This is a follow up to an earlier blog post on the subject of the GCC’s view of the evidence supporting subluxations. The first part can be found here: Part 1
Before I go any further, it is worth having a quick reminder of the GCC’s initial response when asked for their views:
Thank you for your enquiry. The General Council has never considered the research evidence for the chiropractic vertebral subluxation complex.
That was it, their reply in full. Not happy with that response, the GCC were then asked to provide clear, unambiguous answers to four straightforward questions relating to subluxations, evidence and claims.
Copies of my letter and the GCC’s replies can be found at the bottom of the page.
My letter was distributed to members of the GCC’s Education Committee and discussed at their last meeting on 13 April, the various chiropractic training providers were also asked to provide information on how they teach subluxations and what research they draw from. A subsequent meeting was held on 12 May where the advice from the Education committee and training providers was considered.
These are the questions asked and the GCC’s response :
1. (my original email question) Can you tell me at what level the GCC currently view the evidence for chiropractic vertebral subluxation complex (High, Moderate, Inconclusive, positive or negative
etc) with regards to causation of disease or health concerns ? Also if the evidence is considered to be of a positive nature, could you please provide details of the reports used to reach this conclusion.
1. There is no clinical research base to support claims that the chiropractic vertebral subluxation complex is the cause of disease or health concerns.
2. Does the GCC intend to review the research evidence or seek any advice on these claims (ASA/CAP etc), including expected timescale?
2. The GCC does not intend to seek any further advice on the claims made.
3. Provide a statement on how these claims currently relate to the GCC’s Code of Practice?
3a. If considered to breach the COP: What advice would it give to its members?
3b. If not considered to breach the COP; On what justification?
3. Within the next week or so the GCC intends to issue guidance to the profession on claims made for the chiropractic vertebral subluxation complex, a copy of which will be sent to you.
4. What is a subluxation and can it do me harm? ( This is the question removed from the GCC’s FAQ)
4. On your fourth question, the word ‘subluxation’ is a synonym for terms such as joint misalignment, joint dysfunction, facet syndrome and articular derangement.
My apologies to those of you who were hoping to dissect the quality of the GCC’s evidence . They don’t have any …….. dare I say ‘not a jot’!
The answers are very clear, unambiguous and I suspect they will have implications that may be unpopular with some chiropractors.
(answer 1) There is NO research evidence to support any claims that a subluxation (as used by chiropractors) is in any way responsible for causing disease OR other health concerns.
(answer 3) Once the GCC have issued their guidance to their members, their websites and advertising will need to change. To continue to make claims that subluxations are the root cause of health care concerns would breach the GCC’s COP.
Importantly, the GCC acknowledge (answer 4) that terms such as joint misalignment or dysfunction have the same meaning as subluxation. Simply using different terminology is not a get out clause!
The GCC also supplied a copy of another document ‘Advice On The Research Base For The Chiropractic Vertebral Subluxation Complex’
The response at 2.4 from the McTimoney College of Chiropractors where they claims subluxations are only mentioned in the context of the history of chiropractic, seem a little odd. When I sent my letter to the GCC on 28 March, the McTimoney website stated:
The basic principle of chiropractic is that disturbances of the nervous system, resulting from subluxation of the bones of the spine and other parts of the body, are a primary or contributory factor in the pathological process of many common human and animal ailments.
This statement vanished around the time of the 13 April meeting.
This McTimoney prospectus from 2008/2009 also shows that Subluxations were not looked upon simply as a part of the history of chiropractic.
Link: McTimoney prospectus (google cache)
Subluxation isn’t actually mentioned in the ‘History’ section, however the wording used on their website is repeated in the ‘What is Chiropractic’ and also mentioned in the ‘How Chiropractic Works’ section.
What the wider implications of this are will become apparent over the next few weeks/months.
What is clear is that without any evidence to support the various subluxations claims, if the chiropractic profession want to be taken seriously over important issues like evidence based practice – they must consign the subluxation to the history books along with all the other outdated forms of medical quackery!
“The General Council has never considered the research evidence for the chiropractic vertebral subluxation complex” ….. Look what happens when you do!
Edit:
Related (and very amusing) blog post by Zeno Obituary: The death of the subluxation
Copies of my original letter and the GCC’s replies:
My Original Letter 8 Mar LTR_GCC-SubluxationEv2
GCC letter dated: 14 May SubluxGCC
Advice On The Research Base For The Chiropractic Vertebral Subluxation Complex GCCSubluxAdvice
Gammidgy
May 15, 2010
Phenomenal work, SB. Bravo.
