YouTube video:

Ian Rossborough: I have to unfortunately just extend her a little bit to get it in the right place. [crack] [baby cries] That's why we be quick. [loud crying] Hey darling, hey, hey…you'll stop, you'll stop, yeah, it didn't really hurt.

Joel Werner: It's difficult to listen to that. It's a video from chiropractor Ian Rossborough's YouTube channel, and if it sounds familiar it might be because you heard it just a few months ago on RN's Background Briefing.

John Cunningham: There's not many things that make an orthopaedic surgeon emotional, but when you see a premature baby having its back cracked, it literally made my eyes water.

Joel Werner: And that's Melbourne surgeon John Cunningham's reaction to the video. Hi, I'm Joel Werner, and today on the Health Report a special feature on chiropractic controversies.

Almost immediately after that Background Briefing went to air in April, Rossborough's video and Cunningham's reaction to it went viral. There was a furore, outrage. Rossborough was investigated by the Chiropractic Board, and two weeks ago extensive restrictions were placed on his practice.

Background Briefing's Ann Arnold was the reporter on that story, and today she delves deeper into the world of chiropractors, examining some of the more contested aspects of their work.

Ann Arnold: At a chiropractic seminar, a fan is asking Ian Rossborough for a photo. Ian Rossborough has rockstar status among many chiropractors and patients.

Does your son know who Ian is?

Man: Not yet, three years old…

Ann Arnold: But you want him to know?

Man: Yes, that's what I was trying to…next time I will probably…

Ann Arnold: He's charismatic and personable, and his YouTube videos have millions of viewers around the world.

Man: I've seen the video and I've heard the life story about him from my friends and other stuff, so…

Ann Arnold: The YouTube videos, which have now brought him serious trouble, had put the Gonstead technique which he practices well and truly on the map.

He has inspired you?

Man: Yep, that's it.

Ann Arnold: The Melbourne-based chiropractor was a star attraction at this Gonstead seminar in Sydney back in April. The organisers, usually wary of media, allowed me to attend and record.

Man: Once you get your contact point, roll her to you, roll her to you, roll her to you, you don't want to twist. With your knee just drop a little bit to feel it open up, take it down, take it down, go. The trouble with [unclear] here is she thinks too much and doesn't feel enough.

Peter Walters: It is so precise, so thorough, you really know what you're doing when you get involved in the Gonstead technique, there's no guesswork.

Ann Arnold: Peter Walters was the foundation president of the Gonstead Chiropractic Society in Australia after a trip to the US in the late 1980s. Peter has mentored Ian Rossborough.

Peter Walters: And it's very demanding, hard to learn, but once you learn it, extremely satisfying. And you help patients that others just can't. I've guess you've seen some of that with Ian's videos.

Ann Arnold: His success stories.

Peter Walters: Yes, yes. And we've all got those success stories, that's the interesting thing. To be honest, we are pretty proud of the way he has put it out there, because that's not easy, you open yourself up for some pretty good slaps and criticism.

Ann Arnold: Do you feel that as a society or as a profession that you're open to criticism? There's lots of different points of views around obviously about chiropractic.

Peter Walters: I don't mind an informed decision. If people don't like us but they are informed, that's fine with me.

Ann Arnold: There is no doubting the passion of chiropractors, who swear that what they do has direct benefit for their patients. And there's no shortage of patients willing to testify that a chiropractor and only a chiropractor has been able to solve their problem. But chiros struggle to convince others in the medical sphere. Apart from widely accepted evidence that spinal manipulation can benefit chronic lower back pain, there are only small studies and anecdotal experiences. So what is it that chiropractors offer? Fundamental to a lot of their work is the notion of subluxation. It means different things to different practitioners. This is Ian Rossborough talking to me in a room at the seminar.

