Reviews of research studies within the chiropractic community have been used to generate practice guidelines outlining standards that specify which chiropractic treatments are "legitimate" (i.e. supported by evidence) and conceivably reimbursable under managed care health payment systems.[70] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims.[2][52][43][85][86] Chiropractic remains at a crossroads, and that in order to progress it would need to embrace science; the promotion by some for it to be a cure-all was both "misguided and irrational".[87] A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.[88]
Chiropractic's origins lie in the folk medicine of bonesetting,[4] and as it evolved it incorporated vitalism, spiritual inspiration and rationalism.[30] Its early philosophy was based on deduction from irrefutable doctrine, which helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession.[30] This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method,[30] and relies on deductions from vitalistic first principles rather than on the materialism of science.[31] However, most practitioners tend to incorporate scientific research into chiropractic,[30] and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness.[31] A 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.[32]

A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of spinal manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[161] A 2005 American systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.[162] The cost-effectiveness of maintenance chiropractic care is unknown.[12]
“The current study provides the strongest evidence to date that chiropractic care is safe, effective, and results in high levels of patient satisfaction and perceived treatment benefit, thus strengthening our knowledge regarding this conservative nondrug option for low back pain,” Christine M. Goertz, DC, PhD, a chiropractor with the Spine Institute for Quality in Iowa, told Healthline.
Although a wide diversity of ideas exist among chiropractors,[30] they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system.[33] Some chiropractors claim spinal manipulation can have an effect of a variety of ailments such as irritable bowel syndrome and asthma.[7]
Twenty‐six to 71% of the adult population can recall experiencing an episode of neck pain or stiffness in their lifetime. Neck pain is more common in females than in males, with rates reported as high as 77.8%. The natural history is unclear. Neck pain has a costly impact on society because of visits to healthcare providers, sick leave, disability and loss of productivity. There are a number of treatments available for neck pain, one of which is mechanical traction.
Like their MD colleagues, doctors of chiropractic are subject to the boundaries established in state practice acts and are regulated by state licensing boards. Further, their education in four-year doctoral graduate school programs is nationally accredited through an agency that operates under the auspices of the U.S. Department of Education. After graduation, they must pass national board exams before obtaining a license to practice, and then must maintain their license annually by earning continuing education (CE) credits through state-approved CE programs.  
Among people seeking back pain relief alternatives, most choose chiropractic treatment. About 22 million Americans visit chiropractors annually. Of these, 7.7 million, or 35%, are seeking relief from back pain from various causes, including accidents, sports injuries, and muscle strains. Other complaints include pain in the neck, arms, and legs, and headaches.
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