Chiropractic subluxation is still “unsupported speculation”
PainSci summary of Mirtz 2009?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
This landmark paper penned by four chiropractors is a strong indictment of a philosophical pillar of their own profession. Although a bit of a moving target over the years, subluxation theory generally refers to idea that spinal joint dysfunctions have broad health significance, which has been a major component of chiropractic thought since the founding of the profession. The authors analyze and condemn it:
No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation.
And yet it’s been there for more than a century, I’d like to add.
Dr. Harriet Hall explained the significance of the paper in an article for ScienceBasedMedicine.org, The End of Chiropractic.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.
AIM: The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.
METHODS: The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.
RESULTS: The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.
CONCLUSION: There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.
related content
- “Chiropractic identity, role and future: a survey of North American chiropractic students,” Jordan A Gliedt, Cheryl Hawk, Michelle Anderson, Kashif Ahmad, Dinah Bunn, Jerrilyn Cambron, Brian Gleberzon, John Hart, Anupama Kizhakkeveettil, Stephen M Perle, Michael Ramcharan, Stephanie Sullivan, and Liang Zhang, Chiropr Man Therap, 2015.
- “Canadian chiropractors’ attitudes towards chiropractic philosophy and scope of practice: implications for the implementation of clinical practice guidelines,” Lesley Biggs, David Hay, and Dale Mierau, Journal of the Canadian Chiropractic Association, 1997.
- “Opposing Chiropractic: Persecution or Justified Criticism? – Science-Based Medicine,” Sam Homola, Sciencebasedmedicine.org.
Specifically regarding Mirtz 2009:
- “The End of Chiropractic,” Harriet Hall, ScienceBasedMedicine.org.
These four articles on PainScience.com cite Mirtz 2009 as a source:
- Choose the Therapist, Not the Therapy — When you’re in pain, you want to know “what works,” but what you should look for is an honest therapist of any kind
- The Chiropractic Controversies — An introduction to chiropractic controversies like aggressive billing, treating kids, and neck manipulation risks
- Does Spinal Manipulation Work? — Spinal manipulation, adjustment, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain
- Organ Health Does Not Depend on Spinal Nerves! — One of the key selling points for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.