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[2008 updates are highlighted in red]
| Description: |
Chiropractic medicine is one of the most popular forms of CAM in the United States, which may relate to the fact that this therapy was founded in the United States. Chiropractic medicine is based on the concept that the nervous system plays a critical role in health and that many diseases are caused by abnormal pressure of bones on the nerves in the spine. Manipulation of the spine is an important component of chiropractic care. There are two groups of chiropractors. “Straights” only use spinal manipulation, while “mixers” use manipulation along with other therapies, including dietary recommendations, herb and vitamin supplements, ultrasound, and massage. |
| Rationale: |
Chiropractors believe that subluxations, misalignments of the bones of the spine, cause abnormal pressure on the nerves that travel from the spinal cord to the muscles and organs of the body. It is claimed that this abnormal pressure results in impaired muscle and organ function. Treatment involves spinal manipulation techniques, known as “adjustments,” which are thought to normalise bone positions and restore normal function. |
| Evaluation: |
There are no well-designed studies that document that spinal manipulation or other chiropractic methods can alter the disease course in MS. Isolated clinical reports have described improvement in some MS symptoms with chiropractic treatment, but there are no systematic clinical studies of chiropractic treatment for MS symptoms. In studies of other conditions, it has been found that spinal manipulation may decrease low back pain. However, these studies are of variable quality. The effectiveness of chiropractic treatment for chronic neck pain and headache is not clear. |
| Risks: |
Chiropractic treatment is generally well tolerated. Between 1900 and 1980, 135 complications were reported in the medical literature. One of the more common adverse effects is achy muscles, which may be present for one to two days after manipulation. A rare but serious complication associated with neck manipulation is stroke. Very rarely, low back manipulation may cause compression of the nerves of the lower spine (“cauda equine syndrome”). Bone and disc injuries of the spine are uncommon with spine manipulation. Pregnant women, people taking anticoagulant medications, and people with spinal bone fractures, spine trauma, significant disc herniations, bone cancer or infection, severe osteoporosis, and severe arthritis should avoid chiropractic therapy. Importantly, since chiropractors are not as well trained in diagnosis as physicians, people with serious diseases or conditions should be evaluated and treated by a physician and should not substitute chiropractic medicine for conventional medicine. |
| Costs: |
Chiropractic therapy is of low–moderate cost. |
| Committee opinion: |
In the opinion of the Committee there are no well-designed studies that demonstrate that chiropractic spinal manipulation or other forms of chiropractic therapy alter the course of MS or are beneficial for MS-specific symptoms. Spinal manipulation may be effective for low back pain. Chiropractic therapy is of low–moderate cost and, although associated with very rare but serious side-effects, it is usually well tolerated. |
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