Am I a Chiropractor?

July 2, 2010

I don’t really know what it is supposed to mean “to be a chiropractor”. Or more correctly, I don’t know what it is that would allow me to say to someone who calls themselves a chiropractor: “you’re not a chiropractor!” even if they are registered with the GCC…

Statement 1: Despite some people saying that there is some evidence, which is true, I still stand that there is no evidence to support the subluxation model as a whole. The evidence that is available is primarily spinal and specifically within the spinal arena physiological, functional and anatomical. It refers to te efficacy of manipulative therapies compared to others and includes some varying and seemingly logical tautologies but does in my view not test the subluxation model. It tests compenents of the vertebral subluxation model, but no more, and in doing so fails to lend creedence to it. In fact because the studies fail to actually test the subluxation model, I believe the manipulative therapy studies to be both pointless and dissapointing to the chiropractic profession.

Statement 2: It is my belief that because of individual chiropractor’s liking for complexity and lack of a solid starting base (both in terms of assessment method, treatment method and treatment protocol) the exterior view of the chiropractic profession is almost inevitably confused and unsupported. The greatest supporters of chiropractic care and the chiropractic approach are those people who have internalised these complexities and nuances, i.e. chiropractors and patients.

As it stands anyone registered with the GCC can call themselves a chiropractor, whether they practice chiropractic or not. So, the discrimainating point surely is not the technicality of getting a degree and a registration license, but rather what it is that makes that someone who is registered with the GCC looks like what (s)he is doing is providing chiropractic care, or what it means to be a practicing chiropractor. Unless of course the only distinguising factor between chiropractors, osteopath and physiotherapists is GCC registration.

Hence why my question: am I a chiropractor? What are the questions I would need to answer and what are the answers I would need to give to those questions in order to qualify? Amongst those questions, which ones are the ones that make it so that I can only be a chiropractor if I answer them in one particular way?

An obvious one is Q: “what do you do?” A: ” I detect and adjust subluxations”.

Another one is Q: “Why do you adjust subluxations?” A: “to enable innate intelligence to do the healing”.

The issue is ofcourse then “What is a subluxation/an adjustment/innate intelligence?”

Another big issue derived from this is the chiropractic business model, i.e. “Who needs to get adjusted? A: “Only those people with subluxations” I hear you whisper in the corridors Find it fix it and leave it alone was the oldskool adage. But if you don’t have a clear idea of what a subluxation is and what an adjustment is then you basically don’t know who your customer is. Ergo without a clear view on these points, chiropractic simply does not have an economical model.

But back to the beginning: As you can see from this and previous postings I don’t have issue with the meaning of the original chiropractic concept, and I acknowledge it to be an untested theoretical model. I do have some trouble with certain interpretations of the subluxation model and the way some people have opted to interpret matters for pecuniary gain.

So I guess I am making a case for compiling a workable model. I think I have one, and am playing with research models but before telling you what makes me think that I am a chiropractor in its theoretical sense (in my view) I would love to hear form you about what makes you a chiropractor?

Kind regards,


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  • Fedup

    nothing to worry about.

  • Colin Jenkins
  • Richard Lanigan

    To be fair to David Byfield he has made no secret of this fact, stating at a BCA conference in Harogate about ten years ago that there is no difference. He has promoted this agenda on the GCC least we forget the chair of the GCC education committee Graham Pope  is a Physiotherapist. 

    Perhaps you should be asking what is chiropractic and does this traditional image bear any similarity to what the GCC has defined as chiropractic. 

  • Stefaan

    and what is teh difference?

  • Taekwondo23

    if you went to the wioc ur not a chiropractor, your a manipulative physiotherapist.

    an ex wioc grad

  • Paul

    Barney – have you a reference?

  • Barney

    “I must admit the more I talk to ex AECC students and friends who are chiros/osteos I can’t help shake the feeling that the GCC and BCA moved the way they did because they wanted to wed the medical profession rather than because it was in the best interest of chiropractors…

    Absolutely right which is why the BCA rejected the AAC paradigm on chiropractic definition. Misguided and frankly risky. Look what happened to the osteopaths in the U.S. – they have, literally, become doctors to the extent that at some osteopathic colleges there manipulation is an ‘elective.’

