In chiropractic (a manipulative and body-based practice), the relationship between the structure of the spine and other articulating surfaces and their interaction with the nervous system is thought to be key to maintaining or restoring health. The main method for restoring this relationship is manipulation of the spine, other joints, and soft tissues. 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 emphasize vitalistic medicine (the body's ability to heal itself). They use manipulation to correct hypothesized misalignments in the vertebrae in an attempt to restore the flow of a life energy (called innate) and thus heal most disorders. Other chiropractors reject this notion to various degrees; some restrict themselves to evidence-based musculoskeletal treatments.
Uses for Chiropractic
Moderate-quality evidence supports chiropractic manipulation for
Low back pain (1, 2)
A large pragmatic trial including U.S. military personnel with low back pain found that adding chiropractic care to usual medical care improved health-related quality of life, pain, and disability compared to usual care alone (3).
Chiropractic is sometimes useful in treating headache, particularly cervicogenic, although benefits are not long lasting and higher quality evidence is needed (4). Spinal manipulation for acute neck pain may be effective, but evidence is limited in quality and quantity (5).
Some chiropractors treat other disorders (eg, asthma, enuresis, torticollis, and otitis media in children), although there are few high-quality studies of chiropractic as treatment for these disorders, and those studies do not support efficacy.
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 (6). Spinal manipulation is not recommended for patients with osteoporosis or symptoms of neuropathy (eg, paresthesias, loss of strength in a limb). Whether manipulation is safe for patients who have had spinal surgery or stroke or who have a vascular disorder is unclear.
References
1. Coulter ID, Crawford C, Hurwitz EL, et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J.18(5):866-879, 2018. doi: 10.1016/j.spinee.2018.01.013
2. Walker BF, French SD, Grant W, Green S. A Cochrane review of combined chiropractic interventions for low-back pain. Spine (Phila Pa 1976). 2011;36(3):230-242. doi:10.1097/BRS.0b013e318202ac73
3. Hays RD, Shannon ZK, Long CR, et al. Health-Related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care Plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial. Pain Med. 2022;23(9):1550-1559. doi:10.1093/pm/pnac009. Erratum to. Health-Related Quality of Life among United States Service Members with Low Back Pain Receiving Usual Care plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial. Pain Med. 2022;23(6):1198. doi:10.1093/pm/pnac054
4. Fernandez M, Moore C, Tan J, et al. Spinal manipulation for the management of cervicogenic headache: a systematic review and meta-analysis. Eur J Pain. 24(9):1687-1702, 2020. doi:10.1002/ejp.1632
5. Chaibi A, Stavem K, Russell MB. Spinal manipulative therapy for acute neck pain: a systematic review and meta-analysis of randomised controlled trials. J Clin Med. 10(21):5011, 2021. Published 2021 Oct 28. doi:10.3390/jcm10215011
6. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. Published 2019 Mar 13. doi:10.1136/bmj.l689
