by Mal Vickers
Hello all, this is the first post of a two-part series on my concerns about RMIT University and chiropractic. In this first post, I’ll mention some of the recent controversies in chiropractic. In the second post, I’ll write about my visit to RMIT Open Day and my attempt to ask an expert in chiropractic some questions about its practices.
For those that might be wondering – why do this? I’m a former RMIT student. RMIT’s association with pseudoscience, in my opinion, diminishes the greater and more worthwhile subjects such as engineering, arts, humanities and science-based academic courses offered in other departments of the University.
For a quick refresher on the sceptical and historical view of chiropractic you might try the Skeptics Dictionary entry.
RMIT claims the following:
RMIT is a leader in chiropractic tertiary education offering the world’s first government-supported chiropractic program.
RMIT offers undergraduate courses or you can go all the way and receive a PhD in Chiropractic. Indeed it does appear that RMIT is the leading institution educating chiropractors in the Australian.
Is chiropractic at RMIT really worthy of government (read: tax-payer’s dollars) support? Here is a list of recent concerns about chiropractic, some of which relate to RMIT’s involvement. There are many other worthy concerns about chiropractic but this is simply my current pick.
Recent Concern #1, The RMIT Chiropractic Paediatric Clinic
RMIT has been publicly criticised for opening a Chiropractic Paediatric Clinic, along with a public call from Loretta Marron for this clinic to be shut down. You may think that this doesn’t sound like much to complain about, the reason is:
There is zero scientific evidence that chiropractic is effective for any specific childhood condition.
It might otherwise be fine if RMIT were using the clinic 100% of the time for research studies. However, this is a clinic within the university campus, offering chiropractic as treatment in exchange for a scheduled fee. RMIT claims the clinic is
staffed by registered and experienced chiropractors.
[April 2011, Letter from RMIT Chancellor Dr Ziggy Switkovski to Loretta Marron]
The UK’s 2010 Bronfort Report, which sought evidence in favour of chiropractic, stated the following:
‘In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.’
(The definition of otitis media is inflammation of the middle ear and enuresis is the inability to control urination or bedwetting).
Chiropractic treatment is not without risks, thus children are being treated with chiropractic ‘therapy’, without any conclusive evidence that the treatment being performed is effective. From a totally objective, mathematical, non-emotional risk/benefit point of view, if there’s no benefit from treatment the child only gets the risks associated with the treatment.
Recent Concern #2, The Association between Chiropractic and the Anti-Vaccination Lobby
Reported in the mainstream press in July (2011) was an article about chiropractic and the deceptively named Australian Vaccination Network (AVN).
In my opinion, vaccines a stand out as one of medical science’s greatest achievements. I can’t think of another branch of health care that has more effectively and safely reduced preventable disease and death.
Fair enough, people have the freedom to do whatever they want and associate with whomever they want, however it’s puzzling that so many chiropractors support Australia’s largest anti-vaccination group. Of the AVN’s published list of 198 professional members, 128 are chiropractors.
The NSW based Health Care Complaints Commission (HCCC) issued a public warning about the AVN.
Why so many chiropractors are associated with a group that’s promoting the anti-vaccine message, thereby undermining public health and safety, I’m not sure. Does this say something about the education standards of chiropractors?
It would be nice to hear from RMIT that a Chiropractic education included critical thinking, along with an understanding of the methods of objectively measuring health outcomes.
Recent Concern #3, Chiropractors Failure to Inform Patients of Associated Risks
In Australia, it’s an accepted principal that medical doctors inform patients of the risks associated with any treatment. Patients are entitled to be properly informed so that they can make their own choices.
In July 2011 a survey was published in the UK which tried to answer the question; how well are chiropractic patients informed? The results show that many chiropractors do not routinely inform their patients of the significant risks associated with neck manipulation.
There is published evidence that some patients have become confined to a wheelchair or have died as a result of this form of chiropractic treatment.
Whilst I’m not suggesting that Australian medical doctors flawlessly inform patients of the risks of any treatment, that doesn’t logically prevent me from asking for the same high standards from chiropractic.