    On the subject of hommeopathy as nothing more than a placebo, the well-known homeopathic vet, Chris Day, did a study twenty years ago in which one hundred milking cows infected with mastitis were treated in two groups: the first had antibiotics and the second had homeopathic tincture in their water trough. The second group showed greater improvement. It would be an amazing stretch of imagination to say the cows ‘thpought’ they were getting better because there was something (about 25 ml in a large water trough) they were consuming!

  • Colin Jenkins

    I must admit the more I talk to ex AECC students and friends who are chiros/osteos I can’t help shake the feeling that the GCC and BCA moved the way they did because they wanted to wed the medical profession rather than because it was in the best interest of chiropractors…

    I can tell you and it’s probably not a surprise that from the outside it looks a mess…

  • Stefaan Vossen

    In that context, I agree, but the signal I want to send out to chiropractors out there is that the possibility of reliance on the current state of scientifically assessed knowledge does not represent the real potential that is out there. It also would be great shame to give up on the broader meaning of the chiropractic theory in favour of relatively poor results. Medipractic is basing itself and finding support in such (what I deem to be) poor results and as a therapeutic branch will in my estimation come crashing down shortly unless it reviews its scope and reinvents itself to be more akin to the chiropractic it thought it would be wise to distance itself from. It seems Freudian in a way…Just as it tries to run away from its parent it realises that it can’t do without it…tells the same bad jokes and makes the same embarrassing comments, particularly those it once said “when I grow up I will never say that to my children” lol

  • Colin Jenkins

    I was speaking hypothetically, in a context where there was only neutral/neg for a particular treatment based on this:-

    “Do you mean: negative/neutral results from good spinal adjustment efficacy studies are in fact questionable because in some cases the pain is partly caused by gait dysfunction; something a spinal adjustment cannot affect…?”

    PS: did you know your website domain registration just expired..?

  • Stefaan Vossen

    @ Colin
    “the only conclusion at this point in time should be “it doesn’t work” and clinicians should question using it”
    not sure how you come to that conclusion, or whether you mean this to be applicable to the chiropractic debate. We were after all talking about the studies with negative or neutral results. If you do feel it is applicable to this debate, I disagree that “because efficacy tests are not testing plausibility (and gait is all tied into that)” and partially because I personally feel that in the face of the presence of high quality positive evidence for spinal manipulation, it stands to reason that all that will happen by inclusion of further criteria which are likely to be of benefit, the results are likely to only get better. Unless we are of course talking about homeopathy, about which I don’t know enough to comment.
    Also a tad confused about “But until then, it doesn’t work and that’s all clinicians have to go on and what they must base their decisions on.” As we surely agree that clinical experience, in situation where little high quality evidence is available is paramount? Finally we must also not forget that the arena we find ourselves in is delicate,… one where the practice may not have much evidence going for it, but there is still someone in a lot of pain in front of us. Helping that person makes it all a lot less morally questionable. But maybe I didn’t quite get what you meant

  • Colin Jenkins

    e.g. homeopathy again (sorry – it’s just so useful as an example) – efficacy studies overwhelmingly say it doesn’t work above placebo so clinicians should probably stop using it (or find that argument to treat knowingly).

    But that is separate from the science (and I choke saying that in homeopathy context) – but yes – somebody *may* come up with why it doesn’t work in the future and find a workaround.

    But until then, it doesn’t work and that’s all clinicians have to go on and what they must base their decisions on.

    Anything else is morally questionable; the practice being separate from the science…

  • Colin Jenkins


    Yes and because efficacy tests are not testing plausibility (and gait is all tied into that) the only conclusion at this point in time should be “it doesn’t work” and clinicians should question using it.

    Which of course is not to say researchers should not try and find out why it doesn’t work…

  • Stefaan Vossen

    Yes, but to be fair it is not the study that is questionable, just the conclusions we infer from them.

  • Colin Jenkins


    Do you mean: negative/neutral results from good spinal adjustment efficacy studies are in fact questionable because in some cases the pain is partly caused by gait dysfunction; something a spinal adjustment cannot affect…?

