Chiropractic: What Does the Science Say?

Chiropractic is one of the most widely used and culturally accepted forms of alternative medicine. It presents itself as a hands-on, natural solution to back and neck pain, but the discipline's foundations — and many of its ongoing practices — are grounded not in modern science but in 19th-century metaphysics and medical pseudoscience.

Origins in Vitalism

Chiropractic was founded in 1895 by Daniel David (D.D.) Palmer, a magnetic healer with no formal medical training. According to chiropractic lore, Palmer restored a janitor’s hearing by manipulating his spine. From this singular anecdote, Palmer developed the core doctrine of chiropractic: that most diseases are caused by spinal misalignments, or “subluxations,” which interfere with a vital force he called “innate intelligence.” Restoring alignment, Palmer claimed, would allow this force to flow freely and restore health.

This idea was not based on anatomical or physiological evidence, but on vitalism — the belief that life is governed by a non-physical essence. At the time, this placed chiropractic outside the realm of emerging scientific medicine, which was already discarding vitalism in favor of germ theory and biochemical models of disease. Yet despite over a century of scientific progress, many chiropractors today still invoke Palmer’s philosophy in some form.

The Claims

Modern chiropractors often say they treat musculoskeletal problems, particularly back and neck pain. However, many still adhere to Palmer’s original vision, asserting that spinal adjustments can prevent or treat a wide range of non-musculoskeletal issues — including asthma, digestive disorders, and even immune dysfunction.

Central to chiropractic theory is the spinal “subluxation,” but this concept is scientifically elusive. In orthodox medicine, a subluxation is a partial joint dislocation visible on imaging and understood as a structural problem. Chiropractic subluxations, however, are subjective and inconsistently defined. They do not reliably appear on X-rays or MRIs in ways that correlate with symptoms or illness, nor is there a physiological mechanism explaining how these subtle shifts could impact organs or systemic health.

Modern chiropractic

Contemporary chiropractic is deeply divided. One faction comprises practitioners who limit their scope to musculoskeletal complaints, especially lower back pain, neck stiffness, and headaches. These chiropractors often reject Palmer’s metaphysical explanations and strive to practice within an evidence-informed framework, resembling physical therapists more than traditional chiropractors.

The other faction, sometimes called “straight chiropractors,” holds firmly to the original philosophy. They maintain that spinal adjustments can cure or prevent a wide array of systemic ailments such as asthma, allergies, digestive problems, and even neurological disorders. This approach also promotes routine adjustments for healthy people as a form of wellness maintenance, a claim lacking any credible scientific basis.

The persistence of these divergent approaches reflects both professional ideology and economic incentives. Some chiropractors market extensive treatment plans, encouraging long-term patient loyalty. This commercialization risks prioritizing business over patient well-being and scientific accuracy.

What Does Science Say?

Clinical studies have found that spinal manipulation may offer modest short-term relief for acute low back pain and tension-type headaches. Yet these benefits tend to be similar to those achieved by physical therapy, massage, or even placebo. Regarding chronic back pain, neck pain, or non-musculoskeletal conditions, the evidence for chiropractic treatment is weak to nonexistent. Multiple high-quality reviews have concluded that chiropractic adjustments do not improve asthma, hypertension, digestive issues, or immune function.

The concept of “subluxations” in chiropractic has never been demonstrated on imaging or confirmed through physiological mechanisms. Unlike true spinal subluxations in medicine — which are visible, structural dislocations — chiropractic subluxations are vague, unmeasurable, and inconsistently defined.

Worse, spinal manipulation — particularly of the neck — carries risks. In rare cases, it has been linked to serious complications such as strokes caused by tearing arteries in the neck (vertebral artery dissection).

Why is Chiropractic Still so Popular?

Despite these scientific shortcomings, chiropractic remains popular for several reasons. Its hands-on approach offers a level of personal attention many patients find lacking in conventional medicine. The ritual of spinal manipulation, including the audible “crack,” can produce a feeling of relief or satisfaction, which contributes to its appeal. The placebo effect plays a significant role in how patients perceive benefit, especially for subjective symptoms like pain.

Marketing also bolsters chiropractic’s persistence. Clinics often advertise natural, drug-free healing and promote long-term “maintenance” treatments, creating a sense of ongoing necessity. In many countries, chiropractic is regulated and covered by insurance, giving it an official stamp of legitimacy that may mislead consumers about its scientific basis.

Moreover, dissatisfaction with conventional medicine fuels chiropractic’s appeal. Patients who feel ignored, rushed, or disbelieved by doctors may turn to chiropractors for a more holistic and attentive experience, even if that care lacks scientific rigor.

The Slippery Slope into Pseudoscience

While spinal manipulation for certain types of back pain can be classified as physical therapy, chiropractic’s broader claims often cross into pseudoscience. The continued promotion of subluxations as a universal cause of disease, along with treatment of unrelated health issues, undermines its credibility.

Some chiropractors exacerbate this by rejecting vaccination, recommending unnecessary diagnostic imaging, or selling unproven supplements. When chiropractic extends beyond plausible manual therapy into ideology-driven practices, it becomes not just ineffective but potentially dangerous.

The Risks

Some musculoskeletal treatments can offer temporary relief, but the risks of unnecessary or excessive manipulation — especially for vulnerable populations like children or those with bone conditions — are not insignificant. Neck manipulations, especially, have been associated in rare cases with vertebral artery dissection, potentially leading to stroke. The risk is low but serious enough to warrant caution, particularly since these manipulations are often performed on young, otherwise healthy individuals without clear medical indications.

The practice of performing spinal adjustments on infants and children has also drawn concern, as there is no scientific rationale supporting it, and potential harm exists.  Additionally, practitioners who promote chiropractic as a cure-all may dissuade patients from seeking real medical diagnoses and treatment.