Have you wondered how the chiropractic field fits into the scheme of modern medicine? Is it alternative, complementary, or traditional? I’ve been to chiropractors a few times for back pain and came away better off than when I began.
But I wondered why there’s been so much controversy about the practice, and why there always seems to be “bad blood” between MDs and chiropractic doctors. Have things always been like this, or is there some new divide between these two professions?
And what is the effectiveness of chiropractic in general? Was my case typical or would I have been better off going to an MD or massage therapist? Now that my back pain, after 15 years of remission, has begun to make an encore appearance, I wanted to get to the bottom of what some call “the chiropractic question.”
Figure 1: Chiropractic factoids
Combing through scientific and medical journals is one thing, and usually just highlights the traditional bias that MDs have against all alternative medical techniques. So I had to dig deeper and find some unbiased sources that would give me the straight story about the effectiveness of chiropractic.
Thankfully, sources like YouTube, Mayo Clinic, WebMD and Quackwatch were on hand to help me piece together a balanced set of information and make a decision about where I’ll turn for my next round of back treatment.
So, what’s the verdict about chiropractic? The results of my research project surprised me.
Both Sides of the Chiropractic Controversy
There are about 70,000 chiropractors in the U.S., representing a segment of the economy that generates more than $14 billion annually. That’s big business by any measure. Does that mean chiropractic medicine is safe, effective and affordable?
In order to answer those questions, we need to define some terms and see what the other players in the medical community think. There have been some studies done to try and answer questions like these, which we will delve into below.
Figure 2: Some disadvantages of chiropractic treatment
Chiropractic is a healthcare modality that attempts to relieve pain, primarily along the spine, by using various types of physical manipulation. Bodily areas of treatment depend on the specific patient, but most commonly, chiropractors treat pain the back, neck, legs, arms, and headaches.
Chiropractors take pride in the fact that they use what they call “natural methods” of healing. They typically advise exercise, lifestyle improvements, better nutrition, and self-awareness about one’s state of health.
It’s not unusual for chiropractors to use herbal therapy in their practice, alongside massage, exercise therapy, general physical rehab, and sometimes nutritional analysis. A few also are licensed as acupuncture professionals.
Figure 3: Daniel Palmer “invented” chiropractic medicine in the 1890s
In the vast majority of cases, chiropractic visits will entail spinal manipulation, which means the chiropractor will put at least a little bit of pressure on your spine at some point in the procedure. These “spinal adjustments” are said to bring about better bodily function and relieve much pain. Sometimes a device is used for these adjustments, but it is also done with the bare hands. There might be other joints treated besides the spine, but the spine is the main point of encounter for most chiropractors. Pressure might be very soft or very strong, while the movement of the hands ranges between extremely slow and very fast.
Don’t be surprised if your chiropractor uses all sorts of different methods to increase “freedom of movement” of your joints. The other goal, besides improving movement, is to relax all the muscles along the treated joint. In addition to ultrasound, some chiropractors use electrical stimulation, heat and other methods to achieve their treatment goals. After the muscles are relaxed and the joints are able to move freely, the chiropractor usually begins to work on spinal manipulation. Treatment can also include ice, heat, biofeedback, relaxation therapy, braces, exercise, corsets and more.
Patients who go in for back pain are usually surprised as how painless the procedures are, especially if you are complaining of low-back pain and tightness. Some patients suffer from severe lower-back pain immediately after an auto accident or a fall. Sometimes after a visit to an emergency room, they are directed to see a chiropractor who specializes in post-accident pain treatment.
Be ready to give the chiropractor your health history and submit to a full medical exam if it is your first time to visit. You might need to have a few x-rays taken if you have certain types of pain complaints.
Because there are about 250 million separate chiropractic visits per year in the U.S. alone, it’s worth taking a closer look at exactly what the theory is behind this alternative form of medical treatment. The main philosophy of chiropractic is that “misaligned vertebrae” are responsible for putting undue pressure on spinal nerves. The thinking goes that this pressure is unhealthy because it disrupts normal “nerve signals” to the human body, thus leading to all sorts of diseases, pain and generalized medical maladies.
Soreness: One of the downsides of chiropractic treatment is soreness after a visit. This is usually the result of the body trying to adjust to what was done during the visit. Some patients complain of discomfort, more pain, headaches, swelling, and fatigue. When these symptoms do not abate after a few hours or days, or if they get worse with each visit, it is probably time to try another type of medical treatment for pain.
Figure 4: A section of a human spinal column
Bone damage: Another complaint among some chiropractic patients is bone damage. This is much more serious than fatigue and soreness. Because of the manipulative techniques used in chiropractic treatment, there can be nerve damage and bone fractures. People who suffer from previous vertebral problems, osteoarthritis, bone cancer, osteoporosis or bone fractures should be careful and think about consulting a doctor before deciding to have any kind of “spinal manipulation” therapy.
