As often happens, my experience with a patient got me to thinking. Not that I had given up thinking before that, but a novel thought is often welcome. The new patient, a 40-ish lady, had brought in X-rays of her neck. In viewing them, I was astonished at the deterioration in her mid-cervical spine. The degeneration was extreme for a woman of her age, and seemed to surround the fourth cervical vertebra, C4, wedged in flexion at an awkward angle.
The public health question was brought up a few years ago at the annual Research Agenda Conference, where many of chiropractic's respected academic and scientific community gather. A survey was taken, asking whether or not the chiropractic subluxation concept was a risk to public health. The majority of the attendees voted that the subluxation didn't fit the traditional definition of a public health risk all by itself.
Public health is often defined broadly, at least by the World Health Organization, as "the art and science of preventing disease, prolonging life and promoting health." Musculoskeletal disorders, for example, can be due to factors such as falling injuries, morbid obesity, or repetitive motion. Traditional public health measures would be to prevent falls, promote losing weight and prevent repetitive joint stress, all of which might also prevent the secondary variable, the subluxation.
This seems logical and not especially controversial. But add the neurological component to the mechanical subluxation and dark clouds begin to circle above some public health advocates. That is to say, claiming the vertebral subluxation complex might cause some type of neurological chaos that could cause all kinds of symptoms ... well, just get ready for damnation.
In an article published in Archives of Physiotherapy in 2019,1 the authors surveyed 324 DCs in Alberta, Canada, who had websites. They were looking for those DCs giving an explanation of what a subluxation is, and what disorders might be associated with such an entity.
Overall, 121 websites tried to do this in some way. Of those, 29 (8 percent) discussed chiropractic for children. This seemed to send some kind of "alert" to the authors, who were concerned this was a bad thing. I am sure it was because the mental image of "cracking a child's neck" seems more abusive than an adult adjustment procedure. But my question for the authors would be: Why would an exam of a child, by a chiropractor, because of injury or scoliosis, be more dangerous than an exam by a pediatrician?
The article also stated that there was concern the spinal "silent subluxation," meaning no symptoms, was advertised on some websites as a public health risk. The authors theorized that some of this advertising was promoting "fear-creating rhetoric."
In this case, I must agree. This is not how most of us discuss chiropractic with our patients. We don't say, "You won't get down the road another mile unless you have this subluxation fixed!" I hope some of this advertising is simply misplaced exuberance in offering the value of chiropractic care.
With articles like this, it appears that to some in the health care world, chiropractic itself is the public health risk! Thankfully, there are those who have defended the profession, showing that we have a lot to contribute to public health. Dr. Claire Johnson and other acquaintances of mine published an editorial in JMPT in 20082 that explained clearly why chiropractic has much to contribute to public health: geriatrics, natural health promotion, access for military health care, integrated medical delivery, etc.
The young woman I described earlier had a sobering subluxation with marked neck pain. It is my contention that the C4 lesion could have been corrected years earlier, possibly preventing her current condition. Considering only about 10 percent of the population has sought chiropractic care, it is logical to think there are many more people like her out there.
Whether the subluxation is a bonafide public health risk or not, it is still a health risk about which people need to know. I've never liked the word subluxation, but that's my problem. This lady doesn't care what we call "it" and neither do most people. They just want to get better, and not suffer any more such "risks" of pain and disability.
References
- Macron AR, et al. The "subluxation" issue: an analysis of chiropractic clinic websites. Arch Physiother, 2019;9(11).
- Johnson C, et al. Chiropractic and public health: current state and future vision. (Editorial) JMPT, July 1, 2008;31(6):397-410.
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