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Archived Comments for: Subluxation: dogma or science?

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  1. A reply to Subluxation: dogma or science?

    John Hart, self

    16 August 2005

    I agree that subluxation needs more research before it can be accepted as fact. The authors suggest that case reports will help move this process along (p. 15). In addition to the case reports cited on bladder problems, the paper would have been more complete had it cited some of the other case reports from the scientific literature, where subluxation was addressed in patient care (1-7).

    I thought there was a bit of a double standard where the reader is informed about the “usefulness” of spinal manipulation, yet its tentative character is not mentioned (p. 3). Given the plethora of contradictory evidence on the efficacy of spinal manipulation for back pain (8-15), is there some reason why a tentative character was placed on only one approach in chiropractic (subluxation type care), while the other approach (manipulation for back pain) got a pass?

    Sincerely,

    John Hart, D.C.

    Greenville, S.C.

    U.S.A.

    References

    1. Alcantara J, Plaugher G, Van Wyngarden DL. Chiropractic care of a patient with vertebral subluxation and Bell's palsy. J Manipulative Physiol Ther. 2003 May;26(4):253.

    2. Alcantara J, Heschong R, Plaugher G, Alcantara J. Chiropractic management of a patient with subluxations, low back pain and epileptic seizures. J Manipulative Physiol Ther 1998 Jul-Aug;21(6):410-8.

    3. Alcantara J, Steiner DM, Plaugher G, Alcantara J. Chiropractic management of a patient with myasthenia gravis and vertebral subluxations. J Manipulative Physiol Ther 1999 Jun;22(5):333-40.

    4. Elster E. Upper Cervical Chiropractic Care for a Patient with Chronic Migraine Headaches with an Appendix Summarizing an Additional 100 Headache Cases. Journal of Vertebral Subluxation Research 2003:1-10.

    5. Hulse M. Cervicogenic hearing loss. HNO 1994 Oct;42(10):604-13.

    6. Kessinger RC, Boneva DV. Vertigo, tinnitus, and hearing loss in the geriatric patient. J Manipulative Physiol Ther 2000 Jun;23(5):352-62.

    7. Pistolese RA. Epilepsy and seizure disorders: a review of literature relative to chiropractic care of children. J Manipulative Physiol Ther 2001 Mar-Apr;24(3):199-205.

    8. Assendelft WJ, Koes BW, van der Heijden GJ, Bouter LM. The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling. J Manipulative Physiol Ther 1996 Oct;19(8):499-507.

    9. Assendelft WJ, Lankhorst GJ. [Effectiveness of manipulative therapy in low back pain: systematic literature reviews and guidelines are inconclusive] [Article in Dutch]. Ned Tijdschr Geneeskd 1998 Mar 28;142(13):684-7.

    10. Brox JI, Hagen KB, Juel NG, Storheim K. [Is exercise therapy and manipulation effective in low back pain?] [Article in Norwegian] Tidsskr Nor Laegeforen 1999 May 30;119(14):2042-50.

    11. Ernst E. Chiropractic for low back pain. (Editorial). BMJ 1998;317:160-160 (18 July).

    12. Ernst E. Manual therapies for pain control: chiropractic and massage. Clin J Pain 2004 Jan-Feb;20(1):8-12.

    13. Ferreira ML, Ferreira PH, Latimer J, Herbert R, Maher CG. Does spinal manipulative therapy help people with chronic low back pain? Aust J Physiother 2002;48(4):277-84.

    14. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine 1996 Dec 15;21(24):2860-71; discussion 2872-3.

    15. Weiner DK, Ernst E. Complementary and Alternative Approaches to the Treatment of Persistent Musculoskeletal Pain. Clin J Pain 2004 Jul-Aug;20(4):244-255.

    Competing interests

    None declared

  2. Response by authors to Dr Hart

    Keith Charlton, none

    9 September 2005

    We are aware of dispute in the extensive clinical-experimental literature bearing on the validity/utility of manual therapies for low back pain. However, to the best of our knowledge, the best evidence at this time is that manipulation is an effective treatment for LBP (1). We are aware of only one clinical experiment which addresses the validity/utility of subluxation (loosely construed) and its correction (2).

    References:

    1. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J 2004;4(3):335-56.

    2. Haas M, Groupp E, Panzer D et al. Efficacy of cervical endplay assessment as an indicator for spinal manipulation. Spine 2003; 28(11): 1091-6.

    Competing interests

    none

  3. A comment on Subluxation: dogma or science?

    Paul Nudd, Action Potential Chiropractic Healthcare

    20 September 2005

    The medicare system in the USA including 'physicians' (medical practitioners?) and physical therapists acknowledges the existence of 'subluxation' and presumably its 'deleterious health consequences' as shown on the APTA News Release which can be viewed in it's entirety at:

    http://www.apta.org/AM/Template.cfm?Section=Search&template=/CM/HTMLDisplay.cfm&ContentID=18731

    The document does not refer to "orthopedic subluxation" or to "subluxation syndrome" but simply to subluxation, as I do in my practice. However I propose that the statement: "Physician services include manual manipulation of the spine to correct a subluxation." implies 'deleterious health consequences' of the uncorrected subluxation.

    I also propose that chiropractic could be defined as: 'the detection and correction or reduction of vertebral subluxations' and vertebral subluxations could be defined as: 'spinal joint dysfunction with deleterious health consequences'. Perhaps we should warn our patients that the deleterious health consequences are not yet supported by scientific (statistical) evidence, only by undocumented and therefore anecdotal evidence.

    Sincerely,

    Paul Nudd

    Chiropractor

    Hornsby Australia

    Competing interests

    None declared

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