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When Should You Consider Chiropractic Care?

Recent studies have identified the pros and cons of spinal manipulation.

Key points

  • Chiropractic practitioners claim that their spinal realignments can help with back and neck pain, as well as other conditions.
  • Evidence suggests that pain reduction is possible, but it may be due to the placebo effect.
  • Becoming a chiropractic doctor does not require extensive training.
  • Chiropractic adjustment can, rarely, cause serious injury and should be avoided by people with certain conditions.

The concept of chiropractic medicine was born on Sept. 18, 1895, when Daniel David Palmer, a Canadian who moved to Davenport, Iowa, met a deaf janitor named Harvey Lillard. Mr. Palmer, a grocer who was also a self-proclaimed magnetic healer, possessed no medical training but claimed that he fixed Lillard’s deafness by adjusting his spine. Mr. Palmer eventually opened several chiropractic schools. One of those, Palmer College of Chiropractic, is still active in Iowa.

Chiropractors believe spinal problems, called subluxations, are the underlying cause of many medical issues. Practitioners advertise that their spinal realignments can help with everything from back pain and headaches to asthma, high blood pressure, diabetes, neuroblastomas, meningitis, and various cancers. Chiropractors argue that since your spine and the attached nerves send signals to the entire body, stimulating the spine through chiropractic adjustments will improve the health of the entire body. Many patients find this explanation feasible. No scientists do.

Is It Hard to Become a Chiropractor?

The acceptance rate for Palmer is an unprecedented 100 percent. Thus, it seems that almost anyone has the opportunity to become a chiropractor. The average GPA of someone entering chiropractic training tends to be significantly lower than someone entering a typical allopathic or osteopathic medical school.

Training typically involves taking a few trimesters of basic science courses, and some electives on how to bill insurance companies and ensure long-term patient retention. Students in chiropractic schools do not learn to care for sick patients. They usually just examine friends and other students. In most schools, chiropractic students are only required to evaluate 35 patients in order to graduate; only 10 of those must be real live patients. For the remaining cases, students are permitted to simply observe, read about, or view computer simulations.

Former National Council Against Health Fraud president William T. Jarvis, Ph.D., once stated that chiropractic schools prepare students to practice “conversational medicine”—where they glibly use medical words but lack the knowledge or experience to deal appropriately with the vast majority of health problems.

Is Chiropractic Manipulation Effective?

The major reason that people see a chiropractor is for relief of pain, usually back pain. Two interesting things about pain: It is the most common neurological complaint reported by patients and it is a symptom that is most likely to respond positively to the use of placeboes.

Both of those features may work to the advantage of chiropractors. The high incidence of pain brings in lots of patients and its susceptibility to the placebo effect makes patients believe that they benefited from the treatment. The fact that most medical therapies for back pain are ineffective may also work to the advantage of chiropractors. In truth, recent studies have reported that chiropractic manipulation was no more effective than massage in terms of the ability to relieve back pain.

Is Chiropractic Manipulation Harmful?

Chiropractic adjustment can, although rarely, cause serious negative consequences, such as strokes and arterial wall failure, in vulnerable patients. A 2003 study found that manipulation therapy of the neck can be a risk factor for strokes. This happens due to the formation of a tear in the vertebral artery after a spinal adjustment. Unfortunately, there are very few studies that have systematically analyzed the hazards of chiropractic manipulation.

One comprehensive search of eight electronic databases examined for injuries due to spinal manipulation in children 18 years or younger. The authors could only identify 14 cases of direct adverse events, including subarachnoid hemorrhage, paraplegia, and severe headache. The authors concluded that very little could be drawn from these observational data. The paucity of thorough investigations has allowed chiropractors to imply that their services are safe because they are covered by Medicare and most insurance companies. However, this coverage has been achieved through political action rather than scientific merit.


In general, given available knowledge, chiropractic manipulation should be avoided by pregnant women, people with spinal bone fractures or dislocations, severe osteoporosis, severe arthritis, diabetes, cancer or infection of the bone, and those taking blood-thinning medications. Children should not be allowed to undergo treatment by a chiropractor.

Chiropractic theory and practice are not based on any known scientific principle and while the use of heat, ultrasound, and massage might provide temporary relief, chiropractic manipulation is useless against the vast majority of diseases. Overall, in spite of the poor quality of education and training, chiropractic manipulation is safe for most people and may provide modest relief from pain that, according to recent studies, is likely due entirely to the placebo effect.


Pasquier M et al (2022) Factors associated with clinical responses to spinal manipulation in patients with non-specific thoracic back pain: A prospective cohort study. Frontiers in Pain Res (Lausanne), Jan, PMID: 35295527 PMCID: PMC8915706 DOI: 10.3389/fpain.2021.742119

Gevers-Montoro G et al (2021) Clinical effectiveness and efficacy of chiropractic spinal manipulation for spine pain. Frontiers in Pain Res, PMID: 35295422 PMCID: PMC8915715 DOI: 10.3389/fpain.2021.765921

Vohra S et al (2007) Adverse events associated with pediatric spinal manipulation: A systematic review.

Pediatrics Vol 119 (1): e275–e283.

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