  • Stefaan Vossen

    I agree that plausibility of methodology is irrelevant in the face of outcomes of efficacy trials but only if the efficacy trial assesses the methodology.
    By discussing the “subluxation concept” (and for relevance to the chiropractic profession I am now doing so in the context of the biomechanical realm alone) in a widened scope (ie beyond “spinal subluxations”) to the inclusion and acknowledgement of gait and bite dysfunction as a causal mechanism (although I am sure there might be more) I am seeking to achieve three things:
    -greater coherence with the chiropractic philosophy (even if historically it did in my view place too great a practical emphasis on the primacy of spinal dysfunction, I feel that including a wider appreciation of further causal mechanisms and polycausality provides greater coherence with the conceptual intentions of its originators, but that might just be me)
    -increase plausibility by virtue of coherence of findings in other clinical settings (lots of podiatrists will be advertising their services for back pain, some dentists are picking up on it too now in the UK)
    -improve efficacy trial outcome measures. I know I am not supposed to be biased, but I think that by including gait and bite assessments into the clinical protocol of the back pain specialist, better results will be obtained. And I would like that. If it doesn’t, I will jack it all in.
    Efficacy trials looking at spinal manipulation in isolation are useless unless they have excluded ascending gait dysfunction (including anatomical leg length discrepancies) and descending bite dysfunction. Not useless completely of course, but just surprising how good the results they yield actually are. I would have expected them to be worse.
    To make matters worse, it is not so that every person with a gait dysfunction or bite dysfunction has such a dysfunction to the detriment of a presenting complaint (eg back pain, ie you’re allowed to have one, but it’s presence doesn’t mean that it impacts on your complaint) hence the use of the words ascending and descending to denote their impact on distal areas.

  • Colin Jenkins

    Treatment with homeopathy for asthma:-

    Anecdotal evidence: good
    Plausibility: near nil
    Efficacy: no effect above placebo.
    Conclusion: placebo.

    Treatment with chiropractic adjustment ‘for’ asthma:-

    Anecdotal evidence: good
    Plausibility: ?
    Efficacy: ?
    Conclusion: ?

    Fill in the ?

    (Where “Efficacy” is a statistical conclusion via many studies, meta analyses etc)

  • Colin Jenkins

    “After all, a highly implausible treatment may be shown to have high efficacy; which just means we don’t understand the science yet.”

    Sorry I meant to follow that with – And in that context you can justidy spending time trying to figure out the science – because it works.

  • Colin Jenkins

    Hi Stefaan,

    Yes, by plausibility I mean the plausibility of any existant explanation of mechanism – any explanations of how a treatment works scientifically/physiologically to effect a result.

    Thus plausibility is essentially irrelevant when performing efficacy trials/studies because in that context one is testing results.

    If I may use homeopathy as an example again. Homeopathy is not on the ropes because of lack of plausibility (near nil), but because of lack of efficacy as evidenced from good quality studies.

    Thus the pleas of homeopaths that they need more time to sort out the science (plausibility) are quite frankly, silly.

    After all, a highly implausible treatment may be shown to have high efficacy; which just means we don’t understand the science yet.

    If homeopathy had been shown to have high efficacy from good quality studies, even with it’s near nil plausibility, it could still of sat quite happily in an EBM world(*).

    Similarly a treatment can have high plausibility but no efficacy based on high quality studies; implying (for example) we missed something in the science.

    (*)As I understand it science based medicine (SBM) adds a precondition of reasonable plausibility, which seems a step too far to me. Why stop treating in the face of high evidential efficacy just because of little plausibility; it seems rather arrogant. But maybe I’m misinterpreting SBM…?

  • Stefaan Vossen

    @Colin Jenkins
    I think central to the view your presenting is the concept of “plausibility”, can I just ask: “the plausibility of what?”. Are we talking about the plausibility of manipulation affecting specific conditions?
    My personal view is that it is very plausible to improve form and posture by addressing ascending gait, descending malocclusion and general spinal dysfunctions. What the patient can get from that is a different question altogether and tightly bound to the plausibility of that poor form playing a significant role in whichever condition one proposes to improve upon. Thos etwo sets of plausibility albeit closely related in the patient’s psyche and experience are very distinct in the clinician’s mind.
    Kind regards,

  • Colin Jenkins

    @fed up,


    I have spent my whole life as somebody that claims to help cure the common cold by playing the piano to patients and by other equally weird means.

