Chiropractic

Lore & Background

Chiropractic was founded by D. D. Palmer, who claimed he received the principles from 'the other world' from a doctor who had died 50 years previously. Palmer called it 'a science of healing without drugs' and based it on vitalism, spiritual inspiration, and rationalism. The early philosophy rejected the inferential reasoning of the scientific method and relied on deductions from vitalistic first principles. A core concept, vertebral subluxation, was imbued with metaphysical meaning, interfering with the body's function and its inborn ability to heal itself. This concept remains unsubstantiated and largely untested, and debate continues within the profession about whether to retain it.

Reader's Guide

Chiropractic is well established in the United States, Canada, and Australia, alongside other manual-therapy professions. Most who seek chiropractic care do so for low back pain. However, there is no compelling evidence that primary or maintenance chiropractic adjustment is effective for any symptoms or diseases, including low back pain. A 2011 critical evaluation of 45 systematic reviews concluded that the data failed to demonstrate convincingly that spinal manipulation is an effective intervention for any condition. Safety data are insufficient; manipulations are frequently associated with mild to moderate adverse effects, with rare serious or fatal complications, including deaths from vertebral artery dissection. Chiropractic has had a strong political base and sustained demand for services, gaining more legitimacy and greater acceptance among conventional physicians and health plans in the United States in the late 20th century. During the COVID-19 pandemic, professional associations advised adherence to CDC and WHO guidance, but a small number of chiropractors spread vaccine misinformation and promoted unproven dietary supplements.

Did You Know?

• Chiropractic was founded by spiritualist D. D. Palmer in the 1890s, who claimed he received it from 'the other world' from a doctor who had died 50 years previously.
• The American Medical Association called chiropractic an 'unscientific cult' in 1966 and boycotted it until losing an antitrust case in 1987.
• Several deaths have been associated with cervical manipulation, and there is controversy regarding the degree of risk of vertebral artery dissection leading to stroke and death.
• The chiropractic concept of vertebral subluxation is not supported by clinical research evidence that would allow claims that it is the cause of disease.

Origins & the 'Straight' Philosophy

Chiropractic traces its roots to the folk-medicine tradition of bonesetting, but its formal founding arrived in the 1890s through D. D. Palmer, a spiritualist who claimed the discipline was revealed to him by a deceased physician from 'the other world.' Palmer branded it 'a science of healing without drugs' and built its early philosophy around deduction from what he considered irrefutable doctrine. This 'straight' philosophy, passed down through generations of practitioners, deliberately rejected the inferential reasoning of the scientific method in favor of deductions from vitalistic first principles. Strategically, this doctrinal framework served multiple purposes: it distinguished chiropractic from conventional medicine, provided legal and political shields against accusations of unlicensed medical practice, and enabled chiropractors to carve out an autonomous professional identity. Over time, most practitioners evolved into what are called 'mixers,' blending the materialistic reductionism of modern science with the metaphysical heritage of their predecessors and a holistic wellness paradigm. A 2008 commentary even urged the profession to actively distance itself from the straight philosophy, calling for the elimination of untestable dogma and a genuine embrace of critical thinking and evidence-based research.

The Subluxation Doctrine & Pseudoscientific Underpinnings

At the heart of traditional chiropractic lies the concept of vertebral subluxation, a term that in mainstream medicine simply denotes a partial or incomplete dislocation of a joint. D. D. Palmer, however, transformed this anatomical term into a metaphysical and philosophical construct rooted in vitalist and pseudoscientific traditions. He initially theorized that subluxations pinched nerves within intervertebral spaces, then revised this to propose that they altered nerve vibration—making it either too tense or too slack—thereby disrupting the health tone of distant organs. His son, B. J. Palmer, further expanded the doctrine, and it became instrumental in establishing a legal distinction between chiropractic and conventional medicine. The broader chiropractic worldview also incorporates the idea of Innate Intelligence, an inborn self-healing capacity supposedly mediated through the nervous system. Some practitioners extend this framework to claim spinal manipulation can influence conditions as varied as irritable bowel syndrome and asthma. Despite its centrality to the profession's identity, vertebral subluxation remains unsubstantiated and largely untested, and the entire theoretical edifice has been described as fundamentally at odds with evidence-based medicine.

Efficacy, Safety & the Evidence Gap

The clinical evidence surrounding chiropractic manipulation is notably thin. A 2011 critical evaluation that examined 45 systematic reviews concluded that the available data failed to convincingly demonstrate that spinal manipulation is an effective intervention for any condition, including the low back pain for which most patients seek chiropractic care. Conclusions about cost-effectiveness are similarly constrained by low-quality studies, uncertainty about actual efficacy, and insufficient supporting evidence. On the safety front, there are not sufficient data to definitively establish the safety of chiropractic manipulations. The practice is frequently associated with mild to moderate adverse effects, and serious or even fatal complications, while rare, do occur. A particularly contentious issue is the potential risk of vertebral artery dissection from cervical manipulation, a condition that can lead to stroke and death. Several deaths have been linked to this technique, and while some have argued the relationship is causative, many chiropractors dispute that claim. The degree of genuine risk remains a subject of ongoing controversy both within and outside the profession.

Institutional Conflict & the Road to Legitimacy

Chiropractic has never been regarded as a mainstream branch of medicine, and its institutional history is marked by sustained conflict with the medical establishment. In 1966, the American Medical Association labeled chiropractic an 'unscientific cult' and mounted a boycott that lasted until the AMA lost an antitrust case in 1987. Despite this adversarial history, chiropractic maintained a strong political base and sustained public demand for its services, which helped it survive and grow. By the late 20th century, the profession gained greater legitimacy and wider acceptance among conventional physicians and health insurance plans, particularly in the United States, Canada, and Australia, where it sits alongside other manual-therapy professions like osteopathy and physical therapy. Yet tensions persist. Significant disagreements among chiropractors over vaccination have negatively impacted public vaccination rates and the profession's mainstream standing. During the COVID-19 pandemic, while professional associations advised adherence to CDC, WHO, and local health guidance, a small but vocal faction spread vaccine misinformation and promoted unproven dietary supplements, further complicating the profession's public image.

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