The End of Chiropractic?

By Grant Jacobs 12/12/2009

Science-based Medicine reviews a research paper in a chiropractic journal showing that a key chiropractic claim–treatment of subluxation–has no merit. What’s new is this includes chiropractors rejecting this central claim of chiropractic treatment. Progress, perhaps?

Some of you will know that I have previously written about a local chiropractor’s claims in advertisements.

In these I have avoided dealing with bone manipulation itself, as I feel that this is best addressed by a spinal specialist, which I am not. (In my previous articles I wrote about the logic of the claims made, in particular claims outside of spinal treatment. Chiropractic claims (good background in this link) include that treatment of the spine will address a excessively wide range of conditions and illness far removed from spinal origins. The breadth of the claims, their lack of connection with the spine and lack of evidence supporting them, to be very polite, make the claims suspect.)

This paper in a chiropractic journal rejects a core claim of chiropractic treatment, treatment of subluxation as a treatment for (supposed) secondary conditions.

Subluxation is better known to us non-medics as partial dislocation. It’s a slight misalignment of the vertebrate, regarded in regarded in chiropractic theory to be the cause of many health problems.

Do these really exist?

Do they cause the health problems chiropractics consider they do?

Harriet Hall writes:

What’s the evidence? In the 114 years since chiropractic began, the existence of chiropractic subluxations has never been objectively demonstrated. They have never been shown to cause interference with the nervous system. They have never been shown to cause disease. Critics of chiropractic have been pointing this out for decades, but now chiropractors themselves have come to the same conclusion.

Mirtz and colleagues’ paper surveys the research literature for evidence supporting these claims, measuring them against Hill’s criteria.

Their paper opens with a brief background statement and aim:

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.

and concludes:

Hill’s criteria are the most commonly used epidemiologic model for suggesting a causal link for any diagnostic or treatment approach. There is a significant lack of evidence in the literature to fulfill Hill’s criteria of causation as regards chiropractic subluxation. No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability. [My emphasis added.]

I’d encourage readers to head over to Harriet Hall’s excellent article and read the details there.

As Harriet Hall notes, it will be very interesting to see the reactions of chiropractic practitioners to this paper. If this is anything to go by, I imagine they’ll get defensive nonsense.


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

Mirtz et al, Chiropractic & Osteopathy 2009, 17:13 (Open Access; PDF file)


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