Ian Rossborough: I would describe the subluxation as a point, usually in the spine, where there is a biomechanical dysfunction of the spinal vertebra, particularly in relation to the disc. There's always a dysfunctional component in relation to a functional component. So you've got one vertebra that's not functioning well in relation to one that is, and on top of that you've got related disc dysfunction, you've got a change to the nervous system tone, which includes nerve impulses to and from the brain because it's a global thing. Then you've got to include on top of that the systemic effect of that lesion, how it's affecting the human body. That whole thing together as a whole is a spinal subluxation.

Ann Arnold: There is no medical evidence for this kind of subluxation. Conventional medicine refers to subluxation as a partial dislocation, visible on scans. Chiropractic subluxation, the global kind that Ian Rossborough described, is usually not visible on scans. And according to many chiropractors, treating the subluxation can help a range of conditions, from autism to asthma.

Ian Rossborough: If you ask me have I ever had a patient have their headaches disappear after I have adjusted them, I'd have to say absolutely. If you asked me is there a spinal level for a headache, I'd say no. Is there an adjustment for headache? No. Is there a specific treatment for headache? No. But whether it is headache, breathing dysfunction, certain aspects of gut function like constipation, loose bowels, things like that, we very often see when we find that biomechanical lesion and the nerve irritation that it is associated with it, the patient will come back and tell us, hey, by the way, that bowel dysfunction that I've had for 30 years and I've been treated for has virtually gone away overnight.

Ann Arnold: There are many mysteries to chiropractic outcomes.

Ian Rossborough: There is another level to what we do and that is we get the information off the patient that they can't tell us. We look for things like tissue profusion, how much oxygen is in the skin, how tight are the muscles, how's the rest of their body adapted to the problem that we've found. Even though there's three or four or five groups of evidence to point towards a problem in the spine, which is the primary problem, which one is the main offender that is causing everything else? The actual process of learning how to read the information off the body, find the primary subluxation, and then go and correct it is extremely difficult. It's a little bit athletic but it's more tacit. You have to have a lot of compassion, you've got to care whether your patient gets well, and you have to be very invested in the contact with the patient.

From a chiropractic point of view, we have no business touching you if the biomechanics of your body are functioning properly and your nervous system is at normal tone. So we need to find some sort of evidence that there is a biomechanical dysfunction in the spine, pelvis or the way the head sits on the spine, sometimes in the extremity joints. And the reason why they are important, even though the nerves don't go through your…they go through your spine to get to your arms and legs but they don't necessarily go through your arms and legs to get somewhere else, but there's a lot of information coming back up from those joints.

Ann Arnold: Ian Rossborough and other chiropractors talk about nerve irritation caused by spinal misalignment, affecting a range of other problems. That notion is disputed by Dr Martin Krause, neurologist and clinical associate professor of medicine at the University of Sydney.

Martin Krause: I think that's an hypothesis that lacks any scientific evidence. It's hard to comment on this. You can't argue against it, but I don't think there's any evidence that this is true.

Ann Arnold: So evidence-based medicine doesn't support these ideas. But what do the leaders of the chiropractic profession say about subluxation? There's a clear and perhaps symbolic split on this issue. It is evidence versus…well, something more abstract. This is the evidence position.

Rodney Bonello: I think there's nothing wrong with the term if it's used to simply denote a mechanical problem in the spine.

Ann Arnold: Chiropractor Rodney Bonello, an adjunct professor at Murdoch University, heads up a breakaway professional body, Chiropractic Australia. It was formed a year ago in response to what he saw as an image problem for chiropractors.

Rodney Bonello: Now, where the term subluxation is used incorrectly is when it's used in its old-time sense, and that is that it is the cause of disease, and that to cure diseases part of the treatment would be the removal of subluxations.

Ann Arnold: Four years ago the president of the European Chiropractors Union declared that chiropractic subluxation had not been scientifically tested and 'we should be very careful not to create constructions that do not exist.'

