In chiropractic , a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action or makeup (defined by D.D. Palmer and B.J. Palmer, founders of chiropractic). Chiropractors claim subluxations are not necessarily visible on X-rays .
157-440: Chiropractic ( / ˌ k aɪ r oʊ ˈ p r æ k t ɪ k / ) is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine . It is based on several pseudoscientific ideas. Many chiropractors (often known informally as chiros ), especially those in the field's early history, have proposed that mechanical disorders of
314-423: A syndrome with signs and symptoms which include: altered alignment; aberrant motion; palpable soft tissue changes; localized/referred pain; muscle contraction or imbalance; altered physiological function; reversible with adjustment/manipulation; focal tenderness. Chiropractic treatment of vertebral subluxation focuses on delivering a chiropractic adjustment which is a high velocity low amplitude (HVLA) thrust to
471-471: A 2018 interview with The BMJ , Edzard Ernst stated: "The present popularity of complementary and alternative medicine is also inviting criticism of what we are doing in mainstream medicine. It shows that we aren't fulfilling a certain need-we are not giving patients enough time, compassion, or empathy. These are things that complementary practitioners are very good at. Mainstream medicine could learn something from complementary medicine." Alternative medicine
628-476: A bone-out-of-place (BOOP) subluxation... Clearly, the BOOP subluxation model fails miserably when considered in the light of basic neuroscience facts... BOOP subluxationists become angry and defensive when the BOOP model of subluxation is criticized... The reactionary nature of certain BOOP subluxationists is to accuse those who don't buy into the BOOP model of being anti-chiropractic—an astonishing leap of ignorance, to say
785-405: A campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research. ↓ Restoration of structural integrity ↓ Improvement of health status ↓ Innate intelligence ↓ Body physiology Although a wide diversity of ideas exist among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship
942-472: A classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy , colorpuncture and light therapy ) and putative , which invokes physically undetectable or unverifiable energy. None of these energies have any evidence to support that they affect
1099-469: A code. ICD-9 has never provided a code that truly describes this and differentiates between the chiropractic subluxation and the allopathic subluxation. Chiropractors have been compelled to try to fit a square peg into a round hole for many years. At the time of writing (August 2014) it was still uncertain which codes in the newer ICD-10 would be useful for chiropractors and how they would be interpreted. Traditionally there have been five components that form
1256-414: A corresponding increase in success of its treatments. In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine". Use of alternative medicine in the west began to rise following
1413-591: A crossroads, and that in order to progress it would need to embrace science; the promotion by some for it to be a cure-all was both "misguided and irrational". A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills. Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries. Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with varied results. There
1570-446: A culture which have existed since before the advent of medical science, Many TM practices are based on "holistic" approaches to disease and health, versus the scientific evidence-based methods in conventional medicine. The 2019 WHO report defines traditional medicine as "the sum total of the knowledge, skill and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in
1727-460: A family doctor. Quackwatch , an alternative medicine watchdog, cautions against seeing chiropractors who: Writing for the Skeptical Inquirer , one physician cautioned against seeing even chiropractors who solely claim to treat musculoskeletal conditions: I think Spinal Manipulation Therapy (SMT) is a reasonable option for patients to try ... But I could not in good conscience refer
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#17330854537641884-529: A joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact". Chiropractic subluxation should not be confused with a medical subluxation , which is a "significant structural displacement" visible on static imaging studies such as X-rays . Chiropractic is a field of alternative treatment outside scientific mainstream medicine , whose practitioners (chiropractors) are not medical doctors . In 1910, D.D. Palmer ,
2041-613: A medical subluxation and a chiropractic "vertebral subluxation" create confusion and difficulties when it comes to following official ICD-9 and ICD-10 coding. In a 2014 article in Dynamic Chiropractic by a chiropractor who is a certified professional coder , these difficulties were discussed in detail. He noted that the WHO recognizes the differences between the two types of "subluxations", and also pointed out certain difficulties for chiropractors: ...the official definition of 739 codes
2198-435: A method is proven to work, it eventually ceases to be alternative and becomes mainstream medicine. Much of the perceived effect of an alternative practice arises from a belief that it will be effective, the placebo effect , or from the treated condition resolving on its own ( the natural course of disease ). This is further exacerbated by the tendency to turn to alternative therapies upon the failure of medicine, at which point
2355-459: A nerve interfering with the passage of energy down that nerve causing disease to organs supplied by that nerve, and that chiropractic "adjustments" can alleviate the pressure thereby treating or preventing such disease. There is no scientific evidence for the validity of this theory." To be fair, statements by some chiropractors have tended to perpetuate this misunderstanding: "Pressure on nerves causes irritation and tension with deranged functions as
2512-431: A non-drug approach to treating some health conditions. In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe, cognitive biases that help maintain self-esteem and promote harmonious social functioning, and the post hoc, ergo propter hoc fallacy. In
2669-577: A particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods. Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices. Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine ,
2826-430: A patient to a chiropractor... When chiropractic is effective, what is effective is not 'chiropractic': it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers ... If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider. Chiropractors emphasize the conservative management of the neuromusculoskeletal system without
2983-536: A patient's condition even though the objective effect is non-existent, or even harmful. David Gorski argues that alternative treatments should be treated as a placebo, rather than as medicine. Almost none have performed significantly better than a placebo in clinical trials. Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication. A patient who receives an inert treatment may report improvements afterwards that it did not cause. Assuming it