Zeno
May 15, 2010
Brilliant! I can say no more.
Badsciencemonk
May 15, 2010
Excellent!
Blue Wode
May 15, 2010
Stunningly good work.
Porsupah
May 15, 2010
Stripped of the manifold pseudoscientific justifications, does the core claim not reduce to “if we massage aches, you may feel better”?
Andrew Gilbey
May 15, 2010
Brilliant. I shall use this as ammunition for some complaints to the NZASA!
Andrew Gilbey
May 15, 2010
That was NZ ASA, rather than NASA. Not least becuase the assumptions behind chiropractic are hardly rocket science.
Andrew Gilbey
May 16, 2010
Nooooooooooooooooooo – the monster, he lives!!!!
Neuro-emotional complexes or N.E.C.s, as defined below, are possibly the most overlooked factor in our patients’ health. They influence one third of the total health picture and are rarely treated because we haven’t known how to find them or intervene for their resolution. The technology is now here to diagnose and treat them in the course of a regular office visit.
Downloaded from: http://www.chiroeco.com/chiropractic/news/9520/45/The-triangle-of-health;-once-more-with-feeling/
Similarly:
Neuro Emotional Technique It was trademarked and developed by Scott Walker, D.C. to safely and quickly release Neuro Emotional Complexes* from the body. It utilizes the body’s own …
http://www.transformationnow.net/NEAT1.html
Actually, I haven’t had time to check the various claims. So in all fairness, they may be entirely valid and evidence based.
Richard Lanigan
May 16, 2010
Interesting posting. Looking at the GCCs version of subluxation and how they explained it, I can hardly blame you for thinking it is “Bogus” . I have proposed we change the name of spinal joint dysfunction just for you guys, however I dont quiet understand how a noun can not exist anymore.
In 2007 I but a freedom of information request into the GCC asking them how they had arrived at their definition of subluxation. This is what they told me ; “The GCC subluxation was based on the WHO definition of subluxation and “160 people, including experts and national authorities and professional and NGO’s, in over 54 countries” had reviewed this document prior to publication”.
You are supposed to be skeptical, go figure who the “quacks” are, the would be doctors who were not clever enough to get into medical school and became chiropractors.
The GCC’s education committee is chaired by a physiotherapist Graham Pope and his deputy is a medical doctor Christopher Stephens and the 3 chirpractors on the commitee are of the “if you cant do, teach” variety. I would not attach to much weight to their expertise on what chiropractors do in practise.
skepticbarista
May 16, 2010
Many thanks for ALL the comments.
Ironically it was a chiropractor who prompted my to contact the GCC in the first place. Comments posted by ‘Fedup’ on another post on my blog, related to subluxations and evidence, that made me decide to see what the official GCC line was. The GCC’s initial response showed that they didn’t really want to talk about subluxations & evidence and that made me push a little further.
Just to be clear, I take no credit for the death of the subluxation. Subluxations have been questioned and discredited for almost as long as chiropractic has been around, if anything all my letter did was provide the GCC with a convenient opportunity to pull the plug on an inconvenient bit of quackery.
As I mentioned in Part 1 of this subject. The GCC said “In September 2009 the GCC commissioned a review of these (education) criteria”, although no direct mention of subluxations, they may have already been on the agenda.
I’m expecting the GCC’s ‘Criteria for the Recognition of Degrees in Chiropractic’ document (currently May07) will change shortly: http://www.gcc-uk.org/page.cfm?page_id=25
Subluxations have been on the critical list for a while – now the life support systems have been switched off.
I was looking for a typical chiropractic website subluxation quote this morning and ended up finding a chiropractor (who for the moment shall remain nameless) who not only have a whole page devoted to what subluxations are, their effects and how they are treated, but they continue to make unsubstantiated claims for colic, ashtma and other non-musculoskeletal conditons (on 2 websites – one devoted to treating babies).
I have contacted the clinic directly (via their website) to suggest they review their website content as I’m sure the colic claims are simply an admin oversight
skepticbarista
May 16, 2010
Page 5 of the UCA membership application form:
http://www.united-chiropractic.org/modules/mastop_publish/files/files_4ae51a23cc2a0.pdf
Core Values of the United Chiropractic Association.
