- Research article
- Open Access
The “subluxation” issue: an analysis of chiropractic clinic websites
Archives of Physiotherapy volume 9, Article number: 11 (2019)
Vertebral subluxation theories are controversial in chiropractic. Divisions are evident in the chiropractic community among those who align their practices to subluxation theories and those who do not. This study investigated how many clinics offering chiropractic in the Canadian province of Alberta promote a theory of subluxation, which health ailments or improvements were linked to subluxation, and whether the subluxation discourse was used to promote chiropractic for particular demographics.
Using the search engine on the Canadian Chiropractic Associations’ website, we made a list of all clinics in Alberta. We then used Google searches to obtain a URL for each clinic with a website, totalling 324 URLs for 369 clinics. We then searched on each website for “subluxation” and performed content analysis on the related content.
One hundred twenty-one clinics’ websites (33%) presented a theory of vertebral subluxation. The health ailments and improvements discussed in relation to subluxation were wide-ranging. An observed trend was the marketing of chiropractic for children, which was observed on 29 clinic websites (8%).
Based on the controversy surrounding vertebral subluxation, the substantial number of clinic websites aligning their practice with vertebral subluxation should cause concern for regulatory bodies.
The concept of vertebral subluxation – also called chiropractic subluxation or the vertebral subluxation complex – remains controversial, even within the chiropractic community [1,2,3,4,5]. The theory of vertebral subluxation, originally posited by D.D. Palmer at the turn of the century, has played a central role in the development of the practice of chiropractic [1, 5]. However, a considerable amount of research and commentary – often produced by the chiropractic community – has highlighted that there is no science to support the concept of vertebral subluxation [1,2,3,4, 6]. The concept is scientifically implausible, and there is no evidence to support the idea that it is associated with any ailment or the promotion of general health [1,2,3,4,5]. As such, in some jurisdictions, chiropractic organizations have taken a stand against vertebral subluxation. In 2010, for example, the General Chiropractic council in the UK stated, “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” . Similarly, in 2015, various international bodies, including chiropractic schools, put forward a position statement that declared “the teaching of vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historical context is therefore inappropriate and unnecessary” . The Alberta College and Association of Chiropractor’s 2008 position statement on the “Definition of Subluxation” makes no reference to vertebral subluxation but states that “the ACAC acknowledges and understands that the definition of a chiropractic subluxation may be ‘different from the current medical definition, in which subluxation is a significant structural displacement, and therefore visible on static imaging studies’” .
Indeed, divisions are evident among chiropractors over the role of subluxation and its related health problems [1, 5, 10]. The chiropractic community differs greatly in how subluxations are to be defined, and there currently exists no “gold standard” in the detection of subluxation [3, 11]. Furthermore, research has shown that in chiropractic education and training confusion exists among chiropractic students regarding the role subluxations play in chiropractic and whether these understandings of subluxation align with or contrast with an evidence-based approach [12, 13].
Despite the emerging consensus about the lack of science to support the subluxation theory, many chiropractors continue to embrace subluxation and offer services to patients based on its existence [1, 5]. The objective of this study was to examine the use of “subluxation” on the websites of Alberta health clinics offering chiropractic services. We examined how often the unscientific concept is promoted and used to market chiropractic services. We also sought to analyze the discourse surrounding vertebral subluxation, such as whether it was linked to specific medical conditions and used in marketing chiropractic services to particular demographics, including children.
We used the Canadian Chiropractic Associations’ website  to obtain a list of health clinics offering chiropractic in the province of Alberta. On the 4th and 5th of January 2018, we used the “Find a chiro” search engine available on the website and recorded all clinics listed when searching for “Alberta”. This list totaled 493 clinics. We then searched for each of the 493 clinics using Google in order to match the clinic with a URL. In total we found a URL for 369 of the 493 clinics. These 369 clinics had a total of 324 URLs. This was because some clinics had multiple locations, or fell under an umbrella company, which shared the same URL. The two largest of these cases included one URL for 19 different clinics , and one URL for seven clinics .
We the inputted the formula: subluxation site: [clinic URL] into the Google Chrome search engine to capture all cases where “subluxation” appeared on the website. In cases where more than 10 page links appeared on a URL, we opened only the first 10 appearing on the search results. We then asked the following questions regarding the use of the “subluxation” content:
Is a theory of subluxation described (brought up and/or discussed in a health-related context)? If so, how is subluxation described?
