Chiropractic care is a popular form of complementary health care focusing on the diagnosis and treatment of musculoskeletal disorders, primarily through spinal manipulation. Millions of people seek these services annually, often for relief from back and neck pain. While proponents describe it as a safe, non-invasive option, the profession faces significant debate and patient skepticism. This caution stems from documented risks, weak scientific evidence supporting some practices, and the financial implications of long-term treatment models.
Acute Physical Risks of Spinal Adjustments
The most serious and widely documented risk associated with spinal manipulative therapy (SMT) is the potential for acute, severe adverse events, particularly following high-velocity adjustments to the neck. This technique, known as cervical manipulation, involves a quick, forceful thrust that can, in rare instances, damage the delicate vascular structures supplying the brain. The most feared complication is Vertebral Artery Dissection (VAD), which involves a tear in the lining of the vertebral arteries that pass through the cervical spine.
A dissection can lead to the formation of a blood clot, which may travel to the brain and cause a vertebrobasilar stroke. While the absolute incidence is low (estimated from 1 in 20,000 to 1 in several million manipulations), this risk is a unique concern for neck adjustments. Studies note that stroke patients under 45 are statistically more likely to have recently visited a chiropractor. However, this association is complicated because initial symptoms of a developing dissection, like severe neck pain or headache, often prompt the patient to seek chiropractic care.
Beyond vascular injury, spinal adjustments carry the risk of direct mechanical trauma to the musculoskeletal and nervous systems. High-force manipulation can potentially exacerbate pre-existing conditions, such as a herniated intervertebral disc. This occurs by further displacing the disc material and increasing pressure on spinal nerves, which can lead to symptoms like radiating pain, numbness, or muscle weakness, collectively known as radiculopathy.
Patients with underlying structural weaknesses are particularly vulnerable to injury from spinal manipulation. Individuals with severe osteoporosis, spinal tumors, or certain forms of inflammatory arthritis risk vertebral fracture or spinal cord compression. Identifying these contraindications requires a thorough screening process, as failure to do so can result in serious harm, including cauda equina syndrome, which is a medical emergency.
Limitations of Scientific Evidence
A central controversy revolves around the concept of the “vertebral subluxation complex” (VSC). This theory posits that minor spinal misalignments interfere with the nervous system, causing disease throughout the body. The fundamental issue is that the VSC lacks a credible scientific or empirical basis in mainstream medicine, and reputable scientific bodies have concluded there is no clinical evidence to support it as a cause of disease.
The lack of scientific support becomes a patient safety concern when chiropractic care is applied to conditions beyond the musculoskeletal system. High-quality systematic reviews have found little evidence that spinal manipulation is effective for non-musculoskeletal issues like asthma, hypertension, or infantile colic. While some practitioners treat these internal disorders based on the VSC theory, the practice is not supported by rigorous randomized controlled trials.
A more significant danger is the risk of delayed diagnosis for serious or progressive medical conditions. As primary contact practitioners, chiropractors encounter patients whose symptoms may mimic musculoskeletal issues but are actually “red flags” for serious pathology, such as cancer or stroke. If a chiropractor relies solely on spinal adjustments for a progressive condition, the patient may experience a delay in receiving proven medical treatment. Documented cases of malpractice have occurred where failure to recognize and refer a patient with non-musculoskeletal symptoms resulted in a worsened prognosis.
Issues of Overtreatment and Financial Burden
A common practice raising ethical and financial concerns is the recommendation of “maintenance care” or “wellness care.” This model involves frequent, long-term, scheduled spinal adjustments that continue after a patient’s initial symptoms, such as acute back pain, have fully resolved. The stated goal is to prevent future problems and maintain general health, often based on the discredited VSC theory.
This approach is widely criticized because there is no scientific evidence supporting the idea that maintenance adjustments provide a general health benefit or prevent disease in healthy individuals. In the absence of symptoms or a chronic condition, this treatment schedule is essentially an unsubstantiated financial model that can create patient dependency. The practice encourages patients to pay for unnecessary services over months or years, leading to a significant financial burden.
The high frequency of recommended visits translates directly into substantial out-of-pocket expenses for patients, especially when insurance coverage is limited. The estimated cost of this type of preventive care is conservatively estimated to be in the billions of dollars annually. Furthermore, some practitioners operate outside of their established professional boundaries, advising patients on medical conditions like diabetes or encouraging them to forgo proven medical care. This “scope creep” can lead to inappropriate advice that compromises a patient’s overall health management.