Talk:Chiropractic treatment techniques

Removal of the Earnst article "Deaths after chiropractic: a review of published cases"
Earnst has repeatedly been shown to have misrepresented data to make it appear significant and have a large effect (in the case of the article in question, and the reverse for effectiveness). View the subsequent articles posted as comments to see the exact details. The article in question has 5 critiques and 1 comment. Thus I believe that the prominent inclusion of this article fails to show NPOV. To the people who have not read the article, Earnst finds 26 deaths occurring over 76 years internationally.

If this source is to be reintroduced, it would need to be in the safety section, and would need to have some balance. I would recommend you examine the chapter "Safety and HVLA thrust techniques" from "Manipulation of the spine, thorax and pelvis; an osteopathic perspective 3rd ed" by Gibbons and Tehan for an in depth discussion on the subject.

Back to the article in question, Earnst is showing that vertebral artery dissection (VAD) is the cause of death. He implies that this occurs due to cervical manipulation, but fails to show that it can occur by other mechanisms. View Haldeman's work analyzing the cause of VAD "The 367 case reports included in this study describe 160 cases of spontaneous onset, 115 cases of onset after spinal manipulation, 58 cases associated with trivial trauma, and 37 cases caused by major trauma (3 cases were classified in two categories).", and his later work analyzing the patients who suffered VAD "Ninety two percent of cases presented with a history of head and/or neck pain and 16 (25 %) cases presented with sudden onset of new and unusual headache and neck pain often associated with other neurological symptoms that may represent a dissection in progress." Therefore, it is possible that individuals experiencing symptoms of a VAD might be motivated to visit a chiropractor for relief, and whether their neck is manipulated or not, may still suffer complications including death.

Earnst's article in question includes 10 cases from 1937-1980. Obviously, clinical warning signs, red flag complaints, and pre-manipulation screenings have improved dramatically over time. These precautionary procedures are now standard in chiropractic school, as well as in osteopathic schools that still teach manipulation technique. I am not sure if PT/MD manipulation training includes this (I am aware that some do, but the requirements are not rock solid).

Pacmann117 (talk) 20:46, 30 August 2014 (UTC)


 * It's a matter of opinion whether Ernst is right or not, but it's a very prominent RS, so we've used it. It's one of those numerous situations where following NPOV will always leave someone unhappy. We don't remove RS without extremely good reason, and his results are only disputed by chiropractors, not others. His analysis actually finds far fewer deaths than other RS which have found many more deaths related to spinal manipulation, and which have identified which professions were involved, and specifically which techniques were more risky. I think you'd find it better to just keep him, rather than also have the other RS included. Their clear statistics don't paint a good picture of chiropractic. I would love to include more, but that's the compromise with chiropractic editors which was reached and I let it lie. That prevented more edit warring, and sometimes it's just not worth the grief to fight for inclusion of some sources. Actually that content did get included here: Spinal_manipulation. -- Brangifer (talk) 22:05, 30 August 2014 (UTC)


 * I meant on this page. Does comparing to other pages count as an argument?


 * Pacmann117 (talk) 22:34, 30 August 2014 (UTC)


 * As an argument? I'm not sure what you mean. It's just information. -- Brangifer (talk) 23:02, 30 August 2014 (UTC)


 * I am not sure why you mentioned Spinal_manipulation. I understand that my previous arguments are reflected on that page. Pacmann117 (talk) 23:06, 30 August 2014 (UTC)


 * I have moved it to the end of the paragraph, since that was the context. It was not a stand alone comment, so that should help. It's just a clarification that even though that research was not included here, it was included somewhere else. -- Brangifer (talk) 23:44, 30 August 2014 (UTC)

I can see your point that it is a prominent RS, but would question why. I believe its prominent placement in many of Barrett's articles may be responsible for this. Have you read the critiques and comments here? And who else would be disputing his results other than chiropractors? The actual occurrence he suggests is explicitly stated by others in the critiques: "over the full 75-year time period of the study, we could calculate a slightly higher estimate of mortality, equal to 26 per 7.5 billion encounters"

In any case, I am suggesting that it be removed if it is not in the safety discussion. It currently is not. Deaths could be important to that section. The opening paragraph is not an appropriate place for it however. This does not have to do with it being a commonly cited RS, nor with its inclusion in the article, so please reply to this concern first.

I think it should be excluded from the opening statement at least because: 1) It is not NPOV 2) Even if it is theoretically NPOV, its prominent placement suggests otherwise. 3) It cites a sentence that has death and mortality in it. This is redundant, and overemphasises perceived risk. 4) It is outdated, and thus does not reflect current risk. (This argument is elaborated upon in my previous post) 5) It does not acknowledge or suggest that VADs might have multiple causes, or that the patients seek care for their symptoms. (cited above in my previous post)

Think of it from the average reader's perspective. If they visited antibiotics and the opening statements made references to safety concerns, death, adverse effects, and mortality rates this would set a certain non-NPOV, would it not? Most every treatment that can be named has risk, and if the risk is to be discussed, it should be in the safety discussion.