Are health problems or general health improvements (use as a prevention or “wellness” strategy, increased energy, etc.) linked to “subluxation” (including: spine subluxation, vertebral subluxation, subluxation complex)?
Is “subluxation” theory critiqued (i.e. discredited, described as outdated or problematic, etc.)?
Is “subluxation” mentioned on the website in an alternative manner from that already coded?
Are any particular demographics focused on when discussing subluxation?
While coding, we observed some discourse that appeared to working towards creating anxiety or fear in (potential) clients. Due to its subjective nature, discourse of this sort was not formally quantified but some examples were captured and included in the results in order to highlight the presence of this problematic marketing.
To ensure validity, in all cases where “subluxation” appeared on a website, a screen shot of the discourse was taken with the clinic’s URL appearing in the URL bar at the top of the Google Chrome browser. In cases where subluxation appeared numerous times on the same page, we took a screen shot of each use. After our analysis, a researcher external to the project assessed all coding with respect to question #1. Any discrepancies were rechecked by the original coder.
Theory of vertebral subluxation
Of the 369 clinics, 159 (43%) had websites containing the word “subluxation”, and 121 clinics’ websites (33%) present a theory of vertebral subluxation. That is, subluxation was described as a misalignment in the spine causing interference between the brain and body, and/or as having an impact on the nervous system or organ system functioning, and/or as affecting overall health or optimal health. Examples of these uses are displayed in Table 1. One additional website presented the vertebral subluxation theory but solely in the context of pets. Sixteen clinic websites (4%) mention “subluxation” in a variety of manners but do not clearly posit a theory of chiropractic vertebral subluxation.
Health problems or health improvements linked to subluxation
A wide range of health problems or general health improvements were linked to vertebral subluxation and are displayed in Table 2. It was not our objective to quantify the presence of each health topic. The health problems and improvements mentioned are extensive, including serious diseases and potential organ malfunction, a wide-range of child specific health problems such as ADHD, bed-wetting, and colic, and a range of other issues such as stomach and digestive problems, asthma, allergies, ear infections and blood pressure. In addition to the commonly expressed health issue of “nerve interference” (also called “nerve irritation” or “impaired nerve functioning”, etc.), other issues were raised such as “spinal decay” or “spinal degeneration”. It was also common for websites to state that uncorrected subluxations prevent a body from functioning “optimally”, and that a suboptimal body state will struggle to heal itself.
Critiques of subluxation
There was only one website which outlined a somewhat critical perspective of subluxation. The text on this website, under the heading “Information for MDs” and the subheading “Education” read: “CMCC is Canada’s only English-speaking chiropractic college; it teaches an evidence-based medicine paradigm, as opposed to the traditional vertebral subluxation model sometimes taught in the United States” .
Other mentions of “subluxation”
A total of 20 websites (5%) included the use “subluxation” in an alternative context. These included “subluxation” as the name of journal, a heading or subheading for a link, the name of a machine, the name of a process in a clinic (“the subluxation station”), or as part of a glossary.
A notable trend evident in the discourse was the marketing of subluxation for children. In total, there were 29 clinic websites (8%) marketing chiropractic for children (including newborns, infants, toddlers, etc.) when discussing subluxation. Table 2 presents the subluxation-related health issues for children, and Table 3 provides examples of the marketing for children.
Fear-creating rhetoric in the subluxation discourse
There were three additional trends present in the subluxation discourse on the websites, which could be seen as an attempt to leverage fear. The first were numerous cases where subluxations were presented as asymptomatic (e.g. “Some subluxations may seem to cause no obvious symptoms”; “Pain and symptoms are a bad way to judge if you have subluxations or not”; “Individuals who are not currently experiencing pain or other discomfort are not necessarily ‘subluxation free’” etc.). The second included cases where subluxations were reportedly caused, or potentially caused by: concussions; whiplash (e.g. in car accidents); traumatic “physical causes” including “trauma to the body, repetitive motions affecting the spine, bad postural habits, improper workstation habits and design, and weak or imbalanced spinal musculature”; “Chemical causes” including “poor dietary and nutritional practices, drug and alcohol use and abuse, and the ingestion of chemical toxins in the foods we eat, air we breathe, and water we drink”; “emotional causes” such as stress or “stress management skills”, etc. These types of discourse were often coupled with the notion that only chiropractors are able to identify and correct subluxations and that regular checkups should take place. Lastly, the third trend were cases where subluxations were explicitly described as fatal, a “threat” or as “detrimental to health.” See Table 4 for examples:
Our analysis shows that the marketing of chiropractic services on the basis of vertebral subluxation is undertaken by nearly a third of clinics in Alberta that have a working website. Considering that we could not find a URL for more than 120 websites, it is likely that additional clinics in the province align their practices with notions of vertebral subluxation. At least in Alberta, vertebral subluxation is adopted by a significant number of clinics. This is not a fringe issue. Rather, it appears central to the practice of a substantial number of clinics.
