Chiropractic is a health care profession that focuses on the diagnosis and treatment of musculoskeletal disorders, especially those affecting the spine. Chiropractors use spinal manipulations, mobilizations, and other techniques to adjust misaligned vertebrae or joints. The goal is to restore the body’s natural ability to heal itself without drugs or surgery. However, chiropractic remains controversial, with ongoing debates about its effectiveness and safety. This article examines the evidence on whether chiropractors help relieve pain and improve health outcomes or if their treatments make things worse.
What conditions do chiropractors treat?
Chiropractors treat a wide variety of conditions, the most common being:
- Low back pain
- Neck pain
- Joint dysfunctions of the arms and legs
- Headaches and migraines
- Sports injuries
They may also claim to treat problems like asthma, ear infections, infant colic, and more, although evidence is lacking for benefits beyond musculoskeletal conditions. Many people see chiropractors for general health maintenance and the prevention of illness.
How do chiropractors treat patients?
Chiropractic treatment involves manually applying controlled force and movement to joints and the spine. The most common approaches include:
- Spinal manipulation: Using the hands or small instruments to apply force to a joint to restore mobility.
- Mobilization: Gentle movements of joints within their normal range of motion.
- Soft tissue therapies: Massage, trigger point therapy, or muscle release techniques.
- Adjunctive therapies: Heat/ice therapy, electrical muscle stimulation, therapeutic ultrasound.
Treatment plans involve multiple sessions per week over several weeks or months. Sessions include the chiropractic adjustment along with other modalities.
Do chiropractors receive medical training?
Yes, chiropractors complete extensive medical education and clinical training:
- 4-year undergraduate degree.
- 4 years at an accredited chiropractic college.
- At least 4,200 hours of classroom, laboratory, and clinical experience.
Coursework covers subjects like anatomy, physiology, microbiology, pathology, neurology, radiology, nutrition, public health, manipulative techniques, and more. Students must pass national board exams to obtain their license. Chiropractors are primary care professionals focused on conservative treatment. They are not medical doctors and cannot prescribe medication or perform surgery.
Is there evidence that chiropractic works?
Research shows that for some conditions, spinal manipulation and mobilization techniques used by chiropractors can be helpful, especially for short-term pain relief. However, results are mixed and more rigorous studies are needed:
Low back pain
- Evidence suggests chiropractic provides moderate relief of acute or subacute low back pain. Benefits seem equivalent to other conservative therapies.
- For chronic back pain, studies find limited to no benefit from chiropractic treatments.
- Spinal manipulation alone shows little advantage over mobilization techniques that physical therapists can provide.
Neck pain
- For acute neck pain, research indicates that spinal manipulation can provide immediate and short-term relief.
- Results are inconsistent for chronic neck pain. More studies needed.
- Evidence does not show chiropractic as more effective than exercises, physiotherapy, or analgesics for neck pain.
Headaches and migraines
- Spinal manipulation may have a small therapeutic effect on tension or cervicogenic headaches.
- Studies do not support chiropractic for preventing or treating migraine headaches.
- More rigorous trials needed for all headache types.
Other conditions
- Evidence is lacking to support chiropractic for treating non-musculoskeletal issues like asthma, gastrointenstinal problems, ear infections, bedwetting, etc.
- More research is needed on its effectiveness for extremity joint conditions.
What are the risks associated with chiropractic treatment?
Chiropractic adjustments and mobilizations are generally safe when applied appropriately by a trained professional. However, there are some risks:
- Mild discomfort, soreness, or headaches for 24-48 hours after treatment.
- Temporary worsening of symptoms before they improve.
- Serious complications like stroke are rare (estimated at 1 in 500,000 to 2 million manipulations).
- Disc herniation or cauda equina syndrome can occur but are very uncommon.
- Rib fractures, especially in older people with weak bones.
Proper diagnosis and technique reduce risks. Chiropractors should avoid manipulating the neck of patients with a history of stroke or certain coagulation disorders. Risks seem substantially lower from mobilization techniques.
Do chiropractors ever make invalid health claims?
Some chiropractors make questionable claims that are not backed by evidence:
- Treating conditions like autism, ADHD, asthma, infertility, ear infections.
- Providing extensive pediatric care beyond musculoskeletal issues.
- Touting spinal adjustments as a cure-all treatment.
- Claiming to boost immunity through chiropractic.
- Selling long treatment plans not supported by research.
These types of unsubstantiated claims can mislead patients and potentially delay necessary medical treatment. However, such practices do not apply to all chiropractors.
Are chiropractors viewed as mainstream health care?
Perspectives on chiropractic vary:
- In the U.S. and some other countries like Canada and Australia, chiropractic has gained mainstream acceptance.
- The American Medical Association opposed chiropractic in the past but now recommends using non-drug, non-surgical treatments like chiropractic first for low back pain.
- The American College of Physicians recommends spinal manipulation as an option for acute or subacute low back pain.
- Government health plans like Medicare cover chiropractic care.
- WHO guidelines recognize spinal manipulation as effective for lower back pain.
- Some medical doctors remain skeptical of chiropractic care.
- In countries like the UK and Germany, chiropractic is not fully integrated into mainstream health care.
Overall, chiropractic appears to be growing in acceptance as a conservative therapy for certain musculoskeletal conditions, especially back and neck pain.
Conclusion
Research shows chiropractic treatment can provide relief for lower back pain, neck pain, and headaches. However, evidence demonstrates limited benefit for many other conditions they claim to treat. While serious risks from spinal manipulation are low, mild side effects are common. Some chiropractors also make unproven health claims that may misinform patients. More high-quality studies on chiropractic approaches are needed. For musculoskeletal complaints, chiropractors can be one part of a comprehensive treatment plan. But for other health issues, it’s best to rely on standard medical care.