"Oh, yeah, right there" - exeunt

January 16, 2011 3:14 AM

I'm worried about my girlfriend seeing a chiropractor.

I've had two second hand experiences with the profession. The first involved my pregnant cousin having a stroke after a session (the Doctor that treated her afterward blamed the chiropractor). The second, my girlfriend's neck locked up. She could not move her neck for three or four days. I took her to a medical clinic and she was prescribed tranquilizers and muscle relaxants. Didn't do much, save for the obvious of knocking her on her ass. The neck was still locked. She insisted I take her to her chiropractor (yeah, she sees him once every two months), who solved the problem in about ten minutes. She felt great afterward.

Nevertheless, I still don't trust chiropractors. However, I've had both terrible and great experiences with medical Doctors as well. I've had a couple Doctors themselves put me near death because of incompetency, so I realise it exists across professions. I think I know what chiropractors do (not much more than a knuckle-crackling version of a masseuse, but with the spine).

My point is, I've seen both Doctors and chiropractors screw up badly and nearly kill people. I think that I know that chiros are poorly licensed, but, though Doctors are held to a higher, and set, standard, they seem to behave just in much the same way (some are good, some are awful).

Is this just my fetish with accreditation?

More to the point: I really don't want my girlfriend to have an avoidable stroke.

posted by converge to Health & Fitness (28 answers total)

Previously, on MetaFilter

In particular you might want to look at this.
posted by dougrayrankin at 3:26 AM on January 16, 2011

I have no personal experience with chiropractors though I have athlete friends who have found them helpful.

But let's suppose there are some good chiros and some bad ones. It seems like the evidence points towards your girlfriend having found a good one: she sees him/her regularly without problems and got her neck fixed right away. Finding a health care professional that you get along well with is not something to dismiss lightly!

Maybe your girlfriend could even ask her chiropractor about the risks of stroke from neck manipulation and see if she if she feels good about his answer.
posted by carolr at 3:53 AM on January 16, 2011

Is there a question here, besides "Is this just my fetish with accreditation?"

This outsider, not knowing the details of your experiences, gets the impression that you might be a little paranoid about dangerous incompetence in the medical profession. Do doctors sometimes screw up and actually kill people? Of course. Is it so common as to be likely to happen to you? No.

I don't know much about chiropractic, particularly in Canada, but I'm assuming that it's an organized, somewhat regulated profession and that practitioners have to carry malpractice insurance. If there was a significant risk that chiropractic care would cause strokes, such practices would be uninsurable.
posted by jon1270 at 4:07 AM on January 16, 2011

I'd be happy for a friend to see a chiropractor as long as they stayed away from their neck - there is an evidence base that chiropractic helps in back pain. It's not a matter of competence/incompetence, or occasionally screwing up in neck manipulation, it's that they shouldn't do it, there are significant risks involved.
posted by Coobeastie at 4:21 AM on January 16, 2011 [1 favorite]

My husband saw both his regular doctor for back pain and a Chiropractor. The Chiro was, in every way, more helpful - including getting my husband scheduled for an MRI within 24 hours when he needed one, when the MD said it would be "a couple of weeks" before they could get him scheduled.

In every single profession there are people who are good at their job and people who are bad at it.
posted by anastasiav at 5:30 AM on January 16, 2011 [4 favorites]

Others have answered the accreditation question. I just want to point out that you're letting one (admittedly horrific) incident overshadow your own rational response that of course there are good and bad in all professions. You wouldn't be asking this question if she wanted to go see an orthopedist, even though you admit that MDs also make mistakes. She obviously knows what, and who, works for her, so unless you have some evidence that her chiro isn't a good one, let your worries go.
posted by ldthomps at 6:04 AM on January 16, 2011

I think the whole chiropractic thing is quackery but I still go to a chiropractor occasionally for neck problems.. mostly because nobody seems to have a clue how to fix this stuff and chiros at least do something other than give you a blank look and some painkillers. I'm very sorry to hear about your cousin-- I have read alarming things about strokes and neck manipulations, one of the reasons I've pretty much stopped with chiro. The main reason I stopped though is this book, which I evangelize everywhere, because now I can fix this myself nine times out of ten. If your girlfriend's neck goes out a lot it may well change her life.