3140-494: A person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category. Edzard Ernst , the first university professor of Complementary and Alternative Medicine, characterized the evidence for many alternative techniques as weak, nonexistent, or negative and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate. Ernst has concluded that 95% of
3297-571: A project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis . According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically. As of 2005 , the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of
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#17330854537643454-633: A research institute for integrative medicine (a member entity of the Cochrane Collaboration ). Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD). All states require that applicants for MD licensure be graduates of an approved medical school and complete
3611-534: A result of reforms following the Flexner Report of 1910 medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic. Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology. Medical schools' teaching includes such topics as doctor-patient communication, ethics,
3768-422: A result." When chiropractors declare that "pinched nerves" "nerve impingement" "spinal fixations" or others mechanisms of action explain how subluxations affect the person and how chiropractic works they are making the same mistake medical critics make – assuming chiropractic is based on theory. Mechanisms and theories are useful tools, but their limitations should always be kept in mind. The differences between
3925-492: A significant structural displacement, which can be seen with static imaging techniques such as X-rays . The use of X-ray imaging in the case of vertebral subluxation exposes patients to harmful ionizing radiation for no evidentially supported reason. The 2008 book Trick or Treatment states "X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist." Attorney David Chapman-Smith, Secretary-General of
4082-536: A single factor, vertebral subluxation . Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis. A large number of chiropractors fear that if they do not separate themselves from the traditional vitalistic concept of innate intelligence, chiropractic will continue to be seen as a fringe profession. A variant of chiropractic called naprapathy originated in Chicago in
4239-535: A single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies. By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US. Exceptionally, the School of Medicine of the University of Maryland, Baltimore , includes
4396-587: A slight majority favored allowing them to write prescriptions for over-the-counter drugs . A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment. A related field, veterinary chiropractic , applies manual therapies to animals and is recognized in many US states, but is not recognized by the American Chiropractic Association as being chiropractic. It remains controversial within certain segments of
4553-530: A small but vocal and influential number of chiropractors spread vaccine misinformation . Chiropractic is generally categorized as complementary and alternative medicine (CAM), which focuses on manipulation of the musculoskeletal system , especially the spine . Its founder, D. D. Palmer, called it "a science of healing without drugs". Chiropractic's origins lie in the folk medicine of bonesetting , and as it evolved it incorporated vitalism , spiritual inspiration and rationalism . Its early philosophy
4710-522: A source of controversy since its inception in 1895 due to the lack of empirical evidence for its existence, its metaphysical origins, and claims of its far reaching effects on health and disease. Although some chiropractic associations and colleges support the concept of subluxation, many in the chiropractic profession reject it and shun the use of this term as a diagnosis. In the United States and in Canada
4867-567: A source of controversy within the chiropractic profession. The usefulness of spinal manipulation for organic disorders is not supported by evidence. Chiropractic professors and researchers, Nansel and Szlazak, found that: the proper differential diagnosis of somatic (musculoskeletal) vs. visceral (organ) dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, suggest it
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5024-508: A spring-loaded tool to deliver precise adjustments to the spine), Thompson Technique (which relies on a drop table and detailed procedural protocols), Gonstead (which emphasizes evaluating the spine along with specific adjustment that avoids rotational vectors), Cox/flexion-distraction (a gentle, low-force adjusting procedure which mixes chiropractic with osteopathic principles and utilizes specialized adjusting tables with movable parts), adjustive instrument, Sacro-Occipital Technique (which models
5181-463: A strong political base and sustained demand for services. In the last decades of the twentieth century, it gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States. During the COVID-19 pandemic , chiropractic professional associations advised chiropractors to adhere to CDC , WHO , and local health department guidance. Despite these recommendations,
5338-508: A subluxation-based clinical approach may be of limited utility for addressing visceral disorders , and greatly favored non-subluxation-based clinical approaches for such conditions. The same survey showed that most chiropractors generally believed that the majority of their clinical approach for addressing musculoskeletal/biomechanical disorders such as back pain was based on subluxation. Chiropractors often offer conventional therapies such as physical therapy and lifestyle counseling, and it may for
5495-955: A test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or "experimental subordination", observer bias , and misleading wording of questions. In their 2010 systematic review of studies into placebos, Asbjørn Hróbjartsson and Peter C. Gøtzsche write that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding ." Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased side effects or nocebo effects towards standard treatment. Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer
5652-624: A treatment to be harmful will perceive harmful effects after taking it. Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea. A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect. However, reassessments found the study to have flawed methodology. This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered. All of these are reasons why alternative therapies may be credited for improving
5809-485: A visceral component to the definition, while mixers, as exemplified by the United Kingdom's General Chiropractic Council, consider it a historical concept with no evidence identifying it as the cause of disease. Some chiropractors have described the disagreements within the profession about the concept, and have written skeptically about BOOP as an antiquated idea. In 1992 one wrote: The main problem we often run into
