COMMENTARY

In Response - Is the Chiropractic Subluxation Theory a Threat to Public Health?

Samuel Homola, DC

Disclosures

July 30, 2001

Introduction

I have no disagreement with Mr. Bartley's comments.

I am glad to hear that UK chiropractors practice "common sense" physical medicine that is not based on the chiropractic subluxation theory. It speaks well for them that a physiotherapist would come to their defense.

As Mr. Bartley pointed out, there is plenty of scientific literature to support appropriate use of spinal manipulation for musculoskeletal problems, such as the report on spinal manipulation and back pain published by the US Agency for Health Care Policy and Research.[1]

In the United States, as in the United Kingdom, there are many good chiropractors who do a good job treating back pain and other musculoskeletal problems. Unfortunately, chiropractic literature in the United States, as quoted in my article, continues to define chiropractic as a method of restoring and maintaining health by correcting vertebral subluxations. A 2001 chiropractic poll, with 2803 respondents, revealed that 36.1% of chiropractors believe that vertebral subluxation is a major cause of disease.[2]

When chiropractors advocate the subluxation theory, they place themselves in the position of defending dogma. In the United States, chiropractors and physical therapists disagree on the definition of the word "subluxation" and are often at odds with each other.

There may be some yet-to-be-proved beneficial effects of spinal manipulation in the treatment of visceral disease. But such benefit would represent only a small part of appropriate use of spinal manipulation. The bulk of evidence-based literature deals primarily with use of spinal manipulation in the treatment of back pain.

In a 1998 study, chiropractors and medical researchers cooperated to test a long-held belief that chiropractic manipulation could help children with asthma. The study concluded that "In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit."[3]

Many US chiropractors contend that spinal manipulation is an effective treatment for infantile colic. A study published in a chiropractic journal, for example, concluded that "Spinal manipulation is effective in relieving infantile colic."[4] But when such a study was conducted by Norwegian medical researchers, it was concluded that "Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic."[5]

While spinal manipulation as a treatment for visceral disease is controversial and largely unsupported, there is no longer any doubt that such treatment can be beneficial for some musculoskeletal problems. I congratulate the UK chiropractors who work closely with the medical community in the area of physical medicine.

In the United States, where there are many chiropractors who publicly announce that they can restore and maintain health by manipulating the spine, it is necessary to make a distinction between subluxation-based chiropractors and properly limited evidence-based chiropractors when discussing or utilizing chiropractic care.

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