Science Vs - Chiropractors

Episode Date: December 7, 2017

Can they help with back pain or anything else? We talk to chiropractor Carl Cleveland III, physical therapist Anita Gross, neurophysiologist Dr. Marcello Costa...and Kaity Sawrey’s parents. Check out our full transcript here: http://bit.ly/2P3g7NW By the way… Gimlet’s doing a holiday pop up shop selling t-shirts and stickers. So show your support by getting your very own Science Vs tee shirt! Check it out at sciencevs.show/shirt. Credits: This episode has been produced by Rose Rimler, Wendy Zukerman, with help from Shruti Ravindran and Heather Rogers. Our senior producer is Kaitlyn Sawrey. We’re edited by Blythe Terrell. Fact checking by Michelle Harris. Sound design by Martin Peralta and Bobby Lord. Music written by Bobby Lord. For this episode we also spoke to Dr. Richard Deyo, Prof. Tim Mirtz, Prof. Gregory Whitcomb, Dr. Adam Cifu, and Julie Knaak,-- Thank you for your insights. An extra big thanks to Rachel Ward, Emma Morgenstern, Christina Sullivan, Jasmine Romero and Phoebe Flanigan. As well as Alex Ward, Russell Gragg, Fiona Croall and Judy Adair. Also, a shoutout to the Sawreys! Thank you, Bill & Chris.  Selected readings:A history of DD Palmer and chiropractic, which Carl co-wroteAnita’s review on spinal manipulation and neck painThe UK evidence report on manual therapyJAMA editorial on spinal manipulation and lower back painClinical guidelines on treating lower back pain from the American College of PhysiciansAn analysis of neck manipulation and strokeAnd of course….this Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus from Gimlet Media. This is the show where we pit facts against... Oh, that's the satisfying sound of a back being cracked. Because on today's show, chiropractors. Millions of people have back and neck pain, and it's pretty hard to treat. There are drugs that can help, but they can have some pretty nasty side effects. People are desperately looking for other solutions,

like going to the Cairo. In one large survey, almost a third of Americans suffering from neck and back pain had said that they went to one. And, of course, it's not just Americans seeing the Cairo for pain. Our senior producer, Caitlin Sori, called up her parents, who are big fans of their Cairo. Katie, how is New York going?

It's good. So you're still riding your bike to work? Yeah, I do. Don't worry, I'm safe. Your mother is worried. Katie's mum is Chris and her dad is Bill, and the whole Sori family have been going to the Cairo for years. So, Katie, tell us all about it. Yeah, so my parents have been going to the Cairo for ages

and I actually didn't know about this until we called them up to talk to them about it. But I was actually taken to the chiropractor as a newborn baby. Wait, why did they want to take you to the Cairo? Because my delivery, my birth was really rough. They had to really yank me out. And so the idea was that maybe my bones were misaligned. So they wanted to take me to the chiropractor to see if it could help. Yeah, because you had such a traumatic birth. You know, like you had huge marks around your face where the forceps grabbed your cheeks. So you didn't look too terrific for the first few days because of that. And mum says visiting the Cairo seemed to be good

for me. I slept better. And so when my brothers were born, they were also taken off to the Cairo and my parents still go for neck and back pain. Dad has smashed himself a fair bit over the years. So I've fallen out of a tree. I've fallen off a motorbike. Yeah. Dad's been thrown off a motorbike, he's fallen off a ladder. So the Cairo makes him feel better. Same with mum. My muscles feel a lot more relaxed and my neck feels like it's not so grindy, is the best way to describe it. Wait, so do you remember going as a kid? Yeah, so the whole family, we went right up until I was 18, all five of us, every six weeks or so. Okay, so I've never been to a chiro.

What do they actually do when you get in there? Yeah, so the main thing that chiros do is this thing called spinal manipulation. So they're basically checking your spine, all the little segments in your spine, to see if anything's out of place. And then they're popping it back into place. And they can use a little tool or they can use their hands. But it's a quick thrust. It's not like a massage where you're kneading your back.

It's like pop back into place. Anyway, it was just a thing the whole family did. And we'd skip out. Happy little Vegemites. We were happy little Vegemites coming out of the chiropractor's office. It's an Aussie thing. So is this thing that we did throughout my childhood total BS? So tell us about the science. Come on. Because not everyone reckons that going to the chiro will make you a happy little Vegemite. Some say that it's not real medicine and that the ideas behind chiropractic have no science behind them.

