Is Chiropractic All It’s Cracked Up To Be?

Yesterday, we asked you for your opinions on chiropractic medicine, and got the above-depicted, below-described set of results:

• 38% of respondents said it keeps us healthy, and everyone should do it as maintenance
• 33% of respondents said it can correct some short-term skeletal issues, but that’s all
• 16% of respondents said that it’s a dangerous pseudoscience and can cause serious harm
• 13% of respondents said that it’s mostly just a combination of placebo and endorphins

Respondents also shared personal horror stories of harm done, personal success stories of things cured, and personal “it didn’t seem to do anything for me” stories.

What does the science say?

It’s a dangerous pseudoscience and can cause harm: True or False?

Mixed and True, respectively.

That is to say, chiropractic in its simplest form that makes the fewest claims, is not a pseudoscience. If somebody physically moves your bones around, your bones will be physically moved. If your bones were indeed misaligned, and the chiropractor is knowledgeable and competent, this will be for the better.

However, like any form of medicine, it can also cause harm; in chiropractic’s case, because it more often than not involves manipulation of the spine, this can be very serious:

❝Twenty six fatalities were published in the medical literature and many more might have remained unpublished.

The reported pathology was usually vascular accidents involving the dissection of a vertebral artery.

Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.❞

Source: Deaths after chiropractic: a review of published cases

From this, we might note two things:

1. The abstract doesn’t note the initial sample size; we would rather have seen this information expressed as a percentage. Unfortunately, the full paper is not accessible, and nor are many of the papers it cites.
2. Having a vertebral artery fatally dissected is nevertheless not an inviting prospect, and is certainly a very reasonable cause for concern.

It’s mostly just a combination of placebo and endorphins: True or False?

True or False, depending on what you went in for:

• If you went in for a regular maintenance clunk-and-click, then yes, you will get your clunk-and-click and feel better for it because you had a ritualized* experience and endorphins were released.
• If you went in for something that was actually wrong with your skeletal alignment, to get it corrected, and this correction was within your chiropractor’s competence, then yes, you will feel better because a genuine fault was corrected.

*this is not implying any mysticism, necessarily, though that can certainly also be a component for many, and indeed, chiropractic was originally founded as a new religious movement. Outside of the context of spirituality, however, it means simply that placebo effect is strongest when there is a ritual associated with it. In this case it means going to the place, sitting in a pleasant waiting room, being called in, removing your shoes and perhaps some other clothes, getting the full attention of a confident and assured person for a while, this sort of thing.

With regard to its use to combat specifically spinal pain (i.e., perhaps the most obvious thing to treat by chiropractic spinal manipulation), evidence is slightly in favor, but remains unclear:

❝Due to the low quality of evidence, the efficacy of chiropractic spinal manipulation compared with a placebo or no treatment remains uncertain. ❞

Source: Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

It can correct some short-term skeletal issues, but that’s all: True or False?

Probably True.

Why “probably”? The effectiveness of chiropractic treatment for things other than short-term skeletal issues has barely been studied. From this, we may wish to keep an open mind, while also noting that it can hardly claim to be evidence-based—and it’s had hundreds of years to accumulate evidence. In all likelihood, publication bias has meant that studies that were conducted and found inconclusive or negative results were simply not published—but that’s just a hypothesis on our part.

In the case of using chiropractic to treat migraines, a very-related-but-not-skeletal issue, researchers found:

❝Pre-specified feasibility criteria were not met, but deficits were remediable. Preliminary data support a definitive trial of MCC+ for migraine.❞

Translating this: “it didn’t score as well as we hoped, but we can do better. We got some positive results, and would like to do another, bigger, better trial; please fund it”

Source: Multimodal chiropractic care for migraine: A pilot randomized controlled trial

Meanwhile, chiropractors’ claims for very unrelated things have been harshly criticized by the scientific community, for example:

Misinformation, chiropractic, and the COVID-19 pandemic

About that “short-term” aspect, one of our subscribers put it quite succinctly:

❝Often a skeletal correction is required for initial alignment but the surrounding fascia and muscles also need to be treated to mobilize the joint and release deep tissue damage surrounding the area. In combination with other therapies chiropractic support is beneficial.❞

This is, by the way, very consistent with what was said in the very clinically-dense book we reviewed yesterday, which has a chapter on the short-term benefits and limitations of chiropractic.

A truism that holds for many musculoskeletal healthcare matters, holds true here too:

❝In a battle between muscle and bone, muscle will always win❞

In other words…

Chiropractic can definitely help put misaligned bones back where they should be. However, once they’re there, if the cause of their misalignment is not treated, they will just re-misalign themselves shortly after you walking out of your session.

This is great for chiropractors, if it keeps you coming back for endless appointments, but it does little for your body beyond give you a brief respite.

So, by all means go to a chiropractor if you feel so inclined (and you do not fear accidental arterial dissection etc), but please also consider going to a physiotherapist, and potentially other medical professions depending on what seems to be wrong, to see about addressing the underlying cause.

Take care!