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While there are some evolving studies suggesting chiropractic may hold merit, there is no sufficient data to establish the safety. In fact, it is frequently associated with mild to moderate adverse effects, and in rare cases, serious complications.
Going by the social media frenzy, chiropractic looks like a new fad, but it isn’t a new technique. (Image: Shutterstock)
Social media reels featuring someone who seems to be a doctor treating patients with loud crackling sounds from their bones have been going viral. While it might look unsettling initially, these professionals are “chiropractors” specialising in spinal and joint adjustments.
Chiropractors are those who perform “chiropractic”. It is pronounced as “kay-ro-practic”. The history of this art suggests that the term ‘Chiropractic’ derives from the Greek words cheir, meaning ‘hand,’ and praktos, meaning ‘done,’ which together translate to ‘done by hand.’
Going by the social media frenzy, chiropractic looks like a new fad, but it isn’t a new technique. Chiropractic traces its origins to 1895, and Daniel David Palmer is credited with developing this practice. According to the University of Minnesota on its website, Palmer “adjusted” the spine of a deaf janitor and claimed to restore his hearing.
Although chiropractic is an old practice, it has faced challenges in gaining worldwide acceptance, primarily due to a lack of strong scientific evidence. Nevertheless, chiropractors now operate in over 90 countries around the world.
In fact, chiropractic care is regulated in 50 states of the United States and it is the largest alternative medicine profession in the United States with approximately 70,000 members. It’s slowly gaining momentum in India. Let’s discuss if you should believe this or if physiotherapy is the best alternative.
How does this therapy work?
From stretching and using sustained pressure to certain joint manipulations – chiropractors used manual treatment methods mostly using a hand involving a quick and gentle thrust.
They claim that the purpose of the manipulations is to improve the movement of the joints and their function. Manipulations involve applying force over the affected area, moving the joint beyond its usual range of motion. This may produce a cracking sound. Globally, people visit them for treatment of lower back pain, neck pain, muscle pain and headaches apart from other musculoskeletal pains.
Published studies favouring chiropractic
According to a study published in the British Medical Journal, spine manipulative therapy (SMT) produces similar effects to recommended therapies for chronic low back pain.
The study said that SMT seems to be better than non-recommended interventions for improvement in function in the short term but “Clinicians should inform their patients of the potential risks of adverse events associated with SMT.”
Similarly, another study published in the Journal of Americal Medical Association (JAMA) concluded that “among patients with acute low back pain, spinal manipulative therapy (SMT) was associated with modest improvements in pain and function at up to 6 weeks, with transient “minor musculoskeletal harms”. However, it said that “the heterogeneity in study results was large” which means the findings are not dependable.
A retrospective study published in the journal Nature, studied a large dataset from chiropractic clinics in Hong Kong. It found that severe adverse effects (AEs) occurring in relation to spine manipulative therapies (SMT) were “rare” – yielding an incidence of 0.21 per 100,000 SMT sessions.
But it also said, “Further research on this topic is needed, possibly via a practice-based research network which could increase the sample size and allow for such analysis.”
Hence, while studies did show the effectiveness of certain techniques but failed to establish concrete evidence on the effectiveness of the therapy.
Another side of the science-based story
According to a large critical analysis published in Science Direct, Journal of Pain and Management, “Chiropractors’ belief in the ‘innate’ subluxation or spinal manipulation is not rational.”
This article asks the question, “Does chiropractic generate more good than harm?” It says, “Current chiropractic practice raises numerous concerns.”
The analysis reviews multiple studies and concludes that the effectiveness, safety, and cost of spinal manipulation are uncertain. It advises that more and better quality studies are required. “Until convincing data are available, we might question the value of this popular approach to health care,” the study says.
The article clarifies that this overview will be “rejected by proponents of chiropractic” for being biased or one-sided, but its purpose was to offer a critical evaluation.
“At present, such an assessment has not been provided by chiropractors, yet progress in any field is difficult without critical evaluation.”
Another study titled “Frequency and Clinical Predictors of Adverse Reactions to Chiropractic Care in the UCLA Neck Pain Study” found that adverse reactions to chiropractic care for neck pain are common.
Of the 280 participants (83 per cent) who responded, 85 (30.4 per cent) had 212 adverse symptoms as a result of chiropractic care.
“Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain,” the study says.
While there are some evolving studies suggesting that the practice holds merit, currently there is no sufficient data to establish the safety of chiropractic manipulations. “It is frequently associated with mild to moderate adverse effects, and in rare cases, serious or fatal complications.”
Dr Abby Cyriac Philip, known for his sarcastic critiques of alternative medicine, including Ayurveda and homoeopathy, described chiropractic as a “pseudoscientific practice with absolutely no evidence” in a post on the social media platform X.
“There is no sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. Several deaths have been associated with this technique,” he wrote in a long post rubbishing the practice which has gained popularity in India after certain reels went viral on social media platforms.
Please hear me out: DO NOT visit chiropractors for any health-related issue. Stay FAR away from them.This is dangerous.This is from an Instagram account of a chiropractor from Delhi who has >250K (misled) followers. I am quite worried that this nonsense is gaining popularity… pic.twitter.com/riKqC6SdTO
— TheLiverDoc (@theliverdr) October 19, 2023
Whom to trust?
In many countries where this therapy is popular, there are bodies responsible for accreditation and keeping checks. For instance, in the US, the National Board of Chiropractic Examiners (NBCE) offers assurance to the general public.
According to NBCE’s website, “NBCE exams offer assurance to the general public that – regardless of where a chiropractor went to school or was licensed –, he or she has demonstrated a baseline of knowledge as well as ability in diagnosis, diagnostic imaging, principles of chiropractic, associated clinical sciences and chiropractic practice.”
However, in India, there is no designated nobody to oversee if the person offering these services is educated or trained enough to provide this otherwise risky treatment. Many chiropractors News18 spoke to, said that they have degrees from the US or they are registered physiotherapists and also offer chiropractic. But many others have received certifications from certain institutes which are not popular or obscure. But, it all goes unchecked as there is no stipulated body to oversee or check the authenticity of the chiropractors.
Unlike physiotherapists – who are registered under The Rehabilitation Council of India Act, 1994 and registered under state medical councils – chiropractors are not liable to adhere to any medical code of conduct.
“If 100 patients are coming to us in a week, 50 come for chiropractic treatment. However, chiropractic is just a part of treatment and not a full treatment. The actual treatment is physiotherapy and we can use chiropractic for certain movements,” a physiotherapist as well as chiropractor, who works at a wellness clinic based in Gurugram told News18.
In short, it is advisable to choose a healthcare professional based on their skills, qualifications, and certifications rather than their popularity on social media, such as viral reels or follower count.