For chronic spinal pain, I agree with most on the thread, you're looking for a specific person with a good touch rather than an accreditation, because as far as I know the Miracle Cure has not been found. The most effective neck treatment I ever had was a walloping by a crazy Russian who had some sort of 'military technique'. Whatever, it worked.
posted by Erasmouse at 6:16 AM on January 16, 2011

I've never had a negative experience with chiropractors (and none of my friends have either)...I've seen at least 3 in the last ten years.

So, my answer to you would be yes, you are a bit paranoid.
posted by schyler523 at 6:40 AM on January 16, 2011

I'd avoid the kind of chiro who considers every possible malady to be related to spinal maladjustments, but I credit chiropractic (and some chiropractically-oriented physical therapists) with keeping my neck problems under control the last 25 years. Here's a useful set of guidelines for choosing a chiropractor (PDF link) from the Chiropractic Stroke Awareness Group (via the research links at which, the stroke connection does seem to be a real phenomenon).
posted by beagle at 7:16 AM on January 16, 2011

You're not being paranoid. There is significant risk involved in chiropractic manipulation of the neck. Before your girlfriend lets a chiropractor anywhere near her neck, ask her to read this.
posted by deadmessenger at 7:19 AM on January 16, 2011 [3 favorites]

When I took an anatomy course at the U of Minnesota 3 years ago, our professor at one point said, "and that is why you should never let a chiropractor mess with your neck." The slide showed the vertebral arteries, which are blood vessels going to your brain that actually travel through canals in the bones of your neck. It's easy to see how torquing things the wrong way could damage this all-important blood supply to the brain. I'm not opposed to chiropractic in general, but I would agree that they should stick to dealing with back problems, not neck things or generalized symptoms.

To help deal with your anxiety, perhaps you could look for chiropractors that are reviewed well on a site like Angie's List. As you and others have noted, quality varies widely in any profession. The internet makes it a lot easier to find out what other people have experienced with any particular provider.
posted by vytae at 7:23 AM on January 16, 2011 [3 favorites]

If it is a chiro who has been in business for a while, has no complaints against them, doesn't spout moonbeam-talk, then I see no reason to worry.

While people love to hate on chiros, the fact that they still exist in today's litigious society, and the fact that many health plans cover chiropractic care quite generously, leads one to conclude that they can't be nearly as bad as it is made out to be by the haters.

I don't know a WHOLE lot about the chiro techniques, but the realignments seem to be meant to manipulate the spine within the confines of its acceptable range of motion. If the tendons and muscles let the alignment happen without getting damaged, then it would seem to be safe for someone without previous conditions.

I suppose the trouble happens when a patient has a hidden problem, or when the chiro isn't thorough enough in assessing history, or when they simply suck at their jobs. Same thing happens with medicine though. I've certainly heard of more people complaining about back and neck problems after standard medical treatments versus after chiro treatments.

But, anecdote != data, correlation != causation, etc.
posted by gjc at 8:15 AM on January 16, 2011 [1 favorite]

I am not here to express an opinion for or against chiropractors. My concern is that you are trying to tell your girlfriend what she can or cannot do. This seems weird to me. You tell her your concerns, she takes them into consideration, she makes her own decision. End of story. Don't go digging for horror stories from your fellow MeFites to dissuade her. Anyway, just my opinion.
posted by eleslie at 8:19 AM on January 16, 2011 [7 favorites]

As long as you just expect to feel better for a time and not expect a cure. They never cure anything. They just give you relief at the time for varying lengths of time.
I sat on a very long jury trial involving this subject and they had multiple chiropractor expert witnesses. Not one expert would state that they ever cured anything.
I find they are helpful for a temporary fix and expect nothing more. But relief is sometimes great
.
posted by JayRwv at 8:22 AM on January 16, 2011

Anecdote: I've been seeing a chiropractor for about 15 years, since I was 7 or 8, for everything from hip to neck problems. Both my parents have been seeing the guy for much longer. I don't have a big sample size (I've only ever seen the guy plus occasionally his partner), but the only thing he's ever done wrong in those 15 years was give me a shoulder spasm once. As a bonus, I have pretty weak bones that break fairly easily and he's been very careful about that, especially when messing with my neck.

