Contour Analysis Is a Marketing Gimmick
Stephen Barrett, M.D.
Contour analysis—also called moire contourography—is a photographic technique that highlights body contours. A moire effect is obtained by passing an angled light through a grid to the surface of the patient's body . The resultant picture resembles a topographic map. The greater the number of concentric lines, the greater the elevation from the furthest part of the body. Reproducible results can be obtained if the patient is positioned carefully, but even slight shifts in position alter the patterns.
Many chiropractors claim that moire patterns provide valuable information to detect "spinal faults" and measure the progress of their treatment. However, no scientific study has shown them to be clinically useful. Patterns that depart from the "ideal" are easily produced by positioning the patient poorly. After treatment, correction of these "abnormalities" can be demonstrated with another examination in which the patient is appropriately positioned. The ad below, taken from the yellow pages of a telephone directory, illustrates how a "free preliminary spinal examination" with contour analysis is used to attract patients.
The claims made by users and manufacturers of contour-analysis devices range from wishful thinking to complete bunkum. One marketer, for example, claims that the procedure: "reveals distortions, fixations, pronations, muscle imbalance, muscle spasms, anomalies, spinal dynamics"; enables chiropractors to "know where and when to treat . . . when not to treat"; and provides "before-and-after proof of treatment." An article used to promote this device states that contourography can "reveal distortions . . . that could irritate spinal nerves and interrupt the flow of energy along [acupuncture] meridians." Another article claims that the device produces "stress patterns [that] resemble fingerprints and are just as individual and revealing to the chiropractor as fingerprints are to an FBI agent."
Criticism by Chiropractors
Chiropractic leaders in both the United States and Canada have criticized the use of contourography in everyday practice. The Mercy Conference report, produced by experts who attended a consensus conference in California in 1992, concluded:
Patient positioning is very important . . . . as the grid-to-patient distance relationship must be kept constant in order to achieve adequate follow-up evaluations. It is . . . reproducible, but the findings are difficult to quantify and no good correlation to physical findings exists. Adequate correlation is therefore lacking .
A similar Canadian conference held in 1993 concluded:
Moiré contourography has some usefulness as an investigational procedure, but its clinical utility has not been demonstrated. Its application is . . . reproducible, but the results are difficult to quantify and the correlation with physician findings is poor .
The Bottom Line
Thus, routine use of contour analysis for screening patients should be regarded as a marketing gimmick because no clinical use has been scientifically validated.
- Spector B and others. Manual of Procedures for Moire Contourography. Old Brookville, N.Y.: New York Chiropractic College, 1979.
- Haldeman S and others, editors. Guidelines for Chiropractic Quality Assurance and Practice Parameters. Gaithersburg, Md.: Aspen Publishers, Inc., 1993.
- Henderson D and others, editors. Clinical Guidelines for Chiropractic Practice in Canada. Toronto: Canadian Chiropractic Association, 1994.
This article was posted on October 11, 2001.