They even say it could be dangerous. So today we're asking, one, can chiros help your back and neck pain? Two, should you take your baby Katie to the chiro? And three, what are the risks here? When it comes to chiropractors, there are lots of bones to crack. But then there's science. That's Science vs Chiropractors coming up. After decades of shaky hands caused by debilitating tremors, Sunnybrook was the

only hospital in Canada who could provide Andy with something special. Three neurosurgeons, two scientists, one movement disorders coordinator, 58 answered questions, two focused ultrasound procedures, one specially developed helmet, thousands of high-intensity focused ultrasound waves, zero incisions. And that very same day, two steady hands. From innovation to action, Sunnybrook is special. Learn more at sunnybrook.ca slash special. What does the AI revolution mean? For jobs. For getting things done? Who are the people creating this technology and what do they think?

I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI. Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI. And don't forget to subscribe wherever you tune in. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan 11? I'm here, astrophysicist and co-host, Thank you. The Joy of Why. New episodes drop every other Thursday, starting February 1st.

Welcome back. Today, we've got a cracking episode for you. We're looking at whether chiropractic can help treat pain. And yeah, chiropractic. It sounds like an adjective, but it's actually a noun. It bothers us too. But moving on. So, why did chiropractors think that they could help little baby Katie

and everyone else in her family too? Well, we can trace it back to one guy in Iowa more than 100 years ago. You are in Iowa. And to get this story, we spoke to chiropractic royalty. Carl S. Cleveland III. Yes, Carl comes from a long line of chiropractors. My great-grandmother was a chiropractor. My grandfather and grandmother were chiropractors.

And my mother and father were chiropractors as a child. I thought everybody grew up to be a chiropractor. And he's the president of Cleveland University, Kansas City, which was founded as a chiropractic college. In fact, his family started it. And yes, we know it's confusing. Carl Cleveland lives in Kansas City, and this story about the birth of chiropractic is set in Iowa. I away. OK, so back to that one guy who started it all. His name was Dee Dee Palmer. He was Canadian, appeared to be a stocky man, had a full beard. Dee Dee Palmer was a magnetic healer in the late 1800s, so he thought he had a personal excess of magnetic energy

that he could channel through his fingers to treat people. It was a thing back then. But something changed for Didi Palmer, and soon he would switch from magnetic healing to backcracking. Here's basically how the legend goes. So Didi Palmer met this janitor who was hard of hearing, and he also had this hump on his back. And D.D. Palmer thought that he could help. So, he pushed the janitor's back with this big

thrust. And a few days later, the guy came back with some very curious news. Saying, Mr. Palmer, I hear the racket of the wagons in the street. A new profession was born, and Dede Palmer named it chiropractic, meaning in Greek, a practice done by hand. And Palmer then thought he found a cure for deafness, put out a sign, Dede Palmer, healer of the deaf. Soon, Dede shifted away from just curing deafness by manipulating spines. He now wanted to cure practically everything.

And this brings us to the theory behind chiropractic. Basically, Dee Dee Palmer started to think that the spine was the key to health. And here's what he thought was going on. Dee Dee believed that there was energy flowing through the spine to keep us healthy. He was a spiritual man and he saw that when spinal joints didn't move right, that that in some way obstructed the flow of nerve energy and life force through those nerves to the body parts. That is, he reckoned that these kind of blockages in the spine, or what he called subluxations, could make you sick by interfering with that mystical energy. At other times, he said those subluxations tweaked people's nerves.

Dee Dee ultimately thought that 95% of diseases were the result of subluxations. And in fact, he wrote that it was unjust to blame germs for disease. And today, Dede Palmer's term subluxation is still used by a lot of chiros. The word means slightly different things to different chiropractors. For Carl, a subluxation is basically a joint that doesn't move properly. And he thinks that it can sometimes lead to things like asthma and high blood pressure. And Carl reckons that people need to visit the chiro, not just when something's sore, but for regular checkups, kind of like how you go to the dentist.

I see chiropractic being viewed beyond back pain to more spinal hygiene, and that I will see people, as they often do today, once they understand the benefits of chiropractic care, patients will come in for periodic maintenance assessment and maintenance adjustment. Despite the mystical origins of chiropractic, it's actually starting to get some real cred. So the main thing that chiros do is spinal manipulation. It was the thing that Katie told us about.

