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
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.
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.