It seems to have come as news to some, but the Vertebral Subluxation Complex (VSC) has been regarded as a historical concept by the BCA and the chiropractic academic institutions for many years. When I was at the AECC 1989 -93 I was taught it as such.
I’ve reproduced the response from the BCA below regarding the GCC statement but there are some who think that the GCC or the BCA rejecting this concept is the death knell for chiropractic. Everyone is entitled to their opinion and I respect those who are willing to put their name to one. I just happen to think the opposite. Not rejecting it would be.
I have been looking into the situation in Denmark, where chiropractors are covered by the health service and have “cultural authority” as specialists in the non-surgical management of spinal healthcare. Patients with back pain can access a chiropractor directly, without requirement for referral from their GP.
How did they get there? Well, they took many important and sometimes very difficult steps. One of the first was that in 1992 the president of the Danish Chiropractic Association (DKF) made a public statement that they were rejecting all historical concepts (subluxation) associated with chiropractic and that chiropractors in Denmark treated musculoskeletal conditions. (Btw, if anyone can get that statement, I would love to see it).
This followed, by accounts I have heard, an extremely emotional SGM where many were making the same arguments as we are hearing now, that without subluxation chiropractic has no identity etc, etc Well, at that SGM they voted to become a profession that treated musculoskeletal problems.
Their identity doesn’t seem to have suffered too much.
I’ll blog later on what other steps they took in Denmark, and how we could learn from them. But for now I’ll reproduce the definition on chiropractic from their association website:
“A chiropractor is a licensed health care professional dealing with investigation, diagnosis, prevention and treatment of pain conditions and reduced function of the musculoskeletal system.”
“BCA Statement on Vertebral Subluxation Complex
The BCA welcomes today’s statement from the General Chiropractic Council (GCC) on Vertebral Subluxation Complex, which appears here http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf
As a responsible organisation, the BCA understands the need to ensure that the public is properly informed about the evidence base for chiropractic treatment so that it is able to make informed choices about the care it receives. For many years, the BCA has not supported the concept of the Vertebral Subluxation Complex in the light of the absence of evidence supporting claims made it can be the cause of disease and serious illness. It also notes that no provider of UK undergraduate chiropractic education teaches Vertebral Subluxation Complex theory in the context of modern healthcare delivery.
The BCA supports and encourages the inclusion of chiropractic in mainstream healthcare provision in the UK. To facilitate the integration of chiropractic, unsubstantiated historical concepts and ambiguous terminology must be discarded in favour of an emphasis on delivering an evidence-based care model that is easily understood by other members of the healthcare team.
The BCA reminds members of their obligations under the GCC Code of Practice and Standard of Proficiency. In ensuring compliance, they should refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access. This advice has no bearing on scope of practice, which is not defined in the Chiropractors Act, but all chiropractors are required to adopt the practice of a reasonable and competent chiropractor.
Chiropractors are the leaders in non-surgical spinal healthcare. There is strong evidence to support the inclusion of chiropractic in musculoskeletal healthcare initiatives, most recently contained in the NICE Guidelines http://guidance.nice.org.uk/CG88 Chiropractors have specific expertise in the assessment, treatment and management of spinal and joint pain syndromes, and are well placed to deliver cost-effective services within the mainstream UK healthcare framework.
Notes to the above statement:
The issue from which this advice stems is that a member of the public has requested information from the GCC about its view on the strength of the research evidence supporting the contention that the VSC is the cause of disease, many health conditions and in some cases, premature death.
The enquiry was made in the context that outcome 4(a) in the current version of the GCC’s Criteria for Recognition of Degrees in Chiropractic, requires that students must “understand the history, theory and principles of chiropractic in a contemporary context” is accompanied by guidance that includes reference to “vertebral subluxation-centred models”.
/Continued….
-2-
The GCC’s Education Committee sought observations on the following from the three recognised UK providers of undergraduate chiropractic degree programmes (AECC, MCC and WIOC): -
- How the chiropractic vertebral subluxation complex is covered in the detailed curriculum; and
- What relevant research they draw from.
The detailed responses from each of the institutions can be read in the paper which was considered by the GCC at its meeting on 12 May 2010
http://www.gcc-uk.org/files/page_file/C-120510-11.pdf
The GCC’s Education Committee provided the following advice to the GCC which it accepted at its meeting on 12 May 2010 : -
- The chiropractic vertebral subluxation complex is taught only as an historical concept.
- There is no clinical research base to support the belief that it is the cause of disease or health concerns.