Are Australian chiropractors informing patients of the significant risks associated with manipulation of the neck? Does RMIT educate its up-and-coming chiropractors to inform patients of the risks? These are questions I’ll try to have answered.
Subluxations
I’m also interested in the current understanding of chiropractic subluxation theory. The subluxation idea dates back to the founder of chiropractic in 1895 by a former grocer and magnetic healer D.D. Palmer. A subluxation is said to be a place within the body where bones impinge on the nervous system, supposedly leading to all manner of diseases. Over the years, chiropractors have suggested that one day, medical science will discover the truth about subluxations. However, despite huge advances in medical imaging techniques, the subluxation idea appears to be less likely related to anything scientific or physical.
In May 2010, the UK’s General Chiropractic Council made the following statement based on the latest scientific evidence:
The chiropractic vertebral subluxation complex 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.
[Note, this GCC quote and the link to it has been changed since this article was first posted, see the comments below]
Better Health Channel Website
The Victorian Government Health Department hosts a website informing the public of various health treatment choices. There seems to be no distinction made on this site between practices that are effective and those that aren’t.
On this site you’ll also find some extraordinary claims made about chiropractic. Put your critical thinking skills to the test? The page on chiropractic can be found here.
That’s all for now! Coming soon in part two, we’ll gain some fascinating insights from my recent visit to RMIT Open Day.
Victorian Skeptics 
Mal, as a fellow graduate of RMIT, I share your pain, and we’re not alone. Vic Skeptics has had several emails from RMIT graduates, wondering what happened to the integrity of their Alma Mater and what could be done to redress it. (The answer in my view is simple: the Bean Counters have taken over the shop and Money has replaced Science as the guiding principle – a bit like the Pharmacy Guild, really). Your investigations and article are a good start.
I’d like to draw the reader’s attention to Loretta Marron’s excellent article on page 10 of the June 2011 Skeptic magazine, where she calls for the RMIT’s Chiropractic courses to be shut down.
We’re also looking forward to Tim Mendham’s talk on “Woo Courses” at January’s Skeptics Café (See “EVENTS”). Tim assures us that while Victoria is not the only Australian state whose tertiary institutions run courses in pseudoscience, it is by far the worst offender.
Which form of chiropractic do you think is worse? Gonstead or applied kinesiology? I have (shamefully) used both in my life. The gonstead guys go nuts with the cracking where the kinesiologists don’t appear to do anything dangerous. On the other hand, the kinesiologists seem way more wacky to me.
Phillip Ebrall – Professor of Chiropractic at Central Queensland University and who I understand is involved in the RMIT Research, made some interesting statements on Ken Harveys item about Blackmores here; http://theconversation.edu.au/pharmacies-to-push-supplements-as-fries-and-coke-to-prescriptions-3578
Excellent piece. Looking forward to part 2.
Just one correction. Unfortunately, in August 2010, the UK General Chiropractic Council removed the words “or health concerns” from its statement on the Vertebral Subluxation Complex following pressure from the four UK chiropractic assocations:
Click to access Guidance_on_claims_made_for_the_chiropractic_VSC_18August10.pdf
Many thanks Mr Blue Wode :) I’ll correct the post and change the link.
Tremendous choice, Mal and I’m looking fwd to part 2.
I too have real concerns about the fundamentalist, “Mystical Chiropractors” as I call them. Some points I’ve found myself discussing in just the last week….
On August 21st, a video appeared on YouTube called “Homeopathic Evidence and Research”. Behind the camera is Simon Floreani national president of the Chiropractors’ Association of Australia. In front is Issac Golden pushing homeoprophylaxis, the Cuban hokus pokus and his own notably flawed PhD.
Without blowing ones trumpet too much this vimeo clip waxes lyrical about certain CAA chiropractors and anti-vax sentiment – plus challenges much of Goldens message.
This is a shorter version omitting the 1st third & focussing on Golden’s claims.
