Do Chiropractors Really Help?

9June 2020

Occasionally, believe it or not, I recommended chiropractic therapy to my own massage therapy patients. Sometimes I believed they needed more skilful and direct stimulation of spinal joints than I could provide myself, and I believed that the scientific evidence then showed that appropriate spinal manipulation had the potential to help back pain in this way, with acceptable risks.

I have experienced it myself on many occasions, and I have also observed many clients expressing relief and pleasure in response to incidental spinal “adjustments” joint pops that occur in the course of doing massage therapy, little explosions as I slide up the spine. Many people seem to feel that a happy spinal adjustment feels like “scratching an itch you can't reach.” Why might that be? Whatever you have been told before, and despite the availability of many explanations on the internet, the nature of joint popping is not well understood.46 It is firmly in that category of trivial mysteries for which there is simply no research funding, and as such it will probably remain unexplained for some time to come.

Whatever a joint pop really is, it probably provides a novel sensory experience: a little blast of proprioceptive stimulation.47 Since all living systems seem to thrive on sensory input, and generally suffer without it, I speculate that a joint crack essentially feels like getting “unstuck,” and is analogous to finally getting to stretch your legs after getting off a long flight which is not intended to trivialize it.

Indeed, it also seems consistent with another widely reported feature of SMT: the benefits often don't last long! Soon the “itch” needs to be “scratched” again. It also could explain why the benefits of SMT are so variable and uncertain: it is highly dependent on many factors. For instance, whether a joint crack feels “refreshing” to you depends on how you feel about the whole idea of joint cracking.

This is one of those “there are two kinds of people in the world” things: some people crave spinal joint cracking, expertly applied or otherwise, and to others it seems like fingernails on a chalkboard. My wife, for instance, wants at least one spine-cracking hug per day, and clearly becomes impatient when it has been too long since the last one! Other people would view such a hug as an alarming assault people with such anxiety about spinal joint popping typically have never been to chiropractor and never will, or they take a dim view of what happened to them when they reluctantly tried it.

See the donation page for more information and options. I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada.

You might run into me on Facebook or Twitter. This is a painstakingly prepared list. My daring plan was to make this the best such list I could find, which I assumed would be difficult or impossible. Surely there are excellent compilations of this sort already? But it's actually pretty thin pickings: I‘m surprised how little I found, and how much of what I found was rather shabby.

You can really sink oodles of time into wrangling not only a bunch of links, but all the reading required to describe them well. This would have been completely impossible if I hadn't already been reading on this topic for many years. I originally wrote it with great earnestsness for ScienceBasedMedicine.org's Chiropractic Reference Page, in my capacity as SBM's Assistant editor, and I‘ve adapted it a little for use here just a little lighter.

NCAMM's summary of chiropractic is a prominent example of poor quality information about chiropractic. NCCAM is a well-funded institution with a CAM-friendly agenda,48 so it's quite noteworthy that they offer such weak support for chiropractic treatment, confirming that most of the evidence is negative, inconclusive, or only weakly positive despite being generally uncritical of the profession.49 Wikipedia has a lengthy and well-written page specifically devoted to Chiropractic controversy and criticism.

One of the first substantial chiropractic skepticism resources available on the Internet, and it remains the largest (although perhaps SBM is catching up now). Chiropractors everywhere must have strong opinions about this site. Operated by Stephen Barrett, MD, and ScienceBasedMedicine.org's regular guest author and chiropractic insider, Samuel Homola, DC. Most articles remain relevant despite their age.

The National Council Against Health Fraud is another project of the prolific Dr. Chiropractor. Barrett. See the NCAHF Position Paper on Chiropractic and the NCAHF Fact Sheet on Chiropractic. The chiropractic page on WhatsTheHarm.net lists cases of alleged harm from chiropractic treatment, with many links to more information. (Personally, I have received hundreds of anecdotes about chiropractic harm from my own readers over the years.) Chirotalk: The Skeptical Chiropractic Discussion Forum probably the only such discussion forum online.

The Skeptic's Dictionary has a substantial chiropractic entry. As important as the subject is, there are only a few books criticizing chiropractic. Chiropractic books often have poor ratings in web-based bookstores regardless of their quality. They attract outraged ratings from many chiropractors, and positive ones from a minority of sympathetic and skeptical readers.

. com SBM's review by Dr. Hall calls A Chiropractor's Lament a “valuable addition to the literature on chiropractic, combining Long's personal story with everything you never wanted to know about chiropractic. It's fun to read and packed with information. Even if you think you‘ve heard it all before, there are revelations here that will be new to you, that will elicit surprise, indignation, and laughter.” Inside chiropractic: a patient's guide (book), by Samuel Homola.

Homola is a chiropractor, and the most prominent critic of his own profession. His book is an essential patient guide to a profession that is so full of controversy that consumers need a guide before going to chiropractic office. If you like getting your spine cracked, or you think you need to be “adjusted,” read this book before making your next chiropractic appointment! Spin doctors: the chiropractic industry under examination (book), by Paul Benedetti and Wayne MacPhail.