The GCC did consult all of the professional associations and the College of Chiropractors prior to its meeting, and has had further dialogue with representatives at the end of last week. This guidance relates to marketing materials and websites and is not an attempt to define the scope of chiropractic practice.
The GCC’s Guidance is as follows:-
The chiropractic Vertebral Subluxation Concept is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns. Chiropractors are reminded that they must make sure their own beliefs and values do not prejudice the patient’s care – GCC Code of Practice Section 8.3. They must provide evidence based care which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners including the individual chiropractor her/himself – GCC Standard of Proficiency Section A2.3 and the Glossary refer. Any advertised claims for chiropractic care must be based only on best research of the highest standard – GCC Guidance on Advertising – issued March 2010 refers.
Any members referring to the VSC on their websites, are recommended to review the context of the wording used as a matter of urgency to ensure compliance with the GCC’s Code of Practice and Standard of Proficiency and thus prevent the possibility of a complaint being made to the GCC about the use of the terminology.
Please contact BCA Head Office if you require any clarification.
Richard Brown DC, LL.M, FCC, FBCA, FEAC
President, British Chiropractic Association 24th May 2010″
Hi Richard,
I think you had a differenet outlook on your training than many of those who trianed with you. It’s probably a pity you hadn’t the grades to be an orthopaedic surgeon and rather like many of those in the BCA executive (rather than its membership) that have decided that chiropractic is something different.
The Danes also decided not to fight the Nazis in WW2 perhaps the brits should have taken their lead there too?
BTW loved the fact that when I got to the bottom of this page there was an ad for a physical therapist.
Perhaps you should retrain and try and fight for xray rights.
By: Paul on May 26, 2010
at 5:23 pm
PS isn’t it a shame to see your Alma Mater begin the process of merger with the British School of Osteopathy…
By: Paul on May 26, 2010
at 5:43 pm
Subluxation is just a word a name for “spinal joint dysfunction” and their is a theory behind it well articulated by Meridel Gaterman.
Rejecting a word is hardly going to spell the end of chiropractic. Its what you embrace instead of it a biomedical model which will cause the problems internationally.
This was tried in the US and Canada in the 90s National Association of Chiropractic Medicine and the Orthopractors in Canada never took off. Because they were just “deskilled” medical doctors and not a good basis to build a reputation on. If what Richard Brown et al were offering was so good for the profession it would have happened years ago.
They could never win the debate so they get the GCC and the skeptics to do it for them. I can tell you Simon Singh is having a good laugh about this.
It will be interesting to see what happens but I would bet my mortage that in ten years time registered chiropractors in the UK will be like the Osteopaths in the states and not conforming to international standards of chiropractic education. If thats what you want fair enough its not for me.
By: Richard Lanigan on May 26, 2010
at 6:06 pm
Hi Again,
When you were at AECC they never mention anything about “Subluxation” in a historical sense or other. What calss was that in then. You see the Eddie Izzard skit as a reflection of chiropractic I see someone who does not understand chiropractic. http://www.chiropracticlive.com/?p=39
The Danes also cover chiropractic care for Colic which hardly fits with Alan Jordons theory of chiropractic. The Danes dont get so hung up on chiropractic lexicon as the the Brits and Americans if they were to “Reject” it it might become an issue. What Alan think of the Orthopractic movement in Canada.
By: Richard Lanigan on May 26, 2010
at 6:24 pm
Hi Richard L (someone had compained that they can’t tell which one of us is posting, I hope you like Richard L.)
I was taught that the idea that a “subluxation” could have important implications on health other than local spinal pain/dysfunction had been rejected. We were told to use the term “fixation” which excluded those implications.
There were a couple of tutors who still subscribed to to “subluxation theory”, and the concept was debated, and there were some contemporaries who bought into it, but it certainly was not taught as what chiropractic was still based around from an AECC perspective.
The Danes cover chiropractors to treat colic because they gained the health services trust. How did they do that?
By: Richard Hollis on May 27, 2010
at 8:18 am
“The Danes cover chiropractors to treat colic because they gained the health services trust. How did they do that?”
Possibly becuse they stuck to what they were qualified for and did well?
By: Paul on May 27, 2010
at 8:59 am
Hi Paul
Indeed. Alhough I suspect you and I may have a different idea of what that means. Here’s how how the Danes were first introduced into the health service.
The Danish Institute for Health Technology Assessment (DIHTA) issued guidelines to be implemented in 1991-2 for their health service.
