Answers to Questions about Chiropractic:
What Percentage of Chiropractors Base
Their Practice on Subluxation Theory?

Samuel Homola, D.C.

Question

I have heard chiropractors say that most chiropractors no longer believe in the subluxation theory and that modern chiropractors do not practice the way they did years ago. Yet every chiropractor I have consulted has told me that I had vertebral subluxations that would affect my general health. What is going on?

Answer

According to a recent survey [1], 76.5% of chiropractors teach that there is a relationship between spinal subluxations and internal health and that subluxation is a significant contributing factor in 62.1% of visceral ailments. The overwhelming majority of respondents (88.1%) said they want to retain the term "vertebral subluxation complex" and 89.8% opposed limiting use of chiropractic adjustments to treatment of musculoskeletal problems.

These findings should not be surprising, since dictionaries and many state laws define chiropractic as a method of adjusting vertebral subluxations to restore and maintain health by removing "nerve interference." Most chiropractic schools still teach subluxation theory. In July 1996, the Association of Chiropractic Colleges, representing 16 North American chiropractic colleges, issued a position paper stating that "Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation." In addition, nearly all chiropractic associations endorse this paradigm.

Since the only thing unique about chiropractic is its subluxation theory, it would be difficult or impossible for the profession to abandon it. Spinal manipulation—minus the theory—is already offered by physical therapists and other practitioners of physical medicine. Chiropractors fear that they will be replaced by physical therapists if the chiropractic profession dumps the subluxation theory.

There will always be people who utilize implausible and scientifically unsupported treatment methods such as homeopathy and subluxation-based chiropractic. But the percentage of the U.S. population visiting chiropractors annually may never rise much above the current 10% level if chiropractic remains so ill-defined.

With recent studies indicating that spinal manipulation is no better than massage or physical therapy in the treatment of back pain [2], chiropractors may be more reluctant than ever to limit their scope of practice to musculoskeletal problems. Even though most people who go to chiropractors go for treatment of back pain, the number who visit chiropractors might actually diminish when manipulation becomes more available in physical medicine—especially if chiropractic continues to define itself as a method of adjusting subluxations to restore and maintain health. Figures showing that chiropractors perform 94% of the spinal manipulation in North America mean little if the manipulation is done for the wrong reasons in the majority of cases.

References

  1. How Chiropractors Think and Practice: The Survey of North American Chiropractors. Institute of Social Research, Ohio Northern University, 2003.
  2. Spinal manipulative therapy for back pain. Annals of Internal Medicine, June 3, 2003.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This article was posted on January 22, 2004.