How Effective Are Chiropractors?

Chiropractors rely on several main methods of treatment which include manipulations and adjustments, stretches and on occasion nutritional and lifestyle advice. Spinal manipulations are perhaps the most known forms of treatment that involves cracking/maneuvering the back to relieve pain and tension. Made especially popular on Youtube by “Cracking compilations”, it is claimed to help with neck, shoulder and lower back pain, however, the effectiveness of chiropractors and the adjustments they do on patients has long been a controversial topic in the medical community.


We will be covering documented evidence on the various types of ailments chiropractic treatment has been used for and how well it has worked, the pros and cons of treatment as well as alternatives to chiropractic treatment.

There are also varies schools of thought within the chiropractic community which is said to determine the methods used and in turn, the results of treatment.

Different Schools of Thoughts

​1. ​Mixed Chiropractic (Therapeutic)

This is how the traditional chiropractor used to treat, based on principles chiropractic was found on. It entails diagnosing the medical condition the patient is suffering from and using alternative tools to help symptoms and correct the ailment. Obviously this does not include medicine that a physician is authorised to give nor does the chiropractor have all the standard medical tools to diagnose but based on their diagnosis, they may give some therapeutic massage, adjustments, or homeopathic and naturopathic treatments.

However the problem experienced by many chiropractors that followed this system was that they neither had the medical knowledge or the tools to medically diagnose patients in the traditional sense which limited its effectiveness. Aside from the alternative medical treatments, there was little reason to chose a chiropractor over a trained physician.

​2. ​Vertebral Subluxation Chiropractic (Non-Therapeutic)

These kinds of chiropractors follow the theory of vertebral subluxation which simply says that our nerves are the key to good health and this the bulk of these nerves are located in or around the spinal column. Our nervous system is responsible for all the information that travels between the brain and the rest of the body, gives us sensations of pain and allows the regular function of our organs. This is widely accepted by the medical community too however where it branches off is in how treatment is said to help said nerves.

The theory follows that as many of the vital nerves are in and around bones, the daily emotional, physical and menials stresses that our bodies go through can cause a misalignment in the bones which affects how nerves communicate with each other. This is said to worsen all processes in the body, giving rise to pains, feelings of low energy and poor health. When adjustments are made, the bones and tissue are so to move back into place to allow normal, healthy communication and firing of nerves.

The problem with this theory is that it has no scientific foundation. Adjustments and manipulations performed by a chiropractor has shown no evidence of re-aligning the spine nor does science support the fact that movement of the bones will significantly benefits nerve function. For this reason, chiropractic treatment has not been considered medicine but rather good for therapy.

The majority of the newer chiropractors follow the subluxation theory so we will assume this to be the understood method and theory behind treatment when talking about the benefits, risks and effectiveness.

Does Chiropractic Treatment Work?

Lower Back Pain

Practitioners claim that chiropractic treatment is effective for both acute and chronic back pain, perhaps one of the most common ailments patients go to see a chiropractor for. A paper by Shakelle et al (1992)* showed that manipulations can provide relief for acute back pain and subjective feedback from many who have undergone treatment support this too.

However, the paper also suggests that it mainly provides short-term benefits and that too for uncomplicated acute back pain, that is, if it is the sole cause of the pain and not related to another ailment or problem. Ernst (1998)* adds that the 8 randomised trials that do support the effectiveness of chiropractic were methodologically flawed so it cannot be claimed that even in the short run, it is effective without doubt.

The paper goes on to say that the most effective results for treatment of acute lower back pain came from a combination of exercise and education whereas spinal manipulation or drugs on their own were less effective.

There is less consensus that chiropractic has any positive effects on chronic lower back pain. The Cochrane collaboration* found that spinal manipulation were no more effective than ‘fake’ spinal manipulations where the practitioner pretended to adjust the spine. The same organization concluded that spinal manipulation are no better or worse than other treatments for lower back pain.

Neck and Shoulder Pain

Pribicevic et al (2010)* found low level evidence supporting chiropractic management of shoulder pain to be effective. It consisted of case studies and a small controlled trial which isn’t high quality evidence but provides some support nonetheless. It will also spark further research with well designed trials to investigate the efficacy of chiropractic for shoulder pain.

Evidence for the treatment of neck pain with manipulations exists for both chronic and acute neck pain but is fairly weak with a much stronger effect when combined with exercise, stretching and physiotherapy (Bryans et al 2014)*.

However, there is still much needed research required in the safety of neck and upper back manipulation due to the number of recorded cases of mild to fatal side effects. The evidence that supports it is simply one part of the research and should not solely be used to make a decision because as experts pointed out, the trials have usually been controlled on patients without any prior complications. Some serious side effects from manipulation in the upper and neck regions has resulted in fatalities through stroke by over-stretching vital arteries in the chest.

