Chiropractic is not a treatment

Does dentistry work? Does medicine? Does chiropractic? The answer is impossible to give because these three are professions not treatments. One can ask, does filling teeth prevent further cavities or does heart surgery prolong life or does manipulation improve back pain but you cannot ask a simple question of the whole complex profession.

Chiropractic is often described as a package of care consisting of manipulation or mobilisation techniques, exercise prescription, ergonomic and lifestyle advice as well as general health and wellness advice.  Often our role overlaps with counselling as we talk with someone about losing a job, stress management or relationship issues. All of these can, of course, have an impact on general health and even back pain.

Many studies have looked at how to predict who will get back pain and who won’t. Unfortunately most research doesn’t come up with a worthwhile answer except in one area – psychology. Asking someone if they like their job or if they like their spouse or partner is quite useful to predict who is more likely to get back pain. If someone answers no to either question then they are more likely to get back pain than someone who answers yes. So counselling is an important if more amateur part of a chiropractors job than seeing a trained psychotherapist. We often refer people to  psychotherapist if a brief chat is not really going to be enough.

You can ask does the package of care compare well to another package of care. This is what the the Medical Research Council asked in 1990. They found that chiropractic care was 70% more effective than conventional medical care in the treatment of back pain. It was a pragmatic study, that is, all the chiropractors, doctors and physio’s were allowed to do whatever treatment they would normally do. Of course the physio’s hated the results and criticised the study heavily.

In a repeated study the professional rivalries were reduced by looking at the treatment interventions themselves, especially manipulation and exercise compared to drug therapy. The BEAM trial in 2005 showed that for back pain exercise is good, manipulation is better and that manipulation and exercise is best. Drug therapy did not do so well.

This was a good lesson for chiropractic or more particularly for chiropractors themselves. It meant that we cannot own a particular treatment modality, in this case – manipulation. Physio’s and osteopaths were also involved in the trial and showed they they had skill in manipulative care too.

As the market place for spinal care gets more crowded some chiropractors have sought to distinguish what they do from other health providers by stating their belief in the value of treating the vertebral subluxation complex. The origins of this rather archaic and vague term dates back to the inception of chiropractic as a profession in the 1800’s and has different meanings in medicine. Most chiropractors registered with the British Chiropractic Association prefer to describe the spinal problems that we treat in terms of biomechanical and neurological dysfunction that any medical doctor would understand. It is the same problem described differently.

Another difference is between mainstream chiropractors and the ones from the past is the the concept of disease being caused by these subluxations. Whilst there is some interesting evidence, we are a long way off being able to show that treating spinal dysfunction will help with health and disease in general. A comparison can be found with old fashioned ideas of the causes of disease in medicine in general. Until the nineteenth century the concept of the four humours of black bile (melankholia), yellow bile (cholera), phlegm (phlegma), and blood (sanguis) as the cause of all ill-health was widespread. Conventional medicine dropped these concepts as more became known.  Interestingly cholera survived as a description of a different entity.

If chiropractic is to fulfill its role as the specialist provider of non-surgical spine care, working alongside mainstream health care we will have to resolve this dichotomy and explain our role as a profession not just a treatment. We will have to use universally understood terminology and apply evidence informed care for the best interest of our patients.

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10 top tips to avoid back pain on holiday

Watch your back

At this time of year I start to see several people who have injured themselves on holiday. It is not the sort of holidays that you might expect either. Rather than activity holidays like biking, kayaking, tennis and walking trips it is the inactivity holidays that are worst culprit. As stress builds leading up to the departure date, aches and pains start to recur before people even get to their destination. Continue reading

What Causes Joint Clicking?

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Are X-rays good for you?

Using x-rays to see inside the body has been around since 1895 and chiropractors were amongst the first to use this wonderful new technology. The first x-ray machine to be installed in a chiropractic college was in 1910 in Davenport, Iowa. Since then x-ray use fallen in and out of favour in both medical and chiropractic circles. Continue reading

Evidence for chiropractic

A recent study has shown what chiropractic is useful for, where evidence is inconclusive and where it is not effective. Or so it seems. The research published in the Chiropractic and Osteopathy Journal was a review of the top quality randomised controlled trials (RCT) published on manipulation treatment for a range of conditions . It showed good evidence for muscle and joint conditions commonly treated by chiropractors such as back pain, neck pain, migraine and headaches, and surprisingly some forms of dizziness. Continue reading

Let Food Be Thy Medicine or how food can reduce inflammation

The trouble with our modern-day lifestyles is that we are so pressed for time and have so many things to do, we invariably neglect our eating habits – both in terms of the quality of our food and the frequency of our meals. While the effect of fatty foods on your overall physical constitution needs no introduction, the idea that certain foodstuffs can actually keep you in pain is not so well recognised. Continue reading