Deaths and serious injury have been linked to certain types of chiropractic manipulations. Do you know the risks? What kind of treatment is best for back pain?
About 80 percent of adults suffer from back pain at some point in their lives. It can range from a dull ache to sharp stabs that don’t let you sleep. It can be because you tried to lift something heavy at an awkward angle or it can develop over time from poor posture and a computer-based lifestyle.
Many people seek out a chiropractor to ease the pain, but few know what the differences are between chiropractors, physiotherapists and osteopaths. Getting the wrong type of treatment can lead to the problem getting worse.
Traditionally, a chiropractor’s main strategy was to adjust the spine and other bones in the body. The theory is that pain is caused by a misalignment of the skeletal system. Adjustments can mean a quick and sharp twist of the neck or a fast and heavy thrust on bones.
There have been cases of death and injury from these adjustments. Damage to the arteries that carry blood through the spinal cord and up to the brain causes strokes. Other complications include herniated disks or damage to the nerves in the spinal cord which can lead to intense pain, muscle weakness and incontinence.
There is still a lot of debate around how dangerous chiropractic manipulations can be. Partly because many chiropractors are now integrating other types of strategies, such as mobilization of the spine—which is much more gentle—or heat and electrical stimulation therapy along with exercise, which is the treatment offered by physiotherapists. This makes it hard to study how risky the manipulations themselves are.
It is also the case that some people have pre-existing, yet hard to identify, conditions such as arterial wall disease that make them more susceptible to being harmed by chiropractic manipulations.
Review studies—which look at results from many studies and cases, and pool all that information together—are the best way to get a better perspective on a debate. One review of of adverse outcomes, such as fractures or disk herniations, found that in the majority of cases (80 percent) the provider was a chiropractor — compared to 6 percent where the provider was an osteopath or 4 percent where it was a medical doctor.
Another review study looked at randomized controlled trials (which prevent biased results) and found that spinal manipulation is no more effective for low back pain than other therapies.
If chiropractic adjustments are no better than other therapies and potentially more dangerous, why do people seek this type of treatment?
I would suggest it is our desire for a quick fix. You go in a few times, get your bones adjusted and then life will be good again. This is very different from physiotherapy where the therapist will look at your muscle imbalances and weaknesses and then recommend an exercise program to correct them. You will have to do them daily, without the direct supervision of your therapist. You will have to go in once a week for massage or electrical stimulation therapy, and it may take months to weeks to “solve” the problem. This type of treatment asks you to take more responsibility for your own care, which is difficult, but, more effective in the long run.
A quick fix obsession is also reflected by the fact that about 70 percent of people use pain medication for low back pain. This addresses the symptom but not the cause. The main risk factors for back pain—age, fitness level, weight gain, occupational risk—are about lifestyle, not about the placement of your bones.
So what to do if you need help for back pain?
- Try a physiotherapist or osteopath first. They will never use high-velocity, rotational thrusts around a small area of your spine.
- Broaden your perspective: what aspects of your life may be contributing to this problem? What changes can you make that will promote long term back health? These may include being more aware of your posture, taking stretch breaks throughout the day or walking more. Your physiotherapist can help you figure out what will work for your lifestyle.
- Ask questions! If you do see a chiropractor, ask them what techniques they plan to use and what the alternatives are.
- If you decide to receive any spinal manipulations, first get tested for arterial wall disease. This isn’t failsafe—usually tests won’t uncover the condition until it is very advanced, so you still may be at risk even with negative results.
Studies referred to in this article:
“Deaths after chiropractic: a review of published cases.” Published in International Journal of Clinical Practice
“Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases.” Published in Journal of Manipulative and Physiological Therapeutics.
“Spinal manipulative therapy for acute low-back pain.” Published in the Cochrane Database of Systematic Reviews.
Photo Credit: Olenka Kotyk