What is the consensus regarding chiropractics? Is there one?
July 3, 2014 2:03 PM   Subscribe

I just started going to a chiropractor -- not for any one traumatic injury, but more to help me deal with general stiffness and range-of-motion issues. I don't know much about chiropractics. What is the current thinking on this type of treatment?

Short background:

* I'm in my 40s, very active, lift weights. Deal with a lot of stiffness and range-of-motion issues, but nothing really traumatic.

* Insurance pays for chiropractics and massage. Because it's cheap, went (two times now) to a recommended chiropractor. I went mainly for the massage, done by the same office, but also got "adjusted." Not really sure if it made much difference.

Currently, my plan is to keep going for a few months to see how I feel. But I obviously don't want to be doing something that is actually bad for me.

So, what does the latest research say about the effectiveness of these "adjustments"? (I think that's what they're called -- it's where the chiropractor gets you in a certain position, exerts sharp pressure, and there is a sort of little crunching sound). Good idea? Bad idea?
posted by Alaska Jack to Health & Fitness (21 answers total) 8 users marked this as a favorite
Best answer: Wikipedia has a quite good summary of the effectiveness of chiropractic treatment. Just following that is a risk-benefit analysis, which is equally useful.
posted by saeculorum at 2:14 PM on July 3, 2014 [1 favorite]

Best answer: Fatal Adjustments - How Chiropractic Kills - by J. D. Haines, MD

Chiropractic Manipulation and Stroke - A Population-Based Case-Control Study

What chiropractors do isn't evidence-based medicine, to put it bluntly. I'd look at a physical therapist, massage therapist, or orthopedist or something.
posted by sebastienbailard at 2:19 PM on July 3, 2014 [9 favorites]

For the most part, chiropractics for back and neck pain is something that people do because it feels good, not because it's effective at treating the underlying causes of the pain. If your insurance covers physical therapists, I'd look into going there instead because they'll both do some of the hands-on manipulation that does feel good as well as give you actual, evidence-based exercises and practices to deal with the underlying issues.
posted by klangklangston at 2:36 PM on July 3, 2014 [8 favorites]

Best answer: Sometimes it's fine. Manipulation of the cervical spine is an extremely bad idea, and so is manipulation of the rest of the spine, in my opinion. A lot of chiropractic is outmoded, even as a lot of them have moved to more of a soft tissue focus, which is at least more modern.

If you're in generally good health, and you say you are, I wouldn't recommend a chiro. They vary dramatically in quality, and given their culture of salesmanship, there's a good chance your chiro will start loading you down with all the things that are "wrong" with your body, and if you buy into this, you'll be more likely to suffer pain, and feel that your "creaking body," or whatever negative body image this conjures, will then require whatever "maintenance" the chiropractor provides.

There is a broader problem with manual therapy in general (chiro, physical therapy, osteos, massage, and a lot of the medical system in general) in that what we've learned about the nervous system and pain over the past several decades hasn't really been integrated into practice. If you want more info on that you can memail me. I'm thinking of doing a front page post on it at some time in the future, actually.
posted by MillMan at 2:36 PM on July 3, 2014 [6 favorites]

Best answer: There is no scientific basis for the efficacy of chiropractic adjustment in relation to any generalized disease process. Zero. They've stopped talking about the quackiest basis for their techniques (Palmer's theory of "subluxation," which most modern chiropracters know is utter bullshit and are too embarrassed to even discuss, but it's still the theoretical origin of their methods -- it's as if modern medicine still kept an arsenal of witchcraft techniques in use. In fact, it's exactly like homeopathy, where practitioners will admit the theoretical basis of their pseudo-science is complete hogwash but then point to weak empirical claims that it 'works anyway.")

Instead, modern quacks speak in generalities about empirical symptom relief when confronted by scientifically knowledgeable critics, while spinning woo stories to gullible patients (by definition, just going to a chiropracter suggests you are open to believing they practice medicine, hence to believing their explanations, trusting their judgment, and experiencing a hearty placebo effect).

There are indeed examples of entirely empirical therapies in scientific medicine, for which we don't know the biological mechanism very well or, in a few cases, at all. But in no case are these therapies originally sourced in completely false theories of pathogenesis, as is the case for much in the chiropractic, and all of homeopathic, practice. And while much of the practice of scientific medicine is directly empirical, the underlying theories of disease that motivate the empirical practices are sound and proven.

There is nothing a chiropracter can do for you that can't be done by an orthopedist who actually went to medical school (chiro colleges notoriously take very weak students who couldn't get in to medical school in the first place, meaning they well might miss systemic conditions causing your proximate symptoms if you rely on them as physicians)) or a massage therapist who doesn't pretend to be doing more than relieving pain by rubbing your sore muscles.

