Chiropractic is a complementary medical practice that treats problems with the musculoskeletal system. Its main focus is spine care. The musculoskeletal system is made up of a person’s muscles, bones, joints, cartilage, and tendons. It supports a person’s body, allows them to move, and protects their organs.
Traditionally, chiropractic was based on the belief that problems with the musculoskeletal system caused disease through the central nervous system. This belief is no longer officially part of the practice.
This article explores chiropractic manipulation and the scientific evidence available to support its effectiveness. It also considers safety and what to expect at a chiropractic adjustment appointment.
What is chiropractic manipulation?
Chiropractors apply hands-on therapy for musculoskeletal conditions.
The word chiropractic comes from the Greek words cheir (hands) and praxis (practice). As the name suggests, it is a hands-on therapy.
Chiropractic manipulation is the application of pressure to a person’s spine or other parts of their body by a qualified chiropractic doctor, or chiropractor. This pressure allows a chiropractor to adjust and correct alignment.
Chiropractic manipulation aims to reduce pain and improve mechanical function, or the way a person moves.
The basis of chiropractic manipulation
Modern chiropractic is based on a spinal care model. But chiropractic manipulation has its roots in less scientific theories.
Historically, chiropractors believed that a misaligned spinal column could cause disease. This was thought to happen via the central nervous system and something called “innate knowledge”.
The theory was called “vertebral subluxation complex”. Early practitioners believed 95 percent of diseases were caused this way. They believed that chiropractic manipulation would correct problems in the musculoskeletal system and, in turn, cure disease.
Skeptics and scientists found this belief to be lacking in scientific basis. Early chiropractors also rejected the germ theory of disease and immunization. As a result, chiropractic lacked legitimacy in the eyes of the scientific community.
Chiropractic theory has since evolved. It is becoming more accepted as a treatment for musculoskeletal pain.
In 2009, a study published in the journal Chiropractic & Osteopathy explored the theory behind vertebral subluxation complex. It concluded that there was a lack of evidence to fulfil the basic criteria of causation. This meant it was unscientific for chiropractors to claim disease was caused this way.
In 2014, The International Chiropractic Education Collaboration put out a position statement making it clear that the profession no longer supported the vertebral subluxation complex theory:
“The teaching of vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historical context is therefore inappropriate and unnecessary.”
The statement also clarified that a number of chiropractic education institutions do now support the World Health Organization’s (WHO) immunization mission.
In 2016, an article in Chiropractic & Manual Therapies advocated for a new approach to chiropractic that would leave behind its “bad” unscientific elements. Aspects of the profession to be left behind included:
- adherence to a flawed chiropractic ideology focusing on innate intelligence and vitalism
- claims of cures for visceral and other non-musculoskeletal conditions
- anti-vaccination propaganda
- anti-drug and anti-medicine propaganda
- an unhealthy disregard of clinical research, evidence-based practice, and non-specific treatment effects including natural history and the placebo effect
The article went on to lay out a ten-point plan for modernizing the profession. This notably included the need for chiropractors to become “solely musculoskeletal practitioners with a special emphasis on spinal pain”.
Modern chiropractors have, for the most part, left behind the belief systems that claimed spinal therapy could cure unrelated illnesses.
Types of chiropractic practitioner
Although the chiropractic profession has evolved, there are still some chiropractors that believe in unscientific theories.
Chiropractors who hold on to beliefs that the rest of the profession has left behind are referred to as “straights”.
Before making an appointment with them, it is a good idea to find out whether a chiropractor takes a modern or straight approach. This way, a person can make an informed decision about the sort of treatment they are due to receive.
People with musculoskeletal problems may also want to consider:
- physical therapy
- exercise therapy
- other medical treatments
It is always a good idea to discuss treatment options with a doctor before deciding which route to take.
Chiropractic adjustment appointment
Treatment from a chiropractor will often focus on the spine and use massage, heat/cold, and relaxation techniques.
When a person first visits a chiropractor, they may ask questions about musculoskeletal pain.
The chiropractor will then examine the person physically, focusing on their spine. The chiropractor may also perform other tests, such as X-rays, to determine the necessary treatment.
If treatment is needed, the chiropractor will develop a treatment plan. Treatment normally involves using the hands or a device to quickly apply controlled force to a joint. The aim of this is to improve the quality and range of physical movement.
Other treatments the chiropractor may offer include:
- heat and ice
- electrical stimulation
- relaxation techniques
- exercises
- counselling around lifestyle factors that affect musculoskeletal health
- dietary supplements
Does chiropractic adjustment work?
There is growing evidence to suggest that chiropractic manipulation may be an effective treatment for:
Neck pain: According to a 2017 literature review, chiropractic workplace interventions may reduce self-reported mechanical neck pain among office workers.
Lower-back pain: A 2016 study found moderate evidence that chiropractic care may be as effective for lower-back pain as physical therapy. A 2017 systematic review found that spinal manipulative therapy was associated with modest improvements in pain and function for those with lower-back pain.
Chest pain: A 2016 study found chiropractic care to be more cost-effective than self-management for chest pain. It can be seen as a good primary care approach for those with non-specific chest pain.
As the profession has evolved, chiropractic has gained legitimacy as a complementary medical practice. In some countries, it is now considered to be part of mainstream medicine.
In Switzerland, chiropractic is now considered a primary medical profession. According to a 2016 article, the training programme chiropractors go through in Switzerland sets them up to become experts in primary spine care.
There is no evidence that chiropractic works as a treatment for health conditions that do not relate to the musculoskeletal system.
Safety of chiropractic adjustment
Chiropractic adjustment involves manipulating the spine. This may cause mild side effects such as:
A 2007 study looked at the safety of chiropractic care for neck pain. It found that although side effects were common, they were rarely severe or long-lasting.
