"One, Two, Three, Deep Breath In" — Is Chiropractic Fake? Inside the Controversial Medicine

If you've rummaged through accounts on the ASMR or doctor-centric side of TikTok, you've likely seen hands-on videos documenting chiropractic appointments. Video titles peppered with phrases like "perfect pelvic popping," "crunchy releases," and "unbelievable chiropractic cracking" are admittedly intriguing. Said videos — which give viewers a peek into the gnarliest patient alignments, pops, and massages — garner millions of views.

And because these bizarrely satisfying clips are also sometimes alarming, hilarious TikTok creators happily parody chiropractor accounts. (We particularly love Luke White's chiropractor parody TikToks, which showcase him and his giddy pals snapping wooden panels after soothing their inanimate patients with stereotypical words like "deep breath for me" and "this is going to be a big one.")

Jokes aside, neck, back, and joint pain sufferers alike swear by chiropractic alignments. Others call it quackery. So, is chiropractic medicine "fake," or is it miracle work? Perhaps the truth is more nuanced.

Per John Hopkins Medicine, chiropractic medicine "is based on the link between the alignment of the spine and the function of the body" and "the belief that the body has the ability to heal itself if given proper support." Additionally, "chiropractic" was born from Greek words "cheir" and "praxis," which translate to "hand" and "practice." So, do chiropractors have magic hands? Is hands-on spine manipulation worth writing home about?

According to John Hopkins, "chiropractic treatments have proven to be effective in treating certain lower back pain symptoms and muscle and other bone pains."

And the assumption that chiropractors are "quack doctors" is just plain untrue. Most chiropractors don't have an M.D., so they're not medical doctors. Nonetheless, they study for about seven to eight years and earn a Doctor of Chiropractic (D.C.) degree from an institution accredited by the Higher Learning Commission, per Cleveland University-Kansas City.

Though Michael Schneider — an associate professor of health sciences at the University of Pittsburgh — told Time in 2016 that "chiropractic was the original holistic medicine in that it focused on treating the whole person," (which sounds totally woo-woo), his research has found that cervical and lumbar manipulation can be effective in treating low back pain.

“The benefits of chiropractic for acute low back pain have been pretty widely accepted for years now within the medical community,” Dr. Ronald Glick — assistant professor of psychiatry, physical medicine, and rehabilitation at the University of Pittsburgh School of Medicine — shared with Time.

Lesser-known research-backed benefits of chiropractic care include the potential improvement of posture, chronic pain relief (and in turn, lessened symptoms of depression), more affordable chronic back pain treatment, and reduced need for opioid treatment, per Healthline.

Dr. Glick said controversy ensues when chiropractors claim they can treat non-musculoskeletal conditions (e.g. sleep problems, digestive problems, menstrual pains, et cetera), as these claims have "little to no basis in science."

Unfortunately, not all chiropractors are on the same page about this.

“You could walk into a chiropractor’s office and find someone who is a pure back-and-neck-pain guy — a guy who has embraced the scientific research — or someone who says he can cure all things and provide general wellness,” neurologist and chiropractor Dr. Scott Haldeman explained. "It takes just a few rotten apples to spoil the bunch.”

Concerning low back treatment — which does have a basis in science — Harvard Health Publishing released a piece in 2019, citing a 2018 study published by JAMA Network Open. Out of the 750 active-duty military service members with back pain who participated in the study, half received "usual care (including medications, self-care, and physical therapy)." The other half received said usual care "plus up to 12 chiropractic treatments."

After six weeks of care, the participants who saw a chiropractor "reported less pain intensity, experienced less disability and more improvement in function, reported higher satisfaction with their treatment, [and] needed less pain medicine."

While this is great, 10 percent of those who received chiropractic care reported muscle and/or joint stiffness. Just 5 percent of those who did not receive chiropractic care reported similar negative sensations.

Dr. Robert H. Shmerling of Harvard Health Publishing pointed out that the study was fairly short, most participants were relatively young and fit men (the average age was 31, and 77 percent were male), and they knew which care they were receiving. The results would presumably look different if the average participant age was 60, for example.

With respect to the 2018 study, Dr. Shmerling wrote "it's possible that if an older population of people with chronic low back pain had been studied, 'usual care' might have been the better treatment." That's not to say chiropractic care is "unsafe" for elderly patients.

In fact, Singapore-based Dr. Timothy Foo, D.C. stated that "chiropractic is beneficial for the elderly as it helps to maintain balance and coordination to help minimize the risk of falls." Additionally, it can combat joint degeneration.

"The vertebrae and disc in the spine can degenerate at a rapid pace when a misalignment in the spine occurs," wrote Dr. Foo. "Chiropractic care can slow down this process that prevents serious back issues from forming." Still, he urged people to understand that results vary and "not one person is the same."

Healthline called the idea that chiropractic adjustments are dangerous a myth, adding that temporary muscle soreness, stiffness, and increased pain are normal side effects of an adjustment.

That being said, neck adjustment safety is specifically controversial in the chiropractic landscape.

"Why are we as a society still allowing chiropractors to touch people's necks?" med-peds (internal medicine-pediatrics) hospitalist Dr. Clement Lee tweeted on Sept. 21, 2023. Sadly, there's some truth to Dr. Lee's words.

When 28-year-old Georgia resident Caitlin Jensen received a chiropractic neck adjustment in 2022, her life was forever changed, per The Independent. After just 20 minutes of neck work, she suffered a vertebral artery dissection (four arteries were dissected), which caused multiple strokes and cardiac arrest. Left mostly paralyzed, Jensen's dreams of working in the sciences instantly crumbled. She's made incredible progress since the incident, but her day-to-day life will never be the same.

"It is estimated that one in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection," a 2021 paper published in Stroke: Vascular and Interventional Neurology relayed. "Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes."

The Independent added that chiropractors will argue subtle dissection symptoms are the initial causes of pain that prompt individuals to book a chiropractic appointment in the first place. Subtle, somewhat vague vertebral artery dissection symptoms include cluster headaches, dizziness, and neck pain.

In response to Dr. Lee's tweet, a Twitter user linked a 2016 paper, titled "Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation," which found that there is "a small association between chiropractic neck manipulation and CAD."

Dr. Lee admitted that evidence varies: "As mentioned, evidence is mixed. In other studies ... 10 percent of vertebral artery dissections were related to neck manipulation. That's not trivial."

When asked for better alternatives, Dr. Lee mentioned "physical therapy, stress reduction, some medications, and tincture of time."

The mere fact that Dr. Lee's tweet inspired medical doctors, chiropractors, and patients alike to argue in the comments — passionately exploring everything from informed consent to the evils of big pharma — is quite telling. Risks and opposing opinions and findings are always going to exist in the healthcare industry. Though chiropractic care is less contentious now than it was 30-plus years ago, M.D. and D.C. holders may forever butt heads.