Chiropractic care is a widely recognized complementary health approach focusing on the musculoskeletal system, utilizing manual techniques like spinal manipulation to address mechanical disorders. This article explores documented safety concerns, scientific controversies, and professional critiques that lead some experts to advise caution or avoidance of certain chiropractic practices. The discussion focuses on the established risks of specific procedures, the lack of evidence for non-musculoskeletal claims, and the philosophical theories governing some treatment plans.
Acute Physical Risks Associated with Adjustments
The high-velocity, low-amplitude (HVLA) thrust, particularly when applied to the neck, carries a small but serious risk of vascular injury. This specific technique, known as cervical manipulation, has been associated with vertebral artery dissection (VAD). A dissection involves a tear in the inner lining of the vertebral artery, which supplies blood to the brain’s posterior circulation. The tearing of the artery can lead to the formation of a clot, which may then travel to the brain and cause an ischemic stroke.
While this outcome is rare, the consequence of stroke is severe and potentially life-altering or fatal. The association is complex because a dissection in its early stages can cause neck pain, which is often the symptom leading a patient to seek chiropractic care. The mechanical forces of the adjustment are documented to be a potential trigger for VAD.
Spinal manipulation can also exacerbate existing spinal conditions, such as disc herniations or nerve compression. Forceful adjustments can potentially worsen a pre-existing disc bulge or rupture, leading to increased pain or neurological symptoms. For patients with an acute lumbar disc herniation, manipulation carries a risk of worsening the condition.
A more severe, though extremely rare, risk associated with lumbar manipulation is cauda equina syndrome (CES), a condition where the nerve roots at the end of the spinal cord are compressed. CES is a surgical emergency that can result in permanent loss of bowel and bladder function, as well as leg paralysis. While manipulation may not be a direct risk factor, the underlying low back pain that prompts a visit is an independent risk factor for CES, necessitating caution and thorough screening.
Questionable Efficacy for Conditions Beyond Spine Pain
Spinal manipulation shows evidence of effectiveness for certain musculoskeletal issues, such as acute and chronic low back pain, some types of neck pain, and certain headaches. Controversy arises when chiropractic care is claimed to treat non-musculoskeletal (non-MSK) conditions affecting internal organs and systemic health, such as asthma, allergies, high blood pressure, otitis media, and infantile colic.
Scientific reviews consistently find a lack of robust evidence supporting spinal manipulation for the vast majority of non-MSK conditions. Studies show manipulation is ineffective for asthma and dysmenorrhea, and evidence for otitis media and hypertension is inconclusive or negative. This lack of scientific backing can mislead patients into believing a spinal adjustment can address a systemic illness.
Relying on chiropractic treatment for these issues can lead to a delay in seeking effective conventional medical care, which is particularly concerning for pediatric or serious internal conditions. When a condition has a known, evidence-based treatment, pursuing an unproven alternative may allow the underlying disease to progress untreated.
Criticisms of Foundational Philosophical Theories
A major criticism centers on the “Vertebral Subluxation Complex” (VSC) theory, historically considered the core concept of the practice. This theory posits that a minor spinal misalignment, or subluxation, impedes nerve flow, causing disease and suboptimal health throughout the body. Some practitioners present the VSC as the cause of a wide array of systemic illnesses, not just back pain.
Mainstream medical and scientific communities widely reject the VSC theory as a valid diagnosis. There is no credible physiological evidence demonstrating that a slight, undetectable spinal misalignment can obstruct nerve energy and cause systemic disease. Spinal nerves primarily supply musculoskeletal structures, and the idea that a subluxation affects distant organs by interfering with the autonomic nervous system is scientifically indefensible.
Leading chiropractic researchers acknowledge there is no supportive evidence linking the VSC to any disease process or condition requiring intervention. Despite this consensus, a segment of the profession, sometimes called “straight chiropractors,” adheres to this pseudoscientific concept. This adherence drives claims of treating non-MSK conditions and forms the basis for long-term, non-symptomatic care.
Financial and Over-Treatment Concerns
The philosophical belief in the VSC often leads to the promotion of “maintenance care” or “wellness adjustments.” This involves a schedule of regular, recurring visits, often monthly or bi-monthly, even after initial symptoms resolve. The stated goal of this indefinite care is to prevent subluxations and maintain overall health.
The scientific evidence supporting long-term maintenance care for the general population is limited. While some studies suggest that periodic adjustments may help reduce the frequency of flare-ups for patients with a history of recurring chronic back pain, this is not a universal necessity. Promoting indefinite, scheduled visits for asymptomatic individuals lacks a clear, evidence-based rationale.
These long-term treatment plans can place a significant financial burden on patients, especially when based on the unproven VSC theory. Promoting care that lacks clear evidence of necessity beyond the resolution of acute symptoms raises ethical questions about over-treatment. Clinical guidelines for conditions like low back pain typically recommend a short course of care, focusing on the minimum effective treatment dose rather than an open-ended schedule.