    Everybody is happy through. People come, get treated and feel much better afterwards.

    There have been no studies to test efficacy (tightly controlled studies) or effectiveness (studies more in the wild) – all I have is anecdotal evidence. There is absolutely no plausibility.

    20 years into the push for EBM, should I still be doing this? Absolutely. No plausibility. No studies. No problem.

    Then some smart-ass scientist tests efficacy of my piano playing treatment with a set of blindingly good studies showing absolutely no affect above placebo.

    I deny it. I say they know nothing. This is my life. What do they know. They must be in the pay of the big farmer. Ah, it’s a conspiracy. After all, I have thousands of happy patients…

    However, I am now at the stage that there is good evidence at my disposal and in an EBM world I’m now in a tricky position for *that particular treatment*.

    To continue is probably unethical and to stop would seriously compromises my income as it was the best paid treatment.

    And the whole thing generates massive cognitive dissonance. I start to question my whole mode of operation because I realise there is no plausibility for my other treatments and maybe, just maybe they are placebo as well…

    Damn, I should have taken note of what happened to the homeopaths (because they similarly had no plausibility) and devised a strategy earlier – maybe I could have argued the case for treating in the knowledge of placebo. But it’s too late now, the chance has gone…

  • Colin Jenkins

    @fed up,

    I stand by all that and what I have just written.

    Pragmatically, one cannot have good positive evidence for *all* treatments(*). EBM is about hierarchically combining evidence from various sources including the clinician’s experience.

    *Where* good evidence does exist it may be positive/neutral/negative.

    My earlier comments are referring to the fact that from what I have read there is *some* good evidence that *some* chiropractic treatments are not effective above placebo and I wanted to start a discussion about the ethics of *those* treatments in that knowledge – but nobody would engage, which is fair enough.

    *Nobody* (inc. the GCC) is saying you must have good positive evidence for all treatments. (Even though it may seem like it sometimes).

    Nobody is saying there is good neutral/negative evidence for all chiropractic treatments. (Even though it may seem like it sometimes).

    (*)Apologies for the use of the word treatment – I know I should be saying ‘adjustments to patients exhibiting X’ but it’s useful to say treatment at this time because the argument applies to all areas of health care not just chiro.

  • fed up

    Hi Colin, then why say this?

    “But as I said to my sister, the problem traditional chiropractors (healthy spine can improve general well being) have is that more and more good (effectiveness and efficacy) studies are coming in showing that it is probably nothing more than placebo for the majority of conditions.”
    your above conclusion is based on rct’s which have nothing to do with clinician experience.

    Or this
    “There seem to be good studies coming back that say chiropractic does no better than placebo, so it can be explained by placebo.”

    “I know you passionately believe in what you do and that your patients are happy, but I believe you have to start acknowledging the impassionate data coming back; if even a little bit for now.”
    again your conclusion is based on data, not A+B+C.

    “Assume for the moment that studies overwhelmingly support the hypothesis that chiropractic treatment for colic is no better than sham treatment for colic (placebo) and somebody comes in asking for colic treatment, and just colic treatment. Would you be happy to provide it?”

    If the clinician has seen positive outcomes, has “experienced” them, with his treatment for colic is he using EBM if he adjusts the child?

    Everything you have said is what the skeptics are crying out for, EBM, but to them, and it seemed you, that means positive gold standard RCT’s only.Clinical experience for single practitioners is just placebo or regression to mean without controlled studies. Apparently.

  • Colin Jenkins

    It’s also pragmatically impossible in any area of healthcare – which is why EBM is a consideration of various sources of evidence including clinician experience.

  • Stefaan Vossen

    Hi Fed up and Colin,
    I think it is just that the GCC is coming in from a slightly different perceptual angle and has expressed that difference in angle in the choice of words and its sequence, but I don’t for one minute think that the GCC is asking chiropractors to be EB only, that would mean there is no more ‘C’ in ‘GCC’.
    Kind regards,

  • fed up

    Is it just me?

