Chiropractic treatment is a form of massage that involves applying pressure to your joints to “crack” them back into place.
Chiropractic supporters believe aligning your joints in this way allows your nervous system to function optimally, curing you of disease and defect.
In other circles, though, chiropractic is synonymous with quackery.
Naysayers claim that chiropractic is a pseudoscience based on the madcap teachings of its founder and is ineffective and potentially dangerous.
Is chiropractic care a legitimate medical treatment or hapless hoodwinkery?
Here’s what science says.
Chiropractic care is a complementary and alternative medicine (CAM) based on the idea that a chiropractor (someone who practices chiropractic treatment) can realign subluxations (misaligned joints) using chiropractic massage.
Typically, a chiropractor manipulates the spine, though they may also manipulate the joints in the arms and legs. Advocates believe these “chiropractic adjustments” can relieve pain and heal disorders affecting your nervous, musculoskeletal, and organ systems.
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According to most sources, chiropractic was founded on September 18, 1895, when alternative medicine practitioner and magnetic healer Daniel David Palmer restored a deaf man’s hearing by realigning his vertebrae.
The following year, Palmer opened the first school of chiropractic, where he taught a system of healing based on the premise that the body requires unobstructed flow through the nervous system to function well.
In other words, he taught that misaligned joints—particularly in the spine—were the cause of all disease and dysfunction and that chiropractic adjustment was the sole cure.
Initially, chiropractic was a success—by 1925, more than 80 chiropractic schools had opened in the US. Over the following decades, though, the gap between conventional medicine and chiropractic widened (chiropractors disputed germ theory, for example).
By the mid-1960s, the American Medical Association (AMA) instituted a boycott of chiropractic in which they forbade medical doctors from associating with the discipline because they felt that it was an “unscientific cult . . . [that] constituted a hazard to health.”
Tensions continued to escalate until 1987 when sections of the US medical establishment were found guilty of conspiracy against chiropractors, a decision the US Supreme Court upheld in 1990.
Despite this victory, the increased attention on chiropractic highlighted the divisions that had plagued the community since its conception.
Specifically, it made people aware that there are two prevailing philosophies within chiropractic.
On one side are “straights,” chiropractors who strictly adhere to Palmer’s teachings and view subluxations as the cause of all diseases and chiropractic adjustment as the only remedy.
And on the other side are “mixers,” those who are open to more modern scientific theories, use treatments other than chiropractic adjustment to heal patients, and typically class chiropractic as a means to treat back pain only.
To this day, this split persists, with The International Chiropractic Association representing straights and the American Chiropractic Association representing mixers.
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Because there are two broad modes of thought within the chiropractic community, the supposed benefits of chiropractic treatment can differ significantly between chiropractors. That is, chiropractors often disagree about what chiropractic treatment can remedy and what is beyond its remit.
As such, not all chiropractors believe in all of the following benefits of chiropractic.
Nevertheless, these are the most commonly cited benefits associated with chiropractic care and what science says about each.
Before we look at each of these claims, I want to add the caveat that many people subjectively report that chiropractic helps ease their pain, and even if this is due partly or wholly to the placebo effect, it shouldn’t be discounted. What’s more, since chiropractic is generally safe when performed properly, it may be a worthwhile option for some folks.
That said, it’s also worth objectively appraising the research so you understand what to expect from chiropractic treatment and if it’s worth the expense.
Most research shows that low-back chiropractic adjustment eases symptoms of short- and long-term low-back pain about as well as standard medical care or exercise-based treatments (which often include strengthening exercises and stretching).
Since low-back chiropractic adjustment costs slightly less than other massage treatments, it may be a viable treatment option for low-back pain.
That said, other research suggests chiropractic is no more effective at treating back pain than placebo, which means there’s a chance that any improvements you experience after chiropractic treatment are a placebo effect.
Research shows that spinal manipulation is more effective than pain medication and about as effective as strengthening and mobility exercises for treating neck pain, though it’s unclear whether getting chiropractic treatment and performing exercises is better than doing exercises alone.
Two reviews suggest that the best course of action to treat neck pain is a combination of treatments, including a mix of medication, massage, ultrasound, physical therapy, education, and exercise. In these cases, it’s impossible to know how much chiropractic treatment contributes to your improved symptoms, though.
Studies looking at chiropractic for whiplash are generally of poor methodological quality, which means they were badly designed and may make chiropractic seem more effective than it is. This makes it difficult to draw firm conclusions about its efficacy in treating whiplash.
That said, the little research we have is generally favorable.
A review of six studies found that there’s no evidence chiropractic massage effectively treats shoulder pain.
Despite 61% of UK chiropractors believing that chiropractic treatment can alleviate symptoms related to the digestive system, there’s limited evidence this is the case.
Two systematic reviews identified just two studies supporting the claim, though both were of questionable methodological quality: one scored 1 and the other 0 on the Jadad scale, a system used to assess the quality of research from 0-to-5, with 0 being “very poor” and 5 being “rigorous.”
