“Chiropractic” (a name that in my mind should really be “chiropracty”) is a form of treatment for various disorders in which the cure supposedly comes from mechanical manipulation of the body, especially the spine. It is considered “alternative medicine,” and, as Wikipedia says, is of dubious efficacy for everything:
Many chiropractors (often known informally as chiros), especially those in the field’s early history, have proposed that mechanical disorders affect general health, and that regular manipulation of the spine (spinal adjustment) improves general health. A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as “doctor” but is not a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.). While many chiropractors view themselves as primary care providers, chiropractic clinical training does not meet the requirements for that designation. A small but significant number of chiropractors spread vaccine misinformation, promote unproven dietary supplements, or administer full-spine x-rays.
There is no compelling evidence that either primary or maintenance chiropractic adjustment is effective for any symptoms or diseases, including low back pain. A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study “fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.” Conclusions about cost-effectiveness are limited by low-quality studies, uncertainty about efficacy, and insufficient evidence.
There is not sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation.Several deaths have been associated with this technique and it has been suggested that the relationship is causative, a claim which is disputed by many chiropractors.
Here’s the meta-analysis article referenced by Wikipedia, click to access:
Part of the paper’s abstract:
Results Forty-five systematic reviews were included relating to the following conditions: low back pain (n=7), headache (n=6), neck pain (n=4), asthma (n=4), musculoskeletal conditions (n=3), any non-musculoskeletal conditions (n=2), fibromyalgia (n=2), infant colic (n=2), any medical problem (n=1), any paediatric conditions (n=1), carpal tunnel syndrome (n=1), cervicogenic dizziness (n=1), dysmenorrhoea (n=1), gastrointestinal problems (n=1), hypertension (n=1), idiopathic scoliosis (n=1), lateral epicondylitis (n=1), lower extremity conditions (n=1), pregnancy and related conditions (n=1), psychological outcome (n=1), shoulder pain (n=1), upper extremity conditions (n=1) and whiplash injury (n=1). Positive or, for multiple SR, unanimously positive conclusions were drawn for psychological outcomes (n=1) and whiplash (n=1).
Conclusion Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition
Based on the reports of fatalities associated with this procedure (see here for one study of 26 deaths from arterial dissection associated with neck manipulation), I would avoid this therapy: as the paper says, “The risks of this treatment by far outweigh its benefit.”
A new article in the NYT, however, while warning people of using chiropractic for most things, says that it can be useful in alleviating lower back pain. Click below to read it and you may find it archived here (I can’t access it). We thus have a contradiction between the paper and the analysis above.
From the article:
While chiropractors often refer to themselves as doctors, their degree is different from medical doctors.
To practice in the United States, chiropractors typically attend a four-year program where they take courses in basic science and lifestyle and nutrition counseling. They also learn how to perform manual adjustments, which involve putting pressure onto the joints and creating a deep stretch in the tiny muscles that connect the spine’s vertebrae, said William Lauretti, a professor of integrated chiropractic therapies at Northeast College of Health Sciences and a spokesman for the American Chiropractic Association.
(The popping sound heard during this adjustment is a result of gas being released from the fluid that surrounds your joints. While satisfying, Mr. Lauretti said the sound is not the goal of the adjustment.)
After training, chiropractors must pass a national board exam to be eligible for state licensure.
What chiropractors can and can’t do depends on where they practice. For example, in Oregon chiropractors are legally allowed to deliver babies (though they do so rarely) and perform very minor surgery, like stitches and removing skin tags. New York, which has stricter laws for chiropractors, requires them to focus to spinal conditions.
Many insurers will cover many services offered by chiropractors, including adjustments, nutrition counseling and X-rays. Medicare coverage is more stringent, often only covering adjustments, though chiropractors are lobbying Congress to change this.
