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 emphasize vitalistic medicine (the body's ability to heal itself). 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.
Uses for Chiropractic
Evidence (moderate quality) for chiropractic manipulation is sufficient for
Low back pain (1)
Chiropractic is sometimes useful in treating headache, particularly cervicogenic, although benefits are not long lasting and higher quality evidence is still needed (2). It has also been used to treat neck pain (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.
Possible Adverse Effects
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.
References
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. Fernandez M, Moore C, Tan J, et al: Spinal manipulation for the management of cervicogenic headache: a systematic review and meta-analysis. Eur J Pain 24(9):1687-1702, 2020. doi:10.1002/ejp.1632
3.Chaibi A, Stavem K, Russell MB: Spinal manipulative therapy for acute neck pain: a systematic review and meta-analysis of randomised controlled trials. J Clin Med 10(21):5011, 2021. Published 2021 Oct 28. doi:10.3390/jcm10215011
