Modern chiropractic therapy is based on evidence, and here it is
by Peter Tuchin, Senior Lecturer, Department of Chiropractic, Maquarie University
Chiropractic has copped some criticism this week, with a group of prominent Australian doctors and scientists urging Central Queensland University to reverse its decision to offer a chiropractic degree from 2012.
The group claims chiropractic isn’t based on evidence and therefore shouldn’t be taught at university.
As a chiropractor and academic, you’d expect me to defend my profession, so let’s consider the evidence.
Chiropractic therapy encompasses massage, exercise, advice, electrophysical therapies, sports therapy and tapping. But chiropractors are essentially health care professionals that specialise in spinal health.
Spinal manipulative therapy, which forms the bulk of most chiropractors’ day-to-day work, is a therapeutic intervention performed on vertebral joints in the spinal column to alleviate pain.
Chiropractors apply tension to the patient’s ligaments and then deliver a short, high-velocity thrust to increase the movement of the vertebrae. The therapy works by increasing vertebral mobility and improving blood flow to help reduce inflammation. It also changes nerve function which can result in many other effects.
So what does the evidence say about its efficacy? A Cochrane Review of spinal manipulation therapy for chronic low back pain shows that at minimum, it’s as effective as exercise therapy, standard medical care or physiotherapy.
(Interestingly, a Cochrane Review also shows that non steroidal anti-inflammatory drugs, which doctors commonly prescribe to alleviate back pain, only have a slight effect for back pain but also have many side effects and cause adverse reactions.)
Spinal manipulation therapy gained prominence in 2007 when the American College of Physicians and the American Pain Society recommended it as a treatment for chronic or subacute low back pain, alongside exercise therapy, acupuncture and yoga.
There have now been around 70 randomised control trials and 10 systematic reviews which support its use to treat lower back pain. Perhaps most notably, a 2004 study published in the British Medical Journal compared spinal manipulation therapy with exercise and reported better outcomes with spinal manipulation.
Evidence-based therapy
As with any health-care profession, it’s important that chiropractors restrict their therapies to those that are based on evidence. This doesn’t always occur and that’s where much of the medical profession’s criticism is levelled against chiropractic therapy.
Some chiropractors still strongly adhere to the early chiropractic teachings, that ’vertebral subluxation’ could cause many types of disease and conditions of the body. This is not the contemporary approach of chiropractic and shouldn’t be promoted.
Other chiropractors sometimes misconstrue improvements in a patient’s health or well-being as evidence that a treatment works. But, of course, there may have been other factors that helped achieve the effect the patient experienced, which was independent to the chiropractic treatment.
As with other scientific disciplines, the evidence base of chiropractic is constantly evolving, as researchers undertake new studies and trial the effects of different therapies.
When I started working at Macquarie University in the early 1990s, there was very limited evidence for chiropractic treatment for headache and migraine. Now, studies have shown that chiropractic can alleviate headaches, migraines and other conditions. Today’s chiropractors are very effective in alleviating neuromusculoskeletal disorders and medical practitioners should feel confident working with them.
Evidence-based education
Chiropractic has been taught at leading universities in Australia — Macquarie, Murdoch and RMIT — for more than 20 years and these institutions are at the forefront of international research to provide evidence-based therapies.
Macquarie University teaches an evidence-based program which includes subjects on orthopaedics, neurology, differential diagnosis, research methodology, critical thinking, ethics and jurisprudence. We also educate students on patient characteristics, preferences, and clinical observation. Students leave with more 5,000 hours of education and a Master’s degree.
Skeptics are right to question treatments and education that don’t have evidence to support their use. But all good health-care treatment providers will give patients evidence-based information to allow their patients to make informed choices. And that includes chiropractors.
This article was originally published at The Conversation.
Read the original article.
0 Responses to “Modern chiropractic therapy is based on evidence, and here it is”
I’m curious about the “It also changes nerve function which can result in many other effects.” part…
I guess it’s obvious, but just in case it’s not, these guest posts are presented by the editors, not the wider circle of those writing here.
For those what even more reading (!), I’ve linked to Simon Singh & Professor Enrst’s take on chiropractic from their book Trick or Treatment here – available free to read on-line.
