03.Where chiropractic can help
In some respects, chiropractic has come a long way since its quasi-religious beginnings. Qualification now involves intensive study of anatomy, physiology and biomechanics, particularly as these relate to the spine. It’s taught in four Australian universities, and graduates of the four- or five-year courses are considered allied health professionals – they can even title themselves “doctor” – who are funded by Medicare and most private health insurers.
Practitioners are required to register with the Chiropractic Board of Australia, which regulates professional practice and currently has more than 4000 practising members.
Those in chiropractic who prefer an evidence-based approach lament the lack of well-conducted clinical trials, but also point out that not all practices in conventional medicine are evidence-based. Mainstream medical practitioners by and large acknowledge the system’s failings, but also argue they are conscientiously self-critical and continually evaluating and striving to improve the state of evidence in medicine. They also point out that conventional therapies that haven’t been strictly subjected to randomised, placebo-controlled trials are at least biologically plausible – unlike many alternative medicine therapies.
But not all chiropractors believe any shortcomings in conventional medicine let them off the hook in their own profession. Indeed, some of the profession’s harshest critics come from within. Having invested many years and (particularly in some countries) a lot of money obtaining their qualifications, they understandably want to be recognised as highly qualified, scientifically trained health practitioners who can make a legitimate and valuable contribution to people’s health and wellbeing – and they’re concerned references to theories and practices not based on sound scientific principles reflect negatively on the profession as a whole.
The scoliosis dilemma
Scoliosis is a condition where the spine has an abnormal sideways curve. The most common type is adolescent idiopathic (which means it has no known cause) scoliosis, which occurs mostly in girls. While most cases are mild and don’t require treatment, the most common treatment when necessary and appropriate – depending on the degree of the curve, the age of the patient and evidence of progression – is to wear a back brace. Because adolescents’ bones are still growing, the brace helps control the curve so it doesn’t get worse – but it doesn’t cure scoliosis. In extreme cases, surgery to fuse the vertebrae in a more normal alignment may be required.
Because it involves the spine, many chiropractors feel they have something to offer in the treatment and management of scoliosis, and while chiropractic may be helpful for pain relief, it’s the treatment aspect that has orthopaedic specialists concerned. They argue there is no evidence that chiropractic manipulation, exercise programs, electrical stimulation or dietary advice can successfully halt the progression of the curve.
The risk, then, is that people miss out on effective management or delay seeking help while visiting a chiropractor, and by the time they turn to conventional medicine the window of opportunity for obtaining the best results may have passed – either the curve is too large or the growth phase has finished.
For more information about identifying and managing scoliosis, talk to your doctor or visit Scoliosis Australia.