what is chiropractic really good for?

[Ken G]

I have a general question. I realize that people on this forum are generally quite skeptical of alternative medicine, but probably the closest to "mainstream" of the alternatives is chiropractic. Not so much the hooey surrounding curing cancer and so forth, but more around hurt disks or psiatica or other basic back and muscular problems. We've all heard stories about people whose backs hurt so bad that they could hardly walk, and feeling much better after visiting a chiropractor. So what is the evidence that chiropractic does indeed help with certain chronic or acute back problems, and where is the "line" where it crosses over into the same absurd anecdotal stories that things like homeopathy rely on?

[ginnie]

All I can say is that it helps mine.

I noticed a difference after the very first time I went.
I came home, and picked something up off the floor. And I thought to myself, "Somethings different, what the heck?". Then I realized I didn't have a stab of pain when I had bent over.
But I'm in no way advocating chiropractic to anyone else. Its a personal decision that I wouldn't try to influence.

I don't want to steer too much off topic, but regarding 'alternative' treatments - my wife took courses in accupressure. She was a natural for that.
I am subject to panic attacks - it doesn't disable me, but can make life and work very difficult. Her accupressure treatments work very, very well on dissapating them. The first time I had an attack I went to a hospital - I thought I was having heart problems. I felt dizzy, rapid pulse, weak and very stressed. After two treatments of accupressure, I felt absolutely great - I even said to myself audibly, "I'm baaack!"
I guess I could have taken drugs or some other treatment, but it is very convenient having a 'healer' in my home!
Again, I'm not recomending this form of treatment for anyone else -well, actually I can. It can't possibly hurt you - must be the most non-evasive treatment out there.

[Ken G]

I think there are a number of separate issues that are important to distinguish here. One is, what is the healing power of the sick person, which of course is substantial, versus what is the real role of the health professional. Chiropractic is problematic in this regard, because it expressly bases its approach on the healing power of the individual, so it becomes hard to tell if the health professional really has any direct role at all, rather than as a kind of sympathetic coach or cheerleader. The importance of the mental processes in the patient is of course quite relevant in neurological/psychological ailments like panic attacks and so forth (note I would never say such an attack is "all in your head" any more than a broken bone is "all in your leg"). So one has to distinguish some particular intervention that is effective for some physiological reason, versus something that feels nurturing or soothing and removes some psychological or neurological barrier to self-healing. Also, it is important to distinguish the many ways that anecdotal evidence can fool us, compared to double blind testing. If it works, it should show up in blind tests as clearly as in anecdotal stories. So what is the evidence of the former, and what is the distinction between therapy and the placebo effect?

[ginnie]

I think there are a number of separate issues that are important to distinguish here. One is, what is the healing power of the sick person, which of course is substantial. That is of course never more true than in neurological/psychological ailments like panic attacks and so forth (note I would never say such an attack is "all in your head" any more than a broken bone is "all in your leg"). So one has to distinguish some particular intervention that is effective for some physiological reason, versus something that feels nurturing or soothing and removes some psychological or neurological barrier to self-healing. Also, it is important to distinguish the many ways that anecdotal evidence can fool us, compared to double blind testing. If it works, it should show up in blind tests as clearly as in anecdotal stories. So what is the evidence of the latter, and what is the distinction between therapy and the placebo effect?

Point taken.
Being that panic attacks are probably more psychological rather than physical, removing that psychological barrier seems like a good treatment.

Basically, what my wife does is take my pulses at different parts of my body, two pulse points at a time and gently touches them until they are in sync. I know its a lot more complicated than that but that is the gist of it.
More info here: http://www.geocities.com/jrh_iii/acupressure/

And, hey, I'd put peanut butter in my shoes if it made me feel better.

[Ronald Brak]

It makes people feel better.

However, a good pounding that doesn't use chiropractic techniques has been shown to work just as well.

[ginnie]

It makes people feel better.

However, a good pounding that doesn't use chiropractic techniques has been shown to work just as well.

For the pounder or the poundee?

