Clearly there is much disagreement on the subject of the ‘Subluxation’.
We should expect skeptics and chiropractors to disagree and I doubt one will change their views simply on the say so of the other. But the disagreement on what a subluxation is reaches further than this. It is difficult, if not impossible to find a unified, mutually agreed definition of a ‘chiropractic subluxation’, even amongst chiropractors.
What we often see on chiropractic websites, blogs and blog comments are chiropractors stating that the 
World Health Organisation (WHO) accept subluxations.
Recent comments on this blog are typical:
“The WHO accepts subluxation and the theory it is based on …”
But similar comments can be found almost anywhere chiropractors attempt to justify the claims surrounding their version of the subluxation.
Before simply accepting statements like the one above, we really should take a look at what the WHO say about chiropractic manipulations and chiropractic subluxations.
Afterall that comment only says that the WHO accepts the theory … not actually any proven facts!
Perhaps the best place to look is a WHO document entitled “WHO guidelines on basic training and safety in chiropractic”(pdf).
This document lists a subluxation as:
“Subluxation
A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.”
This (or a version of it) would seem to be the one regularly quoted when chiropractors mention the WHO, but what is often overlooked (perhaps conveniently) is the footnote attached to this definition.
“Footnote
This definition is different from the current medical definition, in which subluxation is a significant structural displacement, and therefore visible on static imaging studies”
This clearly says that the chiropractic subluxation differs from the medical subluxation. The medical one being a significant displacement that is visible on imaging equipment (X-rays etc).
From this I can only assume that the chiropractic subluxation is not a significant displacement (I avoided using the word insignificant) and furthermore it is a displacement that does not show itself on X-rays! There are numerous examples of chiropractors claiming that chiropractic subluxations cannot be detected on X-rays and only they can locate them. Admittedly there are chiropractors who say they can clearly see subluxations using X-ray – Perhaps they are actually seeing Medical Subluxations (as defined by the WHO). I suppose this is yet another area where chiropractors disagree with each other …. maybe we can get an answer posted here.
This puts a huge question mark over the whole issue of X-rays for chiropractic patients. If chiropractic subluxations are not visible on X-ray then there is no reason for patients to be given them! I have no doubt that most chiropractors are well trained and perform X-rays safely. But performing an action safely is not the same as that action being necessary!
The same WHO document covers the ‘Philosophy and basic theories of chiropractic’.
Section 1.2 gives us a description of chiropractic and says it has a ‘particular focus on subluxations’, yet there are many chiropractors who say they do not ‘focus’ on subluxations, that the subluxation is only a small part of what they do, it is just a name.
Although this section calls chiropractors ‘primary-contact health care practitioners’ it also says:
“A majority of practitioners within the profession would maintain that the philosophy of chiropractic includes, but is not limited to, concepts of holism, vitalism, naturalism,conservatism, critical rationalism, humanism and ethics (9).”
Do all chiropractors agree with this WHO statement ?
This certainly places chiropractic firmly in the realm of alt-med, right alongside the homeopaths and herbalists!
Do we take the WHO definition as ‘proof’. I don’t think so, the WHO don’t say anything has been proven, only that chiropractors believe it. They actually go as far as to say that consequences of the chiropractic subluxation are ‘hypothesized’
“It is hypothesized that significant neurophysiological consequences may occur as a result of mechanical spinal functional disturbances, described by chiropractors as subluxation and the vertebral subluxation complex (9, 10:169-170, 11).”
A hypothesis is something put forward to explain a set of events or conditions and whilst it may offer grounds for further investigation …… It is NOT in itself proof!
Chiropractors have had over 100 years to do their research and find the proof to substantiate their hypothesis – so far they cannot even find a common description that they all agree on, let alone find the proof to back it up.
The WHO don’t just limit their chiropractic subluxation comments to this document.