Under the section “The chiropractor in the primary health care sector,” the scope of chiropractic practice is delineated: “diagnosis, treatment and prevention of biomechanical functional lesions for patients suffering from low back pain.” The Danish guidelines stratified their recommendations into three areas:
“* treatment that can be generally recommended
* treatment methods that can be recommended in certain conditions
* treatment that cannot be recommended:
Under “treatments which can generally be recommended,” manual therapy (which includes chiropractic) is the first listed. It is cited as having “moderate costs” with the following recommendations:
* Manual treatment can be recommended for patients suffering from acute low back symptoms and functional limitations of more than 2-3 days duration.
* Manual treatment can be recommended as an initial treatment for acute exacerbations of recurrent or chronic low back pain and functional limitation.
* Manual treatment can be considered as an element of a broader strategy for chronic low back trouble.
* Manual treatment can be considered as an element of a conservative treatment regime in patients suffering from nerve root irritation, taking into account the previously mentioned contradictions.
The only other generally recommended treatments were: back school; ergonomics; McKenzie exercise therapy; exercise therapy; and pain relieving medication.”
Trust was gained by Danish chiropractors proving themselves to be able to provide effective evidence based care within these guidelines. Things have moved on hugely for them since then, and now not only can they treat colic, but all the best research on colic, asthma, migraines etc comes from Denmark. Btw there are 3 studies underway currently on colic at Odense.
The truth is, I don’t care about colic one bit. Does it even make up 1% of chiropractic practice in this country? I doubt it. What we should be concentrating is what makes up 90-95% of practice in this country and for which there is now better evidence than ever that our approach is effective.
By: Richard Hollis on May 27, 2010
at 9:32 am
Hi Richard,
I have made some comments to the points Paul raised on chiropractic live which you might like to comment on.
Probably the most high profile chiropractor in Denmark is Ole Wessung and he is not a member of the association because of the clinic number allocation system. Because of that his patients dont get funding from the state and they still want Ole, he does not even have a web site.
Ole generated much more awareness of chiropractic in Denmark than the association did in the 90s or the stuff you are quoting from because he was good and charismatic, are you seriously suggesting Richard Brown and his plethora of evidence could do the same for chiropractic in the UK??
Tell me one senior chiropractic tutor who was a “subluxation chiropractor” at AECC when you were there, or even used the term in clinic. Tell me one tutor who talked about the neurological effects of the “fixation”. This was not taught at AECC it was ignored brushed under the carpet. Your position on subluxation is based on the Chuck Gibson version and if that is all I had, I would choose Alan Jordan version any day.
Same as rehab, you were not taught that either now its all the rage, the currency to buy this “Cultural authority” the BCAs new buzz word ( I have banned its use on my blog).
You know who told Proff Kliger that an understanding of rehab is important and got him to put £10,000 towards a rehab gym in the college. Me not the people who claim all this expertise now. You know thats what I did before I studied chiropractic, I was probably the leading person in that field in Denmark in the 80s.
I studied chiropractic to advance what I did, I want to be part of a progressive profession. I know we have something special to offer the public. The problem arises when guys like Richard Brown and Alan Jordan believe the future is providing a similar service to what I was offering with Ole in the 80s and then they have the nerve to say, I am living in the past and subluxation theory has no place in chiropractic. What is the public to think of statements like that, from guys who have never studied subluxation theory.
Do the Tedd Carrick course or study Meridel Gattermans book, then you will know which approiach is dated.
As Richard Brown is singing the GCCs praises, do you know if he approves their waste of resources on private investigators to keep me under surveillance The Information Commisioners office has forced them GCC to divulge what they found, it appears they even bugged my phones.My MP is not happy, I am a private citizen after all.
Richard how did a nice guy like you take up with these kind of people.
By: Richard Lanigan on May 27, 2010
at 2:20 pm
Hi Richard H
You have expalined well how the Danes snuck themselves into government reimbursement, hiding away the true nautre of the chiropractic profession.
Richard H – what is it you think you are qualified for? Simple Low Back Pain management?
As a chiropractor my main intention is to remove interference from the nervous system and to improve its functions carrying communications from the inner and outer environments of the human body to its innate intelligence so that it (innate intelligence) can continue to regulate the processes of homeostasis and salutogenesis to their highest degree.
Although the alleviation of spinal pain as attained as a result of improved function of the spinal cord cover, it is not the primary focus of my care and attention but a secondary or side effect of that care.
