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Chiropractic for back pain


Expert reviewer, Edzard Ernst, Emeritus Professor, University of Exeter, October 2016
New review due October 2019

Chiropractic is a manual therapy mainly used to treat back pain, and other problems with your bones, muscles and joints. A chiropractor is a regulated healthcare professional who focuses on the relationship between your body’s structure – largely the spine – and how it functions.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important you follow your chiropractor's advice.

Chiropractor working on someone's back

About chiropractic

Chiropractic is a type of manual therapy, in which chiropractors use their hands to make adjustments to your joints, concentrating particularly on your spine. This is called manipulation.

Chiropractors claim that they diagnose, treat, manage and prevent disorders of your musculoskeletal system (your bones, joints, tendons and muscles). Chiropractors also claim that treatment may improve your general health and how well your body’s nervous system works.

Chiropractors use a range of hands-on techniques, such as manipulating the spine to reduce pain, improve function and increase mobility. They may also use other treatments, such as acupuncture, electrotherapy and stretching exercises. Chiropractors also give self-help advice about your condition, specific exercises you can do at home and changes you can make to your lifestyle to reduce discomfort and improve your body’s functioning.

Chiropractors claim to take an integrated approach in their treatment – this means not just focusing on the symptoms of a condition, but also your physical health as a whole, your lifestyle and emotional wellbeing.

Chiropractic for back pain

Back pain is common, affecting eight out of 10 people at some point during their lives. The lower back is the area most often affected.

Chiropractic is most commonly used to treat back pain and neck pain. Some studies show that spinal manipulation is one of several options (including exercise, massage and physiotherapy) that may provide some relief from low-back pain. However, research results are inconsistent. A Cochrane review found that spinal manipulation was no better than other therapies. 

The National Institute for Health and Care Excellence (NICE) recommends manual therapy, including spinal manipulation, to help manage low-back pain if you’ve had it more than six weeks, but under a year.

Some people find that chiropractic treatment works for them. But there is the argument whether this is actually because it’s effective or if it’s simply having a ‘placebo effect’. This is when a fake or ineffective treatment can improve a patient's condition simply because they have the expectation that it will be helpful. 

Overall, because research results are inconsistent for chiropractic treatment, we need more evidence to be sure whether chiropractic is an effective treatment for back pain or not.

Chiropractic isn't suitable if you have osteoporosis or bone cancer, or if you have a condition that affects your spinal cord. It's also best not to have chiropractic while you're taking certain medicines, such as those that thin your blood (anticoagulants) or some types of steroids. Ask your doctor whether chiropractic is suitable for you to try.

Where can I find a chiropractor?

All chiropractors in the UK must be registered with the General Chiropractic Council (GCC). You can contact the GCC through their website or by phone to find a chiropractor in your area.

If you're considering chiropractic, it's important to contact your GP first. Your GP can help to diagnose your condition and will make sure that you understand all the treatment options that may be available to you.

About the procedure

Your first appointment with a chiropractor will start with a discussion about your problem or condition. They will ask about your medical history, diet and lifestyle, before carrying out a thorough physical examination. This will assess how your bones, muscles, joints and nerves are working. Your first appointment will last between 30 minutes and one hour.

Your chiropractor may need to assess your heart, lungs and blood pressure. They may also request that you have a blood test, X-ray or a magnetic resonance imaging (MRI) scan to help make a diagnosis. 

Your chiropractor will discuss their findings with you, give you a diagnosis and you’ll both agree on a course of treatment. They will discuss the type of treatments they’ll use and should mention any potential side-effects. The number of sessions you will need and how often you have them will depend on your particular condition.

This is a time when you may have many questions. Be sure to ask if you’re unsure about anything and if you want something explained again. If you ever feel unsure about what you’re told, visit your GP to discuss this treatment option further. 

Your chiropractor will usually treat you while you lie down in various positions. Chiropractors often use a manipulative technique on your spinal column or joints, consisting of short, rapid forceful movements or ‘thrusts’. These allegedly ‘re-align’ your spine and correct any problems in your spine that may be related to your condition. This technique may result in a sound you can hear – a click or pop similar to when you stretch your knuckles. The 'pop' is simply the sound of bubbles of gas popping in the fluid of the joint as the pressure is released.

