Here’s an article by Samuel Homola, a retired chiropractor who specialized in the care of musculoskeletal problems and is the author of 15 books, including Bonesetting, Chiropractic and Cultism, and Inside Chiropractic.
Chiropractic For Back and Neck Pain
In 2005, the World Federation of Chiropractic defined chiropractors as “…spinal health care experts in the health care system…with emphasis on the relationship between the spine and the nervous system…” This ambiguous definition fails to place proper limitations on the practice of chiropractic, leaving the door open for subluxation-based chiropractors who use spinal adjustments to treat general health problems. Such chiropractors, with only a hammer in their tool box, cannot qualify as a legitimate “back specialist” or “spine specialist.”
According to the Agency for Healthcare Policy and Research, low-back trouble is the second most common reason for office visits to primary care physicians and the most common reason for office visits to orthopedic surgeons, neurosurgeons, and occupational medicine physicians. Back problems are the most common cause of disability among persons under the age of 45 (Acute Low Back Problems in Adults, 1994). Despite the fact that back pain is one of this nation’s most common ailments, the niche for a back-pain specialty remains unfilled. With changes, chiropractic could have filled this niche (specializing like optometry or chiropody), but instead chose to be defined as a form of alternative medicine with a limited treatment method and an unlimited scope of practice.
Most people think of a chiropractor as a “back doctor.” And most people who go to a chiropractor go for treatment of a neck or back problem. It is certainly ironic that many chiropractors consider it demeaning to be called a “back specialist,” preferring to “treat human ailments without use of drugs and surgery.” Unfortunately, most state laws define chiropractic in this way, resulting in scientific and societal suspicion that hinders change and keeps utilization of chiropractic low.
Today, 48 years after publication of my Bonesetting book, I am still of the opinion that the chiropractic profession is not properly defined and limited. Chiropractic associations continue to tolerate implausible theories that provide an umbrella for inappropriate use of spinal manipulation and a variety of proprietary treatment methods applied to the gamut of human ailments. Many subluxation-based chiropractors seek support in the camp of alternative medicine where they are more readily accepted and where quackery is rampant. They are not representative of chiropractors who follow the guidelines of science in limiting their scope of practice. The uncontested proclamations of chiropractors who make vague and all-inclusive claims continue to drag the profession down, as indicated by figures showing that the percentage of the population seeing chiropractors annually decreased from 9.9% in 1997 to 7.4% in 2002 (Altern Ther Health Med. 2005;11:42-49), despite increasing popularity of alternative medicine.
Scientific presentations will not eliminate a belief system such as homeopathy or subluxation-based chiropractic, nor will the actions of a few science-based chiropractors. It seems likely that there will always be subluxation-based chiropractors. Until the majority of chiropractors make a clean break from what has traditionally been known as chiropractic (adjusting the spine to restore and maintain health), changes for the better in the profession as a whole will be problematic. Chiropractic associations will tend to represent the views of the majority, even if these views are scientifically indefensible. And the definition of chiropractic will continue to be based upon consensus rather than upon science.
Since physical therapy as a sub-specialty of medicine is now incorporating use of science-based manipulation in an armamentarium designed for treatment of neck and back pain and other musculoskeletal problems, it might be too late for the chiropractic profession to establish itself as a preferred back-pain specialty or sub-specialty. Forty-six states now allow direct access to the services of a physical therapist without physician referral. According to the American Physical Therapy Association, physical therapy, by the year 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists.
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