A Chiropractor is a health professional concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health
Introduction
How chiropractic is performed
Conditions commonly treated by chiropractors
Safety and regulation of chiropractic
Evidence for its effectiveness
Introduction
Chiropractors (practitioners of chiropractic) use their hands to treat disorders of the bones, muscles and joints. Treatments that involve use of the hands in this way are called ‘manual therapies’. Chiropractors use a range of techniques, with an emphasis on manipulation of the spine. They may also offer advice on diet, exercise and lifestyle, and rehabilitation programmes that involve exercises to do in your own time.
Chiropractic is a complementary or alternative medicine (CAM). This means that chiropractic is different in important ways from treatments that are part of conventional western medicine. The use and principles of chiropractic are not always based on scientific evidence.
Theory
Chiropractic was founded in the US in 1895 by a Canadian grocer and magnetic healer called Daniel David Palmer, who had no conventional medical training.
Palmer argued that most human disease is caused by misalignments of the spine that apply pressure on surrounding nerves. He called these misalignments ‘subluxations’ (a term also used in conventional medicine, where it has a different meaning) and believed that they blocked the flow of a natural energy, or ‘life force’, through the body. Correcting these subluxations, he argued, could restore the proper flow of energy, and so restore health. Thus, he saw chiropractic spinal manipulation as a treatment for virtually all human conditions.
Palmer’s ideas do not always form the basis on which chiropractic is practised today, but this varies widely between individual chiropractors. The GCC say that the idea that subluxations are responsible for illness ‘is not supported by any clinical research evidence’, and that this idea should be taught as a historical concept and not a current theoretical model.
Uses
Many chiropractors only treat conditions related to the spine, such as lower back or neck pain. Some chiropractors, however, use the treatment on a wider range of conditions, including asthma, infant colic, irritable bowel syndrome and many more conditions. See Conditions commonly treated by chiropractors for more information.
The availability of chiropractic on the NHS is limited (see below). Most chiropractic patients pay for private treatment.
Does it work?
There is good evidence that spinal manipulation is an effective treatment for persistent lower back pain. Conventional treatments for lower back pain include painkillers, exercise and physiotherapy.
There is no good evidence that spinal manipulation is an effective treatment for any other health condition. This means that the evidence on spinal manipulation is not strong enough in these cases to form the basis of a recommendation to use the treatment.
There is also no scientific evidence to support the idea that most illness is caused by misalignment of the spine.
Chiropractic and the NHS
Use of chiropractic in the NHS is limited. Your GP or practice nurse can tell you more about the availability of NHS chiropractic in your area.
Currently, the National Institute for Health and Clinical Excellence (NICE) recommends spinal manipulation (as practised by chiropractors) as a treatment option for one condition: persistent lower back pain. Read NICE guidelines on low back pain.
Most people who use a chiropractor pay for private treatment. The cost of chiropractic varies and depends on the length of a particular chiropractic session. On average, a 30-minute session will cost £20-35 and an hour session £40-80.
How chiropractic is performed
Typically, your first chiropractic session will involve an assessment of general health and medical history, and a physical examination. The treatment that follows involves hands-on manipulation techniques, which focus on the spine.
You may also be given advice on exercise, diet and lifestyle. Some chiropractors also provide rehabilitation programmes in which you are taught exercises that are intended to help you recover from musculo-skeletal problems, and prevent further problems in the future.
Sessions typically last between 15 and 30 minutes.
You can learn more by reading the GCC leaflet ‘What can I expect when I see a chiropractor?’, which you can find at the GCC website.
The length of a course of treatment will depend on the type and severity of symptoms. In the case of persistent lower back pain, NICE recommends that treatment should include up to nine sessions over the course of 12 weeks.
Initial assessment
As part of this assessment, a chiropractor should:
- ask about your symptoms
- ask about your general state of health and previous health conditions
- carry out a physical examination of your spine
They may also take X-rays of your spine.
If your chiropractor discovers or suspects that you have a serious health condition, they should advise you to see your GP. You should not use a visit to a chiropractor as a substitute for a visit to a GP.
Once this assessment has been carried out, you should be given a care plan. This describes the chiropractor’s diagnosis about the cause of your symptoms and outlines the suggested treatment.
Spinal manipulation
The main technique used in chiropractic is spinal manipulation. The chiropractor uses their hands to apply force to the muscles, bones and joints in and around your spine.
During the session, you will be asked to sit or lie down. You will usually be asked to remove upper body clothing so the chiropractor can access your spine. If you are asked to undress, you should be offered a gown.
Chiropractors use a wide range of manual techniques, including:
- short, sharp thrusts applied to the spine (intended to remove joint restrictions and improve the range of movement)
- gradually moving joints through a range of different positions (intended to reduce tension within a joint)
- pulling or stretching muscles in a certain direction (intended to strengthen the muscle and improve its range of movement)
Usually, chiropractic treatment is not painful. If the chiropractor is treating an injury that is painful or inflamed, there may be some minor pain or discomfort. If you experience any pain or significant discomfort while having chiropractic treatment, tell your chiropractor immediately.
During spinal manipulation, you may experience a popping sensation in your joints and hear a popping or cracking sound. It is thought this is caused by gas bubbles in the fluids that surround your joints. It is a normal part of spinal manipulation and other manual treatments.
Other elements of treatment
Some chiropractors offer additional treatment elements, intended to improve your symptoms and overall health.
