Do they really work?
You’re at work and lift a heavy box. When you get home later, you notice that your back is sore. You don’t think too much about it until several days later when you notice it’s still sore. You decide that it’s time to get help, so you go to the doctor. You’re surprised that the doctor recommends that you see a chiropractor. What exactly do they do? Will they actually be to help you?
Every year, about 22 million Americans visit chiropractors and of these, around 7.7 million (35%) are trying to get relief from back pain. A study that was recently published in The Lancet found, globally, low back pain is the most common cause of disability. However, it’s not just back pain that is sending people to chiropractors, but complaints of headaches and pain in the neck, arms and legs. According to a 2018 Gallup survey conducted on the behalf of the Palmer College of Chiropractic, roughly 62% of adults in the US have had neck or back pain significant enough that they sought treatment from a healthcare professional at some point in their life. The break down of this number shows that 63% of the people saw a medical doctor while 53% sought treatment from a chiropractor. A different Gallup survey found that more than 62 million people have seen a chiropractor since 2011. Per the 2017 National Health Interview Survey (NHIS), the number of adults who seek chiropractic care has remained constant since 2007. Corresponding to this study was a different one done by the Centers for Disease Control that found women are more likely than men to see a chiropractor, and those that are between the ages of 45 and 64 are more likely to go to a chiropractor than people between the ages of 18-44 or 65 and over. The study also found that non-Hispanic white adults are much more likely to visit a chiropractor (12.7%) than Hispanic (6.6%) or non-Hispanic black (5.5%) adults. As far as children, the study discovered that older children (age 12 to 17) are more likely than younger ones (age 4 to 11) to go to a chiropractor, there isn’t a significant difference in the use between girls and boys and, similarly to adults, non-Hispanic white children are more likely than non-Hispanic black or Hispanic children to go to a chiropractor. The 2012 NHIS study found that among adults who use chiropractic manipulation, about 67% do so to treat a specific health condition, 43% use it for general wellness or disease prevention, 25% enjoy it because it focuses on the whole person (mind, body and spirit), 16% find they have improved energy, 11% say it provides them with better immune function and 5% indicate that it helps to improve their memory or concentration.
In 1896, the first chiropractic adjustment took place in an Iowa office building. A man named D.D. Palmer fixed the building’s janitor’s back pain. Due to the passage of time, it’s not clear exactly how Palmer adjusted the janitor’s vertebral subluxation, (an undetectable spinal misalignment). Palmer was a fan of metaphysics and correlated physical symptoms with spiritual phenomena. This is why chiropractic practice is based on the idea of energy flows blocking the “innate.” This blockage displays itself as things, such as back pain. Palmer believed chiropractic care had a religious and moral purpose. Palmer’s emphasis on the nervous system is considered an early contribution to important physiological discussions that doctors are still trying to figure out today. One of the biggest unsolved mysteries in field is exactly how spinal manipulation reduces back or neck pain. The mechanism isn’t well understood, but increased mobility of the spinal vertebrae and muscle relaxation is thought to contribute significantly.
Even though they aren’t medical doctors, chiropractors are trained and licensed medical professionals. Their education typically involves an undergraduate degree with a focus in the sciences plus four years of chiropractic college that has both classes and hands-on experience. All states in the US require that chiropractors obtain a Doctor of Chiropractic (DC) degree from a Council on Chiropractic Education (CCE) accredited college and pass a licensure exam. Some individuals choose to specialize in a certain area, so they do an additional residency that lasts another two to three years. There are over 100 different chiropractic methods with no one method being better than another. Once out of school, chiropractors must keep current by taking regular continuing education classes. Currently, there are over 70,000 licensed chiropractors working in the US. These practitioners are able to treat various issues and conditions involving the muscles, tendons, ligaments, bones, cartilage and nervous system by focusing on the relationship between the nervous system and spine. During treatment, a chiropractor performs manipulations, or small adjustments, of the patient’s body using their hands or small instruments. These are done to different parts of the body depending on what the complaint is, often the result of a traumatic injury. The thought is that through proper alignment of the body’s musculoskeletal structure, especially the spine, it will allow the body to heal itself without surgery or medication. The goal is to reestablish the structural integrity of the spine while reducing pressure on sensitive neurological tissue. Many chiropractors point out that manipulating vertebrae is useless if you don’t address the entire muscular structure of a human body and how it moves on a regular basis. Each one of our bodies is a direct result of our individual movement patterns. This concept leads to the idea that no one is out of shape. Instead, you’re in the exact shape that you train for. So, if you don’t train, that’s the shape you’re in. This is why chiropractors also focus on educating their patients on how to account for their own health through nutrition, exercise, ergonomics and other therapies. Since the goal is to treat the whole body, not just a specific pain or injury, its approach is considered to be holistic, which is why it’s often categorized as alternative medicine or complementary medicine.
