Spinal adjustment

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A chiropractor performs an adjustment on a patient. Chiropractic spinal adjustment.jpg
A chiropractor performs an adjustment on a patient.

Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease. [1]

Contents

Spinal adjustments were among many chiropractic techniques invented in the 19th century by Daniel David Palmer, the founder of Chiropractic. Claims made for the benefits of spinal adjustments range from temporary, palliative (pain relieving) effects to long term wellness and preventive care.

Description

The intention of a chiropractic adjustment is to affect or correct the alignment, motion and/or function of a vertebral joint. Specifically, adjustments are intended to correct "vertebral subluxations", a non-scientific term given to the signs and symptoms that are said by chiropractors to result from abnormal alignment of vertebrae. [2] In 2005, 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. [3] It is essentially a functional entity, which may influence biomechanical and neural integrity." [3] This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays. [3]

This intention forms the legal and philosophical foundation of the profession, and US Medicare law formulates it in this manner:

"Coverage of chiropractic services is specifically limited to manual manipulation of the spine to correct a subluxation... Medicare will not pay for treatment unless it is 'manual manipulation of the spine to correct a subluxation'." [4]

Chiropractic authors and researchers Meeker and Haldeman write that the core clinical method that all chiropractors agree upon is spinal manipulation, although chiropractors much prefer to use the term spinal "adjustment", a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities." [2]

The International Chiropractor's Association (ICA) states that the "chiropractic spinal adjustment is unique and singular to the chiropractic profession", and that it "is characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion. Chiropractic is a specialized field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession." [5] One author claims that this concept is now repudiated by mainstream chiropractic. [6] The definition of this procedure describes the use of a load (force) to specific body tissues with therapeutic intent. This "load" is traditionally supplied by hand, and can vary in its velocity, amplitude, duration, frequency, and body location [2] : 118  and is usually abbreviated HVLA (high velocity low amplitude) thrust. [7] [8]

Adjustment methods

As the chiropractic profession grew, individual practitioners and institutions proposed and developed various proprietary techniques and methods. While many of these techniques did not endure, hundreds of different approaches remain in chiropractic practice today. Not all of them involve HVLA thrust manipulation. Most cite case studies, anecdotal evidence, and patient testimonials as evidence for effectiveness. These techniques include:

Techniques

There are many techniques which chiropractors can specialize in and employ in spinal adjustments. Some of the most notable techniques include:

Over the years, many variations of these techniques have been delivered, most as proprietary techniques developed by individual practitioners. WebMD has made a partial list: [9]

Effects

Musculoskeletal disorders

The effects of spinal adjustment vary depending on the method performed. All techniques claim effects similar to other manual therapies, ranging from decreased muscle tension to reduced stress. Studies show that most patients go to chiropractors for musculoskeletal problems: 60% with low back pain, and the rest with head, neck and extremity symptoms. (p. 219) [2] Also the article "Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine" states that, “chiropractic was to be a revolutionary system of healing based on the premise that neurologic dysfunction caused by ‘impinged’ nerves at the spinal level was the cause of most dis-ease”. (p. 218) [2] The mechanisms that are claimed to alter nervous system function and affect overall health are seen as speculative in nature, however, clinical trials have been conducted that include “placebo-controlled comparisons [and] comparisons with other treatments”. (p. 220) [2] The American Chiropractic Association promotes chiropractic care of infants and children under the theory that “poor posture and physical injury, including birth trauma, may be common primary causes of illness in children and can have a direct and significant impact not only on spinal mechanics, but on other bodily functions”. [10]

The effects of spinal manipulation have been shown to include: temporary relief of musculoskeletal pain, increased range of joint motion, changes in facet joint kinematics, increased pain tolerance and increased muscle strength. (p. 222) [2] Common side effects of spinal manipulative therapy (SMT) are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort. (p. 222). [2]

Non-musculoskeletal disorders

Historically, the profession has falsely claimed that spinal adjustments have physiological effects on inner organs and their function, and thus affect overall health, not just musculoskeletal disorders, a view that originated with Palmer's original thesis that all diseases were caused by subluxations of the spine and other joints. With time, fewer chiropractors hold this view, with "a small proportion of chiropractors, osteopaths, and other manual medicine providers use[ing] spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial." [11]

