Chiropractic was developed in the late 19th century by a Canadian doctor (and magnetic healer), called Daniel David Palmer (1845-1913).
Early chiropractic philosophy is based upon relatively abstract notions of holistic medicine. However, modern practitioners tend to confine themselves to the following, basic principles:
- A healthy nervous system is the key to a healthy body.The brain (which is itself, part of the nervous system) communicates with the rest of the body via a series of cranial and spinal nerves. These are responsible for all bodily functions including voluntary movements (such as walking), and involuntary functions (such as breathing).
- Structural problems with the spine can adversely affect the nervous system.If the spine becomes misaligned for any reason, the pressure on the spinal nerves is increased; as a result the nerves will become disrupted. This leads to back pain, and problems with the rest of the body.
- By adjusting the spine, pressure on the nervous system is released.In theory, this should relieve the symptoms of back pain and promote the body’s natural healing mechanism. Symptoms in the rest of the body should also be improved. In general, chiropractors use palpation (that is, examination by touch) to determine which area of the spine needs adjustment; some chiropractors also use x-rays and/or measure the temperature of the skin to help form a diagnosis.
Most chiropractors believe that subluxations are ultimately responsible for back pain. In strict, medical terms, a luxation refers to a dislocated joint; a sub-luxation is therefore an incomplete, or partially, dislocated joint. In chiropractic terms, however, a subluxation is simply a joint problem that affects the spinal nerves.
In the vast majority of cases, a high velocity thrust is used to restore normal function to the joint (also referred to as manipulation, or adjustment). In theory, this should restore normal, spinal mobility, alleviating stiffness and back pain. Other forms of treatment may be used including ultrasound, acupuncture, massage etc…
We agree with the basic principles of chiropractic, namely, that a patient’s health is greatly influenced by the state of their nervous system. Structural problems in the spine do lead to back pain and many other conditions.
However, we strongly disagree with:
- the methods used to diagnose the underlying problem;
- the diagnosis that is invariably given;
- the methods used to treat the patient.
Firstly, palpation represents a very crude method of diagnosis (palpation is sometimes used in Orthopaedic Medicine, but never as primary method of diagnosis). In theory, chiropractors can identify problems in spinal position and mobility, but the accuracy of the diagnosis is generally very poor.
Part of the problem here, is that the definition of a subluxation is extremely vague. Given the anatomical structure of the spine, it is manifestly obvious that problems with the spinal joints will affect the nerve-roots (thereby leading to back pain, and other adverse conditions).
Unfortunately, this crude diagnosis does not lend itself to a targeted, and accurate, form of treatment.
In the vast majority of cases, the actual form of treatment used, is a chiropractic adjustment or manipulation, a high velocity thrust, designed to restore normal function to the joint.
The exact nature, and existence, of subluxations is actually highly contested (both outside, and within, the chiropractic community).Most traditional chiropractors believe that subluxations exist and that they are readily visible (on x-ray film). Others define them more loosely; they believe that they exist, but do not believe they are visible. Finally, a few chiropractors reject the theory of subluxation completely.For a sceptical view on subluxation-theory, please refer to this Article in Chirobase.
Unfortunately, these are relatively violent. The joint is often moved beyond its natural range of motion, leading to a significant amount of trauma in the surrounding structures.
Chiropractic may yield reasonably favourable outcomes for patients suffering from short term, acute pain, which may be the result of accident or injury. In this case, the risk of trauma might be outweighed by the potential benefits. However, chiropractic is not suited to the treatment of long term, or chronic, back pain, where the patient’s symptoms will be aggravated (and prolonged) by a high velocity thrust.