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Tips on Choosing a Chiropractor
Stephen Barrett, M.D.
Choosing a chiropractor can be difficult because the majority of chiropractors are involved in unscientific practices [1,2]. If you do decide to consult one, begin with a telephone interview during which you explore the chiropractor's attitudes and practice patterns.
Positive Signs
Try to find a chiropractor whose practice is limited to conservative treatment of back pain and other musculoskeletal problems. Ask your medical doctor for the names of any who fit this description and appear to be trustworthy.
Membership in the National Association for Chiropractic Medicine or the Canadian Academy of Manipulative Therapists (CAMT) is a very good sign, but the number of chiropractors who belong to these groups is small. CAMT's "orthopractic guidelines" describe a science-based approach to manipulative therapy.
In addition to manual manipulation or stretching of tight muscles or joints, science-based chiropractors commonly use heat or ice packs, ultrasound treatment, and other modalities similar to those of physical therapists. They may also recommend a home exercise program. For most conditions that chiropractic care can help, significant improvement should occur within a few visits.
Negative Signs
Avoid chiropractors who advertise about "danger signals that indicate the need for chiropractic care," make claims about curing diseases, try to get patients to sign contracts for lengthy treatment, promote regular "preventive" adjustments, use scare tactics, or disparage scientific medical treatment or preventive measures such as immunization or fluoridation.
Avoid chiropractors who purport to diagnose or treat "subluxations," who have waiting room literature promoting "nerve interference" as an underlying cause of disease, or who post charts or distribute literature suggesting that chiropractic might help nearly every type of health problem.
Avoid any chiropractor who routinely performs or orders x-ray examinations of all patients. Most patients who consult a chiropractor do not need them. Be especially wary of full-spine x-ray examinations. This practice has doubtful diagnostic value and involves a large amount of radiation.
Avoid chiropractors who "prescribe" dietary supplements, homeopathic products, or herbal products for the treatment of disease or who sell any of these products in their offices. For dietary advice, the best sources are physicians and registered dietitians.
Avoid chiropractors who offer Biological Terrain Assessment, body fat analysis, computerized "nutrient deficiency" testing, contact reflex analysis,, computerized range-of-motion analysis, contour analysis (also called moire contourography), cytotoxic testing, electrodermal testing, Functional Intracellular Analysis (FIA), hair analysis, herbal crystallization analysis, inclinometry, iridology, leg-length testing, live blood cell analysis (also called nutritional blood analysis or Hemaview), testing with a Nervo-Scope or similar spinal heat-detecting device, Nutrabalance, NUTRI-SPEC, pendulum divination, reflexology, saliva testing, spinal ultrasound testing to "measure progress, surface electromyography (SEMG), thermography, a Toftness device, weighing on a twin-scale device called a Spinal Analysis Machine (S.A.M.), or any other dubious diagnostic procedure identified on Quackwatch.
Avoid chiropractors who utilize acupuncture, Activator Methods, allergy testing, applied kinesiology, Bio Energetic Synchronization Technique (B.E.S.T.), chelation therapy, colonic irrigation, cranial or craniosacral therapy, laser acupuncture, magnetic or biomagnetic therapy, Neuro Emotional Technique (NET), or Neural Organization Technique (NOT), or who exhibit a dogmatic attachment to any other specific chiropractic technique or school of thought.
Understand that some chiropractic treatments involve significant risk. Spinal manipulations involving sudden movements have greater potential for injury than more conservative types of therapy. Be aware that chiropractic neck manipulation can cause serious injuries. Neck manipulation should be done gently with care to avoid excessive rotation that could damage the patient's vertebral artery. It should never be used unless symptoms indicate a specific need for it. A small percentage of chiropractors advocate neck manipulation to "balance" or "realign" the spine no matter where the patient's problem is located. I recommend avoiding such chiropractors.
Additional Safeguards
Never consult a chiropractor unless your problem has been diagnosed by a competent medical practitioner. Don't rely on a chiropractor for diagnosis. Although some chiropractors know enough to avoid diagnostic difficulty, there is no simple way for a consumer to determine who can do so. As an additional safeguard, ask any chiropractor who treats you to discuss your care with your medical doctor.
Remember that although manipulative therapy has value in treating back pain and may relieve other musculoskeletal conditions, chiropractors are not the only source of manipulative therapy. Physical therapists, many osteopathic physicians, and a small number of medical doctors do it also. The Canadian Association of Manipulative Therapists is a good referral source for Canadian practitioners.
References
Christenson MG, Morgan DRD. Job Analysis of Chiropractic: A Report, Survey Analysis, and Summary of the Practice of Chiropractic within the United States. Greeley, Colorado: National Board of Chiropractic Examiners, 1993. This report is based on the responses by 4,835 full-time chiropractors who responded to a 1991 NBCE survey about their practices during the previous two years. The figures included: Activator Methods 51.2%, applied kinesiology 37.2%, acupressure/meridian therapy 65.5%, acupuncture 11.8%, cranial adjusting 27.2%, and homeopathic remedies 36.9%. "Nutritional counseling, etc." was listed by 83.5%. Although the data don't indicate what this involved, it is clear that a large percentage are inappropriately prescribing dietary supplements.
Chiropractors. Consumer Reports 59:383-390, 1994. This included a survey of 476 chiropractors chosen randomly from the American Chiropractic Association membership directory. Nearly one quarter of the 274 who responded sent material stating that spinal misalignments and "interferences" threatened overall health, and 35% implicated the spine in disorders of the body's organs.
http://www.quackwatch.org/01QuackeryRelatedTopics/chirochoose.html
Stephen Barrett, M.D.