It can be easy to find a good chiropractor. Ask your primary care physician, a relative or a friend if they know of a reputable one. Before meeting with one, read their website, especially patient reviews. When you do meet with the one you selected discuss their treatment approach for your specific condition. Find out if they have any post-graduate certifications or specialties and how long that they have been practicing. Make sure that the chiropractor is willing to work with your primary care doctor or refer you to a specialist, if necessary. Also, be sure to ask about any risks in performing adjustments in general and with your previous/ongoing medical conditions. Another important question is whether or not a visit to the chiropractor is covered by your health insurance. It’s a good idea to call your insurance company before making your first appointment to learn whether or not it’s covered. If it is, you should check to see what your copays or deductibles are. Your insurance company may also require a referral from your primary care doctor. According to a 2002 National Center for Complementary and Alternative Medicine report, over 75% of private health insurers, 50% of health maintenance organizations (HMOs), almost all workers’ compensation systems and over two dozen states Medicare programs cover chiropractic appointments. If you don’t have coverage, the cost of your first appointment is usually around $160 and follow up visits range between $50 and $90 each. The cost is dependent on where you live and the treatments you receive.
In your first visit, the chiropractor will take a medical history, perform a physical examination, and may use lab tests or diagnostic imaging to determine if chiropractic treatment is appropriate for your pain. During this visit, it’s essential that you tell them about any prescription and over-the-counter medications or supplements you’re taking. It’s also important to mention any other health treatments you’re using whether they’re traditional or complementary. All treatment is based on an accurate diagnosis of your pain. The typical treatment plan usually involves making one or more manual adjustments. This means that doctor manipulates the joints, using a controlled, sudden force. In order for them to do this, you’ll have to sit or lie down on a specially designed, padded table and may be directed to move into different positions throughout the process. Don’t be surprised if you hear popping or cracking sounds. One common maneuver that many people are familiar with is the high-velocity cervical adjustment. During this manipulation, the patient relaxes their head in the hands of the chiropractor, who quickly thrusts the head in one direction. There are other techniques that use gentler, low-velocity cervical movements. It’s a good idea to wear loose fitting, comfortable clothing to your appointment and remove jewelry before the manipulations begin. It’s not uncommon after an appointment to have headaches, feel tired, increased level of pain in the area or have soreness/stiffness to the area. These side effects are usually mild and temporary. Some chiropractors incorporate complementary medicine, like acupuncture or homeopathy, into the treatment plan. The scope of what a chiropractor’s license allows them to do varies by state. It’s important to note that if your symptoms don’t get better after several weeks, you should reevaluate the plan.
