Nothing is new. Even amidst advances in gene therapy and synthesis of human tissue most medical interventions have not changed much in the last century and most of these modalities are based on the first forms of medicine. Chiropractic adjustive/manipulative therapy is no exception.
In this section I will explain the historical roots of adjustive/manipulative therapy and why this approach has fallen out of favor with the medical establishment.
Adjustive/manipulative therapy has been used in chiropractic, osteopathy and physical therapy, all of which were founded in the 19th century in response to the shortcomings of mainstream allopathic medicine. These professions drew heavily on cultures such as the Balinese of Indonesia, the Lomi-Lomi of Hawaii, healers in Japan, China and India, the shamans of Central Asia, sabodors in Mexico6, bone setters of Nepal, and bone setters in Russia and Norway. Historical reference to the use of adjustive/manipulative therapy in Greece in 400 BCE is most often cited as the evidence for the practice of spinal adjustment/manipulation.
Hippocrates (460–385 BCE), in his book on joints and Claudius Galen (131–202 CE), a noted Roman surgeon, and Avicenna (also known as the doctor of doctors) from Baghdad (980–1037 CE) all included evidence of the use of adjustment/manipulation. The historical use of these types of techniques for neuromuscular complaints was not in question until the rise of osteopathy and chiropractic in the 19th century. The goal of this paper is to separate the scientific validity of these procedures from the misinformation and discrimination of the professions that primarily utilize them.
There was a turn away from the use of spinal adjustments/manipulation in the 18th century, possible due to the danger of breaking bones during the tuberculosis epidemic. Because of this the modality became associated with village healers called bonesetters. Established medical professionals discriminated against these bonesetters and yet the general public embraced them and still does.
In 1871 Wharton Hood a physician who trained under a bonesetter published a technical manual on manipulation of the extremities in the Lancet. After 10 years the British Medical Association and the medical establishment as a whole was beginning to accept manipulation. Research on manipulation was limited and so acceptance was slow. Medicine at the time was primarily focused on bloodletting in order to change symptoms. Ineffective at best and dangerous at its worst medical professionals in North America were no longer held in high regard. During this time American universities did not train physicians well and a student could fail 40% of his courses and still graduate. The prejudices of medical theology was rampant and the adherence to ineffective interventions pervasive. The public had no trust in the current medical practices and so alternatives began to arise.
Born out of this distrust of the medical profession and the pervasive death from the plague two men popularized spinal manipulation, DD Palmer and Andrew Still. Still’s anatomically and biomechanically based theories, afforded him a successful clinical practice and he was openly critical of the medical profession and its methods.
Even though he was denied access to teach in established medical schools his drugless, non-surgical approach to the treatment of disease gained acceptance among the general public. In 1892 he established the American Osteopathic College in Kirksville, Missouri. Osteopathy enjoyed a parallel growth to the growing body of scientific knowledge that would lead to osteopathic physicians enjoying equivalent legal and professional practice rights as medical physicians in the United States. However, there was, and perhaps still is, a philosophical chasm between the two professions.
While Andrew Still came from a Physicians family, DD Palmer immigrated from Canada to find work. After farming and factory work he began to practice magnetic healing, the work of Mesmer. He would begin to use the word subluxation which was popularized by a physician, Johannes Hieronymi, in 1746, where he used the word to explain spinal dysfunction. In 1820–1821, the publications of medical physicians William and Daniel Griffen and Edward Harrison used the word “subluxation” and described the use of spinous and transverse processes as levers to adjust subluxations. Like Still, Palmer was disdained by the medical profession.
In 1897, in Davenport, Iowa, Palmer opened his first college. Although many of its graduates where jailed in 1906 for practicing medicine without a license. In the Western world it is second only to the medical profession as a primary care healthcare provider.
Unlike osteopathy, however, the chiropractic profession was fraught with internal strife from its inception. Arguments between chiropractors about which vertebra(e) to adjust for which dysfunction leads the public to question how objective the science behind chiropractic is. In-fighting between different approaches within chiropractic continues to this day. In addition to this in 1958 the National Chiropractic Association would promote policies that would create opposition for inter-professional cooperation. Continuing to ostracize the profession from the medical mainstream.
James Mennell, John McMillian Mennelll and James Cyriax can be considered the creators of modern manipulative therapy with a focus on differential diagnosis as it is practiced by“evidence -based” chiropractors today.
Physical therapists were also using spinal manipulation since at least the early part of the 20th century as there was a two year course at the Chartered Society of Massage and Medical Gymnastics in London.
All three professions grew along with the more “evidence-based” medical profession. Although physical therapy, osteopathy, and chiropractic would take very different paths. Osteopathy would coalesce with the medical profession. Chiropractic would stay separate from medicine. Physical therapy would work alongside the medical physicians.
Although all professions use spinal manipulation in very similar ways chiropractic is the only one that is considered alternative. This has more to do with the way it developed historically than it being unscientific or not evidence based as the spinal manipulation in all three methods cannot be easily differentiated. Perhaps the primary difference is that like in the 1800’s individuals who are more distrusting of the medical establishment tend to visit chiropractors.
As you can see the procedures used by chiropractors have the same scientific validity as those used by physical therapists and osteopaths. The difference is primarily due to the how chiropractors are viewed by the public. To learn more about chiropractic can help with neck pain read my eBook.
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