Kill a Subluxation

When I had a back injury that first brought me to a chiropractor, my father asked me what the injury was. I told him the doctor said I had an L3-L4 subluxation. No, my father explained, that was just some nonsense the chiropractor made up. What was the real problem? Oh, well it turned out to be a herniated disc — but that was my welcome into the world of chiropractic subluxation.

It may not surprise you to know that for as long as I have been writing this blog, even though there is no topic that is more inherently chiropractic as the subluxation, I have hesitated to address it. Seemingly so integrated into chiropractic history the concept to me is antiquated and unnecessary to modern, evidence informed practices. I have avoided discussing this hotbed of chiropractic silliness due to the lack of good that usually accompanies such a can-opening of any similar collection of worms.

Now, however, thanks to recent statements on the vertebral subluxation complex from the General Chiropractic Council in the UK and the British Chiropractic Association, I have selected to be silent no more. Instead, I have chosen to be paraphrasic. The statement from the General Chiropractic Council (GCC), appears here:

http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf

There is much in there with which to agree and also with the BCA‘s positive reaction to it. I am borrowing heavily from both as I develop my own affirmation:

The chiropractic vertebral subluxation complex is a historical concept but it remains a theoretical model. It 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. This is not to say that chiropractic treatment is not effective and important — but it is not lifesaving. Subluxations are not fatal.

Chiropractors must make sure their own beliefs and values do not prejudice their patients’ care. Furthermore, chiropractors must provide evidence based care, which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of the practitioner.

Any advertised claims for chiropractic care need to be based only on the best research of the highest standard. Think this is a no-brainer for everyone? I suggest you see what Bill Esteb over at Patient Media thinks about using evidence in advertising (http://www.patientmedia.com/blog/2010/05/rct_and_the_cult_of_scientism.html) Hint: he thinks it’s stupid.

In light of the absence of supporting evidence I do not support the concept of the vertebral subluxation complex as the cause of disease and serious illness nor am I in favor of teaching vertebral subluxation complex theory to chiropractic students in any other context than historical and theoretical.

I fully support and encourage the inclusion of chiropractic into mainstream healthcare and know that in order to facilitate this integration we need to discard ambiguous terminology and unsubstianted historical concepts. We need to emphasize an evidence-based care model that is easily understood by the other members of the healthcare delivery team.

I feel that chiropractors should refrain from making any reference to vertebral subluxation complex in any media to which their patients or the general public may have access.

Chiropractors are the leaders in non-surgical spine care and there is strong evidence to support the inclusion of chiropractic in musculoskeletal healthcare initiatives. Chiropractors have been shown to possess specific expertise in the assessment, treatment and management of spinal and joint pain and are well-placed to deliver cost-effective services within mainstream healthcare. Let’s not mess it up by speaking another language that other healthcare professionals don’t understand while waving the lunatic flag of our now dead forefathers. There was a reason for the reliance on subluxation dogma in this profession. We needed to prove ourselves separate and distinct from medicine in courts of law. That time is passed. We’ve also given up on that whole flat Earth thing. Get over it and move on.

The GCC and BCA statements are the best thing we’ve gotten from England since Hugh Laurie and perhaps we should all strive to be a little more British.

Dr. Brett L. Kinsler is a skeptical chiropractor in Rochester, NY who is 1/4 British — but is now working on increasing that ratio.

Reblog this post [with Zemanta]
Advertisements

16 Comments

  1. May 31, 2010 at 6:47 am

    […] This post was mentioned on Twitter by Al Grant, Alan Henness. Alan Henness said: GCC statement on non-existence of subluxations best thing "gotten [sic] from England since Hugh Laurie": http://bit.ly/dnRS4n #singhbca […]

  2. June 1, 2010 at 6:31 am

    Very interesting post.

  3. June 1, 2010 at 4:08 pm

    Having writing a paper that discusses the conflict between the dogma of subluxation and the science (or lack thereof) I was happy to see both the GCC and BCA accept the reality of our evidence on subluxation complex. Hopefully the forward thinking British will infect their cousins here in the States (colonies) with their old world forward thinking.

    Our paper:

    Keating JC, Jr., Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF. Subluxation: dogma or science? Chiropr Osteopat. 2005 Aug 10;13:17.

    Which can be down loaded for free at:

    http://www.chiroandosteo.com/content/13//17

    Thanks for the blog.

