CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 00, pp. 000–000 © 2006 Lippincott Williams & Wilkins Chiropractic History and Overview of Theories and Methods Samuel Homola, DC Chiropractic is one of the most controversial and poorly de- ognized. Promoting the idea that correcting subluxations fined healthcare professions with recognition and licensure in the spine would cure virtually every disease, B. J. Palm- in the United States. Chiropractic was started by D. D. er’s slogans and advertising strategies attracted many stu- Palmer, a magnetic healer who formulated the vertebral sub- dents to the Palmer School, by then named the Palmer luxation theory. The profession was developed by his son, 50 B. J. Palmer. Although the definition of chiropractic as a School of Chiropractic. method of correcting vertebral subluxations to restore and When World War I ended in 1918, many veterans who maintain health is questionable, spinal manipulation is of could not find employment were attracted by Palmer’s ads value in the treatment of some types of back pain. The chi- (my father among them). “Do you want to follow manual ropractic profession is still based on the vertebral subluxa- labor or a profession?” the ads asked.25 “The common tion theory, and has the confusing image of a back specialty labor field is crowded. There are many persons who want capable of treating a broad scope of health problems. Despite to do hard work. Let those who are anxious have it. You opposition to use of spinal manipulation as a method of treat- fit yourself for a profession.”25 ing a broad scope of health problems (as opposed to the B. J. Palmer took advantage of ignorance and despera- generally accepted use of manipulation in the treatment of back pain), chiropractors seek support as primary care pro- tion. “Give me a simple mind that thinks along single viders in alternative medicine. It is essential to understand tracts,” he said, “give me 30 days to instruct him, and that the theories, philosophies, and methods of chiropractic for an individual can go forth on the highways and byways and objective evaluation. get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived.”37 In 1895, D. D. Palmer, a magnetic healer, announced Today, the chiropractic profession continues to cling to “Ninety-five percent of all diseases are caused by dis- the vertebral subluxation theory despite a progressive in- placed vertebrae, the remainder by luxations of other crease in the educational standards of its schools.27 Ac- joints.”25 Palmer claimed he had cured deafness by using cording to the Council on Chiropractic Education, the his hands to push a displaced fourth thoracic vertebra into minimum requirements for admission to a doctor of chi- alignment.50 ropractic program are 90 semester hours (3 years) of un- Believing that all bodily functions are controlled by the dergraduate study leading to a bachelor’s degree and a flow of nerve vibrations from the brain to the spinal cord grade point average of at least 2.50.15 A few states and and out through openings between the vertebrae, Palmer colleges require a 4-year bachelor’s degree. Chiropractic claimed that adjusting the vertebrae to remove interference school is a 4-year course with approximately 4800 study with this flow of nerve energy would allow the body to hours.1 heal most diseases.38 In 1897, he opened the Palmer Scientific consensus does not support the theory that School and Cure in Davenport, Iowa, offering a 3-week nerve interference caused by vertebral misalignment or study course.50 subluxation is a cause of organic disease.12,16,32,36 Spinal It was not until Bartlett Joshua Palmer graduated from nerves primarily supply musculoskeletal structures. Organ his father’s school in 1902 that chiropractic became rec- function is governed by the autonomic nervous system in concert with psychic, chemical, hormonal, and circulatory factors. The sphincter muscles involved in voluntary con- Correspondence to: Samuel Homola, DC, 1307 East Second Court, Panama trol of bladder and bowel functions are supplied by spinal City, FL 32401. Phone: 850-763-1591; Fax: 850-763-1586; E-mail: [email protected]. nerves and sympathetic fibers that exit well-protected sa- DOI: 10.1097/01.blo.0000200258.95865.87 cral foramina. 1 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Clinical Orthopaedics 2 Homola and Related Research Spinal nerves are commonly compressed by bony spurs (FCER) published the monograph by Rosner titled “The and herniated discs. Even the most severe compression of Role of Subluxations in Chiropractic.”41 A subluxation a spinal nerve which cripples the supplied musculoskeletal was described as a vertebral subluxation complex that structures does not cause organic disease.12,16 “embraces the holistic nature of the human body, includ- ing health, well-being, the doctor/patient relationship, and What Is a Chiropractic Subluxation? the changes in nerve, muscle, connective, and vascular An orthopaedic subluxation is a painful partial disloca- tissues