All that emphasis on something for which there is no evidence …
Richard Lanigan
May 16, 2010
Hi I have no problem with skeptics asking questions and I am delighted you are highlighting how incompetent the regulator are. Subluxation was an issue ten years ago and they regulator have not been able to deal with. Now they think they can with skeptic help, surely you dont thing banning “subluxation” and Abu Hammza is the answer. I am sure you agree it is a bit strange the GCC give you one answer and me another. Same Chief Executive is involved.
In 2000 the second complaint ever was brought against chiropractor Jesper Jensen by GCC Chief Executive Margaret Coats. Their expert was current GCC education committee man and head of the Welsh Institute of chiropractic David Byfield so bad was his report that they binned it on the day of the hearing. Byfield altered the evidence against the chiropractor 37 times so he could have the argument “subluxations cause all disease” which of course is crap.
All a subluxation does is compromise spinal joint function. However in doing it affects mechano receptors in the joint which is the basis for “Vertebral Subluxation theory as recognised by the WHO.
No question the chiropractic profession is in a mess because of very poor leadership. The fact chiropractors have difficulty in articulating what they do without out offending the ASA is pretty pathetic as the debate has been going on for ten years and I more than anyone has been recognised as a promoter of Subluxation theory and have only been in trouble with our authorities for criticising colleagues for talking rubbish. The GCC does not allow you to criticise medipractors.
The subluxation is recognised by the World Health organisation as a name for spinal joint dysfunction and the GCC is a very small player in the world of chiropractic and its influence is diminishing by the day another mass complaint may finish it off. While the chiropractic Stazi police may ban the subluxation and discussion of the theory behind it, it will continue to be used internationally.
You would not go to the “gate keeper” of the British Library to learn about the Magana Carta, he might just tell you it does not exist anymore?
Blue Wode
May 16, 2010
@ Richard Lanigan
The chiropractic trade is in a mess because it’s based on a fictitious lesion:
Quote
“Unsupported by science, chiropractors must either fall back on Palmer’s pantheistic views or admit that the “subluxation” theory is erroneous. Without this theory, chiropractors are reduced to spinal manipulators whose primary treatment modality is shared by osteopaths, physiatrists, sports trainers, physical therapists, and others. Without subluxation theory, chiropractic’s claim that it is a unique and comprehensive “alternative” to standard medicine is lost. D.D. Palmer had only modest success in promoting chiropractic. It was his son, B.J. Palmer, an eccentric promoter and Iowa radio industry pioneer, who developed chiropractic into a successful business enterprise.”
http://www.ncahf.org/articles/c-d/chiro.html
Also, let’s not forget that the World Health Organisation (WHO) Consultation on Chiropractic, from which the 2005 guidelines contained in the following link evolved, consisted of 27 participants, 18 of whom appeared to be professionally involved with either chiropractic or Complementary and Alternative Medicine (CAM). http://www.chiroeco.com/50/bonus/WHOguidelines.pdf
It’s worth noting that serving on the panel that developed the WHO’s guidelines on chiropractic were Margaret Coats, Chief Executive & Registrar of the General Chiropractic Council, Michael Fox, former Chief Executive of the (now defunct) Princeʹs Foundation for Integrated Health, and Anthony Metcalfe, former president of botht the British Chiropractic Association and the World Federation of Chiropractic. (pp. 35-36 in the above link)
Richard Lanigan
May 16, 2010
Hi Blue Wode its been a while.
For your information former BCA president Tony Metcalfe and Margaret Coats are against the use of the term subluxation so its fair to say they lost the argument and the WHO decided to include the term anyway. It is laughable for you to suggest that they argued for it and it makes it difficult for me to take your points seriously.
Secondly if you wish to insist that there is no such thing as “Spinal Joint Dysfunction” thats fair enough however as you have posted the Rome article to make fun of the profession you know there are 324 different names for the spinal lesion that chiropractors adjust so its hardly “fictious”. Your own posting which I have linked to on chiropracticlive would suggest that there is agreement that the lesion does exist but there is much disagreement as to what the lesion should be called. I have suggested calling it a Singh or a Zeno if you prefer one of those names.
Perhaps we should call a sprained ankle something else, some call it a swollen ankle, and inflamed ankle, tarsal ligament strain etc etc.
Blue Wode
May 16, 2010
@ Richard Lanigan
In 2004, Margaret Coats, CEO of the GCC, claimed that there was “scientific evidence” for the *many* interpretations of the word ‘subluxation’. See point 4 here:
http://www.chirovictims.org.uk/images/GCC%20letter%20Page%202%2017%20June%202004.pdf
Do you know what happened to that scientific evidence when the chiropractic subluxation was discussed at the 12th May 2010 meeting?
