"Is there a difference between an adjustment performed by a chiropractor who is a subluxation believer and an adjustment from someone who thinks otherwise about it ? Is it a question of semantics and does it really make a difference to the patient ?"
A reader responded to my posts about chiropractors' beliefs in the subluxation hypothesis (The Silent Killer - part 1, part 2, and epilogue) with the above questions. My answers are yes … no … and maybe so.
Yes. It certainly can make a difference to the patient who presents to a chiropractor who is a true believer. If the chiropractor's mission is to find and correct vertebral subluxations with the intention of removing interference to Innate Intelligence, thus allowing the healing force to flow unimpeded through the nervous system, (1) then this chiropractor's frame of reference is going to be rather different from one who has a biomechanical understanding of the body. Subluxation-based chiropractors are more likely to employ pseudoscientific methods like surface electromyography (sEMG), thermal sensing devices, and X-ray to detect subluxations (2) and to indoctrinate ("educate") their patients. There may otherwise be little or no indication that manipulation of the vertebrae thus identified is necessary or potentially beneficial. In fact, adjustments may actually be harmful because they may cause or aggravate hypermobility, a condition where there is excess movement of a joint. Chiropractors who base their practices on the detection and removal of subluxations may also use adjusting techniques that have little or no effect on spinal biomechanics. These adjustments usually utilize instruments rather than hands-on techniques, and I know of no instrument adjusting techniques for which there is evidence of effectiveness. (3) Many subluxation-based chiropractors rely on upper cervical techniques where only the atlas—the uppermost vertebra in the neck—is adjusted no matter the condition of the remainder of the spine. This is an extreme example of ideology prevailing over science and common sense.
No. It may well be a question of semantics, at least in some cases, with some chiropractors, and with certain patients. Perhaps it doesn't matter how or where someone is adjusted. The chiro-evangelist Sid Williams famously stated on a 60 Minutes broadcast that most patients improved when given a smack in the butt with a snow shovel and only a minority had to actually be adjusted. (4)
Maybe so. Surveys of the chiropractic profession consistently demonstrate that a majority of DCs believe correction of subluxations is the primary purpose of chiropractic practice. They accept that spinal adjustments relieve non-musculoskeletal conditions such as dysmenorrhea, otitis media, and asthma despite the absence of any scientific evidence supporting such beliefs (5). Since the vast majority of patients seek chiropractic care for common musculoskeletal complaints such as low back pain, neck pain, and extremity problems, (6) it would appear that patients who obtain treatment from subluxation-based chiropractors are being subjected to a bait-and-switch scheme and may not obtain the help they are seeking. Nonetheless, some or perhaps many of these chiropractors practice techniques more consistent with biomechanically sound principles similar to methods used by unsubluxated chiropractors, i.e., those who are not bound by ideological ties to unscientific beliefs. In a sense, they are giving lip service to the subluxation doctrine without strictly practicing it. However, when choosing a chiropractor, it would be hard to know if a chiropractor's practice adhered to their avowed principles. Chiropractic advertisements typically claim expertise in treating common musculoskeletal complaints while at the same time promoting subluxation dogma.
So, dear reader, thank you for your thoughtful inquiry. I encourage readers to submit questions and comments either through the Comments section at the bottom of every post or via the Contact Back Issues form near the bottom of the About page. (Note: as of the date of this post there is a problem with the Comments section, so please use the Contact Back Issues form to submit comments. Thank you.)
This is my own impression. I know of no data to support this assumption. X-ray is pseudoscientific in the sense that no evidence exists for the detection of subluxations, in the chiropractic sense of the term, by X-ray examination. See Jenkins et al. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & Manual Therapies (2018) 26:48. back
A study I cited in a previous post compared the Activator instrument to manual adjusting and usual medical care for low back pain. The researchers concluded that manual thrust manipulation "provides greater short-term reductions in self-reported disability and pain scores" compared to usual medical care or mechanically assisted manipulation. (Schneider M et al. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial. Spine vol. 40,4 (2015): 209-17.) back
The 60 Minutes segment on chiropractic aired in 1979. Only part of the program can be seen on YouTube. I contacted CBS to see if I could obtain the entire segment and was told it was available for $300. (Donations for the purchase of this historical broadcast are gratefully accepted.) back
Two such studies were cited in this post. A more recent Australian survey identified "ChiroCon" (i.e., chiropractic conservatism) students who favored treatment for non-musculoskeletal diseases and confirmed an association with "magical health beliefs." (See Innes et al. Who are the chiropractic students favouring a limitless scope of practice? Exploring the relationship with personality, magical thinking, and academic achievement. Chiropractic & Manual Therapies (2022) 30:30.) back
Beliveau et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropractic & Manual Therapies (2017) 25:35. back