How Does Chiropractic Work
What’s the origin of chiropractic?
Spinal manipulation has been used for thousands of years around the world to try and fix health problems. The modern version was developed by Daniel D Palmer in the nineteenth century and called chiropractic from the Greek words for doing and hand (praktikos and cheiro).
Palmer’s first patient was his janitor who had been deaf for seventeen years following a neck injury. Palmer claimed to have ‘clicked’ a joint back into place and the man’s hearing returned. Palmer, however, was jailed for practising medicine without a licence but his son took up the cause and chiropractic began to become popular.
How does chiropractic work?
Chiropractors like many other complementary health practitioners look at the body as a whole when they treat you. A chiropractor considers the body to be like a living machine – if a joint is misaligned or damaged then the smooth running of the machine can be upset causing inflammation, pressure on nerves and subsequent medical problems.
Chiropractors believe stress, poor posture and accidents, including sports injuries and the like can all stop the body machine running smoothly. Almost any aspect of health might be affected by problems in the spine, they believe.
For instance, pressure on nerves connected to the intestines could be the root cause of some digestive disorders. Chiropractic manipulation of the spine at the point where these nerves emerge from the spinal cord through the vertebra could remedy such a disorder. There is scant evidence that chiropractic can deal with anything other than back problems, however.
What happens during a treatment?
Your first session with a chiropractor often involves an assessment of posture, mobility of joints, and usually lifestyle. There are various standard tests such as the Thomas test, which determines mobility in the hip joints, the Yeoman’s test which involves the practitioner flexing your legs one at a time to assess joints for sprain and mobility. The chiropractor might also ask you to bend, raise your legs, test your reflexes, take your blood pressure or even an X-ray to build up a more detailed picture of a problem.
As with osteopathy, chiropractors try to track down restricted or excessive joint movement, especially in the spine because they believe these problems are the cause of inflammation, swelling and pressure that leads to pain and illness.
A chiropractor might use some massage to loosen stiff muscles before focusing on the manipulation techniques. Manipulation usually involves a sharp, precise thrusting movement of a joint to ‘free it up’. There are several standard techniques aimed at making, what chiropractors refer to as, adjustments. However, a new school of thought among progressive chiropractors avoids the forceful thrusting manipulations and instead relies on more gentle and tempered movements and stretches.
For instance, the Toggle Drop involves a swift and precise pressure applied with the hands to specific verterbrae in the spine while you lie face down. The Bunyon adjustment involves the practitioner applying a stretch between vertebra – a traction – to adjust the spine. The various manipulations often causes clicking noises, which can be quite alarming to the patient and may cause a little pain or discomfort at the time but this quickly eases off and the procedure has been shown to be extremely safe. Clicking noises are not caused by bone against bone, they are simply the sound of gases “popping” as they are expelled from where they may be trapped in the membrane surrounding a joint.
Chiropractic will often provide an effective long-term management of a condition and fully relieve symptoms. Patients may return only for a once-yearly maintenance session or if they have twinges. Chiropractors similarly to osteopaths will help you get a better posture, suggest lifestyle changes that might help your overall health and teach you some easy exercises to do at home.
What problems can chiropractic help?
Chiropractors focus primarily on back problems, but there is a long list of other ailments, diseases and disorders that they offer to treat. Evidence for the more outlandish claims is not strong and commentators such as Edzard Ernst and Simon Singh have caused controversy and in Singh’s case ended up with a lawsuit against them because they described such claims as allegedly “bogus”.
Indeed, one chiropractic association has recommended that its members remove reference to any non-evidence based claims from their websites pending Singh’s appeal against the judgement meted out in favour of the British Chiropractic Association. Specifically, they suggest that members remove patient information leaflets that practitioners can treat whiplash, colic or other childhood problems, as there is a serious risk practitioners might be prosecuted.
Of course, many have been too tardy to respond to this call to defence and Alex MacLean (yaxu on twitter) has apparently been scraping and archiving all the chiro sites making allegedly spurious claims about their practice.
- Asthma
- Digestive problems
- Disc injuries
- Headache and migraine
- Joint, posture and muscle problems
- Menstrual pains
- Sciatica
- Spine and neck problems
- Sports injuries
- Tinnitus and vertigo
Where’s the evidence?
There have been various clinical trials of chiropractic several of which have been reported by the well-respected British Medical Journal, published by the British Medical Association. The research reports that showed that chiropractic worked better at treating acute back pain than standard treatments offered in a hospital out-patients. The Clinical Standards Advisory Group in the UK which helps the NHS decide on approaches to healthcare recommends chiropractic for back problems in its guidelines for GPs.
