The University of Pittsburgh announced earlier this spring that it would begin conferring Doctor of Chiropractic degrees through its School of Health and Rehabilitation Sciences. Pitt faculty have framed the move as a way to holistically address a common ailment that can be life-altering: back pain.
“Our Doctor of Chiropractic curriculum will be congruent with the basic and clinical science curricula of other health care degrees offered at Pitt,” Michael Schneider, the program’s director, tells Pittsburgh City Paper via email. “Course content will be based upon the best established and emerging evidence found in peer-reviewed orthopedic, physical therapy, chiropractic and other musculoskeletal scientific journals.”
Chiropractic has an interesting history — founded by Canadian American D.D. Palmer at the end of the 1800s, the discipline allegedly originated from a séance and was originally bound up with other alternative healing practices such as magnetic therapy. Palmer was also vehemently opposed to vaccines and thought spinal adjustments could cure a wide variety of ailments beyond musculoskeletal issues.
Schneider says most of Palmer’s beliefs and practices have been consigned to the dustbin of history.
“There have been significant advances over the past 125 years,” Schneider says. “The chiropractic profession has improved the level of its education, has produced a substantial body of clinical research, and has moved from being ‘alternative’ to ‘integrative.’”
The latter difference is more than semantic: 10 years ago, the National Institutes of Health (NIH) renamed the National Center for Complementary and Alternative Medicine to the National Center for Complementary and Integrative Health in a formal acknowledgment that traditional and alternative medicine can complement more mainstream (or “allopathic”) care. In the case of chiropractic, the NIH sees room for the integration of chiropractic alongside orthopedic medicine and physical therapy.
Richard McGough, a Pitt professor and chief of the university’s Division of Musculoskeletal Oncology, says this is because back pain remains a stubborn problem that affects most people at some point in their lives.
“Much of what we do causes harm (surgery for back pain alone is wretched, we all remember the oxycontin epidemic…) or simply does not work,” McGough tells City Paper via email. (Other requests for comment to local orthopedists went unanswered.) “We are left with having patients stretch their backs, strengthen their core muscles, or go to PT (which is VERY expensive).”
McGough says though he’s not personally aware of data bearing out the efficacy of chiropractic treatment, he supports patients incorporating it into their healthcare regimen if desired. “When we in medicine have essentially nothing that works, trying anything safe may be of benefit. So for patients with back pain, I’m fine with chiropractic adjustments if patients want them,” he says. He adds that yoga and pilates can also be beneficial for back-pain sufferers.
Schneider says that chiropractic isn’t a “silver bullet” but notes the way treatment of back pain has shifted. The American College of Physicians, for example, “recommends non-pharmacological interventions as the first line management approach” for spinal issues.
While studies have found that spinal manipulation can cause adverse effects, some of this may be down to individual practitioners and their specializations. Chiropractic adjustments can range from gentle manipulation of specific sites to power-assisted adjustment of the full spinal column on specialized “drop tables.”
Schneider says Pitt’s program will emphasize safety and patient outcomes. “Our curriculum will include an emphasis on public health, patient safety, and the importance of weighing the benefits and risks of all interventions, both chiropractic and medical,” he says. “There will be very few differences between the chiropractic and medical approaches to the clinical management of spine and musculoskeletal conditions, as they will be presented in our curriculum,” he says.
In spite of the historical differences between allopathic medicine and chiropractic, Schneider says the program has broad buy-in from Pitt medical faculty — “several department chairs from the School of Medicine provided written letters of support” — and likewise has the backing of the Veterans Administration Pittsburgh Healthcare System (VAPHS). VAPHS, like other health systems, has seen steady growth in demand for chiropractic and needs more providers to meet demand.
As the industry expands, Schneider is keen to emphasize that chiropractic offers an alternative and complement to problematic pills and invasive operations.
“More serious adverse events [from chiropractic adjustments] are extremely rare,” he tells CP. “Many patients with non-serious low back and musculoskeletal pain choose chiropractic care because the benefits outweigh the risks.”