What Do Chiropractors Do?

What is Chiropractic?

It is not straightforward and there is a lot of variability in the services, beliefs about and beliefs held by chiropractors.

There are two Australian chiropractic associations. Chiropractic Australia states "Chiropractic is a drug free, surgery free system of healthcare primarily for the musculoskeletal systems (bones, joints, muscles and ligaments) and some of the neurological system (nerves and the spinal cord). Chiropractors use a variety of techniques to reduce pain and improve mobility and function. The one system that most people associate with chiropractic is hand-delivered manipulation of the spine. Some chiropractors call this an ‘adjustment’. They may also use other techniques and/or modalities like heat, ice, massage, specific exercises, ultrasound, and acupuncture. They may also give lifestyle, ergonomic and dietary advice."

The Australia Chiropractors Association defines it as "A health profession concerned with the diagnosis, management 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. (Primary Reference - WFC Dictionary Definition World Federation of Chiropractic, 2001)."

According to the French et al in the Medical Journal of Australia manipulation is used in only about half patient encounters. Soft tissue (specific massage) is also used in about half of patient encounters. Activator, drop piece, blocking and mobilization are also commonly used. Sadly, this study only recorded passive manual therapy interventions.

Unfortunately, there is no regulatory or accreditation mechanisms to record what any particular AHPRA registered chiropractor is likely to think or do in practice. No wonder medical doctors do not like referring to chiropractors.

My view is there is disunity and lack of quality assurance within the chiropractic profession. There are two main camps. The first and thankfully now smaller camp, believe in the vertebral subluxation complex (VSC) as the true cause for all disease. They think VSC's can be reduced by special procedures (including spinal manipulations) called adjustments. The VSC has not been clearly defined nor measured nor linked in a reasoned way to accepted reasoned diagnostic approaches to managing health problems. Neither have adjustments been shown to alleviate the VSC. Therefore, this approach is of not much use in addressing the burdens on the healthcare system in contemporary society. I describe this approach as pseudo-scientific and dogmatic and really should be relegated to nothing more than a historical perspective.

The other chiropractic camp aligns itself with a scientific based medicine (SBM). This approach evolves in response to new information as it comes to hand through the literature. The research is used to improve a suit of therapeutic interventions underpinned by a rational, bio-mechanical, and physiologic approach. This group is interested in patient centred care that eases the burden of MSK dysfunction and therefore disease and co-morbidity on individuals and the society. There is respect for quality research and a willingness to continue to evolve with technology within a musculoskeletal scope that promotes wellness.

There is a feud within the profession and no real regulatory mechanism to differentiate between the two groups. The same division and feud existed at the inception of chiropractic and persists today.

How Chiropractic Started

Chiro started in the US around 1900. At the time healthcare had 3 main factions.

Allopathic Medicine: MD – Characterized by reliance on toxic substances, lack of understanding and application of germ theory (1870s, Pasteur & Koch), and lack of sterile techniques in surgery leading to high mortality during procedures. Infectious diseases, without effective antibiotics and public health efforts in place, prevented wide-scale confidence in medical practitioners, and alternative theories and practices surrounding health developed. There was not yet treatment for diabetes, and no vaccines had yet been discovered for major killers of the day: diphtheria, pertussis, TB, tetanus, yellow fever, typhus, polio, measles, mumps, or rubella.

Osteopathic Medicine: DO – founded by Andrew Taylor Still, MD, DO who emphasized the central role of the blood in maintaining health, and believed manipulation could restore proper blood flow and thus induce health states. Osteopathy was more a movement within medicine and in the US the training and scope is more or less identical between MD's and DO's. (more here).

Chiropractic Medicine: DC – founded by Daniel D. Palmer, who emphasized the central role of the nervous system in maintaining health, and contrary to A. T. Still, believed manipulation could restore proper neurological communication and thus induce healthy states. Palmer was jailed for practicing medicine without a license in 1906. The first chiropractic textbook 'Modernized Chiropractic' published in 1906 included spinal manipulation and other techniques to treat a range of conditions. Although the book did help Palmer get out of jail it caused a controversy (that still exists today) between the so called "straight" (that believed in the VSC) and "mixer" chiropractors who used any approaches that helped patients.

© 2021 Tim Young Chiro & Fleximan Manikin