Most often, patients seek chiropractic adjustment to relieve various types of back, neck and head pain, although it has been trialed for a wide variety of conditions.1
Chiropractic manipulation has faced controversy and receives a mixed response from health care practitioners. This is predominantly due to a lack of evidence for some of its claims and its metaphysical belief system.
In this article, we will explain chiropractic theories and methods, and look at the relevant evidence.
Fast facts on chiropractic manipulation
Here are some key points about chiropractic manipulation. More detail and supporting information is in the main article.
- Chiropractic treatments were first designed in the 1800s
- Chiropractic is the largest discipline within alternative medicine
- There are more than 60,000 chiropractic practitioners in the US
- According to chiropractic medicine, vertebral subluxations are the root of many illnesses
- The evidence for chiropractic medicine being beneficial for anything other than certain types of back pain is weak
- There are two types of chiropractic practitioners: "straights" and "mixers"
- The treatment they offer is referred to as chiropractic adjustment
- Chiropractic adjustment consists of controlled, sudden pressure being applied to specific regions
- Chiropractic adjustment is safe for most patients.
What is chiropractic manipulation?
Chiropractic practitioners are still growing in number.
Chiropractic medicine aims to fix mechanical problems in the musculoskeletal system, believing that these issues affect health and well-being by impacting the nervous system.
It is the largest alternative medical profession.2 Of all the alternative forms of medical treatment, chiropractic has attained the largest degree of success in regards to its size and visibility.
Chiropractic is licensed in all 50 states and some estimate that 1 in 3 people with back pain are treated by a chiropractor at least once.3
Between 1972 and 1998, 160 million office visits were made to chiropractors. Today, there are more than 60,000 chiropractors practicing in the US.4
Despite the prevalence of chiropractic practitioners, the treatment has not convinced much of the mainstream medical world. The major reason for this rejection lies in the unproven theoretical framework upon which it sits.
The basis of chiropractic manipulation
The father of chiropractic theory is Dr. Daniel David Palmer; he started the first chiropractic college in Davenport, IA, in 1897. Dr. Palmer referred to chiropractics as "a science of healing without drugs."
Chiropractic theories are based on folk medicine and embrace vitalism and spiritualism. But, as knowledge of medical science grows, many practitioners have moved away from this esoteric base.
The primary focus of chiropractic practice is vertebral subluxation. A subluxation is regarded as a faulty spinal segment that is fixated. This directly impacts the nervous system which, in turn, effects the musculoskeletal system and other organs.
The National Board of Chiropractic Examiners (NBCE), defines vertebral subluxation as:
"A health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness."5
Daniel David Palmer is considered the founder of chiropractic in the 1890s.
According to the NBCE, the symptoms of subluxation can include:
- Pain and tenderness
- Asymmetry of posture, movement or alignment
- A range of motion abnormalities
- Tone, texture or temperature abnormalities of adjacent soft tissues
In standard medical terminology, a subluxation refers to a full or partial dislocation of a joint or organ. The World Health Organization (WHO) define it as "significant structural displacement, and therefore visible on static imaging studies" in order to distinguish it from the chiropractic form which is not measurable and has its roots in metaphysics.6
Although subluxation is the basis of chiropractic theory, there has been much debate within the ranks of chiropractics as to its validity. A study carried out in 2009 by chiropractic authors concluded:
"No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention.
Regardless of popular appeal, this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability."
On the next page, we look at the different chiropractic schools of thought, what happens at an appointment, whether chiropractic manipulation works and whether it is safe.