Chiropractic therapy, which primarily focuses on spinal manipulation and adjustment, is a popular non-pharmacological approach for managing musculoskeletal conditions, particularly back and neck pain. While generally considered a safe form of therapy for many people, it is not without potential drawbacks and considerations. Understanding these disadvantages, ranging from expected temporary side effects to rare but serious adverse events and practical limitations, is necessary for making an informed decision about care.
Expected Post-Treatment Side Effects
The most common disadvantage patients report is the temporary experience of minor, self-limiting symptoms following a spinal adjustment. Approximately 50% of patients experience some form of reaction after treatment, with muscle soreness being the most frequent complaint.
This discomfort arises because the adjustment affects joints that may have been restricted, requiring surrounding muscles to adapt to the new alignment. Other minor effects can include temporary stiffness, fatigue, or a mild headache. These symptoms are generally mild and resolve on their own, usually within 24 to 48 hours of the appointment.
Low-Frequency Severe Adverse Events
A more concerning, though statistically rare, disadvantage is the potential for severe adverse events, particularly those related to high-velocity, low-amplitude (HVLA) adjustments. The most widely discussed serious risk is cervical artery dissection (CAD), which can lead to a stroke. CAD involves a tear in the inner lining of an artery in the neck, specifically the vertebral or carotid arteries, and is a medical emergency.
Spontaneous CAD is rare, occurring in an estimated one to three people per 100,000 annually. A causal link to chiropractic manipulation has not been definitively established. Studies suggest the association may be due to patients who are already experiencing a developing dissection seeking care for related neck pain or headaches just before the stroke occurs. Nonetheless, the risk is serious enough that it warrants careful evaluation before any cervical spine manipulation.
Other severe, yet uncommon, risks are primarily associated with manipulation of the lumbar spine. These include the potential for a new or worsened lumbar disk herniation or, in extremely rare cases, the precipitation of cauda equina syndrome. Cauda equina syndrome is a surgical emergency involving compression of the nerve roots in the lower spine, which can cause bladder or bowel dysfunction and permanent nerve damage. Fractures of the ribs or vertebrae can also occur in vulnerable patients, such as those with underlying bone weakness.
Medical Conditions That Preclude Treatment
A significant disadvantage of chiropractic therapy is that certain underlying medical conditions make spinal manipulation unsafe or inappropriate, known as contraindications. Individuals with severe osteoporosis are at an increased risk of compression fractures from the force of an adjustment. Similarly, patients with acute spinal fractures, known arterial pathologies such as aneurysms, or severe spinal instability must avoid manipulative therapy.
Active infections affecting the spine, such as osteomyelitis or discitis, are absolute contraindications because manipulation could potentially spread the infection or worsen the condition. Primary or metastatic cancer affecting the bone structure of the spine also makes adjustments unsafe due to the risk of pathological fracture. These conditions limit who can safely receive the treatment, requiring the practitioner to screen carefully.
Financial Burden and Scope Limitations
The potential financial burden is a significant disadvantage. While some insurance plans cover chiropractic services, coverage is often limited, sometimes only reimbursing for manual manipulation of the spine and not for other services like examinations or physical therapy modalities. This limitation often results in substantial out-of-pocket expenses for the patient, particularly since treatment plans frequently call for multiple, ongoing sessions.
A single chiropractic session can range widely in cost, typically falling between $30 and $200, making long-term or frequent care a significant financial investment without comprehensive insurance coverage. Furthermore, chiropractic care is limited in its scope of practice, focusing on musculoskeletal and nervous system disorders. Relying on chiropractic care for conditions that require immediate medical or surgical intervention, such as severe infections or certain types of cancer, can lead to a disadvantageous delay in correct diagnosis and life-saving treatment.