Chiropractic Care

August 3, 2011

Anyone who has ever intentionally cracked her knuckles or stretched and popped her neck has an idea of the benefit of chiropractic, for it is a similar manipulation of the joints that is chiropractic today. Yet despite the many people who report benefiting from chiropractic treatment, chiropractic has a controversial history that goes back to its foundation before the turn of the 20th century.

Chiropractors derive their theories and techniques from the work of D. D. Palmer—a magnetic healer— who performed the first chiropractic adjustment. In 1895, Palmer manipulated a bump on the neck of a janitor in the building where he worked, and after one of these treatment sessions, the janitor reported being able to hear. From this incident and his study of magnetic healing, Palmer developed the idea that a vital force permeates every cell of the body and that misaligned joints (called subluxations in the jargon of the trade) press on the nerves and disrupt the flow of the vital force. He believed that this disruption is the cause of illness and that manipulation of the joints can restore flow of the vital force and thus allow the body to achieve health. It is important to note that Palmer believed that any decrease or increase of life-force flow caused by bones pressing on nerves results in disease and that chiropractic treatment restores normal flow.

These ideas developed and evolved at a time when conventional medical practice (sometimes called allopathic medicine) was dramatically different than it is today. Before the Flexner report, which was published in 1910 and which brought about dramatic reform in medical education, many physicians were either selftaught or had learned medicine at the hands of other physicians. Almost anyone could call himself a doctor. Many medical practices of the time were unpleasant, ineffective, or dangerous. In such an environment, alternative approaches to healing sprang up. Chiropractic was one of these alternative approaches.

Today, chiropractic is commonly considered as one of many complementary and alternative approaches to medicine. This designation reflects chiropractic’s historical rejection of conventional scientific approaches to knowledge and practice. Allopathic medicine is a reductionist approach, focusing on symptoms and attempting to identify their root cause. Chiropractic focuses on symptoms as well, but takes a whole body approach to wellness. Chiropractic is built on the belief that a vital force infuses every cell in the body, and that this belief is not subject to scientific testing. The chiropractic tradition offers a series of principles that are philosophical statements, not testable hypotheses. Chiropractors have not usually subjected their methods to the kinds of scrutiny that are common in medical practice, and they use terms in ways that are not consistent with usage in conventional medical settings. For example, when a chiropractor talks about disease, she does not mean illness. In chiropractic tradition, “disease” is both the cause and effect. In fact, one proponent of chiropractic, Frank DeGiacomo, maintains that the treatment of any classified disease cannot be chiropractic. Contrast this idea with the long list of diseases many chiropractors claim to treat or prevent, and the inconsistencies multiply rapidly. However, philosophical inconsistencies abound in conventional medicine as well. In fact, it is the process of questioning traditional practice that has been the engine of discovery that has led to new and better treatments in both chiropractic and conventional medicine.

Chiropractors believe that the vital force is self-evident and that their practices are the most effective way to help the body achieve health. In response to criticisms of their approach, chiropractors emphasize the idea that nothing outside the body can heal the body but that restoration of the life force can allow the body to heal itself. And, of course, they believe that they have the best techniques for helping the body to heal itself. Some chiropractors reject the use of antibiotics and surgery as inconsistent with their basic principles. Other chiropractors see their healing modality as one among many that individuals may choose to achieve wellness under specific circumstances.

Some chiropractors promote other approaches that they view as consistent with their field. It is not unusual to find chiropractors selling vitamins, herbs, and devices designed to promote health. It is rare, however, for chiropractors to subject their practices to close scientific scrutiny. They argue that it is unfair to judge one healing tradition by the standards of another that takes a different approach. Because of this, chiropractors have faced an uphill battle against the forces of mainstream medicine. For example, chiropractors won an antitrust suit against the American Medical Association in 1987. However, the victory was a validation of their right to practice chiropractic rather than a validation of chiropractic techniques. A study by the RAND Corporation suggested that chiropractic techniques are an effective mode of treatment. Nevertheless, this study has been criticized because chiropractic was not studied under the conditions in which it is usually practiced. Many of the procedures performed were not administered by chiropractors, and physicians screened most patients receiving the procedures to assure that the physical manipulations were safe. A study published in Consumer Reports claimed to demonstrate the effectiveness of chiropractic. Instead, it showed satisfaction with chiropractic. Satisfaction and effectiveness are not identical.

To say that chiropractic is ineffective would be erroneous. The proper statement would be that evidence supporting the effectiveness of chiropractic is limited. Some studies do show its effectiveness for the treatment of back and neck pain when compared to no treatment. It is important to note, however, that such studies do not test the basic premises on which chiropractic is built.

As with any profession, chiropractic is evolving. Some chiropractors eschew treatment of conditions other than those associated with nerves, muscles, and bones. A limited but growing number of chiropractors recognize the importance of rigorously testing the effectiveness of their techniques. Chiropractors have begun to examine the cost-effectiveness of their treatments. Through these changes, chiropractic may increase its acceptance in the mainstream medical community. Those who are committed to the highest standards of research welcome these changes.

SEE ALSO: Acupuncture, Back pain, Chiropractors, Complementary and alternative health practices, Energy healing, Massage, Physical therapy

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