Most MDs and other medical researchers strongly suggest that children should not visit a chiropractor. Children’s bones are still growing and spinal manipulation can cause some serious problems for youngsters and infants.
Stroke: One of the biggest concerns that some people have about chiropractic involves the risk of stroke. It is a known fact that neck adjustments can lead directly to strokes in a limited number of cases. The risk is low, but because it does exist and has been shown to be valid in several studies, many doctors tell their patients to avoid chiropractic treatment that includes any neck adjustments.
Because of the risk of stroke, possible bone damage and various kinds of soreness, MDs often advise their patients to opt out of chiropractic care. This situation has led to a lot of animosity between the two professions, with chiropractors feeling as if their field of expertise is being denigrated, and the MDs believing that they are merely acting in the best interests of their patients.
Traditional MDs often point out that there is no scientific proof that spinal manipulation offers anything other than moderate relief from low-back pain. To make matters worse, chiropractors often lead their own patients to believe that spinal manipulation will solve or cure all kinds of medical problems, when research does not back up those claims.
Most impartial researchers believe that the lack of evidence for chiropractic treatment is the profession’s biggest drawback. One study showed that “more than half of all patients suffer mild to moderate adverse effects after seeing a chiropractor. These are mostly local and referred pains that usually last for two to three days. Chiropractors often claim that these are necessary steps on the road to getting better.” [Spectator, UK, Feb. 18, 2016]
Sadly, there are many cases where patients have been harmed by chiropractic treatment, and ended up having to have long-term rehabilitation care to reverse the damage. In some cases, the damage was permanent.
The biggest problem most researchers have with chiropractic is the lack of evidence of effectiveness, except for some types of back pain and headaches. The dilemma is that even though chiropractors are able to do some good, there are significant risks with spinal adjustment that likely outweigh those benefits.
In nearly all cases where a person can get relief from a chiropractor, that same patient can find identical, if not better, relief from a licensed physical therapist. PTs practice a form of medicine that is based on the scientific method, does not involve dangerous manipulation and high pressure on the spine, and has been shown to be effective for numerous types of bodily pain, not just back pain.
The bottom line is that chiropractic treatment is probably more of a risk than it needs to be, and because a patient can visit a physical therapist for about the same cost, there are safe options for people who want relief from pain.
Chiro Videos, Books and Links to Help You Decide
The following resources include videos, books and websites that offer additional information. Simply click on the hyperlinked resource title and you’ll be able to go directly to a live link for that particular item. Most book listings are from major online retailers like Amazon, Barnes & Noble, and others. All video links are sources from YouTube. Website links for the most part are informational, like WebMD, Wikipedia, and other authoritative business, health and medical resources.
None other than the New England Journal of Medicine recommends this book for doctors and their patients, in order to help them better understand all the major variations of “alternative medicine.” Not focused solely on chiropractic, this handy little book does cover it as part of the broader look at practices like acupuncture, holistic medicine and aromatherapy.
While the overall drift of “Trick or Treatment” is that the huge majority of alternative medical treatments are of no significant benefit, it does have a very few positive comments about chiropractic, namely that it can help lower-back pain in some instances.
For anyone who wants to know the traditional medicine view of all the popular alternatives out there, this is the book. “Physicians should recommend the book to their patients,” say the NEJM, which is quite an endorsement for a non-text of this kind.
More critical of the “alternative and complementary medicine” field than the “Trick or Treatment,” this heavily-researched look at all the non-traditional health fields is in many ways devastating. The main crux of the author’s argument is that most studies that tout “new science” fail to consider the placebo-effect.
It’s easy to make any kind of treatment, be it chiropractic or homeopathy, appear to be effective when research studies don’t use control groups who receive no therapy, or false treatment. As a result, most claims by alternative medicine advocates are tainted from the start because the research is faulty.
What does this mean for the complementary medicine field in general? Mainly that it is based on non-science, wishful thinking, and “cures” that typically amount to short-term emotional states. Headaches, back pain, and even some skin conditions can be “cured” by the mere suggestion that a valuable treatment is being employed. Apparently, we humans really do want to believe that medical experts know what they’re doing and that medicine is effective.
Here is a rare find: an MD who has good things to say about the “mind-body” connection and how it can work in our favor for conditions like back pain, headaches, etc. Not a dismissal of chiropractic but quite the opposite, this is one book written by an MD that most chiropractors will be happy to read.
