Newly Published Guidelines to Save Chiropractic in Europe?

Dr. Joe Betz, B.S., D.C

ICA Board Member,

Idaho Chiropractic Association

CBP Fellow & Instructor

Here we go again! Findings from an “extensive” review of the “literature”¹ conclude that spinal manipulation is only effective for the following conditions:

· low back pain;

· migraine and cervicogenic headache;

· cervicogenic dizziness;

· several extremity joint conditions;

· neck pain (only using thoracic manipulation)

Cervical manipulation alone for neck pain of any duration, manipulation for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, and over 300 other health conditions was either found to be not effective, or was ignored in the review.

This group, which I assume is presenting themselves as “coming to the rescue” of the Chiropractors in Europe, also supports the findings of the equally maligned (and, in my opinion, poorly performed and biased) “Red Flag Only” X-ray Guidelines put out by Bussieres et al.¹ This guideline intended to limit the use of X-ray in Chiropractic practice. However, it is flawed due to the fact that it is based upon the findings of the medical profession on their utilization of X-ray for musculoskeletal conditions. Frontline management by MD’s for low back pain, for example, is the utilization of medication. Of course X-rays are not warranted in this type of management. However the Chiropractic “Red Flag Only” guidelines by Bussieres et al.¹ attempt to loosely apply these MD protocols to the practice of Chiropractic. Obviously, the practice of Chiropractic with mechanical force application to the spine as the primary treatment intervention, should be quite different in its radiography utilization needs, applications, outcomes, indications and contra-indications, etc.

Now back to the main issue at hand in this editorial. With regard to the scope of conditions effectively managed by the application of spinal manipulation, findings of “saviors” of Chiropractic in Europe do not surprise me to any extent. This is what they perpetuated in their CCGPP Guidelines.

However, it is the implications of this particular publication that is most disturbing. Some of you who pay attention to the events unfolding on one side of the world that invariably affect the profession on the other, are well aware of the ongoing situation in the United Kingdom between the British Chiropractic Association and the popular press, in particular a journalist named Simon Singh. Singh is being sued by the British Chiropractic Association for libel for an article he wrote critical of the chiropractic profession.

Singh has since teamed with a medical researcher and author known for being extremely critical of Chiropractic in recent years, and has blasted back at the profession resulting in a significant backlash. What has come into question is the scope of conditions for which Chiropractors should be allowed to claim success within their advertising and marketing materials. Specifically, advertising claims made by Chiropractors asserting benefits of Chiropractic care for non-musculoskeletal conditions have come under aggressive attack. This well-orchestrated effort has resulted in an onslaught of 600 board complaints against Chiropractors filed with the General Chiropractic Council (GCC), Europe’s centralized regulatory agency. This aggressive barrage of complaints equals a complaint against one out of four licensed Chiropractors in Europe. Obviously, these complaints were not filed against the Doctors of Chiropractic by their patients, but rather by disgruntled readers and supporters of Singh, most of whom one would assume had never been to a Chiropractor.

These publicly dramatized activities in Britain have moved the General Chiropractic Council (GCC), the UK-wide statutory body with regulatory powers, to commission a group of researchers to evaluate the evidence of manipulative and manual therapies for conditions. Unfortunately, many of the same researchers that did the horrid CCGPP documents, performed this review. Without much surprise, these individuals ONLY REVIEWED Randomized Clinical Trials (RCT’s) and systematic reviews of RCT’s. So again, as they did with the flawed CCGPP Low Back Pain document, they ignored 90% of the literature on the topic.² The GCC argues that only RCTs are appropriate to consider when determining what can be advertised by Chiropractors.

In my opinion, their findings, published in the journal Chiropractic and Osteopathy,³ work to shift the position of the BCA from defending Chiropractic as a healing profession that has 115 years of experience and published studies helping people with over 300 various conditions, to a glorified musculoskeletal therapist (of only selective regions of course). It is important to know that not all European associations have accepted these findings in Europe. Some groups maintain their position supporting Chiropractic and are adamantly opposed to the direction that these GCC commissioned researchers are driving the profession in Europe.

The International Chiropractors Association developed a COMPLETE Guideline that reviewed ALL levels of evidence, not the RCT exclusively. This guideline has been accepted for inclusion at the National Guideline Clearinghouse (NGC) a project by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. The findings of this clinical practice guideline showed benefits of Chiropractic care for over 300 different health conditions using many different techniques. Chiropractic organizations in Europe who do not want Chiropractors to be reduced to a limited musculoskeletal pain therapists, should consult these documents. Many national and state associations from around the world have officially adopted these guidelines to support their position that Chiropractic is a health care profession, not a limited therapeutic musculoskeletal modality.

Whether you practice Chiropractic in Anytown, USA or some remote corner of Scotland, the ICA Guidelines are continuously being updated for the benefit of you and your patients. You can support this process by joining the ICA and purchasing a copy of the ICA Best Practices and PCCRP X-ray Guidelines. All proceeds go to future revision of the document. Call the ICA today 800-423-4690. While you sit on the sidelines, others are working to strip the purpose of Chiropractic out of the profession.

References

1. Bussieres AE, Taylor JA, Peterson C: Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther 2008, 31: 33-88.
2. ICA Committee’s Critique of CCGPP’s Best Practices: Chiropractic Management of Low Back Pain and Low Back Pain Related Leg Complaints. June 2006.
3. Bronfort G, Haas M, Evans R, Leiniger, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiro Osteopath 2010; 18(3): 1-113.

Chiropractic BioPhysics, Chiropractic Guidelines