“I have a saga of chiropractors,” says 26-year-old Isabella Wager, who played competitive sports in high school and college, and has seen three chiropractors for lower back pain, starting at age 14. The first one performed what are called chiropractic adjustments, applying force to realign her spine, with an audible crack and a flood of relief. The problem was, he didn’t recommend exercises she could do at home for long-term relief. In college, she saw a chiropractor whose sessions involved mostly stretching. He didn’t put her on a plan, either. Finally, a year ago, she found a chiropractor in New York City who struck the perfect balance between performing adjustments and assigning her exercises. “I had instant relief, and I had a plan going forward," she says.
Her most recent chiropractor traced her pain to not engaging the appropriate muscles in everyday positions like sitting or bending down. But until then, “it was weird because no one really knew what the problem was,” Wager tells me. That said, she believes she’s “been greatly helped” by chiropractors, “even though you might have to sift through to find someone who is really going to give you what you need.” But how do you know if you should see a chiropractor?
When should you see a chiropractor?
To begin answering this question, let’s look at what a chiropractor actually does. A chiropractor often treats musculoskeletal issues, according to the National Institutes of Health’s National Center for Complementary and Integrative Health. Much like physicians, they get patients’ health history, perform exams, reach diagnoses, design treatment plans, and measure progress. “Most people think of going to a chiropractor first if they have low back pain, neck pain, overall soreness and stiffness,” explains William Lauretti, an American Chiropractic Association media spokesperson and professor at New York Chiropractic College.
But when would you want to see a chiropractor versus a physician who deals with musculoskeletal issues, like an orthopedist? “Keep in mind that an orthopedist is trained primarily as a surgeon,” Lauretti says. “We offer the non-surgical alternative.”
Consider your level of pain, too. If it’s crappy, but not the worst you’ve felt, and not due to any obvious trauma, you’re probably fine seeing a chiropractor first, says Michael Fredericson, professor of orthopedic surgery, and director and professor of Physical Medicine and Rehabilitation Sports Medicine Service at the Stanford University Medical Center.
When should you opt for another doctor?
On the other hand, if you’ve experienced an acute trauma — from a fall, for example —and the resulting pain is unbearable, “probably start with a physician to get an injection or medication to get things to calm down first,” Fredericson says. He also recommends starting with a physician if you have nerve pain, which can feel like tingling, numbness, or weakness, and may radiate from one part of your body to another, like from your lower back into your leg.
What is a chiropractic adjustment?
Wager referred to the adjustments she received as her chiropractor “cracking” her. Having never seen a chiropractor, the characterization honestly made me a little squeamish. What exactly is a chiropractic adjustment, though?
With a chiropractic adjustment, “we’re taking a stiff joint, a joint that’s not moving into its normal range of motion, and we’re using our hands and applying just a little bit more motion to that point to move it beyond where it’s stuck, back into its normal motion again,” Lauretti explains. When your joint moves past where it’s stuck, a small bubble of gas escapes from the capsule of synovial fluid surrounding the joint, producing that distinct cracking sound.
What are the risks of chiropractic treatment?
As far as the risks involved, Lauretti says that only once in a great while, an adjustment is too vigorous, which may lead to a strain and, very rarely, a dislocation or fracture. He adds that although people often cite stroke as a risk of cervical, or neck, adjustment, large-scale population studies and smaller-scale biomechanical studies show that in some cases, strokes following chiropractic treatment stemmed from underlying conditions, rather than the treatment itself. “Most chiropractic treatment has an extremely low risk of anything.”
Still, the risk seems substantial enough for Fredericson to mention. A high velocity manipulation in the neck, especially in people over 50, carries the risk of injuring the vertebral artery, which can lead to stroke, he notes. Even for young people, for whom they pose less of a risk, he’d reserve them as a last resort. He's actually seen patients admitted to Stanford for strokes that were a direct result of neck manipulation.
What are the benefits of chiropractic treatment?
