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.
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:
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.
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).”
“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”.
“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.”