Over the past several years, I have tried out several holistic healing modalities while recovering from injury. Today’s article will focus on 2 of those modalities – chiropractic and acupuncture. There are many people in the western world who believe that both chiropractic and acupuncture are pure quackery. I say they are wrong and this article will explore this topic.
Chiropractic is defined as the manipulative treatment of misalignment of the joints, especially those of the spinal column, which are held to cause other disorders by affecting the nerves, muscles, and organs. Throughout history, the chiropractic profession has conducted clinical research despite limited funding. Since this modality does not use implantable medical devices or pharmaceutical drugs, it receive little to not research funding from device or pharmaceutical companies, unlike conventional medicine. Chiropractic schools need to self-fund the majority of their research programs. There is limited federal funding, which began in 1992, with the establishment of the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health.
The majority of clinical research in chiropractic has focused on its effectiveness in caring for spine-related injuries and complications from spinal stress. The studies focus on the most common complaints treated by chiropractors: low back pain, neck pain and headaches, and peripheral nerve problems. The studies compare a chiropractic regimen against commonly prescribed pharmaceuticals, or combinations of therapies. Treatment affects are measured over time.
The major studies have found clinical benefit to the participants from chiropractic treatment, some showing superiority of short and long-term effects. Below are three examples of analyses of pools of research:
- Bronfort, G., Haas, M., Evans, R., Kawchuk, G., Dagenais, S. (2008). Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal, 8(1), 213-225.
- Bronfort, G., Nilsson, N., Haas, M., Evans, R., Goldsmith, C.H., Assendelft, W.J.J. & Bouter, L.M. (2004). Non-invasive physical treatments for chronic/recurrent headache. The Cochrane Database of Systemic Reviews.
- Gross, A.R., Hoving, J.L., Haines, T.A., Goldsmith, C.H., Kay, T., Aker, P., Bronfort, G. (2004). Manipulation and mobilization for mechanical neck disorders. The Cochrane Database of Systemic Review.
The greatest strength of chiropractic has shown to be the treatment of neuro- musculoskeletal conditions such as sprain or strain-type injuries of the back and adjacent structures. The strongest evidence is in the area of low back pain, followed by neck, head, and arm issues, especially migraine headaches, tension headaches, and stiff necks. For low back pain, in particular, research has helped make it possible to predict fairly reliably which individuals will benefit.
Recent research has examined the cost-effectiveness of chiropractic care among other holistic therapies (physical therapy, acupuncture, massage) vs. conventional medicine. A 2012 study found chiropractic to be more cost-effective for neck and low back pain when compared with general practitioner care or physical therapy. A 2007 study compared the costs of a patient under the direction of a chiropractor as their primary care physician (PCP) versus a medical doctor. After 70,000 member-months spanning a 7-year period, hospital admission costs were 60% lower, while the cost of days spent in the hospital were 59% lower, and outpatient surgeries/procedures were down 62%.
Finally, the costs associated with pharmaceutical drugs decreased by 85% vs. conventional medicine. All of these comparisons were done in the same time frame, geography, and health maintenance organization product.
Acupuncture is a technique in which practitioners stimulate specific points on the body (known as meridians) by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine.
It appears, from my research, that there have been even less clinical studies done on acupuncture. The effects of acupuncture on the brain and body and how best to measure these affects are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.
NCCIH funds research to evaluate acupuncture’s effectiveness for various kinds of pain and other conditions, and to further understand how the body responds to acupuncture. Recent NCCIH-supported studies include:
- Acupuncture can reduce the frequency of hot flashes associated with menopauseWhether acupuncture can reduce pain and discomfort that may accompany chemotherapy
- Objectively determining if actual acupuncture is more effective than simulated acupuncture or usual care for pain relief, and (if so) by how much.
Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider.
Some people are concerned with the safety of acupuncture, so it’s reasonable to address that concern, since the needles are indeed penetrating your skin. Here is what the science very clearly says about safety.
- There are relatively few complications from acupuncture needles. Complications have resulted from use of nonsterile needles and improper delivery of treatments.
- When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, collapsed lungs, and injury to the central nervous system.
For many, it’s very difficult to reconcile acupuncture with modern science. This is likely because acupuncture is a pre-scientific paradigm based on concepts that are foreign to contemporary western medicine. Its treatments are founded on philosophical constructs, subjective impressions and responses to patterns of disharmony, whereas Western treatments are the result of controlled scientific research. On the other hand, it would be irresponsible to completely ignore the actual research that has demonstrated acupuncture’s efficacy. And true Traditional Chinese Medicine acupuncture is customized for each patient based upon the condition and the examination, and there are multiple variables such as manual or electrical stimulation, number of acupuncture sites treated, frequency of the sessions, and length of treatment.
The area where acupuncture seems to have gained the most clinical ground is in the area of pain reduction. Researchers in Germany conducting acupuncture trials for patients with chronic low back pain found that only 15 percent of subjects who received genuine acupuncture treatment needed extra pain medication, compared with 34 percent who were receiving “sham” (using needles but inserted into non-traditional acupuncture points) treatments, and 59 percent receiving conventional therapy. Long-term pain reduction was also best for subjects who received either real or “sham” acupuncture versus those that received conventional therapy.
So, does acupuncture work or not? Or does it work if you think it works? While some findings support acupuncture’s efficacy, especially for post-operative or chemotherapy-induced nausea and vomiting and post-operative dental pain, others posit that its clinical effectiveness depends mainly on a placebo response. However, even if it is true that it’s a placebo response, does it really matter if in fact it alleviates pain?
At the beginning of this article, I wrote that those who claim that chiropractic and acupuncture therapies are quackery are wrong. I will now openly share my N=1 experience.
After I ruptured the discs in my low back, I went through 6 painful months with the following therapies:
- Cortisone shot – useless
- Physical therapy – modest success
And then the sports medicine surgeon told me it’s time for back surgery. I did my research and learned that less than 50% of back surgeries are successful. I said no thanks. I started acupuncture and then a few months later, I saw a chiropractor.
- Acupuncture – modest success
- Chiropractic – Huge success
Several years later, in my early 50’s, I have set new PR’s in both the back squat and deadlift without any major back issues. In fact, I actually feel stronger and my recovery is just fine.
I feel strongly that holistic therapies have merit and value. Conventional medicine is certainly important, but it’s not everything. Conventional medicine is actually terrible at basic wellness and nutrition, but excels in acute healthcare. I am an advocate of holistic therapies, but I do believe that it is different for each individual. Don’t fear it. Experience it, see what works for your body, and heal.