This week we are carrying on our series looking at the basis and efficiency of alternative health treatments. The idea is to look at some of the claims of alternative treatments commonly available in the UK today, and to evaluate the scientific evidence for them.
What is Chiropractic Treatment?
According to the General Chiropractic Council, the statutory body regulating the profession in the UK (GCC) chiropractic is "a health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health".
The basic idea is that the patient lies on a soft table, and the chiropractor manipulates the body parts, and spine, of the patient in various ways in order to relieve tension and pain.
When many people picture a chiropractic treatment they see a person in a white coat leaning over the patient giving a short, sharp twist to the head. This practice seems to feature in many Chiropractic sessions, but many practitioners would say that this is only a part of what they do.
History of Chiropractic
Chiropractic was founded as a health profession in the US in 1895 by a Canadian called Daniel David Palmer, who had no conventional medical training.
Palmer argued that most human disease is caused by misalignments of the spine that apply pressure on surrounding nerves called "subluxations" (a term also used in conventional medicine, where it has a different meaning) and believed that they blocked the flow of a natural energy, or "life force", through the body.
Correcting these subluxations, he argued, could restore the proper flow of energy, and so restore health. Thus, he saw chiropractic spinal manipulation as a treatment for 95% of all health conditions. (http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx)
What is it Used For?
Chiropractic is mainly used for musculoskeletal conditions (which affect the muscles, bones and joints). These include:
Some chiropractors, however, use Chiropractic treatments to treat a wider range of conditions, such as asthma, allergies, headaches and even mental health issues.
Does It Work?
The Big Question!
According to NICE (National Institute for Health and Care Excellence), the body that makes recommendations for treatment in the NHS, chiropractic is recommended only for one condition – lower back pain. No other conditions are recommended. This says something about how the practice is generally regarded.
A leading professor of Pharmacology at UCL - David Colquhoun – has spoken out at even this limited use of chiropractic. An outspoken critic of what he calls “pseudo-medicine”, Colquhoun said recently in the Guardian:
“there is little reason to believe that manipulation works. People get better at much the same rate regardless of treatment.” (
The Guardian also claims that the studies that have affirmed chiropractic efficacy were poorly conducted and heavily criticised for being too small, and of too poor quality to be used in judgement of the treatment.
Is Chiropractic Damaging?
The Spectator recently ran a piece by Edzard Ernst, Emeritus Professor of Complementary Medicine at the University of Exeter. The piece argued that not only was chiropractic non-effective, but went as far as to call it “damaging” and “dangerous”. The article commented:
“There is now a lot of evidence showing that more than half of all patients suffer mild to moderate adverse effects after seeing a chiropractor…Several hundred cases have been documented in which patients were seriously and often permanently damaged after chiropractic manipulations.”
Some people, it is claimed, have even died after receiving chiropractic treatment. Ernst claims that up to 30 deaths resulting from chiropractic have been documented in the literature.
Advocates of chiropractic say that the evidence for these claims is shaky at best, and offer the fact that respected organisations such as NICE recommend it for use with certain conditions.
Opponents reply that, as stated above, NICE only recommend chiropractic treatment for a single condition, nowhere near the huge list of illnesses that manipulation experts argue the treatment can be used for.
Even the British Chiropractic Association (BCA) say that there is no explanation as to how chiropractic might work. Matthew Bennett, President of the BCA, was quoted as saying:
“We’ve spent 100 years or more going through various hypotheses,”
I guess some like Matthew Bennett would say that we don’t know how it works, but it does seem to work – for some people. This somewhat positive effect could be explained by the placebo effect.
Like Acupuncture, we ultimately come back to anecdotal evidence and placebo effects to support the practice. This is not a strong scientific basis for a medical treatment.
The literature, at first glance, seems to be very much showing the lack of a scientific basis for chiropractic. This seems to have been going on for decades now – and it’s a wonder that chiropractic has survived under this kind of scrutiny.
But survive it has. Maybe the best advice if you have spinal problems, is to exhaust all conventional treatments (medication, physio) first. Perhaps only then, when you are desperate, should you entertain the idea of trying chiropractic.