There is modest empirical evidence for very limited values of "evidence" that chiropractic helps with some kinds of back pain, but very little of this research is double blinded (except by using "sham" treatments as placebo) and most of it is wildly overstated by chiropractic defenders. My back feels better when someone rubs it too. That doesn't fix my eroded vertebrae. Or diagnose them as such either.

Here is the key part of that Wikipedia article linked by saeculorum above. It is accurate in broad terms about the findings of the actual research literature. (The Cochrane review is the current gold standard for evidence based medicine):

Systematic reviews of this research have not found evidence that chiropractic manipulation is effective, with the possible exception for the treatment of back pain.[9] A critical evaluation found that collectively, spinal manipulation was ineffective for any condition.[10] A Cochrane review found very low to moderate evidence that spinal manipulation therapy was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain.[11]

It's not the only form of widely accepted quackery, and it's not the worst given the relatively limited domains in which chiropracters actually treat people and the relatively low risk of having a dude crack your back and call it medicine. Your risk of harm is low (not insignificant, but low). Just don't mistake a chiropractic visit with going to a doctor. And plenty of MDs practice and recommend quack treatments too.
posted by spitbull at 2:52 PM on July 3, 2014 [10 favorites]

You might check out Simon Singh's Trick or Treatment, a meta-review of studies looking at several types of alternative medicine. If I remember correctly, the upshot on chiropractics was that there was some evidence of minor benefit for lower back pain, but that neck adjustments should be avoided like the plague.
posted by sapere aude at 3:05 PM on July 3, 2014 [4 favorites]

My personal experience between chiropracty and seeing excellent physical therapists is that what the physical therapists do is not only more holistic care of the body (not only adjustments but also fixing muscular firing patterns, and providing exercises that retrain and strengthen to resolve issues), but it makes chiropracty look like the dark ages of medicine. I will never go back to the chiropractor. For all their claims of holistic care, they are very much in their own extremely limited box of understanding. Granted, I'm lucky to have gone from mediocre chiropractic care to Olympics level physical therapists. Go for the best quality care you can get, such a major difference! You are worth it!
posted by susanbeeswax at 3:41 PM on July 3, 2014 [1 favorite]

I have many (many! 16 or 17!) chiropractors in my family, so I am biased. I'll say that out of the gate.

There are different fields of chiropractic, and most of them are nutty. However, my family members focus on manipulation of the spine, ultrasound therapy, interferential stimulation, and life changes (such as shoe implants and better pillows). And it works for many, many people. I've personally benefited from it as I was born with a curved spine (scoliosis).

There are alarmists who talk about seizures and paralysis caused by chiropractic care, but I have heard of ZERO cases of this in the patients my family members have seen over the past 30 years. That's 10's of thousands of patients. On the other hand, I have seen patients limp in to my dad's clinic and walk out feeling great.

Take my anecdotal evidence for what it is, but I've been around it my whole life and have seen it work. Just avoid the quacks - especially kinesiologists.
posted by tacodave at 3:51 PM on July 3, 2014 [2 favorites]

Best answer: Sigh. Depressing to see all the usual chiro-bashing from mefites. I don't feel up to the task of responding to each and every point, but I feel it's extremely worth mentioning that:

Allopathic medicine kills and disables far more people than chiropractic, not just in terms of basic numbers but relatively. Look up avoidable deaths caused by hospital stays in the US and be prepared to be horrified (here's one link: http://www.forbes.com/sites/leahbinder/2013/09/23/stunning-news-on-preventable-deaths-in-hospitals/). Meanwhile, the same handful of horror stories about chiropractic are repeated ad nauseam, not as evidence that someone goofed but as evidence that the modality as a whole doesn't work.

When someone dies because of a hospital stay or treatment by a conventional doc, the first response is never "gee their doctor must have been a quack, and we should never trust Western medicine again". Instead, the situation is analyzed to find out what happened. Sometimes it's a bad doctor, sometimes it's a mistake a generally good doctor made, sometimes it's happenstance. Chiro-bashers are entirely too ready to attribute bad outcomes exclusively to the modality itself.

The person you see is more important than the specialty they practice. To rule out a potentially valuable member of your health care team because they are a chiropractor is as silly as choosing someone simply because they are an MD. Different chiros are very different, both in terms of the techniques they use and in terms of their listening skills/general intelligence/personality.

I have worked for two chiropractors (and taken courses from others) and they differed tremendously. One, unfortunately, embodied the negative stereotype of the chiro who wants patients on an endless treatment schedule in order to milk them. The others have cared about their patients and wanted them to get well and stay out of the office as much as possible (until the next skiing tumble/cross-country drive/what have you).

