- There are 2 types of chiropractic (the work of chiropractors) in Aotearoa New Zealand.
- Traditional, alternative chiropractic (also known as vitalistic) is the most common type. It is considered to be a form of complementary and alternative medicine (CAM) not compatible with modern medicine.
- Modern, non-alternative chiropractic (also known as non-vitalistic) is less common and is more compatible with modern medicine.
- Chiropractic spinal manipulation is generally safe. There is a small risk of a pain flare, and an extremely rare risk of stroke if the neck is manipulated. It can generally be used safely alongside standard treatments.
- Spinal manipulation may help with some forms of acute pain, but there is a lack of evidence for chronic (ongoing) pain. There is no evidence that it can treat organ problems.
- There is no proven benefit of regular chiropractic “maintenance” checks.
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Key points about chiropractor
- A chiropractor is a health professional who treats conditions related to bones, muscles and joints (musculoskeletal problems), usually with manipulation.
- Chiropractors are health professionals who provide chiropractic services.
- There are 2 types of chiropractic (the work of chiropractors) in Aotearoa New Zealand – traditional, alternative chiropractic (also called vitalistic) and modern, non-alternative chiropractic (also known as non-vitalistic).
- Find out more about these different types and the evidence for their effectiveness.
Spinal manipulation has been used for thousands of years throughout the world. It became a core feature of chiropractic and osteopathy. Chiropractic was founded by DD Palmer in 1895. He suggested that 95% of all diseases were due to subluxations (see below) in the spine, and the remaining 5% were due to subluxations in the arms and legs.
The New Zealand Chiropractors' Association (NZCA) define subluxation as “when joints of the spine fail to move properly and/or the spinal bones become misaligned causing interference with the nerve messages from the brain to the body and/or from the body to the brain”.
Chiropractic subluxation is not recognised in modern medicine. Modern medicine also has the word subluxation, but it is only rarely used, and means a partial dislocation of a joint that is not related to general health in any way but may sometimes cause pain. Importantly, modern medicine says subluxation does not usually need to be treated. Many physiotherapists use the modern medical term as well and some may use manual techniques to adjust the position of the joints, but it is not thought to relate to general health.
Spinal manipulation therapy in chiropractic usually involves what is called a “high velocity low amplitude” thrust. This means a joint or part of the spine is quickly moved but not by a large amount. Spinal manipulation is not only used by chiropractors – it is also used by many osteopaths and physiotherapists, but these other groups may have a preference for other manipulation techniques.
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Over time 2 distinct groups of chiropractors have developed – the traditional alternative medicine group and the modern non-alternative medicine group. These 2 groups are at odds with each other and their only similarities are their early history and name. There are also some chiropractors who sit somewhere in between.
Vitalistic “traditional” chiropractors
Vitalism is based on the idea that all living beings are sustained by a non-physical non-chemical “vital force”. The vital force theory has similarities with the Chinese Qi theory and ancient western humoral theory.
The NZCA states that vertebral subluxation(external link)(external link) can “affect movement patterns, muscle balance, and even the function of organs and the chemical and hormones they produce. Most subluxations do not cause pain…[but] subluxations always reduce the body’s innate ability to express life and function”. This view differs from that of modern medicine.
Subluxations are thought to need regular monitoring, as undetected subluxations are said to cause harm. The NZCA states: “many people who are not obviously unwell or suffering are surprised to feel even better after chiropractic adjustments.” They believe that regular monitoring is in order, and monitoring may include having x-rays.
This group may also treat children, in the belief that looking for and removing dysfunction and nerve interference will promote optimal brain-body communication. This is also not compatible the views of modern medicine.
Non-vitalistic “modern” chiropractors
Non-vitalistic chiropractors, like most mainstream health professionals, view vitalism as an interesting historical concept but not one that fits with current medical understanding of the mind, body, and health.
This group engages in modern musculoskeletal care, with beliefs around diagnosis and treatment that are largely compatible with modern mainstream medicine. For example, they may not diagnose subluxations, nor do they believe that subluxations are related to organ problems. They may use language very similar to a physiotherapist or medical doctor. Their approach is often very similar to that of physiotherapy, but with a particular focus on the spine. There are large numbers of non-vitalistic practitioners in other countries (eg, Denmark, Switzerland, Australia, and Canada) but fewer in Aotearoa New Zealand where there are more vitalistic chiropractors.
The New Zealand College of Chiropractic is the only place to study chiropractic in New Zealand. One they have done a foundational health sciences year, students do a 4-year Bachelor’s degree at the college where they study anatomy, neurology, philosophy, psychology, marketing, nutrition and x-rays, as well as having hands on instruction. The college appears to follow the vitalism school of thought.
After training, chiropractors are governed by the New Zealand Chiropractic Board. This is a statutory body with various responsibilities that operates under the provisions of the Health Practitioners Competence Assurance Act 2003.
Chiropractors can register with ACC to provide subsidised treatment for injuries for up to a certain number of visits. You can also see a chiropractor privately without any subsidy which means you will pay to see them. You don’t need a referral to see a chiropractor. You can just call and make an appointment.
During an examination a chiropractor will:
- conduct a thorough medical history
- visually check for spinal curves or other indicators
- examine your spine, muscles, and nervous system
- possibly recommend an x-ray
- possibly recommend spinal manipulation using the high velocity low amplitude technique (see above)
- some chiropractors may use other treatment techniques such as exercise prescriptions, stretching, massage, gentle mobilisations and lifestyle advice.
There is some evidence that manipulation can help some people with acute low back pain. There is generally a lack of evidence for its effectiveness in treating chronic pain, but the same can be said about physiotherapy and modern medicine. Having 2 different types of chiropractic makes it harder to study how effective the treatment is.
Spinal manipulation is generally safe. There is a small risk of a pain flare for a few days. With neck manipulation there is also an extremely rare risk of damaging the blood vessels that supply the brain (vertebrobasilar arteries), leading to a stroke (death of brain tissue). Many if not most mainstream medical doctors have doubts about neck manipulation.
From a mainstream medicine view:
- There is no benefit in regular chiropractic checks and manipulation if you don’t have pain
- There is no benefit in having your child or infant checked
- X-rays are not helpful in routinely assessing neck or back pain
- Alignments on x-ray or examination are not related to health.
- Vertebral subluxation(external link)(external link) NZ Chiropractors' Association
- Introducing chiropractic(external link)(external link) NZ College of Chiropractic
- Student handbook(external link)(external link) NZ College of Chiropractic, 2022
- Leboeuf-Yde C, Innes SI, Young KJ, Kawchuk GN, Hartvigsen J. Chiropractic, one big unhappy family – better together or apart?(external link)(external link) Chiropr Man Therap. 2019 Feb 21;27:4
- Simpson JK, Young KJ. Vitalism in contemporary chiropractic – a help or a hinderance?(external link)(external link) Chiropr Man Therap. 2020 Jun 11;28(1):35
- Simpson JK. Appeal to fear in health care – appropriate or inappropriate?(external link)(external link) Chiropr Man Therap. 2017 Sep 20;25:27
- Walker BF, French SD, Grant W, Green S. A Cochrane review of combined chiropractic interventions for low-back pain(external link)(external link) Spine (Phila Pa 1976). 2011 Feb 1;36(3):230-42
Credits: Dr Jeremy Steinberg
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