The Chiropractic Truth: Separating Fact from Fiction

“Take these pills and stop using your computer so much.”

That was conventional medicine’s brilliant solution to my chronic lower back pain—advice spectacularly unhelpful for someone who works online. This dismissal launched me down the chiropractic rabbit hole, not out of some desire to become a spine whisperer, but out of desperation for relief.

WHAT I DISCOVERED WAS a practice trapped between zealous evangelism and reflexive dismissal, with the truth buried somewhere in that messy middle. So let’s cut through both the hype and the hostility to examine what chiropractic care actually is—and isn’t.

What Chiropractic Actually Is (Without the Woo-Woo OR the Dismissal)

Forget the marketing. Forget the hit pieces. Chiropractic is essentially a hands-on approach focused on the spine and musculoskeletal system. It’s not magic. It’s not demonic. It’s not going to cure your diabetes.

What it DOES involve:

  • Manual adjustments to improve alignment
  • Focus on how bone/joint positions affect nerves and muscles
  • A non-pharmaceutical approach to pain and mobility
  • Specific techniques tailored to different conditions and body types

The core concept isn’t actually that radical—your skeletal alignment affects how your body functions. Anyone who’s ever had a pebble in their shoe knows even tiny alignment issues can cause cascading problems.

The most common techniques include:

  • High-velocity, low-amplitude (HVLA) - The classic “cracking” adjustment
  • Flexion-distraction - Gentle stretching and pumping of the spine
  • Instrument-assisted - Using tools like the Activator for more precise, lower-force adjustments
  • Drop-table - Using specially designed tables with sections that drop slightly during adjustment
  • Mobilization - Slower, more gentle movement of joints

Each has different applications and evidence bases, which we’ll get into shortly.

The “Not Real Doctors” Thing

This one gets tossed around a lot. Chiropractors aren’t MDs. True statement. Neither are dentists, optometrists, or psychologists. Doesn’t mean they’re not healthcare providers with legitimate training.

Doctors of Chiropractic (DCs) do 4 years of chiropractic education AFTER an undergraduate degree. Their coursework includes anatomy, physiology, neurology, and a bunch of other -ologies. It’s not a weekend seminar at the Holiday Inn.

The curriculum typically includes:

  • 4,200+ hours of classroom, laboratory, and clinical experience
  • At least 900 hours of supervised clinical training
  • Coursework in diagnosis, radiology, and therapeutic techniques
  • National board exams for licensure

Are there quacks? Of course. Show me a profession without them. I’ve met MDs who still think depression is just not trying hard enough, but I don’t dismiss all of medicine because of it.

“But It’s Dangerous!” (Is It Though?)

This claim deserves scrutiny. When you examine actual data instead of scary anecdotes, chiropractic adjustments have a remarkably low risk profile.

The most commonly cited risk is vertebral artery dissection—which sounds terrifying until you realize:

  • It’s extremely rare (about 1 in 5.85 million adjustments)
  • You have a higher risk driving to the appointment
  • Many cases attributed to chiropractic were likely already in progress before treatment
  • Recent research suggests the association may be correlation rather than causation

A 2019 systematic review in Chiropractic & Manual Therapies found that serious adverse events after spinal manipulation are “rare,” with the most common side effects being temporary soreness, stiffness, or slight increases in pain.

Meanwhile, NSAIDs—the stuff many people pop like candy for back pain—kill about 16,500 Americans yearly from complications. Not trying to play medical whataboutism here, just providing some perspective on relative risks.

That said, certain conditions make spinal manipulation inappropriate, including:

  • Severe osteoporosis
  • Active inflammatory arthritis
  • Some spinal abnormalities
  • History of certain types of stroke
  • Some circulatory problems

This is why a thorough medical history is essential before treatment.

Beyond Back Cracking

Perhaps the biggest misconception is that chiropractors only deal with back pain. While that’s certainly their bread and butter, many conditions respond to proper alignment work:

Headaches

Multiple systematic reviews have found evidence supporting chiropractic care for tension headaches and cervicogenic headaches (those originating from neck issues). A 2019 review in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulation may be as effective as some medications for certain types of headaches.

