Several chiropractic practices are listed as being members of the BCA (the organisation that decided to sue Simon Singh). I took a look at a couple of the conditions that one of these practices – the Bassett Chiropractic Clinics who have clinics named St Albans Chiropractic Clinic, The Hertford Chiropractic Clinic, Watford Chiropractic Clinic, and Kings Langley Chiropractic Clinic – claims to be able to help people with: whiplash injuries and headaches.
Let’s look at whiplash first. There is a review of treatments for whiplash-associated disorder (WAD) that looked at chiropractic and four other treatments. The authors found: two randomised controlled trials (RCT) in support of mobilization as an effective non-invasive intervention, two RCT that reported that exercise alone does not improve range of motion in patients with acute WAD, one RCT that reported improvements in pain and range of motion in patients who underwent pulsed electromagnetic field treatment, a further two (conflicting) RCT that studied the effectiveness of multimodal intervention with exercise, and no RCT that covered chiropractic treatment of whiplash.
The lack of any evidence from a randomised controlled trial relating to the use of chiropractic for whiplash is something that I personally find a little worrying. Randomised controlled trials are important for those who wish to know whether a treatment works – uncontrolled trials are not as reliable and should not be considered as being high-level evidence. [Professor Greenhalgh, the author of “How to Read a Paper”, once wrote that one of the questions doctors should ask of drug company reps is: “Does the material include high-level evidence such as systematic reviews, meta-analyses, or double-blind randomised controlled trials against the drug’s closest competitor given at optimal dosage?” The italics are mine.] While the absence of high-level evidence of the efficacy of chiropractic in WAD does not mean that chiropractic is not effective in treating whiplash-associated disorder, it is my opinion that one should treat with caution claims that chiropractic can be used to treat (or “help people with”) WAD until randomised controlled trials have been conducted.
The authors of this review concluded that: “Future research should be directed toward clarifying the role of exercise and manipulation in the treatment of WAD, and supporting or refuting the benefit of pulsed electromagnetic field treatment.” [My interpretation: the jury is still out.] The only treatment modality that they did recommend was mobilisation for “the treatment of pain and compromised cervical range of motion in the acute WAD patient.”
Now for headaches. I found several systematic reviews that looked at the evidence for spinal manipulation in treating headaches. The first noted the “overall poor methodology of the studies”. [The most common flaws were a small sample size, the absence of a placebo control group, lack of blinded patients, and no description of the manipulative procedure.] The authors concluded that “there is a need for high-quality randomized controlled trials assessing the effectiveness of these interventions in these headache disorders.”
The second paper on chiropractic for headaches [link] noted that the evidence for chiropractic in treating headaches is “weak”. The author concluded that “In the absence of clear evidence regarding their role in treatment, physicians and patients are advised to make cautious and individualized judgments about the utility of physical treatments for headache management; in most cases, the use of these modalities should complement rather than supplant better-validated forms of therapy.” [A further point of interest is that the author stated in their ‘conclusions and recommendations’ section that “With the exception of high velocity chiropractic manipulation of the neck, the treatments are unlikely to be physically dangerous, although the financial costs and lost treatment opportunity by prescribing potentially ineffective treatment may not be insignificant.”.]
The abstract of the third paper (this paper was a systematic review of “The effectiveness of spinal manipulation for the treatment of headache disorders”) noted, in common with the reviews I’ve already looked at, that the evidence was weak due to the methodologies of the trials: “Considerable methodological limitations were observed in most trials, the principal one being inadequate control for nonspecific (placebo) effects. Despite claims that spinal manipulation is an effective treatment for headache, the data available to date do not support such definitive conclusions.”
It is unfortunate that the Bassett Chiropractic website lists whiplash and headaches as conditions that can be helped by chiropractors (“our chiropractors at The Bassett Chiropractic Clinics in St Albans, Hertford and Watford help people with these conditions”) despite the weakness of the evidence for chiropractic/spinal manipulation in treating these conditions. I intend to contact Bassett Chiropractic to alert them to these reviews just in case they are unaware of them and, once I have done so, I will leave them to consider whether headaches and whiplash should remain listed on their website as conditions that chiropractors at their clinics can help with.
Disclaimer: no assumptions have been made about the knowledge or intentions of Bassett Chiropractic Clinics or anyone associated with the group.