Some chiros are great. Some aren't. The good ones are very serious about their practice and their patients.
posted by lilac girl at 8:38 AM on January 16, 2011 [1 favorite]

If you're worried about accreditation (as a proxy for quality), find one who is highly reviewed/recommended. Problem solved.
posted by J. Wilson at 8:40 AM on January 16, 2011

My mother (acute care nurse practitioner, former emergency room nurse) told me to go to a sports medicine/rehab specialist for neck pain, rather than a chiropractor. She said she saw too many people coming into the ER after chiropractic mishaps.
posted by the littlest brussels sprout at 8:55 AM on January 16, 2011 [1 favorite]

I firmly believe chiropractors are quacks, so I've never seen one. FWIW, I have rheumatoid arthritis and a pretty screwed up neck from bad posture at my desk and I've had great experience with physiotherapy. A physiotherapist is also unlikely to attempt dangerous manipulations of the neck. If you're very concerned, you might want to suggest she try seeing a physiotherapist for her problem.
posted by nerdfish at 8:58 AM on January 16, 2011 [1 favorite]

The worry about a stroke comes from movements of the head and neck. As long as that doesn't happen, there is very little danger that I know of. Nthing the idea that you should show her the stuff about neck manipulation, but that's no reason to ask her totally give up something that makes her feel better, even though it is totally bunk.
posted by Hactar at 9:11 AM on January 16, 2011

I teach anatomy, and I am here to second what vytae said about the vertebral arteries. Young women also have looser ligaments, and it's much easier to damage the vessels.
posted by Uniformitarianism Now! at 9:13 AM on January 16, 2011

Folks here have given lots of good links to go educate yourself and learn more on it.

Two things which will allow your gf to get the most from chiro is massage and posture/core exercises. Assuming she doesn't have a vertebral malformation or disc problem, most of the spinal problems folks have are muscular- either tension or scar tissue related.

After an adjustment, the muscles just pull things back into their habitual positions- which is to say, out of position. Which is why most people who get chiro work need to keep going back, over and over.

If she receives massage shortly after her chiro (like within 2 days), it'll help the muscles relax and become accustomed to the adjusted position. Regular core/posture training (Pilates, Alexander, etc.) will help her have the muscle strength to support it better as well.
posted by yeloson at 9:17 AM on January 16, 2011

While people love to hate on chiros, the fact that they still exist in today's litigious society, and the fact that many health plans cover chiropractic care quite generously, leads one to conclude that they can't be nearly as bad as it is made out to be by the haters.

That line of reasoning, while quite understandable, leads to some very poor conclusions. I'm not sure how you imagine that a litigious society would lead to the extinction of chiropractors if the practice was unsound. Quite the opposite, in fact. Doctors are sued so often that they need malpractice insurance just to cover the legal expenses necessary to deal with frivolous claims. The litigiousness of our society has lead to over-cautious, wasteful practices known as "defensive medecine," but they can't change the underlying medical science or mitigate the necessary risks.

Meanwhile, chiropractic, with no established, evidence-based practice or pathology, leaves its practitioners to do whatever necessary to avoid causing risk, or doing much of anything, really. And when a chiropractor gets a little too ambitious and does cause some problems, the patient sues the individual chiropractor, not the practice of chiropractic. It's a lot easier for one's lawyer to argue that this individual was negligent in his practice rather than try to take on the entire field. Also, chiropractors, without that pesky hippocratic oath, are free to have patients sign onerous waivers and releases.

