Chiropractic Treatment: What You Should Know
Chiropractic treatment has gained increasing acceptance by both consumers and insurance agencies, many of which now offer plans covering the treatment. Yet, the research regarding the effectiveness of chiropractic treatment is inconclusive at best. In addition, while chiropractic is generally safe, there are a few risks associated with it.
What Is Chiropractic Treatment?
Chiropractic, which means "done by hand," is a medical system founded approximately 100 years ago by Canadian Daniel David Palmer. It is based on the theory that many illnesses originate in the spine, and for this reason it focuses on spinal manipulation. Chiropractic physicians may also utilize physical therapy techniques, as well as methods drawn from other branches of alternative medicine, such as herbs and supplements.
Most visits to chiropractor physicians are for back pain, but it is also commonly used to treat:
- Neck pain
- Pain in other areas such as the shoulders, knees, and jaw
- Breech birth positioning of a baby
- Infantile colic
- And, more controversially, general health
How It Works
Since its origin, chiropractic theory has based itself on “subluxations,” or vertebrae that have shifted position in the spine. These subluxations are said to impede nerve outflow and cause disease in various organs. A chiropractic treatment is supposed to "put back in" these "popped out" vertebrae. For this reason, it is called an “adjustment.”
However, no real evidence has ever been presented showing that a given chiropractic treatment alters the position of any vertebrae. In addition, there is as yet no real evidence that impairment of nerve outflow is a major contributor to common illnesses, or that spinal manipulation changes nerve outflow in such a way as to affect organ function.
More recent theories suggest that chiropractic manipulation may relieve pain by “loosening” vertebrae that have become relatively immobile rather than by changing their position. In addition, the sudden movements of manipulation may alter the response patterns of nerves in the spine, again relieving pain.
Depending on your condition, chiropractic treatment is usually conducted on a two- or three-times-a-week basis, for a month or more. Some chiropractors feel that regular care is necessary to help maintain sound health and fitness. Others will ask to see you only as needed.
What Do Studies Show About Chiropractic Treatment?
Does It Work?
There is some evidence that chiropractic treatment may relieve pain, at least temporarily. The best evidence regards migraine headaches and other forms of headache. Studies on chiropractic for back pain and neck pain have yielded mixed results. But on a positive note chiropractic does seem to be at least as effective as other commonly used treatments for these conditions. Chiropractic has also been studied as a treatment for asthma, bedwetting, dysmenorrhea (menstrual pain), infantile colic, phobias, and premenstrual syndrome (PMS), but thus far the results of studies have not been very positive.
Is It Safe?
Chiropractic manipulation appears to be generally safe, rarely causing significant side effects. The most common reaction is local discomfort following therapy, which generally disappears within hours of treatment. Other side effects include temporary headache, tiredness, and discomfort radiating from the site of the adjustment.
However, articles have been published that document a total of almost 200 cases of more serious complications that appear to have been caused by manipulation of the neck. These include stroke, vertebral fracture, disc herniation, severely increased sensation of nerve pinching, and rupture of the windpipe. More than half of these reports involve some form of stroke, often due to a tear in a major blood vessel at the base of the neck (the vertebral artery).
Although attempts have been made to determine in advance who will experience strokes following chiropractic, they have not been successful. Thus, stroke must be considered an unpredictable, though rare, side effect of chiropractic manipulation of the neck. To put this in perspective, however, the rate of complications from chiropractic is extremely low; according to one estimate, only one complication per million individual sessions occurs. Among people receiving a course of treatment involving manipulation of the neck, the rate of stroke is perhaps one per 100,000 people. The rate of death is one per 400,000.
By comparison, serious medical complications involving common drugs in the ibuprofen family (nonsteroidal anti-inflammatory drugs, or NSAIDs) are far more common. Among people using them for arthritis, NSAIDs result in hospitalizations at a rate of about four in 1,000 people, and death at a rate of four in 10,000. The rate of complications with these common over-the-counter drugs is perhaps 100-400 times greater than with chiropractic.
Certain health conditions existed before the spinal manipulation, such as nerve impingement causing severe nerve damage, or significant disease of the spinal bones.
Finally, some chiropractors make frequent use of x-ray evaluations. There is no evidence that such evaluations meaningfully guide the course of treatment, and excess x-ray exposure is potentially harmful.
Is It Cost Effective?
There is some evidence that chiropractic may be less expensive than other forms of care, but it is not conclusive.
If You Decide to Visit A Chiropractor
If you’re suffering from headaches, back pain, or neck pain, seeking chiropractic care might be worth a try, since it appears to be at least as helpful as other commonly used therapies. Look for a chiropractor who:
- Does not require long-term or preventive care
- Does not routinely take x-rays
- Does not object to you seeing a specialist for a second opinion
- Limits his or her practice to the treatment of musculoskeletal problems (pain/discomfort associated with muscles and joints)
Great caution should be used when considering neck mobilization or manipulation. Consider consulting with your physician before undergoing neck mobilization or manipulation.
American Chiropractic Association
National Association for Chiropractic Medicine
National Center for Complementary and Alternative Medicine
BC Health Guide
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Last reviewed May 2008 by John C. Keel, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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