Nerve Compression Issues

That shooting pain down your leg? It could be sciatica—nerve compression that can respond well to specific adjustments. A 2018 study in The Spine Journal found that patients with sciatica who received spinal manipulation experienced significant improvements in pain and disability compared to those who received simulated manipulation.

Joint Mobility Problems

Restricted movement in joints like shoulders, hips, or ankles can sometimes benefit from appropriate adjustments. The evidence here is more mixed, with better results typically seen when combined with exercise therapy.

Sports Performance and Injury Recovery

Some athletes swear by chiropractic care for both performance enhancement and injury recovery. The research is still evolving, but there’s evidence suggesting potential benefits for certain types of sports-related injuries and biomechanical issues.

The common thread? These are mechanical problems. And sometimes, mechanical problems need mechanical solutions.

The Subscription Model Problem

“Once you go, you have to keep going forever.”

This one’s complicated. Good chiropractors will have a specific treatment plan with clear goals. Bad ones will try to sign you up for a lifetime membership.

Here’s my take after talking to both types: acute issues often need a short series of treatments. Chronic problems might benefit from maintenance visits. But the “three times a week forever” approach? That’s a business model, not healthcare.

Evidence-based treatment plans typically look like:

  • 6-12 visits for acute problems, with decreasing frequency
  • Re-evaluation after each phase of treatment
  • Clear outcome measures to track progress
  • A transition to self-management with exercises

Ask about treatment goals and expected timelines. If they get vague or pushy, find someone else.

Questions to ask about treatment plans:

  1. “What specific improvements should I expect and when?”
  2. “How will we measure progress?”
  3. “What’s your plan for transitioning me to self-management?”
  4. “What happens if I don’t improve as expected?”

Chiropractic vs. Other Approaches: When to Choose What

Before diving deeper into the evidence, it’s worth understanding where chiropractic fits in the broader landscape of treatments.

Chiropractic vs. Physical Therapy

Both focus on non-pharmaceutical approaches to musculoskeletal issues, but with different emphases:

  • Chiropractic: More focused on joint manipulation and alignment
  • Physical Therapy: More focused on exercise, movement patterns, and functional training

They’re not mutually exclusive—many patients benefit from both. Generally, chiropractic might be better for acute joint dysfunction, while PT might edge ahead for longer-term rehabilitation and movement retraining.

Chiropractic vs. Massage Therapy

  • Chiropractic: Focuses on joint alignment and nervous system function
  • Massage: Focuses on muscle tension, trigger points, and soft tissue

Again, they can complement each other. Massage might be better for purely muscular issues, while chiropractic might be better when joint restrictions are involved.

Chiropractic vs. Conventional Medicine

This isn’t an either/or situation. Responsible chiropractors work within a broader healthcare system and know when to refer to medical doctors. The best approach often combines:

  • Medical evaluation for serious pathology
  • Medication when appropriate for pain or inflammation
  • Chiropractic for biomechanical issues
  • Physical therapy for rehabilitation and prevention

The Science Question

This is where it gets messy. There IS research supporting chiropractic for specific conditions—particularly acute low back pain, neck pain, and certain types of headaches.

But let’s be real—the research quality varies wildly. Some studies are solid. Others make me cringe. And there are legitimate criticisms about publication bias and methodology in the field.

The current state of evidence looks something like this:

Strong Evidence

  • Acute low back pain: Multiple systematic reviews and clinical guidelines now include spinal manipulation as a recommended treatment option
  • Neck pain: Moderate to strong evidence for short-term relief
  • Certain headache types: Particularly tension and cervicogenic headaches

Mixed or Limited Evidence

  • Chronic low back pain: Some positive studies, but results are less consistent
  • Sciatica: Emerging positive evidence, but more research needed
  • Non-spinal joint issues: Limited but promising research for some conditions

Weak or Insufficient Evidence

  • Non-musculoskeletal conditions: Claims about treating asthma, digestive problems, ear infections, etc. lack substantial evidence
  • Prevention of future problems: Limited evidence for maintenance care
  • Immune function: Claims about immune boosting lack credible evidence

A 2021 umbrella review in BMJ Open examined 223 systematic reviews of spinal manipulation and found the most consistent evidence for acute low back pain, with encouraging but less consistent results for other musculoskeletal conditions.