Rodney Bonello: Recently from Europe has come a statement which has been endorsed by Chiropractic Australian and a number of other bodies and endorsed by all of the Australian universities teaching chiropractic, that makes very clear that subluxation should not be used as a reason for treating disease, as an entry for the treatment of disease.

Ann Arnold: The majority of chiros don't belong to Rodney Bonello's organisation, they belong to the original professional body in Australia, the Chiropractors Association. Its vice president is Andrew Lawrence. He endorses the broader definition of subluxation.

Andrew Lawrence: What it is is a spinal segment which is no longer functioning properly that is causing restriction of movement, it's causing muscular irritation, it's causing possible nerve irritation et cetera. It's a construct that we use to help us to work out what we are actually going to do to that patient.

Ann Arnold: But orthopaedic and neurology experts that I've spoken to say, no, this doesn't exist.

Andrew Lawrence: Well, as I said, it's a construct. They have their opinion, and we use the idea of subluxation as a way of quantifying and focusing our attention on what we need to do with the spine.

Ann Arnold: Babies. This is the hot-button issue for chiropractors. Many advertise what they can do for babies and children. There's a view that babies' spines can be damaged during birth, and an early fix by a chiropractor sets them on the right track. But Rodney Bonello from the breakaway group Chiropractic Australia says the evidence isn't there.

Rodney Bonello: Now, the birth process, if you were to watch the delivery of a child, there is a considerable amount of tugging and stretching of the neck, even if we are not using forceps. And so the idea that the neck receives some trauma at that time is a popular idea, and a casual observer would say, yes, that's entirely biologically plausible. However, we haven't seen any scientific validation of the idea that the spine is misaligned at that time or that there is a propensity for the child to have developmental problems or other disorders associated with that. So even though it's an interesting hypothesis, it would be wrong to make strong claims about newborns possessing subluxation and that really does need to be treated. At the moment we can't say that.

Ann Arnold: Doctors say that not only is there no evidence for spinal damage during birth, there is a real risk of damage from spinal manipulation of newborns.

Paul Bauert is head of paediatrics at Royal Darwin Hospital.

Paul Bauert: The ongoing problem, particularly with the smaller babies and children, is that these manipulations that they are carrying out do carry a real risk of causing long-term damage. It's a rare risk but it's certainly there.

Ann Arnold: What is that risk?

Paul Bauert: Well, a lot of the bone in neonates and young children is not actually ossified, it's not hard, it's soft cartilage. And there is a real theoretical risk of damaging that cartilage and later on in life causing problems with skeletal development as the bones ossify, and they ossify abnormally and you may in fact end up with problems like Sherman's disease or scoliosis.

Ann Arnold: In April, amid the outcry about Ian Rossborough's videos, the Royal Australian College of GPs called on doctors to simply not refer children to chiropractors.

Ian Rossborough: Hello buddy, oh you don't look too well. Come over here champ.

Ann Arnold: In another Ian Rossborough YouTube video featured on Background Briefing, he manipulates the neck of a boy with an ear infection, suggesting that the infection was probably the result of a fall, and subsequent bump on the head, which would have lowered the boy's immunity.

Ian Rossborough: Yeah, his head's not on his spine right.

Mum: Lachie, do you remember the fall that you had at school?

Ann Arnold: He jerks the boy's head sideways. The boy is shown later returning to the clinic with no ear infection. Doctors commented that this type of middle ear infection usually clears up anyway.

After the ruling of the Chiropractic Board two weeks ago, Ian Rossborough is no longer allowed to treat children under the age of two at all. He can't do manipulations on children between two and six years old, and his work has to be supervised. There are other conditions on his registration as well. But Ian Rossborough is by no means alone in his unconventional treatment of babies and children. Some chiros practice SOT, sacro occipital technique. Rodney Bonello, president of the new professional body Chiropractic Australia, says that the SOT approach can be useful but there's an underlying evidence gap.

