Doctors used to think chiropractic treatment was a dangerous sham. Nowadays, it's getting more and more mainstream. But does the evidence back it up? A doctor answers.

by Andrea E. Gordon, M.D.

Mention chiropractic treatment in a room full of doctors and you'll hear responses ranging from, "That will give you a stroke!" to, "Helped me when nothing else could." So what is this therapy and why is it so controversial?

WHAT CHIROPRACTORS BELIEVE
Chiropractors believe bones can get subtly out of line and cause muscle spasms or nerve irritation. This causes the pain. Realigning the bones by manipulations called adjustments supposedly helps relieve it.

Several difficulties face researchers when looking at whether chiropractic treatment works. Some chiropractors claim to treat many other kinds of problems, such as asthma and menstrual cramps. And some combine supplements with spinal manipulation.

Chiropractors' assumptions also differ from those in conventional medicine. If you're taught that the skull bones are fused, you'll likely view anyone claiming to adjust them with suspicion. Further, most chiropractors claim their adjustments do more than just relieve pain; they allow the body to function better. If nerves aren't being pinched, all messages they transmit, from digestion to muscle relaxation to hormonal activation, can proceed more normally.

But chiropractic treatment's increasing popularity has exposed physicians more to it. And relatively recent research has demonstrated that it does work for some things. These changes have helped soften doctors' opinions.

DOES CHIROPRACTIC TREATMENT FOR BACK PAIN WORK?
Back pain is perhaps the most common reason for seeking chiropractic adjustment. Some studies have shown that it can be as effective as or more effective than conventional treatment for short-term back pain.

For long-term back pain, a 2004 analysis published by the respected Cochrane Collaboration found that chiropractic adjustments were as good as but not better than other treatments like physical therapy, exercise or pain medication.

DOES CHIROPRACTIC TREATMENT FOR NECK PAIN WORK?
Neck pain and headaches are other complaints chiropractors commonly treat. A 2005 Cochrane review concluded that chiropractic manipulation for neck pain helped when combined with exercise but not when done without.

This brings up the issue of risk versus benefit. Neck adjustments do present a rare risk of stroke. And if you're not really benefiting, the questions is whether even a minimal risk is too high.

WHAT ARE THE RISKS OF CHIROPRACTIC TREATMENT?
Other than the rare risk of stroke from neck adjustments, the other risks of chiropractic adjustment are minimal—usually some soreness. If something isn't improving there is a risk of missing another diagnosis, so you should see your primary-care provider.

WHAT'S MY OPINION?
I recommend chiropractic adjustments for many of my patients with low-back pain, especially sacroiliac-joint dysfunction, which occurs where the hip and back join together. It can be hard to treat. I also send patients with neck pain that doesn't respond to conventional therapy. Many people have poor posture or habits, and I've found chiropractic treatment is one of the ways the resultant problems can be addressed.

ANDREA E. GORDON, M.D., is a board-certified family doctor practicing integrative medicine and teaching at Tufts University Family Medicine Residency at Cambridge Health Alliance in Malden, Mass. She's also an assistant professor of family medicine at Tufts University School of Medicine.

Last updated and/or approved: April 2010. Original article appeared in September/October 2009 former print magazine. Bio current as of October 2009. This article is not meant as individual advice. Please see our disclaimer.

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