THE one piece of advice on here that I somewhat agree with is to be cautious about neck adjustments. Not that you should never have them done for any reason, but have them done only if needed and by an excellent practitioner. The second chiro I worked for is the only one I would--and did--trust to crack my neck.

But really, it's a misconception that you even have to be adjusted! Many chiros do soft tissue work, hydrotherapy, kinesiotaping, postural analysis, muscle testing, and make recommendations about diet and lifestyle changes, assign exercises and stretches. Some of them, where allowed by law, also will use ultrasound or lasers.

Anyway, I don't hope to change the prejudices of the anti-chiro crowd, I just hope to reach the OP and offer another way of looking at things. I'd be happy to say more over memail if desired.
posted by mysterious_stranger at 5:05 PM on July 3, 2014 [2 favorites]

Response by poster: Thanks everyone so far. Good info.

And let's please keep this civil.
posted by Alaska Jack at 6:38 PM on July 3, 2014

I once lived with a chiropractor who told me that one of her fellow students died of a stroke (at age 19) at the hands of another chiropractic student. She also explained their diagnostic tools which seem to be based on skin conductivity, which struck me as very victorian.

I know this is totally anecdotal and it can't be a common thing to happen but I found it scary enough not to want to take her up on the offer of a free session (which she offered to cure my cold.)
posted by pmcp at 9:11 PM on July 3, 2014

They are often anti-vaccination, which is pretty scary, in this post-post-whooping-cough era.
posted by sebastienbailard at 2:05 AM on July 4, 2014

Mod note: A couple of comments deleted. This isn't a place for fighting / arguing / debating other commenters (or complaining about Metafilter); just address the OP with your helpful advice.
posted by taz (staff) at 2:06 AM on July 4, 2014

Best answer: Based on my experience the field of chiropractic is too full of practitioners willing to engage in quackery or multi-level marketing schemes (expensive worthless supplements etc), or delve into areas they have no training in (eg nutrition) for me to tell others how to find one that is 1) trustworthy or 2) effective.

I'm a weight lifter in my 40s too. too. If you're having stiffness and range of motion issues that either affect or are caused by your lifting, your energy and money is better spent on some combination of a really great personal trainer and a physical therapist with a sports medicine background. A good trainer can show you proper form, correct yours in case it's contributing to your issues, and inform you (taking your issues into account) if there are any lifts you should modify or stay away from.

Lifting in your forties is not for sissies! To stay strong, you have to know you're doing it right. And that includes knowing if it might be time to change things up due to slight degenerative changes due to the natural, expected aging process. Henry Rollins is 50ish and stopped doing compound lifts like back squats, for example.
posted by ImproviseOrDie at 3:46 AM on July 4, 2014 [1 favorite]

Best answer: I have limited experience with chiropractors, maybe half a dozen visits a couple of years back.

I had a very annoying chronic lower back pain issue that was not responding well to my general first choice of treatment which is physiotherapy. But a chiropractor (for all of the obvious reasons) never entered my mind until a friend, who's usually quite rational about stuff, enthusiastically recommended somebody she'd been seeing.

Long story short -- after two or three visits, I was almost completely pain free. But it didn't last. The adjustments were working on the symptoms but for whatever reason they weren't getting to the underlying issue. To his credit, the chiropractor said as much himself.

So what ultimately worked for me? I'm certainly in much less day-to-day pain now than I was then. Basically three things.

1. accepting the reality that my body was doing some aging and I couldn't continue to batter it around in the same way I'd been doing (ie: I've slowed down a bit).

2. very occasional use of Naproxen (ie: only when my symptoms suddenly get acute and stay that way for more than 24 hours).

3. on another enthusiastic recommendation, I did a few group Pilates sessions, then booked a private session with the instructor in which I asked her for a workout specific to my particular lower back grievance.

I wouldn't say I'm hundred percent now (whatever that is) but I definitely am in a much better place than I was. My personal view is that as we age, though it tends to happen very gradually, we nevertheless hit various thresholds, often involving subtle interactions of muscles-tendons-connective-tissue etc. Which means the solutions must be a subtle as well, which is something I've come to believe that chiropractors (even the highly recommended ones) lack.
posted by philip-random at 9:51 AM on July 4, 2014 [1 favorite]

Allopathic medicine kills and disables far more people than chiropractic

This is a misleading statement. First, "allopathic" is not the name of any theory actually used in scientific medicine. The term is a slur meant to imply comparability to the bogus pre-scientific "modalities" championed by quacks.

Second, "conventional" scientific medicine treats an order of magnitude more people than all the chiropractors in the world put together. It also treats people with actual, serious, life-threatening or terminal diseases and injuries.