[publius]

Ken,

Is this just an academic question, or are you having back trouble?

All I can do is give you one more anecdote: I see one regularly and he does pretty good by me. I started going several years ago after I threw my back out good, real good one time.

If you're having back trouble, give one a shot. The trick is to find the good ones, and local reputation can help there. Some are good, but are others are basically quacks, trying to sell suplements and that kind of crap.

My chiropractor has this wonderful contraption dubbed a "spinalator". It's a table with a little ball shaped thing in a track that moves back and forth, undulating up and down as it does it so. You lie on it and it works your spine. I look foward to that and I could spend hours on it, it feels so good.

He's got a couple of massage therapists (and some others the titles of which escape me) and they've got magic fingers indeed.

Another contraption he had that I was leery of at first, but came to love was this electrical muscle stimulator thing. He used that on my back one time when I'd really pulled something out of whack. It sends little pulses of current via little electrodes that cause your muscles to contract in little pulsed waves and break up a spasm.

It felt funky, slightly prickly and tingly at first, but it really loosened things up.

-Richard

[jokergirl]

I don't know about chiropractics, but I know that in any of those "fringe" medical things there are a few good people and a lot of charlatans that don't know what they're doing.

I know an acupuncturist who can make acupuncture work in horses and dogs - who should be considered pretty immune to placebo effects.
Yet most, if not all acupuncture studies ever done chalk everythign up to placebo effect.
Which of the two is correct, my anecdotal evidence or the scientific study? I don't want to have to decide - but I would point to my above statement as the answer. AKA most people who do it in the western world have no clue what they are doing.

[HenrikOlsen]

From what I gather, chiropractic therapy can be split in two things, one is the physical manipulation of joints which has real measurable beneficial effects, the other is the ideas behind said manipulation in classic chiropractic teachings, which to my ears sound like utter bunk.

[grant hutchison]

So what is the evidence that chiropractic does indeed help with certain chronic or acute back problems, and where is the "line" where it crosses over into the same absurd anecdotal stories that things like homeopathy rely on?

There's general agreement that it is of benefit for low-back pain, and (some!) neck pain. But it's no better than other proven interventions. Here is the relevant Cochrane Collaboration review, Spinal manipulative therapy for low-back pain:

There was little or no difference in pain reduction or the ability to perform everyday activities between people with low-back pain who received spinal manipulation and those who received other advocated therapies.
This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.

Where it differs from these other useful therapies is in its alleged mechanism of action (the "realignment" of "subluxed" vertebrae), for which there is no medical evidence.

Grant Hutchison

[grant hutchison]

Here is the other big review I'm aware of, addressing the efficacy of chiropractic: rather impishly titled A systematic review of systematic reviews of spinal manipulation, it appeared in the Journal of the Royal Society of Medicine in 2006. As a sort of meta-review, its reference list is a fine entry point to the topic.

Results: Sixteen papers were included relating to the following conditions: back pain (n=3), neck pain (n=2), lower back pain and neck pain (n=1), headache (n=3), non-spinal pain (n=1), primary and secondary dysmenorrhoea (n=1), infantile colic (n=1), asthma (n=1), allergy (n=1), cervicogenic dizziness (n=1), and any medical problem (n=1). The conclusions of these reviews were largely negative, except for back pain where spinal manipulation was considered superior to sham manipulation but not better than conventional treatments.

Grant Hutchison

[Argos]

Skeptical approach to chiropratic.

[jj_0001]

Massage done by a therapist seems to be a reasonable thing. It certainly works when my back goes Wwheeeeee!

But I don't want anyone trying to dissect my spinal or neck arteries, thank you!

[Ken G]

Here is the other big review I'm aware of, addressing the efficacy of chiropractic: rather impishly titled A systematic review of systematic reviews of spinal manipulation, it appeared in the Journal of the Royal Society of Medicine in 2006.

I'm going to wait until there is a synergy of at least a few of such systematic reviews of the systematic review literature. I hate to frame my opinions based on just one author... (also, the link didn't work). But seriously, that does seem like a nice resource.

