October 23, 2018
The Chiropractic Conundrum

The Chiropractic Conundrum

by Berkeley Wellness  

Many Americans—perhaps as many as one-tenth—go at least occasionally to a chiropractor. Chiropractic patients often express satisfaction with their treatment, if for no other reason than that the chiropractor takes time to talk with them, makes physical contact and listens. Even mainstream publications have printed positive words about chiropractic. For example, the September 2011 issue of Consumer Reports magazine mentioned that chiropractic is “possibly effective for back pain” and “purportedly . . . helps the body to heal itself.”

But most physicians view chiropractic as marginal, ineffectual . . . or worse. One outspoken critic is Stephen Barrett, M.D., cofounder of the National Council Against Health Fraud and the webmaster for quackwatch.com. In fact, he admonished Consumer Reports on his own chirobase.org website for giving “ignorant and irresponsible advice about chiropractors.”

Chiropractic (a noun derived from the Greek cheir, meaning “hand,” and praktikis, meaning “practical”) was founded in 1895 by Daniel Palmer, an Iowa grocer, bone-setter and healer.

The core of his belief was the idea that all disease arises from the nervous system, specifically from impingements on nerve roots caused by misalignments of the spinal vertebrae, and that manipulation of the spine is the way to set things right. Palmer had no use for drugs or surgery, an approach that made some sense in an era when drugs as we know them hardly existed and surgery was often deadly. Treatment, he thought, should always be “manipulative,” meaning that the practitioner must use his hands to manipulate the bones, usually the spine. This is the application of force, which patients sometimes call “bone-cracking,” that characterizes chiropractic therapy still today.

Medical science has, of course, made enormous progress since 1895. And chiropractic has changed, too, at least in some respects. For example, many chiropractors recognize that diseases have many causes besides so-called spinal misalignments. When X-rays came into use, chiropractors adopted them as diagnostic tools—perhaps too enthusiastically.

Some chiropractors regard themselves as primary care physicians, dispensing information about diet and exercise. Others treat anything and everything from asthma to premenstrual syndrome to headaches—whatever might be bothering you. Many sell herbal and other supplements, promote health fads like iridology (“reading” the body by looking at the iris of the eye), and use hair analysis and similar tests to diagnose bogus nutritional deficiencies, illnesses and allergies. Some are dismissive of mainstream medicine, including immunizations. Others work with medical doctors, giving and accepting referrals. Some treat only back problems, and use conventional methods such as ice, heat and massage. Given such a range of approaches, it is hard to know what you might encounter when you visit a chiropractor.

In 1987, chiropractors won a lawsuit, filed years earlier, against the American Medical Association for restraint of trade under the Sherman Anti-Trust Act. This cleared the way for chiropractors to be reimbursed by medical insurance, including Medicare. It also helped create a new climate in which some chiropractors have tried to close the gap between themselves and standard medical practice—although others have tried to widen it. And because insurance was involved, it served as an impetus to scientific study. Insurance companies, naturally, require evidence that a treatment actually works.

Chiropractic’s value for treating back pain and other musculoskeletal problems has been studied more than any other aspect, and in 1994 the Agency for Healthcare Policy and Research concluded that chiropractic spinal adjustment could be useful for relieving acute low back pain if started early. But chiropractic has never been proven effective for chronic back pain or radiating back pain (like sciatica).

And many studies have found that spinal manipulation is no more effective than a placebo for back pain. Research has shown that, as a rule, spinal manipulation is no better than other kinds of medical treatments, which often don’t work either.

According to an editorial in the Canadian Medical Association Journal in 2002, there’s no good evidence for the therapeutic effects of spinal manipulation—and some reason to think that neck manipulation can sometimes produce adverse effects, from mild discomfort and headaches to serious damage to nerves, blood vessels and the spine, and it can even cause stroke. Yet few patients are warned about potential bad outcomes. Chiropractors are quick to point out that there are adverse outcomes from drugs and conventional medicine, too.

Nevertheless, use of chiropractors is growing, and one 2002 study from the University of California at Los Angeles found that patients who received chiropractic treatment for low back pain were more satisfied overall than patients treated for back pain by medical doctors.

Chiropractic precautions

If you decide to consult a chiropractor for low back pain, keep these precautions in mind:

  • See your regular doctor first for a diagnosis and possible treatment. Ask your doctor to refer you to a chiropractor if you want to try one.
  • Don’t agree to tests using hair or fingernail analysis, iridology or other unproven methods to detect allergies or deficiencies you never knew you had, or to uncover “unhealthy body chemistry.”
  • Don’t agree to full-spine or full-body X-rays. They expose you to unnecessary radiation and have little diagnostic value for soft-tissue problems. Taking X-rays used to be the only way that chiropractors could get reimbursed from Medicare, but that has changed.
  • Don’t agree to “maintenance” care involving repeat visits over long periods. If your symptoms disappear, you don’t need maintenance visits. If they don’t, you need some other kind of care, such as physical therapy. You may, of course, need an ongoing exercise program that you can follow at home.
  • Don’t agree to neck manipulation; this can be risky.
  • If you want to take dietary supplements, follow the advice of your primary care physician. Buy them at a retail outlet, not from a health care practitioner.
  • If your chiropractor advises you not to get a flu shot or a pneumonia shot, or is opposed to referring you to a medical doctor for treatment, we recommend that you find another chiropractor.