The “Naysayers” Corner

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

	The Chiropractic Identity A Chiro.Org article collection Hold your horses! Before you read these fanciful Chiropractic Identity articles, which suggest that we all drop the dreaded subluxation-fixation hypothesis, so that we can assume the mantle as the Spinal Health Care Experts of the Universe, please read this thoughtful piece by a PhD-level sociologist (Caught in the Crosshairs), who also happens to be the wife of a chiropractor. Her insights into the political maneuvering in our profession are well worth the read
	Chiropractic, One Big Unhappy Family: Better Together or Apart? Chiropractic & Manual Therapies 2019 (Feb 21); 27: 4 It's with heavy heart that I realize that it's all come down to this: chiropractic depicted as a bad soap-opera marriage. What is more upsetting is that this article is penned by some of the best, brightest and most-published of our chiropractic researchers. I love these folks! That said, I'd like to challenge some of their assumptions. Chiropractic is not a marriage between chiropractors. At best, it's a Family. And families interact. I just might marry your sister, for example. Now you may not like me, or you may not like our marriage. But that's a personal problem. The word Evidence has taken on a sacred-cow glow lately, and is only eclipsed by the adoption of the word skeptic by every Tom, Dick and Harry blog-opinionist on the planet. So, let's set the stage for the conversation. This article dishes up several reasons why (as they call themselves) the 'evidence-friendly' faction are opposed to the 'traditional' group. Here's a short list of the infractions that are practiced by the 'traditionalists' They ‘believe’ in “subluxations” Some of them ‘believe’ that you can find “subluxations” on x-rays Some of them ‘believe’ that correcting “subluxations” leads to improved health So let's address these concerns, one at a time. Read more now.
	Chiropractic Conservatism and the Ability to Determine Contra-indications, Non-indications, and Indications to Chiropractic Care: A Cross-sectional Survey of Chiropractic Students Chiropractic & Manual Therapies 2019 (Feb 19); 27: 3 ~ FULL TEXT Chiropractic students are able to recognize contra-indications and indications but find it more challenging to identify non-indications in chiropractic clinical cases. Moreover, students who adhere to a conservative chiropractic approach systematically wish to treat patients, regardless of the symptoms, and even if they present with non-indications. The apparent presence of the conservative approach is of concern because it may predict a proportion of our future chiropractors scope of practice. Therefore, the determinants of this phenomenon need to be explored and understood.
	Chiropractic Identity: A Neurological, Professional, and Political Assessment J Chiropractic Humanities 2016 (Dec); 23 (1): 35–45 ~ FULL TEXT This article provides an overview of chiroractic identity from 6 points of view: (1)   concepts of manual medicine; (2)   areas of interest beyond the spine; (3)   concepts of the chiropractic subluxation; (4)   concepts of neurology; (5)   concepts of mainstream or alternative health care; and (6)   concepts of primary care, first-contact provider, or specialist.
	Analysis and Adjustment of Vertebral Subluxation as a Separate and Distinct Identity for the Chiropractic Profession: A Commentary J Chiropractic Humanities 2016 (Oct 25); 23 (1): 46–52 ~ FULL TEXT When a profession’s identity is not clear with respect to its area of interest and mission, then the public may be less inclined to seek its services. Identifying the chiropractic profession with a focus on vertebral subluxation would give the profession uniqueness not duplicated by other health care professions and therefore might legitimatize the existence of chiropractic as a health care profession. An identity having a focus on vertebral subluxation would also be consistent with the original intent of the founding of the chiropractic profession.
	Chiropractic Identity in the United States: Wisdom, Courage, and Strength J Chiropractic Humanities 2016 (Sep 15); 23 (1): 29–34 ~ FULL TEXT The various clinical specialties and independent groups in the chiropractic profession are so different in their beliefs, practice styles, and political agendas that a common identity is unlikely to be created. Areas of disagreement, including advanced practice, vertebral subluxation, and the philosophy of chiropractic, continue to separate those in the profession. Doctors of chiropractic should accept that differences within the profession will remain for the foreseeable future and that the profession should allow each group to live peacefully and supportively alongside each other. There's more on this topic at our Chiropractic Identity Page
	Subluxation and Semantics: A Corpus Linguistics Study J Can Chiropr Assoc. 2016 (Jun); 60 (2): 190–194 ~ FULL TEXT It was possible to identify 3 distinct concepts which were each referred to as 'subluxation:' i) an acute or instantaneous injurious event; ii) a clinical syndrome which manifested post-injury; iii) a physical lesion, i.e. an anatomical or physiological derangement which in most instances acted as a pain generator.   In fact, coherent implicit definitions of subluxation exist and may enjoy broad but subconscious acceptance. However, confusion likely arises from failure to distinguish which concept an author or speaker is referring to when they employ the term subluxation.
