[Editor’s note: Harriet is taking a break today, so in her stead we have a new post from Sam Homola. Enjoy!]
The chiropractic Webster Technique, one of the most nonsensical chiropractic techniques based on the scientifically indefensible chiropractic vertebral subluxation theory, is a method of adjusting alleged sacral subluxations in order to prevent breech birth and to assure a normal delivery by facilitating “neuro-biomechanical function in the pelvis.”
Whatever effect sacral manipulation might have on the body, there is no reason to believe that a sacral adjustment will improve nerve flow to the uterus or affect sacral nerves which pass through solid bony openings. A sacroiliac joint is an amphiarthrodial synovial-plane joint (one on each side of the pelvis) with irregular interlocking joint surfaces bound together with strong, dense ligaments. While there is slight movement in a sacroiliac joint, subluxation or dislocation is rare, usually caused by painful injury. Most often, sacroiliac pain is the result of ligamentous strain or joint inflammation. The asymptomatic “vertebral subluxation complex” routinely adjusted by subluxation-based chiropractors simply does not exist.
A sacroiliac joint has irregular interlocking joint surfaces that are bound together by dense ligaments that allow slight movement, but subluxation or dislocation is rare.
Movement in the sacroiliac joints is greatest during pregnancy when the hormone relaxin loosens sacroiliac and pubic ligaments to allow widening of the pelvis during birth. Manipulating sacroiliac joints during the final months of pregnancy may strain relaxed sacroiliac ligaments, contributing to the development of low-back pain.
While most adjustive techniques may involve manual manipulation of the sacrum, some are far removed from what might be identified as manipulation. An Activator technique, for example, uses a spring-loaded stylus to tap on the sacrum in what appears to be a useless, arbitrary procedure. A Logan Basic Technique might be used to place thumb pressure on a gluteal sacrotuberous ligament in order to “realign the sacrum”. An upper cervical (NUCCA) specialist will invariably manipulate the atlas to realign vertebrae from the neck down. Such non-standardized adjustive techniques, all based on subluxation theory, may vary from one chiropractic office to another. The first clue that such techniques may have no value is provided by the subluxation paradigms that define the techniques and profession.
The dangers of the Webster Technique
Use of the Webster Technique to realign the sacrum in order to facilitate childbirth by reversing a breech presentation can endanger both the mother and the fetus by delaying appropriate care. Breech presentation commonly occurs during pregnancy, but most breeches rotate into a head-down (vertex) position by the end of the eighth month. Failure to take action to prevent a breech birth before labor begins is inexcusable malpractice, resulting in a life-threatening emergency. Rupture of the amniotic sac, compression of the umbilical cord (reducing blood flow to the baby), displacement of the placenta (bleeding with obstruction of delivery), or entanglement of the umbilical cord and the baby, as well as vaginal injury and injury to the baby, may require an immediate Cesarean section in order to avoid a dangerous breech-obstructed vaginal delivery ─ a horrendous scenario that could have been avoided with ultrasound studies and appropriate obstetrical care. Subluxation-based or not, no chiropractor should be involved with management of a late-stage pregnancy. Use of the Webster Technique to turn a breeched fetus should be forbidden by law. About 4% of babies are breech in a full-term pregnancy, requiring hospital-based care by a board-certified obstetrician.
The Webster technique, often used by pediatric chiropractors, may be followed up by manipulation of new-born babies to correct “birth-related subluxations” ─ a dangerous and unnecessary practice.
A step in the right direction
According to a statement by issued by Consumer Health Digest:
The College of Chiropractors of British Columbia (CCBC) has announced that it has amended its Professional Conduct Handbook and Efficacy Claims Policy statement because of concerns about misleading statements by some chiropractors about pregnancy and childbirth care. The policy statement now says that chiropractors should not represent to patients or to the public that chiropractic has any beneficial effect on:
- fetal development or position such as: breech/breech turning or position and intrauterine/in utero constraint
- labor or birth such as: easier or shorter labor, preventing the need for medical interventions and preventing premature or traumatic birth
- hormone functions or post partum depression
CCBC’s notice specifies that chiropractors should not imply that the Webster technique, a treatment of the pelvis and lower spine, can influence fetal positioning. The Professional Conduct Handbook now states: “When communicating with the public, a chiropractor may advertise or reference the Webster Technique or Certification only as “a specific chiropractic sacral analysis and diversified adjustment for all weight-bearing individuals.” After January 3, 2020, according to the CCBC, complaints about statements that breach the new standard will be investigated.
Opposition to subluxation-based scope of practice
Apparently recognizing the tenuous nature of vertebral subluxation theory, the CCBC is also mandating that registered chiropractors must not make claims embracing a broad scope of health problems [PDF]:
Due to the absence of acceptable evidence supporting such claims, registrants must NOT represent to patients or the public that chiropractic:
(a) can be used to treat diseases, disorders or conditions such as: Alzheimer’s disease, cancer, diabetes, infections, infertility, or Tourette’s syndrome, or
(b) has any beneficial effect on childhood diseases, disorders or conditions such as: ADHD (or ADD), autism spectrum disorders including Asperger syndrome, cerebral palsy, Down syndrome, fetal alcohol syndrome, or developmental and speech disorders.
The march of subluxation deniers
Much to the consternation of subluxation believers, The Canadian Memorial Chiropractic College has joined 12 other chiropractic institutions around the world that have renounced subluxation theory, all in accordance with a Position Statement based on the theme of the World Federation of Chiropractic Educational Statement formulated in November of 2014:
The teaching of vertebral subluxation complex as a vitalistic construct that claims that is the cause of disease is unsupported by evidence. It’s inclusion in a modern chiropractic curriculum in anything other than an historical context is therefore inappropriate and unnecessary.
Unfortunately, no chiropractic college or regulatory body in the United States has openly challenged subluxation theory as the College of Chiropractors in British Columbia has done, and state laws defining chiropractic as a method of correcting vertebral subluxations remain unchanged. As stated by Timothy Mirtz in 2011, “Despite the controversies and paucity of evidence the term subluxation is still found often within the chiropractic curricula of most North American chiropractic programs.”
In the interest of public health, it is incumbent upon health-care professionals, journalists, and informed lay persons to advise against subluxation-based chiropractic care (as opposed to appropriate use of generic spinal manipulation) and other forms of dubious health care that prosper under the veil of legal licensure.