Benefits of Regular Chiropractic Therapy
Chiropractic therapy provides modest, short-term benefits for certain types of back pain and cervicogenic headaches, but the evidence does not support regular ongoing chiropractic care for most conditions, and it carries serious risks in specific patient populations.
For Back Pain
Acute and Subacute Low Back Pain
- Spinal manipulation shows small to moderate short-term benefits for acute low back pain, with pain improvements averaging 10 points on a 100-point scale compared to sham manipulation 1
- For subacute low back pain (2-6 weeks duration), chiropractic adjustments reduce pain more effectively than placebo and improve physician-rated clinical severity more than muscle relaxants 2
- However, spinal manipulation shows no clear differences compared to usual medical care, physical therapy, exercise programs, or analgesics 1
- One large trial (1,334 patients) found manipulation slightly superior to usual care at 3 months (about 5 points on 100-point scales), but effects diminished by 12 months and functional improvements did not reach clinical significance 1
Chronic Low Back Pain
- For chronic low back pain, manipulation is moderately superior to sham manipulation, with pain differences averaging 10-19 points on a 100-point visual analogue scale 1
- Manipulation provides no additional benefit when added to exercise therapy alone 1
- The American College of Physicians guidelines recommend spinal manipulation as one option among several moderately effective treatments, but do not prioritize it over acupuncture, exercise therapy, massage, yoga, or cognitive-behavioral therapy 1
Critical Safety Concerns
- Chiropractic spinal manipulation is strongly contraindicated in patients with spinal fusion or advanced spinal osteoporosis due to case reports of spine fractures, spinal cord injury, and paraplegia, particularly with cervical spine manipulation 1
- The American College of Rheumatology conditionally recommends against chiropractic therapy for rheumatoid arthritis due to potential cervical spine complications and lack of evidence for benefit 1
- While serious adverse events are rare (estimated at less than 1 per 1 million visits), they include worsening lumbar disc herniation and cauda equina syndrome 1
For Headaches
Migraine
- Spinal manipulation is recommended for management of episodic or chronic migraine, with moderate-level evidence supporting its use 3
- Multimodal interventions that include manipulation and massage show benefit for migraine management 3
Cervicogenic Headache
- Spinal manipulation is specifically recommended for cervicogenic headaches (headaches originating from neck structures) 3
- Joint mobilization or deep neck flexor exercises may also improve symptoms 3
Tension-Type Headache
- Spinal manipulation cannot be recommended for episodic tension-type headache 3
- Evidence remains equivocal for chronic tension-type headache, with no clear recommendation for or against manipulation 3
For Limited Joint Mobility
- No high-quality evidence supports regular chiropractic therapy specifically for improving joint mobility in the absence of pain 1
- Supervised exercise therapy and physical therapy show more consistent evidence for improving function and mobility 1, 4
Key Clinical Pitfalls
- Do not use chiropractic manipulation as a substitute for initial physical therapy instruction in back exercises, which should be supervised initially 1
- Screen carefully for contraindications including spinal fusion, advanced osteoporosis, inflammatory arthritis with cervical involvement, and progressive neurological deficits 1
- Avoid long-term regular chiropractic care without clear ongoing benefit, as most acute back pain improves within 4-6 weeks regardless of treatment 4
- Consider manipulation as part of a comprehensive treatment plan rather than as isolated therapy, since it shows no superiority to other effective conservative treatments 1