The relationship between medical doctors (MDs and DOs) and Doctors of Chiropractic (DCs) has long been characterized by professional disagreement and tension. This friction stems from fundamentally different philosophical origins, varying standards of scientific evidence, and practical concerns over patient safety and scope of practice. Discouraging a patient from seeking chiropractic care is often a reflection of these underlying conflicts rather than a rejection of spinal manipulation itself. This perspective has been shaped by decades of institutional conflict and adherence to evidence-based practice.
Historical and Philosophical Opposition
The initial conflict between the professions arose from deep differences in their founding philosophies. Allopathic medicine, the foundation of modern medical practice, focuses on treating specific diseases with scientifically proven interventions. Traditional chiropractic was founded on the principle that many diseases result from vertebral subluxation, a misalignment of the vertebrae that interferes with the body’s innate ability to heal.
Organized medicine responded to this philosophical divide with hostility. In 1966, the American Medical Association (AMA) formally labeled chiropractic an “unscientific cult,” making it unethical for members to associate with chiropractors. This campaign was exposed in the landmark 1987 federal antitrust lawsuit, Wilk v. AMA. A federal judge ruled that the AMA had engaged in an unlawful conspiracy, leading to an injunction prohibiting the organization from restricting physician-chiropractor collaboration.
The Debate Over Evidence and Core Theories
A major source of current medical discouragement is the disagreement over the scientific basis of core chiropractic theories. Modern medical practice operates under Evidence-Based Medicine (EBM), requiring interventions to be supported by high-quality, reproducible scientific studies. Physicians take issue with the foundational chiropractic concept of the “vertebral subluxation complex” (VSC).
Many medical practitioners view the VSC—the idea that minor spinal misalignments cause neurological interference leading to organ dysfunction—as lacking sufficient empirical support. While a medical subluxation is a partial anatomical dislocation visible on imaging, the chiropractic VSC is often a more abstract concept. Medical doctors acknowledge the efficacy of spinal manipulation for specific mechanical issues, such as acute or chronic low back pain, because this is supported by EBM. However, they discourage care based on the VSC theory, especially when it is promoted as a treatment for non-musculoskeletal conditions.
Concerns Regarding Patient Safety and Scope
Concerns about patient safety and diagnostic limitations are practical reasons why medical doctors may discourage chiropractic care. A specific, though rare, risk associated with high-velocity manipulation of the neck (cervical adjustment) is the potential for vertebral artery dissection (VAD). VAD is a tear in the artery wall that can lead to a blood clot, which may subsequently cause a stroke.
Although studies suggest the risk is very low, the devastating nature of stroke heavily influences medical advice. Physicians are also concerned about diagnostic training and scope of practice when a patient presents with complex, non-musculoskeletal symptoms. Serious conditions like spinal tumors, infections, or systemic diseases can often mimic simple mechanical back pain. Reliance on a chiropractor for a non-musculoskeletal condition could lead to a dangerous delay in the timely diagnosis and treatment of a life-threatening illness.
Modern Trends: Collaboration and Integration
Despite historical and philosophical differences, the relationship between the professions is evolving toward greater collaboration. This shift is driven by the increasing acceptance of EBM-supported musculoskeletal care. Chiropractors who focus their practice on evidence-based treatment for conditions like acute and chronic low back pain are finding more opportunities for integration.
Chiropractors are now frequently embedded in multidisciplinary settings, including pain management clinics, Veterans Affairs (VA) hospitals, and sports medicine teams. In these integrated models, the DC’s role is often focused narrowly as a manual therapist, working alongside MDs, physical therapists, and other specialists. This team-based approach, which relies on coordinated referrals, reduces the likelihood of discouragement by aligning chiropractic practice with the medical standard of care.