Answers to Questions about Chiropractic:
Why Is Chiropractic So Controversial?

Samuel Homola, D.C.

Question

I am in the process of writing a magazine article on chiropractic. It's my sense that there is a great deal of controversy surrounding chiropractic medicine. Where does that come from? Who are the critics? What is it about chiropractors they object to? Is there a particular period of time and reason when chiropractors fell out of favor, or has the struggle to gain mainstream acceptance been ongoing? Or is that a misperception? What are the appropriate applications of the therapy and when should a patient see a different kind of practitioner? What are the red flags that should warn a new patient away from a particular chiropractor, and when should a patient consider ending an ongoing relationship with a chiropractor?

Answer

Chiropractic has been controversial since its inception in 1895, when it began with a claim that 95% of all diseases are caused by displaced vertebrae. Unfortunately, the basic theory of chiropractic has changed very little since then. In 1996, for example, the Association of Chiropractic Colleges, representing 16 North American Chiropractic Colleges, issued a position paper stating that "Chiropractic is concerned with preservation and restoration of health and focuses particular attention on the subluxation."

The theory that a subluxation, or slight misalignment of a vertebra, can cause nerve interference that will affect organ function or general health is as implausible as the original 1895 theory. Chiropractors who subscribe to this theory manipulate the spine as a method of treatment for a host of organic conditions—an approach that has rightly been rejected by medical science. This is why the chiropractic profession has never received the full support of mainstream healthcare.

There is considerable evidence that appropriate use of spinal manipulation can be an effective treatment for some types of back pain and related neuromusculoskeletal problems. Such treatment is not yet readily available in medical practice. Studies indicate that 90% of all manipulative therapy in the United States is provided by chiropractors. The problem is finding a good chiropractor who uses manipulation appropriately and who does not claim that such treatment will improve general health.

Generally, the use of manipulation should be discontinued if symptoms worsen during the first week of treatment or if no improvement is noted after two to four weeks of treatment. It is never a good idea to continue with ongoing manipulative treatment as "maintenance therapy" when symptoms are no longer present, especially in the case of neck manipulation, which entails some risk. In special cases, periodic spinal manipulation can be helpful in reducing the symptoms of some types of chronic back pain. But regular manipulation will not prevent the development or progression of disease.

A good chiropractor who cooperates with a family physician and is receptive to having records reviewed by an orthopedic specialist for a second opinion can be helpful in caring for a variety of mechanical-type aches and pains that respond to manipulative treatment and physical therapy modalities. An orthopedist can sometimes recommend such a chiropractor, some of whom work in a multidisciplinary back-pain clinic. It's a good idea to avoid chiropractors who advertise unspecified pain relief or who offer to treat organic ailments and infants. Until the chiropractic profession as a whole renounces the vertebral subluxation theory and its practitioners are uniformly limited, it is advisable to be very cautious when selecting a chiropractor.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This article was posted on January 31, 2005.