Why Chose Evidence-Based Chiropractic?

There is currently a significant divide within the chiropractic profession.

It involves the belief systems chiropractors base their approach on. These different beliefs affect everything from how a practice is run, to how a patient is treated. It is therefore important for potential patients to learn about these differences so they can make an informed decision on which type of chiropractic treatment suits them best.

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The Two Main Chiropractic Philosophies

The Vitalistic Philosophy:

Those who follow the traditional beliefs of the founding chiropractors.

Although few chiropractors now follow the strict original philosophy of the founders, many still hold onto core aspects of their belief system. They often label themselves as “wellness chiropractors”.

The Materialistic Philosophy:

Those who follow what the science says can be achieved with chiropractic.

Generally an “evidence-based chiropractor” only believes and promotes the scientific research findings related to chiropractic treatment and/or manipulative therapy.

These belief systems lie at opposite ends of a spectrum, with most chiropractor’s likely sitting somewhere in the middle. Below we’ll detail the difference between the two.

The Difference In Theories

Chiropractic was invented by an American named D. D. Palmer in 1895. He realised that there are spots in your spine that don’t appear to behave normally. He called these spots “vertebral subluxations” and treated them with spinal joint manipulation.

He came to believe that these subluxations are detrimental to your health in a variety of ways and was quoted as saying:

“A subluxated vertebra … is the cause of 95 percent of all diseases … The other five percent is caused by displaced joints other than those of the vertebral column.”

The medical profession dismissed this idea. However, to this day chiropractors are still taught that vertebral subluxations are a real phenomenon can have a raft of negative effects on your health.

Until recently, many chiropractic colleges (including New Zealand’s) used the following definition of a subluxation:

“A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.”

Wellness chiropractors tend to have a belief system along these lines. They believe that chiropractic treats subluxations and therefore it helps improve a variety of body functions and general health.

In 2015 a different group of chiropractic colleges from around the world put out the following statement:

“The teaching of the vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historic context is therefore inappropriate and unnecessary.”

What are chiropractors (and other manipulative therapists) treating?

The truth is, we don’t know.

There is research findings backing some theories, including:

  • The neuroplasticity model, developed by Dr Heidi Haavak et el. It basically states that altered sensory input from a dysfunctional area in the spine leads the brain interpreting the surrounding world incorrectly. This then leads to less than optimal control of the body and further spinal dysfunction. Spinal manipulation breaks this negative feedback loop and restores normal function.
  • The adhesion model, researched by Dr Gregory Cramer. The models premise is that adhesions build up around the spinal joints when they are not used frequently. Spinal manipulation is a way of breaking up these adhesions and restoring normal joint function.

There are other theories out there, but there is no universally understood answer to how or why spinal manipulation works. Science hasn’t provided us with a clear picture yet and more research is needed.

An evidence-based chiropractor will likely admit they don’t have all the answers and will tell patients the evidence for some of the theories.
A wellness chiropractor may not be as open to this kind of uncertainty. They are more likely to tell patients that they are suffering from ‘vertebral subluxations’ and will insinuate that they are negatively impacting their general health and wellbeing.

The Difference In What Is Treated

Ask a chiropractor what they can help you with and you could get a variety of answers.

Let’s look into the scientific evidence for what can be achieved with spinal manipulation. When it comes to health science research, there are two main types:

Applied Research:

Research that explores whether an intervention is safe or effective for patients. These studies usually use a large group of people as test subjects, testing whether an intervention is able to solve a current problem.

Not all studies are created equal due to test group size, sources of bias and study design. Meta-analysis studies and systematic reviews are the most trusted form of applied research, followed by randomised controlled trials.

Basic Research:

Studies that investigate the fundamental science of what is going on. They are often performed in a laboratory by scientists with the goal to answer questions about the core underlying structures and functions.

Chiropractic basic research is usually performed on a small number of people, looking into very specific changes to the body in a highly controlled setting. This inevitably makes the results less applicable to real-world scenarios.

Research into chiropractic (i.e. spinal manipulation) has found that the treatment can influence numerous aspects of the body. The following details the areas where there is at least some evidence for spinal manipulation having an effect:

Applied Research:

Meta-Analysis & Systematic Review Findings

•  Treatment for acute [1] [2] , sub-acute [2] and chronic [3] [4] lower back pain.

•  Treatment for neck pain. [5]

•  Treatment for cervicogenic headaches and dizziness [6], tension-type headaches [7] and migraines. [8]

•  Treatment for sciatica. [9]

High Strength Study Designs

Applicable To Real-World Scenarios

Applied Research:

Randomised Control Trial Findings

•  Back pain prevention. [10]

•  Sacroiliac joint dysfunction. [11]

•  Pain related to a lumbar disc injury. [12]

These studies are yet to be investigated with the more trusted study designs.

Moderate Strength Study Designs

Applicable To Real-World Scenarios

Basic Research:

  • Changed brain function in the pre-frontal cortex. [13]
  • Altered and enhanced muscle function in the general population. [14]
  • Decreased reaction times. [15]
  • Increased muscle strength in the upper and lower limbs. [16]
  • Prevention of muscle fatigue from developing in certain areas. [17]
  • Increased muscle strength and cortical drive in stroke patients who had muscle weakness. [18]
  • Increased neck range of motion. [19]
  • Reduced joint position sense error. [20]
  • Improved feed-forward activation of core stabilising muscles. [21]
  • Improved sensorimotor function related to falls risk of community dwelling older adults. [22]
  • Improved or altered visual acuity and visual field size. [23]
  • Altered spinal cord reflex excitability. [24]
  • Reduced pain thresholds for those suffering from lateral epicondylalgia. [25]
  • Changes in the way the brain processes sensory and motor information. [26]
  • Improved spinal function. [27]

High Strength Study Designs

Less Applicable To Real-World Scenarios

An evidence-based chiropractor would likely promote the above findings, noting the limitations of each of the studies and where more research is needed to improve the veracity of the results.

Wellness chiropractors also promote the above findings (who wouldn’t), but they often don’t stop there.

The basic research shows that chiropractic can help with specific aspects of nervous system function, mostly related to the musculoskeletal system. Wellness chiropractors have a deep belief that chiropractic can improve general health and often use the results of the basic research as evidence that chiropractic can help all aspects of nervous system function.

It could be argued that the nervous system controls all functions of the human body. With this in mind, these chiropractors often make unsubstantiated claims, such as being able to help asthma, improving immunity, digestion and organ function.

When Chiropractors Are Not Evidence-Based

In 2016 a study found 56% of New Zealand chiropractor’s websites claimed that they could treat health conditions which had no scientific evidence for support.

This study followed a well-publicised event in the UK in 2008. A popular article published in The Guardian was critical of chiropractors who over-advertise their abilities. Following this, a quarter of the members of the British Chiropractors Association (BCA) went under formal investigation and the BCA sued the author. They eventually dropped the case. The ordeal helped motivate the formation of a new law to protect freedom of speech (in favour of the article’s author).

In 2019 the Australian state of Victoria commissioned an independent review of the practice of spinal manipulation on children under 12 years. This followed public outrage caused by a video of a chiropractor holding the 2 week old upside down by the feet and using an adjusting tool on the infant.

Treatment of toddlers/infants can be a touchy topic for chiropractors. Although most trusted clinical research shows little benefit [6] [28] for a variety of conditions, there is possibly some evidence for infantile colic. A meta-analysis study found favourable evidence for reduced crying times. [29] However a different meta-analysis released around the same time found the evidence to be inconclusive [30] and another trusted study found that the majority of the positive results had a high risk for bias. [31]

The Difference In Treatment Approaches