Rodney Bonello: Sacro occipital technique, it's a low-force technique, and in this technique a patient is diagnosed for mechanical problems and then they are asked to lie down on wedge shaped blocks, and these wedge shaped blocks are placed strategically under the pelvis and other parts of the body so that there is a gentle twisting of the body that occurs just by the person lying on those asymmetrical blocks.

The basic theory of SOT is that the sacrum, which is the bone at the base of the spine and the occiput, the part of the skull at the base of the head, acts together to pump cerebrospinal fluid up and down the spine and around the brain, and that there are therapeutic benefits to having this fluid pass through.

The technique in itself has a lot of positives. It's a very gentle technique, which is good, and it is effective in terms of making small, gentle movements in the pelvis. However, to teach that there are wide ranging benefits from the flow of CSF is something which has not been validated and really shouldn't be taught as though it's a fact. And I guess it could be taught in terms of a model or a hypothesis that requires further research, but sometimes that's not what really happens.

Ann Arnold: A sub-branch of sacro occipital technique is CMRT, chiropractic manipulative reflex technique. Pressing the base of the skull is believed to help a range of conditions. But again, Rod Bonello is not convinced.

Rodney Bonello: It involves placing pressure with fingers or thumbs on the small muscles on the base of the skull, and those muscles are associated with headaches and tension in the neck et cetera, and so the technique is obviously therapeutic for those kinds of simple mechanical problems. But in SOT it is often taught that the use of that technique has an effect on organs of the body directly. We would say that that's an interesting hypothesis, and it may well be true, but it should not be taught as though it's a clinical fact, as though it's science, until the research is done.

Ann Arnold: So is it a stretch to say that pressing on a particular part of the neck will have a direct effect on organs?

Rodney Bonello: At the moment we don't have the science to be able to make that statement with any sort of real confidence. If the statement is going to be made it should be made as a hypothesis, as a possibility.

Ann Arnold: The Australian organisation that promotes sacro occipital technique, SOTO Australasia, has been advertising courses on tongue tie, which they claim can be helped by cranial therapy. Calls to the president of SOTO Australasia, chiropractor Tori Wright, have not been returned.

Joel Werner: You're listening to the Health Report here on RN, I'm Joel Werner, and today Background Briefing's Ann Arnold with a special feature on chiropractic controversies. And indeed, the controversies are many and varied.

Ann Arnold: In early April a chiropractor on the New South Wales south coast slipped into a hospital on a clandestine mission; to make a baby poo. The baby, Harvey, was three days old. The chiropractor is Grant Bond.

Grant Bond: Most babies are relatively healthy when they are born but occasionally, for example, Harvey hadn't gone to the toilet for three days, and just by gently adjusting him it allowed him to release and go to the toilet. Other babies with colic or restlessness, they can be indications of where their spine has shifted or what is called a subluxation.

Ann Arnold: This is not the first time a chiropractor has adjusted a hospital patient without the hospital's permission. Chiropractors have discussed on social media the best way to do secret hospital visits; go in visiting hours when it's busy, draw the curtains around the bed, et cetera.

Grant Bond: I don't have hospital rights, I just go in as a friend. It's a service I offer to my practice members, I'm just there as a friend to help them along the way, to the mother and to the newborn.

Ann Arnold: This 'service', though, shocks doctors, and many fellow chiropractors. Apart from questions about the need to adjust a newborn baby's spine, there is the ethics and risks of not telling the hospital and other treating health staff. Unlike many other non-mainstream healthcare providers, chiropractors are registered under AHPRA, the Australian Healthcare Practitioner Regulation Agency, along with doctors, physiotherapists, nurses and others. It's in AHPRA's code of conduct for all health practitioners that they must communicate effectively with other practitioners. But some chiropractors have developed a reputation for disregarding the rules. And when they do unauthorised treatments in hospitals, they say that they are meeting patient demand. When Grant Bond treated baby Harvey in hospital, it was at mum Jocelyn's request.