A 2003 WHO bulletin on Lower Back Pain (something very dear to chiropractors) mentions chiropractic and the reasons people turn to it: (Worth noting the bits I have highlighted in Bold)
“People with low back pain often turn to medical consultations and drug therapies, but they also use a variety of alternative approaches. Regardless of the treatment, most cases of acute back pain improve. At the time, people in such cases may credit the improvement to the interventions some of which clearly are more popular and even seemingly more effective than others (e.g. chiropractic and other manipulative treatments in which the laying on of hands and the person-to-person interaction during the treatment may account for some of the salutary results).”
And …..
“The spread of chiropractic and other manipulative treatments worldwide has won many adherents to this treatment , who perceive that it works better than others. This hypothesis was recently put to the test (25) and, although the respondents still favoured such approaches (chiropractic adjustment, osteopathic manipulation, and physical therapy) perhaps because of the time spent and the laying on of hands meta-analysis cannot confirm the superiority of manipulative treatments (or, for that matter, of acupuncture and massage (26)) over other forms of therapy, or even time as a healer (25), which substantiates the contentions of WHO’s document (1). In most instances, manipulative treatments are more expensive than others (apart from surgery) and not more helpful to outcome (26).
All of this hardly constitutes a glowing commendation from the WHO on chiropractic as an effective treatment option.
What they do say is that there is a difference between medical and chiropractic subluxation. They state that any claimed benefits of chiropractic are only an hypothesis (i.e. not proven). Even for back pain the WHO say it is nothing more than expensive ‘laying on of hands’. For more on what the WHO do suggest for Lower Back Pain, see here: What is the best way to treat back pain? (no mention of subluxations or chiropractic)
Whilst I fully expect chiropractors to disagree with my views, I would remind those reading this that these are the words of the World Health Organisation. It is you who keep quoting them!
What I would now ask chiropractors is:
1. Do chiropractors still accept the view of the WHO on chiropractic and (chiropractic) subluxations? If not will you stop quoting them!
2. Can chiropractic subluxations be seen on X-rays? The WHO would seem to state that it is medical subluxations, as significant structures, that are seen on X-rays. As chiropractors you should not be treating medical subluxations.
3. Should I accept the WHO’s view on chiropractic and your hypothetical subluxation?
4 Can you provide us with a definition of the subluxation that is not only accepted by all chiropractors (or at least the vast majority), but has also been proven to a point beyond simply being an hypothesis?
It should be remembered that it is not a ‘subluxation’ that is being questioned, but the ‘chiropractic subluxation’ and not simply that, but the cause/effects it has on health.
======== Edit: Added on 25 Oct 2010 =======
In case anybody reading this thinks that questioning the chiropractic subluxation is limited to skeptics.
Please read this excellent post from the US by Sam Homola, “a retired chiropractor who specialized in the care of musculoskeletal problems”.
http://www.sciencebasedmedicine.org/?p=6839&cpage=1
“In the eyes of the public, the chiropractic vertebral subluxation theory has confused the definition of the word “subluxation,” a common medical term. Unlike the mysterious, undetectable and asymptomatic chiropractic “vertebral subluxation complex” alleged to be a cause of disease, a real vertebral subluxation, that is, an orthopedic subluxation, can be a cause of mechanical and neuromusculoskeletal symptoms but has never been associated with organic disease.”
A N Other
November 13, 2010
@ Blue wode
Before being able to treat some thing you need to understand it. Please re-read my post of the excerpt of functional pathology. It does explain that simplified explainations of a complex problem is not apprptiate. Chiropractic has done that with the subluxation, as has osteopaths with the osteopathic lesion. Some chiropractors, osteopaths and physiotherapists are trying to improve the care of musculoskeletal problems. But as they have done this they have left behind the restrictive sterotypes you seem to hold. The best care for low back pain will consist of applying the right treatment for the right complaint. This could mean for some low back pain patients that manipulation is the best treatment for them. Conversely, specific exercises could be the best form of treatment for some low back pain patients.
So the step that is happening now in research is finding the sub-groups within low back pain (or any other musculoskeletal complaint)that has the best results from a paricular treatment.
