About chiropractic
What is chiropractic?
Chiropractic is best explained through the three-part dynamic of art, science and philosophy.
The art
The art of chiropractic is the art of adjusting joints. While every joint in the body has nerves and blood vessels that travel around it, the joints of the spine are unique because this is where the spinal nerves exit the spinal column and feed every other part of the body. There are over 200 different named techniques for adjusting the spine—some techniques differ over philosophy, some over science, but most over the style of adjusting. Most people will find that chiropractic is like anything else: one technique may work especially well for them while another may not seem to work well at all. Be sure of one thing: if you are seeing Dr. Matthew or any other doctor of chiropractic and not experiencing results, you should doubt the chiropractor, not chiropractic. It is worth noting that in many states, MDs are taking weekend seminars to learn to deliver adjustments, in no small part because they are seeing the love that patients have for chiropractic and the results that chiropractors are getting with adjusting. In addition, massage therapists and physical therapists in many states are engaged in a legal struggle to have adjusting added to their scope of practice. As a patient, would you prefer to be adjusted by someone with four years’ training, or a weekend seminar?
The science
The process of diagnosing which joints need to be adjusted is part of the science of chiropractic. This is usually based on the way a joint is moving or not moving, the amount of swelling in a joint, the amount of sensitivity present in a joint, and the amount of nerve pressure present in a specific place. The first three symptoms are fairly easy to detect, and ironically so is the fourth, though it is the most contested and controversial aspect of chiropractic. In addition to the tools to detect nerve pressure that chiropractors have designed over the last 100 years (many of which are so well researched and validated that they are used for testimony in court) there are the common orthopedic and neurological tests that are used by medical doctors to determine nerve interference. The compression of a nerve is a fairly easy thing to identify, though the proper treatment is rare. If you are hurting because a nerve in your back is pinched, does it make more sense to you to take a pill to make the pain go away (while the nerve is still being pinched and affecting every muscle, organ and cell the nerve supplies), or to get an adjustment to get the pressure off the nerve—which will remove the pain and the pressure?
The philosophy
The philosophy of chiropractic, upon which the art and science are based, is the philosophy that the body is a self-regulating, self-healing organism, and that your body knows what, when and where it needs better than any doctor could. This philosophy, ironically, is one that is also fundamental in medicine. Medical doctors learn it as vix medicatrix naturae, and it means the same thing; that the body heals itself. The obvious difference between chiropractic and medicine is that chiropractors attempt to facilitate this healing from the outside of the body in order to allow the body to assess itself and give itself the natural biochemistry it needs, whereas medicine tries to identify deficiencies and inject what is thought to be lacking. While there are certainly health conditions that will slow the ability of a body to care for itself in this way—like an organ deficiency such as insulin-dependent diabetes, or the challenge for a woman to produce certain hormones after a historectomy—the majority of us are in a situation where the body’s ability to assess and regulate itself is under no such restriction. In fact, the introduction of drugs from outside is more often a cause of side-effects, other symptoms and deficiencies leading to other problems and conditions, and causing the “need” for additional chemistry and drugs. All of us know someone who has gone through this process, and it is always frustrating and often painful. The body is a miracle of homeostasis—the precise balancing of hundreds of thousands of metals, minerals, vitamins, electrolytes, proteins, carbohydrates, fats, neurotransmitters, biochemicals, immune system cells and toxins. The introduction of any element from outside affects the body’s homeostasis and creates a new “balance”, and the toxicity and foreign origin of pharmaceuticals is a particularly nasty challenge for our bodies to balance. In fact, the study of drugs has traditionally been called toxicology! In chiropractic, we are interested in trusting the body’s innate ability to care for itself and to manage the internal environment. Granted, there are those doctors of chiropractic who believe that it is a miracle cure—that adjusting the neck can restore vision or allow the pancreas to make insulin again. While there certainly are antecdotal clinical cases of these sorts of “miracles”, the true miracle is what the human body is capable of when it can function properly. I would not want to be taken to a chiropractor if I were hit by a truck or severed my arm with a chainsaw—but as soon as I was out of the operating room, I would want my spine and nervous system assessed to make sure I had the best chance to heal as quickly and effectively as possible—proper function!