5966-436: A wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies. Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based. Methods may incorporate or be based on traditional medicinal practices of
6123-480: A wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise. Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation. A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves spinal manipulation (SM) and other manual therapies to
6280-456: Is "nonallopathic lesions, not elsewhere classified.... In other words, 739 is a code that does not describe a subluxation. It does not even say what the patient has; it says that there is no code to describe what the patient has.... [T]he elusive "vertebral subluxation complex" I learned about in school has no place in the ICD-9 code set. All we get is 739, which is a code for conditions that do not have
6437-529: Is a profitable industry with large media advertising expenditures. Accordingly, alternative practices are often portrayed positively and compared favorably to "big pharma" . Vertebral subluxation Straight chiropractors continue to follow Palmer's tradition, claiming that vertebral subluxation has considerable health effects and also adding a visceral component to the definition. Mainstream medicine and some mixer chiropractors consider these ideas to be pseudoscientific and dispute these claims, as there
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6594-431: Is a wide range of ways to measure treatment outcomes. Chiropractic care benefits from the placebo response , but it is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT). The efficacy of maintenance care in chiropractic is unknown. Available evidence covers the following conditions: Alternative medicine Alternative medicine is any practice that aims to achieve
6751-508: Is based on belief systems not grounded in science. Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world. Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted. Traditional medicine
6908-415: Is based on the theory or principle that vertebral subluxations cause "pinched" nerves that cause disease. They have it backwards. Chiropractic is based on the success of the spinal adjustment. The theory attempting to explain the success of the adjustment (nerve impingement, disease, subluxations) followed its clinical discovery. Examples of such erroneous criticisms based on this straw man argument abound in
7065-531: Is beyond our concern here. These assertions were published as a priori truths (what many chiropractors have traditionally referred to as "principle"), and are exemplary of scientifically unjustified assertions made in many corners of the profession. It matters not whether unsubstantiated assertions are offered for clinical, political, scientific, educational, marketing or other purposes; when offered without acknowledgment of their tentative character, they amount to dogmatism. We contend that attempts to foster unity (among
7222-406: Is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work – such as knowing that the practice is based on superstition. Bases of belief may include belief in existence of supernatural energies undetected by
7379-462: Is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been established using scientific methods , or whose theory and practice is not part of biomedicine , or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine. "Biomedicine" or "medicine"
7536-541: Is essentially a functional entity, which may influence biomechanical and neural integrity. The purported displacement is not necessarily visible on static imaging studies, such as X-rays . This is in contrast to the medical definition of spinal subluxation which, according to the WHO, is a "significant structural displacement", and therefore visible on X-rays. As of 2014, the National Board of Chiropractic Examiners states: The specific focus of chiropractic practice
7693-403: Is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven". Anything classified as alternative medicine by definition does not have a proven healing or medical effect. However, there are different mechanisms through which it can be perceived to "work". The common denominator of these mechanisms is that effects are mis-attributed to
7850-431: Is known as the chiropractic subluxation or joint dysfunction. A subluxation is a health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness. In 1996 an official consensus definition of subluxation was formed. Cooperstein and Gleberzon have described the situation: "... although many in
8007-486: Is mediated through the nervous system . Some chiropractors claim spinal manipulation can have an effect on a variety of ailments such as irritable bowel syndrome and asthma . Chiropractic philosophy includes the following perspectives: Holism assumes that health is affected by everything in an individual's environment; some sources also include a spiritual or existential dimension. In contrast, reductionism in chiropractic reduces causes and cures of health problems to
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#17330854537648164-482: Is no conclusive evidence that chiropractic manipulative treatment is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain. Generally, the research carried out into the effectiveness of chiropractic has been of poor quality. Research published by chiropractors is distinctly biased: reviews of SM for back pain tended to find positive conclusions when authored by chiropractors, while reviews by mainstream authors did not. There
8321-437: Is no infection... . There is a cause internal to man that makes of his body in a certain spot, more or less a breeding ground [for microbes]. It is a place where they can multiply, propagate, and then because they become so many they are classed as a cause. Chiropractors use and have used various terms to express this concept: subluxation, vertebral subluxation (VS), vertebral subluxation complex (VSC), "killer subluxations", and
8478-476: Is no scientific evidence for the existence of chiropractic subluxations or proof they or their treatment have any effects on health. The use of the word vertebral subluxation should not be confused with the term's precise usage in medicine, which considers only the anatomical relationships. According to the World Health Organization (WHO), a chiropractic subluxation is a "dysfunction in
8635-403: Is not a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.) . While many chiropractors view themselves as primary care providers, chiropractic clinical training does not meet the requirements for that designation. Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective , with
8792-436: Is not sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects , with serious or fatal complications in rare cases. There is controversy regarding the degree of risk of vertebral artery dissection , which can lead to stroke and death, from cervical manipulation . Several deaths have been associated with this technique and it has been suggested that
8949-451: Is not unreasonable that this somatic visceral-disease mimicry could very well account for the "cures" of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims on the part of such clinical disciplines. Considering this phenomenon, Seaman suggests that
9106-525: Is really no such thing as alternative medicine, just medicine that works and medicine that doesn't", a notion later echoed by Paul Offit : "The truth is there's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends." Alternative medicine consists of
9263-480: Is sometimes derogatorily called " Big Pharma " by supporters of alternative medicine. Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven. The terms alternative medicine , complementary medicine , integrative medicine, holistic medicine , natural medicine , unorthodox medicine , fringe medicine , unconventional medicine , and new age medicine are used interchangeably as having
9420-415: Is supposed to be contagious, a cause in the spine . In the spinal column we will find a subluxation that corresponds to every type of disease. If we had one hundred cases of small-pox , I can prove to you where, in one, you will find a subluxation and you will find the same conditions in the other ninety-nine. I adjust one and return his functions to normal... . There is no contagious disease... . There
9577-710: Is that part of medical science that applies principles of biology , physiology , molecular biology , biophysics , and other natural sciences to clinical practice , using scientific methods to establish the effectiveness of that practice. Unlike medicine, an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay , religion, tradition, superstition , belief in supernatural energies, pseudoscience , errors in reasoning , propaganda, fraud, or other unscientific sources. Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare. This can refer to
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#17330854537649734-408: Is the bone out of place (BOOP) concept. It seems we somehow step on toes when we describe the spine as a functioning entity instead of a stack of bones that can be shifted back and forth into the ideal configuration. The BOOP concept will eventually fade, and we are grateful for its contribution to chiropractic. For many decades, it offered a model to work from. This model has been updated by the rest of
9891-577: Is the most common treatment used in chiropractic care. Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint. Its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion. High-velocity, low-amplitude spinal manipulation (HVLA-SM) thrusts have physiological effects that signal neural discharge from paraspinal muscle tissues, depending on duration and amplitude of
10048-612: Is when alternative medicine is used together with mainstream functional medical treatment in a belief that it improves the effect of treatments. For example, acupuncture (piercing the body with needles to influence the flow of a supernatural energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time. Significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy . Several medical organizations differentiate between complementary and alternative medicine including
10205-500: The General Chiropractic Council , the statutory regulatory body for chiropractors in the United Kingdom, issued guidance for chiropractors stating that the chiropractic vertebral subluxation complex "is an historical concept" and "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns." The chiropractic vertebral subluxation complex has been
10362-643: The United States Medical Licensing Examination (USMLE). There is a general scientific consensus that alternative therapies lack the requisite scientific validation , and their effectiveness is either unproved or disproved. Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias , marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question
10519-499: The World Federation of Chiropractic , has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on X-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static X-ray than a limp or headache or any other functional problem." The General Chiropractic Council , the statutory regulatory body for chiropractors in
10676-427: The chiropractic subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity." This differs from the medical definition of subluxation as
10833-569: The counterculture movement of the 1960s, as part of the rising new age movement of the 1970s. This was due to misleading mass marketing of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures ( cultural relativism ), and growing frustration and desperation by patients about limitations and side effects of science-based medicine. At
10990-466: The joints , especially of the spine , affect general health, and that regular manipulation of the spine ( spinal adjustment ) improves general health. The main chiropractic treatment technique involves manual therapy , especially manipulation of the spine, other joints, and soft tissues , but may also include exercises and health and lifestyle counseling. A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as "doctor" but
11147-419: The materialism of science. However, most practitioners tend to incorporate scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness . A 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of
11304-567: The "brutal civil war": According to various gossip columnists in chiropractic, our profession appears to be currently enmeshed in a brutal civil war between BOOP (bone-out-of-place) practitioners and low back pain practitioners. It should be known that the BOOPers incorrectly call themselves subluxation-based practitioners. My experience has demonstrated that the BOOPers do not know enough about subluxation to call themselves subluxation-based chiropractors. We would all do well to not be subluxation-based in
11461-432: The "silent killer". Chiropractors along with some physical therapists and osteopathic physicians, have also used another term, BOOP, meaning "bone out of place". The WHO definition of the chiropractic vertebral subluxation is: A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It
11618-520: The "whole" person, in contrast to the supposed reductionism of medicine. Prominent members of the science and biomedical science community say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all. Others say that alternative medicine cannot be precisely defined because of
11775-405: The BOOP sense. It should also be known that this so-called war is really an over-dramatized skirmish between vocal BOOPers and a theoretical group of anti-chiropractic DCs. I have yet to meet any of these anti-chiropractic DCs. Unfortunately, the BOOPers seem to think that those who do not embrace the totality of BOOP philosophy are merely non-BOOPers who are still very pro-chiropractic and appreciate
11932-544: The CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database. Alternative therapies do not "complement" (improve the effect of, or mitigate the side effects of) functional medical treatment. Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin . In
