Research and Science in Chiropractic:
By understanding where we have been, we can better know who we are today and prepare for a better future tomorrow.
This page is dedicated to information about research and science for the first one hundred years of the chiropractic profession.
What was chiropractic research and science like in the first one hundred years?
Research and science in the first decades of the chiropractic profession
In the first 50 years of the chiropractic profession, there was a variety of meanings for the terms "research" and "science." Similar to popular conceptions at that time, "science" was perceived to be a static body of knowledge. In the early 1900s, research methods were still developing. The acquisition of new knowledge slowly developed to include experimental methodology that increasingly took hold in biology and medicine in the twentieth century. Within early chiropractic publications, clinical data were not collected or described in sufficient detail to permit replication. Results were over-interpreted and some claimed their findings were indisputable proof of a priori assumptions about chiropractic effectiveness. A few chiropractors recognized the need for better understanding of the scientific method and sought reform from within. However, in the early decades of chiropractic, the colleges were unwilling or unable to introduce coursework in research methods. At the end of World War II, the broad-scope national association of chiropractors in the United States established a nonprofit foundation for the purpose of raising funds for chiropractic research and education. Unfortunately, research plans were poorly conceived and intended goals were unobtainable. When those efforts failed and the possibility of establishing free-standing research centers collapsed, they tried to shift responsibility for research back to the chiropractic colleges. However, the chiropractic colleges lacked the infrastructure to implement experimental research. Decades would pass before succeful research efforts and clinical quantitative studies would become evident in chiropractic.
"Research" and "science" in the first half of the chiropractic century. J C Keating Jr, B N Green, C D Johnson. Journal of Manipulative and Physiological Therapeutics. 1995;18(6):357-78. https://pubmed.ncbi.nlm.nih.gov/7595110/
Development of Research and Science in the Chiropractic Profession
"By the late 1950s, chiropractors continued to increase in numbers and chiropractic continued to gain a foothold in healthcare. At this time, the AMA organized a focused effort in an attempt to eliminate the chiropractic profession through various programs. One included a public propaganda campaign declaring that chiropractors were quacks. The AMA continued its campaign against the chiropractic profession eventually leading to the Wilk et al v AMA et al trial, which was filed in 1976. In 1980, the AMA revised its Principles of Medical Ethics, which allowed medical doctors to collaborate with chiropractors, thus opening the way to interprofessional working relationships. However, many medical providers and the public did not know about this decision.
The final results of the trial were the judge’s decision in 1987 to have the AMA clarify to its members and other components that organized medicine controlled (e.g., hospitals) could work with doctors of chiropractic if they wished. A notice was publicized in the AMA’s journal about the decision of the trial, which helped to clarify that it was permissible for doctors of chiropractic to work in medical environments. It was not until 1990, when the trial decision was upheld by a higher court, that the trial was considered complete. This tension between organized medicine and chiropractic may help to explain some of the reasons why the public was uncertain about chiropractors, why doctors of chiropractic were not previously allowed to work in medical settings such as hospitals, and why chiropractic services were not previously included in some reimbursements (e.g., Medicare). Although these early battles have resolved, chiropractic associations in the US continue to fight legal battles for parity so that chiropractors may better serve the public.Because chiropractic developed and existed outside the medical and university systems for so long, inclusion in mainstream research and science was still embryonic up to the 1990s. Early efforts to evaluate spinal manipulation, which is one of the primary therapeutic modalities of the chiropractic profession, resulted in a Workshop Held at the National Institutes of Health in 1975. The resulting monograph from this conference was one of the first interdisciplinary attempts to better understand the biomechanics and principles behind chiropractic treatments. Afterward, there were greater efforts to increase research in this area, which later included research from chiropractic institutions. Following the National Institute for Neurological Diseases and Stroke (NINDS) conference was a surge of research interest in chiropractic both external and internal to the profession. Efforts to increase scientific literature included the establishment of the Journal of Manipulative and Physiological Therapeutics in 1978, which was later indexed in Medline. Since that time, various studies have been done on the practice of chiropractic and on the modalities that chiropractors use in practice, such as spinal manipulation.
Current, modern theories and research in the chiropractic profession focus on a variety of topics including developments in biomechanics, neurological mechanisms, pain and function, and biopsychosocial factors related to health. Research is ongoing to better understand the doctor patient relationship and how chiropractic treatment affects overall health and wellbeing. Chiropractors are now considered to be more included in mainstream healthcare."
The Chiropractic Profession. Johnson, C. D. & Green, B. N. (2020). The Chiropractic Profession. In I. Himelfarb, J. K. Hyland, & N. E. Ouzts (Eds.), Practice Analysis of Chiropractic 2020 (pp. 15-16). Greeley, CO: NBCE.