Chiropractic Myths and Truths

With a focus on manual therapy, chiropractic care is gaining popularity as a nondrug approach to improving health.
Vance Jones receives a chiropractic adjustment from Dr. Steve Long.
Vance Jones receives a chiropractic adjustment from Dr. Steve Long. Photo by Terence Duffy.

After a series of mountain bike falls and ski injuries, Vance Jones began losing mobility. One day he stood up, only to crash to the floor with a massive back spasm. After pain meds and muscle relaxants failed to help, the Sacramento man reluctantly sought help from a chiropractor. “I had this preconceived notion that what they do causes more harm than good,” he says. Ten years later, he’s a believer. “It’s not a magic fix-all, but he got me on a path to recovery I have been able to sustain through a combination of alignment adjustments, stretching and mobility exercises. I trust him. I see him every other week.”

Jones is among a growing patient base for chiropractic care, which aims to improve one’s health and quality of life with a focus on manual therapy and adjustments to relieve muscle and joint pain, plus nutrition and exercises. While chiropractic care is popular among those seeking a nondrug approach to health problems, the practice is still misunderstood and even maligned as illegitimate. Sacramento Magazine talked to several California chiropractors about myths that still plague chiropractic and the relevant truths of practice today.

MYTH: People become chiropractors because they aren’t smart enough to be medical doctors.

TRUTH: “The rigor would shock people,” says Greg Snow, a doctor of chiropractic and dean of academic affairs at Palmer College of Chiropractic West in San Jose. He says more than 80 percent of Palmer’s students enter the four-year program with a bachelor’s degree, many in the fields of kinesiology or exercise science. At a minimum, program entry requires 90 semester hours, including 24 in science courses, plus courses in differential diagnosis and clinical evaluation and technique. Residencies are not required, but students work in the school’s on-site clinic, and many go onto preceptorships in chiropractic offices, or Veterans Administration clerkships. “The students come out with an incredible amount of knowledge,” Snow says.

MYTH: They are not real doctors.

TRUTH: A chiropractor is not an M.D. but a doctor of chiropractic after meeting academic program requirements and passing National Board of Chiropractic Examiners tests. Students also must pass X-ray competency exams to diagnose patients. To become licensed in California, chiropractic students must apply to the Board of Chiropractic Examiners and pass an ethics and jurisprudence test. Doctors of chiropractic can get board certified in a variety of specialties, says Elizabeth S. Hoefer, president of the California Chiropractic Association. Hoefer is board certified in “craniocervical junction procedures,” specializing in upper cervical procedures for patients with migraines, Meniere’s disease and vertigo.

MYTH: Chiropractic scope of practice is limited to spine manipulation.

TRUTH: State law allows a licensed chiropractor to manipulate and adjust the spinal column and other joints, as well as manipulate muscle and connective tissue. Over 90 percent of spinal manipulation in the United States is done by chiropractors. Chiropractors can legally diagnose and treat any condition, disease or injury as long as they do it in a way that is consistent with chiropractic methods and within their scope of practice. In treating patients with nonpharmacological options, chiropractors have wide latitude; in addition to manual manipulation, massage and physical therapy, they can use heat, light, ultrasound, activator adjustment tools and electrotherapy, nerve stimulation and similar modalities.

MYTH: Chiropractic care is far outside mainstream medicine and health care.

TRUTH: Chiropractic techniques run the gamut from unconventional to routine and familiar. John Linck, a 65-year-old Sacramento man with occasional back and neck tension restricting his movement, says one chiropractor’s use of an activator tool felt like “witch doctory,” but his current chiropractor employs a massage chair, a hand massage device, electrical stimulation and manual adjustments. “He does this head-twist thing, and I can hear it. Instantly, I feel so much better,” he says. “I can look up and down and side to side without that grinding feeling.”

In some practice settings, chiropractors work alongside M.D.s and other providers. The practice has become common at VA medical centers. Robert Walsh, chief of chiropractic services at the VA Palo Alto Health Care System, says there are more than 300 VA chiropractic providers nationwide. “I can’t pull a private practitioner off the street and throw them into our setting and consider them to be safe without further training,” he says. “We are expected to practice guideline concordant care. That’s not the same with private practice.” While some veterans hesitate before accepting a referral to a chiropractic doctor, he added, the practice is proving very effective for patients with low-back pain, especially by reducing reliance on opioid drugs.

