I have decided that because Google looks at blog titles and gets you to read this article, I would start putting ridiculous titles up. The real title is:
Chiropractic, the Prince of Wales and the critics
It is interesting times for the chiropractic profession. Some people may be aware of some of the debate surrounding the validity of chiropractic care, a topic I am particularly interested in. Here I will share with you my views on the ongoing debate.
Much discussion has been created by the interventions by Professor Edzard Ernst, from Exeter University and the science writer Simon Singh. They produced some very good research analysis in which they concluded that amongst others the chiropractic profession does not have much in terms of scientific evidence to support some if not most of its claims. This has been made synonymous with there being evidence of non-effectiveness and that therefore the claims made by chiropractors have been shown to be bogus. I have had some interesting (to me and my geeky brain) debates with Ernst and a number of other interested parties. Ernst himself did concede to my point that proof of lack of evidence is not the same as proof of ineffectiveness but made one very valid point with which I fully agree: if there is no proof to support a treatment modality, then we have to establish whether or not there are risks associated and weigh up proof of benefit versus proof of risk.
The primary risk often spoken of is the risk of a person not seeking effective treatment. Say for example that I claimed to treat cancer and a person then decided to not seek effective, proven chemotherapy. If I have no proof of being able to help this person it would constitute a severe risk to them to ignore proven methods. This seems obvious to me as it does to all UK chiropractors. I am aware that there are some people in the world who make similar claims and I consider that to be criminal. But because there are some people who make these claims, all chiropractors and similarly other complementary and alternative practitioners, are being tarred with the same brush. This is a very serious problem for us as it does not actually represent our profession’s view but because these people are making loud noises and publishing widely people are on occasion thinking that it does represent us.
Secondly they speak of risks directly associated to treatment. Not many chiropractors publish these issues on their websites and I think that this is a failure on our behalf, but that issue too is being confused by some. I deal with musculo-skeletal pain of biomechanical origin, meaning that I help people who suffer from pains that are due to abnormal movement patterns which are caused by problems which are making them move badly. In effect you may have back pain, which is due to excessive stress on a buttock muscle on the left, which you have because you are hobbling on the left leg because you have a thorn in your right foot. So I take the thorn out of your foot and let you go about the business of naturally getting better.
Often times, especially when conditions are chronic (which is something I specialise in) movement patterns have been abnormal for such a long time that muscle tone, firing patterns and condition have been reconditioned in adaptation to the abnormal movement pattern. In reversing the movement patterns I will actively seek to reactive those muscle groups which have become underactive and vice-versa. This does cause some discomfort and anyone who asks me whether they might struggle at first will hear a resounding and entirely unsympathetic “yes” from me. Some people have called such responses “adverse reactions” but in my view real progress requires this change.
The real problem is that there is on occasion real risk: when we are changing the load-bearing capacity of say a disc or a joint a chiropractor may be doing so at a pace that the structure in question is not able to cope with. In those cases injury may result. This is why we in those cases have to be careful and stage the progression slowly so that the structures can adapt to a gradual rather than a sudden build-up. This does carry risk and in these cases skill, expertise and clear communication of these facts are required.
There is also much discussion about the risk of stroke being associated to manipulation of the neck. There is very little evidence to even support the notion. Current statistics show that the likelihood of you suffering a stroke is as high after visiting a chiropractor as it is after visiting a GP. People suffer strokes and however unfortunate that is, there is very little to say that it has anything to do with manipulation. But there are some (albeit very few) very convincing tales out there which are serving those people who wish to associated the two together. The problem is: the chances of you having a stroke times the chances of you going to a chiropractor just before having a stroke (one of the presenting symptoms of pre-stroke syndromes is severe neck pain and headaches) is about the frequency of these convincing events happening. It’s a little like the odds of you bumping into your friend whilst just thinking about them; seems unlikely butis in directproportion ot the frequency withwhich they are close to you geographically and how often you think of them, nothing more mystical than that. In fact it does seem that chiropractors in the UK have been very good at picking up those cases where neck pain was in fact due to these pre-stroke syndromes and referred out, thereby oddly enough reducing the likelihood of strokes occurring or doing extensive damage. But still I will quite happily tell my patients there is a small risk, although there is no evidence of this.
So what are the benefits? Well, so far so good. In my clinic I pick up a number of undiagnosed life-threatening presentations every year who are then swiftly referred and helped by the medical system. Of those people I decide I can help the vast majority of people have been helped significantly (I pick my battles). In fact so many have been helped that I had no problem (showing a 98% success rate on 2000 cases) getting the insurance company to under-write the patient care insurance policy (aka your money-back guarantee). Since it has been in place they haven’t had to pay out once (approx 150 cases). The problem is: I work in a certain way and by certain methods and this may not be representative of all chiropractors, but it does for a lot of them, which is why they are getting annoyed with the negative press.
So what does all this have to do with the Prince of Wales?
The Foundation of Integrated Health (FIH) is looking to provide better integration of complementary therapies where possible, an idea which when done well should result in better, cheaper results if there is any truth to the efficiency of those therapies. The problem with showing whether there is any truth to a therapy means that it must be tested and trialled. This is not easy and not cheap. Particularly when you realise that chiropractors don’t treat “back pain” but rather people with back pain. These people may have back pain for a myriad of reasons. Which means that to research this, an equally large myriad of clinical study groups would have to be assessed. That said I am in the process of designing a pathway to acquire the data… the things I entertain myself with (I am glad my wife still likes me). Finally, the notion of researching chiropractic manipulation for back pain as an entity rather than a syndrome is a bit of a non-sense anyway: you may have back pain because you are flatfooted, obese, have a back problem or even a problem with your teeth closing. Manipulating someone’s back when they need to loose weight will always have poor outcomes…
I hope you found this interesting and please do feel free to let me know your thoughts. Kind regards,
Stefaan Vossen