(http://www.youtube.com/watch?v=b44XgR6hzcg)
It’s worth noting that in the CRP’s finding that upheld Ken Harvey’s complaint against Fran Sheffield’s “homeopathic immunisation” advertisements they noted the NHMRC’s position. It in turn references the Council of the faculty of homeopathy London which strongly (and only) supports conventional vaccination. Something to think on as Golden is boasting about NHS support in the UK apropos his devotion to homeoprophylaxis.
The NHMRC position goes on to quote from the ED of Aust’ Natural Therapies Ass’n that “no qualified natural therapist would recommend homeopathic immunisation as an alternative…”.
The claims chiro’s make about vaccine risk takes on a bizarre face given that vaccine injuries pale alongside serious injuries from cervical manipulation. Eg; the World Chiropractic Alliance made much of narcolepsy from Pandermix vaccine for H1N1. Known to be genetically based it occurs at a rate of 0.003%.
Last year health insurer, Kaiser Permanente withdrew coverage for cervical manipulation citing an upper rate of 0.005%. They wrote:
“Chiropractic manipulation of the cervical spine is associated with vertebral artery dissection and stroke. The incidence is estimated at 1.3-5 events per 100,000 manipulations. Given the paucity of data related to beneficial effects of chiropractic manipulation of the cervical spine and the real potential for catastrophic adverse events, it was decided to exclude chiropractic manipulation of the cervical spine from coverage.”
In a bizarre “press release” on August 30, 2010 countering this “widespread myth” (of links to stroke) the WCA said in part:
“”In an attempt to discredit chiropractic and discourage people from seeking care from doctors of chiropractic, some proponents of allopathic medicine — and attorneys interested in filing spurious lawsuits — continue to disseminate misleading information about a supposed link between cervical adjustments and strokes.”
On a Lateline segment that aired on July 6th 2009 Simon Floreani claimed injury from CM is approx 1 in 5.8 million. Which is aroundish 60 times less than Kaiser Permanente’s most conservative risk level.
Finally, here’s the account from his wife Jennifer Floreani on managing pertussis in their baby:
“This experience did indeed test our resolve and we were forced to draw on our support network of healthcare providers. We performed chiropractic checks on our baby daily and utilised a whooping cough homeopathic. I dosed myself with an array of vitamins to boost his immunity via breast milk and kept him hydrated with constant breastfeeding.
Whooping cough is often slow to develop and may respond well to conservative management, including chiropractic, osteopathy, homeopathy, herbs, acupuncture or acupressure. Within two days, the severity of our baby’s symptoms cleared and within a two week period, each of our boys had a complete resolution of their symptoms.”
@ Paul Gallagher
Unfortunately, at the end of last year, Kaiser Permanente caved in to pressure from the chiropractic community and reinstated its coverage for neck manipulation:
http://www.ebm-first.com/chiropractic/latest-news/1867-kaiser-permanente-reinstates-coverage-for-chiropractic-neck-manipulation.html
A chiropractor employs several hands-on spinal moves, including a variety of replacement processes, to appropriately line up the musculoskeletal composition of the body system. The target is to let the body to recover without making use of medication or surgical treatment.
Hi waukesha wi chiropractors, thank you for your comment, however I think it would have been more helpful if you had more directly address the concerns raised in the post above.
Chiropractors may use those methods, but are they effective for any health conditions? How do you know you’re not simply providing a placebo therapy, wasting the time and money of your patients and possibly distracting them from more effective treatments for their ailments?
Are you also suggesting that chiropractic is a more effective treatment than surgery? If so, which conditions and what scientific evidence do you have?
The thing is, the medical association doesn’t like competition and anyone else taking their profits, this is a fact. Another one is Palmer only introduced the subluxation method as to stop getting prosecuted back in the day for practicing medicine (which it is not)
The problem is (just like the bible I believe) there are many Chiropractors who believe and interpret this differently. I for one haven’t been to one of them that believes correction of subluxation (misalignment of the spine) can fix 99% of diseases like Palmer originally said during his time on this earth, the same can be said with the vaccine issue you mentioned.
