Value of chiropractors questioned

[Blue Wode]

Hot off the presses and perfectly timed comes this article from Professor Edzard Ernst:

Spinal manipulation: are the benefits worth the risks?
E. Ernst, Expert Review of Neurotherapeutics, November 2007, Vol. 7, No. 11, Pages 1451-1452
http://www.future-drugs.com/doi/full/10.1586/14737175.7.11.1451?cookieSet=1

…the early chiropractic literature provides ample evidence for the fact that chiropractic was not originally meant as a treatment for musculoskeletal problems, but as a cure for any human condition [1].

To understand this seemingly bizarre claim a little better, one should glance at the concepts that underlie chiropractic. Palmer was convinced that he had discovered a law of nature. In his view, all human illness and disease were caused by the blockage of the 'innate intelligence’ through vertebral malalignments or subluxations. Therefore, all conditions could and should be treated with adjustments of these abnormalities, in other words, spinal manipulation. This would restore the flow of the innate intelligence and, in turn, would cure whatever condition the patient was suffering from [1].

It seems obvious to any critical evaluator that these concepts are little more than fantasy: there is no evidence for any innate intelligence, and there is no reason to assume that adjusting malalignments of vertebra (if they at all exist) are the cause of disease or illness…

And yet the McTimoney College of Chiropractic course in the UK apparently instructs its students in the following:

By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm

Incredibly, that course (which has produced 500 practising chiropractors) is validated by the University of Wales as a BSc (Hons) Chiropractic degree:
http://www.mctimoney-college.ac.uk/cofc.htm

Even more bewildering is the fact that the UK General Chiropractic Council stipulates in its Code of Practice and Standard of Proficiency that chiropractors’ provision of care must be evidence based. See section A2.3 of the Standard of Proficiency here:
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf


Anyone else confused?

[Raph78]

good morning

i out myself as a chiropractor. i pride myself in offering accurate neuromusculoskeletal diagnosis and ethical treatment/management.
about semantics: you may call it innate intelligence - or the body's continued attempt to more or less successfully maintain homeostasis. innate intelligence is a vitalistic phrase from the 19th century. any bone surgeon plating a broken bone believes in "innate".

the great sir isaac newton,a passionate alchemist, formulated the law of motion in his free time. he gets all the credit for his scientific achievements. that he could have been a rosicrucian did not do his credentials any harm. on the contrary....yes mr palmer was a magnetic healer, so what....? that does not mean chiropractic 2007 is an unscientific cult... move on, dont be so stuck up!

about science:

when similar problems (e.g. back pain) cause different people to feel in very different ways it is not only the numbers achieved by a clinical trial that matter. maybe one ought to consider quality of life measures as the more appropriate way to research chiropractic and, maybe, alternative medicine. asking patients about their experiences is valuable clinical information. grounded theory studies appear an excellent approach to find out what matters to the patient. what is statistically significant is not always clinically relevant. those of you reflecting purposefully on academica in the safe environment of your ivory towers may not know that everyday busy clinic is messy. thats true also for the 5 min gp consultation as opposed to say 15 min with your chiropractor.

one question about the australian study: if you let physios perform largely flick-type manual mobilisation how on earth do you construct a credible sham group faking manipulation? its impossible. period. no wonder that results are not statistically relevant!

the physio curriculum generally does not include manipulation. its usually a post graduate activity. the question must be asked: how good (bad?) was their level of skill? had the study indicated that manipulation could be of help then it would have been criticized for a lack of numbers. you would have found ways of twisting it your way.

placebo, by the way, is not an excuse for a failed therapy. what is wrong with encouraging or reassuring the patient that their condition (e.g. a back sprain) is self limiting and usually resolves well in terms of symptomatology? this is called good interpersonal skills, not BS. about clinical skills:
a lot of gps in the area here do not even bother to have the patient expose their back when asked for help. maybe it would expose their inability to diagnose accurately. common diagnostic errors by gps: everything shooting down the leg is a "trapped nerve". everything not shooting down the leg is a "pulled muscle". for everyone above 55 its the old "arthritis" causing the problem. pattern recognition, cutting corners and knee jerk responses. where's the evidence for such negligent and incompetent clinical behaviour?

