It is the position of the World Chiropractic Alliance that chiropractic care to detect and correct vertebral subluxations offers benefits for all people, including those who do not demonstrate symptoms of a disease or health condition. Therefore, the presence of symptoms and/or a medical diagnosis should not be a factor in determining the need for or appropriateness of chiropractic adjustments, nor should the presence of symptoms be required by any chiropractic board, insurance company or court of law to justify the rendering of chiropractic care to any patient.
This position is based on the long-standing precept of chiropractic that “vertebral subluxation may be asymptomatic, yet still exert various physiological effects,” as stated in the Council on Chiropractic Practice “Clinical Practice Guideline Number 1, Vertebral Subluxation in Chiropractic Practice.”(1)
Further, the Association of Chiropractic Colleges’ Position Paper No. 1, endorsed by all chiropractic colleges in the U.S. and Canada and virtually every chiropractic organization in the world, states: “The practice of chiropractic includes: establishing a diagnosis; facilitating neurological and biomechanical integrity through appropriate chiropractic case management, and; promoting health” (section 3.0, The Chiropractic Paradigm).
The paper goes on to state: “Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation; A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health; A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.” (Section 4.0, The Subluxation).
Nowhere does this defining document state or imply that chiropractic is to be used only for symptomatic patients.
The use of health care procedures on asymptomatic patients is commonplace in all medical and alternative care fields, both as a preventive measure and in recognition of the fact many health conditions do not exhibit outward signs, particularly in their early stages.
The American Heart Association, for instance, calls hypertension the “silent killer” since it shows few, if any, symptoms. Yet, hypertensive patients who are currently asymptomatic are commonly urged to seek health care advice or treatment before it can lead to other cardiovascular diseases such as stroke, heart attacks and congestive heart failure. These same hypertensive yet asymptomatic people are given prescriptions for ACE inhibitors, Beta blockers, central agonists, calcium channel blockers and an ever-growing array of drugs.
The percentage of people with impaired neurological function or organic damage who do not exhibit symptoms may be staggeringly high. Using MRI technology, one study of 98 asymptomatic people found that only 36% had normal discs at all levels, 52% had a minor disc herniation at each level and 27% had a significant disc herniation.(2) In another, this time of 67 individuals who had never had low back pain or radicular pain, MRI showed that disc hernias were present in 20% of those under 60 years of age and 36% in the over-60 year old group.(3)
Dentists also routinely provide a wide range of dental procedures to asymptomatic patients, from x-ray examinations to filling cavities. While, in their early stages, cavities are usually “invisible” and cause no outward physical symptoms, their detection and correction is imperative to prevent more extensive tooth and gum damage.
Identical thinking must be applied to the practice of chiropractic, where regular examinations and adjustments are essential for the correction of subluxations which can lead to or cause neurological dysfunction.
The need for chiropractic care by asymptomatic patients is one that has been widely supported by the chiropractic profession. It is estimated, based on the findings of an expert panel of seven chiropractic researchers, that 97% of the chiropractic profession provides chiropractic services to asymptomatic patients if subluxations are present.(4)
Finally, given all the evidence clearly supporting the role of chiropractic in establishing health and wellness in asymptomatic patients, it is the position of the World Chiropractic Alliance that state, provincial and national chiropractic licensing and governing boards be prohibited from requiring doctors of chiropractic to limit their practices to symptomatic patients, or from censuring any D.C. for providing subluxation-correction services to asymptomatic patients.
1) “Clinical Practice Guideline Number 1, Vertebral Subluxation in Chiropractic Practice,” Council on Chiropractic Practice, 1998, p 4.
2) Jenson MC, Brant ZM, Obuchowski N, Modic MT, Malaksian D, Ross JS: “Magnetic resonance imaging of the lumbar spine in people without back pain.” New England Journal of Medicine, 1994; 331: 69-73
3) Boden SC, Davis DO, Dina TS, Patronas NJ, Wiesel SW: “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects.” Bone joint Surg [Am] 1990; 72: 403-408.
4) “A Consensus Approach to Subluxation Based Chiropractic: Phase 1 Questionnaire Results,” Christopher Kent, D.C., Patrick Gentempo, Jr., D.C., John Grostic, D.C., Ian Grassam, D.C., R. James Gregg, D.C., John A. Hofmann, D.C., and Robert J. Hoffman, D.C., CRJ, Volume 3 – Number 1, 1994.