The Olympics are coming to London this Summer and the presence of such a huge jamboree means it will not just be athletes and race walkers flocking in, but thousands of support staff and businesses including caterers, pole dancers, medical teams and chiropractors.

Yes, chiropractors. Apparently, a ‘Central Medical Unit’ has been appointing “doctors, chiropractors and physiotherapists” in order to treat athletes at the games. Google this ‘Central Medical Unit’ and you will see a plethora of chiropractors who are keen to announce their pride at their inclusion in the event.

We see chiropractor Richard Skippings from Thirsk say “to have been selected is a massive honour”. Chiropractor Lauren Comley from Berkhampsted says on her website “to have been selected is a massive honour.” Tim Button from Mangotsfield also says that “to have been selected is a massive honour”. And we see Bath-based chiropractor Peter Dixon reporting to the newspapers that “to be part of the team and to have been selected is a massive honour”.

It would appear that to be selected for the “Central Medical Unit” is indeed a massive honour.

Except, I cannot find anyone else who thinks so.

Indeed, I am struggling to find any reference to the Olympic “Central Medical Unit” beyond the press releases of chiropractors and osteopaths.

The London 2012TM Olympics do indeed have an Anti-doping and Medical Sport Department. And indeed, this team is recruiting, although they only give job descriptions for physiotherapists. The Medical Services Manager tells us about her team, and highlights profiles of her physical therapists, radiologists, anaesthetists and pharmacists. No mention anywhere, as far as I can tell, of chiropractors and their “Central Medical Unit”.

I could be wrong, and I would welcome any insight in comments as to why there may be this discrepancy.

But what are chiropractors going to do at the Olympics anyway given its very limited therapeutic value and inherent risks? What evidence is there that chiropractic manipulation can either prevent or treat sports injuries?

Not a lot, as you might guess.

Last Autumn a systematic review of the evidence was published in Focus on Alternative and Complementary Therapies entitled “Chiropractic for the prevention and/or treatment of sports injuries: a systematic review of controlled clinical trials.” [full text]

The review searched databases for trials into chiropractic as it is used in sports health. The emerging studies were generally of low quality and inconclusive. Trials were not properly controlled, were too small, did not report in standard ways and did not use validated outcome measures. Thus, the authors had to come to the conclusion that,

Few rigorous trials have tested the effectiveness of chiropractic manipulation for the treatment and/or prevention of sports injuries. Thus, the therapeutic value of this approach for athletes remains uncertain.

As this is the latest review into the subject, it places the chiropractors taking part in the Olympics in a difficult ethical and professional position. As regulated chiropractors, they are expected to abide by their code of ethics that demands that the “care you select and provide must be informed by the best available evidence”. If these chiropractors were to make claims that their therapy could help athletes either prevent or treat sports injuries then they could be subject to professional disciplinary action. They might be misleading their customers if they claimed they could be of benefit.

So, unless the chiropractors are going to be part of the catering or pole dancing services, where claims made are not so stringently enforced, it is not clear what they are doing as part of the “Central Medical Unit”. So, could these chiropractors actually risk disciplinary measures?

Unlikely. I would find it difficult to believe there would be any problem here given that one of the massively honoured chiropractors, Peter Dixon, is chair of the Council of the General Chiropractic Council – the statutory body charged with upholding chiropractic standards. A body that has recently admitted that it is failing to protect the public with its complaints system.

The chiropractic trade has a big problem with evidence. Indeed, Peter Dixon has been criticised by Professor David Colquhoun of being ‘careless about evidence’. The reason is straightforward. Chiropractic is not a medical specialism but a pseudomedical belief system based on the mystical teachings of a 19th Century magnetic healer. It’s central beliefs have not held up to modern anatomical knowledge and its historical and widespread claims that diseases is caused by spinal problems are almost all bogus.

That is why the trials of chiropractic sports applications were of such poor quality. From where I sit, the utility of such research is not to discover if chiropractic can help in a particular area, but to give a veneer of scientific plausibility over existing, questionable practices. Poor quality trials most often give spurious results. They may look positive when all you are seeing is flawed trial design. Thus, a systematic review of the evidence is so important.

As the authors of the FACT paper conclude,

Future studies of chiropractic should adhere to accepted standards of trial design and reporting (e.g. CONSORT guidelines). In particular, studies should be adequately powered, use validated outcome measures, control for non-specific effects and minimise other sources of bias. Reporting of these studies should be such that results can be independently replicated.

That sounds to me like an academic slap around the chops to the profession for producing such a substandard evidence base. Will we see improved future studies?

Don’t hold your breath. Such future studies run the risk of denying chiropractors the massive honour of being selected for the Olympic “Central Medical Unit”.

UPDATES

18th April

It really would appear as if the great and the good of the UK chiropractic trade are the ones to have reveived this ‘massive honour’.

Today we learn from the Stroud News and Journal that chiropractor, Richard ‘Plethora’ Brown, is also saying that ““To be part of this event at any level is tremendously exciting, but the chance to work with the best athletes from around the world is a once in a lifetime opportunity.” Coincidentally, exactly the same words as all the other chiropractors involved.

Richard ‘Plethora’ Brown is the President of the discredited British Chiropractic Association. Under his watch, he almost brought the entire chiroptractic trade to its knees. The BCA decided to sue science writer Simon Singh after he wrote in the Guardian that the BCA were “happily promoting bogus treatments” for children. Brown stated there was a ‘plethora’ of evidence for chiropractic for kids and sued. It took many months of repeatedly asking Brown to publish his plethora as it was doubted that it existed. When he did, bloggers and the BMJ demolished it within hours as worthless. The BCA and Richard Brown were humilated.

Their humiliation did not end their when subsequently they had to withdraw their case against Singh and pay is costs mounting to hundreds of thousands of pounds. Worse, after 600 complaints were made to the General Chiropractic Council by people objecting to chiropractors making claims without evidence, millions were spent on investigations, requiring the GCC to mortgage its premises and ensure chiropractors will be paying the highest medical registration fees for many years to come.

Still, if you get to crack the back of the odd Romanian wrestler then I guess it was all worth it.

24th April

Chiropractors who have been claiming to be “deeply involved in organizing the medical services that will be provided to Olympic athletes at this summer’s Olympic Games in London” have been caught being less than honest.

I tweeted that the business “London Chiropractor” are styling themselves as a UCL ‘Centre of Excellence’. I did not believe this and so Professor David Colquhoun of UCL took it up with the relevant authorities and the claim turned out to be a porky. Read about it here.