Your chiropractor may carry out treatments using ice, heat, ultrasound and acupuncture, as well as offer advice about posture and lifestyle. They may also recommend some exercises for you to do at home. 

Your chiropractor may suggest having regular sessions (maintenance therapy) after your initial problem has got better. Chiropractors claim this reduces the chances of falling ill again. However, there is little evidence to show how effective this type of treatment is.

Your chiropractor may refer you to your GP if your condition doesn't improve. Chiropractors don’t prescribe medicines or carry out any surgery.

Side-effects

As with every treatment, there are some side-effects and risks associated with chiropractic. Ask you chiropractor to explain how these risks apply to you. 

About half of all patients have some mild pain or soreness around the area that was treated. Other side-effects include tiredness and temporary headaches. However, these should pass within a day or two. But be sure to contact your chiropractor or GP if these side-effects continue. You may experience some redness to the skin, but this is rare.

Talk to your chiropractor to discuss any concerns you may have.

Complications

Serious complications because of spinal manipulation, for example damage to arteries in your neck, are probably rare. There have been some concerns about the possible risk of having a stroke because of manipulation to the neck, but the risk is very low – a definite link between having chiropractic and a stroke hasn't been established.

Chiropractors believe that spinal manipulation is safe. However, there is some debate about this and research is ongoing to determine the safety of chiropractic. There is no system to monitor complications or side-effects of chiropractic treatment, as there is with medicines. Therefore, the number of complications caused by chiropractic is essentially unknown.

Frequently asked questions

  • Chiropractic is a regulated healthcare profession. All UK chiropractors must undergo at least four years training at an institution accredited by the General Chiropractic Council (GCC). After qualifying, they must register with the GCC before they are legally allowed to practise.

    It's important that you make sure that your chiropractor is fully trained and qualified. Don't agree to any chiropractic treatment unless your chiropractor has fully explained it and discussed all the risks and complications involved. Your chiropractor should also examine you thoroughly and obtain your full consent before he or she starts any chiropractic care.

  • Chiropractic is often used to treat whiplash. However, not enough research has been done to show whether or not it's really effective for treating this condition. 

    More information

    Whiplash injuries are caused when your neck is over-extended, often as a result of a sudden impact forcing your neck forwards. It can also be caused by your neck over rotating. It's a common injury and often occurs as a result of a rear-end or side-impact car crash. However, whiplash can also be caused by having a fall or any other sudden movement. 

    Whiplash injuries damage your muscles, ligaments, nerves and bones in your neck, forcing them closer together. This can lead to pain and stiffness. Whiplash injuries can vary and the most severe forms can lead to more serious complications (whiplash-associated disorders).

    It's important to try to start moving around and return to your usual activities as soon as you feel able. Although you may feel some discomfort to begin with, carrying on with your usual activities isn’t harmful. Using a collar to reduce movement is no longer recommended and can actually increase how long it takes for you to recover. Chiropractic is often used to treat whiplash. Some people find that it helps ease some pain and discomfort. However, there isn't enough evidence to show whether it’s effective for treating whiplash injuries.

  • Chiropractors insist that spinal manipulation by a registered, trained professional is safe. However, there is some evidence to suggest it may be harmful.

    More information 

    Research has shown that mild side-effects, such as headaches and tiredness, are common after spinal manipulation. These are usually mild and only last for a day or two.

    Spinal manipulation on the neck has led to serious complications in some people, including stroke due to damage to the arteries. However, a definite link between having chiropractic and a stroke hasn't been established.

    If you’re thinking of seeing a chiropractor, make sure they are registered with the General Chiropractic Council. And if you have any doubts, talk to your GP beforehand. They will be able to talk you through chiropractic therapy, as well as other possible options for your condition or pain.


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Related information

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  • Reviewed by Alice Rossiter, Specialist Editor, Bupa Health ContentTeam, October 2016
    Expert reviewer, Edzard Ernst, Emeritus Professor, University of Exeter, October 2016
    New review due October 2019



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