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The Effectiveness of Chiropractic Treatment on Musculoskeletal and Other Disorders
November 12, 2008
Chiropractic care is an increasingly popular alternative to traditional methods of treating spinal and muscular injury. Treatment involves the active manipulation of the spinal column by the chiropractic practitioner in order to promote the body’s natural healing process. Chiropractic treatment may range from one-time spinal readjustment to weekly visits lasting months or years. Patients may seek chiropractic care to resolve pain and injury caused by repetitive stress, trauma, pinched nerves, scoliosis, and a variety of other sources.
How effective is chiropractic care in the treatment of musculoskeletal dysfunction? Those who practice traditional Western medicine are skeptical of the use of spinal manipulation as a treatment for back and neck issues, but what does the scientific data suggest? Is it any more or less effective than other methods of treatment?
Many chiropractors advertise that chiropractic care is effective in the treatment of non-musculoskeletal problems such as asthma, allergy, and digestive disorders. Though the research regarding these claims is sparse, it can still be critically investigated using the scientific data available.
What is Chiropractic care?
Chiropractic treatment focuses on the structure of the spine, muscular, and nervous system, and how these structures affect the overall health and wellness of the body. Chiropractic care is primarily sought to treat pain of the back and neck, though treatment may be utilized for a variety of other problems.
Chiropractic care is based on 3 key concepts:
1. The body has a powerful self-healing ability.
2. The body’s structure (primarily that of the spine) and its function are closely related, and this relationship effects health.
3. Therapy aims to normalize this relationship between structure and function and assist the body as it heals.
Treatment generally includes spinal adjustment (also known as spinal manipulation or chiropractic adjustment), which provides a controlled force to joint and tissues, resulting in restored movement ability and promotion of the healing process. Spinal adjustment is done by hand and generally causes little to no discomfort, though some patients may experience some soreness after the treatment. (http://www.amerchiro.org/content_css.cfm?CID=2205)
Chiropractic theory focuses on how subluxations may cause health problems. Subluxations are believed to encroach on spinal nerves, blocking the flow of “innate intelligence” of the spinal cord and causing disease and discomfort.
The Association of Chiropractic Colleges reached a consensus in 1996 that “chiropractic is concerned with the preservation and restoration of health and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or pathological articular changes that compromise neural integrity and may influence organ systems function and general health.” (Ernst 2008)
Chiropractors must obtain a D.C. (Doctor of Chiropractic) from a properly accredited college in order to practice. This degree generally requires 3-5 years of full time course work, with intensive study of anatomy, physiology, and rehabilitation. Because of the intricate hands on nature of chiropractic work, a large portion of study is conducted in clinical training. Students of chiropractic care must pass national boards and also become licensed in their state. Most chiropractic colleges offer continuing education in a variety of specific areas to assist chiropractors in specialized care as well as satisfying state re-licensing requirements. (http://www.amerchiro.org/level2_css.cfm?T1ID=13&T2ID=66)
There are about 60,000 chiropractors practicing in North America, with billions of dollars being spent for their services worldwide.
The History of Chiropractic Treatment
David Daniel Palmer
The first recorded practice of spinal manipulation is found as early as 2700 BC in China, and 1500 BC in Greece. The term chiropractic comes from the Greek words cheir (meaning hand) and praxis (meaning action). Hippocrates (460-375 BC) in one of his writings stated, “Get knowledge of the spine, for this is the requisite for many diseases.”
Daniel David Palmer founded the chiropractic profession as we know it today in Davenport, Iowa in 1895. He defined his craft as “a science of healing without drugs.” Palmer was well educated in the field of medicine, particularly anatomy and physiology. In 1897 he founded the Palmer School of Chiropractic, which continues to be one of the leading chiropractic colleges in the nation. In the course of the 20th century, chiropractic treatment gained legal recognition throughout the nation, and has become particularly popular as a treatment for back and neck pain since the late 1970s. Recently, chiropractors have expanded their treatment from the musculoskeletal system to ailments such as allergies, asthma and digestive disorders. (http://www.amerchiro.org/level2_css.cfm?T1ID=13&T2ID=62)
Are There Serious Risks to Chiropractic Adjustment?
Chiropractic literature contends that there are no risks associated with chiropractic adjustment, though occasionally patients report mild discomfort or soreness after undergoing a spinal manipulation. A recently released statement from chiropractic literature regarding the safety of these procedures states “The direct evidence suggests that the healthy vertebral artery is not at risk from properly performed chiropractic manipulative procedures.” Though most patients walk away without serious complications, a systematic review conducted in 2001 by Edzard Ernst, MD suggests that mild to moderate complications occur in anywhere between 30% and 61% of patients (based on two separate studies, n=465 and n=336). Mild to moderate side effects were defined as local or radiating pain, headache, and tiredness resulting from treatment. It does appear however, that the occurrence of serious complications is relatively rare.
How Effective is Chiropractic Care in Treating Disorders of the Musculoskeletal System?