As a whole my patients are healthier and more alive.
Richard H you state that evidence for colic and asthma that comes from Denmark – how is it the BCA and GCC deny this evidence as a basis for care yet the Danes do not?
By: Paul on May 27, 2010
at 4:27 pm
CORRECTED SPELLING (-:
Hi Richard H
You have explained well how the Danes snuck themselves into government reimbursement, hiding away the true nature of the chiropractic profession.
What is it you think you are qualified for? Simple Low Back Pain management?
As a chiropractor my main intent is to remove interference from the nervous system and to improve its function; carrying communications from the inner and outer environments of the human body to its innate intelligence so that it (innate intelligence) can continue to regulate the processes of homeostasis and salutogenesis to its highest degree.
Although alleviation of spinal pain is attained as a result of improved function of the spinal cord cover, it is not the primary focus of my care and attention but a secondary or side effect of that care.
As a whole my patients are healthier and more alive.
Richard H you state that evidence for colic and asthma that comes from Denmark – how is it the BCA and GCC deny this evidence as a basis for care yet the Danes do not?
By: Paul on May 27, 2010
at 4:31 pm
For now I will just reproduce my posting (spelling mistakes, ahem, corrected I hope) on Richard L’s blog. I’ll answer some of the other points raised tomorrow, time allowing.
“Hi Richard, thanks for suggesting I post on comments about me on your blog.
Paul, I did not put the link up, rather it appeared automatically as I mentioned this blog on my posting (I imagine because this is a “wordpress” blog like mine)as I was commenting on opinions different to mine, and this blog was a good place to show them. I’m all for people having opinions.
Richard L and I were contempories at college, although he was a couple of years below me, despite appearances
We got on due to a love of football, laughing at everything including ourselves and the fact that he fancied my housemate. Oh, and I stopped him getting into fights with opposing managers at the college football matches with a linesmans flag. Sometimes it’s best not to give your opinion!
Richard, I did learn about VSC in “Chiropractic Philosophy” with Jennie Zee. You might remember I was a supporter of yours in getting Reggie Gold in. As you know, I also hate censorship and want to hear everyones opinion and love hearing something controversal.
Surely you can give me enough credit to know I am able to make my own mind up. I have worked with Alan for 6 years, but with a few others over 17 years in practice too. I have heard Dan Murphy speak, attended a couple of Carrick seminars (only introductory, admittedly) but not heard Gatterman although I would like to. I have only read excerpts from her book but you’re right, I should read it all.
The way we differ, is that although I of course know that spinal joint dysfunction has neurological consequences, I have not been convinced that it has a effect on health in any other way but to the spine.
I like to think myself open minded, rather than prejudiced, so can be persuaded. I just haven’t been.”
By: Richard Hollis on May 27, 2010
at 4:31 pm
Who on earth is Jennie Zee? Never heard of her she obviously was not much of a teacher or a looker. Sure that was not someone you picked up in Alkatraz?
You will never hear me say Alan Jordan is wrong to practice the way he does. This is the problem when I have colleagues criticising the way I practice and for all they know I am very good at it. This is what damages the profession lack of respect for colleagues. I respect anyone who helps other its when they use underhanded methods to win arguments I object.
Your views on Subluxation practice (and many others)were “prejudiced” understandingly by your Chuck Gibson experience . I dont go in for all that bullshit. I have a lecture to students about health recently and with my Health Promotion hat on I would say there is a need for a profession like ours to mpromote health. I started off asking what the most important requirement for good health was and they had not really thought about it.
It was clean water, because if you remove it the person will die in about 7 days. Then its food, then its haveing relationships with people, then its physical activity and thats the part we could come in. If we as a profession focus on people in pain we are marginalising ourselfes from the majority of symptom free people who may become unhealthy without help. This is the way public health is moving to demedicalise health and get rid of the influence of the pharmceuticle industry. The osteopaths are way ahead of us in this country as chiropractors eat their young.
Bye the way you were a bloody good Lino or assistant referee as they are now called. Where have the years gone that was 17 years ago.
You did look good in a suit has to be said.
By: Richard Lanigan on May 27, 2010
at 6:42 pm
Richard L – would have to disagree about the most important requirement for health.
Clean water is all very good but if your nervous sytem is not able to communicate with the rest of the body you effectively become an organ bank…
You gave feed as much clean water, good food, and talk to a body as much as you like, you can even move it around but if its isn’t alive nor functioning through its nervous system none of the aforementioned elements will make much of an impact.