And just this year, in the search for better ways to fight back pain, the American College of Physicians included spinal manipulation on their list of suggested treatments. And so this brings us to the question. How good is the evidence that chiros can help you with your pain? And specifically, let's look at neck and back pain. That's why most people go to the chiro. To get some answers, we called up Anita Gross, a physical therapist and researcher

who specialises in neck pain at McMaster University in Canada. Hello, how are you? A couple of years ago, Anita and her team combed through almost 40 trials looking into whether spinal manipulation, that thing that chiros do, could actually help with neck pain. And a lot of what she found were kind of crappy trials. For example, many of them were small, often involving no more than 30 people. And by the way, in science, you don't officially call these studies crappy.

Instead, you call them low quality. Low quality actually is not the worst. The worst is very low quality. So low quality, believe it or not, has a little bit of hope in it. And she did find some hope. Anita found that for people who had multiple sessions with a chiro, well, they actually did tend to have less pain in their neck. And one of the studies she looked at even compared spinal manipulation to conventional medication, like taking anti-inflammatory drugs, muscle relaxants and even opioids.

And it ultimately found that going to the chiro turned out to be more helpful than drugs. That is, after a year, the people going to the chiropractor had less pain than those who were on the meds. Now, we do need more data here to see if this holds up, but for now, it sounds pretty impressive. So the studies are showing that spinal manipulation actually does help. It's valuable, yeah.

So those studies were in neck pain, and while Anita didn't specifically look at back pain, the research here seems to be pretty similar. So again, we don't have great studies, but what we do have suggests that spinal manipulation can help with back pain. And when patients walk through Anita's door, sometimes she gives spinal manipulation a go. So it's something that I use clinically in my own practice.

Since you do these big reviews and you find that there's low quality evidence that it helps, how come you give it to your patients? To do nothing with your patients isn't of any value either. You're getting them better in their everyday life, their function and being able to actually do their activities. Ultimately, Anita says that mainstream medicine doesn't have a lot of great options for treating this kind of pain. So spinal manipulation is sometimes useful. And Anita did point out that she typically doesn't use spinal manipulation on its own.

She likes to combine it with these exercises that can help people get stronger and move their bodies better. Conclusion. Although the studies are pretty crappy, aka low quality, there is some evidence that going to a chiropractor for spinal manipulation can help people with back and neck pain. So going to the chiro might help you with pain along your spine, but some chiros reckon that it should be used for way more than that. And one of the most controversial claims is that even kids should go to the chiropractor. The American Chiropractic Association

openly encourages this. And according to the National Institutes of Health, chiropractic is one of the most common forms of non-traditional medicine used in kids. Which, of course, takes us back to little baby Katie getting her tiny little spine aligned. Can you describe how they did it? Like what was actually happening? Kind of just massage your head and then they would just lift you up by your ankles and just swing you. But just really gently, really, really gently, and then just lay you back down again.

I'm so nervous for me in retrospect. They recommended I did that every day, which I did for about three months, I think. And then why did you stop at three months? Because you're getting a bit heavy. And I was like, this is not good. Okay. So we couldn't find any studies on newborns and chiros, but several years ago, the UK General Chiropractic Council, an independent body set up to regulate chiros in the UK, put out this big report and ultimately concluded that there wasn't any good evidence that you should take your kid to the chiro. But that doesn't seem to bother our chiropractic royalty, Carl Cleveland III, who comes from a long line of chiros. He believes there is a role for chiropractic for kids.

The birth process typically is a bit traumatic. Children have pain, children have injuries, they have trauma, they fall off of bicycles and out of trees. But if there's limited evidence that chiropractic can help, why would you take your child to a chiropractor? Because those patients respond to care. And I think it's a matter of time before we have formal evidence. But from a practical standpoint, where the satisfied patient that sees the child that is pain-free, that's improvement. It's just a period of time before those studies, in my opinion, that those studies will be completed.

So it's also possible that in the future, as we do clinical trials, those trials will show that it doesn't help. That's a possibility. This is an area where we require additional research. Conclusion. Hoping for evidence is not the same as having evidence. And right now, there is no good research showing that taking your kids to the Cairo

will help them grow into happy little Vegemites. Happy little Vegemites. We spoke to Katie's parents about it. Do you want the science on the kids? Do you want to know that? Yeah, there it pretty much, there's pretty much no good science that it works for anything when it comes to kids. We got sucked in.

