Should You Trust Your Health to a Chiropractor?

There was a time when chiropractors were considered modern day snake oil salesmen. The reputation might have something to do with the profession's founder, D.D. Palmer, who claimed to cure a janitor of his deafness by popping a neck bone back into place in the late 1800s.

The profession has since become more mainstream: Roughly 11% of American adults saw a chiropractor in 2022, mainly for pain management. Chiropractic care is offered by many of the nation's leading health systems. National guidelines for back pain often recognize chiropractic adjustments as a first line of treatment.

Still, the profession hasn't entirely shed its antiestablishment roots, or fully shaken off its reputation for straying from the science. Some chiropractors promise near-miraculous results for diseases with treatments that aren't backed by evidence. Others sell expensive supplements with unproven benefits. (The American Chiropractic Association says that a minority of providers diverge from evidence-based practices, though critics of the industry say it's more common).

What are chiropractors qualified to do?

While chiropractors often refer to themselves as doctors, their degree is different from medical doctors.

To practice in the United States, chiropractors typically attend a four-year program where they take courses in basic science and lifestyle and nutrition counseling. They also learn how to perform manual adjustments, which involve putting pressure onto the joints and creating a deep stretch in the tiny muscles that connect the spine's vertebrae, said William Lauretti, a professor of integrated chiropractic therapies at Northeast College of Health Sciences and a spokesperson for the American Chiropractic Association.

(The popping sound heard during this adjustment is a result of gas being released from the fluid that surrounds your joints. While satisfying, Lauretti said the sound is not the goal of the adjustment.)

After training, chiropractors must pass a national board exam to be eligible for state licensure.

What chiropractors can and can't do depends on where they practice. For example, in Oregon chiropractors are legally allowed to deliver babies (though they do so rarely) and perform very minor surgery, like stitches and removing skin tags. New York, which has stricter laws for chiropractors, requires them to focus to spinal conditions.

Many insurers will cover many services offered by chiropractors, including adjustments, nutrition counseling and X-rays. Medicare coverage is more stringent, often only covering adjustments, though chiropractors are lobbying Congress to change this.

Is there good evidence that chiropractic care is helpful?

Chiropractors advertise their services for a wide range of conditions: back pain, arthritis, diabetes, asthma and ear infections. But what the research says chiropractors are effective at treating doesn't necessarily match up.

There's robust evidence that shows chiropractic adjustments can be mildly to moderately effective at managing lower back pain, said Christine Goertz, a professor of musculoskeletal research at the Duke Clinical Research Institute and a licensed chiropractor. An analysis of 47 randomized controlled trials -- often considered the gold standard of scientific evidence -- determined that manual manipulation was equally effective as treatments like acupuncture or massage therapy.

And the risks of side effects are low compared to some other common interventions, like anti-inflammatory medications and corticosteroid injections. Fractures or other serious complications from spinal manipulation are possible but rare, occurring in roughly 1 per 2 million manipulations, according to one study.

For that reason, spinal manipulation is often recommended as a first line of treatment for low back pain, including in guidelines from the World Health Organization and the Department of Veterans Affairs.

"It is at least as good as, or maybe a little bit better than, other care options for low back pain," Goertz said. (Though, as skeptics note, treatments for lower back pain are not very effective in general.)

There is less evidence supporting the use of chiropractic treatment for neck pain. A review of six studies found that chiropractic adjustments did improve acute neck pain. However, the researchers noted that more research was needed to draw any firm conclusion, since many of the studies had only a small number of participants and other limitations.

Some doctors advise against manipulating the neck because of the potential risk of arterial dissection, in which vessels that supply blood to the brain are torn. This can lead to stroke or death. Some analyses have suggested an association between neck adjustments and this injury, but it's not clear there is a causal link.

There are still many gaps in the research on chiropractic treatment, including on its use among children. There is also no rigorous evidence that supports claims about using it to treat conditions like colic, asthma and infection, Goertz said.

Timothy Caulfield, who studies health misinformation at the University of Alberta, argued that the potential for physical harm from chiropractic care is not the only factor to consider. He pointed to vocal anti-vaccine sentiment among some chiropractors, which he said could help fuel distrust in the medical establishment.

"There are other, kind of broader, social harms," he said.

What should you look for in a chiropractor?

While some chiropractors stick closely to their training and offer care that is supported by scientific research, others veer toward unproven treatments.

"We tend to be much more, let's say, diverse than most other healthcare fields," Lauretti said.

If you're looking for an evidence-based chiropractor, start by evaluating the kinds of statements the provider is making on their website or in advertisements. Claims of miraculous cures should raise alarm bells, especially if they promise to treat conditions that are not musculoskeletal.

While some patients need ongoing care, Lauretti said it's a red flag if a chiropractor tries to sign you up for a subscription or a series of appointments at the first visit.

Some chiropractors sell their own supplements or herbal remedies directly to patients. This isn't necessarily a deal-breaker, Lauretti said. For example, he sometimes recommends calcium pills to patients to protect against osteoporosis. But you should be skeptical of pricey pills with purported benefits that seem too good to be true.

This article originally appeared in The New York Times.

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