As such, the authors of the reviews concluded that there’s no scientific evidence that chiropractic can treat gastrointestinal problems.
Because of the lack of adequate medical interventions for autism, many parents take complementary and alternative routes to treat their autistic children. According to some estimates, 88% of autistic children in the US have used complementary and alternative medicines, with chiropractic being among the most popular.
Two reviews have investigated the effect of chiropractic treatment on autism: one conducted by scientists at the University of California and the other authored by prominent “straight” chiropractors Joel, Joey, and Junjoe Alcantara.
While both reviews acknowledged that there’s little evidence to suggest that chiropractic is an effective treatment for autism, the authors of each arrived at slightly different conclusions.
The review from the University of California concluded that we should discourage the use of chiropractic as an autism treatment because there’s no evidence it works and it may be unsafe, which seems sensible.
The review written by the brothers Alcantara, on the other hand, concluded that despite having no evidence it’s effective or safe, parents of autistic kids may still want to give chiropractic a shot. That said, these authors aren’t exactly impartial, so it’s wise to be wary of their conclusions.
Chiropractic for Immune Function
In early 2020, the International Chiropractors Association (ICA) reported that chiropractic care could boost immune function, implying it could reduce your risk of becoming unwell with COVID-19
In response, more than 150 scientists who specialize in chiropractic research cosigned a report refuting the claim on the grounds that there’s no evidence chiropractic care affects immune function.
In this case, there simply isn’t much evidence for or against chiropractic, so it’s hard to know how much it does or doesn’t help.
That said, some research suggests that asthma patients who undergo chiropractic treatment feel subjectively better and suffer fewer asthma attacks as a result. Given the paucity of evidence showing an objective improvement in asthma symptoms, it’s reasonable to assume that any subjective benefits are partly or entirely due to the placebo effect.
A 2020 meta-analysis found that chiropractic care may reduce the frequency of migraine attacks and the pain sufferers experience to a small degree. However, studies on the effect of chiropractic on migraines tend to be wildly different from one another and of varying quality, which makes them difficult to compare and evaluate as a whole.
As such, it’s still too early to say that chiropractic effectively treats migraine.
Furthermore, other research shows that chiropractic care is no more effective than placebo care, suggesting that any improvement in migraine frequency or severity is likely due to the placebo effect.
There’s no evidence that chiropractic treatment aids weight loss, nor is there any theoretical basis for why it would.
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In one 2017 review of 250 studies published in Chiropractic & Manual Therapies, researchers found that serious adverse incidents, including spinal cord injuries (resulting in disorders such as paraplegia and quadriplegia), worsening of disk herniations, and diaphragmatic paralysis, occur in 1 out of every 2 million manipulations to 13 per 10,000 patients.
Less serious incidents are more common, occurring in 23-to-83% of patients. These events included increased pain or discomfort, stiffness, headache, dizziness, tiredness, lightheadedness, or tingling or numbness in the arms. In most cases, these symptoms resolve within 24 hours of receiving treatment.
In another study conducted by scientists at Copenhagen University Hospital, researchers reviewed 118 studies and found that 46% showed spinal manipulation was safe, 13% showed it was harmful, and the remaining 42% indicated that it was unclear whether it was safe or not, or that it was neutral.
As such, the researchers reported that it’s impossible to provide an overall conclusion about the safety of spinal manipulation but that it’s associated with some level of risk. A third review echoed this opinion.
In the main, the quality and safety of chiropractic treatment is dictated by the practitioner. Thus, saying chiropractic is unsafe because of several incompetent or overzealous chiropracters made their patients feel worse is just as silly as saying dentistry is a fraud because many of them unnecessarily recommend removing your wisdom teeth.
Do your homework on the chiropractor by looking at online reviews and talking to people who’ve used their services before, ask pertinent questions, and be willing to speak up if they do something that you aren’t comfortable with.
Some parts of the chiropractic community claim they can cure all ills using chiropractic massage alone, but this is nonsense, and even many other chiropractors dismiss this as eyewash.
Science tells us that chiropractic treatment may offer a small benefit to those who suffer from back and neck pain or migraines, but there’s little evidence it’s useful for much else. Moreover, serious injuries may occur during chiropractic adjustment, making it riskier than other treatment options.
Given that there are more effective and safer treatment options for many of the above conditions, it’s probably worth exploring other options before relying on chiropractic care.
Many chiropractors claim that misalignments in your body cause “bubbles” of toxins to gather around your spine and joints. During chiropractic adjustment, a chiropractor bursts these bubbles, “detoxifying” your body.
There’s no scientific evidence that this is true, meaning it’s impossible to say which toxins (if any) your body releases after chiropractic adjustment.
There’s some evidence that chiropractic treatment can ease symptoms of back, neck, and migraine pain, though there’s little reason to believe it can help you in any other capacity.
Most chiropractors study for 6-to-8 years beyond high school: 3-to-4 years to earn their bachelor’s degree and a further 3-to-4 years to earn a doctorate degree.
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