When looking at the effectiveness of chiropractic treatments, there are several studies that support it. One study published in 2008 in the Spine Journal looked at the chiropractic treatment experiences of 192 people with back-related pain or sciatica, which is when the sciatic nerve becomes pinched in the lower spine resulting in leg pain. While manipulation isn’t traditionally widely used to treat sciatica, 87% of study participants felt that the care they received for their pain was worthwhile. According to a different study conducted in 2010, spinal manipulation is better than placebo and acupuncture for immediate, short-term relief from low-back and neck pain. The study did point out that the results comparing spinal manipulation to massage, medication or physical therapy were mixed. In the April 2017 edition of the Journal of the American Medical Association, a study was published that found that cervical and lumbar manipulation (the most common neck and back adjustments) is effective in treating low back pain. Other studies have found that chiropractic manipulation can lead to better patient outcomes, especially when combined with standard medical care. When it comes to some conditions, such as fibromyalgia, children’s ear infections, chronic obstructive pulmonary disease (COPD), infant colic and bedwetting, researchers say that there’s too little evidence to know if spinal manipulation helps with these problems. Studies have demonstrated that spinal manipulation doesn’t help with asthma, hypertension or menstrual pain.
Overall, chiropractic manipulations are considered safe, effective treatments. The American Chiropractic Association points to a 1996 study done by the Rand Corporation that found the risk of an adverse effect from a cervical manipulation to be less than one per 1 million treatments. A study published in the Canadian Medical Association Journal in 2001 showed that the risk of a stroke following a cervical chiropractic treatment to be one per 5.85 million treatments. When compared to the risk associated with opioids (the most commonly prescribed medication for back and neck pain), the potential soreness and ache (most common side effects of chiropractic treatment) seems minor.
It’s important to note that high-velocity cervical manipulation has been linked to small tears in the artery walls in the neck, called cervical artery dissections. While these tears can lead to a stroke, it is very rare. Many doctors point out that these tears can occur with any kind of sudden neck movement. In addition, there have been cases in which treatment worsened a herniated disc or neck manipulation resulted in a spinal cord injury. These are also rare. In a Medscape review that was published in 2010, it was found that there were more than two dozen published deaths after chiropractic treatments. The study did note that other deaths may have been unreported. In a different review done in 1997 that looked at complications after neck manipulations, there were 177 cases that resulted in patient injury and 32 of these were fatal. With both of these studies, it’s important to keep in mind that given the millions of people who undergo chiropractic care annually the number of injuries and death is minimal. This is why chiropractors say the risks of injury from chiropractic care is exceedingly low. However, to some medical doctors, even low risks are unacceptable and some will recommend that if their patients are going to see a chiropractor to avoid any high-velocity neck manipulations. Other doctors are uncomfortable with the fact that it’s not known how spinal manipulation actually works to reduce pain. Due to the potential risk for injury, they are hesitant to refer patients to chiropractors. It’s key to remember that we don’t have a great understanding of why some traditional therapies work either nor do they work consistently. Another concern that doctors have is that delays in diagnosis of serious illnesses have occurred as the result of people seeking chiropractic care instead of going to the emergency room. For example, if someone has a severe headache that developed quickly with odd sensations in their face, they could be experiencing the early onset of a stroke. This is why it’s essential to known what symptoms require a trip to an emergency room. Many doctors also have issues with some chiropractors who claim that they can treat non-musculoskeletal conditions. Most of these claims that have little to no basis in science. In addition, doctors highlight that there are certain groups of people that shouldn’t receive chiropractic care at all because it places them at an increased risk of complications. This includes anyone with osteoporosis, spinal cord compression, inflammatory arthritis, cancer (especially spinal), numbness/loss of strength in an arm/leg, spinal instability, have an elevated risk of stroke or are currently taking blood-thinning medications. If you don’t know if chiropractic treatment is appropriate for your condition, ask your doctor before going.
If you’re uncomfortable with seeing a chiropractor, you might want to consider seeing an osteopath instead. An osteopath is license doctor that can practice in all areas of medicine in addition to being able to manipulate the neck without risk of a serious injury. During their schooling, they received special training on the musculoskeletal system, but also spend time in operating rooms and intensive care units. Besides doing spinal manipulations, they can prescribe medication and do injections.
When you look at all of the data, there are very few risks associated with chiropractic care when it’s performed by a licensed professional. It’s important for chiropractors to warn people of all potential risks, even if it is small. If the practitioner doesn’t discuss them, then you shouldn’t go to that person. Similarly to finding a good medical doctor, finding a good chiropractor can provide you with positive health outcomes.