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.
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."
Types of chiropractic practitioners
Debates like the one mentioned in the last section have caused internal schisms in the field of chiropractic manipulation. Broadly speaking, practitioners are now split into two camps - straights and mixers:
Straights: adherents of Dr. Palmer's original metaphysical tenets. They believe that vertebral subluxations interfere with an "innate intelligence" - a concept stating that all life contains inborn intelligence that is responsible for the organization, maintenance and healing of the body.
Straights prefer to remain distinct from mainstream health practitioners. Although straight chiropractors are in the minority at present, their purist approach gives them disproportionate influence.2
- Mixers: this group mix the original theories with modern medical or osteopathic viewpoints. Mixers believe that subluxations are just one of many factors that can contribute to disease. They make up the majority of chiropractors.
Chiropractic adjustment appointment
Chiropractic manipulation in always centered on the spine.
Initially, a chiropractic practitioner will ask questions about previous health issues and conduct a physical exam, paying particular attention to the spine.
Most commonly, the patient will be placed on a padded chiropractic table and manipulated. Controlled, sudden pressure will be applied to specific regions - referred to as high velocity, low amplitude spinal manipulation (HVLA-SM).
Joints may crack and pop throughout the session.7 The motions will often be associated with relief, but sometimes there can also be pain.8
Does chiropractic adjustment work?
Overall, there is no evidence that chiropractic adjustment has any health benefits, other than for certain kinds of back pain. To date, there have not been enough reliable, well-designed studies carried out to support claims.9,10
One of the major issues in trialing chiropractic adjustment is the lack of a workable placebo. In drugs trials, for instance, simply giving a sugar capsule suffices as a placebo. This is not possible for chiropractic interventions; finding a procedure that mimics the physical intervention of chiropractic adjustment but that does not have any physical effects itself is challenging.
Overall, the evidence for chiropractic interventions on back pain are relatively weak and, in general, they do not seem to be any more effective than conventional treatments that include painkillers, exercise and physiotherapy.
Along with lower back pain, there is some weak evidence that other musculoskeletal problems might respond well to the manipulation of bones, joints and soft tissue as practiced by chiropractors; these include acute and sub-acute neck pain, shoulder girdle pain, tennis elbow, osteoarthritis, migraine and headache.11
Safety of chiropractic adjustment
When carried out by a trained practitioner, chiropractic adjustments are a safe procedure.
Serious adverse events are rare with chiropractic adjustment, but could include:
- A herniated disk, or the worsening of an already herniated disk
- Cauda equina syndrome - compression of the nerves at the base of the spine
- Vertebral artery dissection - a specific type of stroke, following neck manipulation.12
People with the following conditions should avoid chiropractic adjustment:
- Severe osteoporosis
- Numbness, tingling or loss of strength in leg or arm
- Cancer of the spine
- Increased risk of stroke
- Spinal instability (excessive motion).
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