What is Chiropractic? Are all chiropractors the same?

Chiropractic. What is it? This is not always an easy question to answer as even the profession can not agree on a definition!

I have decided to write this blog despite the fact that it may offend or even anger other chiropractors because it is important to realise that as in other professions not all chiropractors are the same. I am tired of being lumped in with the chiropractors that do not use the evidence that is available.

A Brief History

Chiropractic was founded in 1895 by Daniel David (DD) Palmer. DD was chatting with the janitor and he found out that the janitor was partially deaf. He said he bent over and heard a pop and that is when his hearing was affected.He manipulated the spine of the janitor and found that his hearing was restored. For a more detailed history click here

The Chiropractic Lesion

The lesion that some chiropractors claim to fix or remove is the subluxation. The World Health Organisation (WHO) defines the chiropractic subluxation as "A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity." 1

There is also the Vertebral Subluxation Complex defined by WHO as "A theoretical model and description of the motion segment dysfunction, which incorporates the interaction of pathological changes in nerve, muscle, ligamentous, vascular and connective tissue." 1

There is no evidence to suggest that these actually exist. Joints can be become restricted ie not move as much as they should, through chronic or acute injury, but there is no evidence to suggest that affects or influences the nervous system or other organs.

Are all Chiropractors the Same?

A resounding NO! All chiropractors are definitely not the same. In my opinion there are 2 extremes of chiropractors and most chiropractors fall somewhere in between these extremes. The first extreme is that through the spinal adjustment, chiropractors can remove subluxations and the body will fix all of its ailments. The other extreme is that if there are no scientific studies for what chiropractors do then it shouldn't be done. The chiropractors who use scientific evidence to support their scope of practice are in my opinion the correct or ethical ones. For definitions of the different types of scientific evidence click here.

What to look for in a chiropractor?

If the chiropractor does the following I would suggest that they are not using science to base their practice on (this list is not in any particular order of importance).

1. Gives you a diagnosis of subluxation or vertebral subluxation complex.

2. Routinely x-rays patients. Most patients do not need x-rays. X-rays expose a patient to radiation and should only be performed if the history and examination indicate it. For a list of x-ray recommendations click here and here

3. Appointments are only 5 minutes in duration.

4. Does not prescribe exercises and/or stretches or at least refer to someone who does.

5. Prescribes excessive numbers of visits. Each case is different and treatment plans should be based on the age of the person, the length of the problem, the severity of the problem, presence of yellow flags and so on. In my opinion 2 to 3 visits per week for 1 to 2 weeks is more than enough for a severe problem initially.

6. Does not stick to the scope of musculoskeletal treatment. Some chiropractors have done additional studies in things like nutrition, however the basic chiropractic qualification in my opinion, is not sufficient to enable chiropractors to prescribe nutritional supplement for anything other than musculoskeletal conditions or help people with emotional or psychological problems.

7. Recommends more of the same treatment if you are not getting better.

8. Uses non scientific instruments (gadgets) to tell/show you that you have a problem that you never knew you had. Sometimes from your history and examination other problems may be suspected. If this occurs and the problem is not a musculoskeletal problem, the chiropractor should refer you out for further testing/review.

9. Tries to get you to sign up to a treatment plan that is longer than 3 months.

10. Insists that you attend a new patient information session. Whilst some scientific based chiropractors do hold information sessions they are not designed to convince you as to why you have to see a chiropractor but will teach you how to look after your own health.

For information of the code of conduct for chiropractors published by the Australian Health Practitioner Regulation Authority click here

To sum it up if you feel that you are not getting any better then perhaps you need a second opinion! As in all professions there are good and not so good chiropractors. A chiropractor that helps one person may not help another with the same symptoms. Ask your friends, your GP and others who they think would suit you.

Musculoskeletal chiropractor

A musculoskeletal chiropractor is one who will tell you that there job is to assist you in restoring your joints and muscles to their full motion and function. They will do this using manipulation (some chiropractors call them adjustments), soft tissue work (massage, trigger point therapy, dry needling and so on) and advice. They will not tell you that you have a subluxation or that they can help you with non musculoskeletal conditions. They will help you to help yourself and not to rely on them for your health needs.

Summary

In summary, chiropractors are not all the same. The science based chiropractors will keep to their scope of practice which is musculoskeletal problems. They will educate you on how to help rehabilitate your injury/pain and how to prevent it from returning without relying on them fully.