The paper does say that they’re of some use for lower back pain, in contrast to the Wikipedia article, but I would still consult a genuine M.D. for any pain. As for neck pain, I myself would stay far away:
Chiropractors advertise their services for a wide range of conditions: back pain, arthritis, diabetes, asthma and ear infections. But what the research says chiropractors are effective at treating is doesn’t necessarily match up.
There’s robust evidence that shows chiropractic adjustments can be mildly to moderately effective at managing lower back pain, said Christine Goertz, a professor of musculoskeletal research at the Duke Clinical Research Institute and a licensed chiropractor. An analysis of 47 randomized controlled trials — often considered the gold standard of scientific evidence — determined that manual manipulation was equally effective as treatments like acupuncture or massage therapy.
The article referenced above is from the British Medical Journal, and you can find it here. Back to the NYT:
And the risks of side effects are low compared to some other common interventions, like anti-inflammatory medications and corticosteroid injections. Fractures or other serious complications from spinal manipulation are possible but rare, occurring in roughly 1 per 2 million manipulations, according to one study.
For that reason, spinal manipulation is often recommended as a first line of treatment for low back pain, including in guidelines from the World Health Organization and the Department of Veterans Affairs.
“It is at least as good as, or maybe a little bit better than, other care options for low back pain,” Dr. Goertz said. (Though, as skeptics note, treatments for lower back pain are not very effective in general.)
There is less evidence supporting the use of chiropractic treatment for neck pain. A review of six studies found that chiropractic adjustments did improve acute neck pain. However, the researchers noted that more research was needed to draw any firm conclusion, since many of the studies had only a small number of participants and other limitations.
Some doctors advise against manipulating the neck because of the potential risk of arterial dissection, in which vessels that supply blood to the brain are torn. This can lead to stroke or death. Some analyses have suggested an association between neck adjustments and this injury, but it’s not clear there is a causal link.
I don’t know of a causal link between the spine’s position and stuff like diabetes and ear infections, so I would never go to a chiropractor for anything. But I’m sure some readers have, and perhaps they’ve been helped, though there’s no blind test with individual readers’ cases. If you have experience with chiropractic, describe it below. Note: I am not touting this therapy; use your own judgement. As I said, I will never use it myself.
The article ends with a section on what you should look for if you’re shopping for chiropractors, but I’ll let you read that yourself.
I’ve seen chiropractors advertising the full menu–Come in and get an adjustment for your allergies! I consider it woo, not better than homeopathy, and would never go near one.
The risks may be low, but I would never go to a chiropractor. I know that the practice has changed over time, but I once looked through a textbook on the fundamentals of chiropractic—it was a book that a friend in chiropractic school was using. The principles espoused in the book were utterly unscientific and crazy. No thank you.
“equally effective as treatments like acupuncture or massage therapy.” This makes me wonder if at least some of the positive effects of chiropractic and other treatments that include hands-on manipulation (such as reiki) come from the stress-relief of human skin-to-skin contact. Would a deep hug be just as effective for asthma as spine manipulation? Also, from what I’ve seen in advertisements, many homeopathic treatment centers are designed to be stress-mitigating with soft music, comfortable chairs, sometimes even a fountain in the waiting room, while we all know what cold, uncomfortable, crowded and generally stress-inducing places medical practices can be these days.
I’ve had physiotherapy by trained physiotherapists, but they were ones I was advised to see from my doctor. The human body does get injured, and one often has to help it. But nothing silly, it usually just meant gentle exercises and the like. The physio mostly checked on progress.
Work and weightlifting injuries mostly.
I think the founder of chiropracty (I like that construction) started as a magnetic healer … lemmee see …
[ looks around …]
Hoo boy – this is a treat :
https://en.wikipedia.org/wiki/History_of_chiropractic
…I’m not sure if “physical therapy” (100% legit IMHO) treats the spine as such – but physical therapists know what they’re doing so the muscles get tone they need that “back problems” are likely related to.
It’s complex, but not impossibly so, that the gestalt of muscle tone/strength can adjust overall bodily “aches and pains” or whatever.
Talk to a physical therapist to see!