What is Chiropractic?
I once heard a chiropractor referred to as an ‘outa whack back quack’, which I have to confess still makes me smile. Chiropractic, which traces its origins back to the 1890s, is defined by the British Chiropractic Association as:
“…a regulated primary healthcare profession. Chiropractors are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system (bones, joints, and muscles), as well as the effects these disorders can have on the nervous system and general health. They have a specialist interest in neck and back pain, but when they assess patients, they take their entire physical, emotional and social wellbeing into account.
“Chiropractors use a range of techniques to reduce pain, improve function and increase mobility, including hands-on manipulation of the spine. As well as manual treatment, chiropractors are able to offer a package of care which includes advice on self-help, therapeutic exercises and lifestyle changes.”
As a survivor of such “hands-on manipulation”, I can at the very least attest to a chiropractor’s ability to elicit from my spine some rather disturbing (albeit painless) cracking and popping sounds. But are chiropractors simply a back-cracking sideshow on the fringes of the healthcare professions or is there clinical evidence of their efficacy in the treatment of back and neck pain?
In fact, there has been a considerable amount of research published over the years of which the following is just a small sample:
Back in 1993, faced with spiralling healthcare costs, the Ministry of Health in Ontario identified low-back pain (LBP) as “one of the most costly causes of illness and disability in Canada”. They commissioned a comprehensive report, “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain”, which analysed the available clinical evidence for the efficacy of chiropractic for LBP compared to other forms of treatment. The report concluded:
“On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate.
“There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain.”
In 1996, a small scale study in Bristol, UK, which specifically focused on neck ‘whiplash’-type injuries as opposed to back pain, concluded:
“Forty-three per cent of patients will suffer long-term symptoms following ‘whiplash’ injury, for which no conventional treatment has proven to be effective. A retrospective study was undertaken to determine the effects of chiropractic in a group of 28 patients who had been referred with chronic ‘whiplash’ syndrome…Twenty-six (93 per cent) patients improved following chiropractic treatment. The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic ‘whiplash’ injury.”
This was followed in 1999 by another study by three of the same authors (all orthopaedic surgeons) plus a chiropractor, which concluded:
“Whiplash injuries are common. Chiropractic is the only proven effective treatment in chronic cases.”
All reasonably positive so far…
However, in 2010, a Cochrane Review was published which examined “combined chiropractic interventions for low back pain”.
“Twelve randomised trials (including 2887 participants) assessing various combinations of chiropractic care for low-back pain were included in this review, but only three of these studies were considered to have a low risk of bias.”
The review concluded:
“Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions. Future research is very likely to change the estimate of effect and our confidence in the results.”
So, not so much a stumbling block as ‘further research required’.
The most recent study, which was published this month, involved 750 active-duty US military personnel being treated for LBP. The study found that after six weeks, when given concurrently with medication and physical therapy, chiropractic manipulation benefited 62.6 per cent of low back pain sufferers. This compared to just 46.6 per cent who reported benefit with medication alone.
Most of the available evidence seems to support the efficacy of chiropractic treatment for the relief of low back and neck pain. Further, despite any cracking and popping sounds, chiropractic is generally regarded as a safe therapy. There are risk factors, but then all medical treatment carries some degree of risk and good practice requires those risks to be explained clearly to the patient prior to the commencement of treatment in order that informed consent can be given.
As for my own experience, I found chiropractic very helpful for the short term relief of sciatic pain, but given the large size of the underlying disc prolapse, it was ultimately surgery which worked for me.