The health ailments and/or health improvements linked to the vertebral subluxation discourse on the websites are wide-ranging (see Table 2). While quantifying the presence of these subluxation-related health topics fell outside of the scope of this study, a lack of consistency across the clinics was observed. For example, some clinics associate subluxation with diseases like prostate cancer, MS or Parkinson’s disease, others with pregnancy and fetus development, and others with stomach issues, autism, ADD/ADHD or hormonal imbalances. Not all of the clinics’ websites include the marketing of chiropractic for newborns, infants and children, but some do.
Overall, this analysis provides insight into the degree to which chiropractic services are science-based, and raises interesting questions about regulation. Currently, chiropractic is a self-regulated profession in Canada. If the profession claims to be science-based, self-regulating chiropractic colleges should consider whether it is appropriate to discuss subluxation in an unscientific manner on their websites. Conversely, if these colleges have no issue with the kinds of subluxation-related discourse presented here, they should make official statements declaring this position – at which point legislators could consider what this means in the context of health policy and self-regulation. In the Alberta College and Association of Chiropractor’s 2008 position statement “Definition of Subluxation”, it reads, “The ACAC regulates the chiropractic profession in Alberta under the Health Professions Act. The ACAC is dedicated to regulating the chiropractic profession in a manner that supports quality care and upholds public trust; as well as furthering awareness and understanding of the benefits of chiropractic care” . To what degree does the discourse presented here align or contrast with this statement? For example, Canadian paediatricians have raised concerns about the marketing of chiropractic to children , and The Canadian Pediatric Society states that “parents should be made aware that there is a lack of substantiated evidence for the theory of subluxated vertebrae as the causality for illness in children” . This study identified 29 clinics marketing chiropractic for children solely in the context of subluxation discourse.
An extensive amount of research has highlighted the problematic marketing claims by chiropractic clinics from numerous perspectives [42, 43]. Some research has even raised the issue of appealing to fear in the context of chiropractic . This study found rhetoric that would support those concerns, including discourse about potentially dangerous subluxations, which are potentially asymptomatic, and which may be caused by accidents, “poor dietary and nutritional practices”, “sitting”, “toxins” and/or “stress”. Furthermore, targeting parents with young children, in the process of having children, having recently been in an accident or suffering from a concussion, would certainly seem to be working contrary to the ACAC’s mandate of “regulating the chiropractic profession in a manner that supports quality care and upholds public trust” . It is hoped that regulatory bodies will recognize these types of discourse as problematic and will act accordingly.
There were clinics in the province for which no URL could be found using the Google search engine. It is possible that the clinics without URLs present and/or align themselves to a perspective of vertebral subluxations differing from the trends we observed in our study. This study only examined the representations on clinic websites. We don’t know what information patients are provided at the relevant clinics. Also, this study identified 29 clinics marketing chiropractic for children solely in the context of subluxation discourse. It is possible that more clinics are marketing – and perhaps aggressively marketing – chiropractic for children.
Based on the controversy surrounding vertebral subluxation, the substantial number of clinic websites in Alberta aligning their practice with vertebral subluxation should receive attention from relevant regulatory bodies. Corresponding regulatory bodies should act accordingly to determine which actions should be taken to clarify the numerous issues raised in this study.
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Kaptchuk TJ, Eisenberg DM. Chiropractic: origins, controversies, and contributions. Arch Intern Med. 1998;158(20):2215–24.
Homola S. Subluxation Theory: A Belief System That Continues to Define the Practice of Chiropractic. Science-Based Medicine. 2011. https://sciencebasedmedicine.org/subluxation-theory-a-belief-system-that-continues-to-define-the-practice-of-chiropractic/ . Accessed 27 July 2018. Archived at: http://www.webcitation.org/71EQvUwCb
Keating JC, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF. Subluxation: dogma or science? Chiropr Osteopat. 2005 Dec;13(1):17.