I think that will lead to a merger of chiropractic, osteopathy and physiotherapy into a single discipline.
Blue Wode
November 13, 2010
A N Other wrote:
Interesting, but until the data are in with that we should be sticking to what the current science tells us.
Bruce
November 14, 2010
@ BW
You wouldn’t know data or science if it bit you in the derriere my friend. Your references and the list of evasive answers are evidence of that. Sadly your reputation, for what it is worth, precedes you.
Blue Wode
November 14, 2010
Once again, chiropractic after a thorough evaluation of all the scientific evidence for it:
The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is. (Churchill)
Bruce
November 14, 2010
What a shock ( yes I know mojo, I read the reference) Ernst again?
If this is the whole basis for your argument, one must hope you get other books for Christmas.
But you get a gold star for tenacity in the hope that someone other than skeptics will take the references seriously. Not sure they are. Dodging A N Others questions again eh? Coming back with quotes from Ernst, mmmmmm credibility?
A N Other
November 14, 2010
@ Blue Wode,
Contemporary research on the effictiveness of different treatments has assumed that “non-specific” low back pain is a homogenous group. Articles by LaBouef has urged researchers to view this group of non-specific low back pain as most likely heterogenous. She leads to the point that research, which assumes this large patient population is homogenous, would therefore fail to show statistical clinical effectiveness for specific treatments beneficial for a certain smaller sub-group within the non specific low back pain group. The result would be that a promsing treatment would be erroneously assumed to be ineffective.
So your denouncement of manipulation, whether it is done by a chiropractor, physiotherapist or osteopath maybe denying a section of the population of an effective treatment.
Also as i previously mentioned, a growing body of evidence show that is more cost-effective to prevent chronicity in those at risk rather than waiting to treat only those in whom it becomes fully apparent.
So your suggestion that we should do what “current science” tells us, would mean that we should continue with things as they are ie medication and keeping mobile and not do any manual therapy, whether that is done be a physio, chiro or osteo. However, current science is showing that there are ways of subclassifying the non-specific group e.g. Fritz, JM (2000).
Again, as i have said before, chiropractic, as well as osteopathy and parts of physiotherapy do simplify a complex problem and use treatments in a haphazard manner. They each have their own theories and histories, with some from each profession actually leading to developments and improvements in the care of musculoskeletal complaints. So there may be certain aspect of osteopathic theories, or chiropractic theories or physiotherapy theories that are correct. For example there are practitioners from each of the disciplines who treat the neck when someone has low back pain and successful resolve their complaint. Does that mean it should be done for everyone. NO. But as i have said before if you read the excerpt on functional pathology, you will get a better understanding of how things are developing within musculoskeltal medicine and the truth that you present may not be completely true
Blue Wode
November 14, 2010
But until that is confirmed by rigorous studies, is it right (ethical) to charge a fee to treat people *as if* the evidence already existed, especially when the risk/benefit profile of treatment is so unfavourable? That would be a win/win for chiropractors, but not for their patients.
Bruce
November 14, 2010
On a side issue, appreciating and accepting evidence for treatment is a sensible way forward, it dies have it’s downside.
Skeptics are that very downside, and from both sides of the fence. You are skeptical of my stance and I and many others like me, of yours.
Skepticism and arrogance from the medical community held back the introduction of antibiotic therapy for ulcers. The researchers were ignored and not for simple weak literature reviews where one quotes their own papers, but for good solid research.
On the other hand, good research and once again primary research and a lot if it would suggest that testimony the foot in ‘neutral’ benefited gait and resolved problems further up the kinematic chain. This has been the stance of the Odysseus world-wide f
Bruce
November 14, 2010
Sorry for the incomplete post above, suffering from monkey boy syndrome this morning!
Bruce says:
November 14, 2010 at 11:17 am
On a side issue, appreciating and accepting evidence for treatment is a sensible way forward, it does have it’s downside.