  • Colin Jenkins

    I still think they are saying the same thing in different ways; because the GCC specifically mentions experience in their list that comprises what they call EBC; I really don’t see the difference.

  • fed up

    “but we do expect doctors to do their best to ensure that any treatment they offer is in the patient’s best interests.”

    “which is clinical
    practice that incorporates the best available evidence from

    As the statement from the GMC was about placebo and homeopathy funny how research wasn’t mentioned.

  • fed up

    Hi Colin.
    This is the GMC quote
    “We do not require doctors to use only evidence-based treatments”

    This is the GCC quote.
    “they must provide evidence based care”

    “We do not require” is very different “to they must provide”

  • Colin Jenkins

    As I read it is saying you must provide EBC “which is clinical practice that incorporates” A+B+C.

    So EBC is not the top of a list – it’s an inclusive term, for a list of fairly standard EBM devices – experience is the bottom of the list but still a valid reason to adjust…

    Some people have made much of the GCC statement, but I don’t think it says much at all really.

  • fed up

    “they must provide evidence based care, which is clinical
    practice that incorporates the best available evidence from
    research, the preferences of the patient and the expertise of
    practitioners, including the individual chiropractor her/himself
    (GCC Standard of Proficiency section A2.3 and the glossary)”

    From the GCC. I know it states expertise from practitioners but the first(most important?) criteria is “they must provide evidence based care” “incorporates the best available evidence from research”

    Why didn’t the GCC just put out a statement similar to the GMC?

  • Colin Jenkins

    PS: it’s impossible only use treatments for which there is good positive evidence and that is not what EBM is about. Even in dentistry for example there are loads of treatments a dentist will perform with no evidence other than experience.

  • Colin Jenkins

    @fed up

    The GCC are not saying that are they? To conform to advertising standards the GCC have said you should not advertise that a chiro adjustment may help X without good positive evidence; but that does not stop you adjusting somebody exhibiting X based on your and your patient’s experience/wishes.

  • fed up

    Rather interesting guardian piece by M Robbins.

    He asked for the General Medical Councils view on homeopathy and placebo. This was their reply.

    “We do not require doctors to use only evidence-based treatments, in any form of medical care, but we do expect doctors to do their best to ensure that any treatment they offer is in the patient’s best interests. This will generally mean that any known risks of the treatment are outweighed by the potential benefits to the patient.”

    Why is the GMC stating Dr’s don’t have to use ONLY evedince based treatments but the GCC wants chiros to?

  • Garland Glenn

    Do they really. I must not be a real chiropractor as my children are still alive. But I do treat subluxations, so what shall I do now?

  • Richard Lanigan

    Hi Colin,
    If the subluxation was exclusive to chiropractors then only chiropractors could teach you about it and when someone challenged the theory you could easily say there were talking shite because the new nothing about chiropractic. Happens all the time and explains how “chiropractic philosophy” becomes dogmatic.

    Others like the medipractors say lets have ownership of musculskeletal pain syndromes because they respond well to spinal manipulation and those subluxation guys are talking crap and are unethical.

    Chiropractics biggest problem are chiropractors. They say chiropractors kill their young.

  • Colin Jenkins

    Hi Stefaan,

    Sorry, I should have made it clear I was referring to this from Richard:-

    “Many chiropractors would like to claim ownership of the “subluxation” that it is exclusively a chiropractic term only relevant to the spine and some would even narrow it down the atlas.”

  • Stefaan Vossen

    that said I am perfectly happy to call it any other name. I have proposed “dysfunctional mechanism” but feel it’s a bit lacking in identifying its causal relationship. Ultimately it should translate as “that which causes the dysfunction”. Any Latinophiles out there?
    Any reverends…

  • Stefaan Vossen

    Thing is, I was raised thinking of subluxations as “anything which will interfere”… and never assumed that chiropractors were the only ones to remove subluxations… It just makes the whole picture so much more complete, coherent and testable to think of all causes of dis-ease to be due to either physical, psychological or chemical subluxations and to acknowledge that some dis-ease is caused by attacks on any of these systems so ferocious (extensive trauma) or fundamental (genetics) that removing the subluxation is not sufficient.
    It accepts limitations and scope but still looks at life in the same beautifully respectful way.
    It also means that there are certain subluxations chiropractors are well-equipped to deal with and certain others they are well-equipped to refer for (ie they can detect them but not adjust them). To top it all off they are well-equipped to pick up when the dis-ease is not coming from a adjustable subluxation and requires referral for a medical approach.
    I mean, the subluxation theory makes infinite sense when thought of in that context, so I never thought of it in any other way.
    My personal understanding of chiropractic theory and philosophy always included a scope wider then that of a single profession, let alone a single source…