However I believe it obviously can cause issues (I myself had misaligned spine when I was younger and had all sorts of nerve problems, mostly when I’d move my head felt like it was cracking open, just pure nerves) after alignment it was fixed. And no I didn’t need to see a Chiropractor for the rest of my life either, just for a short duration till the problem was solved.
I think MOST Chiropractors think like this, the problem is (and this is a problem in every field) just because a professional has an opinion, it does NOT mean every single person in that profession is alike or agreeing in that way of thinking or opinion. The media and particularly the medical industry LOVE to jump on this anytime it is a Chiropractor that says something, one bloke says something and it must include the whole lot of Chiropractors worldwide? What happens if Chiropractors did that against the medical industry every time someone died from drug reaction that wasn’t properly acknowledged? Or a combination of drugs the patient is on that was overlooked? How many times this has happened is FAR FAR greater than any injury caused by Chiropractic, even the governments of major country’s (Australia, America, Canada and NZ just to name a few) INDEPENDANT government studies found Chiropractic to be safe AND effective. And this wasn’t a bias study to from EITHER which are the ONLY ones you can trust.
Also that rumor about neck manipulation causing issues “such as possible stroke” was later debunked as they found people having the same issues for turning their head when reversing the car, some people are prone to it (very little mind you and it is why the number is so small, it is to do with the positioning of the artery to the brain when that movement occurs, it ruptures or becomes blocked by a clot), you simply cannot blame Chiropractic for that at all when it has been replicated in just everyday life events.
I got to admit after I read that I was a bit offput, but what are you going to do, never turn your head over your shoulder again at fear of having a stroke etc? If we banned neck manipulation due to that we might as well ban all anti inflammatories , antibiotics and a whole lot of other medication, stop looking over our shoulders and hell why not wear a neck brace so we can only look forward? While we are at it, lets live in a plastic bubble.
There ARE clinical studies out there that prove chiropractic is safe and effective for certain conditions and there are many, but the thing that is ruining the reputation is a few, not the majority as I mentioned above this is in every profession, if you want to close a profession down due to that,there would be no professions left, in any industry.
Hi Ozboke33, that’s a fairly generic name you have there.
You say: ‘…the medical association doesn’t like competition and anyone else taking their profits, this is a fact.’
If this is fact then I’m sure you can supply very good evidence – please do.
You say: ‘…was later debunked as they found people having the same issues for turning their head when reversing the car’.
Evidence please? A link to the paper perhaps – that would be nice.
I agree that the association between stroke and a chiropractic treatment is not strong and that it’s a rare event. However the adverse reaction data for chiropractic treatment in Australia isn’t being collected – I fail to see how people can be so definitive, based on no data.
Where is the risk/benefit equation in all this? It might be worth pointing to the clear evidence of benefit. If there is no benefit, the risk, no matter if it is very small, just the loss of time and money, it’s not worth it.
You say: ‘There ARE clinical studies out there that prove chiropractic is safe and effective for certain conditions and there are many…’
Exactly which health conditions? Please name them. You may not have noticed, this is the website of a skeptical organisation, is not good enough to just assert things, you need to provide evidence. Being skeptical means that you tend to doubt assertions. Evidence please? Links to the scientific papers showing the results of rigorously conducted clinical trials please?
Obviously more research needs to be done but it doesn’t look like your correct in claiming there’s no evidence of a benefit to neck manipulations.
This is a systemic review of 3 randomized control trials
Conclusion:
“Cervical spine manipulation and mobilization probably provide at least short-term benefits for some patients with neck pain and headaches. Although the complication rate of manipulation is small, the potential for adverse outcomes must be considered because of the possibility of permanent impairment or death.”
http://journals.lww.com/spinejournal/Abstract/1996/08010/Manipulation_and_Mobilization_of_the_Cervical.7.aspx
Hi malvickers,
Well the AMA got sued for this very reason. Do a search if you do not believe me for slandering the Chiropractic profession without cause and making up false accusations and just outright lying about just about everything to stop the competition. This was decades ago. The reputation has been on the recovery ever since.
