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Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health.[1] It is generally categorized ascomplementary and alternative medicine (CAM).[2] Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry.[3]
The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling.[4] traditional chiropractic assumes that avertebral subluxation interferes with the body’s innate intelligence,[5] a vitalistic notion that brings ridicule from mainstream health care.[6] A large number of chiropractors want to separate themselves from the traditional vitalistic concept of innate intelligence.[7]
D.D. Palmer founded chiropractic in the 1890s, and his son B.J. Palmer helped to expand it in the early 20th century.[8] It has two main groups: “straights”, now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider vertebral subluxations to be the cause of all disease; “mixers”, the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[7]
Chiropractic is well established in the U.S., Canada and Australia[9] and is the “third largest of the doctored health professions (behind only medicine and dentistry)”.[10] It overlaps with other manual-therapy professions, including massage therapy, osteopathy, and physical therapy.[11] Most who seek chiropractic care do so for low back pain.[12]
Throughout its history, chiropractic has been controversial.[13][14] For most of its existence it has battled with mainstream medicine, sustained by pseudoscientific ideas such as subluxation and innate intelligence[15] that are not based on solid science.[16] Despite the general consensus of public health professionals regarding the benefits of vaccination, among chiropractors there are significant disagreements over the subject,[17] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[18] The American Medical Association called chiropractic an “unscientific cult”[19] and boycotted it until losing an antitrust case in 1987.[20] Chiropractic has developed a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among medical physicians and health plans in the U.S.,[20] and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.[21]
Many studies of treatments used by chiropractors have been conducted, often with conflicting results.[16][22] Manual therapies commonly used by chiropractors are effective for the treatment of low back pain,[23][24] and might also be effective for the treatment of lumbar disc herniation with radiculopathy,[25][26] neck pain,[27] some forms of headache,[28][29] and some extremity joint conditions.[30][31] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[32]
Chiropractic care is generally safe when employed skillfully and appropriately.[1] Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[33][34] A systematic review found that the risk of death from manipulations to the neck outweighs the benefits.[35] This has no relevance to manipulations performed below the cervical region.