The pseudoscience of chiropractic

By educational degree and state healthcare licensing, I am a chiropractor. I kindly ask that you don’t make hasty judgments against me because my opinion on chiropractic is likely just as poor as (probably worse than) yours.

The founding principles of chiropractic are, first and foremost, a pseudoscience with no legitimate research evidence to support the claims. Chiropractic adjustments are not healthcare (despite what “traditional” chiropractors might argue) and provide no real physiological benefit. At best, an adjustment helps to improve the movement of a joint that had previously been restricted or fixated, and even so, this is most likely anecdotal evidence.

So let’s dive in and discuss some of the common grifts that quack chiropractors will use to sell you “treatment” that does almost nothing for you!

“Vertebral subluxations” and “innate intelligence”

You should take note that both of these phrases are in quotation marks. I wrote them that way because they’re both nonsense. Unfortunately for someone like me—someone with the professional title of chiropractor—these are two of the reasons people often assume I’m uneducated, a grifter, or just another pseudoscience hack.

I, like most of you reading this, scoff at this pseudoscience garbage and opt for actual evidence-based practices.

But, let’s examine these phrases starting with the definitions. I included subluxation in its traditional and valid medical definition, first. The following two, again in sarcastic quotation marks, are made up definitions by a profession filled with pseudoscience.

But adjustments feel so good!

Since I went through chiropractic school, I learned how to adjust nearly every synovial joint in human anatomy. In practice, there are only three reasons why I’ll adjust a patient (for the other two, check out How I Practice). The first is the topic of this paragraph: people request the adjustments because they say the adjustments make them feel better.

This is mostly anecdotal evidence, and anecdote does not constitute legitimate scientific research. If people think they feel better from adjustments and receive them without incident, that’s great! But, there isn’t sufficient peer-reviewed research to suggest the adjustments are providing significant physiological change.^[1]

Of course, you’ll be able to find research that claims a myriad of neurological and physiological benefits. Unfortunately, most of those publications are in chiropractic journals (a chiropractic journal saying chiropractic works seems like a clear bias) where the methods are poor or the measured results are bogus.

Feel free to challenge these comments with your favorite peer-reviewed research paper outlining the benefits of chiropractic adjustments. I’ll happily read them, but in the past 12 years (including 4 years of chiropractic education), I haven’t been convinced that adjustments are worth anything more than anecdotal improvement and ASMR for your social media accounts.

More chiropractic grifts

If you’ve seen a chiropractor who practices pseudoscience (sometimes identified as a “straight” chiropractor, subluxation-based chiropractor, or upper-cervical specific, among other names), you’ve likely been exposed to the following grifts.

Scheduling 3x per week for (x) weeks

A classic grift in the chiropractic profession is to attempt to commit patients to a treatment schedule of 3x per week for 3-4 weeks. The only time scheduling 3x per week for multiple weeks is appropriate is when you’re participating in a rehabilitation protocol (e.g., post-surgery or following an injury) that requires therapeutic exercise and repeated manual therapy techniques. These will also usually come with a prescription from a surgeon or medical provider.

Note: if you’ve been given a prescription for injury rehabilitation, you should seek a physical therapist or occupational therapist vs. seeing your chiropractor. Our education in chiropractic was not particularly robust in injury rehabilitation.

The performance of chiropractic—especially when it’s adjustment-only—is not necessary 3x per week (I would argue that a regularly scheduled adjustment, no matter the timeframe, is never necessary, but that’s beside the point). If your chiropractor is recommending 3x per week for adjustments, then they’re simply trying to transfer money from your account (or your insurance) to their account.

Be wary of the 3x per week scheduling recommendation.

Unnecessary x-rays

A staple of the chiropractic grift is the wildly inappropriate and excessive ordering of plain film radiographs (x-rays). X-rays are wonderful diagnostic tools when used appropriately, but quacks in the chiropractic profession will order them when they’re not deemed medically necessary. There are specific guidelines (e.g., American College of Radiology Appropriateness Criteria®^[2]) which describe when x-rays are medically necessary.

Since x-rays expose patients to radiation, there is a specific risk-benefit^[3] to consider. Every x-ray exposes a patient to radiation which poses a health risk; chiropractors are notorious for ordering x-rays without medical necessity which means the proposed benefit is minimal. X-rays are generally deemed necessary following notable trauma (e.g., a fall or accident that caused significant pain, swelling, or creates an inability to clinically assess the presenting injury), suspected systemic disease (e.g., cancer), or suspicion of other specific diseases (e.g., tuberculosis).

Of course, there are more valid reasons beyond these few; however, the point remains that chiropractors often order x-rays to show the presence of their pseudoscience “chiropractic subluxation” which, as previously described, is not a real thing.

