Daniel D. Palmer developed chiropractic medicine in the 1890s in Iowa. This form of treatment, based on spinal manipulation, has since grown into one of the most popular types of complementary and alternative medicine (CAM) in the United States. After physicians and dentists, chiropractors are the largest group of health care professionals in the US. Approximately 160 million Americans visit a chiropractor yearly.
The American Medical Association (AMA) has made several moves to debunk chiropractic medicine. In the 1960s they established a board, called The Committee on Quackery, devoted to studying and discouraging chiropractic medicine. The AMA went so far as to pass a resolution banning physicians from associating with chiropractors. When the issue was brought before the Supreme Court in 1990, they found the AMA guilty of an illegal conspiracy that attempted to “contain and eliminate” the chiropractic profession.
In chiropractic medicine, it is believed that minor bone abnormalities and misalignments cause medical conditions. These subluxations of the bones in the spine are alleged to produce pressure on the nerves and in turn affect many muscles and organ systems. The goal of treatment in chiropractic medicine is to relieve this pressure on the nerves. In order to do this, chiropractors use a variety of adjustments, or spinal manipulation techniques. Chiropractic medicine holds that the body is able to heal itself, and thus discourages the use of surgery and drugs for treatment.
A dichotomy exists within chiropractic practice between straights and mixers. Straights use only spinal adjustments in treatment. In contrast, the much larger group of chiropractors known as mixers use spinal adjustments and other measures, including dietary recommendations, ultrasound, massage, and vitamin supplements.
Evaluation in MS and Other Conditions
There are no well-documented, rigorous clinical trials that demonstrate the effectiveness of chiropractic medicine on MS or MS-specific symptoms. The studies that do exist have many shortcomings or are individual case reports of successful treatment.
Some musculoskeletal issues, such as low back pain, may benefit from chiropractic treatment. The Agency for Healthcare Policy and Research has endorsed chiropractic therapy to treat recent low back pain of short duration. However, low back pain may also resolve itself with time or respond to nonmanipulative forms of therapy provided by primary care physicians, physical therapists, orthopedic physicians, or neurologists. Furthermore, physical therapists and osteopaths also perform spinal manipulation that may be beneficial.
Chiropractic therapy is often used to treat neck pain. However, this course of treatment is less proven than spinal manipulation for low back pain. Some smaller studies have documented positive results, but are much less conclusive than the low back pain research. Also, neck manipulation carries a small chance of causing a stroke.
Small or single-case studies have noted some benefit for the treatment of headaches and spinal cord injuries in patients with neurological disorders. However, these results are not conclusive. Additionally, no strong evidence supports the use of chiropractic medicine for the treatment of conditions such as ear infections, asthma, or gastrointestinal issues.
Chiropractic therapy is generally tolerated well. One hundred thirty-five complications were reported between 1900 and 1980. The majority of the complications resulted from neck manipulations. The most common side effects associated with treatment are achy muscles, headache, and fatigue. Bone fractures, disk injuries, and injury to lower spinal nerve (cauda equina syndrome) are rare. Neck manipulation carries with it the risk of producing a stroke; although this risk is very rare (1 in 20,000 to 1 in 3,000,000) it should still be taken into account when considering this type of treatment.
People with spinal-bone fracture or dislocations, spine trauma, cancer, severe disk herniations, severe osteoperosis, infection of the bone, severe diabetes, and severe arthritis should avoid chiropractic manipulation, as should women who are pregnant and people taking blood-thinning medications. In addition, it is important to not substitute chiropractic treatment for conventional medicine in patients with serious disease or symptoms, Physicians are trained for diagnosis and treatment of diseases in a way that chiropractors are not, so it is important for people with possibly serious conditions to be evaluated and treated by a physician before considering chiropractic therapy.
Currently, there is no strong indication that chiropractic therapy is a useful treatment for slowing the course of MS or reducing the severity of attacks. Certain symptoms, such as low back pain, may respond favorably to chiropractic manipulation. Less evidence exists to support its use to treat neck pain and headaches. Rare but very serious side effects, including stroke, can occur with chiropractic therapy. Chiropractors are not as well trained as physicians in the diagnosis and treatment of serious conditions. Thus, physicians should be relied upon for the diagnosis and treatment of potentially serious conditions.
References and Additional Reading
Bowling AC. Complementary and Alternative Medicine and Multiple Sclerosis. New York: Demos, 2007, pp. 70-73.
Ernst E, ed. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. Edinburgh: Mosby, 2001, pp. 45–48.
Haldeman S, Hooper P. Chiropractic approach to neurologic illness. In: Weintraub MI, Micozzi MS, eds. Alternative and Complementary Treatment in Neurologic Illness. New York: Churchill Livingstone. 2001, pp. 93–108.
Navarra T. The Encyclopedia of Complementary and Alternative Medicine. New York: Checkmark Books. 2005, pp. 27–29.
Swenson RS, Haldeman S. Chiropractic. In: Oken BS, ed. Complementary Therapies in Neurology: an Evidence-Based Approach. London: Parthenon Publishing Group, 2003, pp. 27–49.
Elster E. Eighty-one patients with multiple sclerosis and Parkinson’s disease undergoing upper cervical chiropractic care to correct vertebral subluxation: a retrospective analysis. J Vertebral Sublux Res 2004; August:1–9.
Ernst E. Chiropractic care: attempting a risk-benefit analysis. Am J Public Health 2002;92:1603–1604.
Ernst E, Harkness E. Spinal manipulation: a systematic review of sham-controlled, double-blind, randomized clinical trials. J Pain Symptom Management 2001; 22:879–889.
Hurwitz IL, Morganstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA back pain study. Spine 2002;27:2193–2204.
Kaptchuk TJ, Eisenberg DM. Chiropractic—origins, controversies, and contributions. Arch Intern Med 1998;158:2215–2224.
Smith WS, Johnston SC, Skalabrin EJ, et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurol 2003;60:1424–1428.