Chiropractic Therapy: Helpful or Harmful?

Americans spend more than $34 billion per year on alternative medicine therapies, with approximately 5.9 billion of that being spent on chiropractic therapy. Many people swear chiropractic treatment helped them (even getting pregnant!), others lament about how it has harmed them, and still others are pretty ambivalent. What is the truth?

AITSE decided to investigate, starting with a peer-reviewed article with 208 references. Since many chiropractors earn more than physicians and expansion of chiropractic practice is in their interest, some of their publications may not be completely balanced. In fact, according to E. Ernst, MD, PhD, FRCP, the “chiropractic research literature” is “overtly biased,” being focused on “aggressive marketing” and proving efficacy. Therefore, we have taken information both from publications by practitioners of chiropractic and from peer-reviewed publications by medical doctors.
So, what is chiropractic? Founded in 1890, chiropractic was originally based on the pseudoscientific idea that the  body heals itself through “innate intelligence,” a vital force or the god within each person that regulates all bodily function.  According to chiropractic’s founder, chiropractic is a type of religion. Current practitioners would like to distance themselves from the “innate” concept, but still speak of vertebral subluxations, which “block the flow of the innate.” Other terms used for these subluxations are vertebral blockages, spinal lesions, or spinal stenosis. The purpose of chiropractic manipulations, then, is to correct vertebral subluxations, thereby improving health.

Since the idea that subluxation causes disease has no actual basis in science, diagnosis of them or the diseases they are said to cause can be problematic. Some chiropractors resort to applied kinesiology, a pseudoscientific technique that seeks to discover medical issues by subjectively measuring muscle strength. Others use blood and urine analyses and 96% of American chiropractors use X-rays. Interestingly, Dr. Scott Haldeman states that “minor misalignments of vertebrae are normal and not necessarily a sign of trouble,” and the National Association of Chiropractic Medicine seems to agree when they say that most people have these irregularities.

Nonetheless, chiropractors continue to treat a variety of medical ailments, including respiratory illnesses, digestive problems, skin disease, reproductive system malfunctions, infections, hypertension, urinary problems, colic, and bedwetting, to name just a few, through spinal adjustment to relieve vertebral subluxations. Remind anyone of snake oil? Their treatments may include massage, traction, electrotherapy, and of course cervical or lumbar spinal manipulations or adjustment, whether by hand or by machine. Many chiropractors will also “prescribe” use of homeopathic remedies, which are pharmacologic substances that are diluted until only diluent is left.

Interestingly, both according to conventional medicine and to one of their own, chiropractic is ineffective in treatment of anything other than musculoskeletal problems. But, is it effective there? Thirty-four leading chiropractors speculated that at least 50% of the pain-relief benefit their patients experience is probably due to the placebo effect. Since chiropractors routinely “pop” the back, it is also likely that there is a release of endorphins. This would result in temporary relief of pain. Moreover, even with lower back pain, where chiropractic therapy should be at its most helpful, it is only as effective as conventional therapies. But it is much riskier.

Of course, those who suffer with chronic pain will understand that, when desperate, we are willing to try anything. So, besides the obvious financial investment, what are the drawbacks of chiropractic therapy? First, approximately 50% of patients experience mild to moderate adverse effects after “adjustments” are performed. These include pain, headache, and fatigue, and are hardly surprising when one considers that spinal manipulations may stretch the tissues beyond their physiologic limit. More seriously, spinal manipulations can cause serious and even fatal vascular accidents (tearing of major blood vessels), bone fracture, and permanent neurological injury. More information can be found in Table 5 of Dr. Ernst’s paper.

There are also indirect problems with chiropractic. Consultation of a chiropractor instead of a primary care physician can lead to “delayed or missed diagnoses.” The possible consequences of taking a 2 week old infant with a fever or an elderly person who is experiencing unexplained changes in weight, possibly indicating cancer or heart disease, to a chiropractor instead of a licensed physician do not bear thinking about.

Finally, much has been written about the radiation risks in the use of X-rays, often repeatedly, in chiropractic diagnosis and treatment. Amazingly, just one lumbar series will expose the reproductive organs to more radiation than over 2000 chest X-rays over a period of six years! And, since much disease is not effectively diagnosed through X-rays, the only purpose of the X-rays are to convince the patient that chiropractic treatment is necessary and useful. Apparently, full spine radiography is more likely to cause bone cancer than to detect it. Obviously, there are ethical problems with the use of X-rays by chiropractors.

Having said all this, there will still be people who opt to seek help from a chiropractor. If you are one of those, please do be aware that the chiropractic literature itself lists several conditions as absolute contraindications for chiropractic treatment. These include osteoporosis, bone fractures, tumors, local infections, and bleeding disorders, to name a few. Then, if you are still determined to go, let us recommend that you at least read this article by a chiropractor before you do. The purpose of AITSE is to provide the public with the information necessary to make a good decision. What you do with it is up to you.