For those interested, the above link is lifted from the June 2004 correspondence which the group, Action for Victims of Chiropractic, conducted with the GCC. See here:
http://www.chirovictims.org.uk/victims/news.html
Richard Lanigan
May 16, 2010
I was expelled from the council for calling Margaret Coats a liar. On legal advice I withdrew the remark because if someone tells you something that is not correct it does not automatically follow they are liars. However if she said it was night time I would not take her word for it.
Look what Coats said “There is confusion over the term subluxatio because it has different meanings to different people” this ties in with what I have just said. Chiropractors have over three hundred names for the leision. She then goes on to say “There is scientific evidence for many of the interpretations of this word, especially those that point to the spine as a source of pain and disability” Metcalfe and Coats see chiropractic as a mechanical treatment for low back pain period and that is what she is referring too.
I see back pain as a product of lifestyle, not a disease and not something you “treat”, however you can improve spinal joint fucnction (subluxation) getting the joint moving stimulates mechano receptors which will inhibit the transmission of nociceptive impulses, (Melzack and wall pain gate theory) and help get people active again which will help with back pain.
By 2007 Coats was aware that (Gattermans) evidence for subluxation theory had been presented to the WHO and under pressure from me and another Chiropractor Graham Wight they put it on the GCC website FAQs. Now the GCC has been medicalised they have a physiotherapist chairing the education committee mostly sceptics on the committee and feel confident enough with the skeptic threat to completely medicalise chiropractic as the did with osteopaths in the states. The GCC will use the term “fixation”rather than a singh and deny the existence of a subluxation. I guess you can choose any GCC version that suits any argument you want to make. You will notice I dont quote from the Sun or the GCC because I find them both unreliable sources.
Simon Perry
May 16, 2010
Brilliant work Al, well done.
Andrew Gilbey
May 16, 2010
@ Richard Lanigan
Are you by any chance Richard Lanigan DC of PArk Chiropractic in Kingston on Thames?
If so, and even if not, do you think that this statement, “Babies and children can benefit from chiropractic, osteopathy and spinal health care as conditions like colic, ear infection, asthma can be caused by spinal nerve irritation” suggests that chiropractic may be beneficial for infant colic?
I ask, becuase it came dirct from the Park Clinic’s website http://www.parkclinic.info/index.htm Correct me if I’m wrong, but I believe there has recently been a little publicity around this particular claim.
Richard Lanigan
May 16, 2010
Hi Andrew that’s me, its no secret who I am.
I have noted all the publicity, have met Simon Singh a few times and supported his campaign for free speech. I have 4 children and have provided spinal care for many over the years. My children have never had so much as a spoon full of Calpol, no days off school for my young ones now I am not going to put it all down to chiropractic but it is part of their healthy lifestyle and they are unusually healthy according to a paediatrician friend of mine.
No doubt there is a lack of convincing evidence in the areas you refer to however that is not the same as saying there is no emperical evidence to support the use of spinal care on children. Hence the use of the words “may be beneficial” rather than “treats colic”. Now if you are saying “nerve irritation” has no role to play in asthma, colic, etc I am happy to discuss it with you. I recently wrote this posting in the eye of the storm “Why children with colic should have spinal care”. http://www.chiropracticlive.com/?p=50 after all the publicity you would think it would be easy to pull apart such a statement, I look forward to your analysis.
Andrew Gilbey
May 17, 2010
Greetings, Richard. Great to your family enjoy good health! Good job too, as there’s nothing worse than a car repair man who owns a car that’s clearly knackered. I guess the same goes for your trade too!
To be quite honest, the words ‘may be beneficial’ or ‘treats’ are probably interpreted as being interchangeable by lay people. Suggesting they would be interpeted differently sounds like the kind of obfuscation used in legal argument (no offence meant Jack of K) – fine in principle, but all just words in practice!
I’ll check out that link later.
Dudeistan
May 17, 2010
Didn’t the McTimoney College in Abingdon close down a few years ago?
Richard Lanigan
May 17, 2010
The point is, there is not a lot on offer for these chilhood conditions. If your child has colic, a spinal adjustment “may” be worth a try based on the “evidence”. Thats the view the Danish (and possibly the Norwegian and Sweedish government) took and they fund chiropractic care for colic. Having lived in Copenhagen for 12 years most would say its a very progressive country.
