The decision to seek chiropractic care is often driven by a desire for non-pharmaceutical relief from back or neck pain. While spinal manipulation is widely utilized, medical and scientific communities have raised serious objections regarding patient safety, the profession’s scope of practice, and its scientific basis. Examining the potential physical harm and the philosophical principles guiding some practitioners reveals concerns that warrant consideration before pursuing this treatment.
Acute Physical Dangers of Manipulation
A major concern centers on the immediate physical risks associated with high-velocity, low-amplitude (HVLA) thrusts, particularly when applied to the upper spine. Cervical manipulation, often involving a forceful, rapid rotation of the neck, has been linked to vertebral artery dissection (VAD). This dissection is a tear in the inner lining of the vertebral artery, a primary vessel supplying blood to the brain.
The tear can lead to a blood clot forming within the artery wall. If this clot travels to the brain, it causes an ischemic stroke, which affects the brainstem and can result in devastating outcomes, including paralysis or death. Although these events are rare, the potential for a life-altering consequence from treating a non-life-threatening condition is a significant public health issue. Furthermore, symptoms prompting neck pain relief can sometimes be the initial signs of an already developing VAD.
Beyond vascular risks, aggressive spinal adjustments can directly injure the musculoskeletal structures they treat. Forceful manipulation, especially of the lumbar spine, can potentially worsen or cause a new disc herniation. This displacement can compress spinal nerve roots, leading to radiating pain, numbness, and muscle weakness, often requiring extensive medical intervention. Serious adverse events reported in systematic reviews have included nerve root compression, dural tears, hematomas, and bone fractures, demonstrating that the mechanical force applied carries an inherent risk of structural damage.
Treating Conditions Outside the Scope of Practice
A separate concern arises when practitioners extend treatment beyond the musculoskeletal system into areas lacking scientific support, a phenomenon often described as “scope creep.” The danger is not direct injury from the adjustment, but the delayed or missed diagnosis of a serious, systemic medical condition. Conditions such as asthma, ear infections (otitis media), colic, and various childhood illnesses are frequently claimed by some chiropractors to be treatable through spinal adjustments.
Relying on spinal manipulation for these issues can lead to a dangerous diagnostic delay, as patients may be persuaded to forgo standard medical consultation. For instance, treating a child’s chronic ear infection with adjustments, instead of antibiotics or a pediatrician evaluation, allows the underlying bacterial issue to progress, potentially leading to hearing loss or other complications. Advising adjustments for childhood asthma or developmental delays postpones the application of evidence-based therapies, such as inhaled corticosteroids or specialized behavioral interventions.
The scientific literature confirms there is no credible evidence supporting the use of spinal manipulation for non-musculoskeletal disorders. When patients believe that a spinal misalignment is the root cause of a systemic illness, they may avoid necessary consultations with primary care physicians or specialists. This reliance on an unproven treatment for non-spinal ailments undermines appropriate medical management.
The Lack of Scientific Consensus on Core Principles
The fundamental disagreement between traditional chiropractic practice and mainstream medicine lies in the profession’s core theoretical concept: the “vertebral subluxation complex” (VSC). This concept posits that a subtle spinal misalignment interferes with the nervous system’s function, thereby causing or contributing to disease in distant organs and systems throughout the body. The adjustment, in this view, serves to restore the body’s innate ability to heal by correcting this nerve interference.
This philosophical premise is not supported by contemporary medical science. While orthopedic subluxation is a recognizable medical term for a partial dislocation of a joint, the chiropractic VSC—defined as a neurological impediment that causes organic disease—has never been scientifically validated. Major medical and scientific bodies do not recognize VSC as a pathological entity or a cause of non-musculoskeletal health issues.
The continued adherence to this non-evidence-based theory by a segment of the profession creates a significant credibility gap. The claim that a minor spinal issue can cause systemic illness is inconsistent with current understanding of anatomy, physiology, and pathology. This philosophical divide means that while some practitioners operate within an evidence-based framework focused on back pain, others practice based on a mechanism the broader scientific community considers unproven or refuted.