The doctor-author explains that authentic research has shown a verifiable link between back pain and psychological states, as well as stress. It’s not all physical, at least in the beginning of the ailment, he says. Does this bolster the chiropractic philosophy? Without doing so explicitly, it does indeed.
In important ways, the author’s system for treating chronic pain is more psychology than anything else. He suggests getting rid of negative emotions, critical states of mind, emotional baggage and you’ll be on your way to better physical health. The mind and the body are inextricably linked in countless ways, and the doctor wants us to know that the first step to a pain-free life is the elimination of stressful mental states. It might not all be “in your head,” but he suggests that it all begins there.
For advocates of chiropractic treatment, here are a few dozen exercises that you can do yourself, in the privacy of your bedroom or den, that might help eliminate head, neck, back and shoulder pain. Written by a chiropractor who advocates exercise and a healthy lifestyle, in addition to regular check-ups, the book offers a clear roadmap for a way out of chronic pain.
Don’t be put off by the publication date (1997) because most of these exercises are effective, and used by both chiropractors and physical therapists for older patients who suffer from various types of bodily pain.
There’s nothing groundbreaking or controversial here, and the exercises are clearly illustrated with lengthy descriptions as to what they are supposed to do in each case. If you’ve ever had physical therapy after a car accident or for pain, you might recognize several of these routines, but it’s nice to have them in a book format for easy reference.
From a pro-chiropractic point of view, this is the profession’s defense, of sorts, against all the arguments against it. Written in an easy-to-read style and not bogged down in medical jargon, the “War” lays out the many arguments that traditional science has hurled against the chiropractic profession since the early 1900s.
Honest and forthright, the author attempts to defeat each criticism. Whether he is able to effective save the reputation of his profession is an open question. Some reviewers feel he missed the mark, while others believe he did a bang-up job of polishing the face of chiropractic medicine.
The chilling tale of the legal war between the AMA and the chiropractic field is one that most people have no idea about. This telling is of course biased toward the chiro side, but it’s still a gripping drama of legal intrigue, character assassination and spy-novel conclusions.
Always trying for the “balanced approach,” Time magazine never seems to be able to make up its mind or take a stand on any contentious issue. But that wishy-washy journalistic tradition does not detract from this comprehensive piece on the world of chiropractic medicine. Is it junk science or the best new way of treating chronic pain?
Time offers up a routine list of criticisms of the chiropractic, but then details a couple of studies that imply the non-traditional approach is the most effective one for lower-back problems. In the end, however, the piece weasels out and offers the perennial Time conclusion that “more research is needed.”
Still, the piece offers a solid overview of the chiropractic profession, the key criticisms against it, and the profession’s answers to those arguments. If you want to see the “big picture” of the modern chiropractic debate, this short article is the way to go. But, “more research is needed…” (Not really).
In contrast to Time Magazine’s “nice” discussion about the controversies of the chiropractic field, this academic paper by a PhD makes no bones about the real “war” going on. A single pull-quote summarizes the author’s view: “Although it has existed for nearly 100 years, the chiropractic health-care system has failed to meet the most fundamental standards applied to medical practices: to clearly define itself and to establish a science-based scope of practice. More disturbing is the fact that chiropractic has made no contribution to the worldwide body of knowledge shared by the health sciences and continues to isolate itself from the mainstream of the health-care community.”
Words like “disturbing” and “troublesome” pepper the study, and you’ll likely come away with a newfound skepticism about all things chiropractic. For those who like to dig deep, view lots of details and have a bibliography for more research, this little piece is a goldmine of data and facts.
Do you want a 4-minute video class on chiropractic? This is the one, but be warned that it is of the “anti” variety. There are no smiling DCs in white coats showing us how to relieve back pain. This is the straight stuff, a laundry list of sorts that packs a punch. Watch the author as he delves into the history of chiropractic medicine, explains what he sees as its extremely weak foundations, and delivers a devastating critique of the field’s founder.
As chiro critiques go, this short little video goes right for the jugular, but don’t miss the comments by several chiropractors who weigh in to voice their objections.
Almost 40 years ago, the classic TV show 60 Minutes did a piece on chiropractic that set off a modern-era debate about the profession. Know up front that (a very young) Mike Wallace touched a few nerves of the chiropractors he interviewed, as is the way with all 60 Minutes critiques.
Wallace and company venture into a college of chiropractic medicine, interview teachers and students for an earful of astounding statements. It’s almost as if Mike just lets the chiropractic advocates take as much rope as they want and hoist themselves high with it. Not for the squeamish, this was back in the day (for those of you under 50) when 60 Minutes was a much, much more aggressive reporting program.
But, almost a half-century later it still looks like dynamite, and delivers the goods, as Mike always did. No mater your age, this is fascinating viewing.