[Ken G]

Is this just an academic question, or are you having back trouble?

Just academic, luckily, but I was having the usual kind of conversation with someone who basically said "I don't care what the medical community says, I have seen others, and have myself, gone from hardly being able to walk to playing tennis with no pain after one or two visits to the chiropractor". Faced with that kind of anecdotal evidence, it's pretty pointless to say "but such-and-such a study said...". I think Grant's point may sum it up-- the treatments can be effective, but somehow alternative medicine gets a better image when it works than does mainstream medicine. In a way, I think mainstream medicine is expected to work, and gets ragged on when it fails, while alternative medicine is expected to be hooey, so when it actually works it seems to be a success worthy of note. But the general consensus I'm seeing does seem to confirm that for back pain, in particular, chiropractic can be quite effective, even if the "explanations" for why it is effective are complete mumbo jumbo.

I personally have the sense that a mystical explanation is part of what puts people into a positive mindset, so is actually in a way part of the effectiveness of chiropractic, even if it is obviously make believe. For example, I myself prefer getting a massage from a practioner that has crystals all around me, aromatherapy wafting through the air, and soothing music in the background. I know quite well that there is no "magical" forces at play there, but it proves to me that the massage therapist is "into it", in the sense that they really care about what they are doing-- not just going through the motions.

[ginnie]

Just academic, luckily, but I was having the usual kind of conversation with someone who basically said "I don't care what the medical community says, I have seen others, and have myself, gone from hardly being able to walk to playing tennis with no pain after one or two visits to the chiropractor". Faced with that kind of anecdotal evidence, it's pretty pointless to say "but such-and-such a study said...". I think Grant's point may sum it up-- the treatments can be effective, but somehow alternative medicine gets a better image when it works than does mainstream medicine. In a way, I think mainstream medicine is expected to work, and gets ragged on when it fails, while alternative medicine is expected to be hooey, so when it actually works it seems to be a success worthy of note. But the general consensus I'm seeing does seem to confirm that for back pain, in particular, chiropractic can be quite effective, even if the "explanations" for why it is effective are complete mumbo jumbo.

I personally have the sense that a mystical explanation is part of what puts people into a positive mindset, so is actually in a way part of the effectiveness of chiropractic, even if it is obviously make believe. For example, I myself prefer getting a massage from a practioner that has crystals all around me, aromatherapy wafting through the air, and soothing music in the background. I know quite well that there is no "magical" forces at play there, but it proves to me that the massage therapist is "into it", in the sense that they really care about what they are doing-- not just going through the motions.

I guess you could always try chiropractic, and if it doesn't work for you then go to the doctor and get some drugs.

...and some classical music in the background and incense and low lighting is present in my accupressure treatments. Just to be comfortable , ya know?
Note: I said classical not New Age regurgitated and malformed Eno impersonations!

[Dragon Star]

My father is a horse trainer by trade, and about 10 years ago he got flipped on...and it totally wrecked his back. Everything from his hips to his shoulders was out of alignment, and in quite a bit of pain. After visiting a doctor for an opinion, he told my dad he'd probably have to give up training horses for irreparable damage.

But my dad's boss, a high school gym teacher and sports therapist, wouldn't hear it...he had my dad start stretching a certain way against a wall (standing feet away from the wall, leaning on it with the shoulder and pushing the hip in as far as possible, among a few other techniques) after 2 weeks, he was absolutely 100% fine, and has continued training ever sense without a single problem.

Although probably not exactly the same thing as chiropractic medicine, it goes to show the possibility. Worked for him.

[grant hutchison]

... (also, the link didn't work) ...

Hmmm. Works for me.
Anyone else have trouble with this?

Edit: Oh, I see Henrik has been in and edited it since I posted; I must've messed up the cut and paste originally. Thanks, Henrik!

Grant Hutchison

[ryanmercer]

Making money (for the chiropractors)

[Ken G]

Here is the other big review I'm aware of, addressing the efficacy of chiropractic: rather impishly titled A systematic review of systematic reviews of spinal manipulation, it appeared in the Journal of the Royal Society of Medicine in 2006.

