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
- 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.
Chiropractic can help manage chest pain in a cost-effective way.
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.