Neck manipulation has NEVER been proven to be caused by Chiropractic. If you did actual research instead of writing this blog then anyone that argues with you then ask them for facts? Take the easy way out why don’t you. This is more like a gossip column than anything factual I’ve found that you have written here.
Instead how about doing some fact finding for yourself? The risk is so little it is in line with how many people already suffer from vertebral dissections WITHOUT chiropractic. You can get it from lifting your hands over your head to work on something above you, turning your neck to look behind you, the list goes on.
The fact is if you are a candidate at risk this will happen regardless. Chiropractic may trigger it but so would any of the above situations. This has been found in each investigation. Again do your research.
Chiropractic is beneficial for a lot of courses, (do a pubmed search) some have weaker evidence than others but there are studies there, just need more, this will happen in time as even the medical industry started somewhere (remember when they used to put leechers on people way back in the day?) The chiropractic industry just doesn’t have unlimited resources like the drug companies do to do randomized double blind clinical studies on HUGE numbers which cost a damn lot (a lot more than you think) to push through their findings.
There is one thing I agree on though with what you have said, if RMIT are pushing non evidenced based practices they should re-think this. CQU have a top of the line course that really strive on pure evidence based practices. It is most likely why the course is so damn hard. It is a full Bachelor of Science with you majoring in Chiropractic. It is done different than other universities which they pride themselves on and you do finish with a higher degree than any other university in Australia for Chiropractic.
I’m a huge fan of evidenced based practices so you will not EVER hear me say (or write) something unless there is proof out there backing this up.
Also for the risk / benefit right here. Have you even seen the studies on pain killers for headache? Do you know what the risks are? They are HUGE. Taking ibuprofen increases stroke risk later in life ALSO increases heart attack chance? This is just a prime example. If you don’t believe me it is right here.
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm
Panadol also, increases heart attack risk, high doses cardiovascular failure and new research shows that taking while being pregnant before 100% thought to be safe, now puts the baby at risk (high risk) for ADHD.
Aspirin, (just like Ibuprofen) stomach and intestinal bleeding, increases risk of macular degeneration due to the overly good blood thinning properties, also increase to stroke and risk of ulcers..
These are all at the recommended (accepted when stated otherwise) dosage.
Doctors kill 2,450% more than gun related deaths for surgery and pharmaceuticals.
PLEASE get your facts straight when you target a profession. When people look at the FACTS and the alternative it is WHY Chiropractic is so popular and on the rise each year. Because it works and is safe, especially when compared to the alternative.
PS I am a HUGE fan of critical thinking, I have sought out the good AND the bad on Chiropractic (also with medical which I am a huge fan of in certain scenarios also and have high respect for them) so I 100% am not biased in any way shape or form.
So many of my friends and colleagues are MD’s, DC’s and they all get alone, refer to each other, as long as you are not some whack job (which is easy to see and avoid in ANY profession) promoting things that are completely unrealistic, you will get along just fine.
Dear scoopriot,
>…but it doesn’t look like your correct in claiming there’s no evidence of a benefit to neck manipulations.
Please re-read my post, I was suggesting that the risk of neck manipulation was significant, worth considering and that chiropractors should warn patients of the risks before they undergo the procedure.
This systematic review you quote is 19 years old. Other better quality, systematic reviews have been published since then. I’m unable to locate the full text of the review online. As such I don’t know and I can’t see the quality of the studies used in this review.
No I won’t be dropping my concern about this procedure based on your hard to find 19 YO systematic review.
Would you be willing to consider this notification from 62 Canadian neurologists published eight years after the review you quote?
http://www.chirobase.org/15News/neurol.html
“The public must be made aware that the neurological damage that can result subsequent to upper neck manipulation can be debilitating and fatal.”
Even the 19 YO review you quote says that there may be “short term benefits” but you are risking “…the possibility of permanent impairment or death.”