    SMP

  4. June 2, 2010 at 1:00 pm

    Thanks for providing the link to your paper. It is quite relevant to this discussion and I hope it was examined when the GCC and BCA policies were crafted. The preservation of historical theoretical constructs can indeed be preserved without the necessity of dogmatic muck.

  5. Michael Schneider, DC, PhD said,

    June 3, 2010 at 12:04 am

    I think this is a very important issue for chiropractors to bring to the attention of the general public; that subluxations of the spine are not some sort of life-threatening or serious “lesion” that only chiropractors can “fix”.

    The word “luxation” means “complete dislocation of a joint” and the word “subluxation” means”partial dislocation of a joint”. Using these definitions, chiropractors who adjust or manipulate the spine are very likely treating “subluxations”. This is really not a controversial idea. Manipulation is most likely doing something to improve the movement and/or position of the spinal joints. A partial dislocation of a joint is painful, and therefore manipulation that reduces this partial dislocation probably relieves pain immediately. And this is exactly what patients with back and neck pain report after a succesful chiropractic adjustment or manipulation.

    What is very controversial and unsubstantiated is the notion that subluxations cause diabetes, cancer, autism, and other internal disorders. Chiropractors who claim that they treat subluxations as a means to cure these and other diseases are making unfounded claims and have little to no evidence support their therapy.

    I agree with the suggestion we need to dispose of the outdated idea that subluxations cause internal disease. Thank you for bringing this subject up on your blog and educating people about this proper and improper use of the term subluxation.

  6. June 3, 2010 at 9:28 am

    I like your use of the “vertebral subluxation complex” as opposed to just subluxation. It is more descriptive. That is, it inherently makes reference to components such as histopathology and myopathology instead of merely misalignment. The vertebral subluxation complex makes you think more of functional and associated tissue changes of the motor unit.

  7. June 3, 2010 at 11:31 am

    I appreciate your thoughts, Dr. Schneider. I especially enjoyed your panel participation at the Association of Chiropractic Colleges / Research Agenda Conference (ACC/RAC 2010 Las Vegas) when you addressed the lack of evidence for subluxation theory as a component of public health. That was probably the highlight of that conference for me.

  8. June 3, 2010 at 11:38 am

    I am not positive I agree that using the VSC term is such a great idea for chiropractors. I think the addition of “complex” was an attempt to add some legitimacy to an otherwise bone out of place. Had the term subluxation not evolved with the science, it may have enjoyed a quiet death and fallen out of favor. Enhancing what the term subluxation encompasses allows it to live on, in my opinion, beyond its useful life. Thanks for your comments and for reading the blog.

  9. June 3, 2010 at 11:51 am

    Thanks for Tweeting my blog post! I think it is funny that you marked my use of word “gotten” as incorrect. I did a bit of research on this and learned that it is actually an old English way of using the term that is no longer accepted in British English but is still very much in use (and correct) in the New World. *Sigh* I guess my quest to become more British is not going quite as well as I had hoped.

  10. John said,

    July 11, 2010 at 9:28 am

    Since we are not calling it subluxation and now look at let say for one simple example disc herniation or disc degeneration in the spine. Yes, this can cause serious problems. Also, problems in the upper neck can have a serious impact on health. Call them what you want, they can cause serious problems.

  11. John said,

    July 15, 2010 at 6:35 pm

    Just saw a patient with migraines and one with vertigo with an atlas subluxation or let’s call it afixation, I don’t care. Neither have returned to the E.R. and are well. I guess that is not important to help them get well but I will see it over and over.

    With only 10% of people seeing chiropractors do really think we are the biggest threat out their to the public health? Or is this just a personal adventure for your own gain? Do you not see the bias?

  12. John said,

    July 15, 2010 at 9:29 pm

    Hey doc,
    What is the ACA definition of subluxation? You have them posted on your site? Just wondering?
    Thanks

  13. July 15, 2010 at 9:33 pm

    My bias is toward improving the profession, elevating our clinical status, intellectual honesty and scientific accuracy. Are we the biggest threat to public health? Quite the opposite — we might be a great asset to public health measures.

  14. John said,

    July 15, 2010 at 9:42 pm

    I have no idea who these people are out there that you are so upset with..

  15. John said,

    July 15, 2010 at 9:43 pm

    Sorry about the messed up sentene above. I hit enter by accident.. I need a preview button.

  16. John said,

    July 15, 2010 at 9:51 pm

    Do you really think that our profession is not growing because people use the phrace or term subluxation? Like tommorrow all associatons announced publicly we will not longer use the word subluxation. The next week bam everyone starts to go to a chiropractor?


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: