The Evolution of Chiropractic — Science & Theory
By Scott Haldeman, D.C., M.D., Ph.D.
International Conference on Spinal Manipulation
I have had the privilege of being associated with chiropractic and chiropractic ideas all of my life through my father and grandmother, both of whom were practicing chiropractors. I have also been lucky to have participated in one of the most exciting phases in the evolution of chiropractic over the past 35 years. I thought that it would be of interest to younger researchers and clinicians to present my views on how the profession has evolved to its current position in society and how this evolution has impacted our understanding of chiropractic. I plan to discuss how we can put the changes in the role of science over the past 100 years in perspective and how these changes are likely to impact our lives as researchers, chiropractors, and physicians studying and treating patients with spinal disorders.
Chiropractic, in its early stages, had some very colorful and interesting theoretical perceptions. The most widely quoted theory was that one could seek chiropractic care for anything that was wrong and that chiropractic would make it better. It was also widely believed that everybody should be seeing a chiropractor on a regular basis even if they were healthy. This concept led to the situation where chiropractors became outcasts to the medical system. These claims were often repeated in flamboyant advertising in newspapers and resulted in complete separation of chiropractic from the rest of the world of health care that was unable to accept this point of view without some research support. The last 2 decades have seen a dramatic change to a situation where chiropractors are now widely accepted and have high quality scientific meetings that are often cosponsored by medical institutions. Chiropractic has spread from the United States throughout the world to the point where there are now more chiropractic colleges outside the U.S. than inside the U.S. The acceptance of chiropractic has been so successful that the annual conferences by the World Federation of Chiropractic are cosponsored by the World Health Organization (WHO). As further indication of the acceptance of chiropractic, a WHO Collaborating Center Task Force on the Cervical Spine and Related Disorders has been established, with a number of individuals with chiropractic training included on the various panels. Chiropractic has moved rapidly from the outskirts into the mainstream of health care. The independent reviews of research and clinical practice by such agencies and commissions as the AHCPR, the New Zealand commission, the Australian, Danish and British guidelines for treating people with back pain or spinal problems have included input by chiropractic authorities and many of the procedures practiced by chiropractors have received favorable recommendation. How has this happened?
In the early part of the Twentieth Century, there were many traditional treatment approaches that had been offered to patients for years. Manipulation had been practiced almost since the beginning of recorded history. The practice of medicine consisted primarily of a variety of herbs, extracts and metals which had been handed down from practitioner to practitioner with limited effectiveness. Surgery consisted of crude methods of treating injuries and wounds and attempts to remove diseased organs and drain infections. All of these traditional practices were based on clinical tradition and experience and almost all of the theory supporting their use was speculative with very little scientific support. Clinicians of the day were required to speculate or postulate on the mechanism by which these treatments could be successful. When patients said they felt better after treatment, it was considered a good treatment. Clinicians had to guess at the reason they were treating in a certain way based primarily on their training and experience rather than any true evidence to support the treatment approach.
Treatment of spinal disorders at the beginning of the Twentieth Century consisted of mobilization or immobilization of the spine. Basically, the patient was placed in a brace with bed rest or given manipulation and exercise. The theories referred to restoring motion and thereby relieving inflammation, putting vertebrae in place and relieving neuro-vascular compression or interference. Classic chiropractic theory of that time described the effect of the adjustment in terms of putting vertebrae in place and reducing nerve compression. Classic osteopathic theory referred to putting vertebrae in place and thereby reducing vascular compression. The theory held by many medical practitioners suggested that manipulation increased vertebral motion and somehow reduced inflammation.