i do find that a skilled, specific high velocity manipulation can influence proprioception. proprioception produces muscle tone. proper muscle tone protects joints and moves them purposefully. poor proprioception causes weakness leading to injury (sprain). one of the features of sprain is muscle spasm and joint restriction. sometimes the muscle spasm or pain is caused by the joint sprain locally. in those cases manipulation helps. sometimes e.g. a distant problem is the cause for muscles failure. watch this clip (hope u dont mind, simon) http://http://www.youtube.com/watch?v=-6R2XAncZCw
joint mobilisation or flicking does not provide that sort of nerve response.


you could have put stacey in a double blind randomised trial, have her shoulder mobilised, rubbed and flicked upon by physios and guess what - she would still be no better and prof ernst would have had a good day.



are there ways to assess whats wrong with patients individually? the root cause of their musculoskeletal pain? sure. are they quantifiable? probably not. is there still evidence for it? yes. does that make it bad science? no. does it work? you bet. i dont think that good chiropractors have a waiting lists if they were no good.


over the past 3 years i must have treated about 13.000 cases, of which about 10.000 received cervical manipulation. i recorded one case where a patient had pain down the arm for 1 day after treatment. a few had headaches for a day or two or felt a bit sore temporarily. i have never come across a serious injury leaving lasting damage. but, maybe, in your eyes i should be a flick physio. at least they dont do damage....

i do not intend to spend too much time in here. i just popped in as some of the comments posted here were so outrageous and ignorant that a couple of things needed rectifying.

enjoy your sunday, and have an even better monday

[JJM]

{snip}

i out myself as a chiropractor. i pride myself in offering accurate neuromusculoskeletal diagnosis and ethical treatment/management.

Of course you do. Pride in their work, and opposition to criticism, are the unifying principles of chiro.

about semantics: you may call it innate intelligence - or the body's continued attempt to more or less successfully maintain homeostasis. {snip}

Great, pick one homeostatic mechanism and refer us to the medical evidence it is influenced by chiro. That is, don't show us chiro articles because they are seldom worth reading.

{snip} that does not mean chiropractic 2007 is an unscientific cult...

DD Palmer's ignorance does not make chiro an unscientific cult- that is called a straw-man argument. It is what chiros do that makes it an unscientific cult. {snip}

about science:

when similar problems (e.g. back pain) cause different people to feel in very different ways it is not only the numbers achieved by a clinical trial that matter. maybe one ought to consider quality of life measures as the more appropriate way to research chiropractic and, maybe, alternative medicine. asking patients about their experiences is valuable clinical information.

Maybe you could provide some evidence?

grounded theory studies appear an excellent approach to find out what matters to the patient.

What?

what is statistically significant is not always clinically relevant. {snip}

Vague ...

one question about the australian study: {snip}

Yes, one question, what is the Australian study?

{snip} about clinical skills:
a lot of gps in the area here do not even bother to have the patient expose their back when asked for help. {snip}

First, claimed deficiencies in GPs do not justify chiro. Second, a GP may decide to handle a case conservatively, or refer to medical specialist. Stick to your case.

i do find that a skilled, specific high velocity manipulation can influence proprioception. {snip}

Another opportunity to cite the medical literature.

watch this clip (hope u dont mind, simon) http://http://www.youtube.com/watch?v=-6R2XAncZCw
joint mobilisation or flicking does not provide that sort of nerve response.

A video clip might be a good illustration, after sending us to the medical literature that supports the demonstration.

{snip} [rhetorical banter, no evidence here]

[anecdote, no evidence here]

{snip} i just popped in as some of the comments posted here were so outrageous and ignorant that a couple of things needed rectifying. {snip}

Yes, there was another outrageous and ignorant chiro a bit earlier. He claimed to influence nervous flow. When I cited the evidence that chiros cannot do that, he blustered and said he could not read the article.
http://www.chirobase.org/02Research/crelin.html

So, I will ask you as I did him, what, specifically, do you do for your customers; and what is the evidence behind it?

If you do choose to answer, please use the shift key appropriately. There is, probably, one on either side of your keyboard. It makes things easier to read.

[richard]

good morning i out myself as a chiropractor. i pride myself in offering accurate neuromusculoskeletal diagnosis and ethical treatment/management.