John Chardos, an M.D. at the VA Palo Alto Health Care System, admits he was skeptical about chiropractors until he saw one 15 years ago for nerve pain in his arms that was so bad that he could no longer pick up his children. He rejected an M.D.’s advice to take an anticonvulsant drug and instead saw a chiropractor. At first, he says, the chiropractor prescribed fish oil and a special type of salt, then after an examination “diagnosed the problem and did manipulations and acupressure. He was able to help me out. I could now bend my arms.” Now chief of integrative primary care at the VA, Chardos is impressed with the chiropractors’ expertise, evidence-based approaches and teamwork. “Our experience is that we can prevent an acute low-back problem from becoming a chronic problem,” he says.

MYTH: Most people can adjust themselves.

TRUTH: While self-adjustments may provide some relief temporarily, they are rarely effective over the long term. The popping noises in the joints when you either get an adjustment or attempt your own are the sound of a decrease in pressure in the capsule around the joint, which releases gases. That pop returns motion and function to the joint. But while cracking one’s knuckles or other joints may feel good, you are not likely restoring motion to the areas that should be targeted, says Heather Dehn, a Sacramento chiropractor. “You are overstretching the joint and the support structures around it.” An adjustment, on the other hand, is quick and not deep, “not just stretching and stretching until something reaches its limit and makes noise.”

MYTH: Chiropractic care is inherently dangerous.

TRUTH: Chiropractic is one of the safest alternative health care approaches for treatment of musculoskeletal problems. A systematic review of 26 randomized clinical trials led by physicians and published in the Journal of the American Medical Association in 2017 found that spinal manipulation for low-back pain improved pain symptoms and was not associated with any serious adverse events.

“The evidence supporting the safety, cost-effectiveness and patient satisfaction with chiropractic is substantial,” says Snow. “But we have to battle the turf wars and the stigma that years of misinformation spread about the profession that were less than scientific.” Much of chiropractic’s negative safety reputation stems from cases in which patients seeking relief for neck pain have suffered a cervical artery dissection (CAD), or tear in a blood vessel running up the neck, potentially leading to a stroke, says Sherry McAllister, a chiropractor and president of the Foundation for Chiropractic Progress based in Folsom. She says claims that chiropractic adjustments trigger CAD are based on case studies that do not establish a direct causal link, and she cites a recent study in the Annals of Medicine concluding that the incidence of stroke associated with chiropractic visits is 1 per 8.1 million.

Chiropractors say they are trained to know when to refer a patient to an M.D. “The doctor must listen carefully to the patient’s history, take their vitals and perform orthopedic tests,” says McAllister.

MYTH: Chiropractors are not held to the same kind of ethical standards and regulations as other kinds of health care professionals in California.

TRUTH: Just as California M.D.s are regulated by the Medical Board, chiropractors are regulated by the Board of Chiropractic Examiners. In both cases, the boards investigate and discipline doctors for violations. In her nine years on the board, Dehn says most disciplinary cases involved chiropractors arrested for DUI or accusations of insurance fraud or unprofessional conduct, and less often involved negligence or other incidents surrounding patient care.

MYTH: Research has demonstrated that chiropractic care is effective for almost any condition.

TRUTH: Chiropractic care has been shown to be safe and effective for treatment of acute and chronic lower-back, headache and neck pain and for some other musculoskeletal problems.

There is not scientific consensus on efficacy of chiropractic for non-musculoskeletal conditions, like viral infections or diseases of the heart, lungs or other organs. “You can get some really interesting results with chiropractic for non-musculoskeletal conditions,” says Snow. “The problem is that they are not always predictable.” Snow adds that because chiropractors are holistic providers, many of the benefits for patients are less measurable: “Touching someone with your hands and listening to them. Figuring out what is going on and trying to help them. Sometimes it’s an adjustment; sometimes its nutrition and lifestyle changes. Sometimes it’s passive things like soft-tissue mobilization. Being reassuring and providing optimism and coaching what to do to avoid exacerbating symptoms is crucial to what we do in practice.”