Homola S. Real orthopaedic subluxations versus imaginary chiropractic subluxations. Focus Altern Complement Ther. 2010 Dec 1;15(4):284–7. https://doi.org/10.1111/j.2042-7166.2010.01053.x.
Simpson JK. The five eras of chiropractic & the future of chiropractic as seen through the eyes of a participant observer. Chiropr Man Therap. 2012 Dec;20(1):1.
Mirtz TA, Morgan L, Wyatt LH, Greene L. An epidemiological examination of the subluxation construct using Hill's criteria of causation. Chiropr Osteopat 2009 Dec;17(1):13.
Council GC: Guidance on claims made for the chiropractic vertebral subluxation complex. https://www.chirobase.org/08Legal/gcc_guidance_2010(2).pdf . Accessed 27 2018. Archived at: http://www.webcitation.org/71EVQv8wj
The European - South African - Australian Education Collaboration. Clinical and Professional Chiropractic Education: a Position Statement. https://chiropracticuk.co.uk/wpcontent/uploads/2016/04/12._Edu_position_statement_19-10-15.pdf . . Archived at: http://www.webcitation.org/71ESpMIRo
Alberta College and Association of Chiropractors: Position Statement: Definition of Subluxation. http://albertachiro.com/wp-content/uploads/docs/2011/10/Position-Statement-Definition-of-Subluxation.pdf. Accessed 27 2018. Archived at: http://www.webcitation.org/71ETMUUU2
Villanueva-Russell Y. Caught in the crosshairs: identity and cultural authority within chiropractic. Soc Sci Med. 2011;72(11):1826–37.
Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF. How can chiropractic become a respected mainstream profession? The example of podiatry. Chiropr Osteopat. 2008;16(1):10.
Gliedt JA, Hawk C, Anderson M, Ahmad K, Bunn D, Cambron J, Gleberzon B, Hart J, Kizhakkeveettil A, Perle SM, Ramcharan M. Chiropractic identity, role and future: a survey of north American chiropractic students. Chiropr Man Therap. 2015;23(1):4.
Mirtz TA, Perle SM. The prevalence of the term subluxation in north American English-language doctor of chiropractic programs. Chiropr Man Therap. 2011;19(1):14.
Canadian Chiropractic Association. Association chiropratique canadienne: Homepage. https://www.chiropractic.ca/. . Archived at: http://www.webcitation.org/71KOg8DR9
Optimum Wellness Centres: Homepage. https://www.optimumwellnesscentres.com/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KPEAJOG
Momentum Chiropractic and Wellness: Homepage https://momentumchiro.ca/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KPWHEvn
Revelation Health Centre: 5 FAQ’s about subluxations: Calgary chiropractor answers all. http://revhc.ca/subluxations-frequently-asked-questions/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KRFowrT
Byrne Health Chiropractic and Wellness Centre: What are subluxations? https://www.actionchiro.ca/info/subluxations . Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KRML49e
Full Motion Health and Pain Management: What are nerve interferences? https://www.fullmotionhealth.com/info/subluxations. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KRQsmFg
Froment Chiropractic Centre: About chiropractic. http://www.fromentchiropractic.com/about-froment-chiropractic/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KRZrApd
Temple Chiropractic and Massage: October 2016 Newsletter. http://www.templechiro.com/uploads/october_2016_newsletter.pdf. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KRf4e5A
Lloydminster Chiropractic Centre Midwest Physiotherapy: Dr. Kevin McEachern – Chiropractor. http://www.lloydminsterchiropracticcentre.com/dr-kevin-mceachern-dc/. Accessed 31 July 2018 Archived at: http://www.webcitation.org/71KRj1oa4
Optimum Wellness Centres: What is a subluxation?. https://www.optimumwellnesscentres.com/what-is-a-subluxation/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KRohsZU
Noji Family Chirorpractic and Wellness Centre: Lethbridge chiropractor/ Dr. Benjamin Noji. https://www.nojichiropractic.com/meet-dr-benjamin-noji/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KRvrw79
A-Associated Chiropractic & Acupuncture. ND. The benefits of chiropractic. https://www.reddeerbackandneck.com/the-benefits-of-chiropractic-care . Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KS2FFuv
Calgary Spine and Sport: Chiropractic News: Subluxation and heart disease learn the truth! Tell the truth!. https://www.calgaryspineandsport.com/blog/chiropractic-news/2015/03/23/subluxation-and-heart-disease-learn-the-truth-tell-the-truth/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KS7Y67Y