This is good news for chiropractic manipulation of the neck? Seriously?
Dear Ozbloke34 (not your real name I imagine), you are free to use the legal system as much as you wish. That’s quite a ‘gish gallop’ you’ve put together. If you have a look back at my last reply to you I asked you to support many of the wild assertions you made, a simple link to the evidence would do. You’ve instead chosen to make more assertions, more completely unfounded ones I’m guessing. Ozbloke = internet troll.
Malvickers, here is some research for you which took a grand total of 6 seconds to find on google. You might want to look into google one day…
Lumbar pain
A meta-analysis reports that treatments with spinal manipulation (chiropractic adjustments) are more efficient than comparable treatments for cases of lower back pain:
Anderson, R., Meeker, W. C., Wirick, B. E., Mootz, R. D., Kirk, D. H., and Adams, A. A meta-analysis of clinical trials of spinal manipulation. J Manipulative Physiol Ther 1992;15(3):181-194.
Systematic reviews of the literature show that treatment with spinal manipulation (chiropractic adjustments) is as effective as, if not more effective than, conventional medical treatments (anti-inflammatory, analgesic), rest, massage or physiotherapy in relieving acute or chronic lower back pain:
Bronfort, G., Haas, M., Evans, R. L., and Bouter, L. M. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J 2004;4(3):335-356.
Van Tulder, M. W., Koes, B. W., and Bouter, L. M. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine 9-15-1997;22(18):2128-2156.
A randomized double-blind clinical trial demonstrates that chiropractic adjustments are superior to muscle relaxants for relief of lower back pain:
Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., and Verzosa, G. T. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther. 2004;27(6):388-398.
Sciatic pain
A recent cohort study showed that patients with acute lower back pain accompanied by sciatic nerve pain returned to work faster when treated with chiropractic than when they received conventional medical treatments:
Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. J Manipulative Physiol Ther. 2007 Feb;30(2):135-9.
A randomized double-blind clinical trial demonstrated the effectiveness of chiropractic adjustments in patients suffering from acute lower back pain and sciatica caused by a disc protrusion:
Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr;6(2):131-7.
Headache (cephalgia)
Systematic reviews of the literature report that not only is manipulation of the cervical vertebrae (chiropractic adjustments) effective in the treatment of migraines and headaches of cervical origin in the short and long terms, but these treatments are also safe and associated with few serious side effects:
Cassidy, J.D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F.L., and Bondy, S.J. Risk of vertebrobasilar stroke and chiropractic care : results of a population-based case-control and case-crossover study. Spine 2008;33(4S):S-176-S183.
Bronfort, G., Nilsson, N., Haas, M., Evans, R., Goldsmith, C. H., Assendelft, W. J., and Bouter, L. M. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004;(3).
Vernon, H., McDermaid, C. S., and Hagino, C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med 1999;7(3):142-155.
Shekelle, P. G. and Coulter, I. Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel. J Spinal Disord 1997;10(3):223-228.
Cervical pain
Systematic reviews of the literature report that manipulation of the cervical vertebrae (chiropractic adjustments) provides relief from cervical pain, and that this type of treatment is superior to conventional medical treatment:
Bronfort, G., Nilsson, N., Haas, M., Evans, R., Goldsmith, C. H., Assendelft, W. J., and Bouter, L. M. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004;(3).
Shekelle, P. G. and Coulter, I. Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel. J Spinal Disord 1997;10(3):223-228.
Recent randomized clinical trials support the use of spinal manipulation (chiropractic adjustments) in the treatment of acute and chronic neck pain, reducing both pain and functional disability:
Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007 Apr;87(4):431-40.
González-Iglesias J, Fernández-de-las-Peñas C, Cleland JA, Gutiérrez-Vega Mdel R. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009 Jan;39 (1):20-7.
Palmgren PJ, Sandström PJ, Lundqvist FJ, Heikkilä H. Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain. J Manipulative Physiol Ther. 2006 Feb;29(2):100-6.