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“Some chiropractors employ manipulation in the same way physical therapists, M.D.s and D.O.s do – as a physical therapy for patients with back or neck pain who have been conventionally diagnosed and found to be appropriate candidates for this therapy. However, chiropractors also use the term “spinal manipulation” as a synonym for “spinal adjustment” which, in their unique vocabulary, is a treatment for the ubiquitous and nonexistent subluxation. Only chiropractors use the term in this manner because only chiropractors believe the chiropractic version of the subluxation exists…Not surprisingly, chiropractors cannot agree on a definition for their subluxation, how to diagnose one, or its clinical significance. They can’t even agree on a name for it – it’s variously called the vertebral subluxation complex, manipulable lesion, spinal lesion, joint dysfunction, and so on. Nor can they agree on its role in chiropractic – large and unremitting intramural battles have been fought over the subject. Nevertheless, chiropractors daily tell patients that they are suffering from subluxations which must be corrected at the risk of ill health. Again, one means of correction is the chiropractic “adjustment,” which chiropractors also refer to as “manipulation.” If chiropractors are this confused, then one can well understand how the writers and editors of NCCAM’s [National Center for Complementary and Alternative Medicine] website could be confused, but it’s time to set the record straight. The correction of subluxations via a spinal adjustment/manipulation is not the same as the use of spinal manipulation by physical therapists and other health care providers as a means of alleviating back or neck pain. While it is true that a chiropractor might “find” a subluxation and claim it is the cause of a patient’s pain, this is not a legitimate diagnostic method nor is its correction via an adjustment/manipulation a legitimate therapy for the patient’s pain. NCCAM does its readers a real disservice in failing to explain this critical difference. As it stands, readers may be left with the incorrect assumption that a chiropractor’s use of adjustments/manipulations to correct subluxations is a useful therapy for neck or back pain. This is especially important because some chiropractors have intentionally tried to exploit the efficacy of manipulation for back pain as proof that chiropractic “works.” They have also falsely claimed that they are more proficient at, and safer in performing, spinal manipulation than other practitioners, to the point of trying to use the political process to prohibit physical therapists from employing manipulation.” Jann Bellamy, Science Based Medicine (26th July 2012)