	Straight Chiropractic Philosophy As A Barrier To Medicare Compliance: A Discussion of 5 Incongruent Issues J Chiropractic Humanities 2013 (Oct 24); 20 (1): 19–26 ~ FULL TEXT The number of Medicare beneficiaries who used chiropractic spinal manipulation grew 13% from 2002 to 2004, remained flat through 2007, and then declined 5% through 2008. An estimated 1.7 million beneficiaries (6.9%) used 18.6 million allowed chiropractic services in 2008. In inflation-adjusted dollars, allowed charges per user increased 4% through 2005 and then declined by 17% through 2008; payments per user increased by 5% from 2002 to 2005 and then declined by 18% through 2008. Expenditures for chiropractic in 2008 totaled an estimated $420 million. Longitudinal trends in allowed claims for spinal manipulation varied by procedure: the relative frequency of treatment of one to two spinal regions declined from 43% to 29% of services, treatment of three to four regions increased from 48% to 62% of services, and treatment of five regions remained flat at 9% of services.
	A Diachronic Study of the Language of Chiropractic J Can Chiropr Assoc. 2013 (Mar); 57 (1): 49–55 ~ FULL TEXT This study investigates how the language of chiropractic has changed over time. A collection of material, published up until approximately 1950 and consisting of textbooks, monographs and lecture notes from Canadian Memorial Chiropractic College, was analyzed to identify commonly occurring words and phrases. The results were compared to a corpus of recent articles from the Journal of the Canadian Chiropractic Association. This permitted the identification of words which were over-represented in the historical literature and therefore likely have become somewhat archaic or represent themes which are of less import in the modern chiropractic literature. Words which were over-represented in the historical literature often referred to anatomical, pathological and biomechanical concepts. Conversely, words which were comparatively over-represented in the modern chiropractic literature often referred to concepts of professionalism, the clinical interaction and evidence-based care. A detailed analysis is presented of trends in the use of the conceptually important terms subluxation and adjustment.
	The Five Eras of Chiropractic & the Future of Chiropractic As Seen Through the Eyes of a Participant Observer Chiropractic & Manual Therapies 2012 (Jan 19); 20 (1): 1 ~ FULL TEXT Chiropractic has endured a turbulent history, marked by tremendous advances in areas such as education and licensing while marred by interprofessional conflict and a poor public image. The prolonged interprofessional conflict was instrumental in shaping the culture of chiropractic. These obstacles have long-since been removed although there are lingering effects from them. This article examines the chiropractic profession's history by dividing it into five Eras and suggests that there are three options available for the future of the profession. One: maintaining the status quo. Two: uniting under an evidence based scientific approach as partners in the health care delivery system that has buried the "one-cause, one-cure" sacred cow. The steps required to achieve this outcome are outlined. Three: openly dividing the profession into evidence based practitioners and subluxation based practitioners. Adopting this option would allow each branch of the profession to move forward in the health care delivery system unhindered by the other.It is unclear which option the profession will choose and whether the profession is mature enough to follow option two remains to be seen. What is evident is that the time to act is now.
	The Prevalence of the Term Subluxation in North American English-Language Doctor of Chiropractic Programs Chiropractic & Manual Therapies 2011 (Jun 17); 19: 14 ~ FULL TEXT Palmer College in Florida devoted 22.72% of its curriculum to courses mentioning the subluxation followed by Life University (Marietta, GA) and Sherman College with 16.44% and 12.80% respectively. As per specific coursework or subjects, an average of 5.22 courses or subjects have descriptions mentioning the term subluxation. Three schools made no mention of the term subluxation in their academic catalogs; they were National University of Health Sciences, Canadian Memorial Chiropractic College, and Southern California University of Health Sciences.
	Chiropractic at the Crossroads or Are We Just Going Around in Circles? Chiropractic & Manual Therapies 2011 (May 21); 19: 11 ~ FULL TEXT This paper is the author's perception of the many changes which have impacted, both positively and negatively, on chiropractic and the chiropractic profession over the past 30 years. Some of those changes have advanced the professional status of chiropractic, improved undergraduate training and paved the way for a research culture. Unfortunately, other changes, or lack of changes, have adversely affected the profession's growth, credibility and the public utilisation of chiropractic services in Australia. It would also appear, that the crossroads confronting the profession in Australia are not unique, as there are many parallels with what has occurred or is occurring internationally.