Headaches

Lastly, headaches is another popular ailment chiropractors are often consulted for. There is some evidence to show chiropractic being effective for headaches, specifically cervicogenic headaches (CGH). At some doses of spinal manipulation, there can be pain relief for CGH, or informally known as tension headaches.

The problem is, there are hundreds of different types of headaches. Aside from tension headaches the most common ones are migraines, cluster, sinus and hormone headaches. With most headaches having fairly similar symptoms, it can be hard to distinguish which can be helped with spinal manipulations.

Many scientists believe that tension headaches can be relieved with any shoulder, neck or back muscle relaxation which is how spinal manipulation are thought to help. Since tension headaches are often related to muscle stiffness, even a massage and hot baths can ease the muscles.

The info-graphic below briefly covers spinal adjustment benefits and the risks of chiropractic.

Alternative to Chiropractic?

Many forms of medicine does has side effects however when they are manageable and the treatment is effective, these side effects can often be overlooked. Unfortunately, chiropractic is not currently at that stage and plenty more research is needed before we can make definite claims on effectiveness and safety. After all, the practice is no older than a century old so there may be a lot of kinks that need to be corrected.

For this reason, an alternative option to using chiropractic is traditional acupuncture. Acupuncture has been around for over 5000 years with plenty of clinical records, safety regulation and a governing body to maintain a certain quality of treatment. Is it currently the second most popular form of medicine after orthodox medicine and for good reason.

Acupuncture also agrees with the importance the nerves play in our overall health and of course in pain relief however the methods of treatments are completely different. They are far less invasive, risky and more refined. As the study of acupuncture even predates most current forms of medicine, it is no wonder so many patients are benefiting from treatment after regular therapies have failed.

Even when acupuncture was first discovered, they had established important ‘Shu Points’ for treatment which we later found out to be trigger points after evolution in medical anatomy, i.e. area that were found to be vital in addressing musculoskeletal pain. Acupuncture has also since claimed the existence of meridians in the body which only recently (Bong-Han Theory) were discovered to exactly map thread like vessels around the body thanks to technology. It is an interesting area of discussion as to how these discoveries were made so long ago when modern technology has only recently been able to confirm their existence.

Regardless, there is plenty of evidence to support the treatment of chronic and acute pain throughout the body through acupuncture. Most popularly, the Journal of Internal Medicine showed through a large number of randomized trials* that acupuncture is significantly more effective at treating chronic pain than say, a placebo effect of other forms of treatment, making it a suitable option for referral.

A study by Liu et al (2015)* showed that based on 3 high quality and 5 medium quality reviews, acupuncture is more effective than no treatment and equally as effective as conventional treatment for lower back pain. The same has been proven for shoulder and neck pain with far fewer risks of damaging major arteries or long term damage. Treatment is usually in the form of inserting hair-thin needles and occasionally a combination of herbs and education on lifestyle so it is far less aggressive than heavy medication or spinal manipulations.

Lastly, with regards to headaches, Travola et al (1992)* found pain relief to be ranging from 30% to 50% better with acupuncture, helping over 80% of the trialled patients in the treatment of migraines and tension headaches. This study was supported with two other papers following this one.

What’s the Verdict? Is Going to a Chiropractor Good?

As we have mentioned, chiropractic is a very new form therapy and requires much more research before anyone can claim its benefits or safety however from the evidence we have seen, it has shown to be effective in various cases but also detrimental in others. It is unclear the mechanism through which it would be effective but individual case study reviews have been mixed.
There are other more effective, alternative treatments which are able to achieve the same results chiropractic is trying to achieve but with more precision and scientific foundation such as acupuncture.

We aim to provide unbiased information and factual data and leave the assessment of the most suitable treatment, to the individual.
Sources:

1. (https://www.ncbi.nlm.nih.gov/pubmed/1388006)

2. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113536/)

3. (http://www.cochrane.org/CD008112/BACK_spinal-manipulative-therapy-for-chronic-low-back-pain)

4. (http://www.jmptonline.org/article/S0161-4754(10)00217-4/pdf)

5. (https://www.ncbi.nlm.nih.gov/pubmed/24262386)

6. (https://www.ncbi.nlm.nih.gov/pubmed/21640251)

7. (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1357513)

8. (https://www.hindawi.com/journals/ecam/2015/328196/)

9. (https://www.acupuncture.org.uk/a-to-z-of-conditions/public-review-papers/migraine-and-acupuncture-the-evidence-for-effectiveness.html)

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