A 2019 global summit of "50 researchers from 8 countries and 28 observers from 18 chiropractic organizations" conducted a systematic review of the literature, and 44 of the 50 "found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function." [11]

Safety

There is has been limited research on the safety of chiropractic spinal manipulation, making it difficult to establish precise estimates of the frequency and severity of adverse events. [12] [13] [14] Adverse events are increasingly reported in randomized clinical trials of spinal manipulation but remain under–reported despite recommendations in the 2010 CONSORT guidelines. [15] [16] Chiropractic spinal manipulation is frequently associated with mild to moderate temporary adverse effects, and also serious outcomes which can result in permanent disability or death, [17] [18] which include strokes, spinal disc herniation, vertebral and rib fractures and cauda equina syndrome. [2] [19] A scoping review found that benign (mild-moderate) adverse events such as musculoskeletal pain, stiffness, and headache were common and transient (i.e., resolved within 24 hours), and affected 23–83% of adults. [14] Serious outcomes are thought to be very rare, yet remain less studied than mild-moderate adverse events. [20] [21] One retrospective study examining 960,140 sessions of chiropractic spinal manipulation found two severe adverse events, both being rib fractures in older women with osteoporosis (incidence of 0.21 per 100,000 sessions). [21] There are several contraindications to chiropractic spinal manipulation, including poor bone integrity, cervical arterial pathology, spinal metastasis, and spinal instability. [22] [21]

See also

Related Research Articles

<span class="mw-page-title-main">Chiropractic</span> Form of pseudoscientific alternative medicine

Chiropractic 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 has esoteric origins and is based on several pseudoscientific ideas.

A subluxation is an incomplete or partial dislocation of a joint or organ.

<span class="mw-page-title-main">Vertebral subluxation</span> Chiropractic concept

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. Subluxations are not necessarily visible on X-rays.

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.

<span class="mw-page-title-main">Spinal manipulation</span> Intervention performed on spinal joints

Spinal manipulation is an intervention performed on spinal articulations, synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. National guidelines come to different conclusions with respect to spinal manipulation with some not recommending it, and others recommending a short course in those who do not improve with other treatments.

The National Association for Chiropractic Medicine(NACM) was a minority chiropractic association founded in 1984 that described itself as a "consumer advocacy association of chiropractors". It openly rejected some of the more controversial aspects of chiropractic, including a basic concept of chiropractic, vertebral subluxations as the cause of all diseases. It also sought to "reform the chiropractic profession away from a philosophical scope of practice and towards an applied science scope of practice." It stated that it was "dedicated to bringing the scientific based practice of chiropractic into mainstream medicine" and that its members "confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery." "While the NACM is focused on furthering the profession, its primary focus is on the rights and safety of the consumers." The NACM was the object of much controversy and criticism from the rest of the profession. It quietly dropped out of sight and its demise apparently occurred sometime between May 30, 2008 and March 6, 2010.

<span class="mw-page-title-main">History of chiropractic</span> History of chiropractic

The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. Palmer claims to have had principles of chiropractic treatment passed along to him during a seance by a long-dead doctor named Dr. Jim Atkinson. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samuel H. Weed coined the word "chiropractic" by combining the Greek words cheiro (hand) and praktikos.

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.

Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. MUA is used by osteopathic/orthopedic physicians, chiropractors and specially trained physicians. It aims to break up adhesions on or around spinal joints or extremity joints to which a restricted range of motion can be painful and limit function. Failed attempts at other standard conservative treatment methods, over a sufficient time-frame, is one of the principal patient qualifiers.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

NUCCA is an acronym for the National Upper Cervical Chiropractic Association. It was founded in 1966 by chiropractor Ralph Gregory and based primarily upon the work he and John Grostic had performed before Grostic's death in 1964. The new style of upper cervical adjusting technique was taught in 1966 at the first NUCCA seminar, which was held at the Howard Johnson Motel in Monroe, Michigan.

Throughout its history, chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. A 2003 profession-wide survey found "most chiropractors still hold views of Innate Intelligence and of the cause and cure of disease consistent with those of the Palmers". A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation.

