitimate medical professions. If a new area of medicine arose, they would not "feel threatened" by it, they would welcome it into their membership. The AMA's funding comes from its members. How would they benefit from shunning potential members???

Brian Dunning, Laguna Niguel
January 29, 2010 10:31am"

The antitrust lawsuit against the AMA must have been over looked.
http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association

Michaelb, Poway, USA
April 13, 2013 8:52am

In my experience, chiropractic works. Physical therapy does not.

On June 15, 2005 (age 29) , I had to call an ambulance because I could not sit up in bed. I rolled to the floor and crawled to my phone to do this. At the emergency room, I was diagnosed with scoliosis, multiple herniated discs, and sciatica. I also have had plantar fasciitis since around 1994 that was not diagnosed until 2011. I was sent to physical therapy, where I was placed on alternate hot/cold treatments, made to do stretches with a ball, ride a stationary bike, and take Elavil. None of this made any improvement in my condition, and I was, for the most part, still unable to stand or walk without a cane. I kept up the therapy for about 6 months, when the insurance company put a halt to it.

A chiropractor at my church offered me free treatments four days a week for several months, and over the course of that time, I stopped using my cane on a regular basis, and stopped taking prescription medicine for the pain, which had gone down to a mild soreness. Although I have subsequently paid this chiropractor for occasional further adjustments, and have been treated by free chiropractors at soup kitchens, 90% of these adjustments leave me feeling noticeably better for a significant amount of time.

Clearly this article is apologism for profiteering by Big Pharma. My recovery (and no, it's neither perfect nor a "cure") had nothing to do with medicine or physical therapy and everything to do with chiropractic.

Scott Hutchins, New York, NY
May 23, 2013 9:22am

I recently began Chiro treatment for persistent lower back pain. I was willing to suspend the innate cynicism I had accumulated over the last 40 or so years. After the requisite xray I was told that I had mild scoliosis from birth and that nothing could be done about that. I also had numerous 'subluxations' that were going to be treated using the 'Activator Method'. I was given an impressive demo of the Activator shooting ball bearings.I was skeptical already and asked for a working definition of the subluxations. Gobbledyegook was given. Then I was told one leg was a quarter inch shorter than the other and treating the subluxations would slowly treat that.
I am a sometime carpenter and I do not for a second believe that anyone can eyeball the difference in length of anything as irregularly shaped as a human leg with this degree of precision let alone legitamately tell me later that his treatment of my subluxation complexes has gotten the legs closer but not yet equal. I certainly don't believe he can eyeball a change of a fraction of a quarter of an inch.
For this tiny change I have paid upwards of $500 dollars with no change in persistent lower back pain.

This has got to be pure snake oil hoakum. I will say that Dr. 'Thumper' (my nickname) has an impeccable tableside manner and my cynicism notwithstanding I feel warm and fuzzy when I leave the office.

I have a PhD. carrying (cell biology, major university) faith healer who deals in leg lengthenings. He's much cheaer

Phil Ashworth, Lenoir City, TN
May 30, 2013 9:47am

You are more expensive than a chiro or was that a misprint??

Had I known scientists earn more than chiropractors in Tennessee I would have sussed out the potential.

Mountain Denier, sin city, Oz
August 1, 2013 1:14am

who ever is reading this testimony today should please celebrate with me and my family because it all started like a joke to some people and others said it was impossible. my name is ANDY SMITH, i live in London, United Kingdom i am happily married with three kids and a lovely wife something terrible happen to my family along the line, i lost my job and my wife packed out of my house because i was unable to take care of her and my kids at that particular time. i manage all through seven years, no wife to support me to take care of the children and there come a faithful day that i will never forget in my life i met an old friend who i explain all my difficulties to, and he took me to a spell caster and and the name of the temple is called, priest grace, i was assure that everything will be fine and my wife will come back to me after the wonderful work of priest grace, my wife came back to me and today i am one of the richest man in my country. i advice you if you have any problem email him with this email: ogbonispelltemple@gmail.com and you will have the best result. take things for granted and it will be take from you. i wish you all the best for luck his email: ogbonispelltemple@gmail.com

ANDY SMITH, London United Kingdom
October 6, 2013 4:32am

The major disappointment with this article is that Mr.Skeptoid forgets the premise of progress. Why would one be a reformist Chiropractor? Because it's progressive and an evolution of what was once a primitive idea. A magnetic healer manipulating the spine is one thing, but in today's scientific world, not accounting for inflammatory and heart disease in your recommendations for care is ignorant.

