Spinal manipulation is, without a doubt, an effective natural treatment. However, health is about a balance; most medical treatments that have the power to do good also have the power to do harm. Chiropractic is overall very safe, with few risks, and we do all we can to minimise these as well as to remain vigilant to constantly learn and improve the quality and safety of treatment.

Learning when NOT to treat is also the main goals of any medical practitioner. The infamous Hippocratic Oath introduces the phrase “first do no harm”. For Chiropractors, this means learning when NOT to adjust or manipulate the spine with high velocity thrust or manipulation. With Chiropractic, my own approach is that not every client requires spinal manipulation or adjustment, and to learn that some clients require very gentle mobilization and muscle release. 

Our professional indemnity insurance is a fraction of a doctors or surgeon, a good indication that Chiropractic is low risk. There have been several articles and suggestions, however, that chiropractic does more harm than good. These allegations have been mostly inaccurate, misleading and unsubstantiated. 

 Risks and Dangers of Chiropractic 

Criticism of Chiropractic has sometimes been based on the fact that manipulation can give a temporary, mild increase in pain. The evidence is that pain after treatment is temporary, does not influence long-term outcomes and is similar to pain after exercise (DOMS), which after all we commonly expect without quibbling. 

Does chiropractic cause arthritis or joint hypermobility? 

There is no evidence for this but clearly, again, it is imperative not to overmanipulate; this also applies to self-adjustments (See Joint Manipulation Misconceptions).

Bruising and tenderness temporarily after treatment can occur, but is not an issue. Find out more in our leaflet about Your First Chiropractic Visit. 

More serious (and much more hurtful to chiropractors) is the suggestion that their treatment actually kills people, based on almost no evidence. Cerebrobasilar stroke is a rare, but potentially fatal, condition responsible for about 2% of all strokes. It sometimes has early symptoms of neck pain, headaches or unsteadiness, which are also the are symptoms for which people consult Chiropractors, Osteopaths, Physiotherapists and doctors. 

The World Health Organization’s Task Force on Whiplash and Associated Disorders conducted a large study and suggested that these rare strokes are slightly more likely after a visit to the GP or Chiropractor, yet other professions like Osteopathy were not included, which seems rather biased to say the least. 

Some articles aiming to malign Chiropractic have written that chiropractic manipulation causes strokes (yet do not include manipulation by osteopaths, Physiotherapists or doctors). The WHO report and logical thinking would suggest in these cases that people are very likely presenting with early symptoms of the stroke when they seek help. This is in fact what happened in one case in the UK, when the Chiropractor was accused of causing the stroke, yet the medical verdict at trial was that the stroke was present already and about to happen.  

Medical professionals and Chiropractors should be well educated in recognising and acting on the early signs of a potential stroke.  It is distressing enough witnessing a stroke, let alone being wrongly accused of causing it, yet time and again the profession is denigrated as Chiropractors are wrongly accused of causing strokes. 

Those who criticise Chiropractic often present only part of the relevant information, which is pseudoscience in itself, but is commonly used to invalidate the effectiveness of Chiropractic. 

To portray only part of the relevant information in a critique is itself pseudoscience, yet strong ontological commitment to only part of the knowledge base seems often to be the stance taken to contest the scientific basis of chiropractic.

 

This article is based on and has been contributed to by Alan Breen, Professor of Musculoskeletal Health Care, Anglo-European College of Chiropractic, Bournemouth University, 13–15 Parkwood Road, Bournemouth BH5 2DF, UK. 

References 

  1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008;8:8–20 
  1. Borghouts JAJ, Koes BW, Vondeling H, Bouter LM. Cost-of-illness of neck pain in The Netherlands in 1996. Pain 1999;80:629–36 
  1. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84:95 – 103 
  1. Waddell G. The Back Pain Revolution. Edinburgh: Churchill Livingstone, 1998 
  1. CSAG. Back Pain. London: Department of Health, 1994 
  1. Foster NE, Pincus T, Underwood MR, Vogel S, Breen A, Harding G. Editorial: Understanding the process of care for musculoskeletal conditions – why a biomedical approach is inadequate. Rheumatology 2003;42:401–3 
  1. van Tulder M, Becker A, Bekkering T, et al.; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006;15 (Suppl. 2):S169 – S222 
  1. Department of Health. The Musculoskeletal Services Framework. London: Department of Health, 2006 
  1. Breen AC. Chiropractors and the treatment of back pain. Rheumatol Rehabil 1977;16:46–53 
  1. Burton AK. Back pain in osteopathic practice. Rheumatol Rehabil 1981;20:239 – 46 
  1. Pedersen P. A survey of chiropractic practice in Europe. Eur J Chiropract 1994;42:S3–S28 
  1. AHCPR. Clinical practice guidelines no.14 – acute low back pain problems in adults. Washington DC: Agency for Health Care Policy Research, US Department of Health and Human Services, 1994 
  1. Government, Science and Technology – Sixth Report. London: House of Lords – Science and Technology Committee, 1999 14 Meeker WC, Haldeman S. Chiropractic: A profession at the crossroads of mainstream and alternative medicine. Ann 
  1. Intern Med 2002;36:216–27 
  1. Rubinstein S, Knol DL, Leboeuf-Yde C, van Tulder MW. Benign adverse events following chiropractic care for neck pain are associated with worse short-term outcomes but not worse outcomes at three months. Spine 2008;33:E950–E956 
  1. Dziewas R, Konrad C, Drager B, et al. Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003;250:1179 – 84 
  1. Cassidy JD, Boyle E, Cote P. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine 2008;33 (Suppl. 4):S176–S183 
  1. Ernst E. Can chiropractic maim and kill? The Times 2001 July 10 
  1. Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007;100:330–8 
  1. Ernst E, Assendelft WJJ. Chiropractic for low back pain: we don’t know whether it does more good than harm. Letter to the Editor. BMJ 1998;317:160 
  1. Laugharne R, Laugharne J. Psychiatry, postmodernism and postnormal science. J R Soc Med 2002;95:207 – 10