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Can Chiropractors really help my neck and back pain? Are they safe?

Posted: August 18, 2010

(3) Comments

  • steadyhealth.com steadyhealth.com

BuckMD Readers - We received a couple comments on this earlier post. Take a look, and add your own comments!

 I don't know a lot about chiropractors.  I've never worked with any, didn't learn much about them in my medical training, and don't refer a lot of patients to them since a lot of insurances don't cover chiropractic treatment.   

But a lot of people swear by them.  And I have a few medical colleagues who recommend them for certain patients.  And our very own medical center has a Center for Integrative Medicine that provides chiropractic treatment (you can see their take on what a chiropractor does here).

There's obviously something to it, so I have scoured the medical literature to provide you with the most objective information I can find.  Here goes...

Do people suffering from chronic neck or back pain benefit from chiropractic treatment?

Spinal manipulation has been shown to be mildly beneficial in the treatment of uncomplicated low back pain.  Uncomplicated means that there is nothing more serious going on, like severe arthritis, pinched nerves or slipped discs.     

There's just not enough good information about whether or not spinal manipulation is beneficial in the treatment of neck pain.  Some studies showed it might be; others showed it was only helpful if used in conjunction with exercise, and others showed no benefit. 

There is no evidence that spinal manipulation is beneficial in the treatment of headaches.

Is the cure temporary or permanent?

That's hard to say.  Most problems that cause back or neck pain are chronic and recurrent so the treatments don't "cure" the condition but rather relieve the symptoms of an acute flare-up.  If the symptoms come back, it's not necessarily that the treatment didn't do what it was supposed to.

Are there any adverse effects of chiropractic treatment?

Minor complaints are fairly common after spinal manipulation, occurring in a third to a little over half of patients.  They include headache, fatigue, and pain at the site of manipulation.  Some people report dizziness and nausea, but these are less common.

Serious adverse effects from spinal manipulation (slipped disc, stroke or torn blood vessels in the spinal column) are pretty rare.  Since the cervical spine (i.e. neck) is so much more mobile than the lumbar spine, it may be at higher risk for these problems.  Because of this - and because spinal manipulation doesn't have any proven benefit in treating neck pain - you should probably avoid seeing chiropractors for neck pain. 

If you're having back or neck pain, come in and see us at Student Health.  We have a full-service Physical Therapy and Sports Medicine Department right here in the building and we will be happy to discuss all of your treatment options with you after we figure out what the problem is.

John A. Vaughn, MD (OSU SHS)

Comments

  • Thursday, August 12, 2010 2:19:32 PM Posted by: Austin Carter The fact that this quackery is covered by our student health insurance is a disgrace to the university. Dr. Vaughn states "There's obviously something to it..." I disagree. Every well-designed double blinded study shows that chiropractic treatment is no better than placebo. Surely, as an academic university, the most basic criterion for our health coverage should be efficacy. We need to throw this pseudo-science to the curb along side bloodletting and other treatments that lack physiological mechanisms, and spend our hard earned money on real science-based medicine.
  • Monday, August 16, 2010 1:45:44 PM Posted by: Dr. Vaughn Thanks for taking the time to comment. My goal was to answer the question as objectively as I could based on the information available to me. Interestingly, I received comments from a reader in Arizona that expressed a much different point of view - see below. Thanks to both of you for engaging in a lively conversation on this topic!
  • Monday, August 16, 2010 1:50:11 PM Posted by: George from Arizona Your original post seems fair, but you make the mistake of assuming chiropractic is a monolithic profession that equals spinal manipulation. While spinal manipulation is a large part of the chiropractic toolbox, it is only a tool. There are many forms and methods of spinal manipulation, soft tissue therapies, exercise and other tools used by chiropractors. Furthermore, neck pain, headaches and lower back pain are symptoms, not a proper diagnosis. Is chiropractic effective for lower back pain? Well the very first question I'd ask you is what is the cause of that back pain? Is mechanical in origin? Is it from a disc lesion? Spinal stenosis? Inflammatory arthritis? Next I might ask you, would a chiropractor treat back pain from a disc herniation the same way as he would a fixation of the SI joint? The answer is absolutely not! Still there is a more important question. Is chiropractic care effective for back pain? Compared with what? Treatment outcomes are notoriously poor for chronic back pain. Consider the following.... J Altern Complement Med. 2006 Sep;12(7):659-68. One-year follow-up of a randomized clinical trial comparing flexion distraction with an exercise program for chronic low-back pain. Cambron J et al. "In this first trial on flexion distraction care (a specific form of chiropractic manipulation), flexion distraction was found to be more effective in reducing pain for 1 year when compared to a physical therapy." This is just one study that compares chiropractic directly with some of the therapies you might recommend to your patients.

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