Why do chiropractors keep going back to subluxations? Professor Ernst examines the evidence behind the therapy.
Traditionally chiropractic was almost entirely based on the notion that 'subluxations' of the spine need to be 'adjusted' by spinal manipulation – if not, illness would be the inevitable outcome.
We all know this is not true, some might say ridiculous, yet the chiropractic profession has been slow to doubt this gospel. Now, finally, this fundamental tenet is being challenged by one prominent, experienced and outspoken chiropractor. Here are some quotes from his most recent article:[1]
'An orthopaedic subluxation, a true vertebral misalignment, or a mechanical joint dysfunction that affects mobility in the spine is not the same as a mysterious asymptomatic "chiropractic subluxation", which allegedly causes disease by interfering with the nerve supply to organs.'
'Such a subluxation has never been proved to exist. There is no plausible theory and no credible evidence to support the contention that nerve interference, originating in a single spinal segment can cause an organic disease.'
'Unable to provide evidence that commonly occurring vertebral misalignment can cause organic disease, advocates of the subluxation theory have reasoned that there must be some other "joint dysfunction" that can affect general health. They have chosen, by consensus, to call this undetectable lesion a "vertebral subluxation complex".'
'A largely ignored landmark review of the literature by Nasel and Szlazak, published in 1995, concluded that there is not a single appropriately controlled study to indicate that any dysfunction in structures of the spinal column is a cause of organic disease. [2]'
'A review of the current evidence on the epidemiology of the subluxation construct also failed to find any credible evidence supporting the chiropractic vertebral subluxation theory.[3]'
After having studied these issues for many years, I am inclined to agree with these views. Many chiropractors, however, object vehemently. Why? The answer, in my view is simple. If you take the basic concept of 'subluxation' away from chiropractic, what remains? The answer, I fear, is NOT A LOT!
Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter
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