Skeptics are that very downside, and from both sides of the fence. You are skeptical of my stance and I and many others like me, of yours.
Skepticism and arrogance from the medical community held back the introduction of antibiotic therapy for ulcers. The researchers were ignored and not for simple weak literature reviews where one quotes their own papers, but for good solid research.
On the other hand, good research and once again a lot of primary research, would suggest that keeping the foot in ‘neutral’ benefited gait and resolved problems further up the kinematic chain. This has been the stance of the podiatric profession world-wide for years.
Current podiatry research is challenging that it would seem. There are now biomechanics scientist suggesting that forefoot neutral is irrelevant to the situation.
Evidence is not always right, and of course neither is skepticism, that’s why if the Nightingale Collaboration does what it has suggested it will do for all professions, it may just be what the health care community needs. If it is bigoted and biased it will go the same way as some ‘eminent scientists’ out there in the credibility stakes. One standard of evidence and investigation across the board please then we will all be satisfied.
A N Other
November 14, 2010
@ Blue Wode,
So with the highlighted flaws in research i have shown, you would be happy to let peolpe suffer with their low back pain. Is that ethical?
Again the words highlighted by yourself confirm the point that no form evidence should be viewed as 100% certain, which is something you seem to do e.g low back pain is a self limiting complaint (when there is evidence to the contrary).
Blue Wode
November 14, 2010
Where chiropractic is concerned, due to its unfavourable risk/benefit profile, yes. Better to learn coping strategies, IMO.
A N Other
November 14, 2010
@ Blue Wode,
What sort of treatment do chiropractors do?
Also opinion is not evidence. But there is evidence for using coping stratergies in low back pain.
Bruce
November 14, 2010
Infavourable risk/ benefit profile, what nonsense. Yes I know, Ernst told you it was true.
Same old, same old
Marcus
November 14, 2010
Just like the NHS suggests not to self diagnosed based on information in their website, I think it’s prudent not to rely on anything here re: effectiveness of cam and chiro. Comments on a blog post would make the real scientists laugh.
Andrew Gilbey
November 14, 2010
The only bad science I see on this blog comes from chiropracty sympathisers.
Bruce
November 14, 2010
@AG
Wow that’s a shock!
Bruce
November 14, 2010
@AG
You are well known as a fair minded individual who looks at things rationally, oops sorry no you are not, got that wrong, you are a fully paid up member of BIGOTS, antipidean branch I believe so the standards you set for chiropractic you fail or are unwilling to use on, say Ernst, but I believe others have, that’s right isn’t it;-)
skepticbarista
November 15, 2010
Finally got back online after a hard drive failure.
Can I ask again how many chiropractors (or supporters) agree with the WHO view of chiropractic and Lower Back Pain …. That is the FULL WHO view, not simply cherry pick certain parts. Some have already commented in part – but only on the definition (that they like to quote) rather than the fuller meaning.
How about you Bruce? Fully agree with the WHO view, reject the WHO view, or revert to cherry picking the bits you like.
If you need a reminder then read the text in the main post and check the referenced docuements.
But an overview is that the WHO think that chiropractic is an expensive, non-effective treatment, any problems associated with the VSC are an unproven chiropractic hypothesis and that “Regardless of the treatment, most cases of acute back pain improve” and that it does not warrant the use of X-rays
For those chiros who (in an attempt to gain some credibility) often quote the WHO, can you find a WHO document that gives clear, positive support for chiropractic?
Bruce
November 15, 2010
As, unlike you guys, I don’t have a team of people behind them feeding me BS to throw, I will try and look at the documentation as a whole, without bias and as a member of the public. What I will try and do is be honest and objective.
Having read the documentation, I am not convinced when the documentation is taken as a whole, without cherry picking as you suggest, that WHO is derisory regarding the chiropractic profession. My perception of their stance is that they offer suggestions for improvement as well as offering positives in the current state of play, but this is no different, if my understanding is correct, from many other papers produced by WHO.
