The Cracklash begins
It’s not just the evidence for chiropractic that’s a bit shaky these days.
For a long time, there has been an uneasy truce between the different chiropractic factions in the UK, all believing different things and each with different rituals.
It seems that they all came together when statutory regulation was first mooted and the carrot of respectability that that offered overcame those fundamental differences — temporarily at least.
Since the GCC was set up, the trade bodies representing the different factions (‘straights’, ‘mixers’, etc) appear to have been reluctant bedfellows, and there seems to have been various fallings out and lots of jostling for position and power.
But they trundled along and put a brave face on things for the sake of the profe$$ion.
After the BCA’s misconceived attack on Simon Singh, sceptical eyes were focused on chiropractic and the claims made by its followers. After being disgusted by the claims we saw being made by a large number of chiropractors on their websites, Simon Perry and I independently poked the GCC with a somewhat sharp stick.
What a hornet’s nest we stirred up, with the GCC eventually acknowledging that chiropractic had to be based on proper evidence and not on wishful thinking.
Skeptic Barista prodded and poked the GCC in an attempt to find out just how evidenced-based they wanted to be and to find out whether they were, indeed, committed to an evidence based foundation for chiropractic. Their initial stance was:
The General Council has never considered the research evidence for the chiropractic vertebral subluxation complex.
An astonishing admission by a body charged by Parliament to regulate chiropractors and to set standards for chiropractic training.
However, gently poking further, they eventually pronounced the subluxation to be “an historical concept” and that:
There is no clinical research base to support claims that the chiropractic vertebral subluxation complex is the cause of disease or health concerns.
More on this can be found here.
- how the chiropractic vertebral subluxation complex (VSC) is covered in the detailed curriculum
- what relevant research they draw from
Each of them (the Anglo-European College of Chiropractic, the McTimoney College of Chiropractic and the Welsh Institute of Chiropractic) answered with varying degrees of enthusiasm and the GCC concluded that:
- The chiropractic vertebral subluxation complex is taught only as an historical concept.
- There is no clinical research base to support the belief that it is the cause of disease or health concerns
So if they are to be believed, there will be no conflict and opposing factions in the future because all new trainee chiropractors will learn that it is just an historical concept, consigned to the history books as an outdated and irrelevant concept that explains absolutely nothing and based on no evidence whatsoever; something dreamed up 120 years ago by a magnetic therapy salesman.
But we know that as recently as December 2008, the subluxation loomed large in the prospectus of the McTimoney college for their MCHiro ‘degree':
…healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements)
Subluxations, or misalignments, in the body can occur at any time. They may be related to accidents, sporting activities, household tasks, emotional and physical stress, even a bad mattress.
When subluxations occur, a person can experience pain – of any description, of any duration, anywhere down the course of the nerve. This may lead to malfunction in either the muscles or internal organs. For example, tingling fingers can often be caused by subluxation of the neck vertebrae.
If they really have now binned the concept of the subluxation there must have been an extraordinary volte-face at the college since then! Or they have simply given it a new identity and speak of it in whispers lest an outsider hears.
No. They still talk about subluxations on their website as if they are the very foundation of chiropractic.
How Chiropractic Works
The nervous system is responsible for all body functions. The correct alignment of vertebrae in the spinal column is vital to maintain nerve pathways. Subluxations in the body can occur at any time. They may be related to accidents, sporting activities, household tasks, emotional and physical stress, even a bad mattress. Some causes are so subtle that changes can occur without the patient’s knowledge, as symptoms can take years to arise. Chiropractors believe that much ill health in adult life may be related to events such as accidents in childhood.
When subluxations occur, a person can experience pain – of any description, of any duration, anywhere down the course of the nerve. This may lead to malfunction in either the muscles or internal organs. For example, tingling fingers can often be caused by subluxation of the neck vertebrae. (Source, cached)
The lead author of the Bronfort Report, Gert Bronfort, works for Northwestern Health Sciences University — an establishment that gives degrees in chiropractic, acupuncture, TCM and massage therapy. While he did not look at the evidence for the existence of subluxations, it is against his report that chiropractic claims (and my complaints) are now being measured. Strange, then, that his establishment seems quite taken with the idea of the subluxation. Indeed, there are some 60 mentions of ‘subluxation’ on their website, including:
Subluxation is a disturbance in one or more of the joints of the body; in particular, a disturbance in the spine can interfere with the function of the nervous system.