which are understood to accompany the kinesio- tion.41 A chiropractic subluxation is an asymptomatic mis- logic aberrations of spinal articulations.”41 In this mono- alignment or a “vertebral subluxation complex” thought to graph, Rosner also stated that “slight misalignments may be a cause of disease.41 Such a subluxation has never been not be detectable by any of the current technological meth- proven to exist.12,16,34 ods.”41 The illusive and often undetectable chiropractic sub- It is unreasonable to assume that slight misalignment of luxation, considered to be a factor in the development of a vertebra or an undetectable subluxation complex can visceral disease and back pain,41 has been defined by as cause disease or ill health when those effects do not occur many as 100 different names, such as a manipulable lesion because of gross vertebral displacement or by impinge- or a neurobiomechanical lesion.41 Symptoms resulting ment of a spinal nerve. from vertebral misalignment caused by degenerative Many of the immunologic and physiologic effects at- changes, disc thinning, or structural abnormalities some- tributed to the spinal adjustment are temporary, such as times can be relieved temporarily with manipulation. Such production of endorphins, a decrease in prostaglandin lev- subluxations are not correctable and are not often signifi- els, and an increase in leukocyte respiration.8,41 They have cant. In rare cases, binding or locking of overriding ver- never been shown to be related to the cause and cure of tebral facets can be dramatically relieved by one manipu- disease. Numerous forms of physical stimulation, such as lation that restores mobility.42 deep massage, hydrotherapy, or acupuncture, can produce In 1995, in a landmark and largely ignored study of the similar biochemical effects. literature by two chiropractors, Nansel and Szlazak sug- According to a 2003 random survey of 1102 active gested that there are no appropriately controlled studies to North American chiropractors, 88.1% of 687 respondents indicate that dysfunction in structures of the spinal column thought that the term vertebral subluxation complex could cause organic disease.34 They reported that, “it has should be retained by the chiropractic profession.33 The now been firmly established that somatic dysfunction is respondents also thought that vertebral subluxation is a notorious in its ability to create signs and symptoms that significant contributing factor in 62.1% of visceral ail- can mimic, or simulate (rather than cause), internal organic ments.33 The majority (89.8%) thought that the adjustment disease.”34 However, Rosner, in a report published by the should not be limited to musculoskeletal conditions.33 At Foundation for Chiropractic Education and Research, con- least one chiropractic journal, the Journal of Vertebral tends that these findings are contradicted by studies sup- Subluxation Research, is devoted to preserving and pro- porting the concept of subluxation.41 moting the subluxation theory. Articles on spinal adjust- In July 1996, the Association of Chiropractic Colleges ments as effective treatments for conditions such as mul- (ACC), representing 16 North American chiropractic col- tiple sclerosis, otitis media, and infertility are published in leges, reached a consensus and stated that “Chiropractic is this journal. concerned with the preservation and restoration of health, Goertz, in an article published by The American Chi- and focuses particular attention on the subluxation. A sub- ropractic Association in 1998, reported that 94% of chi- luxation is a complex of functional and/or pathological ropractic patients were treated for neuromusculoskeletal articular changes that compromise neural integrity and conditions.21 Yet, chiropractic colleges, associations, and may influence organ system function and general health.”5 research organizations continue to promote chiropractic This theory seems to ignore autonomic cranial and sacral as a method of adjusting the spine to improve general nerves which do not pass through movable articulations.12 health.22,47 The ACC’s paradigm and its views on subluxation were There is no proof that subluxations cause organic dis- endorsed by the International Chiropractic Association and ease,12,16,34 but chiropractic theory and philosophy sup- the American Chiropractic Association in November 2000 port different spinal adjustive procedures that allegedly are and by the World Federation of Chiropractic in May 2001. effective in restoring and maintaining health by removing The document was included in Appendix A of the 2005 nerve interference (Fig 1). Christensen et al, in a survey edition of Job Analysis of Chiropractic,11 published by the analysis published by the National Board of Chiropractic National Board of Chiropractic Examiners. In 1997, the Examiners in 2005, rated 15 adjustive procedures com- Foundation for Chiropractic Education and Research monly used by chiropractors. Most chiropractors (96.2%) Copyright © Lippincott Williams & Wilkins.