Can regular, or even intermittent chiropractic care help prevent disease? This is a complex, controversial topic featuring stark polarity in opinions and experiences…but, what does the evidence say?

NEW RESEARCH REVIEW POSTED ON RRS EDUCATION: “Effect of Chiropractic Treatment on Primary or Early Secondary Prevention – Systematic Review” (Chiropractic and Manual Therapies 2018)

Generally speaking, it is important to consider whether it is possible to prevent a disease from occurring, rather than wait to treat it once it is present. However, primary prevention (PP) or early secondary prevention is not always possible and can only be applied in conditions where the causes are known and avoidable or modifiable. It is also only practical to apply a preventive approach when it is less expensive and less likely to lead to adverse effects than the treatment itself.

Some medical conditions are known to be effectively prevented through PP or early secondary intervention. However, some chiropractors propose to prevent spinal problems and even disease in general through the treatment of spinal ‘subluxations’, even before the emergence of symptoms. This often includes disorders that are outside of the chiropractic scope of practice or even beyond the legal boundaries of chiropractic legislation.

The idea that spinal ‘subluxation’ can cause a host of diseases and that its correction can prevent these is not consistent with modern medical concepts that recognize the etiology of most diseases as multi-causal/factorial. Therefore, the idea that the correction of spinal ‘subluxation’ could overcome the combined effects of environmental, social, biological, and noxious lifestyle factors seems naïve and is without supporting evidence.

The ‘subluxation’ model is summarized as follows: 1) disturbances in the spine (‘subluxations’) exist; 2) these can cause a multitude of diseases; 3) ‘subluxations’ can be detected in a chiropractic examination before symptoms arise; 4) chiropractic adjustments can remove ‘subluxations’; 5) removing ‘subluxations’ results in improved health. To date there is no proof of the existence of the ‘subluxation’ and therefore, a causal link between spinal ‘subluxations’ and various diseases should not be implied. Finally, even if an improvement is seen in a condition following chiropractic treatment, it does not prove causation (especially when observed in one, or a very small number of people!). Without proof of a link between chiropractic treatment and primary prevention, it could be considered unethical for chiropractors to promote preventive treatments to their patients.

Therefore, this review asked the following questions:
  1. For which physical, non-musculoskeletal diseases has the effect/benefit of chiropractic treatment been studied in the chiropractic literature?
  2. Which study designs have been used?
  3. Were the designs appropriate to uncover effects of intervention?
  4. Was the basic methodological quality sufficient to make results credible?
  5. What evidence is there that chiropractic treatment can prevent disease or stop it in its early stage?
primary prevention
 
Conclusions:

This study found no evidence to support the notion that manipulative therapy/chiropractic care can prevent or stop early disease. Thus, the authors suggest that if the chiropractic profession wants to maintain credibility, political associations and educational institutions should not recommend spinal manipulation for the sole purpose of disease prevention unless appropriate, high quality research evidence can be produced to support this type of care.

Chiropractors can provide information and inspiration to help patients avoid preventable disorders and help them to monitor lifestyle and symptoms changes. In the broader context of our role in a contemporary healthcare system, the high prevalence of back and neck problems in conjunction with their recurring nature underscores the need for chiropractors to care for people during acute episode and guide their patients through various periods of back pain. This is where the bulk of our evidence lies, which makes one wonder why some chiropractors would feel the need to “extend their scope of practice to implausible areas, when there is so much to do in the musculoskeletal field”.