Subluxation may occur as the result of injury, compensation for injury, or as an effect of normal adaptation to physical and non-physical stressors and influences. Clinical indications for the diagnosis of subluxation may include:
- Asymptomatic functional distortion
- Postural abnormalities
- Clinical conditions or end-organ manifestations of abnormal nerve function that are either mediated or affected by spinal segmental nerves
- Clinical conditions that are created by normal compensatory mechanisms in response to injury, trauma, or abnormal stresses (Source, cached)
The Scottish Chiropractic Association seem to be trying to dodge the issue by saying:
Spinal vertebrae can become misaligned or fixated causing interference to the joint and its associated structures. Chiropractors have historically referred to these as subluxations. Many synonyms (joint blockage, joint dysfunction, aberrant articulation) exist for this theoretical model which can cause pain, restriction of mobility, imbalance and many other symptoms. Chiropractors specialize in locating and then working with patients to correct these problem areas. (Source, cached)
The United Chiropractic Association appear to have been a bit more diligent and many pages using the ‘S’ word have now been removed, but it’s not that long ago that they stated:
In simplest terms, a subluxation (a.k.a. Vertebral Subluxation) is when one or more of the bones of your spine (vertebrae) move out of position and create pressure on, or irritate spinal nerves. Spinal nerves are the nerves that come out from between each of the bones in your spine. This pressure or irritation on the nerves then causes those nerves to malfunction and interfere with the signals traveling over those nerves. (Source, cached)
The McTimoney Chiropractic Association have similarly removed all mentions of the subluxation from their website, but it recently said this in an anecdote:
On examination I found a subluxation apparent at L2, with the pelvis rotated left posterior, right inferior tilt and left ASIS superior. Subluxations were also apparent at T2, T5 and T9. I found Georgia’s symptoms were consistent with pressure on the obturator nerve, and proceeded to make standard McTimoney adjustments to correct the pelvic misalignment and the vertebral subluxations. (Source, cached)
As you go through life, a loss of proper function (movement) in the vertebrae, which some chiropractors call a subluxation, may interfere with the healthy working of your spine and the nerves that run through it. This may affect your body’s natural ability to recover from injury and you may find yourself increasingly unwell, unable to shake off apparently minor aches, pains and even some illnesses.
The big divide
Listen to some on one side of the subluxation divide and you’d get the impression that not one single chiropractor in the UK believes in subluxations any more than they do in Santa Clause; others vehemently defend the subluxation as the essential foundation of real chiropractic.
Indeed, a Google search for “chiropractic clinic subluxation” restricted to .uk domains, returns nearly 2,500 pages. Not all are chiropractors websites, but it does show there are significant numbers of then still claiming this now outdated concept as a reason for your ill-health and for lightening your wallet through ‘wellness’ or ‘maintenance’ chiropractic care:
Nearly any kind of stress can cause a subluxation: a fall or an accident (even a very small one that happened years ago); a poor sleeping position; poor posture; fatigue; emotional stress; poor nutrition or a combination of stresses. A subluxation need not happen all at once. It could set in the body over time. (Source, cached)
Since many subluxations in infants are in the upper cervical area, there is a strong possibility, especially when there has been a history of birth trauma, that these babies are suffering from head and neck pain due to spinal subluxations in this area. (Source, cached) [Note: this website is still making claims about colic]
The ‘straight’ chiropractors are not taking this lying down: the battle lines have been drawn, the first salvoes of revolt have now been fired and past cracks are beginning to re-open.
Following on in a grand tradition, I hereby dub this the Cracklash.
The United Chiropractic Association devoted five pages of their summer 2010 newsletter (cached) to defend the beleaguered subluxation, claiming that the subluxation is “a very real and verifiable entity”, citing US State and Federal laws, the Foundation for Vertebral Subluxation (yes, it has its own website), and a plethora of chiropractic organisations. But not much evidence.
It also looks like they are trying to make the most of the current state of affairs by trying to coax new members to their side, ready to do battle.
Then there was the aforementioned Foundation for Vetebral Subluxation. Their President, Christopher Kent, penned An Analysis of the General Chiropractic Council’s Policy on Claims Made for the Vertebral Subluxation Complex (cached).
The website introduction says:
The management of vertebral subluxation has been the chiropractic profession’s unique contribution to the healthcare system for 115 years.
Unique contribution to healthcare?
Kent accuses the GCC of building straw men and resorting to special pleading. But most of his article consists of a textual analysis of the GCC’s statement and a denigration of RCTs. Oh, and building straw men and resorting to special pleading.
But he does ask one very pertinent question:
Are we a profession with a clearly defined mission or are we a profession simply seeking some niche which offers access to a slice of the health care pie?
Something for all to ponder as we watch, from the sidelines, the Cracklash unfold.
I’ll bring the popcorn.