Canadians visit chiropractors about thirty million times a year, and surveys show that patients are generally satisfied with their treatment. But studies also show that as many as two hundred Canadians a year may suffer strokes brought on by neck manipulation. Spin Doctors takes a hard, dramatic, and spine-chilling look into the world of chiropractic medicine.

Most important, you'll learn how to protect yourself and your family from dangerous adjustments, practice-building tactics, bogus treatments, and misleading information. Paul Benedetti is an award-winning journalist who, for more than a decade, has written investigative stories about alternative medicine and health fraud. Wayne MacPhail is a journalist who has written about AIDS, alternative medicine and other health, science, and social issues for twenty-five years.

. com A thorough examination and judgement of more than thirty of the most popular “alternative” treatments, such as acupuncture, homeopathy, aromatherapy, reflexology, chiropractic and herbal medicine. The ultimate verdict on alternative medicine is delivered for the first time with clarity, rigour and authority (Chiropractor). A thorough examination and judgement of more than thirty of the most popular “alternative” treatments.

See SBM's review. Chiropractic: The Victim's Perspective, by George Magner (1995 ). British science writer Simon Singh was sued in 2008 by the British Chiropractic Association for criticizing spinal adjustment for children with conditions like asthma and ear infections, calling it “bogus” and pointing out the lack of evidence. The BCA withdrew its lawsuit two years later, having suffered a public relations disaster.

The other famous chiropractic legal case is Wilks vs. American Medical Association (AMA), fought from 1976 to 1987. Previously, AMA rules made it officially unethical for medical doctors to associate or refer patients to chiropractors. A federal antitrust suit was brought against the American Medical Association (AMA) and 10 other institutional co-defendants by chiropractor Chester A. Chiropractor.

After many years of appeals, the case ultimately concluded with a ruling against the AMA, specifically finding them guilty of prevent physicians from referring patients to chiropractors (violating Section 1, but not Section 2, of the Sherman Antitrust Act). The judge expressed faith in the AMA's goodwill and “subjective belief that chiropractic was not in the best interests of patients,” but still judged that their “concern for scientific method in patient care could have been adequately satisfied in a manner less restrictive of competition.” The AMA nows permits medical doctors to refer patients to chiropractors.

The Chiropractic ControversiesThe Chiropractic Controversies

Harriet Hall, “but it actually did little to change ‘discriminatory' practices or to enhance the reputation of chiropractic.” “Can Chiropractors and Evidence-Based Manual Therapists Work Together?,” Samuel Homola, Journal of Manual & Manipulative Therapy, 2006. Chiropractor. Dr. Sam Homola covers the topics of subluxation theory and spinal manipulative therapy in this 2006 article, managing to be precise and thorough without losing his amiable tone (exactly what I aim for on PainScience.com).

Vertebral Subluxation on Wikipedia.com. An emotionally neutral evaluation of the chiropractic idea of intervertebral subluxation – Chiropractor. I can save you some reading time: the bottom line of the article is that a century of debate has failed to produce any clear answers. Subluxations remain elusive. “Subluxation: Chiropractic's Elusive Buzzword,” Stephen Barrett, ChiroBase.org. Four updates have been logged for this article since publication (2006 ). All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. more Like good footnotes, update logging sets PainScience.com apart from most other health websites and blogs. It's fine print, but important fine print, in the same spirit of transparency as the editing history available for Wikipedia pages.

Complete update logging started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles. See the What's New? page for updates to all recent site updates. This is one of my oldest articles, with origins in the early 2000s and revised and updated many times since, but without logging the changes.

I started logging all updates consistently in 2016.) 2019 Added a couple sources regarding the prevalance and persistence of subluxation-based chiropractic, most notably Mirtz et al. 2016 Added a mobile-only article summary. 2016 Editing and reorganization of the introduction, a new summary of the main controversies, and a significant new reference about Medicare billing.

2006 Publication. ChiroWeb.com [Internet] Gallup poll: Americans have low opinion of chiropractors' honesty and ethics; 2006 Mar 25 [cited 12 Mar 9] When I was a Registered Massage Therapist (2000-2009), my clients asked me about it frequently. That was the original inspiration for this article I wrote it for my clients, like many of the older articles on PainScience.com.

Finding a Good Chiropractor. Archives of Family Medicine. 1998; 7( 1 ):2023. PainSci # 56032. Chiropractic is a puzzling profession because, according to Sam Homola, a chiropractor himself, it “is one of the most controversial and poorly defined healthcare professions with recognition and licensure it has the confusing image of a back specialty capable of treating a broad scope of health problems.” Ernst E.

2008 May; 35( 5 ):54462. PubMed # 18280103. Samuel Homola, Doctor of Chiropractic, is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. He is hardly the only critic of his own profession, but he is probably the most famous and widely read.

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