Longmont, Colorado Chiropractor

Last time, I started this post with a little history of chiropractic and how the powers that be tried to contain us and eliminate our existence. I said I would get into the safety of what I do for a living on the second post, so here it is.

It was published in 1993.

This comprehensive study reviewed all the published literature on low back pain and made some astounding suggestions. In a nutshell, it concluded that: chiropractic should be the treatment of choice for low back pain – excluding traditional medical care altogether!

The specific Findings of the report were:

• There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management
• Many medical therapies are of questionable validity or are clearly inadequate
• There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients.
• Chiropractic is more cost-effective. There would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors.
• There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management

The specific Recommendations were:

• Chiropractic services should be fully insured under the Ontario Health Insurance Plan
• Chiropractic services should be fully integrated into the health care system. Because of the high incidence and cost of LBP, hospitals, managed health care groups, community health centers, comprehensive health organizations, and health service organizations and long-term care facilities should employ chiropractors on a full-time and/or part-time basis
• A good case could be made for placing chiropractic as the gatekeepers for all musculoskeletal complaints that presented to hospitals.

. It seems that the department chairs of several hospital-based orthopedic residency programs designed a basic examination on musculoskeletal competency and gave it to their residents. 82 per cent of medical school graduates failed the examination. Four years later the test was simplified and, once again, 78% of the examinees failed to demonstrate basic competency in musculoskeletal medicine. When this test was given to final quarter chiropractic students 70% of them passed the exact same exam!

The differences between these 2 student groups should be noted. The medical students had already graduated from medical school (as MDs) and had completed their rotations through various hospital departments. Finally, they had been accepted into an orthopedic residency program…the pinnacle of medical musculoskeletal specialists. The chiropractic students however were still just students. 80% medical failure versus 70% chiropractic success.   Quite astonishing!

Of this group, 10 of the patients had the complicating factors of high blood pressure, use of oral contraceptives, or a history of smoking, all of which are associated with vascular disease.   The actual incidence of stroke or VAD following cervical manipulation was found to be one per 5.85 million cervical adjustments. That means that the average chiropractor could work for 1430 years (or practice 48 full chiropractic careers!) before they might be involved with this type of litigation!

Other reports listing a higher frequency of adverse events have been compromised by the tendency of those authors to inappropriately list the pracitioner as a chiropractor, even when it turned out that the injury was caused by a medical doctor, a physical therapist or a hairdresser!

Rather than raising concerns about the safety of chiropractic, these statistics emphasize that spinal manipulation, in the hands of unskilled practitioners, is dangerous, and the practice must be closely regulated.

The World Health Organization recently released a comprehensive set of guidelines that clearly states that chiropractic is a separate profession, rather than a set of techniques that can be learned in short courses by other health professionals. They also make it clear that medical doctors and other health professionals, in countries where the practice of chiropractic is not regulated by law, should undergo extensive training to re-qualify as chiropractors before claiming to offer chiropractic services. In some countries there have been recent efforts by medical groups to provide short courses of approximately 200 hours in chiropractic technique. WHO’s guidelines indicate that a medical graduate should require an additional minimum of 1800 class hours, including 1000 hours of supervised clinical training, before claiming to offer chiropractic services.

B.   The Safety of Low Back Adjusting

Lower back injury alleged to have occurred following spinal manipulative therapy has been reported in patients with pre-existing disc herniation or prolapse. While it is suggested that the forces required to cause a disruption of the annular fibers of the healthy intervertebral disc well exceed that of a rotational manipulative thrust, some disc herniation/protrusion may certainly be aggravated by an inappropriately applied manipulative maneuver, as it may be by other simple activities of daily living such as bending, sneezing, or lifting. The most frequently described severe complication is compression of the cauda equina by massive midline nuclear herniation at the level of the 3rd, 4th or 5th intervertebral disc.

Of the 30 cauda equina complications associated with manipulation reported in the French, German and English literature over an 80 year period, only 8 were allegedly related to chiropractic treatment.