12089-728: The UK National Health Service (NHS), Cancer Research UK , and the US Center for Disease Control and Prevention (CDC), the latter of which states that " Complementary medicine is used in addition to standard treatments" whereas " Alternative medicine is used instead of standard treatments." Complementary and integrative interventions are used to improve fatigue in adult cancer patients. David Gorski has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine with skeptics such as Gorski and David Colquhoun referring to this with
12246-501: The US and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be "experimental and investigational". Medicine-assisted manipulation, such as manipulation under anesthesia , involves sedation or local anesthetic and is done by a team that includes an anesthesiologist ; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain. Many other procedures are used by chiropractors for treating
12403-458: The US remains primarily a manual medical system; physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. Practitioners may distinguish these competing approaches through claims that, compared to other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use
12560-757: The US, their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa , broadly allow treatment of "human ailments"; some, such as Delaware , use vague concepts such as "transition of nerve energy" to define scope of practice; others, such as New Jersey , specify a severely narrowed scope. US states also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements, or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. A 2003 survey of North American chiropractors found that
12717-490: The United Kingdom, states that the chiropractic vertebral subluxation complex "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease." As of 2014, the US National Board of Chiropractic Examiners states "The specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction. A subluxation is a health concern that manifests in
12874-417: The alternative therapies he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology , are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine. In 2003,
13031-408: The alternative treatment. A placebo is a treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery . The placebo effect is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the nocebo effect , when patients who expect
13188-491: The art of medicine, and engaging in complex clinical reasoning (medical decision-making). Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease,
13345-445: The body in any positive or health promoting way. The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment. It includes
13502-402: The body's function and its inborn ability to heal itself. D. D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. He qualified this by noting that knowledge of innate intelligence was not essential to
13659-517: The chiropractic adjustment. This is not a unique state of affairs, abstract entities populate many branches of science... Subluxations, genes, gravity, the ego and life are all heuristic devices, "useful fictions" that are used to explain phenomenon that are far larger than our understanding. We use them as long as they work for us and discard or limit their application when they become unwieldy or unable to account for new observations... Critics of chiropractic have incorrectly assumed that chiropractic
13816-461: The chiropractic community have been used to generate practice guidelines outlining standards that specify which chiropractic treatments are legitimate (i.e. supported by evidence) and conceivably reimbursable under managed care health payment systems. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims. Chiropractic remains at
13973-470: The chiropractic concept of joint complex (somatic) dysfunction should be incorporated into the differential diagnosis of pain and visceral symptoms because these dysfunctions often generate symptoms similar to those produced by true visceral disease and says that this mimicry leads to unnecessary surgical procedures and medications. Other chiropractic researchers have also questioned some of the claimed effects of vertebral subluxation: The literature supports
14130-454: The chiropractic profession reject the concept of "subluxation" and shun the use of this term as a diagnosis, the presidents of at least a dozen chiropractic colleges of the Association of Chiropractic Colleges (ACC) developed a consensus definition of "subluxation" in 1996. It reads: Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on
14287-407: The chiropractic subluxation. Historically, the detection of spinal misalignment (subluxations) by the chiropractic profession has relied on X-ray findings and physical examination. At least two of the following four physical signs and/or symptoms must be documented to qualify for reimbursement : It has been proposed that a vertebral subluxation can negatively affect general health by altering
14444-482: The claims of efficacy of isolated examples where there is evidence for alternative therapies. The Scientific Review of Alternative Medicine points to confusions in the general population – a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy ) gets misattributed to an alternative medicine being taken;
14601-418: The competent practice of chiropractic. This concept was later expanded upon by his son, B. J. Palmer, and was instrumental in providing the legal basis of differentiating chiropractic from conventional medicine. In 1910, D. D. Palmer theorized that the nervous system controlled health: Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent . Impressions are made on
14758-637: The conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However,
14915-477: The condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or HIV infection , multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative therapies are actively harmful (e.g. cyanide poisoning from amygdalin , or
15072-539: The diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change. Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique , therapeutic practice and in their relationship to the medical mainstream. Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another. Critics say
15229-628: The dominant health care system. They are used interchangeably with traditional medicine in some countries." The Integrative Medicine Exam by the American Board of Physician Specialties includes the following subjects: Manual Therapies , Biofield Therapies , Acupuncture , Movement Therapies, Expressive Arts, Traditional Chinese Medicine , Ayurveda , Indigenous Medical Systems , Homeopathic Medicine , Naturopathic Medicine , Osteopathic Medicine , Chiropractic , and Functional Medicine . Traditional medicine (TM) refers to certain practices within
15386-425: The dysfunctional spinal segments to help correct the chiropractic subluxation complex. Spinal adjustment is the primary procedure used by chiropractors in the adjustment. The chiropractic subluxation is the heart of the split between "straight" and "mixer" chiropractors. Straight chiropractors continue to follow Palmer's vitalistic tradition, claiming that subluxation has considerable health effects and also adding