Fast-forward to modern “medical TV” shows, a genre that rarely does analytical pieces, refrains from controversial topics, and tends to offer “happy talk” to smiling studio audiences. “The Doctors” is one example. Its recent discussion of chiropractic medicine was a mostly positive look at the “modern” profession, even though the host never explained why today’s chiropractic is different from that of Mike Wallace’s 60 Minutes’ piece.
The bottom line here is much like the Time Magazine story. Chiropractic has its uses and as long as we know its limitations, so the narrator explained, it has its place alongside traditional, science-based medicine.
Much has been made of a Journal of the American Medical Association article that spoke of chiropractic in a non-committal way. Many chiropractors appear to have misinterpreted the article’s main points and have been referring to it as “evidence” that the mainstream medical community now fully accepts chiropractic techniques.
The linked article gets to the bottom of this small but revealing controversy, and illustrates just how the chiropractic profession seems to want vindication from those traditionalists it routinely dismisses as “dangerous” and “money-hungry.”
Facts and Fiction about Chiropractic Medicine
Myth: A standard chiropractic “adjustment” makes your spine emit a cracking sound.
Fact: Most chiropractors know how to adjust the human spine in order to decrease pain and return normal function after muscle spasm or muscle tightness as the result of an accident or other event.
Myth: Once a patient goes to a chiropractor, they have to return for many hundreds of visits.
Fact: Every patient has a different treatment plan based on their own case, and while there are serious situations that call for many repeat visits, some patients only need a few sessions with a chiropractor to make them well. Something like a minor car accident or over-working a muscle during exercise are common problems that usually only need a few sessions for effective remedy. Other, more serious problems might need a long-term approach for relief.
Myth: Chiropractors only deal with the back.
Fact: They are licensed to work on the entire body, wherever there are joints. Ankles, shoulders, fingers, wrists, the spine, elbows, knees and many more spots are typical areas where chiropractors work. They also treat many “whole body” pain maladies, ligament issues, and osteoarthritis-related difficulties.
Myth: Chiropractors are not “real” doctors.
Fact: In the U.S., chiropractors are indeed able to legally refer to themselves as “doctors.” Sometimes you’ll hear the term “chiropractic physician,” which is also legally allowed. Only a very limited number of healthcare workers are allowed to refer to themselves as “doctor” in the U.S., including MDs and osteopathic physicians.
Myth: All neck adjustments are dangerous and should be avoided.
Fact: There has been a vast body of research on neck adjustments. While there are rare cases of complications, most side effects tend to be quite benign. It is not unusual for a patient to have temporary soreness, for example, after a neck adjustment.
Myth: You need to have an MD refer you to a chiropractor.
Fact: Chiropractors are able to treat you as a first-provider, just as an MD or dentist can. Any patient can go directly to a chiropractor and make an appointment. Keep in mind that many chiropractors work in tandem with MDs on chronic back-pain cases and other, similar problems. In fact, both MDs and chiropractors often refer patients to each other when they believe the other professional is more equipped to deal with the specific situation that is causing the patient discomfort or pain.
Some medical writers say “the jury is still out” on chiropractic, which is strange because the discipline has been around for more than 100 years. That’s a pretty elderly jury!
Fortunately, the majority of unbiased literature on the subject is pretty clear: the jury is not “still out.” The jury has made a decision and the decision is unambiguous. Chiropractic medicine has its uses for low-back pain, some types of headaches and a few other maladies, but that’s about it. It is not a full-blown field of “medicine” nor is its core philosophy based on sound science.
Tellingly, many in the field has used recent literature in a misleading way to make it appear that traditional medical science views chiropractic as a “first stop” for patients who suffer back pain. But there’s more.
After a 100-year war by the mainstream medical community against chiropractic practitioners, there appears to have been a bit of a truce, with some MDs now saying publicly that chiropractic has its place as a sort-of physical therapy when used judiciously.
To be honest, these new admissions appear to be nothing more than an attempt to halt the war of words that was the status quo for a century. Ask your own MD and see what he or she thinks of the chiropractic profession. It’s hard to find a practicing physician that has routinely positive things to say, and most will warn their patients that alternative forms of medicine can be dangerous.
As for me and my returning back pain, I’ll be heading to a licensed physical therapist this time around. As one of prominent medical researcher said, “Chiropractors are physical therapists with delusions of grandeur.” I’ll take a licensed PT over a chiropractor and won’t lose a minute of sleep about the decision. For me, the jury has reached a verdict.
We do not offer medical advice of any kind, so if you have a concern about your state of health, be sure to speak with a physician or other medical professional. This article is for general informational purposes only and is not intended to be any kind of official medical guidance.
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