The leadership of the BCA and GCC are “clearly knackered”, as for the “trade” itself? The principle of chiropractic that there is a relationship between the function of spinal joints, nerves and wellbeing, has not been changed by all of this. The theory behind “spinal joint dysfunction” (subluxation) stands up well to scrutiny, the American style marketing methods do not. My hope is that in the long term it will make the profession stronger. My fear is it will medicalise the profession as happened with osteopaths in the us.
Dudeistan
May 17, 2010
Spinal joint dysfunction is not a diagnosis. It simply suggests that one or more components within the triad of disc and its pair of zygapophysial joints is causing stiffness and/or pain.
Spinal joint dysfunction may sometimes feature a subluxed zygapophysial joint, but imaging cannot confirm this and clinical tests for such a lesion lack considerable sensitivity and specificity.
Treatment is therefore empirical. Manipulation may help restore function in a patient with spinal joint dysfunction, but it cannot be confirmed whether a subluxed zygapophysial joint has actually occurred and has been ‘put back into place’.
DD Palmer’s definition of the term subluxation is significantly different from the WHO definition. Enlightened chiropractors who reject DD Palmer’s concept of subluxation should be wary of implying that spinal joint dysfunction is largely due to the WHO definition of subluxation.
To do so would be as absurd as physiotherapists claiming that extension exercises can squeeze extruded material from a herniated disc back into place.
Richard Lanigan
May 17, 2010
Hi Dudeistan,
There was a move to have it closed down in 2006. The College is validated by the chiropractic regualtor the GCC, however the college is not recognised by the people who set international standards of chiropracic education. This has polarised the profession in the UK and resulted in far too much politics in the regulation of chiropractic.
Skeptic Barista, enjoyed the disussion and appreciate there was no name calling or book burning. You have made a good case against the “GCCs subluxation” and the way many chiropractors articulate “vertebral subluxation” theory.
I apologise if you thought I had made an assumption about you because of your work. I painted flats for the GLC in the late 70s. My dad was a bricklayer my mother left school at 14, I saw her put many politicians in their place over the years. I hate people who think a few letters behind their name makes them wise.
skepticbarista
May 17, 2010
Richard,
My response on your blog was in reply to fedup’s comments, I take no offence what-so-ever at any comment made by yourself, nor do I actually take offence at fedups comments, he’s used that argument before and it still makes me laugh.
Actually I find “The Tea Boy who dunked the GCCs subluxation” tag quite amusing, I may steal it and add it to my ‘About’ page (where coffee making is a minor part) or even the header of my blog!
Dudeistan
May 17, 2010
Quote by Richard Lanigan: “I apologise if you thought I had made an assumption about you because of your work. I painted flats for the GLC in the late 70s. My dad was a bricklayer my mother left school at 14, I saw her put many politicians in their place over the years. I hate people who think a few letters behind their name makes them wise.”
You’ve lost me on this one. Are you sure you are addressing the right person in your last paragraph?
BTW, I was a part-time lecturer at the college in Abingdon in the late 1990s.
Richard Lanigan
May 17, 2010
Hi Dudeistan,
The last part was for Skeptic Barista.
Spinal joint dysfunction or subluxation is not meant to be a “diagnosis”. Diagnosis is what medical trained people do, ie grade 2 sprain strain hardly an exact science either.
Vertebral Subluxation Complex (syndrome)is a clinical presentation of motion dysfunction in a vertebral joint that may affect other soft tissues. The whole concept of joint out of place and putting it “back into place’ is dated. A joint has a range of movement that can range between too much (Partial dislocation) and a fused joint. Loss of movement effects mechano receptors in the joint.
A joint could loose its range of motion even though the articulating surfaces of the joint were still in the correct position, a subluxation would therefore be present even though anatomically the joint was in the correct position, but failing to stimulate the joint receptors.
“DD Palmer’s definition of the term subluxation is significantly different from the WHO definition”. Of course it is we have imaging and a better understandin of how neves work. He had a bone out of place theory pressing on a nerve which MRI shows clearly does not happen unless there is pathology present. 20 years ago doctors thought discks slipped out of place we now know that is not true either. It was not just DD who got things wrong
DD Palmer is a historical figure who founded chiropractic in 1895, however his hypothesis that there is a relationship between structure of the spine and function of the nervous system is still relevant if not the way he understood it at the time.
Dudeistan
May 17, 2010
I undertand the bit about mechanoreceptors, but a subluxation either exists or it doesn’t (or did exist and no longer does due to natural healing).
Proving the existence or former existence of a subluxed zygapophysial joint is akin to proving that Francis Bacon wrote most of Shakespeare’s plays.