Jocelyn: He hadn't been to the toilet since the first day when he passed all the meconium and everything, and he was starting to get a bit windy and a bit restless. And after Grant worked on him he certainly cleared all that up and he has been very, very settled ever since.

Ann Arnold: This was just weeks after an edict from the Chiropractic Board, the regulator, that chiropractors should not promote benefits other than musculoskeletal. But Grant Bond was adamant that chiropractic care has a broad range of applications.

Grant Bond: Like, for example, I have seen some people with epileptic seizures, I've seen lots of people being helped with sinus issues, energy levels are a big thing these days, improved posture. You see a lot of people with rounded shoulders and ladies with humps on the back of their neck. Breathing, easy breathing. As we know with Harvey, better bowel function. Just a better digestive system. Sciatica. I mean, the list goes on. But chiropractic has never been about treating symptoms, it's about allowing the human body to express its inborn ability to heal and repair itself and have the natural state of being healthy.

Ann Arnold: Chiropractor Grant Bond, who was interviewed in April, as were all the people in this story. If some chiropractors are promoting and perpetuating beliefs that don't have a scientific basis, part of the problem, according to Rodney Bonello from Chiropractic Australia, is the way they are getting their information.

Rodney Bonello: A person can come along and just advertise a seminar and deliver the material. They can even seek for that material to be accredited for continuing education hours, but there is very little control, almost no control on what they say and the way they present their material, whether the person speaking is appropriately qualified, has done any research themselves, or has quoted responsible research findings. There are no controls over that at the moment. I think that's an area that really does need to be looked at.

Ann Arnold: You talked at a recent seminar at Sydney University on the advertising of therapeutic goods and services. There was a panel on chiropractic debates and issues, and you talked very animatedly about gurus and secret societies.

Rodney Bonello: Yes. In terms of guruism, the people who provide the seminars tend to either be names in the chiropractic profession, that is people with long-standing reputations, and promote what they do as best practice. And the underlying message is 'if you want to be really successful and as good at this technique as I am and get as good results as I do for your patients, you need to emulate me'. Now, that is a system of guruism where the disciple follows the teacher, and that's fine in some realms, but in terms of a scientifically-based healthcare system we can't rely on guruism.

Ann Arnold: Back at the Gonstead technique seminar, there's no apology for disciples following the teacher. During lectures an old video is played frequently featuring an American chiropractor. He had worked with Gonstead himself. The video is watched almost reverentially. Chiropractor Peter Walters explains:

Peter Walters: This is a Dr Alex Cox. In '94 he was about to retire. No one had made a video of him. He spent his working life with Dr Gonstead, and he demonstrated 78 set-ups, and that's our gold standard now. We never vary from generation to generation. We've got the standard.

Ann Arnold: For those present, this is valuable passing on of knowledge. Chiropractor Ian Rossborough says medical research simply isn't keeping pace with what they do. So it's not surprising that their results are not borne out by robust evidence.

Ian Rossborough: The effects on the body of our care is neurological, and that's much harder to test than anything else. You can test chemical levels in blood but it's very hard to test actual neurology and changes in nervous tone.

Martin Krause: I don't know what he means with 'nervous tone'.

Ann Arnold: Sydney neurologist Martin Krause doesn't accept this concept, let alone that nerve work can't be tested.

Martin Krause: As a neurologist I measure every day neurological function. We can measure all kinds of outcome. If you treat someone for pain you can measure the pain before and after. You can measure the effect of the pain on everyday activity, and you can measure that as well. There are lots of tools available and you can test that against an alternative treatment. That's what we normally do, we test it against placebo, something that doesn't work.

Ann Arnold: Perhaps the biggest controversy of all regarding chiropractors is an anti-immunisation stance that runs through the profession.

John Cunningham: There was a movement amongst chiropractors that with the properly aligned spine somehow your immune system would function in some turbocharged way and you wouldn't need vaccination. It is of course rubbish. There is nothing to that concept. But they kept promoting it.