Pacmann117 (talk) 22:36, 30 August 2014 (UTC)


 * I am seeing a clear unnecessary inclusion of safety that almost seems copied and pasted into each section, but not the safety section.


 * In the opening statement "The safety of manipulation, particularly on the cervical spine has been debated.[7] Adverse results, including death, are rare, with very low mortality rates.[8][9] Chiropractors may use exercise and other treatments and advice.[5]"


 * In the interventions section: "The safety of manipulation, particularly on the cervical spine has been debated.[7] While injuries and deaths may be under-reported,[8] these are generally rare, with very low mortality rates.[9] Chiropractors may also use exercise and other conservative treatments and advice.[5]"


 * And yet again in the MSK section "While safety has been debated,[7] and serious injuries and deaths can occur and may be under-reported,[8] these are generally rare and spinal manipulation is relatively safe[13] when employed skillfully and appropriately.[9]"


 * Pacmann117 (talk) 22:50, 30 August 2014 (UTC)


 * You mention the first paragraph a couple times. That's what we call the WP:LEAD, and there are special rules for. It must consist of only duplicated material from the body of the article, so repetition is required. It doesn't have to use the exact same words, because prose and flow is also important. -- Brangifer (talk) 23:04, 30 August 2014 (UTC)


 * There are multiple issues with the WP:LEAD that I would like to discuss as well. But we have to finish the discussion about the article at hand, and where it should belong first, correct? Pacmann117 (talk) 23:13, 30 August 2014 (UTC)


 * It's been a while since I've analyzed this article. It has undergone a lot of change since I first created it! I too see some problems with the lead, but we do need to fix the body first. When we're done with that, we can start a new section to discuss the lead. -- Brangifer (talk) 23:57, 30 August 2014 (UTC)

I tend to agree that there seems to be some unnecessary duplication, and also detail, for this article. These matters are covered in depth in their respective articles, so they only need passing mention here, and less duplication. This can be fixed. Let me give it a try and then tell me what you think. We can revert and revise it accordingly, so wait with any edits until I'm done. I'll return here and let you know. Then criticize the hell out of my edits! -- Brangifer (talk) 23:57, 30 August 2014 (UTC)


 * Sounds good. Thanks for taking a look. Pacmann117 (talk) 03:07, 31 August 2014 (UTC)


 * I haven't forgotten you. Some guests arrived and I have other duties, but I'll get back to you when I can. -- Brangifer (talk) 14:20, 31 August 2014 (UTC)


 * Pacmann117, I made a series of edits which eliminated duplication and simplified sourcing. Also some copy edits. QuackGuru also made some edits. Some heading levels have changed, and sections rearranged. Take a look now. -- Brangifer (talk) 18:46, 7 September 2014 (UTC)

MUA. Why is it here?
MUA is manipulation under anesthesia. It is very uncommon, is not considered mainstream chiropractic, and is not even legal in all states. Why are statements in the WP:LEAD sourced from MUA sources. Namely, why is the statement "Typically, it is performed on patients who have failed to respond to other forms of treatment.[6]" included in this page at all? MUA is indeed a last ditch effort, and is considered to be the nuclear weapon of manipulation. I revised this statement to read: "Typically, it is performed on patients who have neck or back pain." and provided the reference here:

But also the statement "Spinal manipulation (SMT) became more popular in the 1980s.[3]" is sourced from a MUA site. And although SMT gained popularity during the late 80s it was because of the AMA suit, and subsequent inclusion of chiropractic in insurance, referrals from other professions, etc.... So I think this should added, or the 1980s reference should be removed altogether.

Pacmann117 (talk) 23:29, 30 August 2014 (UTC)

non-MSK section contains error
I previously edited the statement "The use of spinal manipulation for non-musculoskeletal is controversial. It has not been shown to be affective for asthma, headache, and anything other than low back pain. Massage is effective in adults for chronic low back pain and chronic neck pain.[14] [27] and no scientific data for idiopathic adolescent scoliosis.[28]" to "The use of spinal manipulation for non-musculoskeletal is controversial. It has not been shown to be affective for asthma, hypertension, or dysmenorrhea.[15] There is no scientific data that supports the use of SMT for idiopathic adolescent scoliosis.[28][29]"

Brangifer caught the previous typo of "affective", but rejected other changes. Namely, reinstating the errant word headaches. The article cited for evidence for or against asthma, hypertension, and menstrual issues clearly supports the use of manipulation for headaches. The MSK section on this wiki page also has 3 references to that extent and states that manipulation is effective for headaches. So I propose that headaches be removed from the non-MSK section.