Recently, it has been recommended that chiropractic, osteopathy, and acupuncture should be prescribed on the NHS for some patients with back pain.
Millions of pounds are spent each year in the UK and elsewhere on clinical trials into the effectiveness of different back pain treatments, one of which is chiropractic.
What do conventional doctors think about chiropractic?
Chiropractic had a poor image among the medical profession for most of this century, in the 1960s the American Medical Association condemned it as an ‘unscientific cult’ although the AMA lost its legal battle in 1987 and now chiropractors work in hospitals and sports clinics.
In Britain, chiropractors made sure they built up research evidence and in 1994 The Chiropractors’ Act gave them official recognition which means that if you use a registered chiropractor you have the security of knowing they are a state-registered health professional.
You are almost as likely to be referred to a chiropractor as an osteopath by your GP, but usually only for musculo-skeletal problems. Many doctors still prefer to send patients to an osteopath instead. However, clinics and community health centres often have chiropractors on-site complementing the work of the doctors and nursing staff. One thing that more and more doctors agree on is that the old advice of long periods of lying flat and still or restrained in a medical corset are not the way to treat back problems.
What is a subluxation?
A medical subluxation is an incomplete or partial dislocation of a joint or organ. The World Health Organization (WHO) considers a subluxation to be a “significant structural displacement, and therefore visible on static imaging studies.” In the spine, such a displacement may be caused by a spondylolisthesis.
An orthopedic dislocation of any joint will usually need medical attention to help relocate or reduce the joint. Nursemaid’s elbow is the subluxation of the head of the radius from the annular ligament. Other joints that are prone to subluxations are the shoulders, fingers, kneecaps, and hips affected by hip dysplasia. A spinal subluxation is relatively rare, but can sometimes impinge on spinal nerve roots causing symptoms in the areas served by those roots.
Can chiropractors remedy subluxations?
Chiropractors talk of vertebral subluxations and have their own unique definition for this problem, they say it is relatively common and is apparent as a spinal vertebra having lost its proper juxtaposition, or alignment, with one or both of its neighbours. This apparently interferes with the nervous system. Conventional chiropractic attempts to remedy vertebral subluxations using manipulation techniques. However, even though research is ongoing mainstream medicine and even progressive chiropractors have rejected the subluxation hypothesis.
15 Responses to “How Does Chiropractic Work”
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September 26th, 2009 at 7:36 am
@Andrew Making fun of god? Which one? I don’t think I even mentioned god in the post…anyway, isn’t he/she/it up for a laugh, then? Heaven’s going to be an awfully boring place if we can’t take the piss out of each other when we get there. It is for eternity, after all…
Moreover, if you’d actually read the post, you’d have noticed that I, personally, have used chiropractic successfully for a back problem, so I don’t think I was even dissing the practice in the first place, so not sure what your comment is about on any count. Oh, by the way, this post was given the once over by a chiropractic for technical accuracy at the time of writing.
September 25th, 2009 at 6:16 pm
First of all I resent your making fun of God. Further more there is plenty of x-ray and MRI evidence that spinal misalignments have been corrected by the combination of chiropractic adjusments and targeted exercise.
June 25th, 2009 at 6:06 pm
An important point to make is that the majority of modern chiropractors do not make spurious claims, they cite case studies where they have observed pain relief or relief from various conditions after they have assessed and treated a patient. There is no way to carry out a full-scale clinical trial on a practice that tailors its approach to the individual patient presenting unique symptoms…
June 19th, 2009 at 7:23 am
@Maria I don’t think a belief in a monotheistic religion has anything to do with purported placebo effects. Moreover, I’m certainly not one to sing the praises of alternative medicine, as regular readers may have noticed. I have personally experienced positive results with chiropractic treatment for a serious back problem where conventional approaches totally failed but I only undertook it as a last resort after two years of serious pain and a chronic game of GP-specialist ping-pong. Now, I know I’m setting myself up to be hoist by my own petard by reporting a single anecdotal case, but even Edzard, Singh, and others admit that for back problems there is clinical evidence that chiropractic works. As to whether it’s any good for asthma, glue ear, childhood colic, whiplash injuries, that’s a different matter altogether.
June 18th, 2009 at 9:10 pm
Chiropractic works like praying; if you believe there is an old guy with blue eyes and a long beard up there in the sky, listening to you and providing you with solutions for your problems, it will work for sure. But if you know that the spine cannot be repositioned by hands because of all the other systems like the muscular system supporting it, it will not work.