Ralph, I have to tell your excellent posting will not go down very well with these “sceptics”. The don’t like chiropractors who “shout them down” or who don’t reference, the highly respected researchers, Edzard Ernst MD, Stephen Barrett MD and Hariet Hall MD who have had thousands of articles published on the peer reviewed quack watch web sites. These researchers obviously believe in each other judging by the way they reference each other. They must have gone to the same school of research methodology. Not to forget Edmund Crelin Ph.D refferences from the 60s,which JCC is very attached to. I must say I love the music from the 60s, however the science leaves a lot to be desired. I read somewhere that Stephen Barrett sued a chiropractor for libel and lost. Apparently the chiropractor wanted to clarify Barrett’s MD status “he's a psychiatrist who has never been board certified who failed his board certification 3 times. Apparently Barrett failed the neurology section which might go some way to explaining his lack of understanding of chiropractic. Now not being an expert on quacks perhaps some of our more learned forum members could clarify for me, does this lack of knowledge make Barrett a quack or a chiropractor, my Chambers dictionary describes a quack as a “boastfull pretender to knowledge and skill that he does not possess”. There seems to be a lot of quacks about if this is true.

Ralph, I know I must look really sad spending so much time on this, but it was for a talk I gave to chiropractic students last week. I wanted them to see how evidence can be used and abused and even with the best intentions you can light a candle but if the person is blind it is not going to help. Out of politeness I will respond to the “scientific evidence” (80%) presented by blue wode et al. when I get some time before withdrawing from the thread. Honestly I do have a life. Richard "the ignorant chiropractor"

[Blue Wode]

Good afternoon, Raph78, and welcome to the UK Skeptics forum.

yes mr palmer was a magnetic healer, so what....? that does not mean chiropractic 2007 is an unscientific cult...


move on, dont be so stuck up!

How can anyone move on here unless good scientific evidence is provided for 'chiropractic' (i.e. not spinal manipulation)?

maybe one ought to consider quality of life measures as the more appropriate way to research chiropractic, and maybe, alternative medicine.

But lots of people find their quality of life improved (i.e. feel better) by simple, cheap, and enjoyable non-medical interventions, e.g. after a couple of whiskies, a nice hot bath, a visit to the hairdressers, a trip to the movies or a walk through the countryside, etc.

what is statistically significant is not always clinically relevant, those of you reflecting purposefully on academica in the safe environment of your ivory towers may not know that every day busy clinic is messy. thats true also for the 5 min gp consulation as opposed to say 15 min with your chiropractor

According to this 2004 survey of UK chiropractors
http://www.gcc-uk.org/files/link_file/ConsultTheProfession.pdf
52.22% of chiropractors spend somewhere between 0- 15 minutes with their patients. (See page 33)

As for GPs, the length of routine booked appointments is not less than 10 minutes. For practices with only an open surgery system, the average face-to-face time spent by the GP with the patient is at least 8 minutes.
http://www.bma.org.uk/ap.nsf/Content/QualityOutcomes~patient

the physio curriculum generally does not include manipulation. its usually a post graduate activity. the question must be asked: how good (bad?) was their level of skill?

Indeed, it would be interesting to know the answer to this question posed by the results of the UK BEAM trial:

Three brief comments on the excellent BEAM Trial (1). My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se.

It would be relevant to know which of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size. This might significantly influence the referral pattern. A post-hoc analysis might answer this question.

It is regrettable that the study only monitored serious adverse effects. There is compelling data to demonstrate that minor adverse effects occur in about 50% of patients after spinal manipulation (2). If that is the case, such adverse events might also influence GP’s referrals.

E Ernst, Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth

References

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ, doi:10.1136/bmj.38282.669225.AE. BMJ 2004;19 November:1-8.

2. Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med 2002;112:566-70.

http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126

[My bold]

placebo, by the way is not an excuse for a failed therapy. what is wrong with encouraging or reassuring the patient that their condition (e.g. a back sprain) is self limiting and usually resolves well in terms of symptomatology? this is called good interpersonal skills not BS.

