Chiropractic

Chiropractic (/ˌkaɪroʊˈpræktɪk/) is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. The main chiropractic treatment technique involves manual therapy but may also include exercises and health and lifestyle counseling. Most who seek chiropractic care do so for low back pain. Chiropractic is well established in the United States, Canada, and Australia, along with other manual-therapy professions such as osteopathy and physical therapy.

Many chiropractors (often known informally as chiros), especially those in the field's early history, have proposed that mechanical disorders affect general health, and that regular manipulation of the spine (spinal adjustment) improves general health. A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as "doctor" but is not a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.). While many chiropractors view themselves as primary care providers, chiropractic clinical training does not meet the requirements for that designation. A small but significant number of chiropractors spread vaccine misinformation, promote unproven dietary supplements, or administer full-spine x-rays.

There is no good evidence that chiropractic manipulation is effective in helping manage lower back pain. A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study "fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition." Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient. No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases.

There is not sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation. Several deaths have been associated with this technique and it has been suggested that the relationship is causative, a claim which is disputed by many chiropractors.

Chiropractic is based on several pseudoscientific ideas. Spiritualist D. D. Palmer founded chiropractic in the 1890s, claiming that he had received it from "the other world", from a doctor who had died 50 years previously. Throughout its history, chiropractic has been controversial. Its foundation is at odds with evidence-based medicine, and is underpinned by pseudoscientific ideas such as vertebral subluxation and Innate Intelligence. Despite the overwhelming evidence that vaccination is an effective public health intervention, there are significant disagreements among chiropractors over the subject, which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic. The American Medical Association called chiropractic an "unscientific cult" in 1966 and boycotted it until losing an antitrust case in 1987. Chiropractic has had a strong political base and sustained demand for services. In the last decades of the twentieth century, it gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States. During the COVID-19 pandemic, chiropractic professional associations advised chiropractors to adhere to CDC, WHO, and local health department guidance. Despite these recommendations, a small but vocal and influential number of chiropractors spread vaccine misinformation.

Chiropractic is not regarded as a mainstream branch of medicine.

Chiropractic's origins lie in the folk medicine of bonesetting, and as it evolved it incorporated vitalism, spiritual inspiration and rationalism. Its founder, D. D. Palmer, called it "a science of healing without drugs". Its early philosophy was based on deduction from irrefutable doctrine, which helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic first principles rather than on the materialism of science. However, most practitioners tend to incorporate scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness. A 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.

Although a wide diversity of ideas exist among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Some chiropractors claim spinal manipulation can have an effect on a variety of ailments such as irritable bowel syndrome and asthma.