These can include advice on diet and nutrition, and physiotherapy. Some chiropractors may also offer other complementary and alternative treatments, such as acupuncture.
Conditions commonly treated by chiropractors
Chiropractic is commonly used for musculoskeletal conditions (affecting the muscles, bones and joints), such as:
- lower back pain
- neck pain
- shoulder pain
- slipped discs
- sciatica
Some chiropractors use the treatment on a wide range of conditions that are unrelated to muscles, bones and joints, such as:
- asthma
- allergies
- painful periods
- infant colic
- fibromyalgia
- high blood pressure
- mental health conditions, such as depression, phobias or anxiety disorders
- gastrointestinal disorders (of the stomach and bowel)
They may also use chiropractic as maintenance therapy (intended to prevent disease from occurring).
NICE recommended uses
The National Institute for Health and Clinical Excellence (NICE) provides guidelines to the NHS on use of treatments and care of patients. Currently, NICE recommends that spinal manipulation – as practised by chiropractors – be considered as a treatment option for one condition:
- Persistent low back pain (that has lasted longer than six weeks, and less than one year.)
Safety and regulation of chiropractic
There is statutory regulation of chiropractic in the UK.
Chiropractic is one of two complementary and alternative medicines (CAMs) that operate under statutory regulation. The other is osteopathy.
Regulation
Statutory regulation of chiropractic works in the same way as regulation for conventional medical doctors.
This means it is illegal to practise chiropractic or call yourself a chiropractor unless you are registered with the General Chiropractic Council (GCC).
The GCC only accepts registration from practitioners who have certain qualifications in chiropractic and who agree to comply with their code of practice.
Regulation aims to protect patient safety, by setting and monitoring standards of training, practice and conduct. It does not mean that there is scientific evidence that the treatment provided is effective.
Chiropractors in the UK must adhere to standards of practice laid down by the GCC. If you use a chiropractor and they do not adhere to this standard of practice you can complain to the GCC, which has a duty to investigate the complaint.
You can read more about the qualifications required of chiropractors and the code of practice they must adhere to at the General Chiropractic Council website. You can also use this website to find a registered practitioner.
Never use an unregistered practitioner.
Safety
Minor adverse effects after spinal manipulation are reported in up to 60% of patients. The most commonly reported adverse effects are:
- headache
- stiffness
- pain
- fatigue
These effects usually develop within four hours of a session and typically resolve themselves within 24 hours.
Serious complications that have been linked to spinal manipulation include tearing of an artery wall leading to stroke, injury to the spinal column leading to paralysis, and build-up of blood between the skull and the outer layers of the brain, which can result in coma or death. These events usually occurred after spinal manipulation involving the neck. Some of these events may have occurred due to a pre-existing health condition, and not the spinal manipulation itself.
These more serious complications of spinal manipulation are rare. Estimates of the rates of serious complications range widely, from 1 in tens of thousands to one in millions.
Special precautions
The use of chiropractic is not recommended in cases where there is an increased risk of damage to the spine or other bones, or the nerves.
This means that people with certain health conditions may not be able to have chiropractic. They include people with:
- severe osteoporosis
- primary cancer of the bone or a secondary cancer that has spread to the bone
- poorly controlled arthritis or gout
- poorly controlled diabetic neuropathy
- fractures
- compression of the nerves in the spinal cord
Chiropractic is also not recommended if you are taking blood-thinning medicines, such as warfarin.
Evidence for its effectiveness
To be able to judge whether any health treatment is safe and effective, we need evidence. Evidence on a treatment is gathered by conducting fair scientific tests of the treatment.
When we use a treatment and feel better, this can be because of phenomena such as the placebo effect, and not because of the treatment itself.
Positive evidence
There is good evidence that chiropractic is an effective treatment for:
- persistent lower back pain
This means that scientific trials conducted to investigate the effect of chiropractic on lower back pain found that it did have a beneficial effect.
Negative evidence
There is some evidence that chiropractic is not an effective treatment for:
- non-spinal pain
- infantile colic
- carpel tunnel syndrome
- asthma
- painful periods
This means that scientific trials found that chiropractic had no beneficial effect when used to treat these conditions.
Inconclusive or no evidence
There is inconclusive evidence on the effectiveness of chiropractic for:
- headaches
- neck pain
A review of eight fair tests of the effectiveness of chiropractic for headaches reached no firm conclusion. More research is needed before firm conclusions can be drawn.
There is a lack of good-quality evidence on the effectiveness of chiropractic for other conditions for which it is used by some practitioners. These include:
- allergies
- fibromyalgia
- high blood pressure
- mental health conditions, such as depression, phobias or anxiety disorders
This means that good-quality fair tests into the effectiveness of chiropractic for these conditions have not been conducted.
Effectiveness of Manual Therapies: the UK Evidence Report was commissioned by the General Chiropractic Council to provide a summary of the scientific evidence on the effectiveness of manual treatment for the management of a variety of conditions.
The report, published in February 2010, found high quality evidence that spinal manipulation is an effective treatment for persistent lower back pain.
It also found moderate quality evidence that spinal manipulation is an effective treatment for acute low back pain, some joint conditions, migraine and some kinds of headache. There was also moderate quality evidence that thoracic spinal manipulation is an effective treatment for some kinds of neck pain.
This moderate quality evidence is not strong enough to form the basis of a recommendation to use the treatment for these conditions.