We simply don’t know. This is a concept that physiotherapists, chiropractors and osteopaths don’t seem to get.
P.S. I am a physiotherapist.
Richard Lanigan
May 17, 2010
The mechanical component of the Vertebral Subluxation Complex” is the loss of range of movement of the zygapophysial joint. Adjusting the joint would restore movement and begin the process of correcting the subluxation and improving nerve function. The medical model tend to focus on subluxation dysfunction in the excessive range of movement and ignore loss of movement
If there is a loss of movement in a joint a physiotherapist should know its not “natural healing” that happens, the joint will begin to degenerate after a period of loss of motion . Thats how I got into chiropractic, ACL rupture 1982 knee was immobilised for 12 weeks and the joint began to degenerate, I never played at the same level again. Now they realise maintaining joint movement is the key and why the prognosis for ACL injuries is so much better.The penny may not have dropped yet in relation to spinal joints.
How does a physiotherapist rehabilitate a sprained ankle, leave it stay stiff or try to restore the range of motion to the joints. If you leave the stiffness in the joint, it will degenerate thats what brought Marco Van Bastians career to a premature end when surgery could not resolve the problem brought on by poor management after an injury.
You can palpate the spinal joint and do other tests to assess for subluxation dysfunction, before the the adjustment and again after to measure changes in the jointand asses if the adjustment corrected the subluxation. I dont understand your analogy about Bacon and Shakespeare and know little about English literature. If you are saying loss of movement in a spinal joint does not matter and will always heal naturally thats not what the WHO concluded from the evidence presented to them from Gatermans work.
Dudeistan
May 17, 2010
How come moat patients with Vertebral Subluxation Complex get better without physiotherapy or chiropractic?
Richard Lanigan
May 17, 2010
I guess that depends what you mean by “better”. The WHO definition of health is much more than absense of symptoms.
I have not mentioned symptoms or conditions only vertebral subluxations and loss of joint movement. You are assuming therfore if you leave a stiff joint alone it will get “better” without physiotherapy or chiropractic. My knee which has never again had full extension is testament to the fact that is simply not true. Read the Gaterman book on animal studies where the fused joints just for a few weeks they had begun to degenerate.
Dudeistan
May 18, 2010
Sorry Richard, but most people with LBP get better naturally. It is a self-limiting condition. I accept that some have recurrent episodes or chronic back pain but we simply don’t know whether this is due to Vertebral Subluxation Complex.
Richard Lanigan
May 18, 2010
I agree with your first point and mentioned it in comment No 16. The point you raise is what divides the chiropractic profession. On the one hand you have someone like me who says that spinal joint dysfunction (vertebral subluxation complex) affects how nerves work and maintaining the spine is part of a healthy lifestyle.
At the other side of the divide you have the Medipractors, BCA guys who see themselves doing a similar job to physiotherapists, but at a much higher level in the health service. They are the experts on spinal manipulation, orthopaedics and they can take and read X rays. In 1990 they put their one egg (the Meade study) into one basket, statutory self regulation and began the process of medicalising chiropractic and laying claim to their territory- “Back Pain”.
What they have never understood is there are probably more physiotherapists doing spinal manipulation in the UK than chiropractors but as it only makes up a small part of your profession its not that important to physiotherapists. I am happy to work with physiotherapists because they way I work is different to you.
Medipractors are looking to put you out of business ie NICe guidlines etc.
Most people come into my clinic because they have heard “Chiropractic cures back pain” I tell every single patient, there is no cure for back pain because it is caused by things they do every day, especially sitting. If they are in pain I give them ergonomic advice and explain how effective Ice is in reducing pain and inflammation. If their lifestyle has caused their sacra iliac or spinal joints to stiffen up it may help to get them moving again so I would do my assessment adjust the “subluxations” send the person home with this advice. No sitting (rest in recumbent position) stay active and ice the pain full joints for 20 minutes every hour.
They will come back in a few days and I will do the same and they should be back doing normal activities in about a week. Visiting me is like going to a gym to exercise those small spinal joints that may not move during normal exercise. I also lead swiss ball, core stability classes in Esporta every week, which I believe is the key for preventing back pain returning. Probably nothing unique in all of this, physiotherapists, osteopaths, etc all may do something similar.
This is the part thats different and related to the (Vertebral Subluxation Complex). If during the history the patient mentioned they had asthma. When I did my report of the exam findings I might talk about the Autonomic Nervous System and how their kyphosis for example had created tension in their upper thoracic area and may have synthesised nerves, lowering the threshold for action potentials to fire thus predisposing the individual to asthma attacks.