In a study published by McMorland and Suter in June of 2000, researchers conducted a retrospective of 119 patients diagnosed with mechanical neck or lower back pain. Because many of these patients also presented with chronic headaches as a result of their spinal dysfunction, the researchers also analyzed the effect chiropractic care had on the treatment of chronic headaches. At the end of treatment, patients with neck pain, lower back pain, and chronic headaches experienced approximately a 50% reduction in their specific pain on a self-report scale.
In a meta-analysis of studies designed to test the efficacy of chiropractic manipulation on the treatment of spinal pain, the researchers conclude that chiropractic adjustment seems to be an effective treatment for back pain. They qualify this statement however by criticizing the current research methodology of most of the studies conducted, and stating that strong conclusions cannot be reached because of the lack of primary clinical trials. (Assendelft 1992)
In a randomized trial conducted by Skargren (1998), individuals with back pain (ages 18-60) were assigned to either chiropractic treatment or physiotherapy. Results were measured based on patient reports of pain, general health, and recurrence rates. No statistically significant differences were detected between the groups, though the results to suggests that chiropractic care may be slightly more effective in treating short-term pain than physiotherapy, and physiotherapy slightly better at treating chronic back pain.
Studies regarding the effectiveness of chiropractic treatment are discordant in their findings. The studies conducted by chiropractors and published in chiropractic journals strongly support the effectiveness of chiropractic care. Those case histories reviewed and analyzed by MDs and published in medical journals tend to present chiropractic treatment as minimally effective. As a result, it is difficult to arrive at a strong conclusion regarding the effectiveness of spinal manipulation. However, the data seem to suggest that chiropractic treatment is at least as effective as traditional drug and physiotherapy treatments.
Is There Any Evidence that Chiropractic Care is Effective in Treating Other Disorders?
Although many chiropractic organizations and practitioners contend that chiropractic work is an effective treatment for allergies, asthma, and digestive disorders, there is little to no scientific research to support these claims. Chiropractors base these claims on testimonials from patients regarding the severity of their condition before and after consistent chiropractic treatment.
There have been a few studies conducted regarding the effectiveness of chiropractic care on the severity of asthma. In a study conduced by Balon in 1998, researchers treated 91 children with mild to moderate asthma with either active or simulated chiropractic care for four months. Both the chiropractic care group as well as the control group reported an increase in quality of life, but no statistically significant scientific data was found regarding any improvement in airway responsiveness. The researchers concluded that chiropractic care provided no medical benefit in the treatment of asthma symptoms.
Balon also conducted a meta-analysis in 2004 of studies regarding the effectiveness of chiropractic care in the treatment of asthma and allergy, and reaches the same conclusion. The claims made by chiropractors that spinal adjustments treat these issues are based primarily from anecdotal evidence and uncontrolled case studies. There is no scientific evidence that chiropractic care is an effective treatment for non-musculoskeletal issues.
The scientific data suggests that chiropractic care is an effective treatment for pain of the lower and upper back, neck, as well as chronic headache. However, to reach truly strong conclusions on this matter, unbiased, primary clinical trials must be conducted. Even though the data on the effectiveness of chiropractic care is sparse, most studies suggest that chiropractic treatment is not likely to cause significant harm. Claims by chiropractors that spinal adjustment can be used to treat non-musculoskeletal disorders should be critically evaluated with further clinical trials. At this point, there is no scientific evidence to support these claims.
Because the safety concerns of chiropractic care are negligible, and scientific data suggests that those patients considering chiropractic care are likely to receive at least the same improvements as more traditional methods would afford, chiropractic care is a viable option for treating musculoskeletal disorders.
Assendelft, Willem J.J., Koes, Bart W., Van Der Heijden, Geert J. M. G., Bouter, Lex M. (1992). The Efficacy of Chiorpractic Manipulation for Back Pain: Blinded Review of Relevant Randomized Clinical Trials. Journal of Manipulative and Physiological Therapeutics, 15(8), 487-494.
Balon, Jeffrey W., Mior, Silvano A. (2004). Chiropractic Care in Asthma and Allergy. Annals of Allergy, Asthma and Immunology, 93(1), s55-s60.
Balon, Jeffrey, Aker, Peter D., Crowther, Edward R., et al. (1998). A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma. The New England Journal of Medicine, 339(15), 1013-1020.
Ernst, Edzard (2008). Chiropractic: A Critical Evaluation. Journal of Pain and Symptom Management, 35(5), 544-562.
McMorland, Gordon, Suter, Esther (2000). Chiropractic Management of Mechanical Neck and Low-Back Pain: A Retrospective, Outcome-Based Analysis. Journal of Manipulative and Physiological Therapeutics, 23(5), 307-311.
Skargren, Elizabeth I., Carlsson, Per G., Oberg, Birgitta E. (1998). One-Year Follow-up Comparison of the Cost and Effectiveness of Chiropractic and Physiotherapy as Primary Management for Back Pain: Subgroup Analysis, Recurrence, and Additional Health Care Utilization. Spine, 23(17), 1875-1882.
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