OK, that works now. I found this quote interesting:
" Ferreira7 concluded that SM is not substantially more effective than sham treatment for pain and no better than NSAIDs in improving disability in chronic back pain. The most recent, most comprehensive and most authoritative review9 states that SM or mobilization is superior to sham treatment and to detrimental or ineffective treatments but not better than other interventions for back pain. "

I think the general conclusion is as you report it (there can be benefits to the back that are comparable to other treatments), but to me the study still leaves two crucial issues unconsidered: 1) the cost-per-benefit analysis, and 2) the side-effect-per-benefit analysis. For example, if you look at the above quote, it suggests that anyone would choose NSAI drugs if they knew they would work as well as a trip to the chiropractor, but there are several flaws in that attitude. One is that an NSAI drug does not make the patient feel "cared for". The other is that NSAIDs must be taken constantly and for long periods of time to be effective, and that can lead to damage to the organs that labor to clear the drugs from the body. Some people have a strong aversion to that situation. Of course, a bad chiropractor can also damage the body, but many people like their chiropractors and feel confident they will not do harm (even though I'm not aware the chiropractic includes the Hippocratic oath!). So it's not clear that the study really factored in every relevant criterion when they reached their conclusion. Nevertheless, the data that is summarized is still useful for reaching partial conclusions.

Also, they mention that chiropractic can be expensive, but I'm not aware of a systematic comparison of the costs of chiropractic visits versus visits to the osteopath. Of course, costs are very difficult to compare, because one never knows how much of the cost is related to better handling of relatively unlikely but potentially devastating outcomes. I suspect that hospitals and osteopaths involve a considerable overhead related to preventing rare but critical outcomes, which doesn't show up in most anecdotal tales.

Another factor to weigh is what patients report as the overall pleasure/anxiety they experience in the interaction with the health professional, which just wasn't part of that study. The assumption of the mainstream is probably that the patient's momentary attitude is not terribly important, but it may relate to their likelihood of carrying through on a particular course of therapy. I suspect that this may the area, above all, in which chiropractic "trumps" hospitals and clinics.

[DyerWolf]

A friend of mine recently complained of a stiff neck (he'd slept weird and woke up with a crick in his neck - couldn't turn his head to the left).

The next day he told me he'd seen his Chiropractor, and things were improved.

I teased him for wasting money on an expensive masseuse.

His response?

"Expensive hell; a $20 co-pay is cheaper than a half-hour massage!"

Best justification for a chiropractor I've heard yet.

[grant hutchison]

Paying $20 to run a ~1:1,000,000 risk of stroke or tetraplegia, in order to fix something that would get better on its own?
I'm not getting the attraction, personally.

Grant Hutchison

[DyerWolf]

I hear you.

I'm very skeptical of the efficacy of chiropractic - especially as many patients seem to 'require' prolonged treatments (compare to physical therapy).

Anyway, his was the only explanation I've heard that came close to justifying spending money on chiropractic, rather than physical therapy or stretching, exercise and rest (which, IMO, are probably better for you anyway). I've often said; if you want a massage, just get a massage.

[grant hutchison]

I think the general conclusion is as you report it (there can be benefits to the back that are comparable to other treatments), but to me the study still leaves two crucial issues unconsidered: 1) the cost-per-benefit analysis, and 2) the side-effect-per-benefit analysis.

Well, to be fair, you didn't actually ask for this information until now. Your original post just asked for evidence relating to effectiveness.
Cost-benefit has been done in many different settings: here is a relatively recent review of the situation in the UK, which also demonstrates how messy these things can get, given the variety of more-or-less-equally successful treatments available, and the relapsing and recurring nature of back pain.