I would ask them to monitor their inhaler use during their spinal care to see if there were any changes and very very often there are changes sometimes quiet extraordinary. The point I am trying to make here I was not treating someones back pain or their asthma, I was giving their spinal joints a little workout, because if left with reduced range of motion they will deteriorate and not necessarily produce symptoms until a diagnosis of arthritis is being made 30 years later.
I dont have signs on the window saying I treat asthma or back pain however when you help someone with asthma, they tell friends, who look at the website and you might get a number of people coming in just with asthma. You help some others, spinal care makes no difference. At the outset I always explain what I have just written and this is why spinal care “may” help, a whole range of apparently unrelated conditions.
The medipractors want to focus on back pain because they have a few studies and therfore it must be true and back pain is theirs to keep. So when Simon Singh wrote his article and directed it at BCA medicpractors rather than the likes of me they were furious and sued him. It was a bit like calling a homophobe, gay.
Dudesitan
May 18, 2010
Quote from Richard Lanigan: “At the other side of the divide you have the Medipractors, BCA guys who see themselves doing a similar job to physiotherapists, but at a much higher level in the health service.”
Two responses to this statement.
Firstly, 60% of physiotherapists do not work in the musculo-skeletal field. They work in areas of cardio-pulmonary medicine (including intensive care), paediatrics, neurology (stroke rehab, management of Parkinson’s, MND and MS), rheumatology and care of the elderly. That’s not to mention those in occupational health and in sports medicine. I would estimate only a small percentage of those physiotherapists in musculo-skeletal medicine perform high velocity manipulations (whether this is a good thing or not).
Secondly, I spend 50% of my week running an orthopaedic spine assessment clinic. My remit includes referring patients for advance imaging (MRI, CT, isotope bone scanning), surgery, epidurals, discography and facet/nerve root blocks. One of my colleagues (also a physiotherapist) carries out many of these nerve/root blacks herself. Admittedly, not all physiotherapists do this kind of advanced work, but a substantial minority do.
My point is – and clearly we sing from the same hymn sheet here – is that chiropractic and physiotherapy overlap only in a relatively small area. So comparing the two is akin to comparing apples with pears.
For the record, I personally believe Vertebral Subluxation Complex is a logical working hypothesis (to the extent that I also believe it may responsible for the majority of acute back pain episodes we see). But that’s just it – a hypothesis. Just as any potential benefits of chiropractic treatment for asthma is a hypothesis.
Just as it is very difficult to test the Vertebral Subluxation Complex hypothesis, I would argue that it difficult to test the hypothesis that chiropractic can help patients with asthma.
It’s all down to basic principles of testing hypotheses. To make claims of clinical efficacy without testing these hypotheses makes one open to criticism (such as from the likes of Simon Singh).
Richard Lanigan
May 18, 2010
I agree again, thats why I mentioned physiotherapists who do manipulation (just a small part of your profession). The chiropractors biggest proplem is not the “hypothesis” its chiropractors themselves who want to remove themselves from CAM and be “real doctors”, often refered to as quacks (people who do medical practise without the training or the expertise).
It was interesting talking to you and hopefully we are all a bit wiser.
Dudesitan
May 18, 2010
http://www.spinebase.com – drop me a line Richard.
Dudesitan
May 18, 2010
Oh crap the email link is missing: spinebase@yahoo.co.uk
BadlyShavedMonkey
May 20, 2010
More good work on analysing the claims of chiropractic.
Which leads, very naturally, to the most important question that the GCC should be required to answer definitively and unambiguously;
What is chiropractic?
It must be pretty hard to statutorily regulate a therapy that vanishes like mist as soon as its central tenet is examined critically.
Zeno
May 26, 2010
Well. Exactly!
skepticbarista
May 24, 2010
A quick update:
This was posted out on Twitter by Blue_Wode earlier today:
I couldn’t help but smile as I read it
P.S. If you’re on Twitter you should follow Blue_Wode !
JJM
May 24, 2010
To me, the nonchalant treatment by the GCC means that they will go about quackery as usual. Sure, they have acknowledged the chiropractic subluxation is not scientifically supported; but they claim it never mattered to their practice, and that it remains as a notion (they used the lay version of “theory”, meaning “notion” or “hunch” in their press release).
