By Narda Robinson, DO, DVM You, a small animal general practitioner in Toronto with a penchant for both integrative medicine and science-based practice, have just taken a job in a multidoctor practice. You have been hired to continue the integrative medicine service previously staffed by a veterinarian inclined to practice anything and everything holistic. While you have a completed program in medical acupuncture and use it routinely, you are curious about other approaches and would like to expand your integrative medicine repertoire. Cautiously, you investigate which modalities the previous practitioner offered so you can determine the next steps for continuing your integrative medicine education. A brief review of her records leaves you concerned, as you find that the treatments offered at the clinic included homeopathy, glandular therapy, hair analysis for nutrient prescribing, auric cleansing, iridology and animal chiropractic. Recognizing the lack of safety and effectiveness data for small animals for any of the first five aforementioned approaches, you think more seriously about pursuing training in animal “adjusting,” otherwise known as animal chiropractic. Because it’s important to know how the treatments you perform work along with how well they work and whether they are safe, you click on your favorite online research databases and begin looking. And looking. Mechanisms When you tried to find scientifically based information on the mechanisms of action with the search terms “chiropractic” and “spinal manipulative therapy (SMT),” you find yourself surprisingly empty-handed. While most chiropractic training programs spend a substantial percentage of course time on the central nervous system and primary afferent nerve endings and mechanoreceptors, just how the thrust of SMT applied to the body impacts the nervous system “remains unclear”1 and “not known.”2 While it may be true that SMT influences signaling from primary afferent neurons to the motor control system and pain processing centers, experimental work in this area still has far to go. The more you search, the more you wonder, “Where’s the research?”—reminiscent of the 1980s fast-food commercial that asked, “Where’s the beef?”3 Effectiveness Next, you investigate whether, in fact, chiropractic manipulation or SMT in general actually works on animals. That is, even if no one actually knows what it does, maybe it would be helpful to be able to reassure clients and colleagues (as well as yourself) that adjusting will help your patients even if you can’t explain how the changes are taking place beyond mechanoreceptor activation. You start with canine chiropractic. Were you able to find any rigorous, scientifically based clinical trials demonstrating effectiveness for neck or back pain? No. How about data for any clinical condition in dogs? None. Your search finds not one clinical study showing that canine chiropractic is beneficial. While you were able to locate studies that used cats as experimental models, none have been done on awake cats with naturally occurring disease. This, then, begs the question whether chiropractic would help or hurt for conditions such as back pain and intervertebral disc disease. Further questions pop up. What would happen if chiropractic was used on an animal with back pain that turned out to stem from neoplasia of the spine? Would an adjustment pose a risk of spinal cord injury? How many cases of back pain would therefore need a radio-graph before treatment? It’s just not known. Safety Gradually, memories of past news events in Toronto seep to the surface. You recall reports in the local paper about deaths of patients from stroke after chiropractic neck manipulation.4 You remember the literature searches you performed on upper cervical thrusting and the information your read about how chiropractic manipulative thrusting can injure arteries in the neck, leading to problems such as dissecting hematoma of the vessel wall. The more exploring you do, the more you find. You also speak with human neurosurgeons in your bicycling club who treated patients with manipulation-induced stroke, strongly reminiscent of reports readily available online.5-8 You speak with chiropractors, who point to papers promoted by chiropractic groups that disputed this association. 9,10 Next Steps? You now start to wonder whether chiropractic is the next “right” course for you in terms of continuing education and technical skills development. If the benefits of chiropractic haven’t been validated by clinical research in small animals, and if other modalities carry less risk, why not stick to the latter? You then find yourself contemplating a statement you read recently that referred to chiropractic in a veterinary journal: “Often there is no precedent for these new therapies in animals, and the onus rests with the veterinary community to educate itself to provide best care for patients and clients and to establish evidence-informed best practice.”11 You tend to agree. While others may feel comfortable practicing modalities with the potential for harm without validation studies, that’s not your style. And that’s OK. References Pickar JG and Bolton PS. Spinal manipulative therapy and somatosensory activation. Journal of Electromyography and Kinesiology. 2012; 22:785-794. Pickar JG. Neurophysiological effects of spinal manipulation. The Spine Journal. 2002; 2:357-371. Wikipedia. Where’s the beef? Accessed at on 11-19-15 at https://en.wikipedia.org/wiki/Where%27s_the_beef%3F. Abbate G. Chiropractic neck manipulation linked to woman’s death. The Globe and Mail. January 17, 2009. Accessed on 11-19-15 at http://www.theglobeandmail.com/news/national/chiropractic-neck-manipulation-linked-to-womans-death/article992903. Barrett S. Chiropractic’s dirty secret: neck manipulation and strokes. Quackwatch. Accessed on 11-19-15 at http://www.quackwatch.com/01QuackeryRelatedTopics/chirostroke.html. Stewart B. Canadian neurologists warn against neck manipulation. Chirobase.org. Accessed on 11-19-15 at http://www.chirobase.org/15News/neurol.html. Harvard Health Publications. Accessed at http://www.health.harvard.edu/heart-health/chiropractic-neck-adjustments-linked-to-stroke on 11-15-15. Jones J, Jones C, and Nugent K. Vertebral artery dissection after a chiropractor neck manipulation. Proc (Bayl Univ Med Cent). 2015; 28(1):88-90. Cassidy JD, Boyle E, Cote P, et al. Risk of vertebrobasilar stroke and chiropractic care. Eur Spine J. 2008; 17(Suppl 1): S176-S183. Kosloff TM, Elton D, Tao J, et al. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies. 2015; 23:19. Mich PM. The emerging role of veterinary orthotics and prosthetics (V-OP) in small animal rehabilitation and pain management. Top Companion Anim Med. 2014; 29(1):10-19. Originally published in the January 2016 issue of Veterinary Practice News. 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