Wait, what did your dad just say? He said they got sucked in. They just trusted the chiropractor. Back in the day, everyone was going. So like everyone was the same sort of thing. So we didn't question as much. It feels a little bit like you're sort of sucked into this vortex almost of believing everything they say. After the break, we go further into the vortex. Welcome back. So today we're talking about chiropractors and this thing they do called spinal manipulation. And we just heard that it may help with back and neck pain, but there's no good science behind taking kids to the chiro.

Now we're going to dive right into the core beliefs of chiropractic to see if the idea of spinal manipulation holds up. Now a lot of people might have heard about a spine being out of alignment or misaligned and that's why you go to the chiro. But what exactly is a misaligned spine? Well, to understand that, we have to go back to old Iowa. Didi Palmer, the guy who came up with chiropractic, thought that a lot of our health issues could be traced back to a misaligned spine. And the thing that was making your spine misaligned was what he called subluxations. Now, at one point, he thought these subluxations could block a mystical force that flowed through the spine, causing disease. Now, that's clearly not science. But Didi also had this theory that's shifted a little, but has basically stuck around today. And that is that subluxations are bones out of place,

or some say stiff joints, that then squish against our nerves in some way, making us sick. And this could lead to things like asthma or high blood pressure. And now, not every Cairo thinks this way anymore, but a lot of them still do. A study of several hundred Canadian Cairos found that almost one in five thought fixing a subluxation was the key to health. The science behind it is not likely to come because the science behind it is simply not there.

The belief system is entirely contrary to our knowledge of physics and chemistry and biology. That's Marcello Costa. He's originally from Italy, but is a professor of neurophysiology at Flinders University in Australia. And he says that there is no good evidence that problems with your spine are to blame for many of the diseases that some chiros claim to fix. So, take asthma, for example. Now, we don't know exactly what causes asthma. It's been linked to genetics and immune reactions. But here's the important thing. We don't have any good evidence that manipulating the spine can have any effect on asthma. There's no basis whatsoever that it can cure asthma. That's a complete nonsense.

There's no, not only there's no evidence that one can believe, but there's no reason whatsoever to assume that manipulating the spine will help the asthma of a young child. And so in a sense, it's a complete bongos, it's a complete nonsense. And maybe this asthma thing is low-hanging fruit. Like, it kind of seems obvious that it's a bit bonkers. But Marcello says that even if you just zoom out to this idea that a back could be misaligned and afflicted with subluxations, well, he says that even that concept is spineless.

And the subluxations simply do not exist physically. They don't exist at all? They don't exist at all? They don't exist at all. It's simply just telling you a complete film. The fact that some of them believe this is even more worrying. And some of them actually don't believe it and they want to ditch this idea of subluxations altogether. Several papers have now been written by Kairos

acknowledging that there is no good evidence behind subluxation. One paper called it an untested hypothesis and said that it was like, quote, an albatross around our collective necks, end quote. Now, Marcello says that there are clear-cut medical conditions that affect your spine, like a slipped disc. That's where the jelly-like stuff in medical conditions that affect your spine, like a slipped disc. That's where the jelly-like stuff in between the bones of your spine push against the nerves, and this can hurt. But that's often not what chiros are talking about

when they talk about misalignments or subluxations. And Marcello says that if you do have these conditions... You do really need a proper doctor and not a pseudo-doctor. And if Marcello sounds particularly gnarky, it's because he hates that chiros have this veneer of legitimacy around them. Like, they call themselves doctors, even though they don't have a medical degree. And so here's a kind of fun fact about chiropractors.

A survey of more than 1,000 chiros found that one in four of them agreed with this statement. Quote, Yeah, one in four thought that. But still, there is evidence that going to a chiro might help you with back and neck pain. But if chiros aren't fixing subluxations, then what are they doing to help with your pain? Well, scientists aren't quite sure how spinal manipulation works.

Research into this very question says that it could be that that sharp thrust triggers a chain of events that might block pain receptors or it could reduce muscle tension or stiffness. And then there's another explanation, that it's not to do with paint receptors or stiffness, but actually it's just about someone taking care of you and from that you're expecting to feel better.

It's that thing we call the placebo effect. We put this to Bill and Chris, Katie's parents. Would it matter to you if it was placebo and it wasn't sort of aligning your back and, you know, whatever they say it might be? No, no, we'd still go. Why? Why?

