The Science of Chiropractic
The Pillars: Part 3
Hello and welcome to my blog!
Today I wanted to take some time and talk about the third Pillar of Chiropractic: Science. At Dr. Super’s House of Health, I have built my practice around evidence-based literature. This means our healing practices are supported by science and based on updated research, and my techniques are driven by empirical evidence as well as patient outcomes. My waiting room is filled with scientific literature, and my patients often come in and see me with textbooks spread out across the table: spinal mechanics manuals, techniques manuals, diagnostic manuals, and research articles I clip from magazines or print off the internet. I also change the way I practice based on what current research says. For example, Activator Method® is one of the most widely researched chiropractic techniques and is “the only instrument adjusting technique with clinical trials to support its efficacy” (Activator, 2022). Flexion-Distraction technique is one of my favorites to use for disc injuries and is shown to cause statistically significant increases in disc height after just 6 weeks (Choi, 2022). However, there is a lot of bias against chiropractic due to a “lack of scientific evidence” to prove what we do works. This is not for a lack of trying, but studying chiropractic with a traditional scientific study comes with a lot of challenges. There are also scientific journals that are biased against chiropractic medicine. I have myself experienced this bias when publishing my own case study, “Chiropractic Care of a Patient with Chronic Muscle Spasms and Headaches with Complex Comorbidity: A Case Report”. Journal after journal would deny our study simply based on the fact that “Chiropractic doesn’t fit into our medical journal”. I think it’s important to explain why chiropractic is so hard to study and what science DOES support. Just as our bodies have the ability to adapt, so too should our minds, practices, and knowledge as physicians when presented with new information.
There is also the perception that chiropractors are “quack” doctors and don’t care about the science. This simply isn’t true. We are only now beginning to understand some major concepts about the body, how it moves, how it heals, and the nature of disease. However, we cannot always wait for science to “catch up” and give us all the answers when it comes to healing the body and I end up learning more about the body from my patients than from any text book. When I was in the cadaver lab in grad school, I quickly realized that when you compare humans to an anatomy textbook, only 30% or so match a textbook! Everyone’s body is different and most of us have anatomic variations or unique movement and compensation patterns. This is one of the reasons why studying chiropractic results in patients is so difficult. One patient may have a bony anomaly that makes having a subluxation more significant than if they had a “typical” bone shape. I may adjust the sphenoid on two people and each one has a completely different result. How can you compare the effect of an adjustment between patients with different bone structures or anomalies? I also quickly realized that every chiropractor adjusts with a different speed, depth, torque, or technique and no two adjustments can ever be the same. Is it even possible to compare the results between techniques if the application of that technique will always vary between individuals? This is but another challenge when studying the effects of a chiropractic adjustment.
For the reasons listed above and a limitation of resources, I decided to publish a case report instead of doing a cohort or a double blind study. In the world of research, there is a hierarchy of study designs with a double-blind study being the “gold standard” and a case report being the omega of the bunch. In a double blind study, the person delivering the treatment (let’s say a pain pill vs a sugar pill) will be “blinded” to what treatment they are giving the patient, and the patient is also “blind” to what treatment they are receiving. This helps to eliminate bias or illuminate placebo effects. In the chiropractic world, a double-blind study is almost impossible since a chiropractor will know whether or not they are giving a real adjustment.
So what does the literature say about chiropractic if it’s so hard to study? Well, it says a lot. Let’s start by comparing people who see a general practitioner (GP) vs. a chiropractor (D.C.). A comparative analysis of chiropractic and general practitioner patients in North America (Canada and the U.S.) compared patients who saw a GP vs a D.C. and found that patients in both countries who saw only a chiropractor have fewer chronic conditions, take fewer drugs, and have no regular doctor (Hurwitz, 2006). So a person who sees a chiropractor needs less drugs and has less chronic illness? That comes as no surprise to me! How about the effects of chiropractic care for babies? A Systematic Review of infant’s who received chiropractic treatment for colic concluded, “Our findings reveal that chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events” (Joel Alcantara, 2011). Well no wonder screaming babies melt into calm babies at the office after an adjustment! How about mothers who present with breech babies? That’s why Webster’s technique is used and has been shown to have an 82% baby turn rate for expecting mothers (Richard A. Pistolese, 2002). What can chiropractic do for athletes? In a single-blind randomized clinical trial, female athletes were given ankle adjustments over a 3-week period and had a 50% increase in vertical jump height (Sofia, 2014)! In another single-blind randomized control study, researchers studied the effects of chiropractic treatments on hip extension ability and running velocity among young male running athletes. The researchers found that the treatment group showed significantly greater hip extension after chiropractic treatment than did the control group, increasing their running step. What about the elderly and fall risks? A randomized controlled trial found that “Sensorimotor function and multisensory integration associated with fall risk and the physical component of quality of life improved in older adults receiving chiropractic care compared with control” (Kelly R. Holt, 2016). So obviously chiropractic care can have a positive effect on our health even if we cannot use the traditional scientific method to prove so!
