Chiropractors Spar Over Acceptable Treatment for Whiplash

A dispute has broken out in the ranks of the chiropractic community over how the Oregon Board of Chiropractic Examiners should give advice on treating patients injured in auto accidents by seatbelts and other blows from the sudden suspension in momentum.

Michael Burke, a Portland chiropractor, told The Lund Report that a special advisory committee has crafted a new section on Whiplash-Associated Disorder that will recommend chiropractic treatment up to 56 weeks, a position he says is not rooted in medical evidence but built on a desire to enhance the business of chiropractors.

“The evidence doesn’t support 56 weeks of treatment,” Burke said. “There is more evidence that patients treated intensively after whiplash take longer to heal than those who get less treatment.”

The Oregon Board of Chiropractic Examiners has been working over the past several months to provide a new revision of the Oregon Chiropractic Practices and Utilization Guidelines, a kind of standard of care manual used by auto and health insurers to inform payment protocols. The guidelines were first written in 1990 and haven’t been updated since 2000. A whiplash section would be only a small part of the overall guidelines, if approved.

Burke said that some members of the Oregon Chiropractic Association -- of which he is not a member -- had hijacked the guidelines to create an unnecessary whiplash section. He said that treatment decisions for whiplash, like other ailments, should fall back on an algorithm based on reported pain and the chiropractor’s observations of the patient.

“The chiropractors should be weaning people off treatment,” he said, by helping the patient to engage in their own health rather than hoping a chiropractor can cure them using spinal adjustments alone. “You make a patient dependent on passive care.”

Burke’s criticism has drawn a sharp rebuke from some fellow chiropractors, including Allen Knecht of Portland, who was angry that Burke would try to derail their work with complaints to the media: “I’m disgusted by his behavior professionally.”

Vern Saboe, an Albany chiropractor and the chief lobbyist for the Oregon Chiropractic Association, who has served on a committee to add more detailed guidelines for treating whiplash, also begged to differ with Burke’s accusation.

Saboe said that he was the one defending the profession against unscrupulous chiropractic clinics he referred to as “PIP mills,” which prey on people injured in car accidents by quickly running up a tab on the personal injury protection of auto insurance policies.

Without a special section governing whiplash, these unethical chiropractors had been using a single vague reference to whiplash treatment that could potentially last “two to 12 months” to justify treating patients much longer than prudent.

He said the same ultimate standard as other chiropractic ailments would still apply -- patients must be re-examined and show improvement every 12 visits, and only special circumstances, such as ligament damage, would allow for reimbursement up to 56 weeks -- which he said was not a recommendation but merely the outer limit of observable value. “It must show a progression of care,” he said.

Saboe said his difference of opinion with Burke stemmed from his work examining insurance claims for plaintiffs, while he said Burke typically examined records on behalf of insurers.

“These are not treatment recommendations,” he said. “These won’t be perfect. They will be hugely better than what we have now.”

Burke said more chiropractors than just those at PIP mills were over-treating whiplash and the guidelines will only provide a framework to excuse overtreatment without providing any concrete standards to show patients were improving more than they would heal on their own.

The Oregon Board of Chiropractic Examiners decided last week to send the updated Oregon Chiropractic Practices and Utilization Guidelines back to the advisory committee for further revision. Saboe said that the revisions would mostly involve undoing editing errors by the full board as well as reinserting the algorithm that Burke stressed, which he said had been inadvertently deleted.

Joyce McClure, a Portland chiropractor and the vice-president of the Oregon Chiropractic Association, who has steered the committee revising the guidelines, declined to say when its work would be concluded or what she thought might be the final outcome.

“It’s not finalized,” McClure said. “I don’t want to be construed of aligning with either thought process.”

Correction: The article was edited to note that Michael Burke's criticisms were directed at members of the Oregon Chiropractic Association, but not necessarily the association as a whole. The article has also been corrected to note that whiplash entails more than just seat belt injuries.