By: Paul on May 27, 2010
at 6:57 pm
Richard L, I was not so much “prejudiced” about subluxation after the CG experience as appalled at the depths some will go to to make money. It certainly kept me awake worrying about the way the profession seemed to be heading and who was influencing chiropractors in the UK. Heres a link to Jennifer Zea
http://www.wellnesspossibilities.com/Wellness-Provider-Information.aspx/Dr.%20Jennifer%20%20Zea_384
I think she left after my 2nd year, if so, before your time. We had 1 hour a week (whoa!) of chiropractic philosophy, if I remember rightly (and I’ll admit, it’s all v hazy after 21 years), which was not examined. Not the best attended class as a result.
All this AECC talk has brought back some funny memories. I’ve just remembered your face the first time I revealed my extensive repertoire of Irish rebel songs. I’m still a republican monarchist in case you’re asking.
Paul. I sense you are belittling a desire to help people with spinal pain. Maybe I’m dull, but I’m happy to specialise in helping people with sometimes complex, worrying and very painful problems. That is the primary focus of my care.
Of course a reduction in pain and improved mobility will have the happy consequence of improving their health and quality of life. I also will of course advise on any other lifestyle and health issues that crop up.
As I said, the Danish health service trust chiropractors. As I understand it, following some new evidence in the 1990′s midwives were permitted to refer to chiropractors for colic. Since then better evidence has come out that chiropractic is ineffective.
As it stands that doesn’t mean that chiropractors can’t treat colic in Denmark or the UK, but do need to give a proper explanation regarding the state of the evidence (eg not good, but some anecdotal reports of improvement and might be worth a try would seem reasonable) and get consent on that basis from a parent first. What you can’t do in the UK is advertise that treatment. But you knew that, right?
I’d like to stop talking about colic now. As I said before, it surely can’t account for even 1% of practice in the UK.
The Bronfort report showed that 90% of chiropractic practice in the UK was supported by good evidence. This compares very favourably to medicine, who our friend Ben Goldacre says, is supported by good evidence in 40-80% of treatments given, depending on the field. I think we should all be talking, no shouting, about that!
By: Richard Hollis on May 28, 2010
at 3:26 pm
Richard H
I am sorry you think I am belittling a desire to help people with spinal pain – not at all nor do I think for any reason you are dull. I do apologise for being disrespectful at the beginning of this discourse.
If I am in pain the first person I present to is a colleague. Why shouldn’t it be your primary focus of care?
Some of my best friends are pain practitioners and to tell you the truth they are very very good at providing a service to people who as you say have sometimes complex, worrying and very painful problems
I think it is great to be able to have discourse with someone willing to debate the other side of the coin without necessarily denying the otherside or ridge of that same coin.
Pain reduction is absolutely valid and backed by a whole host of study and as a choice within the chiropractic profession – why the hell not. My problem comes when pain practitioners have not the same respect for the whole spectrum of practice within the profession of chiropractic and deny that it is both valid and historically the root of our profession.
This is the point for most of the chiropractic profession. Why you should you pain practitioners seek to validate yourselves and define the profession through your limited scope when there is a fuller spectrum of benefit to be had?
An improved neural function and adaptation to internal and external stimuli: improved growth and development, improved immune response, improved digestion, improved elimination, improved locomotion, improved sports performance, improved academic performance – an improved and unlimited life potential and experience within the confines of the physical abilities bestowed through genetic capacity.
Personally I would love to see colic as the major presentation of children and infants to my practice. This would ensure chiropractic became a parental choice for alternate health information and courses of treatment other than drugs and surgery.
This is how medicine indoctrinates parents toward choices of a better life for their children through vaccination, drugs and surgery.
And I would practice for free if I could.
Chiropractic would give something of a better life potential and experience for their children something every parent wants but often lacks the information to provide.
In regard to evidence I am not sure it’s the best route to go to denounce another opinion via the ‘you have no evidence so why should we’ argument although it might be valid to point out incongruency and adverse long term consequences.
By: Paul on May 28, 2010
at 8:26 pm
Hi Richard,
Have got in touch with Jenny Zee, interesting view on the history in the UK. Was Johannes Breun in your year he is on the bench for Denmark and comes on when players get injured.
I have asked a question on the blog http://www.chiropracticlive.com/?p=743 and was wondering what you thought.
Most of those blogs on your blogroll dont keep their blogs up to date.
By: Richard Lanigan on June 19, 2010
at 8:12 pm