I love what I do, and I love that it helps people. My thirst for knowledge is what pushed me to join the medical field and it will continue to push me to learn all I can about chiropractic. The body is a mystery and we will never master it. All I can do is learn everything I can about the body and keep an open mind as to what the body is capable of. Despite the fact that we spend our entire lives within our body, we know next to nothing about it. We have spent more time exploring space than we have the oceans (of which we have thoroughly explored about 5% of the earth's oceans), and we know more about the ocean than we do the human body. The body is the most advanced mechanical system known to man, and each one of us is completely unique. There is so much we do not know, like why do we have a dominant hand (Holder, 2022)? Why do we yawn (S. Warren, 2019)? Why do we dream (Team, 2020)? We might not have the answers to these questions yet, but I look forward to discovering more about the human body with each patient interaction I have.
Feel Well and Do Good,
ADIO
Dr. Super
Research – activator methods. Activator Methods Intl Ltd. (n.d.). Retrieved April 1, 2022, from https://www.activator.com/research/
Choi, J., Hwangbo, G., Park, J., & Lee, S. (2014, August 30). The effects of manual therapy using joint mobilization and flexion-distraction techniques on chronic low back pain and Disc Heights. Journal of Physical Therapy Science. Retrieved April 1, 2022, from https://www.jstage.jst.go.jp/article/jpts/26/8/26_jpts-2014-026/_article/-char/ja/
Hurwitz, E.L., Chiang, LM. A comparative analysis of chiropractic and general practitioner patients in North America: Findings from the joint Canada/United States survey of health, 2002–03. BMC Health Serv Res 6, 49 (2006). https://doi.org/10.1186/1472-6963-6-49
Joel Alcantara, Joey D. Alcantara, Junjoe Alcantara, The Chiropractic Care of Infants with Colic: A Systematic Review of the Literature, Volume 7, Issue 3, 2011, Pages 168-174,ISSN 1550-8307, https://doi.org/10.1016/j.explore.2011.02.002. (https://www.sciencedirect.com/science/article/pii/S155083071100036X)
Richard A. Pistolese, The Webster Technique: A chiropractic technique with obstetric implications, Journal of Manipulative and Physiological Therapeutics, Volume 25, Issue 6, 2002, Pages 1-9, ISSN 0161-4754, https://doi.org/10.1067/mmt.2002.126127. (https://www.sciencedirect.com/science/article/pii/S0161475402000155)
Sofia Hedlund, Hans Nilsson, Markus Lenz, Tobias Sundberg, Effect of Chiropractic Manipulation on Vertical Jump Height in Young Female Athletes with Talocrural Joint Dysfunction: A Single-Blind Randomized Clinical Pilot Trial, Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 2, 2014, Pages 116-123, ISSN 0161-4754, https://doi.org/10.1016/j.jmpt.2013.11.004. (https://www.sciencedirect.com/science/article/pii/S0161475413002959)
Kelly R. Holt, Heidi Haavik, Arier Chi Lun Lee, Bernadette Murphy, C. Raina Elley, Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial, Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 4, 2016, Pages 267-278, ISSN 0161-4754, https://doi.org/10.1016/j.jmpt.2016.02.003. (https://www.sciencedirect.com/science/article/pii/S0161475416000506)
Holder, M. K. (2001, November 1). Why are more people right-handed? Scientific American. Retrieved March 26, 2022, from https://www.scientificamerican.com/article/why-are-more-people-right/
S.Warren is a Certified Clinical Somatic Educator. (2019, April 29). What is pandiculation? Somatic Movement Center. Retrieved March 26, 2022, from https://somaticmovementcenter.com/pandiculation-what-is-pandiculation/
Team, B. and S. (2020, September 29). Why do we dream? A sleep expert answers 5 questions. Cleveland Clinic. Retrieved March 26, 2022, from https://health.clevelandclinic.org/why-do-we-dream-a-sleep-expert-answers-5-questions/