15543-441: The early twentieth century. It holds that manual manipulation of soft tissue can reduce "interference" in the body and thus improve health. Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an "innate intelligence" exerted via
15700-482: The established science of how the human body works; others appeal to the supernatural or superstitious to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive risk–benefit outcome probability. Research into alternative therapies often fails to follow proper research protocols (such as placebo -controlled trials, blind experiments and calculation of prior probability ), providing invalid results. History has shown that if
15857-433: The existence of somatovisceral and viscerosomatic reflexes, but there is little or no evidence to support the notion that the spinal derangements (often referred to as subluxations by chiropractors) can cause prolonged aberrant discharge of these reflexes. Equally unsupported in the literature is the notion that the prolonged activation of these reflexes will manifest into pathological state of tissues, and most relevantly, that
16014-424: The expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo . Journalist John Diamond wrote that "there
16171-468: The founder of chiropractic, wrote: Nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionating—too much or not enough action—which is dis-ease. In 1909, D.D. Palmer's son, B.J. Palmer , incorrectly claimed that chiropractic subluxation caused contagious diseases, writing: Chiropractors have found in every disease that
16328-442: The healing effects of medicine despite lacking biological plausibility , testability , repeatability or evidence of effectiveness. Unlike modern medicine , which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials , producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of mainstream medicine and do not originate from using
16485-459: The healing profession, but chiropractors have been hesitant to let this antiquated model go. Some within our profession hold onto this model with a religious fervor. The chiropractic profession has moved into a new age. The BOOP concept has been updated and science is ever upon us in the 90s. Let's start asking questions again and drive the chiropractic profession kicking and screaming into the 21st century. Chiropractor David Seaman wrote in 1994 about
16642-509: The histories of complementary medicine and of integrative medicine . Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery. Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had
16799-758: The human nervous system and is a primary underlying risk factor for many diseases. Straights view the medical diagnosis of patient complaints, which they consider to be the "secondary effects" of subluxations, to be unnecessary for chiropractic treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies into their practice style. Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology such as "perform spinal analysis", "detect subluxation", "correct with adjustment". They prefer to remain separate and distinct from mainstream health care. Although considered
16956-781: The intentional ingestion of hydrogen peroxide ) or actively interfere with effective treatments. The alternative medicine sector is a highly profitable industry with a strong lobby, and faces far less regulation over the use and marketing of unproven treatments. Complementary medicine ( CM ), complementary and alternative medicine ( CAM ), integrated medicine or integrative medicine ( IM ), and holistic medicine attempt to combine alternative practices with those of mainstream medicine. Traditional medicine practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Alternative methods are often marketed as more " natural " or " holistic " than methods offered by medical science, that
17113-406: The joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle advice. Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States (although New Mexico has become the first US state to allow "advanced practice" trained chiropractors to prescribe certain medications). In
17270-566: The label "back and neck pain specialists" was regarded by 47% of them as a least desirable description in a 2005 international survey. Chiropractic combines aspects from mainstream and alternative medicine, and there is no agreement about how to define the profession: although chiropractors have many attributes of primary care providers, chiropractic has more attributes of a medical specialty like dentistry or podiatry . It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems, but
17427-542: The lack of support that alternative therapies receive from medical scientists regarding access to research funding , sympathetic coverage in the medical press , or inclusion in the standard medical curriculum . For example, a widely used definition devised by the US NCCIH calls it "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine" . However, these descriptive definitions are inadequate in
17584-599: The lay person be difficult to distinguish the unscientific from the scientific. In science-based medicine, the term "subluxation" refers to an incomplete or partial dislocation of a joint , from the Latin luxare for 'dislocate'. While medical doctors use the term exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word subluxation with a metaphysical and philosophical meaning drawn from pseudoscientific traditions such as Vitalism . Palmer claimed that vertebral subluxations interfered with
17741-459: The least. Furthermore, anyone who does not buy into the model is trying to "medicalize chiropractic"—another example of low-IQ thinking. And if tears do not well up in your eyes when you hear the phrase, "The power that made the body, heals the body," you are accused of having no passion for chiropractic—still another example of depressed, frontal-lobe activity. Even worse, if you don't buy into every bizarre, New Age, tree-hugging notion that comes down
17898-439: The length, breadth, and depth of chiropractic clinical training do not support the requirements to be considered primary care providers, so their role on primary care is limited and disputed. Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy , physical therapy, and sports medicine . Chiropractic is autonomous from and competitive with mainstream medicine, and osteopathy outside
18055-564: The loose terminology to give the appearance of effectiveness). Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not (e.g., the use of the expressions "Western medicine" and "Eastern medicine" to suggest that the difference is a cultural difference between the Asian east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work). Alternative medicine
18212-492: The maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness." When used outside the original setting and in the absence of scientific evidence, TM practices are typically referred to as "alternative medicine". Holistic medicine is another rebranding of alternative medicine. In this case, the words balance and holism are often used alongside complementary or integrative , claiming to take into fuller account