Ann Arnold: This is Melbourne surgeon John Cunningham who is a member of a group called Stop the AVN which has been in a long-running and often bitter dispute with the Anti-Vaccination Network.

John Cunningham: And it became apparent that the largest professional group of people who were members of the AVN were actually chiropractors, and many chiropractors were promoting their practices on the AVN website.

Ann Arnold: Chiropractors have been warned very specifically by their regulatory board about anti-vaccination messages, from as far back as 2013. But the social media links continue, albeit subtly. There are links, for example, through Facebook to the International Chiropractic Paediatric Association. It's an American body with a known anti-vaccination stance.

Shellharbour chiropractor Grant Bond says that's where he gets his information.

And when you say the research that you're aware of, where do you go to to get your research?

Grant Bond: As we all do, go to Google and go online, there's lots of chiropractic websites as well that have lots of research.

Ann Arnold: Can you suggest any that you would go to as a first point of call?

Grant Bond: There's a chiropractic…chiropractic for kids, off the top of my head. Like I said, I can get you that information…

Ann Arnold: Was that the American one, ICPA?

Grant Bond: Yes, that's the one.

Ann Arnold: Grant Bond's patient Jocelyn has brought her two older children to see him once a month since they were born. The children are vaccinated, but she says the chiropractic treatment enhances their immunity.

Jocelyn: Just for preventative health, yes, to keep their immune system strong. They are pretty rough and tumble type kids, so they have had falls or little colds. I guess as Grant has probably explained to me in the past, that by having their spine and everything in good alignment it delivers the right…is it nerves and whatnot, to the right places, it just helps with I guess assimilation of all their nutrients and things like that. So yeah, just as a preventative.

Ann Arnold: And it helps with their immune systems?

Grant Bond: Yes, well, chiropractic is based on the fact that the nervous system is what controls how the body works, the spine is there to protect the nervous system, and any misalignments can reduce the flow of electricity through that nervous system. So part of the science is called neuro-immunology which is the relationship between the nervous system and the immune system, and it shows that people who have had regular chiropractic care have a stronger immune system. So yes. And I find that commonly with all my long-term practice members, that they get less colds and flus, and if they do they tend to get over them a lot quicker.

Ann Arnold: Chiropractors have also been told by their regulator not to suggest they can treat immunity.

Grant Bond has in the past posted anti-vaccination messages on Facebook. He says he doesn't discuss the topic with his patients. But personally he doesn't agree with immunisation.

Grant Bond: I've never pushed the agenda of pro-vaccination because, once again, I'm about a natural approach to good health. So to me, sticking an injection in your arm and putting chemicals in your body, that way is not a natural approach.

Ann Arnold: The president of the new professional association, Chiropractic Australia, is pro-vaccination.

Rodney Bonello: We believe that chiropractors should participate in the healthcare initiatives of a modern society, and the initiatives of the government, and that means an immunisation program. However, chiropractors should not be promoting the non-immunisation of children, that just flies in the face of good science and good modern healthcare.

Ann Arnold: Rod Bonello.

Andrew Lawrence, the vice president of the larger and older professional group, the Chiropractors Association, was less clear about his position.

Chiropractors who oppose vaccination talk about putting chemicals in children's bodies and it is better to find a more natural alternative, and sometimes that the chiropractic work can have an effect on the immune system. Do you share that view?

Andrew Lawrence: No, I don't share a view that chiropractic is an immune booster as such.

Ann Arnold: And are you for or against the system of vaccination, the vaccination regime that Australian currently has? Do you think it's a good policy or a problematic one?

Andrew Lawrence: Look, that's a personal view that I'm not prepared to share.

Joel Werner: Andrew Lawrence, vice president of the Chiropractors Association, speaking with Background Briefing's Ann Arnold. If you want to listen to Ann's original report or watch any of the videos mentioned in today's show, just head to the Health Report website via the RN homepage. But that's it. I'm Joel Werner. See you soon.