  • Colin Jenkins

    Why would some chiropractors want ownership of a term that is completely entrenched (to the surprise of some) across fields already. e.g. something a dentist said to me last week:-

    “If you mentioned subluxation to a dentist he would first have to identify, through the context, which working definition of subluxation one was referring to as there are 2. First, when a tooth is traumatised and intruded into the surrownding tissues it is referred to as being subluxed, second a partial dislocation of the TMJ affecting the fibrious disk between the skull and condylar head of the mandible is referred to as a subluxation. I think we disucssed this before, I have no problem with chiros/medi’s using the term subluxation so long as they can point me to their working definition.”

  • Richard Lanigan

    I honestly dont think many chiropractors give a lot of though to what being a chiropractor means. They focus more on their technique and the opinions of like minded practioners. I have tried to seek out different points of view to challange my own chiropractic paradigm ie by doing a lot of postgraduate education away from chiropractic. Going to chiropractic seminars to hear the guys I had fundamental differences with speak. I have change my views on many things and recognise there are many ways to skin a cat, however you have to be guided by principles that a body of chiropractors recognise and wish to subscribe to. The WFC has to put that question to the chiropractic profession now and give chiropractors a choice to stay or leave based on the question asked.
    Your question about subluxation is very important. A “subluxation” describes joint dysfunction, a “vertebral subluxation” describes dysfunction of a vertebral joint a “vertebral subluxation complex” is the theory describing physiological changes that happen after an adjustment and how they may affect some of the systems our body requires to maintain optimal wellbeing.
    Many chiropractors would like to claim ownership of the “subluxation” that it is exclusively a chiropractic term only relevant to the spine and some would even narrow it down the atlas. To take that view leaves leaves chiropractic open to the acquisation that they have made up a lesion that suits their beliefs. Subluxations are real, you can palpate them and they are visible in dissected cadavers. It is ridiculous for the GCC to deny their existence on the grounds that we should no longer use the term bone because Marc Anthony said in his funeral oration that “The evil that men do lives after them, The good is oft interred with their bones”
    Next the GCC will announce that bones are a historical term and in future chiropractors must use medical diagnosis and refer to ; The femur, tibia or fifth cervical vertebra right rotation fixation etc etc. Come to think of it that has already happened

  • Stefaan Vossen

    Maybe this post is a little too controversial in its nature and in asking for criteria that would constitute the profession’s opinion on criteria of inclusion above and beyond GCC registration I set myself up for a fall. Please allow me to ask another question instead:
    Are all subluxations spinal?
    Kidn regards,

  • Stefaan Vossen

    Hi Colin,
    I think you are right (again) and should have used the word “relatively” pointless. But I used the term to point out the very conclusion you came to: it is premature to assess plausibility hypotheses unless it has been verified that adjustments are effective above placebo… The point being that I reckon that unless further distinctions are made between spinal adjustments and other types of adjustments as I don’t believe that significant results can be achieved in any outcome study unless these are included in the exclusion criteria… or of course included in the treatment protocol.
    King regards

  • Colin Jenkins

    Hi Stefaan,

    “I believe the manipulative therapy studies to be both pointless and dissapointing to the chiropractic profession.”

    I can understand why they may be disappointing :) but they are not pointless, surely. Like I said a couple of days ago and davidp said yesterday, good efficacy studies can cut right through plausibility issues, because you are testing results.

    It seems way premature to me to put huge effort into verifying plausibility hypotheses unless before-hand you have formally verified that adjustments are in fact effective above placebo.

    Or, a la homeopathy do you feel that chiropractic adjustments are not suitable for such studies? And if so why…? Homeopaths for example claim that their solutions are too individualistic to be tested and yet generic homeopathic solutions can be bought in shops…!


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