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. (See also Overview of Integrative, Complementary, and Alternative Medicine.)
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.
Evidence for chiropractic manipulation is sufficient for
Low back pain (1)
Chiropractic is sometimes useful in treating headache, particularly migraine and cervicogenic headache (although data are inconsistent); it has also been used to treat neck pain (2). Manipulative therapy (which includes osteopathy as well as chiropractic) has been beneficial and safe in colic, or in excessively crying infants; however, these studies had some methodologic limitations (3).
Some chiropractors treat other disorders (eg, asthma, enuresis, torticollis, and otitis media in children), although very few high-quality studies of chiropractic as treatment for these disorders have been done, and they do not support efficacy.
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.
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 J18(5):866-879, 2018. doi: 10.1016/j.spinee.2018.01.013.
2. Bryans R, Descarreaux M, Duranleau M, et al: Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 34(5):274-89, 2011. doi: 10.1016/j.jmpt.2011.04.008.
3. Dobson D, Lucassen PL, Miller JJ, et al: Manipulative therapies for infantile colic. Cochrane Database Syst Rev 12:CD004796, 2012. doi: 10.1002/14651858.CD004796.pub2.