The fantastic thing is that this premise of the body’s innate intelligence holds true whether you believe that a Creator designed us, or whether you believe that millenia of evolution has perfected us to this point—in either case, I guarantee you that you were not born with a valium or antibiotic deficiency!
The research
One of the areas in which chiropractic has faced the most challenge is in what is called “evidence-based” health care. This has emerged out of the desire on the part of insurance companies to reduce their costs and increase their profits. This is most easily done by refusing to cover certain treatments, and beyond that by reducing the amount they pay for a treatment. The fact that over the last hundred years chiropractic has survived a focussed attack from the American Medical Association is unimportant to insurance companies. The fact that chiropractors have survived and thrived because of our patients’ efforts to make and keep chiropractic legal and legitimate is unimportant to insurance companies. The fact that over 30,000 jail terms were served by chiropractors for “practicing medicine without a license” in states that were unwilling to license us, because those chiropractors refused to stop doing what they knew was right for their patients is unimportant to insurance companies. The fact that there are clinical, though antecdotal, cases of chiropractic helping with every health condition known to man, has little to do with gaining credibility in this day and age.
There is a fast-growing body of research on chiropractic. Most is from overseas, from countries like Britain, Australia and Canada, where the health care system is public and access to records makes research easier. Some is from the USA despite the fact that research here is funded by pharmaceutical companies that in reality have an active interest in preventing research on an inexpensive, natural, noninvasive treatment. To be fair, the great differences in the way chiropractic is practiced, and the fact that almost every state outlines a different scope of practice for chiropractors, makes research more difficult. Since we can not agree as a profession on what chiropractic is, it is difficult to design an effective research strategy.
Below are listed some of the most compelling studies on chiropractic and their results. While most are several years old, in the absence of current research, they provide a perspective on the cost, safety and effectiveness of chiropractic.
| Work days lost | ||
| Who | Chiropractic | Medicine |
|---|---|---|
| Western Journal of Medicine | 6.26 | 25.56 |
| Journal of Occupational Medicine | 34.3 | 54.5 |
| FCER Studied 10,000 Worker’s Compensation cases of back injuries in Florida with same or similar Dx | Chiropractic patients had 50% less days off from work | |
| U.S. Department of Labor and Statistics | Four years after a single spinal fusion surgery, 71% of patients had not gone back to work. After multiple surgeries, 95% had not returned to work. | |
| British Medical Journal | “a reduction of 290,000 days of sickness in 2 years” if chiropractic treatment was used in place of medical treatment | |
| Treatment and disability cost | ||
| Source | Chiropractic | Medicine |
|---|---|---|
| College of William and Mary Medical School | If chiropractic care was mandated, it would reduce the cost to treat low back pain | |
| Journal of Occupational Medicine measured cost in Utah work comp cases with the same diagnosis | $68 | $668 |
| University of Richmond Medical costs assessment | If chiropractic care was insured on a level plane with medical care it would result in a decrease in treatment costs | |
| Chiropractic Journal of Australia Disability costs for work injuries in Australia for the same diagnosis | $392 | $1569 |
| British Medical Journal Cost savings in 2 years if low back pain patients were required to see DCs instead of MDs in Britain | $25.5 million | |
| Patient Care Reviewed 6,183 patent files from 2 years of insurance data | $518 | $1020 |
| Journal of Manipulative and Physiological Therapeutics 2-year retrospective analysis of 395.641 patients with the same diagnoses | 53% higher rate of hospitalization in patients who were not under chiropractic care. $1138 more per episode—not including medication costs—with medical care | |
| FCER Compared treatment costs in work comp claims in Florida | Chiropractic treatment costs were 50% less than medical treatment costs | |
| Spine | “The most costly service category was diagnostic procedures (25% of total medical costs), with surgical costs (21%) and physical therapy (20%) representing the next two most costly categories. Mental health and chiropractic care represented a small percentage of overall costs (0.4% and 2.9%, respectively).” | “The most costly service category was diagnostic procedures (25% of total medical costs), with surgical costs (21%) and physical therapy (20%) representing the next two most costly categories. Mental health and chiropractic care represented a small percentage of overall costs (0.4% and 2.9%, respectively).” |
| US Department of Health (AHCPR) | “Chiropractic and manipulative treatments are at least as effective in the treatment of back pain as medical care.” | |
Treatment and Disability Costs Manga Report
A report for the government of Ontario, Canada, used to determine whether chiropractic should be included in their national healthcare program: “If chiropractors were the primary treating doctors for low back pain, there would be decreased hospitalization and disability and a ‘savings of hundreds of millions of dollars’. In fact, it is possible that chiropractors should be the ‘gatekeepers’ for lower back problems.”
