There's a lot, and I mean a LOT, of confusion about chiropractic: what it is, how it works, its safety, and its effectiveness. Let's dive into some of the things you may have heard and sort out truth, myth, and what we just don't know about it yet.
It's really no surprise to me that there are a lot of misunderstandings about chiropractic. The fact is, if you get 10 chiropractors together and ask them what they do, you'll get 10 answers with some points in common and other ideas that seem completely contradictory. If I'm honest, it's frustrating to me, as a practitioner, because I never know what kind of conversation I'm about to enter when the topic comes up at the store, when I talk to a new patient, or when I visit the physical therapist down the street. So let's crack into it. (See what I did there?)
Myth #1: Chiropractors give people strokes
Might as well jump right in. Stroke is a general term that means a part of the brain has been deprived of oxygen, due to either lack of blood flowing into it (ischemic) or blood escaping the vascular system (hemorrhagic). Headache and neck pain are 2 of the most common symptoms that precede stroke; that is, they are often present even before the red flag warning signs (see graphic below). These same symptoms also prompt a lot of people to seek chiropractic care. Current research and meta-analysis indicate that when stroke does occur after neck adjustments, it is most likely to be coincidental, e.g. the stroke was already in the very early stages before the treatment took place.
One study, published in 2016 in the Journal of Manipulative and Physiological Therapeutics, considered the rates of stroke in over 1 million Medicare patients aged 66-99 who sought chiropractic care for neck pain. This report found that 5 in 1000 had a stroke of some kind up to 30 days after a neck adjustment. Researchers concluded that the "incidence of vertebrobasilar stroke was extremely low " and that the "small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant."
Items to note about this study:
Even though the age of the study population puts them at increased risk for stroke, the incidence was still low.
Researchers recorded 5 strokes of "any kind" per 1000 people. That means, even in that small number, not all were of a type thought to possibly result from neck manipulation.
The rate of stroke after receiving care was about the same for patients who saw the chiropractor as it was for those who saw medical doctors.
To expand on this, the bulk of studies indicate that people with healthy vasculature are at almost no risk at all of stroke after an adjustment. In April 2023, Medical News Today summarized it this way: "There is a possibility that rigorous cervical manipulation could cause arterial dissection in people who are predisposed to it." [emphasis added]
In 2016, a meta-analysis (gathering many articles and taking all their findings into consideration) was published by Cureus. The analysis, performed by the neurosurgery department of Pennsylvania State Hershey Medical Center, concluded that:
studies have not been of very good quality, partly due to the risk of bias and confounding variables (i.e. studies are sometimes designed by people who already believe adjustments cause stroke, and they fail to exclude other possible causes in study participants)
studies have not demonstrated a causal link between neck manipulation & stroke (they may be connected on the timeline, but nothing has proven that strokes were caused by neck adjustment)
Fortunately, more and more work is being done by individuals who are neutral and interested in creating well-designed chiropractic research studies. I believe that meta-analysis 10 years from now will demonstrate the scientific validity of chiropractic.
So the truth about chiropractic and stroke is that there is extremely minimal risk for most people. Your chiropractor should take a thorough history and perform an appropriate exam before planning & providing your treatment. If you are at increased risk for stroke or any injury, that still may not exclude you from chiropractic care, as there are many methods and modifications available.
Lastly, here is a graphic to help you quickly spot the warning signs of a stroke. F.A.S.T. is more common, and it is the one currently available on the American Stroke Association website, but I like the additional details on this.
Johns Hopkins provides an overview of stroke risk factors, symptoms, diagnosis, and treatment here.
Myth #2: Chiropractors don't believe in science
As the story goes, chiropractic was born in 1895, when D.D. Palmer noticed a bump on the back of a deaf janitor, pushed against it, and the janitor's hearing returned; the details vary depending on the teller. In my opinion, Palmer was a strange but intelligent guy. In a letter found in the archives of the college he founded, he makes some interesting statements. He says he got the idea for chiropractic from the ghost of a dead medical doctor. He goes on to describe his plan to position chiropractic as a religion, seeing this as the best route to gain freedom & acceptance for the young field, which grew from a mixture of magnetic healing, folk medicine, osteopathy, bonesetting, and mainstream science's understanding of anatomy, the spinal cord, and the nervous system. Even during his time, according to the letter, not all chiropractors were on board with every aspect of Palmer's ideas. He writes "It is strange to me why every chiropractor does not want a copy of my book." Some of his earliest students went on to denounce his concept of "innate intelligence" and the idea that subluxations & spinal irritation are the cause of all disease; they warned against his description of chiropractic as a religion and went on to found colleges of their own. The colleges as well as the disagreement among chiropractors still exist today.
