If you’ve been around my channel long enough, you know I have a bone to pick with Chiropractors.
BX:
In response, many chiropractors have spoken out in defence of their profession – sometimes
firing back with critiques about surgeons and the danger inherent in what we do.
So today, we’ll address those critiques head on, and I’ll add a little bit of nuance
to my previous arguments.
Let me first be more precise: my frustration is not necessarily with all chiropractors,
but rather those who insist on performing manipulations as the mainstay of treatment
for mechanical back and neck pain, or those who promote the use of spinal manipulation
for treatment of a myriad of non-musculoskeletal diagnoses.
B1: jack harlow clips
When I say “manipulation” I am referring to the application of pressure to a person's
spine or other parts of their body by the chiropractor.
This could be anything from a hammer tap or gentle palpation to a swift rotational jerk
or Y-Strap adjustment.
B2: examples of above mentioned things
Now, by targeting chiropractic manipulation, it may seem that I’ve painted the entire
profession with a broad brush, but there are some chiropractors that I really like – Aaron
Kubal, Matt Colby, Raymond St. Augustine, and Bobby Maybee to name a few – all of
whom I have interviewed on my podcast.
BX: Aaron Kubal
Matt Colby Raymond St. Augustine
Bobby Maybee
Chiropractic manipulation may be present in their treatment method, but there are many
other techniques deployed alongside it, to create a robust approach that differs depending
on the injury and patient.
The style of chiropractic treatment that I appreciate is fairly similar to physiotherapy;
that is to say, it addresses specific musculoskeletal weakness and imbalance with exercises tailored
to the aforementioned deficiencies that put the patient in an active role, to systematically
strengthen and correct them.
If you’re a chiropractor and fit within this realm…
BX: meme of people agreeing
We might actually get along.
Otherwise, my frustration hinges on three major factors based on my own observation
and research:
Chiropractic manipulation puts the patient primarily in a passive role (someone is doing
something to you without you participating in the treatment).
Chiropractic manipulation lacks a solid scientific basis (which we are unable to confirm through
scientific study) Some chiropractors deploy a similar treatment
approach for many patients with a wide variety of MSK problems – perhaps, they are the
ones with the broad brush…
BX: show bob ross with “chiro?”
while he paints with a big brush
Or show someone painting a house where the wall says “many different injuries” and
the large paint brush or roller says “identical form of manipulation”
I have explored each of these critiques in detail in previous videos and will leave links
to those down below for those of you who are interested in further details or the references
upon which these critiques are founded.
And before we move on, I want to quickly clarify some things, as my critiques have been misconstrued
in the past.
I am not saying that a technique must have a confirmable scientific basis to hold value
to a patient, as everyone’s experience is their own.
Where we run into problems is when something with no confirmable scientific basis does
hold statistically significant scientific risk AND / OR when it is proposed as a treatment
for something to which it has no confirmable correlation.
I am also not suggesting that passive techniques can’t hold some value.
They totally can – massage, acupuncture, cupping, ultrasound or electric stimulation,
etc…
B3: other passive techniques
You may feel marked improvement after one such session.
B4: Harlow: “Oh, trust me”
But again, the difference lies in what practitioners of other methodologies claim that they can
effectively treat, and / or what the evidence shows them to be viable treatments for…
From my observation, chiropractic has assumed a role as an alternative solution to mechanical
back pain, neck pain and sometimes even more severe physical disorders associated with
the spinal column: such as paralysis and even spondylitis.
BX:
Chiropractors have no business making claims like these.
Furthermore, the risk associated with other passive methodologies is relatively lower
than with some chiropractic techniques
B5: neck crack
To put it bluntly – these techniques are more likely to sever an artery in your neck
(and yes that has happened before, we covered it in a previous video).
B6: neck massage
Then this.
BX:
Now I’m willing to wager, that this is the type of inflammatory comparison (which I have
used many times in the past) is exactly the type that leads to the following response:
BX: Maybe someone is typing a comment on the computer?
“Yeah?
Well surgery is MORE Dangerous Than Chiropractic!”
To which, I respond: yes it absolutely is.
BUT – and this cannot be overstated – we do everything we can to avoid surgery.
BX: someone saying: huh?
This is the biggest difference.
Interns buckle up, I’m about to break it down.
Medicine is a huge field that covers a wide variety of conditions, diseases, injuries,
and diagnoses.
All of these maladies occur in many different states of acuity and chronicity.
Musculoskeletal care is only one slice of this large pie.
But even within that MSK slice multiple different types of diagnoses are contained.
Traumatic injuries, repetitive injuries, infections, genetic diseases, cancers, metabolic conditions,
and more come under the purview of musculoskeletal specialists.
All of these diagnoses reflect a very large and diverse population of patients with medical
problems of varying severity, some being relatively minor, while others are of a life-and-death
nature.
Given the wide variety of conditions and severity, it should come as no surprise that there are
a variety of risks, and a wide range of complication rates associated with their management.
BX: Show an image of a MEDICAL pie with slices labelled, including a MUSCULOSKELETAL slice.
Chiropractic therapy, on the other hand, at its core is focused on only a single musculoskeletal
condition, mechanical back or neck pain of an acute or chronic nature.
If we want to be generous, in some instances, a chiropractic therapist might also be able
to treat additional non-axial musculoskeletal injuries as well… if they use an evidence-based
active therapy approach.
However, it quickly becomes clear that chiropractic therapists can effectively treat only a very
small sliver of the pie slice that allopathic musculoskeletal specialists treat, and almost
none of the overall medical condition pie.