Manga Report conclusions
- DCs are more effective for low back pain than MDs.
- No clinical or case control studies showed manipulation to be unsafe for LBP—in fact, it is far safer than medical Tx.
- If DCs were used, Canada would save hundreds of millions of dollars annually.
- Patients were more satisfied with chiropractic care
- Despite medical disapproval and significant increased out of pocket expenses, chiropractic is growing
- The Canadian Government should encourage people to shift to chiropractic treatment and consider making DCs the “gatekeepers” for low back pain
Patient satisfaction
There have been dozens of studies on patient satisfaction regarding treatment by Medical Doctors, Doctors of Chiropractic, physical therapists, massage therapists, and mental health providers.
So far, every study comparing chiropractic care with medical care shows a significantly greater satisfaction with chiropractic. No study yet has shown otherwise.
AHCPR—U.S. Department of Health
- Acupuncture is not effective
- Physical therapy is not cost effective
- Only 1% of cases should receive surgery
- Epidural injections are rarely helpful and only in radicular involvement
- Antidepressant medication is not effective and can be dangerous
- Sclerosing injections are not effective
- Over the counter anti-inflammants are as effective as effective as prescription ones
- Shoe cushioning may be effective
- A few rest days followed by early movement and reintroduction into activity is important
- Manipulation is an effective treatment for low back pain
British Medical Journal
29% more patients improved under chiropractic care than those treated medically. This was measured during the three years after treatment, comparing pain, daily activities of living and satisfaction with their treatment. Chiropractic patients also expressed better sleep and were able to sit for longer periods.
| How safe is medicine? | |
| Journal of the American Medical Association 1998 | 106,000 Americans die each year from drugs prescribed by their MD |
| Journal of the American Medical Association 1998 | Over 2 million Americans become seriously ill each year from reactions to medications prescribed to them by their MD |
| Gerlin Reader’s Digest | 120,000 iatrogenic deaths annually each year in the US. 1 in 200 patients die from hospital mistakes |
| New England Journal of Medicine 1999 | 16,500 deaths each year from NSAIDs |
| Journal of Rheumatology 1992 | 1 in 2,500 osteoarthritis patients die each year related to NSAID use |
| NCMIC 2001 | The risk of tetraplegia or death resulting from NSAID use is 160-1,500 times greater than the risk due to manipulation |
| US Department of Labor and Statistics | 2 in 100 mortality rate from spinal fusion surgery |
| How safe is chiropractic? | |
| Journal of the Canadian Chiropractic Association | 1 in 3,846,153 neck manipulations |
| Journal of Manipulative and Physiological Therapeutics 1995 | 1 in 2,000,000 neck manipulations |
| Journal of Manipulative and Physiological Therapeutics 1996 | 1 in 900,000 upper cervical manipulations |
| Canadian Medical Association Journal 2001 | 1 in 5,850,000 neck manipulations |
| Canadian Chiropractic Protective Association | No claims against chiropractors for death or stroke |
| NCMIC 2001 (Chiropractic malpractice insurance carrier) | Only 19 deaths worldwide for a 65 year period, from 1934-1999 |
Most significant fact
Average doctor of chiropractic’s annual malpractice costs: $2,134. Average medical doctor’s annual malpractice costs: $91,203. This speaks to how hard it is to hurt someone with chiropractic, and how rarely we are sued!
Safety comparison
| Activity | Risk of death per person, per year |
|---|---|
| soccer and football | one in 25,000 |
| taking contraceptives | one in 5,000 |
| motorcycling | one in 50 |
| skiing | one in 430,000 |
| drinking one bottle of wine per day | one in 13,300 |
| driving | one in 5,900 |
| smoking two packs of cigarettes per day | one in 200 |
| professional boxing | one in 14,300 |
| taking NSAIDs | one in 2,500 |
| hospital stay | one in 200 |
| chiropractic manipulation | one in 6,842,106 |