	Historical Overview and Update on Subluxation Theories J Chiropractic Humanities 2010 (Dec); 17 (1): 22–32 ~ FULL TEXT This article presents a personal view of the historical evolution of theories of subluxation in the chiropractic profession. Two major themes emerge from this review: those related to the mechanical behavior of the spine and those related to the neurologic implications of these mechanical issues. Chiropractic subluxation theory is one of the few health-related theories whereby these mechanical and neurologic theories have been unified into a comprehensive theory of disorder of spinal function. For this disorder, doctors of chiropractic have used the term subluxation. These theories, and their unification in the “subluxation concept,” have undergone evolution in the profession's history. The “subluxation concept” currently faces challenges, which are briefly reviewed in this article. The only way forward is to strengthen our efforts to investigate the “subluxation concept” with high-quality scientific studies including animal models and human clinical studies.
	Subluxation – Historical Perspectives Chiropractic Journal of Australia 2009 (Dec); 39 (4): 11–164 ~ FULL TEXT The notion that by changing the word subluxation to another term we will somehow change the clinical, political, and philosophical connotations of the concept central to chiropractic practice is simply not rational. Changing the term used for the articular lesion treated by chiropractors (subluxation) does not eradicate the clinical, political, and philosophical issues that surround the construct; it obviously evades the issues. [30]
	Subluxation – Historical Perspectives Part II Chiropractic Journal of Australia 2009 (Dec); 39 (4): 143–150 ~ FULL TEXT Subluxation is a term that has been used by the chiropractic profession since its early days. The term, meaning less than a luxation, has been used for millennia, similarly so has manipulation been the preferred intervention to overcome this problem. This paper reviews some of the early uses of subluxation and manipulation identifying highlights, to help the reader appreciate that subluxation and manipulation, both spinal and general, are as old as civilisation itself.
	How Can Chiropractic Become a Respected Mainstream Profession? The Example of Podiatry Chiropractic & Osteopathy 2008 (Aug 29); 16: 10 ~ FULL TEXT The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise. Several lessons can be learned from the podiatric medical profession in this effort.
	Is Chiropractic a CAM Therapy or is it a Separate Profession? J Can Chiropr Assoc 2005 (Sep); 49 (3): 133-136 ~ FULL TEXT Whatever the future course of CAM, whether portions of it gain more credibility or whether it languishes as a passing fad, is largely irrelevant to chiropractic. The bottom line is we are not prospering under the CAM label and thus should have no further association with it. The challenge for chiropractic is to exhibit the foresight, the professional integrity, and the courage, to do what is necessary. Chiropractic must give up its “rule of the nerve” and embrace evidence based health care in its entirety. It must do so as a profession separate from CAM and simultaneously seek alignment with established health care systems. Chiropractic must face the challenge of defining a credible role for itself devoid of “philosophical” trappings. Such a course will not be easy, but it provides the only option for re-inventing chiropractic as a credible, viable, sustainable, and separate profession.
	Subluxation: Dogma or Science? Chiropractic & Osteopathy 2005 (Aug 10); 13: 17 ~ FULL TEXT Subluxation syndrome is a legitimate, potentially testable, theoretical construct for which there is little experimental evidence. Acceptable as hypothesis, the widespread assertion of the clinical meaningfulness of this notion brings ridicule from the scientific and health care communities and confusion within the chiropractic profession. We believe that an evidence-orientation among chiropractors requires that we distinguish between subluxation dogma vs. subluxation as the potential focus of clinical research. We lament efforts to generate unity within the profession through consensus statements concerning subluxation dogma, and believe that cultural authority will continue to elude us so long as we assert dogma as though it were validated clinical theory.
	Chiropractic As Spine Care: A Model For The Profession Chiropractic & Osteopathy 2005 (Jul 6); 13: 9 ~ FULL TEXT This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession. There are more articles like this at our Chiropractors As the Spinal Health Care Experts Page
	Dysafferentation: A Novel Term to Describe the Neuropathophysiological Effects of Joint Complex Dysfunction. A Look at Likely Mechanisms of Symptom Generation J Manipulative Physiol Ther 1998 (May); 21 (4): 267–280 ~ FULL TEXT Since the founding of the chiropractic profession, very few efforts have been made to thoroughly explain the mechanism(s) by which joint complex dysfunction generates symptoms. Save for a few papers, only vague and physiologically inconsistent descriptions have been offered. The purpose of this article is to propose a precise and physiologically sound mechanism by which symptoms may be generated by joint complex dysfunction. This thought provoking FULL TEXT article was released exclusively to Chiro.Org by National College of Chiropractic and JMPT. You may also enjoy this response from another chiropractic researcher.

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Updated 11-11-2023