Just like GPs do in their 8-10 minute consultations without the expense, inconvenience and potential risks associated with visiting a chiropractor.

a lot of gps in the area here do not even bother to have the patient expose their back when asked for help. maybe it would expose their inability to diagnose accurately.

As supported by the Hancock et al study
http://www.medpagetoday.com/Geriatrics/PainManagement/tb/7307
perhaps clinical experience has taught those GPs that exercise, paracetamol, and reassurance are all that's required.

i do find that a skilled, specific high velocity manipulationc an influence proprioception. proprioception produces muscle tone. proper muscle tone protects joins and moves them purposefully. poor proprioception cause weakness leading to injury (sprain). one of the features of sprain is muscle spasm and joint restriction. sometimes the muscle spasm or pain is caused by the joint sprain locally. in those cases manipulation helps. sometimes e.g. a distant problem is the cause for muscles failure. watch this clip (hope u dont mind, simon) http://http://.youtube.com/watch?v=6R2XAncZCw joint mobilisation or flicking does not provide that sort of nerve response.

you could have put stacey in a double blind randomised trial, have her shoulder mobilised, rubbed and flicked upon by physios and guess what - she would still be no better and prof ersnt would have had a good day.

Anecdotal.

are there ways to assess whats wrong with patients individually: the root cause of their musculoskeletal pain? sure. are they quantifiable? probably not. is there still evidence for it? yes. does that make it bad science? no. does it work? you bet. i don't think that good chiropractors have a waiting lists if they were no good.

What do you mean by ‘good’ chiropractors? Many chiropractors are excellent salesmen who are able to convince asymptomatic and gullible patients that they require ongoing treatment. See here:
http://www.chirobase.org/09Links/pb.html

over the past 3 years I must have treated about 13.000 cases, orfwhich about 10,000 received cervical manipulation. i recorded one case where a patient had pain down the arm for 1 day after treatment. a few had hedaches for a day or two or felt a bit sore temporarily. i have never come across a serious injury leaving lasting damage. but, maybe, in your eyes i should be flick physio. at least they dont do damage....

Anecdotal. See here for the latest on safety:

Spinal manipulation: are the benefits worth the risks?

Today, the chiropractic profession is divided into the 'straights’ who still believe every word of Palmer’s gospel, and the 'mixers’ who have freed themselves, at least partly, from his theories. The straights treat most diseases with spinal manipulation, while the mixers managed to gradually redefine themselves as back specialists.

-snip-

In conclusion, spinal manipulation is based on questionable pathological concepts and therefore lacks biological plausibility [1]. Its risks may be considerable [4] and its benefits have not been convincingly demonstrated in rigorous trials [2]. What follows is sobering: the benefits of spinal manipulation do not seem worth the potential risks.

http://www.future-drugs.com/doi/abs/10.1586/14737175.7.11.1451

i do not intend to spend too much time in here. i just popped in as some of the comments posted here were so outrageous and ignorant that a couple of things needed rectifying.

Thank you for dropping by.

[Raph78]

hi richard, buddy! how is it going?

wow weve got this going now, have we?

well, my medical friends. get your grays anatomy out but dont let it drop on yer feet. lets give you a neurophysiology talk.

now, your homework will be to understand Turker et al (1994). Reflex response in motor units in human masseter muscle to mechanical stimulation of a tooth. Exp rain Res 100 (2) 307-15 and Slemenda et al (1997) Quadriceps weakness and OA of the knee. ann int med 127 (2) 97-104. and to see the relevance IN TERMS OF PROPRIOCEPTIVE MEDICINE.

grays: read up also on the MYOTATIC REFLEX and how it governs and controls muscle tone. and what changes the rate of firing input into the spinal cord. and how that generates alpha motor neuron activity back to the muscle to close the loop. and how that increases muscle activation. and how that produces tone. and how tone prevents injury.

muscle testing is an art. those who know how to test will be aware of rate coding and muscle recruitment. the size principal also states that motor unit activation depends upon the load forced upon a muscle (manual muscle test, resisted weight test as in video). so, a healthy muscle should not fade. if it DOES its proprioceptively inhibited - which is reversible.

the myotatic reflex gets stimulated by STRETCH (like high velocity manipulation - just an idea). manipulation is a fast stretch.....are you getting the idea? thats why the stuff on the video works. and thats chiropractic in action affecting the nervous system.