<span class="mw-page-title-main">Veterinary chiropractic</span>

Veterinary chiropractic, also known as animal chiropractic, is chiropractic for animals – a type of spinal manipulation. Veterinary chiropractors typically treat horses, racing greyhounds, and pets. Veterinary chiropractic is a controversial method due to a lack of evidence as to the efficacy of chiropractic methods. Contrary to traditional medicine, chiropractic therapies are alternative medicine. There is some degree of risk associated with even skilled manipulation in animals as the potential for injury exists with any technique used. The founder of chiropractic, Daniel David Palmer, used the method on animals, partly to challenge claims that the placebo effect was responsible for favorable results in humans. Chiropractic treatment of large animals dates back to the early 1900s. As of 2019, many states in the US provide statutory or regulatory guidelines for the practice of chiropractic and related treatments on animals, generally requiring some form of veterinary involvement.

Osteomyology is a multi-disciplined form of alternative medicine found almost exclusively in the United Kingdom and is loosely based on aggregated ideas from other manipulation therapies, principally chiropractic and osteopathy. It is a results-based physical therapy tailored specifically to the needs of the individual patient. Osteomyologists have been trained in osteopathy and chiropractic, but do not require to be regulated by the General Osteopathic Council (GOsC) or the General Chiropractic Council (GCC).

The World Chiropractic Alliance (WCA) is a not-for-profit corporation founded in Arizona in 1989 that serves as the voice of conservative "straight" chiropractors.

<span class="mw-page-title-main">Daniel David Palmer</span> Founder of chiropractic (1845–1913)

Daniel David Palmer was a Canadian American chiropractor who was the founder of chiropractic. Palmer was born in Pickering, Ontario, but emigrated to the United States in 1865. He was also an avid proponent of pseudoscientific alternative medicine such as magnetic healing. Palmer opposed anything he thought to be associated with mainstream medicine such as vaccination.

Passive physiological intervertebral movements (PPIVM) refers to a spinal physical therapy assessment and treatment technique developed by Geoff Maitland used to assess intervertebral movement at a single joint, and to mobilise neck stiffness.

Primary spine practitioners are health care professionals who are specially trained to provide primary care for patients with spinal disease.

Cervical manipulation, commonly known as neck manipulation, is a procedure involving adjustment of the upper seven vertebrae of the spinal column. This procedure is most often utilized by chiropractors, as well as osteopathic physicians who practice osteopathic manipulation. This type of manipulation may increase the risk of stroke and other issues, with studies suggesting the relationship is causative.

<span class="mw-page-title-main">Cervicocranial syndrome</span> Medical condition

Cervicocranial syndrome or is a neurological illness. It is a combination of symptoms that are caused by an abnormality in the neck. The bones of the neck that are affected are cervical vertebrae. This syndrome can be identified by confirming cervical bone shifts, collapsed cervical bones or misalignment of the cervical bone leading to improper functioning of cervical spinal nerves.Greenberg Regenerative Medicine | Bryn Mawr, Pennsylvania Cervicocranial syndrome is either congenital or acquired. Some examples of diseases that could result in cervicocranial syndrome are Chiari disease, Klippel-Feil malformation osteoarthritis, and trauma. Treatment options include neck braces, pain medication and surgery. The quality of life for individuals suffering from CCJ syndrome can improve through surgery.