The chiropractic profession itself in the UK and internationally, irrelevant of the use of the ‘word’ subluxation seems to be split into two major camps, the mixers ( who treat musculoskeletal complaints, using and adhering to medical diagnosis of the same) and the straights ( who are traditional in their methods and observations).
I think asking around, that the split is represented in Britain by the education given on the one hand WIOC and AECC and on the other the MCC who I believe advertise/advertised that they are a school which teaches the traditional methods. This is not to say that chiropractors who practice in either of these camps, are graduates from the schools offering that style of teaching, but on the whole that seems to be the case. The traditional side is bolstered, it would seem, by American and Antipdean traditionalist.
With this in mind and accepting the lack of robust evidence and standardisation of procedures in both physiotherapy, medicine and in fact podiatry and dentistry, then I am certain and know that there will be many camps with many views.
An example would be BIMM which is seen by some surgeons I know as quackery or the dentists who use techniques for the TMJ/ headaches etc, not taught in regular ‘mainstream’ dentistry, as the same.
Without any form of healthcare standardisation, based on one standard of evidence, equally enforced across the board in a neutral, unbiased way, then, as we can see here, bias, agenda, vindictiveness, bigotry, bullying and opinion will retain a place in any debate. One could argue that they need to be taken out of the frame of reference eg a potential role for Nightingale.
Saying all that, it is difficult to change perception quickly through the medium of democratic process so unless old style fascism or communism is brought in, and even then all the above problems may still occur. One cannot legislate for beliefs pro or con, opinion or personal experience both pro and con.
My personal opinion, based on communication and experience is the attack, in itself, rather than the format and continued bigotry, by the skeptics may be good for the chiropractic profession, in fact any healthcare profession to include medicine, dentistry, podiatry and physiotherapy. It potentially stops complacency, it must improve research, it initiates and will lead to standardisation and it focuses coherent thought.
So to complete the circle, this is what I believe WHO are trying to do, not just with chiropractic but with all forms of health care.
BadlyShavedMonkey
November 18, 2010
@Bruce
“As, unlike you guys, I don’t have a team of people behind them feeding me BS to throw”
Well, if I have a team of lackeys they certainly never seem to turn up to give me any help. Are you sure you have your facts right?
fed up
November 18, 2010
wow, bw and sb have gone rather quiet.
skepticbarista
November 18, 2010
As the topic of this post was the WHO’s view of chiropractic, it seems appropriate to link to this article:
http://vertebralsubluxation.mccoypress.net/2010/11/17/interview-with-who-intern-aryn-gabai-dc.aspx?ref=rss
It provides a chiropractors ‘inside’ view of how the WHO see chiropractic. Whilst the WHO do seem to be specifically against chiro, they are a very long way from supporting it:
Quote:
“1. Do the staff at WHO understand vertebral subluxation?
The only D.C. on staff at WHO International Headquarters is Dr. Molly Meri Robinson, who believes that the concepts of joint dysfunction and manual manipulation are more accurate to describe what chiropractors care for. Anything beyond a strict science is considered taboo and religious in nature at WHO, and the nonphysical aspects of VSC are poorly understood.”
So it would seem that the mythical VSC should be catagorised under the ‘taboo and religious in nature’ section.
This is something that those chiros who repeatedly quote the WHO as of they are supportive of chiropractic should keep in mind!
………. Of course chiros may just put the WHO down as bigots!
fed up
November 21, 2010
lol blueode aka ee wife in her opiion is duckin and a diving an ethical question
Badly Shaved Monkey
November 22, 2010
Posting on forums while inebriated does not make people look good.
Jolo
December 8, 2010
ahh. now I see what subluxation means. thanks!
“The true genius shudders at incompleteness – and usually prefers silence to saying something which is not everything it should be.”
Edgar Allan Poe
Bruce
February 12, 2011
As this thread mentions chiropractic, I presume my post will nit be removed for being out of context.