18369-484: The majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1,100 North American chiropractors, which found that 88 percent wanted to retain the term "vertebral subluxation complex", and that when asked to estimate the percent of disorders of internal organs that subluxation significantly contributes to, the mean response was 62 percent. A 2008 survey of 6,000 American chiropractors demonstrated that most chiropractors seem to believe that
18526-405: The medical literature. Some examples: "The teachers, research workers and practitioners of medicine reject the so-called principle on which chiropractic is based and correctly and bluntly label it a fraud and hoax on the human race." "The basis of chiropractic is completely unscientific." The theory on which chiropractic is based [is false], namely that a "subluxation" of a spinal vertebra presses on
18683-928: The minority group, "they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers." Mixer chiropractors "mix" diagnostic and treatment approaches from chiropractic, medical or osteopathic viewpoints and make up the majority of chiropractors. Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and hence they tend to be open to mainstream medicine. Many of them incorporate mainstream medical diagnostics and employ conventional treatments including techniques of physical therapy such as exercise, stretching , massage , ice packs , electrical muscle stimulation , therapeutic ultrasound , and moist heat . Some mixers also use techniques from alternative medicine, including nutritional supplements , acupuncture , homeopathy , herbal remedies , and biofeedback . Although mixers are
18840-407: The minority, emphasize vitalism , " Innate Intelligence ", and consider vertebral subluxations to be the cause of all disease; and "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage , and ice therapy . D. D. Palmer founded chiropractic in the 1890s, claiming that he had received it from "the other world". Palmer maintained that
18997-549: The more expansive view of chiropractic is still widespread. Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM); and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine. Many chiropractors believe they are primary care providers, including US and UK chiropractors, but
19154-466: The national chiropractic associations in 77 countries, adopted this consensus statement which reaffirms belief in the vertebral subluxation. The ACC paradigm has been criticized by chiropractic authors: All in all, the ambiguities that permeate the ACC's statements on subluxation render it inadequate as a guide to clinical research... Whether the ACC's subluxation claims have succeeded as a political statement
19311-519: The neurological communication between the brain , spinal cord and peripheral nervous system . Although individuals may not always be symptomatic , straight chiropractors believe that the presence of vertebral subluxation is in itself justification for correction via spinal adjustment. V. Strang, D.C., describes several hypotheses on how a misaligned vertebra may cause interference to the nervous system in his book, Essential Principles of Chiropractic : The vertebral subluxation has been described as
19468-434: The overwhelming evidence that vaccination is an effective public health intervention, there are significant disagreements among chiropractors over the subject, which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic. The American Medical Association called chiropractic an "unscientific cult" in 1966 and boycotted it until losing an antitrust case in 1987 . Chiropractic has had
19625-435: The pejorative term " quackademia ". Robert Todd Carroll described Integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify" Rose Shapiro has criticized the field of alternative medicine for rebranding
19782-638: The period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals. Changes included relaxed medical licensing, the development of managed care , rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health). Mainly as
19939-530: The peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory, their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement,
20096-429: The philosophy of chiropractic from a contemporary and nondogmatic perspective. In an article written in 2004, Seaman openly disparaged the idea still propounded by "modern-day advocates of this concept": ... it is essentially impossible to have nerve interference. To summarize, nerve interference is described, by modern-day advocates of this concept, as a reduction of neural or mental impulses, which occurs in response to
20253-441: The pike and is circularly attached to subluxation, you will be accused of being an atheist—an excellent example of the need for psychiatrists and the drugs they prescribe. Believers within the chiropractic tradition assert that spinal health and function are directly related to general health and well-being, including visceral disorders, but the efficacy and validity of spinal manipulation to address visceral disorders systems remains
20410-532: The possible exception of treatment for back pain . A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study "fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition." Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient. No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases. There
20567-427: The present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training; alternative medicine is taught in more than half of US medical schools and US health insurers are increasingly willing to provide reimbursement for alternative therapies. Complementary medicine (CM) or integrative medicine (IM)
20724-507: The relationship is causative , a claim which is disputed by many chiropractors. Chiropractic is well established in the United States, Canada, and Australia. It overlaps with other manual-therapy professions such as osteopathy and physical therapy . Most who seek chiropractic care do so for low back pain . Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues. Chiropractic has two main groups: "straights", now
20881-538: The result being a modification of functionality – too much or not enough action – which is disease. Vertebral subluxation, a core concept of traditional chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades. In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains
21038-591: The same meaning and are almost synonymous in most contexts. Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the United States National Institutes of Health department studying alternative medicine, currently named the National Center for Complementary and Integrative Health (NCCIH), was established as the Office of Alternative Medicine (OAM) and
21195-446: The same practices as integrative medicine. CAM is an abbreviation of the phrase complementary and alternative medicine . The 2019 World Health Organization (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into
