Chiropractic Myths

Author: Craig Coghlin, B.A., CPT, CSCS, ART Provider, D.C. (candidate)
There are always going to be things in this world that people don’t understand, so they simply rely on the easiest, most convenient explanation offered. This usually comes from misunderstanding of the truth, urban legends, and just general unenlightened assumptions. Unfortunately for the profession that I soon will be entering into, there are many of such myths and misconceptions. Below I have listed some of the more popular ones, and have attempted to explain them as plainly as possible. If anyone has any other concerns, or have heard other things about the profession they are curious about, please feel free to email me.

"If you crack your knuckles too much, you’ll get arthritis (and so chiropractic adjustments can’t be good for you either)!"
Absolutely false. Research has been done on the topic of early onset osteoarthritis and its link to chronic knuckle cracking and has actually found that knuckle cracking can cause a delay in the development of osteoarthritis1. That’s not to say though that you should crack your knuckles every chance you get! This article found that there were indeed injuries sustained through knuckle cracking by way of the person applying too much force to their finger causing sprains.

1Chan PS, Steinberg DR, and Bozentka DJ. Consequences of knuckle cracking: A report of two acute injuries. The American Journal of Orthopedics. 1999 May. Vol 41(5), 949-50.

"Why should I bother going to a Chiropractor, I can just crack my own body!"
Maybe you can, but it’s not a good idea! The chiropractic adjustment or manipulation is delivered by a highly trained doctor to the joints that are dysfunctional and in need of manipulation (usually due to a restriction of some sort). Contact points and line of thrust are extremely important in the effectiveness and safety of an adjustment. When you “self crack” what happens most of the time is that you are “cracking” a joint or joints that are hypermobile (too much motion), and you are simply accentuating the instability of these joints instead of addressing the problem of your stiffness. Sometimes the easiest way is not always the right way.

"Receiving a spinal adjustment hurts."
An adjustment, as mentioned above, is delivered by a highly skilled doctor with years of training and a lot of clinical experience. Rarely do patients experience discomfort as a direct result of the manipulation, but on occasion it may happen. As with any manually applied therapy, certain factors can alter the sensations experienced after the adjustment. Some minor complaints that have been mentioned in the literature include local discomfort, fatigue, and headaches2. As rare as this is, if experienced, the patient should expect the discomfort to subside within 24-48 hours.

2Meeker WC, Haldeman S. Chiropractic: A profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine. February 5, 2002. Vol. 136, No 3.

"Spinal Adjustments are dangerous and can cause serious side effects including stroke and death!"
To say that a manually applied manipulation of a joint is without risk would be false. Chiropractic is widely recognized as one of the safest and effective forms of health care available. But in reality, no form of health care is completely without risk. The number of deaths even loosely linked to a spinal adjustment in the history of chiropractic health care (well over 100 years) is very low. But if a spinal adjustment were to be able to be linked to the accidental death of a patient, the media would have a hay day. Yet what is overlooked by many people claiming that typical medical care is much safer, is the number of deaths per day directly resulting from negligence or improper care of a patient from a medical doctor.

Some major complications that have come up in the literature resulting from a spinal manipulation include vertebrobasilar artery dissection, disc herniations leading to cauda equina syndrome, a

d cerebral comprimise3. The odds of having a disc herniation due to an adjustment are said to be about one in one hundred million adjustments2, and of those that do cause a herniation, 49% of them were done while the patient was anesthetized3. Anesthetizing patients is a practice of which a chiropractor cannot perform, thus the chances of a chiropractor creating a herniation becomes even lower (we’re not the only health professionals who are allowed to manipulate). Cerebral compromise has only been documented to have occurred in those patients with a pre-existing cerebral condition which was not properly diagnosed by the responsible clinician, or was missed by the history taker3.

Vertebrobasilar artery dissections are a hot topic in chiropractic right now. Dissection occurs when an artery in the back of the neck becomes damaged and sometimes may cause a stroke. In particular, many people have become scared of receiving a manipulation of the neck out of fear of this occurrence. This, again, is due to misinterpretation of facts. It is estimated that the chance of this occurring ranges from 3 or 4 in one million adjustments, to 1 in four million adjustments. In an article written by Haldeman, Kohlbeck, and McGregor their results indicated that a stroke, or vertebrobasilar artery dissection in particular, should be considered a random, unpredictable occurrence of any neck movement4. These neck movements could include having your hair done at a salon, turning to check your blind spot while driving, spinal manipulation, or even simply cradling a phone on your shoulder. Another article by Rothwell, Bondy, and Williams concluded that the incidence of stroke is so low that it’s too hard to study accurately5.

Dr. Walter Herzog, Associate Dean of Research at the University of Calgary published a study that concluded there is no force applied to the arteries of the neck during an adjustment and that the arteries are not stretched during an adjustment6.

There are many risk factors for stroke that astute chiropractors take into consideration before manipulating their patients including blood clotting problems, hypertension, smoking, high cholesterol, birth control pills, heart problems, or trauma from blows to the head. So if you’re still concerned about neck manipulation, be sure to speak to your chiropractor about any risk factors you may have. He or she will be more than happy to find other methods of treatment that suit your needs.

As a point to ponder in regards to risks of therapy, the incidence of severe complications arising from the intake of acetylsalicylic acid (aspirin) is very high ranging from stomach upset, to gastric bleeds, to death.

The efficacy and safety of chiropractic treatments is well researched, and new research is being done every day. In fact, it was noted by David Edy, M.D., PhD from Duke University that only 15% of medical interventions are supported by research, yet are performed on a regular basis by medical doctors and surgeons alike. This just goes to show that there will always be treatments in every profession that scientists will be unable to prove; we just know it works through years and years of clinical experience.

3Assenddelft W, Bouter L, Knipschild P. Complications of spinal manipulation: A comprehensive review of the literature. Journal of Family Practice. May 1996. Vol. 45(5), 475.

4Haldeman S, Kohlbeck FJ, and McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. Journal of Neurology. Aug 2002. 249(8):1098-104.

5Rothwell DM, Bondy SJ, and Williams JI. Chiropractic manipulation and stroke: A population-based case-control study. Stroke. May 2001.

6Herzog W. Internal forces sustained by the vertebral arteries during spinal manipulative therapy. Journal of Manipulative and Physiological Therapeutics. Oct. 25, 2002. Vol. 8, 504-10.

Written by

Craig Coghlin, B.A., CPT, CSCS, ART Provider, D.C. (candidate)
Empowerment Strength and Conditioning