I’ve come across chiropractors who claim they can help treat conditions that lie beyond the realm of musculoskeletal conditions, such as anxiety or depression, and some even offer nutrition counseling, which I can’t help but regard with a skeptical side eye. For which conditions do we have evidence of chiropractic treatment providing benefit?
“At this point, I think the strongest evidence is clearly with back pain — low back pain and middle back pain,” Lauretti says, like what Wager experienced. Based on the clinical guidelines from the past 20 years or so, “the preferred treatment for back pain is really what chiropractors are trained to do,” including mobilizing the area, and encouraging patients to stay active and giving them some exercise. Fredericson agrees, noting that for nonspecific low back pain — that is, back pain without obvious nerve issues — chiropractic treatments seem to work as well as other treatments, such as physical therapy and certain medications.
Evidence of chiropractic treatment helping with tension headaches is still evolving, but growing nonetheless, Lauretti says. This makes sense, since, as Fredericson explains, such headaches might arise from fatigue of your eye muscles, or straining of the muscles above your neck or over your forehead.
“If there’s any knock I have on chiropractors, it’s that there’s a lot of variation in the quality of the practitioners,” Fredericson says. “There are some I see who are amazing, who do incredible work, and there are some who are kind of branching out into things they may not have been trained in.” For instance, “they’ll start getting real heavily into nutrition,” but took, say, one course on it.
Many chiropractors also practice what’s known as functional medicine, which looks at the effects of different lifestyle factors on your health, such as mold or deficiencies in your hormone levels, he adds. But Fredericson personally place more trust in a physician trained in functional medicine. That’s because the specialization requires a thorough understanding of basic medicine first. If a patient comes in feeling fatigued, any number of things could be going on, from a thyroid issue to a latent infection. “Without really hardcore medical training, you might miss something. That kind of gets out of the realm of what [chiropractors] were trained in.”
But while chiropractic training might not necessarily cover all the areas medical training does, it’s still rigorous. The four-year program is “very, very demanding,” Lauretti says. “You’re going hardcore.” At New York Chiropractic College, where he teaches, the heavy course load includes basic sciences, hands-on clinical training, and a clinical internship program.
Wariness of chiropractic treatment is “still out there” and probably stretches as far back as the founding of the field in the late 19th century, Lauretti says. “I think in the early years, the education of chiropractors was maybe substandard, and they were maybe making outlandish claims of what they could treat.” He believes that since then, the educational standards and evidence of chiropractic treatment’s benefits have increased. In general, chiropractors have “always been the outsiders” relative to physicians, which may have something to do with chiropractors having yet to break into more prestigious medical institutions, since they work primarily in private practice settings. “If your medical doctor has trained at some of the prestigious medical institutions, they may have ever actually encountered a chiropractor there.”
How do you find a chiropractor if you want to see one?
So if you decide to see a chiropractor, how do you find a reputable one who meets your needs? First, all chiropractors are required by law to be licensed through their state, so make sure whoever you’re considering has a license, Lauretti says. If a chiropractor immediately takes an x-ray, rattles off a bunch of problems, and asks you to come in frequently, “they may be trying to sell you something you don’t really need,” Fredericson says. He suggests calling the office, and asking how long visits last and what they entail to ensure they spend time on not only adjustments, but soft tissue work, too.
Once the chiropractor obtains your medical history and performs an exam, they’d ideally come up with a reasonable treatment plan that aligns with your goals, and you’d see meaningful progress after around the first five visits, Lauretti says. Otherwise, your plan may need re-evaluation. Make sure the chiropractor also shows you how to correctly do any exercises they recommend, Fredericson adds.
Wager suggests finding a chiropractor, who, like the one she landed on in New York City, is “not only going to treat the symptoms, but work to identify the issue and give you daily exercises that are going to give you long-term results.”
As with any health professional, you’ll want to reach out to a chiropractor only for certain problems, namely musculoskeletal pain that isn’t the result of acute trauma, and do your homework to make sure they’re a good fit and, importantly, legit.