Also, I think the first line should read "The use of spinal manipulation for non-musculoskeletal is controversial, and should be considered experimental." This would reflect the idea that no one knows exactly what manipulation may be effective for, and for anyone to say otherwise is irresponsible.

Pacmann117 (talk) 00:08, 31 August 2014 (UTC)

This is an article about Chiropractic treatment techniques
A list of specific chiropractic treatment techniques is missing from this article. I thought there was a section devoted to the chiropractic treatment techniques. QuackGuru ( talk ) 19:25, 7 September 2014 (UTC)


 * This is the original version when I created the article. It has changed a whole lot! They should be based on RS, without promotion. The ones which now have articles can be listed, and any others mentioned by the RS in that diff. The current See also links to the articles. You're welcome to develop such content. - Brangifer (talk) 22:31, 7 September 2014 (UTC)


 * I need sources. Here is one I found in the edit history. http://healthprofs.com/cam/content/chiropractic_treatments.html QuackGuru  ( talk ) 03:57, 8 September 2014 (UTC)


 * healthprofs.com is no longer a RS. It used to be affiliated with WebMD. Look at this diff of the first version of the article. In that version, you will find three RS for this type of information. Unfortunately two are now dead links. Here's what I could find now, and that should be good enough:
 * https://web.archive.org/web/20080406091309/http://www.amerchiro.org/pdf/PDR/H-Chiropractic%20Techniques.pdf
 * http://www.chiro.org/LINKS/FULL/CANADA/Modes_Of_Care.html
 * http://www.nbce.org/wp-content/uploads/analysis_chapter_09.pdf
 * You might want to look through the article's history and find a better version. There might be some good sources. -- Brangifer (talk) 04:46, 8 September 2014 (UTC)
 * I added all three refs but only summarised one of the refs. Someone else can expand the section or delete or comment out the two remaining unused refs. QuackGuru  ( talk ) 23:50, 8 September 2014 (UTC)

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Merged stubs
I have merged a number of low quality stubs into this article to make it easier to keep an overview and to be able to jointly assess the quality of the statements. I have left larger articles be, but suggest their merging as well. Carl Fredik  💌 📧 11:01, 5 May 2016 (UTC)
 * Involved editors are welcome to comment here:, . Carl Fredik   💌 📧 06:01, 9 May 2016 (UTC)
 * There is no consensus to merge. All articles have the potential to be expanded prior discussion were closed with consensus to maintain a stand-alone article. I am seeing a systematic bias against these subjects. I believe most techniques are quackery, but notable nonetheless the reason for an article is a sign of notability. Also User:CFCF why did you open three discussions to merge now? Should we close the discussion on the Fringe Noticeboards and move it here? Valoem   talk   contrib  13:03, 9 May 2016 (UTC)
 * I have opened one discussion — I am not aware of any other discussions? Carl Fredik   💌 📧 14:31, 9 May 2016 (UTC)
 * Haha, you mean this discussion Fringe_theories/Noticeboard?
 * Where every comment not originating from you is pro-merge? I think we have strong consensus to merge all the articles, that is before I have even been made aware of this. Carl Fredik   💌 📧 14:33, 9 May 2016 (UTC)
 * Three discussions now here, Fringe Noticeboards and now here on this talk page. Valoem   talk   contrib  15:25, 9 May 2016 (UTC)


 * What is the point in keeping an article like this Diversified technique, it is essentially made up of two chiropractic fringe references, no independent coverage. Article has been around since 2008, yet nothing reliable ever added to the article in years. This should tell you something. Yet you want to keep this? There is no evidence these articles need individual articles for themselves, the merges were entirely appropriate. It is also easier for the reader to have all this information on a single article. HealthyGirl (talk) 21:05, 9 May 2016 (UTC)

- please stop evading consensus by restoring the articles. There is sufficient support for the all-out merging of at least ones you are reverting. You are almost alone in your arguments on the fringe noticeboard page, please do not engage in further disruptive editing. Carl Fredik  💌 📧 17:46, 19 May 2016 (UTC)
 * No I am not. Do not merge unless discussion has been closed. Valoem   talk   contrib  17:50, 19 May 2016 (UTC)
 * The merges have been performed by me and other edits, please do not revert them, it results in a massive duplication of text. This later causes the articles to deviate in ways that are damaging to the encyclopedia where one is maintained and the other not. Carl Fredik   💌 📧 17:55, 19 May 2016 (UTC)
 * The articles involved are:
 * Gonstead technique
 * Koren Specific technique
 * Activator Techniques