The study concluded that the benefits of chiropractic* care for neck pain outweigh the potential risks.
Research also suggests chiropractic* manipulation is safe for those with lower back pain. A 2016 study found no serious side effects of chiropractic* care for lower back pain.
What’s the truth about chiropractors?
While chiropractors are widely known for treating back and neck pain, they also treat bone and soft tissue conditions.
In this article, we explore myths and truths of chiropractic care. We also describe the training that chiropractors undergo, how safe these treatments may be, and the research behind the practice.
What certifications must chiropractors have?
A chiropractor’s work involves making adjustments to reduce back pain.
A common myth is that chiropractors do not undergo a significant amount of training.
In fact, they typically complete about 8 years of higher education before they are licensed.
Chiropractors tend to have 4 years of undergraduate education.
They usually graduate with a pre-med major after having taken courses in sciences, such as biology, chemistry, psychology, and physics.
They then attend a chiropractic* graduate program. On average, these involve 4 years of education with a total of 4,200 instructional hours in course credits.
Chiropractic program specifics
Divided by year, a chiropractic graduate program usually involves:
- First year: Courses in general anatomy, chiropractic principles, biochemistry, spinal anatomy.
- Second year: Courses in chiropractic procedures, pathology, clinical orthopedics, imaging interpretation, and research methods.
- Third year: Courses in clinical internships, integrated chiropractic, pediatrics, dermatology, practice management, and ethics and jurisprudence.
- Fourth year: A clinical internship, in which a student studies under a chiropractor and completes rotations in a hospital or veterans’ clinic.
Other studies often accompany those mentioned above.
After completing the educational and training requirements, an aspiring chiropractor in the United States will sit for their state licensing board. Once they have obtained licensure and certification from the board, they will become a doctor of chiropractic.
Chiropractors often receive additional training and certification in a wide variety of specialties, including nutrition, sports medicine, acupuncture, and rehabilitation.
According to the American Chiropractic Association, the average chiropractic program involves as many classroom hours as a program that trains medical doctors.
Are chiropractors legitimate?
Another common myth is that a chiropractor merely cracks a person’s back or bones.
Chiropractic care is centered around spinal manipulation. However, practitioners also study how the spine and its structures are related to the body’s function.
What do chiropractors attempt to heal?
Chiropractors attempt to heal whiplash-related conditions.
A majority of a chiropractor’s work involves making adjustments to heal:
- lower back pain
- whiplash-related conditions
- neck pain
They may also provide services such as postural testing and analysis, as well as others designed to promote nutrition and healthful exercise.
Does it work?
According to the National Center for Complementary and Integrative Health in the U.S., chiropractic* therapy is the type most commonly used for back pain. An estimated 74 percent of Americans with pain in this area have used chiropractic* care at some point in their treatment.
Results of a 2010 review cited by the center suggest that spinal manipulation may be useful for treating back pain, migraine headaches, whiplash, and other conditions affecting the upper and lower extremities.
Like other forms of treatment, chiropractic* care will not benefit all injuries. Sessions should be tailored to a person’s needs and performed by a licensed chiropractor.
Who could benefit?
Several myths surround this question. One myth is that chiropractors only treat back pain. In fact, chiropractic care can also help to heal pain in the foot, elbow, shoulder, and neck.
The same review cited by the National Center for Complementary and Integrative Health concluded that chiropractic treatment is not useful in treating:
- asthma
- hypertension
- menstrual pain
Authors of the review failed to find definitive evidence that chiropractic care treated musculoskeletal conditions, such as fibromyalgia, temporomandibular joint disorders, and mid-back pain.
Chiropractors also do not treat traumatic injuries, such as bone fractures. A chiropractor will usually perform an X-ray to ensure that treatment will not worsen a traumatic injury.
Science supporting chiropractic treatment
Studies suggest that chiropractic methods are viable options for managing pain.
A 2018 review included 17 years of studies involving spinal manipulation and mobilization, which is a more passive form of manipulation.
The studies investigated the effects of these treatments on chronic lower back pain, and the authors concluded that the chiropractic* methods were “viable” options for pain management.
A 2017 review examined the effectiveness of spinal manipulation in treating lower back pain.
The authors concluded that treatment improved both function and pain for up to 6 weeks.
The American College of Physicians recommend that those with lower back pain use a variety of non-pharmacological treatments, including spinal manipulation.
Researchers generally agree that more studies are needed to determine the ideal length and frequency of chiropractic* sessions and to identify what injuries may benefit from specific treatments.
Is it safe?
One of the most common sources of contention regarding chiropractic* treatments concerns safety.
A person may experience side effects of spinal manipulation, including:
There have been occasional reports of long-term danger related to chiropractic care.
The National Center for Complementary and Integrative Health reports that severe complications may include worsening pain and cauda equina syndrome, which involves nerve damage in the lower spinal cord.
According to the American Chiropractic Association, most discomfort and soreness subsides within 24 hours of spinal manipulation.
The World Health Organization (WHO) state that it is unsafe for people with certain health conditions to undergo chiropractic manipulation. These conditions include:
- bone disease and infections
- broken bones
- inflamed joints, such as in cases of rheumatoid arthritis
- some circulation problems
- infections of the nervous system
Takeaway
An aspiring chiropractor must spend thousands of hours studying before obtaining a license. In 2016, an estimated 47,400 chiropractors were practicing in the U.S., according to the country’s Bureau of Labor Statistics.
Chiropractic care is drug-free and non-invasive, and it may treat some musculoskeletal problems. While this form of alternative medicine may not benefit everyone, it is generally considered safe for most people.