The most honest assessment? Chiropractic works demonstrably well for some mechanical musculoskeletal issues. The evidence gets thinner when you move beyond that core. And claims about treating things like asthma, colic, or boosting your immune system? That’s where my skepticism kicks into high gear.

My Personal Take

After digging through studies, talking to practitioners on both sides, and yes, trying it myself, here’s where I’ve landed:

  1. Chiropractic seems most effective for specific mechanical problems with specific mechanical solutions

  2. The best chiropractors know their limitations and refer out when appropriate

  3. It’s neither miracle cure NOR dangerous pseudoscience—it’s a specific intervention for specific problems

  4. The combination of adjustment WITH proper exercise/stretching produces better outcomes than either alone

  5. It works best as part of an integrated approach rather than as an isolated treatment

This isn’t about choosing sides in some tribal medicine war. It’s about having more tools in the toolbox. Sometimes you need surgery. Sometimes you need medication. And sometimes, you need someone to fix that vertebra that’s been pressing on a nerve for six months.

Finding Someone Who’s Not Full of It

If you’re considering trying chiropractic, here’s my advice for finding someone reasonable:

  • Board certification: Look for a board-certified chiropractor. The “DC” letters after their name should actually mean something.

  • Technique preferences: Several specific methods stand out for their more systematic, evidence-oriented approaches:

    • Gonstead Technique: Often considered the “gold standard” in chiropractic, Gonstead practitioners use a comprehensive system that includes detailed analysis before any adjustment. They employ x-rays (when necessary), palpation, instrumentation, and careful structural analysis to identify the precise problem areas rather than generic manipulations. Gonstead practitioners:

      • Focus on specific adjustments rather than general manipulation
      • Use minimal rotation of the spine during adjustments (reducing risks)
      • Employ precision that often requires less force
      • Rely on objective criteria rather than vague wellness concepts
      • Follow a systematic “listing” system to document exactly what’s being adjusted and why

    • Other evidence-focused methods include “Diversified” and “Cox Flexion-Distraction,” which similarly emphasize specific adjustments based on biomechanical principles rather than vague wellness claims.

  • Red flags to watch for:

    • Anyone claiming to cure non-musculoskeletal conditions
    • Those who refuse to coordinate with medical doctors
    • Practitioners pushing excessive X-rays without clear justification
    • Those using scare tactics about “subluxations” causing disease
    • Anyone with anti-vaccine or extreme anti-medicine views
    • Those selling expensive supplement packages
    • Practitioners recommending very long treatment plans upfront

  • Good signs:

    • They perform thorough assessments before treatment
    • They incorporate exercise/stretching recommendations
    • They’re willing to coordinate with your other healthcare providers
    • They have clear treatment goals and reassessment points
    • They can explain in plain language what they’re doing and why
    • They’re comfortable saying when something is outside their scope

Questions to ask at your first visit:

  1. “What’s your approach to treatment plans and how often will we reassess?”
  2. “How do you determine when I should be referred to another provider?”
  3. “What specific techniques do you use and why?”
  4. “How do you stay current with research in your field?”
  5. “What are realistic expectations for my condition?”

And for the love of everything, tell them your complete medical history. Some conditions make certain adjustments inappropriate or risky.

Bottom Line

Chiropractic care isn’t going to align your chakras or detoxify your liver or whatever other nonsense you might hear. But for certain mechanical problems, it can be remarkably effective at reducing pain and improving function.

It works best when:

  • The problem is musculoskeletal in nature
  • You have a clear diagnosis
  • You work with a practitioner who combines adjustments with self-management strategies
  • It’s integrated with other appropriate treatments

It’s not a religion. It’s not a miracle. It’s a specific healthcare approach that works well for specific problems. And sometimes, that’s exactly what you need.

If you’ve had experiences with chiropractic—good or bad—I’d be curious to hear them. We learn from data points, and personal experiences are definitely data points.