The persistence of folk medicines over time does not argue for their efficacy, but rather against it -- if there were any true science behind it, it would evolve until it no longer much resembled its original practice, the way every scientific field has. Instead, chiropractic, homeopathy, acupuncture, etc. all remain more or less only superficially changed. Since the practices are not evidence-based, they don't evolve as our ability to collect and study evidence grows.

As for their being covered by insurance -- well, of course they are. They're a lot cheaper for insurance companies to pay than real doctors. If the patient wants to see a chiropractor instead of sports medecine specialist and, most likely, a physical therapist afterwards, the insurance company is thrilled.
posted by patnasty at 9:46 AM on January 16, 2011 [2 favorites]

A common theme you often find in the anecdotes of chiropractic treatment are much more positive reports on the quality of the patients interaction with the chiropractic practitioner than with a doctor. Chiropractors tend to be more patient with their patients, and are usually reported as being more interested and attentive, and willing to spend more time, than their medical counterparts.

And this is the key to their "success" and popularity, as well as revealing of an unfortunate trend in medical practice caused by our flawed medical insurance + reimbursement system.

Chiropractic is, at essence, a service industry. The only thing that really matters is how happy your patient is at the end of the session. So chiropractors naturally tend to become better and better customer service reps for their own practices. With no objectively observable ways of measuring their success or failure other than their patients satisfaction, they are free to focus on doing whatever it takes to make their patients happy. Doctors, meanwhile, tend to be concerned only with the objective criteria of successful treatment, and often quite negligent of the service side of their business. There's no money in it for them -- their reimbursement rates for treatments are predetermined, so for them, the best business practice is treating as many patients as they can.

This is unfortunate, as it turns out that a patient's self-report of the efficacy of a medical treatment seems to correlate pretty strongly with time spent with the doctor and their level of satisfaction with their interpersonal interaction. In other words, when your doctor spends time with you, listens to you, and makes you feel that your problems are being taken seriously, you respond more positively to the treatment and feel less discomfort.
posted by patnasty at 10:20 AM on January 16, 2011 [2 favorites]

Metafilter is not a good place for a conversation on chiropractic (if you actually want a conversation).

Talk to your MD. I've had several MDs refer me to DCs, and some who won't. But talking to them will be informative. In the US, DCs are accredited by your state as doctors with a limited scope of practice. As far as I know, there has not been a legal finding that a DC has ever caused a stroke.

Meanwhile, all sorts of horrible things happen with MDs in hospitals, treatments that go in and out of vogue, inconsistency in treatments between MDs, lots of money flowing in from drug companies, etc etc.

I think as in any profession, it is not the degree or title that matters most, but the skill of the individual. If you are going looking for an MD or a DC, shop around, don't get scammed.
posted by quarterframer at 10:27 AM on January 16, 2011

If you want someone with credentials, you could find an osteopath. Whether your girlfriend is interested in switching or whether you'd feel more comfortable with a medical doctor doing spine manipulations, only you can find out.
posted by Margalo Epps at 11:09 AM on January 16, 2011

Response by poster: Thank you all for the sources and suggestions. I will check them out.
posted by converge at 11:20 PM on January 16, 2011

I used to work for a chiropractor and would recommend you advise her against it, if for no other reason than she's be wasting her money (chiropractic = placebos and overpriced supplements) and depending on how good the "doctor" is at manipulating her psychologically, possibly a lot of it. And of course, the possibility of something bad happening to her physically (like a stroke) is a real one and also a great reason to avoid.

I will admit that I have a bit of an axe to grind against chiropractic but it drives me crazy that people take them seriously as medical professionals when just about all of their training is in SALES.
posted by Jess the Mess at 6:04 PM on January 17, 2011

Re: Tight muscles pulling out of alignment after an adjustment.

Many good chiropractors will have a massage therapist on hand to reduce tightness to avoid exactly that problem.
posted by schyler523 at 12:12 PM on January 19, 2011