BX: Show the MUSCULOSKELETAL slice of the pie with a tiny sliver labelled with MECHANICAL
BACK/NECK PAIN.
BX: Compare the tiny sliver of Mech back/neck pain vs the size of the whole HUGE pie.
Given that chiropractic care is focused on the treatment of a relatively benign musculoskeletal
condition that has a favourable natural history, it makes sense that the risk associated with
chiropractic care is less than that associated with medical or surgical care.
By “favourable natural history” I mean to say: the condition to which chiropractic
care is most often directed – mechanical back or neck pain of an acute or chronic nature
– if untreated, will generally resolve on its own without treatment in 6 weeks or less.
This was first shown in the late 1980’s by the late Dr. Gordon Waddell, an orthopaedic
surgeon and back pain pioneer and corroborated by other researchers since then.
A 2011 overview published in the Therapeutic Advances of Musculoskeletal Disease tells
us: approximately 50% of people [have] resolution of back pain symptoms at 1 week, and 80–90%
better by 6 weeks (An Overview of the Management of Persistent Musculoskeletal Pain - PMC).
Thus we can infer: not all pain is cause for concern.
I do, however, recognize that it still may drastically inhibit a person’s day to day
function.
It should be noted that the fear and confusion surrounding pain, especially when it is severe,
chronic, or lacks a clear physiological basis leads many people to worry unnecessarily (which
can make it worse) and ultimately to try out alternative approaches like chiropractic,
when it's possible nothing needs to be done.
A more in depth understanding of pain, how it manifests and when to worry may be helpful
to many people – let me know if you’d be interested in a video on this topic!
When the pain is persistent and potent, a patient and care provider may be compelled
to do something about it – and many surgeries have been performed that were unsuccessful
in treating the pain.
As I’ve already stated, surgery is inherently dangerous.
We’re cutting into your body, drilling or sawing bone in order to permanently alter
your MSK system, all while you’re in a short term medically induced coma, not to mention
the pain medication that necessarily follows.
As such, Gordon Waddell actually developed a method of delineating between pain with
an anatomical basis and something historically referred to as “psychogenic pain” (a term
which is no longer in use), which arises from the complex interplay of multiple factors
including mental state, temperament, environment, past trauma, etc.
The eponymous Waddell Signs help to “identify patients with low back pain who were likely
to experience a poor surgical outcome from lower back surgery.
More recently, clinicians have utilised Waddell signs to detect psychogenic, sometimes inappropriately
labelled non-organic, manifestations of low back pain in patients” (Waddell Sign - StatPearls
- NCBI Bookshelf), as explained in the National Library of Medicine archive.
These signs are designed to keep patients with pain with no identifiable physical origin
off the operating table.
Surgeons have other testing procedures designed to achieve the same end.
Do chiropractors have similar testing procedures?
Are they likely to tell you that you are unsuitable for Chiropractic Manipulation?
Like, how often is that likely to occur?
Or instead, do they tell you to book with the administrative staff for several follow
up treatments?
When you consider that there is a risk higher than chance associated with some chiropractic
procedures, the recurring nature of the practice may also be unsettling.
To be honest, chiropractic care really shouldn’t offer any additional risk, because if you
did nothing, there would be no risk and the pain symptoms would still go away – if it
is the mechanical type with an identifiable root cause.
So comparing the relative risks of chiropractic care and allopathic musculoskeletal care is
not even meaningful because it is kind of like comparing one fruit in the produce section
to the whole freaking grocery store.
Even if we limit our comparison to back-related complaints, there is another reason why this
comparison is disingenuous.
You see, you cannot compare the risk of chiropractic therapy for mechanical complaints against
the risk of surgical care for mechanical complaints because surgery is not used for the treatment
of mechanical complaints.
Mechanical back and neck pain is not a surgical indication.
In fact, surgical indications for the spine include:
structural or neurologic instability of the spine,
loss of bowel or bladder function as a result of neural compression,
objective lower extremity weakness or paralysis as a result of neural compression,
or intractable pain that has failed all other non-operative treatments including physical
therapy, chiropractic therapy, medical management, and bracing
It is a treatment of last resort.
So given that surgery is only used to treat problems that have failed chiropractic therapy,
it should come as no surprise that while not directly comparable, the risks and associated
complications are higher.
I am a surgeon – it is my job to perform operations on people and yet, I actively avoid
surgery at all costs…
non-surgical options are the healthiest approach for my patients if at all possible.
If the same thing can be solved non-surgically, then that is a better option.
When choosing treatment options as a surgeon, we are always trained to use the option that
is the most effective but that offers the lowest risk profile.
Meanwhile there are chiropractors out there, using techniques known to be associated with
legitimate risk as a signature move, a finisher if you will…
like the salt bae seasoning his steak.
B7: salt
But only the steak is a person, and the salt is a Y strap… ostensibly NOT a non-risk
manoeuvre.
BX: the thumbnail for Y-Strap Cipriano Video
These issues have been exacerbated with the rise of social media influencer type chiropractors
and their ASMR, cracking-celebrities-in-yoga-pants approach.
Obviously, these people are interested in growing their brand and the financial gain
associated with that, oftentimes in my opinion at the expense of the treatment.
It is doubly frustrating to know that there are chiropractors out there who run a respectable
practice who have felt unfairly attacked.
I hope this video has helped to identify where and with whom my frustrations lie as well
as address the critiques formulated against me.
If you’re interested in moving better and preventing injury in a non-operative manner
please visit my online gym Human 2.0 for free, right here on YouTube!
Outro