21352-569: The same time, in 1975, the American Medical Association , which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation. By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine. By 1983, mass marketing of "alternative medicine"
21509-823: The same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials . In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results. Cancer researcher Andrew J. Vickers has stated: Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label "unproven"
21666-406: The schools or in the wider profession) at the expense of scientific integrity is ultimately self-defeating. To be sure, the profession's lack of cultural authority is based in part upon our characteristic disunity. However, attempts to generate unity by adoption of a common dogma can only bring scorn and continued alienation from the wider health care community and the public we all serve. In May 2010
21823-649: The science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine. Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods. Examples include healing claims for non-vitamin supplements, fish oil , Omega-3 fatty acid , glucosamine , echinacea , flaxseed oil , and ginseng . Herbal medicine , or phytotherapy, includes not just
21980-531: The scientific method, but instead rely on testimonials , anecdotes , religion, tradition, superstition , belief in supernatural " energies ", pseudoscience , errors in reasoning , propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine , pseudo-medicine , unorthodox medicine , holistic medicine , fringe medicine , and unconventional medicine , with little distinction from quackery . Some alternative practices are based on theories that contradict
22137-437: The skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness." While some chiropractors limit their practice to short-term treatment of musculoskeletal conditions, many falsely claim to be able treat a myriad of other conditions. Some dissuade patients from seeking medical care, others have pretended to be qualified to act as
22294-422: The spine and related tissues. There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools. The following adjustive procedures were received by more than 10% of patients of licensed US chiropractors in a 2003 survey: Diversified technique (full-spine manipulation, employing various techniques), extremity adjusting, Activator technique (which uses
22451-420: The spine as a torsion bar), Nimmo Receptor-Tonus Technique , applied kinesiology (which emphasises "muscle testing" as a diagnostic tool), and cranial. Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation. Koren Specific Technique (KST) may use their hands, or they may use an electric device known as an "ArthroStim" for assessment and spinal manipulations. Insurers in
22608-940: The spine, other joints and tissues, and general health issues. The following procedures were received by more than one-third of patients of licensed US chiropractors in a 2003 survey: Diversified technique (full-spine manipulation; mentioned in previous paragraph), physical fitness /exercise promotion, corrective or therapeutic exercise, ergonomic / postural advice, self-care strategies, activities of daily living , changing risky/unhealthy behaviors, nutritional/dietary recommendations, relaxation / stress reduction recommendations, ice pack/cryotherapy , extremity adjusting (also mentioned in previous paragraph), trigger point therapy, and disease prevention /early screening advice. A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on
22765-463: The spine. The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%. A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a United States chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods. Reviews of research studies within
22922-423: The 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. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence. In 2001 the World Federation of Chiropractic , representing
23079-410: The tenets of chiropractic were passed along to him by a doctor who had died 50 years previously. His son B. J. Palmer helped to expand chiropractic in the early 20th century. Throughout its history, chiropractic has been controversial . Its foundation is at odds with evidence-based medicine , and is underpinned by pseudoscientific ideas such as vertebral subluxation and Innate Intelligence. Despite
23236-401: The term nonallopathic lesion may be used in place of subluxation . Other chiropractors consider subluxation as more of an abstract concept rather than a medical condition. Tedd Koren says, The vertebral subluxation cannot be precisely defined because it is an abstraction, an intellectual construct used by chiropractors, chiropractic researchers, educators and others to explain the success of
23393-408: The thrust are factors of the degree in paraspinal muscle spindles activation. Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence
23550-581: The traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community. This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions. In 2005,
23707-495: The use of medicines or surgery, with special emphasis on the spine. Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues. There is a range of opinions among chiropractors: some believed that treatment should be confined to the spine, or back and neck pain; others disagreed. For example, while one 2009 survey of American chiropractors had found that 73% classified themselves as "back pain/musculoskeletal specialists",
23864-518: The use of plant products, but may also include the use of animal and mineral products. It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements". Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents. The United States agency National Center for Complementary and Integrative Health (NCCIH) has created
24021-1035: The veterinary and chiropractic professions. No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Two US states (Washington and Arkansas) prohibit physical therapists from performing SM, some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations. Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment",
24178-493: Was based on deduction from irrefutable doctrine , which helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method , and relies on deductions from vitalistic first principles rather than on
24335-482: Was renamed the National Center for Complementary and Alternative Medicine (NCCAM) before obtaining its current name. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope". The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science (though some alternative medicine promoters may use
24492-513: Was so pervasive that the British Medical Journal ( BMJ ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen". An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during
24649-414: Was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition. The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result. There are also reasons why a placebo treatment group may outperform a "no-treatment" group in
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