Electrical muscle stimulation

Electrical muscle stimulation (e-stim) or transcutaneous electrical nerve stimulation (TENS) are passive modalities with minimal physiological benefit. Generally, the benefit exists in pain modulation but only while the unit is connected.

E-stim primarily utilizes the pain-gating theory where touch sensation travels faster to your brain than pain^[4]. Thus, if you put e-stim on an area of your body that hurts, your brain will perceive the mild electrical impulse instead of the pain.

Other types of e-stim may assist in reducing active muscle spasm or may help to stimulate contraction of a previously inhibited muscle (e.g., a Russian stim protocol), but generally, your quack chiropractor is using e-stim for two reasons: time and money.

Many quack chiropractors schedule multiple patients for the same time slots to maximize their income (not to help more people since they’re often not providing any real healthcare procedures). Since they can’t “treat” two or more patients at one time, one or more of them will be given a time-wasting modality—the most common of which is e-stim.

You’ll be attached to an e-stim unit for 10-20 minutes; you (or your insurance) will be billed for this mostly-useless modality, and you’re out of the way so the chiropractor can be with another patient.

“Buy my supplements”

Not exclusive to quacks in the chiropractic profession, the sale of supplements is the ultimate “wellness” grift. Most importantly, supplements are completely unregulated. There is absolutely no oversight for the formulation and sale of a dietary supplement—unless something goes wrong (e.g., significant volume of public complaints or prevalence of injury, illness, or death) and the FDA or another oversight committee gets involved.

So frequently, these supplements will be pitched as some sort of fix or cure for a particular issue. You’ll see famous grifters like Andrew Huberman do this (yes, Andrew Huberman is a grifter).

If you pay attention, you’ll notice that every supplement sale website or advertisement has a legal disclaimer stating that the statements are not evaluated by the FDA, and the information and supplements are not intended to diagnose or treat any specific ailments. The grifters will tell you how the supplements will help with specific symptoms, ailments, or even diseases—and yes, that’s both unethical and illegal, and it’s why I keep using the word “grift.”

How I practice

I don’t practice the way you might expect chiropractor to practice. I almost exclusively perform treatment on the fascial system as described by the Stecco family and their esteemed colleagues. The Fascial Manipulation® technique involves assessing and treating the connective tissue system rather than specifically targeting muscles (e.g., massage or stretch techniques) or manipulating joints via classic adjustments.

If you’re curious about the research behind this technique, check out the incredible volume of research available from Stecco and their colleagues. For more on my style of treatment(s) and booking, check out my health services page.

“Traditional” chiropractic and adjustments

As far as “traditional” chiropractic goes, I don’t shoot x-rays unless there is a specific reason to do so (I don’t think I’ve ordered more than 5 x-rays in private practice [since 2018]), I don’t have an e-stim machine, I don’t use other machines or equipment other than my table and my hands/elbows for the fascial treatments, and I don’t shill supplements.

I do perform adjustments on three specific occasions. As previously mentioned, I’ll adjust a patient when they request it. If they want it and can tolerate it, I’ll adjust them. The other two instances are actual interventions for pain and/or imbalance. These two adjustments are for the sacroiliac (SI) joints or the rib head articulations.

The SI joints are the joints where your spinal column connect to your pelvis—most people describe the pain pattern as lower back pain when SI joint fixation exists. When the SI joints become restricted, they can cause significant pain. More significantly, SI joint fixation causes an apparent leg-length discrepancy; the position of the hip joints is shifted which means one leg is set lower than the other. When you stand on solid ground, your feet are on an even plane which will shift the position of your hips joints.

This causes pelvic obliquity and a resulting functional scoliosis. This creates a tension imbalance in the functional/structural components of the myofascial system which can lead to more significant issues in the future. A quick SI joint adjustment (I use the pelvic drop technique) corrects the joint restrictions and helps to correct these imbalances.

The rib heads are where the rib attaches to the transverse processes of your thoracic spine. Many patients describe rib head restrictions as a sharp pain adjacent to the spine that hurts with deep breaths. Rib head restrictions are mostly just painful and won’t cause a tremendous functional issue, but the pain can be significant. A rib head adjustment will free the restriction and will often provide immediate relief of the pain. Oftentimes, no other intervention is needed.

Final statements

Chiropractic earned a terrible reputation by pushing the pseudoscience long after scientific research debunked the original claims of the early 1900s. Subluxations are injured joints. Innate intelligence is not real.

I don’t hate body work, and I use adjustments in certain situations. My job is cool—I treat professional bodybuilders, and I’ve helped some of the world’s best athletes improve their bodies’ aesthetic, function, and size. I’m not targeting everyone who carries the title of chiropractic; I just hate the pseudoscience aspect of the profession. If you read this and were offended by what I said, then this post was probably about you.