What's the truth about chiropractors?
Last reviewed Tue 5 June 2018By Rachel Nall, RN, BSN, CCRN Reviewed by Judith Marcin, MD
Chiropractors attend graduate-level health colleges to treat disorders of the bones, nerves, muscles, and ligaments. They graduate as doctors of chiropractic degrees, but they are not medical doctors.
While chiropractors are widely known for treating back and neck pain, they also treat bone and soft tissue conditions.
In this article, we explore myths and truths of chiropractic care. We also describe the training that chiropractors undergo, how safe these treatments may be, and the research behind the practice.
What certifications must chiropractors have?
A common myth is that chiropractors do not undergo a significant amount of training.
In fact, they typically complete about 8 years of higher education before they are licensed.
Chiropractors tend to have 4 years of undergraduate education.
They usually graduate with a pre-med major after having taken courses in sciences, such as biology, chemistry, psychology, and physics.
They then attend a chiropractic graduate program. On average, these involve 4 years of education with a total of 4,200 instructional hours in course credits.
Chiropractic program specifics
Divided by year, a chiropractic graduate program usually involves:
First year: Courses in general anatomy, chiropractic principles, biochemistry, spinal anatomy.
Second year: Courses in chiropractic procedures, pathology, clinical orthopedics, imaging interpretation, and research methods.
Third year: Courses in clinical internships, integrated chiropractic, pediatrics, dermatology, practice management, and ethics and jurisprudence.
Fourth year: A clinical internship, in which a student studies under a chiropractor and completes rotations in a hospital or veterans' clinic.
Other studies often accompany those mentioned above.
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After completing the educational and training requirements, an aspiring chiropractor in the United States will sit for their state licensing board. Once they have obtained licensure and certification from the board, they will become a doctor of chiropractic.
According to the American Chiropractic Association, the average chiropractic program involves as many classroom hours as a program that trains medical doctors.
Are chiropractors legitimate?
Another common myth is that a chiropractor merely cracks a person's back or bones.
Chiropractic care is centered around spinal manipulation. However, practitioners also study how the spine and its structures are related to the body's function.
What do chiropractors attempt to heal?
A majority of a chiropractor's work involves making adjustments to heal:
lower back pain
They may also provide services such as postural testing and analysis, as well as others designed to promote nutrition and healthful exercise.
Does it work?
According to the National Center for Complementary and Integrative Health in the U.S., chiropractic therapy is the type most commonly used for back pain. An estimated 74 percent of Americans with pain in this area have used chiropractic care at some point in their treatment.
Results of a 2010 review cited by the center suggest that spinal manipulation may be useful for treating back pain, migraine headaches, whiplash, and other conditions affecting the upper and lower extremities.
Like other forms of treatment, chiropractic care will not benefit all injuries. Sessions should be tailored to a person's needs and performed by a licensed chiropractor.
Who could benefit?
Several myths surround this question. One myth is that chiropractors only treat back pain. In fact, chiropractic care can also help to heal pain in the foot, elbow, shoulder, and neck.
The same review cited by the National Center for Complementary and Integrative Health concluded that chiropractic treatment is not useful in treating:
Authors of the review failed to find definitive evidence that chiropractic care treated musculoskeletal conditions, such as fibromyalgia, temporomandibular joint disorders, and mid-back pain.
Chiropractors also do not treat traumatic injuries, such as bone fractures. A chiropractor will usually perform an X-ray to ensure that treatment will not worsen a traumatic injury.
Science supporting chiropractic treatment
A 2018 review included 17 years of studies involving spinal manipulation and mobilization, which is a more passive form of manipulation.
The studies investigated the effects of these treatments on chronic lower back pain, and the authors concluded that the chiropractic methods were "viable" options for pain management.
A 2017 review examined the effectiveness of spinal manipulation in treating lower back pain.
The authors concluded that treatment improved both function and pain for up to 6 weeks.
The American College of Physicians recommend that those with lower back pain use a variety of non-pharmacological treatments, including spinal manipulation.
Researchers generally agree that more studies are needed to determine the ideal length and frequency of chiropractic sessions and to identify what injuries may benefit from specific treatments.
Is it safe?
One of the most common sources of contention regarding chiropractic treatments concerns safety.
A person may experience side effects of spinal manipulation, including:
There have been occasional reports of long-term danger related to chiropractic care.
The National Center for Complementary and Integrative Health reports that severe complicationsmay include worsening pain and cauda equina syndrome, which involves nerve damage in the lower spinal cord.
According to the American Chiropractic Association, most discomfort and soreness subsides within 24 hours of spinal manipulation.
The World Health Organization (WHO) state that it is unsafe for people with certain health conditions to undergo chiropractic manipulation. These conditions include:
bone disease and infections
inflamed joints, such as in cases of rheumatoid arthritis
some circulation problems
infections of the nervous system
An aspiring chiropractor must spend thousands of hours studying before obtaining a license. In 2016, an estimated 47,400 chiropractors were practicing in the U.S., according to the country's Bureau of Labor Statistics.
Chiropractic care is drug-free and non-invasive, and it may treat some musculoskeletal problems. While this form of alternative medicine may not benefit everyone, it is generally considered safe for most people.