Chiropractic Pain Research

Responding to SciBabe’s Article on the Chiropractic Profession

Yvette d’Entremont, also known as the SciBabe, recently wrote an article called “Chiropractors are Bullshit” and discussed her views on the chiropractic profession on The Joe Rogan Experience. The article and podcast with Yvette were laced with inaccurate information and a clear confirmation bias against the chiropractic profession. Below are some of the inaccurate statements made by SciBabe and supporting evidence underneath.

“There is scant medical evidence that a chiropractor is your best treatment option for…anything”

Since most people initially seek care from a chiropractor for low back pain, it seems appropriate to focus there. The most recent clinical practice guidelines recommend heat, exercise, spinal manipulation, acupuncture, and massage as first-line therapies for low back pain. All of these services (with the exception of acupuncture) are services commonly provided by chiropractors for low back pain.

The current low back pain guidelines used to advise healthcare providers on the  can be found here: American College of Physicians (ACP), National Institute of Health and Care Excellence (NICE), Towards Optimized Practice (TOP), and Journal of Orthopedic and Sports Physical Therapy (JOSPT).

“Medical doctors often refer patients to the proper experts, and outside of a narrow scope of experts, this rarely includes someone who is a ‘duly-licensed non-M.D.,” because that person’s views on medicine would not be aligned with their standards of care.” 

Clinical practice guidelines are intended to provide healthcare professionals with information on the most effective treatment options for various conditions based on the current research. As stated above, the current standards of care for low back pain include spinal manipulation and other therapies commonly provided by chiropractors.

“We didn’t have proper scanning equipment to identify issues in the spine” 

Imaging technique has definitely improved since the 19th century, however, this statement reflects an inadequate understanding of low back pain (and pain in general). Abnormal radiographic findings in the spine are common in asymptomatic individuals and are more closely associated with age than they are pain severity. In fact, the current practice guidelines for low back pain discourages routine imaging due to the high false positive rates.

“Unlike chiropractic, physical therapy will address the underlying soft tissue issues that cause pain.”

This statement is based on the outdated bio-structural model and is inconsistent with the current understanding of pain. The relationship between soft tissue issues and pain is complicated because of the high presence of structural abnormalities in people without pain (ie. rotator cuff tears, meniscus tears, disc herniations, tendinopathy). In fact, about 90% of low back pain episodes are classified as “non-specific,” meaning that the exact cause of pain cannot be determined. The assumption that physical therapy or any medical professional can reliably determine the “underlying soft tissue issues that cause pain” is not supported by the current literature.

“It appears there is a link between chiropractic manipulation and risk of stroke due to potential artery dissection.”

The American Heart Association and American Stroke Association (also endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons) released a scientific statement stating that the association between stroke and chiropractic manipulation was not well established and probably low. These patients are likely already presenting with a stroke that is in progress, regardless of treatment provided.

“Although the incidence of cervical manipulative therapy associated cervical artery dissections in patients who have previously received cervical manipulative therapy is not well established, and probably low, practitioners should strongly consider the possibility of cervical artery dissections as a presenting symptom, and patients should be informed of the statistical association between cervical artery dissection and cervical manipulative therapy prior to undergoing manipulation of the cervical spine.”
-AHA/ASA Scientific Statement 

For more research articles on the safety of chiropractic manipulation, you can find them here:

“Chiropractic beliefs are dangerously far removed from mainstream medicine, and the vocation’s practices have been linked to strokes, herniated discs, and even death.”

This statement is made without context. All medical interventions have an associated risk when performed, but their occurrence rates vary. The risk of death from cervical manipulation has been estimated to be 1 in greater than 3,330,000 to 3,730,000 manipulations while the risk of death from gastrointestinal bleeding from NSAIDs is estimated to be 1 in 1,200 patients.

Medical error has also been reported as the third leading cause of death in the United States and many of the commonly used medications have also been linked to adverse events such as stroke and death (ibuprofen, tramadol, and duloxetine).

“Chiropractors can also cause damage by being used for primary care or emergency medical needs, as their training is not appropriate for such care…The chiropractor somehow missed that her son’s arm was broken, and the injury was not detected until many days later when they visited an emergency room.”

I am not privy to the case referred to above to specifically comment on it, but it is inappropriate to condemn an entire profession based on a single case. In SciBabe’s interview on the Joe Rogan Experience, she describes her experience with spinal manipulation performed by her Doctor of Osteopathy (D.O.) for an episode of low back pain. It turned out that her lower back pain was caused by a fractured rib (fractures are a contraindication for spinal manipulation) which was also somehow missed. It is biased to berate the entire chiropractic profession based on a single case and not hold other healthcare professions to a similar standard.

“A June 2003 review study in the Annals of Internal Medicine showed that massage is more effective at relieving pain than chiropractic.”

The study cited was based on three randomized control trials for massage compared to 26 for spinal manipulation. While the study did conclude massage was effective for back pain, it also concluded spinal manipulation had small clinical benefits that are equivalent to other commonly used therapies.

This study also stated that “the risk of lumbar manipulation are low and serious adverse experiences are extremely rare and generally not life-threatening,” which is also a  contradiction to SciBabe’s statements about the safety of treatments provided by chiropractors.

And finally, “don’t let a chiropractor fool you by reciting the warning label from a vaccine that they’re not qualified to administer.” 

Similarly, please do not take medial advice from someone who is not licensed to administer it.