Moving ahead into the early 20th century, chiropractic was under serious attack from conventional medicine. Chiropractors were being jailed for practicing medicine without a license, and they took great pride in suffering for their cause. The American Medical Association had pointed out an old statute from their by-laws, using it to forbid their members from interacting with chiropractors under any circumstances. Chiropractors were described as "rabid dogs," and the Committee on Quackery was formed in 1963 "to contain and eliminate chiropractic." Dramatic, isn't it? Finally, in 1992, after nearly a century of animosity and court battles, the Supreme Court gave the last word on the matter: the AMA must end its campaign against chiropractic. Kansas had been the first to license chiropractors in 1913, and in 1975, Louisiana was the last.
Both "straight" chiropractors and "mixers" practice across the U.S. today. The former adjusts to remove subluxations (malposition of vertebrae) which cause nervous system interference, thus rendering the body vulnerable to illness and lowered expression of health. I don't know if I never heard about D.D. Palmer's ghost experience & bent toward religion or if I just forgot, but I've often noticed a peculiar reverence in some chiropractors for their profession that I could definitely describe as religious. "Mixers," the category in which I fall, focus more on biomechanics and combine adjustment with treatments such as exercise, physical therapy, ultrasound, laser, massage, nutritional supplements, etc. in order to help your body function at its best. I do agree that, because the nervous system is what controls the body, it's reasonable and likely that chiropractic care can affect non-biomechanical systems (i.e. blood pressure, digestion, etc), I don't believe chiropractic is the only answer.
So I would call this partially true. Chiropractors do believe in science, but not all of them interpret data the same way.
If you're curious about D.D. Palmer's letter, you can read it here.
Myth #3: Chiropractors aren't as educated as "real" doctors
The course of study for chiropractic and medical doctorates is strikingly similar. Acceptance requirements for chiropractic colleges vary, but both programs include:
About 4000 hours of class & clinic work in 4 years covering --
Anatomy & physiology
Neuroanatomy
Microbiology
Immunology
Nutrition
Embryology
Pediatrics
Obstetrics/Gynecology
Neurology
I'm probably missing some.
The main difference is in the last 2 years of school, where the focus for medical doctors is on infections/diseases & medical treatments, while the chiropractor learns more about chiropractic methods & techniques. Both spend time caring for real patients under the supervision of licensed doctors in their field before graduating. Both must pass state licensing exams and take continuing education classes every year to maintain their license. While medical doctors practice similarly from one state to another, the scope of practice for chiropractors varies.
Here in Missouri, "The 'practice of chiropractic' is defined as the science and art of examination, diagnosis, adjustment, manipulation, and treatment both in inpatient and outpatient settings, by those methods commonly taught in any chiropractic college or chiropractic program in a university which has been accredited by the Council on Chiropractic Education..." It does "not include the use of operative surgery, obstetrics, osteopathy, podiatry, nor the administration or prescribing of any drug or medicine..." [MO Statutes, Title XXII Occupations and Professions, Chapter 331]
Chiropractors & medical doctors are equally educated, but they emphasize different things as necessitated by their clinical focus and treatment methods. One thing I've noticed over the last decade or so is that medical doctors are recognizing the shortcomings of traditional medical care and offering more holistic health options. We absolutely need competent medical providers for the treatment of trauma and certain injuries and diseases, but medicine falls short in creating wellness.
Have you heard any of these myths about chiropractic before? What do you think about them? What others have you wondered about?
Dr. Amy Crowe is a chiropractor serving patients in downtown Kansas City, MO.
If you'd like to schedule an appointment, please call the office at 816-416-9920 or click here to schedule online.