Here's why you go to an evidence-informed Chiropractor:

1. Patient-centered care
2. Longer doctor-patient interaction per visit than most other medical professionals.
3. Vastly superior knowledge of Anatomy and biomechanics than any general medical practitioner.
4. A touch of holistic/preventative focused care.
5. TREATMENT of patient at the clinic using the HANDS, NOT drugs.
6.Minimum 3 year undergraduate degree ,4 years of Chiropractic Schooling with 4200+ hours of training with majority of it in Anatomy, Physiology, Radiology and Biomechanical sciences.
7. Evidence gathering that is often more detailed than your typical medical or physical therapist exam: which includes a detailed history, physical examination, potential imaging recommendations which can be done in-house and HANDS ON treatment of patient on site.

In parts of world including developed Europe, Chiropractic is taught at universities. Only in pharmaceutical/medical dominated North America do we have such a boring conversation about legitimacy of a generally good and positive profession.

Sherwin Randin, Vancouver, Canada
November 22, 2013 8:48am

This site isn't really about open-minded analysis, reason, logic, or skepticism, is it? It's your personal soap box where you can broadcast your prejudices. And there's nothing wrong with that. Your skepticism is one sided. You do not approach topics with an open mind looking for the actual facts. You just look for information that confirms what you already believe.

If you really want to go at these topics with real skepticism, you would be well served to be skeptical of your own assumptions and prejudices as well. Chiropractors have corrected, for countless people, chronic skeletal misalignments (some resulting from injuries suffered in auto accidents and other traumas), and as a result, many people live lives that are free of pain and physical restrictions which medical doctors and physical therapists could not solve.

You say: "If you have some medical condition that you've been treating with chiropractic, consider going to a medical doctor for a proper diagnosis."

If you are really interested in finding out verifiable facts, you may want to talk to people who have done just as you suggest. You may also want to talk to people whose medical doctors were flying blind, feeling their way in the dark with guesswork, and whose chronic conditions were finally improved when they tried chiropractic care.

BB, San Francisco, CA
March 24, 2014 1:54pm

Brian, I love you but this time you are dead wrong on all counts.

A good chiropracter is a therapist who will help you.

A bad chiropracter is a thief who will steal your money and hurt you.

You need to refrain from the sin common in medicine of judging the profession by the criminals leeching on it for profit.

Torchwood, Gainesville Fl
September 23, 2014 10:12am

Whenever I run into something like this:

"Clearly this article is apologism for profiteering by Big Pharma."

I think of how many times Brian has been accused of being an apologist for"secret" nuclear reactors and weapons, the "secret" production of plutonium at regular nuclear power plants, the "secret" of the bottom levels of DIA being alien bars and hangouts, the "secret" underground tunnels affectionately labelled "D.U.M.B. (Deep Underground M-something B-something), the "secret" prison camps that FEMA is theoretically building for all of us, the "secret coming disaster" (it's a shame that 2012 ended so... boringly) and HAARP and contrails and grassy knolls and "secret" this and "secret" that until you find yourself talking in Dr. Seuss rhythm.

I conclude, no one has enough time to be an apologist for all these things.

Therefore, Brian *must* be the leader of a "secret", underground movement, whose membership consists of people who find themselves laughing until they nearly die after reading about some trendy movements.

* * *

Is there a word for "Silly Beyond All Rational Belief" statements?
I suppose "SBARB" is too complex. I theorize that all SBARB's must be words of two syllables or less (of course, "syllables" is more than two, so it's a self-defeating definition...)

I also think a vote for Best-of-Brian articles would be a good idea.
But that's because I'm a "secret" [blah, blah-blah, blah].

Hope this gave you a smile,

Dave

QuantumDavid, Denver, CO
September 23, 2014 3:04pm

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