No legitimate chiropractor is ever central to the treatment of cancer, brain injuries, AIDS, or diabetes.

This claim is often thrown out spuriously by defenders of chiropractic and homeopathic and other pre-scientific medical theories and methods. It's a straw man. No chiropractor has ever saved or extended someone's life with manipulation. Medical doctors do save and extend lives. They treat actual illnesses as opposed to fictional and vague ones.

Chiropractors are not medical doctors. Their training is a pale simulacrum of the medical education revived by an RN or a PA, let alone an MD. Whether you have gained a benefit from seeing one or not, the benefit was not caused by any actual, provable domain of chiropractic specialty expertise. Many people feel better after taking or being treated with placebos. That explains almost all the anecdotal claims you will hear.

The field is on the defensive. Insurance reimbursements are declining rapidly as insurance companies increasingly refuse to cover non-evidence-based treatments. Incomes for new chiros are declining rapidly. The fad is fading away. Now PTs can earn doctorates too, exactly replicating (with much more sophisticated and demanding training) the only expertise for which chiro could aim any evidentiary basis. Chiro colleges will take almost anyone, and are dependnt on student loan support for their extremely high tuitions. The deep ties between chiro practices and insurance fraud have been widely publicized. It makes the remainng defenders of the faith (which is mostly what it is) very defensive indeed -- sometimes viciously so. Remember, that's all they have when they can't argue with reproducible clinical evidence or even a coherent theory of their practice that stands scientific scrutiny.

The OP asked about the general status of chiropractic as a branch of medicine. The answer is "low, and in sharp decline."

A refutation of that would need to cite evidence that simply doesn't exist, not just attacks on mainstream medicine's many flaws and embedded forms of quackery (legion of course, but so what? Your leg is broken or you have a high fever, you're going to want an MD not a DC), and happy anecdotes proffered as data without proof or context. You would need to cite an exciting new body of research based evidence that chiropractic was taken seriously or in any way ascendant, when the actual literature shows chiropractic's legitimacy to be in decline as its claims are assssd by modern EBM techniques.

Of course chiropractors and members of their families will complain about such representations. They have a financial interest, just like pharmaceutical companies or hospitals do. Indeed, a huge portion of chiropractic education is focused on practice building and business skills (compared to almost none for MDs). All (American) medicine is partly about the money because Capitalism.

The difference is whether what's for sale is science or bullshit. Chiros don't have a monopoly on bullshit. But they have very little science to sell you either.

The OP asked for research, not testimonials. So far no one has cited any research findings in defense of chiropractic.
posted by spitbull at 10:28 AM on July 4, 2014 [7 favorites]

See also
posted by runcibleshaw at 10:50 PM on July 5, 2014 [1 favorite]

Best answer: Here's a good overview of the current status of chiropractic, from 2008. I bolded the key findings.

J Pain Symptom Manage. 2008 May;35(5):544-62. doi: 10.1016/j.jpainsymman.2007.07.004. Epub 2008 Feb 14.
Chiropractic: a critical evaluation.
Ernst E.
Author information

Chiropractic was defined by D.D. Palmer as "a science of healing without drugs." About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic. The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic. A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews. Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.
Comment in
Re: Chiropractic: a critical evaluation. [J Pain Symptom Manage. 2008]
PMID: 18280103 [PubMed - indexed for MEDLINE]
posted by spitbull at 6:08 AM on July 6, 2014 [1 favorite]

Best answer: I've lived in the Chiropractic capitol of the world for various parts of my life, where chiro shops are more plentiful than gas stations. People in the community have largely bought into it, complete with the aforementioned MLM supplement/magnet/vitamin scams.

I have heard internet stories of truly horrible things like strokes and paralysis, but I have never heard any second or third (or fourth) hand stories about any of that in real life. What actually does happen regularly is people waste time and money they could be using to get actual medical diagnosis and treatment for their problems.

Anecdote: I have an aunt who spent precious time getting her back "worked on" by a chiro, when her problem was actually pancreatic cancer. The chiro had no idea and had her coming back for months before she went to a real doctor who understood the total medical situation and quickly began the appropriate tests. No one can quantify what that delay will cost her, but in my mind it's definitely moved chiropractic out of the "benign quirk" and into the "malicious quack" category.
posted by the christopher hundreds at 4:59 PM on July 6, 2014 [1 favorite]

One of the best summaries of chiropractic I can find online is at The Skeptic's Dictionary.
posted by Flexagon at 5:34 PM on July 6, 2014

Response by poster: Thanks everyone. Great info.
posted by Alaska Jack at 9:39 PM on July 13, 2014

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