Complementary treatments represent an additional healthcare cost in four out of the five rigorous cost effectiveness studies conducted in the UK. These studies are confined to acupuncture and spinal manipulation. Estimates of cost per QALY from three studies compare favourably with other treatments approved for use in the NHS, but for spinal manipulation the health benefits were small to moderate and are of questionable clinical significance. Measurement of costs was incomplete in all studies and omitted follow-on costs. Standard modelling methods were not used. Absence of blinding and sham control treatments may have increased non-specific treatment effects. Estimates of cost effectiveness may be less favourable in situations for which the complementary treatment is offered routinely rather than in the novel situation of a clinical trial.

Risk-benefit studies are made very difficult by the poor and variable recording of adverse events in chiropractic, as in other "alternative medicine". Such studies may have been done, but I would take results with a pinch of salt.

The other is that NSAIDs must be taken constantly and for long periods of time to be effective, and that can lead to damage to the organs that labor to clear the drugs from the body.

Well, this isn't necessarily so. For the sort of episodic low-back pain that causes so many immobile days and visits to chiropractors, a short pulse of NSAIDs (three to five days) can restore movement, allowing exercises to reverse the situation. Although it's certainly possible to damage yourself with NSAIDs in that sort of time period, it does require a significant degree of bad luck or a significant deviation from the manufacturer's recommendations.

Also, they mention that chiropractic can be expensive, but I'm not aware of a systematic comparison of the costs of chiropractic visits versus visits to the osteopath.

I'm intrigued by the contrast you seem to be making, here. In the UK, at least, both these practices are considered equally "alternative", though osteopathy is thought to be potentially less risky, since (despite its name) it also targets soft tissue and involves correspondingly less vigourous manipulation.

Grant Hutchison

[dgruss23]

My back "goes out" between my shoulder blades. A visit to the Chiropracter fixes it. In fact, if I go more than 2 weeks without a visit, it starts to go out again. I don't buy all the extraneous mumbo-jumbo that goes with some chiropracter's. Just snap my spine back into place and I'm good to go. And Advil isn't going to fix my problem. Nor is exercise. I work out all the time and it will still go out.

[publius]

I was just reading something about the Olympics (I got interested in this crazy tape some of the athletes were wearing, something called Kinesio taping, that looked like some weird tatto). Anyway, the US Olympic team and those of others nations have team chiropractors (and just everything else as well). The chiro was one of them who worked with that tape.


-Richard

[spratleyj]

I don't see how chiropractors aren't "mainstream" "medicine", I thought they just put your "bones" into place? I had back problems from basketball and so I went to the chiropractor and it was better the very next day...

[nauthiz]

I'm intrigued by the contrast you seem to be making, here. In the UK, at least, both these practices are considered equally "alternative", though osteopathy is thought to be potentially less risky, since (despite its name) it also targets soft tissue and involves correspondingly less vigourous manipulation.

Osteopathy in the USA is a bit unique, as osteopaths are fully accredited doctors that have received all the training an MD would get plus an extra year (approximately) for osteopathic training, and most of them end up working as physicians at a normal hospital. Consequently, American osteopaths tend to be much more interested in evidence-based medicine, though mileage can vary - I imagine one could still find a doctor who is willing to do some of the crazier stuff like cranial manipulation if one wanted to. At the other end of the spectrum, though, an osteopath may not operate his practice any differently from a colleague with a regular MD education. The latter's the case for my father, who holds a DO but is an emergency physician and the director of his department. I don't think he's performed a lick of OMT any time in the past decade. (It's not something that's really applicable to his area of medicine.)

[HenrikOlsen]

I don't see how chiropractors aren't "mainstream" "medicine", I thought they just put your "bones" into place? I had back problems from basketball and so I went to the chiropractor and it was better the very next day...

They put your bones into place so the energies can flow freely or some silliness like that.
As many have said before in this thread, the action seems to be beneficial in many cases, the reasoning behind it is utter bunk.

[grant hutchison]

Just snap my spine back into place and I'm good to go. And Advil isn't going to fix my problem. Nor is exercise. I work out all the time and it will still go out.

Not all exercise is the same; in fact, you may even be doing something that is provoking your back problem. A physio might be able to identify that for you, and would also provide specific exercises to undo the knot in your back.

Grant Hutchison