References

  1. ↑ "Sense about Chiropractic" (PDF). Sense About Science. Retrieved 31 December 2012.
  2. 1 2 3 4 5 6 7 8 9 Meeker WC, Haldeman S (2002). "Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine". Ann Intern Med. 136 (3): 216–27. CiteSeerX   10.1.1.694.4126 . doi:10.7326/0003-4819-136-3-200202050-00010. PMID   11827498. S2CID   16782086.
  3. 1 2 3 World Health Organization (2005). WHO guidelines on basic training and safety in chiropractic (PDF). ISBN   978-92-4-159371-7. Archived from the original (PDF) on 13 March 2022. Retrieved 2008-02-29.
  4. ↑ "Coverage for Chiropractic Services". Medicare.
  5. ↑ ADJUSTMENT AND SPINAL MANIPULATION ICA Policy Statements: Spinal Adjustment and Spinal Manipulation. ICA.
  6. ↑ David Chapman-Smith (2000). The Chiropractic Profession: Its Education, Practice, Research and Future Directions. NCMIC Group. p. 160. ISBN   978-1-892734-02-0.
  7. ↑ Lisi, Anthony J.; Bhardwaj, Mukesh K. (2004). "Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome". Journal of Manipulative and Physiological Therapeutics. 27 (9): 574–578. doi:10.1016/j.jmpt.2004.10.002. PMID   15614245.
  8. ↑ Peter Gibbons, Philip Tehan. Manipulation of the spine, thorax, and pelvis: an osteopathic approach
  9. ↑ Chiropractic Applications. WebMD
  10. ↑ American Chiropractic Association (1994). "Infant and child care policy". Dyn Chiropr. 12 (17).
  11. 1 2 Côté, Pierre; Hartvigsen, Jan; Axén, Iben; Leboeuf-Yde, Charlotte (February 17, 2021). "The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature". Chiropractic & Manual Therapies. Springer Science and Business Media LLC. 29 (1): 8. doi: 10.1186/s12998-021-00362-9 . ISSN   2045-709X. PMC   7890602 . PMID   33596925.
  12. ↑ Ernst, E. (July 2007). "Adverse effects of spinal manipulation: a systematic review". Journal of the Royal Society of Medicine. 100 (7): 330–338. doi:10.1177/014107680710000716. ISSN   0141-0768. PMC   1905885 . PMID   17606755.
  13. ↑ Gouveia, Liliana Olim; Castanho, Pedro; Ferreira, Joaquim J. (2009-05-15). "Safety of chiropractic interventions: a systematic review". Spine. 34 (11): E405–413. doi:10.1097/BRS.0b013e3181a16d63. ISSN   1528-1159. PMID   19444054. S2CID   21279308.
  14. 1 2 Swait, Gabrielle; Finch, Rob (2017). "What are the risks of manual treatment of the spine? A scoping review for clinicians". Chiropractic & Manual Therapies. 25: 37. doi: 10.1186/s12998-017-0168-5 . ISSN   2045-709X. PMC   5719861 . PMID   29234493.
  15. ↑ Gorrell, LM; Engel, RM; Brown, B; Lystad, RP (September 2016). "The reporting of adverse events following spinal manipulation in randomized clinical trials-a systematic review". The Spine Journal (Systematic Review). 16 (9): 1143–51. doi:10.1016/j.spinee.2016.05.018. PMID   27241208.
  16. ↑ Ernst E, Posadzki P (2012). "Reporting of adverse effects in randomised clinical trials of chiropractic manipulations: a systematic review". N Z Med J. 125 (1353): 87–140. PMID   22522273.
  17. ↑ Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med . 100 (7): 330–8. doi:10.1177/014107680710000716. PMC   1905885 . PMID   17606755.
  18. ↑ Nordqvist, Christian (July 2, 2007). "Spinal Manipulation Should Not Be Routinely Used, New Study Warns". MedicalNewsToday.
  19. ↑ Senstad O, Leboeuf-Yde C, Borchgrevink C (February 1997). "Frequency and characteristics of side effects of spinal manipulative therapy". Spine. 22 (4): 435–40, discussion 440–1. doi:10.1097/00007632-199702150-00017. PMID   9055373. S2CID   7482895.
  20. ↑ "Safety and regulation of chiropractic". NHS Choices. 20 August 2014. Retrieved 22 September 2016.
  21. 1 2 3 Chu, Eric Chun-Pu; Trager, Robert J.; Lee, Linda Yin-King; Niazi, Imran Khan (2023-01-23). "A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy". Scientific Reports. 13 (1): 1254. doi:10.1038/s41598-023-28520-4. ISSN   2045-2322. PMC   9870863 . PMID   36690712.
  22. ↑ Chu, Eric Chun-Pu; Trager, Robert J; Tao, Cliff; Lee, Linda Yin-King (2022-10-01). "Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness". The American Journal of Case Reports. 23: e937991. doi:10.12659/ajcr.937991. ISSN   1941-5923. PMC   9597265 . PMID   36258651.
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