In 2008, the prestigious Equine Veterinary Journal published an article on the effects of chiropractic manipulations on the movement of the equine back and limb. While the found some “small but significant” effects, the authors admitted, “There were no changes in limb angles at walk and almost no changes at trot.” This article did not indicate the chiropractic manipulations were likely to be of benefit to horses.
Still, it was disturbing to note that the authors were not accurate in their use of references citing the effectiveness of chiropractic in humans, and that they also seemed to ignore the vast body of evidence that shows that “chiropractic” – whatever that means – is not based on solid science, and has not been shown to have therapeutic effectiveness. So, I wrote a letter to the EVJ, which was published in July, 2008.
“May 18, 2008
Equine Veterinary Jounral
The article “Effect of chiropractic manipulations on the kinematics of back and limbs in horses with clinically diagnosed back problems” (EVJ 2008; 40(2): 153 – 159) is welcome in that it attempts to make an objective assessment as the clinical effects of such manipulations. However, it is extremely disturbing that the authors make assertions about the “widely documented” effectiveness of human chiropractic in support of their assertions.
In the article, in the introduction, the authors state that, “The effectiveness of chiropractic manipulations has been widely documented in human medicine.” In support of this statement, the authors give four references. In fact, none of the references provides support for the authors’ assertions.
1. Gaumer, G. Factors associated with patient satisfaction with chiropractic care: survey and review of the literature. J Manip Phsiol Ther 2006; 29(6): 455 – 62. This article pertains to patient satisfaction, not effectiveness. Indeed, the article concludes, “The evidence about the factors that underlie high levels of chiropractic satisfaction is not consistent. Communication quality seems to be a consistent predictor of patient satisfaction with chiropractors.”
2. Hurwitz, EL, Morgenstern, H, Kominski, GF, et al. A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study. Spine 2006; 31(6): 611 – 21. This article does not conclude that chiropractic manipulations are effective, rather, it concludes, “Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding.”
3. Eisenberg, DM, Post, DE, Davis, RB, et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine. 2007; 32(2):151-8. This article does not indicate that chiropractic is effective at all. Rather, it notes, “A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP [low back pain] did not result in clinically significant improvements in symptom relief or functional restoration.”
4. Leaver, AM, Refshauge, KM, Maher, CD, et al. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial. BMC Musculoskelet Disord 2007; 8:18. This article does not address effectiveness of chiropractic, rather, “This paper presents the rationale and design of a randomised controlled trial to compare the effectiveness of neck manipulation and neck mobilisation for acute and subacute neck pain.” Clinical conclusions of the trial have not yet been published.
Further concerns in the paper pertain to the diagnosis of “subluxations,” the underlying diagnosis of the chiropractic profession that has itself never been demonstrated in any species. Indeed, “With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.” (Ernst, E. Chiropractic: a critical evaluation. J Pain Symptom Manage. 2008; 35(5): 544-62.)
Again, while studies on equine chiropractic (whatever that may be) are surely welcome, providing irrelevant references for erroneous assertions does not advance the cause of any legitimate scientific investigation.
David Ramey, DVM”