evidence that statistical significance may be different from clinical significance? honestly mate, you must be joking. where have you been in the days of evidence based practice? do i need to quote my own study?

quality of life is not "im feeling better". thats rather blunt isnt it? there are some excellent QOL questionnaires out there, e.g. the fine bournemouth questionnaire by bolton and breen. you clearly must be a novice to qualitative science.

but coming back to "quality" science the australian study i referred to was the one you all quoted. the one with the australian researchers and the australian physios. remember? the one that claims chiropractic does not work although not a single chiropractor took part and the physios just tickled the skins of the patients calling this manipulation.

give me one study that proved that a stroke was directly caused by neck manipulation. hang on, that would be a case study. give me randomised double blind clinical trials showing that chiropractic neck manipulation causes strokes. the experts have spoken and found that manipulation does not put more force on the neck than AROM. (Haldemann, Sackett, Herzog and all the big boys who are hot on this topic) http://www.chiropracticawarenesscouncil.org/truth.html

maybe a point against vaccination is that it has a NNT of 23, that means that if you have the jab and DONT get the flu its to only 4-5% thanks to the jab. thats taken from bandolier. Its disgusting to call that preventative!

thankfully my NNT is close to 1 and most people are really happy with my care.


i invite ANY of you to shadow me for a whole day and then come out for a drink at night to discuss.

[Raph78]

i read ernst from nov 2007

the guy loves himself just quoting his own articles, doesnt he?

what exactly was his education in manipulation? how long has he practiced and what did he do?

given that he slams ALL cam disciplines he seems a bitter man that realized he wasted more than half his life to study worthless BS

i actually reviewed some of his meta analyses, incluidng the one on treatment of children with asthma. he carefully selects on studies that proof his point and deliberately omits the ones that he doesnt like. thats sad, man

[Raph78]

yes, the practice building including a lot of the seminars are dodgy. i call it the "wellness wallet". its a disgrace.

you find that in (private) dentistry too. this is not exclusive to a certain strain of chiropractors

[Admin]

What would improve debate here would be if the Chiropractors actually dealt with relevant details regarding Chiropractic rather than attempting to belittle or discredit everyone who questions them (the Ad Hominem fallacy) and introducing medical concepts that are mainstream and nothing to do with Chiropractic.

[Raph78]

hi john

discussing proprioception is a medical debate. its not a chiropractic insider. it helps explain chiropractic as i was asked to do. it also explains massage, and possibly acupuncture. it does not explain the flu jab.

its just that not many understand the working principle behind proprioception. those might only vaguelyremember it from multiple choice days at medical uni.

[Blue Wode]

evidence that statistical significance may be different from clinical significance? honestly mate, you must be joking. where have you been in the days of evidence based practice? do i need to quote my own study?

Once again, please provide the scientific evidence for 'chiropractic'.

give me one study that proved that a stroke was directly caused by neck manipulation. hang on, that would be a case study. give me randomised double blind clinical trials showing that chiropractic neck manipulation causes strokes.

Once again, here is the most current systematic review (2007) on adverse effects associated with spinal manipulation:

Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

http://www.jrsm.org/cgi/content/full/100/7/330

Would you please provide us with the scientific data that shows that spinal manipulation is safe for infants and children under 12.

the experts have spoken and found that manipulation does not put more force on the neck than AROM. (Haldemann, Sackett, Herzog and all the big boys who are hot on this topic) http://www.chiropracticawarenesscouncil.org/truth.html

How can anyone take seriously an organisation that links to the World Chiropractic Alliance (WCA): http://www.chiropracticawarenesscoun.../articles.html

For example, here is an excerpt from one of the WCA's position papers:

The correction of subluxation is applicable to any patient exhibiting evidence of its existence regardless of the presence or absence of symptoms and disease. Therefore, the determination of the presence of subluxation may stand as the sole rationale for care.

http://www.worldchiropracticalliance.org/positions/rationale.htm

maybe a point against vaccination is that it has a NNT of 23, that means that if you have the jab and DONT get the flu its to only 4-5% thanks to the jab. thats taken from bandolier. Its disgusting to call that preventative!

