Since early in its history, two factions have existed in the chiropractic profession, which have disagreed on some basic but central principles (1). Somewhat oversimplified; one group regards the chiropractic scope of practice as primarily related to musculoskeletal disorders, whereas the other considers manual treatment of the spine (denoted ‘adjustments’) as a panacea, which is purported to effect positive or curative changes in all health and disease, irrespective of the underlying disorder. Increasingly, the former can be identified as progressive and evidence-based and the latter as conservative and dogmatic (1).
The theoretical basis for the latter has taken slightly different guises over time, from outright vitalistic concepts of ‘life-forces’ with religious undertones (2), to more scientific-sounding but fuzzy notions about perturbations of the autonomic nervous activity effecting specific organs or bodily functions (3) to - more recently - believing that ‘adjustments’ have a positive effect on clusters of dormant neurons in the brain, with virtually unlimited possibilities for treatment, including neurodegenerative and neurodevelopmental disorders (4).
Common to these theories is the conviction that the human body is capable of maintaining optimal health, if the nervous system is allowed to regulate all tissues without interference. Furthermore, mechanical spinal dysfunctions (denoted ‘subluxations’) are thought to be the primary cause of such interference and are amenable to spinal ‘adjustments’.
Referring to these theories, some chiropractors promote a chiropractic lifestyle, offer manual treatment for conditions for which no supporting evidence exists, recommend regular manual treatment as a primary preventative measure in healthy individuals, and advise against other healthcare initiatives such as vaccination (5,6), for which evidence does exist.
It is disturbing how groups of chiropractors still stick to these conservative concepts that lack general contemporary acceptance in the scientific community. Remarkably, these unscientific concepts are apparent also in modern-day chiropractic students (7,8), which is especially troubling.
We speculate that there are three main types of chiropractic ‘educational patterns’: 1) private and independent chiropractic schools that a) might partially or wholly accept and encourage some degree of conservative and vitalistic approach to chiropractic, or b) do not have the resources to properly regulate conservative and vitalistic thoughts. 2) Chiropractic schools embedded in or affiliated with a university but independently of any medical course that, nevertheless, might have staff, who more or less overtly, include elements of chiropractic conservatism in their interactions with students, and 3) chiropractic degree courses that are embedded in a medical school. Medicine has the longest and most well-established tradition for scientific inquiry of the healthcare professions (9). Thus, such outdated concepts cannot easily establish themselves without ridicule in such an environment.
Studies have previously been published on this topic. One survey (7), in which chiropractic students from a private and independent institution in Europe responded to a questionnaire on chiropractic conservatism, revealed that a large majority of students held very conservative views on the nature of chiropractic, the implications of ‘spinal subluxations’, and the effects of spinal ‘adjustments’. These findings were surprising, as the school officially adheres to an evidence-based approach. Further, it was shown that the students with the most conservative views had no apparent limitation to their scope of practice, apart from respecting obvious contra-indications to chiropractic treatment. For instance, they would not deter from treating preventively to help children avoiding the development of diseases later in life.
Another survey, in Australia (8), showed that many chiropractic students expressed very conservative views on spinal ‘adjustments’, for example believing that spinal adjustments help the immune system and prevent spinal degeneration. These students attended two chiropractic courses provided at state universities but unaffiliated with any medical faculty.
Danish chiropractors are licensed on the basis of a university-based five-year chiropractic degree program, which is closely integrated with the medical education. The national chiropractic organization, of which there is only one, is well-organized and professionally managed, and chiropractic services are included in the publicly funded health-insurance system (10). Furthermore, research-funding is available via The Foundation for Chiropractic Research and Postgraduate Training, which supports a relatively large and active research community. The Foundation is continuously and proportionally financed, as part of the agreement on public reimbursements of chiropractic service fees, corresponding to approximately 4000 €/chiropractor/year (11). Chiropractors in Denmark can work in various clinical positions that extend beyond the primary care, for instance as diagnosticians at hospitals, and recently, a 5-year post-graduate in-hospital residency program for a chiropractic musculoskeletal specialty was initiated (12). Thus, the chiropractic program is placed in a lively clinical and research environment and taught by chiropractors and other academic staff who are active researchers.
We were curious as to whether Danish chiropractic students, nevertheless, share the same conservative views on chiropractic scope of practice as those revealed in the previous two studies. For this reason, we conducted a survey of chiropractic students attending the third, fourth- and fifth-year programs, at the Department of Clinical Biomechanics at the University of Southern Denmark.
The objectives of this study were to establish the level of conservatism in Danish chiropractic students, to investigate if this was linked to year of study, and to compare the results from previous studies on the university and non-university-based institutions.