Diversified technique attributed to wrong person
The claim that Palmer developed the Diversified technique has been added to the relevant section of this article here. This is sourced to a single popular press article, written by an unknown author that contains no references to support the claim. Ultimately, the claim is incorrect. The diversified technique was developed by a slow and steady move away from the dogmatic approaches espoused by Palmers by various early chiropractors. The current version of the non-proprietary and eclectic technique used by the majority of chiropractors today is attributed to Joe Janse, D.C. This is verified by this online article in the Journal of Chiropractic Humanities and the book Technique Systems in Chiropractic. 2001:56A:75B7:9B00:D3:7051:DE4:DD01 (talk) 04:03, 6 June 2016 (UTC)

November 7 POV
This article is heavily biased throughout. I am here to learn a few things about chiropractic care, not get brow-beat for the inquiry. There should be a place for the negative detracting perspective in a lower section labeled 'concerns'

At current there is a strong position, that is not neutral, presented from the opening words of the article and this does not seem like Wikipedia quality. thanks.

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Article is Pseudoscience and should be deleted
I don't see any reason for this information to be on Wikipedia at all. This seems to promote the fringe idea that this pseudoscientific alternative medicine practice is real and legitimate, which it is not. Miserlou (talk) 14:23, 31 August 2021 (UTC)
 * Have you got any policy based reason why it should be deleted? -Roxy the grumpy dog . wooF 14:26, 31 August 2021 (UTC)
 * Miserlou, you've been here long enough to know that we document ALL notable topics, including pseudoscience and conspiracy theories. Yes, some techniques are rooted in pseudoscience, and the entire basis of the "profession" is pseudoscientific. We document those facts. -- Valjean (talk) 14:34, 31 August 2021 (UTC)
 * When I arrived on this page, the word pseudoscience was not used anywhere. It still reads as if these are legitimate medical treatments. Related pages contain no critical warnings at all, for instance the organization cited prominently in the lede of this article: American_Chiropractic_Association is presented as if this is a legitimate medical organization, which it is not. This whole area of Wikipedia smacks of whitewashing. Miserlou (talk) 16:22, 31 August 2021 (UTC)
 * I think you really tipped your hand with this edit: https://en.wikipedia.org/w/index.php?title=Chiropractic_treatment_techniques&oldid=1041638525 - which removes the _only_ reference to this being alternative, junk medicine. This whole thing is a total violation of WP:MEDRS and now you're blatantly reverting and whitewashing in order to use Wikipedia to legitimize sham pseudoscience. I think you should desist immediately and disclose WP:MEDCOI if you're a "doctor" of this nonsense. Miserlou (talk) 17:03, 31 August 2021 (UTC)
 * My objections are procedural. This is not the chiropractic article, so you shouldn't make it a coatrack for chiroskepticism. If you have specific RS about specific techniques as pseudoscience, then you can deal with it at the right spots. That means the subject can get mentioned where it's relevant. The shotgun approach would violate RS. Use a rifle approach. Get specific.
 * I'm not a chiropractor, but am an infamous enough chiroskeptic expert on chiroquackery to have them put my picture on the front page of one of their journals, name me chiro enemy no. 1, solicit personal info about me, and threaten my children and my life. It has cost me hundreds of thousands of dollars, so I'm used to their attacks. I don't need yours too. Back the fuck off and stop the personal attacks. I am not your enemy or a friend of chiropractic. FYI, I created this list article and favor the mention of pseudoscience in the first sentence of the Chiropractic article.
 * MEDRS applies to certain aspects of this subject, but not to all aspects, and thus not to all references. FRINGE also applies here.
 * Now stop the edit warring and use this discussion page for its intended purpose, which includes the creation of new content. Float your ideas here, together with the exact wordings and refs you'd like to use, then let's see if we can get to where you'd like to go. That's how collaborative editing works. -- Valjean (talk) 17:28, 31 August 2021 (UTC)
 * @Roxy - the policy is WP:MEDRS. It is a much higher standard for medical topics than WP:RS. Miserlou (talk) 16:29, 31 August 2021 (UTC)

I have reworked the lead to bring the lack of evidence matter up to the first paragraph. I also reworked the descriptions to make it clear that "adjustments" and spinal manipulation aren't exactly the same thing. Some refs are in the lead, while other refs are in the body. -- Valjean (talk) 17:50, 31 August 2021 (UTC)

Chiropractic
Remove this article about chiropractic. This is a misleading, ignorant information. I heard bad comments about Wikipedia not being trustful. I disagreed until now, when I saw the article on chiropractic. "It is just an information", some other ignorant answered. It is misleading. Do you know how many deaths caused by opioid, and disability post surgery would be avoided if the patient had received chiropractic treatment in the first place. This is awful. 2603:9001:5800:C8AE:4CA:3CE4:613F:5F24 (talk) 22:46, 6 May 2022 (UTC)
 * Please see WP:FRINGE and WP:RS. jp×g 02:44, 13 September 2023 (UTC)

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