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By Steven Novella, MD, Assistant Professor of Neurology, Yale University School of Medicine

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In chiropractic (a manipulative and body-based practice), the relationship between the structure of the spine and function of the nervous system is thought to be the key to maintaining or restoring health. The main method for restoring this relationship is spinal manipulation. Other joints and soft tissues may also be manipulated. Chiropractors may provide physical therapies (eg, heat and cold, electrical stimulation, rehabilitation strategies), massage, or acupressure and may recommend exercises, ergonomic measures, or lifestyle changes.

Some chiropractors, called straight chiropractors, practice a form of vitalistic medicine. They use manipulation to correct hypothesized misalignments in the vertebrae in an attempt to restore the flow of a life energy (called innate). They believe that this method can heal most disorders. Other chiropractors reject this notion to various degrees; some of them restrict themselves to evidence-based musculoskeletal treatments.

Uses for Chiropractic

Evidence for chiropractic manipulation is sufficient only for

  • Short-term relief of acute uncomplicated low back strain

After the acute stage, continuing adjustments may not provide additional benefit. Thus, the usefulness of chiropractic for chronic back pain is unclear. Chiropractic is sometimes useful in treating headache disorders (although data are inconsistent) and nerve impingement syndromes; it has also been used to treat neck pain.

Some chiropractors treat other disorders (eg, asthma in adults and children; enuresis, colic, torticollis, and otitis media in children), although only a few studies of chiropractic as treatment for these disorders have been done, and they do not support efficacy.

The usefulness of manipulation for conditions not directly related to the musculoskeletal system has not been established.

Possible Adverse Effects

Serious complications resulting from spinal manipulation (eg, low back pain, damage to cervical nerves, damage to arteries in the neck) are rare. Spinal manipulation is not recommended for patients with osteoporosis or symptoms of neuropathy (eg, paresthesias, loss of strength in a limb). Whether it is safe for patients who have had spinal surgery or stroke or who have a vascular disorder is unclear.