Choosing a chiropractor can be difficult because the majority of chiropractors are involved in unscientific practices [1,2]. If you do decide to consult one, begin with a telephone interview during which you explore the chiropractor's attitudes and practice patterns.
Positive Signs
Try to find a chiropractor whose practice is limited to conservative treatment of back pain and other musculoskeletal problems. Ask your medical doctor for the names of any who fit this description and appear to be trustworthy.
Membership in the National Association for Chiropractic Medicine or the Canadian Academy of Manipulative Therapists (CAMT) is a very good sign, but the number of chiropractors who belong to these groups is small. CAMT's "orthopractic guidelines" describe a science-based approach to manipulative therapy.
In addition to manual manipulation or stretching of tight muscles or joints, science-based chiropractors commonly use heat or ice packs, ultrasound treatment, and other modalities similar to those of physical therapists. They may also recommend a home exercise program. For most conditions that chiropractic care can help, significant improvement should occur within a few visits.
Negative Signs
Avoid chiropractors who advertise about "danger signals that indicate the need for chiropractic care," make claims about curing diseases, try to get patients to sign contracts for lengthy treatment, promote regular "preventive" adjustments, use scare tactics, or disparage scientific medical treatment or preventive measures such as immunization or fluoridation.
Avoid chiropractors who purport to diagnose or treat "subluxations," who have waiting room literature promoting "nerve interference" as an underlying cause of disease, or who post charts or distribute literature suggesting that chiropractic might help nearly every type of health problem.
Avoid any chiropractor who routinely performs or orders x-ray examinations of all patients. Most patients who consult a chiropractor do not need them. Be especially wary of full-spine x-ray examinations. This practice has doubtful diagnostic value and involves a large amount of radiation.
Avoid chiropractors who "prescribe" dietary supplements, homeopathic products, or herbal products for the treatment of disease or who sell any of these products in their offices. For dietary advice, the best sources are physicians and registered dietitians.
Avoid chiropractors who offer Biological Terrain Assessment, body fat analysis, computerized "nutrient deficiency" testing, contact reflex analysis,, computerized range-of-motion analysis, contour analysis (also called moire contourography), cytotoxic testing, electrodermal testing, Functional Intracellular Analysis (FIA), hair analysis, herbal crystallization analysis, inclinometry, iridology, leg-length testing, live blood cell analysis (also called nutritional blood analysis or Hemaview), testing with a Nervo-Scope or similar spinal heat-detecting device, Nutrabalance, NUTRI-SPEC, pendulum divination, reflexology, saliva testing, spinal ultrasound testing to "measure progress, surface electromyography (SEMG), thermography, a Toftness device, weighing on a twin-scale device called a Spinal Analysis Machine (S.A.M.), or any other dubious diagnostic procedure identified on Quackwatch.
Avoid chiropractors who utilize acupuncture, Activator Methods, allergy testing, applied kinesiology, Bio Energetic Synchronization Technique (B.E.S.T.), chelation therapy, colonic irrigation, cranial or craniosacral therapy, laser acupuncture, magnetic or biomagnetic therapy, Neuro Emotional Technique (NET), or Neural Organization Technique (NOT), or who exhibit a dogmatic attachment to any other specific chiropractic technique or school of thought.
Understand that some chiropractic treatments involve significant risk. Spinal manipulations involving sudden movements have greater potential for injury than more conservative types of therapy. Be aware that chiropractic neck manipulation can cause serious injuries. Neck manipulation should be done gently with care to avoid excessive rotation that could damage the patient's vertebral artery. It should never be used unless symptoms indicate a specific need for it. A small percentage of chiropractors advocate neck manipulation to "balance" or "realign" the spine no matter where the patient's problem is located. I recommend avoiding such chiropractors.
Additional Safeguards
Never consult a chiropractor unless your problem has been diagnosed by a competent medical practitioner. Don't rely on a chiropractor for diagnosis. Although some chiropractors know enough to avoid diagnostic difficulty, there is no simple way for a consumer to determine who can do so. As an additional safeguard, ask any chiropractor who treats you to discuss your care with your medical doctor.
Remember that although manipulative therapy has value in treating back pain and may relieve other musculoskeletal conditions, chiropractors are not the only source of manipulative therapy. Physical therapists, many osteopathic physicians, and a small number of medical doctors do it also. The Canadian Association of Manipulative Therapists is a good referral source for Canadian practitioners.
References
Christenson MG, Morgan DRD. Job Analysis of Chiropractic: A Report, Survey Analysis, and Summary of the Practice of Chiropractic within the United States. Greeley, Colorado: National Board of Chiropractic Examiners, 1993. This report is based on the responses by 4,835 full-time chiropractors who responded to a 1991 NBCE survey about their practices during the previous two years. The figures included: Activator Methods 51.2%, applied kinesiology 37.2%, acupressure/meridian therapy 65.5%, acupuncture 11.8%, cranial adjusting 27.2%, and homeopathic remedies 36.9%. "Nutritional counseling, etc." was listed by 83.5%. Although the data don't indicate what this involved, it is clear that a large percentage are inappropriately prescribing dietary supplements.
Chiropractors. Consumer Reports 59:383-390, 1994. This included a survey of 476 chiropractors chosen randomly from the American Chiropractic Association membership directory. Nearly one quarter of the 274 who responded sent material stating that spinal misalignments and "interferences" threatened overall health, and 35% implicated the spine in disorders of the body's organs.
http://www.quackwatch.org/01QuackeryRelatedTopics/chirochoose.html
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