North Edmonton Chiropractic Clinic: The chiropractic hypothesis. http://www.northedmontonchiropractic.ca/community-content/chiropractic-hypothesis.html. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KSCBPur
Able Body Health Clinic: Introduction to chiropractic in Canada. http://www.ablebody.ca/physician-information/introduction-to-chiropractic-in-canada/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KUODMKz
Harper Chiropractic Health Care: Birth Trauma. http://www.harperchiro.ca/health-issue.php?name=birth-trauma. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KUbvmwp
Chiropractic Centre for Health: Dealing with a colicky baby. https://www.myspinedocs.com/colicky-baby/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KUkYACe
Marda Loop Family Chiropractic: How do infants become subluxated? http://www.livelifewell.ca/how-do-infants-become-subluxated/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KUzw4Er
Marda Loop Family Chiropractic. Attention deficit hyperactivity disorder. http://www.livelifewell.ca/attention-deficit-hyperactivity-disorder/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KV8lbIc
Dr.Forrester.ca: Chiropractic care for infants and children. http://www.drforrester.ca/children.html. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KVH5BkV
Calgary Spine and Sport: How can a subluxation affect a child? https://www.calgaryspineandsport.com/experts/24.html. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KVP3J0y
Adapt Chiropractic. 2017. Gentle pediatric care. https://www.goadaptchiro.com/pediatrics. Unavailable to archive.
Revelation Health Centre: 25 fun factoids on chiropractic care & health as a whole. http://revhc.ca/25-fun-chiropractic-care-health-factoids/. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KWF79K8
Dr.Forrester.ca: Chiropractic care for an easier pregnancy and safer birth. http://www.drforrester.ca/pregnancy.html. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KWNVH0d
Pure Health Chiropractic: Subluxations “The Silent Killer”. https://www.purehealthchiro.com/blog/46727-subluxations-the-silent-killer. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KWVhMW5
SpineGuys.com: Auto injuries. http://www.spineguys.com/health_conditions/autoinjuries.asp. Accessed 31 July 2018. Archived at: http://www.webcitation.org/71KWkaoXH
Kirkey S. Pediatricians alarmed by chiropractic treatments for babies that ‘border on the fraudlent’. The National Post. 2018. https://nationalpost.com/health/pediatricians-alarmed-by-chiropractic-treatments-for-babies-that-border-on-the-fraudulent. Accessed 27 July 2018. Archived at: http://www.webcitation.org/71ETlwkvf
Spigelblatt L. Chiropractic care for children: controversies and issues. Paediatr Child Health. 2002 Feb;7(2):85–9.
Murdoch B, Carr S, Caulfield T. Selling falsehoods? A cross-sectional study of Canadian naturopathy, homeopathy, chiropractic and acupuncture clinic website claims relating to allergy and asthma. BMJ Open. 2016;6(12):e014028.
Shelley J, Clark M, Caulfield T. The face of chiropractic: evidence-based? Focus Altern Complement Ther. 2015;20(1):13–22. https://doi.org/10.1111/fct.12151.
Simpson JK. Appeal to fear in health care: appropriate or inappropriate? Chiropr Man Therap. 2017 Dec;25(1):27.
The authors thank Morgan Barber for assisting in intercoder reliability, as well as Robyn Hyde-Lay and Candice Kozak for administrative support.
The authors declare that they have no competing interests.
This work was supported by funding from the Canadian Institute of Health Research, Alberta Innovates-Health Solutions, and the Women and Children’s Health Research Institute, University of Alberta.
Ethics approval and consent to participate
Consent for publication
Not applicable. There are no details on individuals reported in the manuscript. All quotes are taken from webpages accessible by any member of the public. No images are contained in the manuscript.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
About this article
Cite this article
Marcon, A.R., Murdoch, B. & Caulfield, T. The “subluxation” issue: an analysis of chiropractic clinic websites. Arch Physiother 9, 11 (2019). https://doi.org/10.1186/s40945-019-0064-5