Because it helps. The pain, you know, it's all about whether it feels good for you. Fair point. If it's making people feel better, what's the problem here? Well, there are some risks. Anita Gross, the physical therapist from the beginning of the show, talked to us about these. When she was doing her big assessment of the evidence out there on chiros and neck pain, she also looked at the risks here. Because getting a spinal manipulation,

particularly the kind that twists and cracks your neck, does seem kind of scary. So Anita found that sometimes people said that their neck pain actually got worse after a spinal manipulation and other people would get headaches, nausea or even dizziness. Here's Anita. The manipulation happens so quickly, then, ah, you got that dizziness.

Now we don't know how often this happens because many studies actually don't record the side effects but either way those things tend to go away on their own. Now very rarely there are more serious problems that can happen. Bones can fracture and a twist or a push on the neck can actually dislodge a blood clot or even cause a small tear in the artery. And there are cases where people have actually died. May was seeking treatment for what she said was just a pinched nerve and less than a week later she was dead. Last year, Katie May, a 34-year-old model,

died soon after going to the Cairo, and her family blamed the treatment. Now, we weren't talking about Katie May specifically, but Anita told us that this is really rare. But these kinds of cases can happen. Yeah, a young person between the age of 20 and 40-something goes, gets their neck manipulated, and then they die. Like, we've had a few cases like that.

Oh, my gosh. What are they dying of? From aneurysms or the vascular system just being torn in the neck, and then they get bleeds into the head. So what are the chances that this will happen to you if you go to the Cairo? Well, scientists actually don't know. Some say that one out of every few million manipulations could lead to a death. Others say it's more common. And some even question whether chiropractors caused these deaths or something else did. Conclusion.

While serious injuries from chiropractic are rare, they do happen. And less serious issues, like pain or stiffness, tend to get better on their own. So, when it comes to science versus chiropractors, does it stack up like a nice, healthy spine? Well, for people with back or neck pain, the research shows that getting a spinal adjustment from a chiropractor might help. But we don't really know why. As for taking your kids to the chiro,

there's no good evidence that it will help them. And what about the whole point of Cairo, that our spines need to be aligned for our overall health, that subluxation thing? Well, there's no good evidence that it's real. And finally, this isn't a totally risk-free option. Very rare but very serious consequences can occur from

spinal manipulation, even death. But of course pretty much everything that people do with their bodies carries some risk and sometimes those risks are worth taking if people are getting a real benefit. But for a lot of things that some chiros are saying they do, there's just no good evidence that it will help. Some of those claims are based on their belief that the evidence will come, rather than the science that we have now. Feel sorry, Katie's dad.

Sees it this way. It's a bit like religion. You've got to filter out the bulls**t. I reckon. Wait, what did your dad just say? He said, chiropractors are a bit like religion. You've got to filter out the bulls**t. Bill's sorry.

I know. He's so sassy. That's science versus chiropractors. We all adore our victim, Mike. He puts a rose in every tree. This episode has been produced by Rose Rimler, me, Wendy Zuckerman, with help from Shruti Ravindran and Heather Rogers. Our senior producer is Caitlin Sorey.

We're edited by Blythe Terrell. Fact-checking by Michelle Harris. Sound design by Marne Peralta and Bobby Lord. Music written by Bobby Lord. For this episode, we also spoke to Dr Richard Deo, Professor Tim Mertz, Professor Gregory Whitcomb, Dr Adam Chifu and Julie Knack. Thank you for your insights.

An extra big thanks to Rachel Ward, Emma Morgenstern, Christina Sullivan, Jasmine Romero and Phoebe Flanagan, as well as Alex Ward, Russell Gregg, Fiona Crawl and Judy Adair. Also, a shout-out to the Soarees. Thank you, Bill and Chris. By the way, Gimlet's doing a holiday pop-up shop selling T-shirts and stickers. So show your support for our show by getting your very own Science vs T-shirt.

It'll be fun for those Christmas dinners. Links are in the show notes. Check it out at sciencevs.show slash shirt. Next week is our last show for the season, and we're looking at obesity. Who's to blame for making us fat? So I take the stool. It goes literally into a blender,

just like you're imagining a regular blender. There's a lot of chunks, like corn. Is that what we're talking about, corn? I'm Wendy Zuckerman. Back to you next time. It's a new bike. It's a good one. It's got two brakes on it.

Okay. That has nothing to do with cars colliding with you though, Caitlin. It doesn't matter the bike you have. It means I can stop more quickly. What about your helmet? Yep, new helmet. Okay. nothing to do with cars colliding with you though caitlin it doesn't matter the bike you have means i can stop more quickly what about your helmet yep new helmet okay we've got to go we'll let you go okay all right okay nice talk with you