“Some chiropractors still strongly adhere to the early chiropractic teachings, that “vertebral subluxation†could cause many types of disease and conditions of the body. This is not the contemporary approach of chiropractic and shouldn’t be promoted”
You mean like the NZ Chiropractors Association?
http://www.chiropractic.org.nz/what-is
And the Chiropractors association of Australia?
http://chiropractors.asn.au/Content/NavigationMenu/AbouttheCAA/Policies/default.htm
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Some chiropractors still strongly adhere to the early chiropractic teachings, that “vertebral subluxation†could cause many types of disease and conditions of the body. This is not the contemporary approach of chiropractic and shouldn’t be promoted.
Some? Most I say. And what are the colleges here in NZ doing about it? There seems to be no policing of the claims at all. I really wonder if there are any chiropractors in New Zealand that follow the “contemporary approach”.
The apartent repudiation of subluxation theory here also goes against what would be taught in the course that is being objected to:
http://www.abc.net.au/pm/content/2011/s3384081.htm
“Professor Phillip Ebrall is running the course and has been singled out for criticism. He defends the teaching of subluxation theory.
PHILLIP EBRALL: Subluxation theory will be taught because it is an emerging theory that’s developing an amazing amount of evidence at new levels in support of some of its underlying principles. “
Does that mean Tuchin also objects to the course in it’s current form?
“at minimum” is an interesting way of interpreting the Cochrane summary which says:
“The results of this review demonstrate that SMT appears to be as effective as other common therapies prescribed for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy.”
So no better, no worse……would I be influenced by the suggestion that at a minimum it is as good but obviously it must be better???
Be that as it may. The “Lower Back” is far enough away south to not kill me by breaking my neck. As a paralympic shooter I kniow who was a lumberjack found out when he had a neck injury “cured” by a chiropractor.
[Relevant, but not in reply to those writing here.]
Those wishing to follow further discussion on this may find this thread from the same source as the writer points to useful:
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576
It’s a fairly ‘involved’ sort of discussion. I’d suggest focusing in particular on the comments by Prof. Marcello Costa (Professor of Neurophysiology, Department of Physiology at Flinders University); Prof. David Colquhoun (Professor of Pharmacology, University College London; Prof. Colquhoun has previously written speaking out against chiropractic and other forms of ‘medicine’ considered lacking substance); and Prof. Ebrall, who I understand heads the new department in question.
e.g.
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576#comment_15777
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576#comment_16013
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576#comment_16012
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576#comment_16001
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576#comment_16175
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576#comment_16023
http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576#comment_16183
Rather ‘demand’ that others ‘have evidence’ of what the course offers whilst not providing information about the course, I feel Prof. Ebrall would have done better to simply present what the course offers.
My own thoughts on that treatments are, ultimately, to be offered to the public. The public, have a right to know if the basis of their treatment is sound. Part of this comes back to what is taught (or not) to their practitioners. The onus is on his course material to be worthy of the public’s interests. In my opinion Prof. Ebrall should front up as to what the course contains openly and constructively.
There’s a few remarks here from outside that forum that may be of use to some:
http://occamstypewriter.org/notranting/2011/12/09/a-year…-only-partially-digested/#comment-1388
This article on chiropracty (by a chiropractor) is interesting:
http://quackwatch.org/01QuackeryRelatedTopics/chiroeval.html. Basically he’s saying: musculo-skeletal care, probably OK; anything else, nonsense.
Alison,
That’s the general impression I got when I read around before writing my articles on chiropractic. There are wider problems with letting chiropractic continue; I wish I had time to elaborate on why, but cutting to the conclusion my current thoughts are that governments and interested medical groups would be best to shut down chiropractic entirely and encourage those who have an interest in physical therapy to work under the general medical umbrella, rather than the chiropractic label with all its issues.
Sam Homola, a former chiropractic, shares his views on the future of chiropractic at Science-Based Medicine:
http://www.sciencebasedmedicine.org/index.php/subluxation-theory-a-belief-system-that-continues-to-define-the-practice-of-chiropractic/