It would seem that there is a guy called Richard Lanigan of ‘chiropracticlive’ blog, fame, who wishes to have an open debate with you SB and of course, Andy Lewis, simon perry and Zeno at one of your skeptics in the pub meetings. I understand it relates to ‘traditional chiropractic’, which I believe is the segment of the UK chiropractic profession who treat the ‘subluxation’, but you have so far declined?
That’s strange, I thought you guys enjoyed debate?
Me
February 12, 2011
Did you bother to check what was actually said, Bruce?
skepticbarista
February 12, 2011
Bruce,
I can’t speak for any of the others you mention in your comment and am not aware of all the conversations Richard may have had with other people on this subject.
Inviting somebody to speak at any of the skeptics in the pub events is nothing to do with me, Richard would need to talk directly to the people in charge of organising the speakers. I suspect that some people view the Skeptics in the Pub events having ‘cherry picked’ speakers who simply preach to the converted. This is not so, I know the CNHC gave a talk in Leicester and the GCC were also invited. The GCC declined until all the complaints have been dealt with ……… so we may be in for quite a long wait! Hopefully they will attend at some point in the future and chiropractors may find it an interesting talk to attend. The events are open to everyone, so any chiropractor who wanted to attend one, would be free to do so
I am aware of Richards views on chiropractic and on chiropractic regulation within the UK and am sure Richard has expressed those views on his blog, where they have been openly discussed. I am not aware that he wants to discuss anything new.
On the subject of ‘subluxations’: Richard has his views and he is perfectly entitled to them, but many chiropractors have differing views on what a subluxation is or what actually constitutes ‘traditional chiropractic’ – does that include ‘innate intelligence‘ – it was certainly a part of Palmers chiropractic. If chiropractors themselves can’t agree on these things then it is almost pointless debating the subject with one person (who for well documented reasons is not a practicing UK chiropractor).
Add to this the fact that the UK regulator still maintain that the subluxtion;
So any debate is something that has been openly disucssed on various blogs, something that chiropractors struggle to agree with between themselves and their regulator and something that is lacking in clinical research evidence!
I can’t help but feel that Richards time would be better spent establishing a common stance that all (or the vast majority of) chiropractors agree on and then discussing that with the GCC ……. a discussion that would be very interesting!
Bruce
February 12, 2011
Just passing on the info.
It seems you guys just love putting your opinions out there, just thought it would be interesting to see why you guys are really refusing a meet with those you criticise.
Maybe one of the ‘skeptic in the pub’ bashes, to coin a phrase, would be a good venue. You guys would be on your home ground so would retain the advantage. You could have Richard Lanigan with say, two of his chosen colleagues debating against you, Alan Henness and Simon Perry, on the other side. Both groups claiming an expertise on the subject. That surely is fairer than throwing stones from behind a wall, but of course would require commitment, a solid understanding of the subject matter and most definitely ‘cojones’. The question is, are those available?
Of course the debate would be between those who support and practice ’ traditional’ chiropractic rather than the musculoskeletal guys, but it would give you an opportunity to debate with those you continue to criticise in an open, fair and public forum. But then again maybe you really don’t want that.
For this, I would happily travel to attend. I may have been to a couple of ‘in the pub’ venues in the past but it’s usually full if nodding dogs but this would be a very interesting debate to view.
Anyway, I am sure it will never happen based on previous actions and comments although it may be a good exercise for both parties.
But then, if your critics are correct, that’s really not what you guys want.
Me
February 12, 2011
So you didn’t check, did you? Don’t you think it might be a good idea to go have a look? Evidence and all that.
Bruce
February 12, 2011
Skeptic Batista
I think your response was measured and fair and I appreciate your comments.
Thank you
Bruce
February 12, 2011
@ ME: Myalgic Encephalomyelitis I presume. Hope you get well soon.
According to a herbal medicine site they reckon: Echinacea and Ginko Biloba. Products containing GLA such as Evening Primrose Oil, Starflower Oil and Flax seed may help.
Can’t say for certain but hey it’s worth a shot lol