They also call on their people to talk about evidence-based treatments; but that is a very low standard. They can point to a 10-year-old study (too lazy to look it up) that showed most of a hundred babies recovered from colic after manipulation as “evidence.” The fact that they would likely have recovered without treatment is lost.
fedup
June 11, 2010
Just copying a post I’ve put on chirolive.
I was thinking how could you prove the subluxation existed and I think I know how.
“Conclusions
Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.”
The Brontford report looked at quality RCt’s, the kind the skeptics hold so dear, so the evidence to show chiropractic and osteopathy works is credible.
All we have to do is find the chiros and osteos who took part in these studies and ask them WHAT they corrected or manipulated. If every chiro in all the RCT’s used in the Brontford report state he/she manipulated a subluxation at…….. and all osteos say they manipulated a lesion at ….. then subluxation and lesion have been proved. If a RCT’s of good standard shows evidence that manipulating a subluxation or osteopathic lesion improves low back pain compared to placebo or sham then lo and behold we have evidence it exists.
Would like your thoughts SkepticB.
skepticbarista
June 11, 2010
You are clearly hoping/expecting that the chiros will come back and say that they corrected a ‘subluxation’ and that this will prove the theory that they cause health issues. It’s an interesting idea and I’d like to see the results, although I have to say that there are a number of potential problems with your proposal.
There are two key areas (there are more) that would been to be addressed before there was any value in it at all.
First, and perhaps the most important issue to resolve would be to clearly define exactly what a subluxation is.
It would have to be a definition that is agreed by every chiro, not just those who participated in the trials. It would be pointless doing any survey and reporting the results, if half the chiro profession then argued against it – but hey, that’s chiropractic for ya!
This is probably means your plan would fail before it even started. It is abundantly clear that chiros can’t agree on what a subluxation is, it’s no good 10 different chiros saying they corrected ‘a subluxation’ if they all subscribe to differing views on what the subluxation is.
The same requirement for a universally agreed definition would also need to be applied to the other therapies (osteopathy, massage etc) covered in the report.
If you think you can overcome this problem, please feel free to post a clear definition for the ‘chiropractic vertebral subluxation complex’ – if you can get the whole of the chiro profession to agree to it, including the GCC & the chiropractic associations then I for one will be quite impressed.
Next, your plan has the potential to be heavily biased.
From the conclusions, you have only listed those conditions where a manual therapy was condidered to be effective, you have already ignored the much longer list of conditions where the report says there was no evidence to show any beneficial effect.
One would have to assume that these chiros would also claim to have been correcting a subluxation, often with negative (or at best inconclusive) results. If you simply cherry pick the positive results (from a chiro point of view) and then ask questions, you are very likely to find the answer you are looking for.
There is also a very important statement in the “Limitations of the Report Conclusions” from the report:
(emphasis added).
If you managed to over come even these two problems and conduct your survey, you would need to be willing to accept the results! Have you considered the impact of perhaps finding out that these chiros were not actually correcting a subluxation, but performing some other form of manipulation or massage to benefit the conditon, what if the results of your survey show Osteopathy to be the most effective form of treatment!
Of course if you are looking for research into subluxations you could try looking here: http://www.chiroandosteo.com/content/17/1/13
It’s where I started when your comments prompted me to look for evidence …. that prompted me to contact the GCC …. that prompted – well you know the rest!
fed up
June 13, 2010
I’m not hoping or expecting, as I’ve said many times in the past I don’t use the term subluxation. But chiros and osteos correct “something” with an adjustment/manipulation. Agreed? If the something they found and then adjusted, which was shown to be positive in a RCT, was given a name then whatever that “thing” is has to be there. Agreed?
.
“BUT I could show you what a chiropractor means when he talks about subluxations, or when a osteopath talks of a lesion, “The osteopathic lesion is not ‘a bone out of place’ but any obstruction to physiological processes or irritation” or when a physio talks of malalignment syndrome “The Malalignment Syndrome describes a newly recognised syndrome that commonly occurs in patients seen by physicians, chiropractors, physiotherapists, massage therapists and veterinarians.” by “Wolf Schamberger, Clinical Associate Professor, Department of Medicine, Division of Physical Medicine and Rehabilitation and The Allan McGavin Sports Medicine Center, University of British Columbia, Vancouver, Canada”
They all mean the same thing.
“In this book the author presents the evidence for looking at the group of symptoms involved and treating them as a single syndrome with a single cause – biomechanical malignment.”
So, there is evidence to show that manipulation works, so as far as I can see watever the practitioner calls what he’s manipulating it has to be real. Agreed?
We could all call it a Higgsluxation.