Do you view childhood vaccinations as a preventative healthcare measure?

[Admin]

about semantics: you may call it innate intelligence - or the body's continued attempt to more or less successfully maintain homeostasis. innate intelligence is a vitalistic phrase from the 19th century. any bone surgeon plating a broken bone believes in "innate".

So, what is the difference between homeostasis and innate intelligence?

What's the difference between the body's own self-repair mechanisms and pseudo-medical intervention (Chiropractic manipulation, Acupuncture, Homeopathy, etc.)?

As far as I can see all of these pseudo-medical interventions actually do nothing as the body repairs itself anyway; however, they do seem to have some positive effect on patients (placebo effects in other words).

Here is the essential problem with these placebo interventions: in order for them to 'work' they have to be believed in by the patients (i.e. there needs to be a 'perceived authenticity' about these practises) so the practitioners have to maintain the belief that there really is something medical going on - which leads us to the dilemma at the heart of alternative medicine.

Chiropractic is a silly idea that was invented back in the 19th century, and it hasn't changed fundamentally since that time. It 'works' via placebo effects, and I'm pretty sure most Chiros know this, but they can't admit it. To do so would remove the perceived authenticity that is required for people to get the benefit of placebo effects from it.

SMT (which Chiros have adopted to treat lower back pain) accepted, there's not really any decent evidence that Chiropractic is a useful medical intervention for anything.

We'll always have stalemate with alternative medicine for the simple reason that the practitioners cannot admit that what they're dealing in is placebo medicine.

Those, like skeptics, who are interested in evidence-based medicine however, can see through the (necessary from alternative medicine's point of view) façade presented to us.

[Blue Wode]

i read ernst from nov 2007

the guy loves himself just quoting his own articles, doesnt he?

what exactly was his education in manipulation? how long has he practiced and what did he do?

given that he slams ALL cam disciplines he seems a bitter man that realized he wasted more than half his life to study worthless BS

i actually reviewed some of his meta analyses, incluidng the one on treatment of children with asthma. he carefully selects on studies that proof his point and deliberately omits the ones that he doesnt like. thats sad, man

Here's some background information on Professor Edzard Ernst:

It is hard to imagine a member of the UK's medical elite devoting their life to complementary medicine. Ernst, however, comes from a culture where alternative therapies have long blended with the mainstream. He is from four generations of conventional doctors but, he says, "Even as a young boy I was treated with complementary therapies - mostly homeopathy."

His first post was in a homeopathic hospital in Munich, where he was greatly impressed. "If you study medicine and pharmacology, you know [homeopathy] can't work," he says. The active substances in homeopathic medicines are so diluted that pharmacology says they cannot have an effect. "Then you start working in a homeopathic hospital and people get better. Is that a miracle? It certainly is very impressive for a young doctor.

"Looking back, I wonder if a lot was a placebo effect."

More...
http://education.guardian.co.uk/academicexperts/story/0,1392,1048903,00.html

"I have received training in spinal manipulation and have applied it clinically, but have no financial competing interests related to spinal manipulation."

See under ‘conflicts of interest’ at the end of this systematic review:
http://www.mja.com.au/public/issues/176_08_150402/ern10520_fm.html

[Raph78]

usually the body repairs itself. sometimes not. as in chronic back pain. and there is good evidence that chiropractic can help that.

can you quote anybody else apart from "edzi oops ive done it again"? he just regurgitates his own previous papers. i remember his quote that st johns wort is dangerous because if someone with depression taking it got better then they would have the strength to commit suicide. great scientist...

[Blue Wode]

usually the body repairs itself. sometimes not. as in chronic back pain. and there is good evidence that chiropractic can help that.

can you quote anybody else apart from "edzi oops ive done it again"? he just regurgitates his own previous papers.

Here you are:

(The value of chiropractic)
Virtually all experts agree that the best available evidence in any area of health care is that provided by Cochrane reviews. The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion. Four Cochrane reviews of spinal manipulation are available today.
Back pain is by far the condition most frequently treated by chiropractors. The Cochrane review of spinal manipulation for back pain summarised 39 clinical trials.1 The authors’ conclusions were very clear: ‘There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.’

http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

[My bold and underscoring]