Summary of a video by Dr. Shawn Thistle – Chiropractor
I recently stumbled upon a great video1 by an esteemed colleague of mine that goes over a few (of the many) myths surrounding chiropractors and their care. Below I have summarized some of the evidence behind his video and added some information to give a better understanding of the issues for those who are interested. 5 Chiropractic Myths
5 Chiropractic Myths
Vertebral Misalignment – There is no quality evidence stating static misalignments occur or that we can detect and fix them.2 This “bone out of place model” is simply not scientific.
Our current understanding of how spinal manipulation works is quite different. We do not put bones back into place. A better explanation is adjusting/spinal manipulative therapy:
- Helps reduce stiffness in the spine in an area of the spine that is not moving well 3
- Decreases Temporal summation (nerve signals to the brain) to reduce pain 4+5
- Causes a muscle spindle reflex response to reduce local muscle tone/spasm 6
- Causes a local endorphin release and down regulation of local inflammatory responses 7+8
Chiropractors Use/Need Repeated X-rays – For most neck or back pain, diagnostic imaging is not necessary or helpful
Unfortunately some chiropractors want to take repeated images to look for “poor posture/curves” or “vertebral misalignments”.9 This imaging helps them make people adhere to a certain care plan. Often diagnostic images, even MRI’s, very poorly correlate with what is actually going on with your back or neck pain.10 Health professionals have guidelines on when imaging is appropriate to look for fractures.11 It is important for patients to know that regular imaging is not standard practice when you see a chiropractor.
Anatomical Body Shaming to blame for your pain. (more of a pet peeve) – Some practitioners will attribute all of a patient’s issues to one short leg, or a rotated pelvis, etc…. Most times these findings are clinically meaningless
These minor differences are likely not the reason for your issues. It sounds great… “your leg is long” (very common in healthy and unhealthy populations)12 or “your pelvis is rotated, that’s why you have low back pain” (unlikely they can accurately determine which side would be rotated and if it is at all). 13,14 The problem is attributing your issues to these benign causes has the potential to do more harm than good.
Back or neck pain require long term treatment
If you have neck or back pain and you are seeing a chiropractor or physiotherapist, you are more likely to recover well if you notice positive changes EARLY in your treatment plan. If not, it is up to the practitioner to work with you to modify the treatment plan. A good treatment plan will have both passive (practitioner working on you) and active (you doing work) components. 15
Adjustments/Spinal Manipulative Therapy is dangerous or aggressive
There have been many studies done to ensure that manipulation is safe. 16,17 Now, manipulation is even suggested as a first line of therapy for back pain by the Harvard Medical School.18 That being said, if you do not wish to have manipulation done, simply tell your chiropractor. They will not be offended and will respect your request.
People new to manipulation may find the noise startling. Some people believe the sound is bones smashing together or ligaments ripping, that is not the case. The sound that occurs when you pull on your finger joints is the same sound that occurs during an adjustment in your back. A small bubble of gas forms in the joint space and makes a “pop.” The difference is, in the spine there are many joints very close together. For more information see my previous post here.
If you have any questions regarding these myths or any others you have heard, feel free to book a 15 minute consult with me to see if I can shed some light on your questions about chiropractic care.
- (2017). Retrieved from FNXL Media: https://fxnlmedia.com/portfolio/chiropractor-debunks-common-chiropractic-myths
- Mirtz TA, Morgan L, Wyatt LH, Greene L. An epidemiological examination of the subluxation construct using Hill’s criteria of causation. Chiropractic & Osteopathy. 2009;17:13. doi:10.1186/1746-1340-17-13
- (1999). The effect of spinal manipulative therapy (SMT) on pain reduction and range of motion in patients with acute unilateral neck pain: a pilot study. Journal of the Canadian Chiropracic Association .
- Bishop MD, Beneciuk JM, George SZ. Immediate reduction in temporal sensory summation after thoracic spinal manipulation. The spine journal : official journal of the North American Spine Society. 2011;11(5):440-446. doi:10.1016/j.spinee.2011.03.001.
- Inami A, Ogura T, Watanuki S, et al. Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy: A [18F]FDG PET Study. Evidence-based Complementary and Alternative Medicine : eCAM. 2017;2017:4345703. doi:10.1155/2017/4345703.
- Pickar, Joel G. et al. Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat. Journal of Manipulative & Physiological Therapeutics 2001, Volume 24 , Issue 1 , 2 – 11
- Vernon, Dhami, Howley, & Annett. (1986). Spinal manipulation and beta-endorphin: a controlled study of the effect of a spinal manipulation on plasma beta-endorphin levels in normal males. Journal of Manipulative and Physiological Theraputics.
- Teodorczyk-Injeyan, Julita A. et al. Spinal Manipulative Therapy Reduces Inflammatory Cytokines but Not Substance P Production in Normal Subjects Journal of Manipulative & Physiological Therapeutics (2006), Volume 29 , Issue 1 , 14 – 21
- Shilton, Branney, Vries, d., & Breen. (2015). Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. Chiropractic and Manual Therapies.
- Jensen, Brant-Zawadzki, Obuchowski, Modic, Malkasian, & Ross. (1994). Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. New England Journal of Medicine.
- Bandiera G, Stiell IG, Wells GA, Clement C, De Maio V, Vandemheen KL, et al. The Canadian C-spine rule performs better than unstructured physician judgment. Annals of Emergency Medicine. 2003 Sep.;42(3):395–402.
- Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy. 2005;13:11. doi:10.1186/1746-1340-13-11.
- Meijne a, Wilco et al. ‘Intraexaminer And Interexaminer Reliability Of The Gillet Test’. Journal of Manipulative and Physiological Therapeutics 22.1 (1999): 4-9. Web.
- Preece SJ, Willan P, Nester CJ, Graham-Smith P, Herrington L, Bowker P. Variation in Pelvic Morphology May Prevent the Identification of Anterior Pelvic Tilt. The Journal of Manual & Manipulative Therapy. 2008;16(2):113-117.
- Haldeman, Carroll, Cassidy, Schubert, & Nygren. (2008). The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary. Spine.
- Funabashi, M. et al. Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements. Sci. Rep. 6, 38107; doi: 10.1038/srep38107 (2016).
- Cassidy, Boyle, Cote, Hogg-Johnson, Bondy, & Haldeman. (2017). Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study. Journal of Stroke and Cerebrovascular Diseases.
- Chiropractic care for pain relief. (2016, March 18). Retrieved from Harvard Health Publications – Harvard Medical School : http://www.health.harvard.edu/pain/chiropractic-care-for-pain-relief