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I read with interest the case report by Beck et al.1
During the course of their case report Dr Beck and coauthors refer to the involved care provider as a “chiropractitioner” and describe the intervention delivered by that care provider as “chiropractic manipulation”. However, in Germany, a chiropractor and a chiropractitioner are very different. In that country a person who uses the title chiropractor will have successfully completed a course of study, usually of a minimum of five years, at a college/university accredited by the European Council on Chiropractic Education (ECCE). On the other hand, a chiropractitioner (also called a Heilpraktiker) usually has no formal qualification in chiropractic and at most may have completed a series of weekend seminars (personal communication, President, German Chiropractic Association). Therefore, it needs to be highlighted that the two are so different that it is inappropriate to use the terms chiropractic and chiropractic manipulation when referring to the care provided by a chiropractitioner.
A number of members of the German Chiropractic Association and I have personally contacted the lead author of the original case study to which this letter pertains. Dr Beck confirmed that it was not a qualified chiropractor that had “manipulated” the spine of the patient involved. Moreover, Dr Beck described the involved care provider as a “lay medical practitioner” (a Heilpraktiker) (personal communication, Dr J Beck).
I am attempting to clarify this important difference between a chiropractor and chiropractitioner because there is the potential to create confusion such that the injury reported by Beck et al could be incorrectly attributed to a chiropractor as compared with a chiropractitioner (lay medical practitioner). In fact, unfortunately, this has already happened. A brief review of Dr Beck’s case report, by a BMJ editor,2 inappropriately uses the title “chiropractic causes CSF leak” and suggests the care provider was a chiropractor.
It has previously been reported in the medical literature that the terms chiropractic and chiropractor have often been inappropriately applied to therapists, who were not chiropractors, when the care they provided appeared to result in complications.3 More specifically Terrett has stated, “The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT [spinal manipulative therapy] injury, by medical authors, respected medical journals, and medical organizations. In many cases this is not accidental, as the authors had access to original reports, which identified the practitioner involved as other than a chiropractor.”
In summary, the case report by Beck et al should have made explicit the difference between a chiropractor and a chiropractitioner. The intervention to which Dr Beck’s case study relates was not a “chiropractic manipulation”, was not delivered by a “chiropractor”, and therefore in no way involved “chiropractic”. Sadly, it seems as though the terms chiropractic and chiropractor have again been misused. Given the above, it would seem appropriate to change the titles of both Dr Beck’s case report and the brief summary in the BMJ. Furthermore, authors of future case reports that relate to the use of spinal manipulative therapy should make every effort to clearly delineate the involved care provider’s relevant training or qualifications, or both.
We thank Mr Wenban for his comments on our article. We appreciate that he clarifies the differences in educational status between chiropractors and others who apply chiropractic therapy in Germany.
Unfortunately, we have to mention, that we were cited incorrectly. The educational background of the caregiver (a physician, a chiropractor, a physiotherapist, a Heilpraktiker, or other) was not specified by us, either in the article or in personal communications.
We do not believe that the risk of this rare complication is zero, regardless of the educational status of the care provider.
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