Question
Hello again Dr. A,
Thank you for the prompt, thorough response on 10/19.
My pcp said my symptoms don't justify/warrant a MRI. My pt said I'm 3 times as likely to have surgey if I get a MRI. I'm not ready for the needles yet.

Here in modern times, medical miracles abound. All the  knowledge and technologies allow people to live longer, it's a proven fact. On the other hand is chiropractic. My "Subluxation complex prognosis is as follows:

Phase two spines generally return to near normal function. The degeneration and bone spur formation usually slows and in many cases stops.

Is this a non-evidence based statement? Is there absolutley no proof, or research that suggests this can be factual? Is this a play on words? Maybe it just kinda sorta works, but not enough to be worth the money and time commitment. If does work, I want some. This guy is a very respected and popular Dr.  Is he actually trying to sell something that is false, a sham ? It boggles my mind that I can't seem to get the straight dirt on all this Chiropractic business. Is it a valid medical disipline, or a religion of sorts, that requires you to have faith  before it will work ?
Respectfully,
R.T.

Answer
Russ,

Thank you for your follow-up question.

1. "Subluxation complex" is an ambiguous term which carries over from the origin of the chiropractic profession. In the late 1800s and early 1900s, chiropractic sought to establish itself as a separate and distinct profession from medicine and osteopathy. To do this, chiropractic established its own set of terms to support its claim to exclusivity and distinctiveness. "Subluxation" (which in medicine refers to a partial dislocation of a joint) took on a particular meaning which, variably, referred to spinal "misalignment" creating "nerve interference." This is not a concept which is supported by today's knowledge and is only endorsed by chiropractors who do not embrace an evidence-based approach, although (and regrettably), this term is often found in the legal scope of practice of chiropractors in most states. Historically, "subluxation" became embedded as a distinctively chiropractic term when it was used as a legal defense for chiropractors charged with practicing medicine without a license in the early 1900s (the line of reasoning being that only chiropractors were trained to "detect and correct" subluxation. Therefore, the term "subluxation complex" isn't really an accurate diagnosis.

A 2005 paper published in the journal Chiropractic & Manual Therapies explored the identity of chiropractic. The authors stated:

"More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care...

The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach."

A 2008 paper published in Chiropractic & Manual Therapies also stated:

"More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care.

The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach."

2. "Phase 2 subluxation complex", in my opinion, is a nonsensical term which does not really provide any useful clinical information. As to whether or not the statement about degenerative changes being halted (presumably by chiropractic manipulation/adjustment), I am not aware of any scientific data to support that claim, and would place the burden of proof on the individual making that statement.

One author discusses the role of subluxation this way:

http://tinyurl.com/687fta4

3. Chiropractic as a profession is only as valid as the individuals practicing it. Chiropractic continues to be plagued with practitioners who do not demonstrate the implementation of the best available scientific evidence in guiding them in the treatment of patients, and that knowledge should be tempered with the patient's preferences (when given treatment options) as well as the practitioner's best clinical judgement based on experience and familiarity with the scientific literature. Chiropractic is a health care profession, not a religion. Practitioners who introduce a metaphysical or spiritual overtone to their patient care do not advance the cultural authority of the profession.

The World Federation of Chiropractic's definition of chiropractic as a profession:

A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation.

The World Health Organization recognizes chiropractic as:

A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation with a particular focus on subluxations.

The Association of Chiropractic Colleges defines chiropractic as:

Chiropractic is a healthcare discipline that emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery. The practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. In addition, doctors of chiropractic recognize the value and responsibility of working in cooperation with other health care practitioners when in the best interest of the patient.

The American Chiropractic Association defines the profession as:

"... a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.  Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches."

The word "chiropractic" literally means, from Greek, "done by the hands." Chiropractic care, or more accurately, spinal manipulation as a therapeutic modality, has been shown to be beneficial for certain musculoskeletal conditions. It is not a panacea for all ailments. Chiropractic additionally encompasses a variety of other therapeutic modalities, including soft tissue manipulation, rehabilitation, and lifestyle recommendations. A chiropractor distinguishes himself or herself as a physician when they also include a comprehensive patient examination and specific meaningful diagnosis as well as differential diagnoses (i.e., what else could be causing the problem?) into their patient work-up.

Additional facts on chiropractic may be found here:

http://tinyurl.com/yg6na8r

http://tinyurl.com/5um2cua

As I mentioned in my previous response, a number of chiropractors who seek to reform the profession by promoting best-evidence practices in line with current scientific knowledge (such as the West Hartford Group members) reject antiquated chiropractic dogma and metaphysical concepts, and seek meaningful integration with mainstream health care.

I hope that this helps to answer your question.