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Are Chiropractors Safe? The Bare Bones

“Snap! Crackle! Pop!” No, it’s not your morning cereal. The sounds you hear are coming from your spine as a chiropractor stands over you, manipulating your back into contortions that cause your vertebrae to crack louder than Jiffy Pop. You ask yourself, “Are chiropractors safe?”
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About half of all Americans suffer from back pain, and many turn to chiropractors for help – but are chiropractors safe? Those who swear by chiropractic believe it helps them ease myriad complaints, from low-back pain to headaches and even digestive problems and allergies. But the line between fact and fiction is fuzzy when it comes to these claims. There have been very few reputable studies on the effects of chiropractic, and many Western doctors believe the potential risks far outweigh the supposed benefits. After all, we’re playing with spines here, and many chiropractors are admitted to practice without a bachelor’s degree. How are we to distinguish between alternative medicine and quackery?

Dem Bones, Dem Bones
Chiropractic medicine is a holistic approach to wellness that focuses on healing the body through manipulation of the musculoskeletal system, especially around the spine. Basically, chiropractors use a combination of massage, pressure, stretches, and exercises to align your vertebrae; they believe doing so will alleviate pain and balance other systems in the body. It’s meant to be a complementary form of treatment for those with chronic pain who seek a conservative alternative to drugs and surgery. 

In order to practice, chiropractors must pass a state licensing exam after completing two to four years of undergraduate education and four years of specialized chiropractic courses. At the end of their training, chiropractors earn a doctor of chiropractic (DC) degree. Some DCs choose to pursue postdoctoral education in areas like neurology, sports injuries, nutrition, occupational injuries, and even pediatrics, but the majority maintain a general practice. 

Advocates of chiropractic claim it helps to ease back pain and tension headaches, aid relaxation, improve posture and balance, and decrease inflammation in muscles and joints. Some people even believe it alleviates allergies and digestive woes by removing stress from the central nervous system. 

The problem with these claims is that there’s really no way to prove them or distinguish them from a placebo effect. The medical industry hasn’t invested in researching alternative therapies anywhere near as much as it has drugs and surgical treatments, so there is no firm basis from which to compare the two approaches. The American Chiropractic Association cites a few examples of studies on its Web site, but nowhere near enough to be conclusive. 

All It’s Cracked Up to Be?
There are no systematic reviews of research proving that spinal manipulation is both safe and effective; in fact, some studies have revealed seriously adverse effects associated with the practice. Until 1987, the American Medical Association pronounced chiropractic an “unscientific cult”and urged the public to avoid it. Though the practice now has greater legitimacy among physicians and insurance companies, some reports—such as Edzard Ernst’s “Prospective investigations into the safety of spinal manipulation,” published in the 2001 issue of the Journal of Pain and Symptom Management—suggest that 50 percent of chiropractic patients experience mild negative events, like “local discomfort, headache, tiredness, and radiating discomfort.” More serious complications associated with spinal manipulation are “dissection of the vertebral and internal carotid artery, epidural hematoma, intracranial aneurysm, cauda equina syndrome [compression of the nerves around the spinal cord], contusion of the spinal cord, myelopathy [spinal cord injury], radiculopathy [nerve pain], and peripheral nerve palsy.” Though there’s certainly a bias in terms of where research funds are directed, we should still be alert to the potential risks of spinal manipulation. 

The bottom line, according to those who are leery of chiropractic, is that the spine is perhaps the most delicate, complex, and essential part of the human body. It’s hard to feel comfortable about having a “doctor” with only six to eight years of training (as opposed to eleven for an MD) poking around in there. 

Proceed with Caution
Remember the sex talk you got from your mom? The one that went, “I don’t want you to do this, but if you do, use protection”? That’s pretty much traditional medicine’s attitude toward chiropractic these days. If you do feel comfortable with spinal manipulation, and you’ve exhausted other forms of treatment and want to try something new that doesn’t involve drugs or surgery, choose your practitioner wisely. To really reap the maximum benefit from chiropractic—or any mode of treatment, for that matter—you need to be your own advocate. Get informed and stay involved. Here’s what you need to know to undergo chiropractic care safely and effectively: 

1. Check your DC’s credentials. Make sure he or she graduated from a school accredited by the Council on Chiropractic Education (CCE). You can find a directory of schools on the CCE’s Web site. Also, make sure the DC is licensed in your state by going to fclb.org and clicking on “Chiropractic Boards.” You can also find a DC through the American Chiropractic Association’s Web site. Recommendations from a friend or doctor are great leads, but you’ll also want to do a background check through these sites.

2. Stay regular and mark your progress. Chiropractic treatment takes time and requires regular visits, often supplemented by exercises you do at home. Your DC should be taking a holistic approach to your care and helping you keep a goal in sight. This means going beyond spinal manipulation to helping you modify the behaviors that made your back hurt in the first place. For example, do you have an unsupportive desk chair or poor posture that is throwing you out of alignment? A good DC will guide you toward resolving both the causes of your discomfort and the pain itself. Remember that the goal of treatment is to prevent you from having problems in the future, not to keep you coming back every week.

3. Always walk around a little after each adjustment. You want your joints and muscles to get used to the proper alignment, instead of getting back into their old, painful grooves. The right chiropractor will show you stretches and exercises to do on your own to reinforce the effects of spinal manipulation.

Many people feel that chiropractic really helps them with a wide variety of problems, and you, too, may find it successful. All new treatment regimens, however, should be approached with caution in order to reap the maximum results with the minimum risks.

A Delicate Balance
The crux of the matter is that there’s no clear verdict on chiropractic. There simply haven’t been enough mainstream studies to conclude whether the practice is both safe and effective. Some people are comfortable moving forward based on others’ testimonials and their own experience, which is fine as long as they take responsibility for their own care. For others, that just isn’t enough. If you have back pain or other issues that haven’t been fully addressed by your traditional doctor and are looking for alternative therapies, acupuncture, massage therapy, and yoga may give you the help you need without subjecting you to the risks associated with spinal manipulation. But if you’re one of those for whom chiropractic medicine has eased pain and alleviated symptoms, feeling good may be the only proof you need of its benefits.

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