The science and evidence base for chiropractic

Can anyone in the UK call themselves a chiropractor?

No. It is illegal for anyone in the UK to use the title ‘chiropractor’ or to imply that they are a chiropractor unless they are registered with the General Chiropractic Council (GCC). However, trained chiropractors who are not registered with the GCC can continue to practice as long as they do not call themselves chiropractors.

Why do some chiropractors call themselves doctors?

In the UK the courtesy title ‘Dr’ is used by medical doctors, dentists, vets, chiropractors, and others. The title ‘Dr’ is not protected in law, and may be used by chiropractors providing they make it clear that they are registered chiropractors. They are not registered medical practitioners. A degree in chiropractic does not command the same depth and quality of training as a degree in medicine.

The GCC’s Code of Conduct requires chiropractors to make it clear that they are registered chiropractors and not registered medical practitioners. The ASA’s guidance (which is binding on all chiropractors) on the use of the title ‘Dr’ makes it clear that chiropractors should not mislead the public by using the title Dr, concluding: “…a chiropractor should not use the claim “Dr Smith (Doctor of Chiropractic)” but could claim “Mike Smith, who is a doctor of chiropractic” or similar.”

Can chiropractic help me?

Possibly, if you are suffering from back pain. Spinal manipulative therapy (which is also offered by physiotherapists and qualified medical doctors), has shown some evidence of benefit in the treatment of back pain, but it is important to remember that conventional treatments are usually equally effective and much cheaper.

Although the NICE guidance issued in 2009 recommended spinal manipulation for back pain, it did not specifically recommend chiropractic. It should be noted that the NICE guidance has been roundly criticised by many, including Prof David Colquhoun (see here, here and here).

In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.

Do I have to have an x-ray?

Your chiropractor should only recommend that an x-ray be taken if there is a valid clinical reason for doing so. It is important to remember that chiropractic spinal manipulative therapy for back pain is comparable to conventional treatment where no x-ray is required and that there is no evidence that chiropractors can locate any ‘subluxation’ on an x-ray. There is a risk associated with any x-ray and decisions about x-rays should not be taken lightly. As with all medical treatments, a balance has to be made between the benefits and the risks. However, if there is no good evidence that subluxations can be detected (and none that they are the cause of any problems), then the risk-benefit analysis comes down heavily in favour of not having an x-ray taken.

Is chiropractic treatment safe?

Research has shown chiropractic to be less safe and no more effective than conventional treatments that are much cheaper. If treatment is applied to the neck, it carries the risk of stroke or death. Elsewhere on the spine chiropractic therapy is relatively safe, although around half of all patients experience some side effects of treatment such as feeling more uncomfortable, stiff or tired for a day or so. Other harmful aspects of chiropractic that are often not considered, but that are far more common than reported events, include decreased use of immunisation due to misinformation given to parents, financial harm due to unnecessary treatment, and psychological harm related to unnecessary treatment and exposure to false chiropractic beliefs about ‘subluxations’.

In defence of the risks associated with their practices, chiropractors often cite the many problems encountered by the medical profession. For example, drugs have side effects, even when used properly, and surgery is not without risks. However, physicians often work with drugs and surgery in an effort to prolong and/or save lives, and many of their patients will have been destined to die irrespective of having undergone medical interventions. Chiropractors, on the other hand, invariably deal with non-life threatening, chronic diseases, and do not, as a rule, save lives or use invasive techniques which would carry the risk of haemorrhage and infection.

What is a ‘subluxation’ and can it do me harm?

A subluxation complex, or ‘subluxation’, is the term used by chiropractors to describe a perceived loss of function in the spine and nervous system, allegedly due to a reduction in its normal motion or alignment. Chiropractors say that it can affect the quality of your life. However, unlike an orthopaedic subluxation, which is an incomplete or partial dislocation of a joint (frequently the result of trauma and it is a more severe abnormality which tends to occur in areas other than the spine and, as such, is rarely treated by chiropractors) the chiropractic ‘subluxation’ has never been proven to exist.

Since chiropractors view the spine as an entity, where they think they have diagnosed ‘subluxations’ they will normally manipulate and ‘adjust’ them. As it is not uncommon for ‘subluxations’ to be diagnosed in the upper spine, even if a patient suffers from back pain, many, if not most back pain patients receive upper spinal manipulations which invariably place them at unnecessary risk of serious injury or death.

Can I get chiropractic care on the NHS?

At present the availability of chiropractic is not widespread on the NHS. As a consequence, most chiropractors work in private practice.

Do I need to tell my GP?

There is no compulsion on a chiropractor to share the details of your condition and treatment with your GP. However, in order for your medical records to remain complete and up to date it is in your interests to ask your chiropractor to send a report to your GP. Your chiropractor should be willing to comply with your request.

Should I pay in advance for a long schedule of treatment?

If a chiropractor suggests a long course of treatment (more than 6–12 sessions) it would be wise to seek a second opinion from a medical doctor or an orthopaedic consultant.

How do I find a chiropractor?

You can use ‘Check the Register’ link on the GCC’s website, or consult local directories. In contemplating chiropractic treatment it is important to remember that chiropractic legislation in the UK does not specify the scope or style of chiropractic practice. This leaves chiropractors free to recommend and administer treatments which are not supported by reliable scientific evidence  eg subluxation-based chiropractic, regular ‘wellness’, corrective and/or preventive maintenance care, craniosacral therapy and applied kinesiology.