Hovering in the gray area between standard health care and alternative health care, you’ll find chiropractics. Which is a practice created through treating musculoskeletal injuries. (Physicians overtake the first type, while acupuncturists and massage therapists make up the second.)

Michael Schneider, an associate professor of health sciences at the University of Pittsburgh states that, “Chiropractic was the original holistic medicine in that it focused on treating the whole person, not just the body part that hurt”. With extensive research on chiropractic care, he implies that cervical and lumbar manipulation can be a remarkable treatment for those who struggle with low back pain. These back and neck adjustments are the main reason most people schedule a visit to the chiropractor. A study published in April 2017 in the Journal of the American Medical Association supported this, finding that based on the latest research, spinal manipulation can modestly reduce a person’s lower back pain.

Other studies provide information that when used alongside standard medical care, chiropractic manipulation tends to lead to extensively positive outcomes for patients with lower back pain.

Dr. Ronald Glick, who is not only an assistant professor of psychiatry, physical medicine and rehabilitation at the University of Pittsburgh School of Medicine, but coauthor of several of Schneider’s research papers. Dr. Glick states, “the benefits of chiropractic for acute low back pain have been pretty widely accepted for years now within the medical community” further putting into perspective that “when I started in practice over 30 years ago, people would look askance at a physician who recommended chiropractic, but that’s not the case anymore”.

Schneider also says that the most supporting research in advocating for chiropractic involves treating back pain. He also explains there’s also supporting research for neck pain and some types of non-migraine headaches. Though his profession has widely been argued for its credibility in results, he states. “The controversy comes in when chiropractors make claims about treating non-musculoskeletal conditions”—claims he says have little to no basis in science.

This image of an un-unified front in the chiropractic industry is the largest hurdle today’s chiropractors are facing, says Dr. Scott Haldeman. Who’s a neurologist and chiropractor teaching at both UCLA and UC Irvine. “You could walk into a chiropractor’s office and find someone who is a pure back-and-neck-pain guy—a guy who has embraced the scientific research—or someone who says he can cure all things and provide general wellness,” Haldeman explains.

“Like any other type of doctor, some chiropractors are good, some are just OK and some are bad,” says Dr. Simon Dagenais, a chiropractor and clinical epidemiologist. Commonly stated, “It takes just a few rotten apples to spoil the bunch.”

Another difficult to navigate issue that presents itself to chiropractors of all sorts is the public ideology that spinal manipulation can result in injury or, more severely, stroke or torn arteries.

“The stroke question is basically resolved,” Haldeman says, when citing research that shows the risk of suffering a stroke following a chiropractic visit is extremely low, on par with the risk associated with visiting a physician. “Neck pain can be a sign of a stroke in process,” he says, “so people may go see a doctor or chiropractor about that pain and then associate the subsequent stroke with their visit.” When it comes to said artery tears, Haldeman’s personal research showed only 23 of those cases among more than 134 million chiropractic manipulations.

A more open ended discussion is whether or not more acute injuries can appear from a chiropractic visit. During a study of neck pain patients, they found 30% had some kind of “adverse” side effects following chiropractic treatment. “In most cases, that adverse event was increased pain or stiffness, and it resolved itself quickly,” says Dr. Eric Hurwitz, first author of the study and graduate chair of epidemiology at the University of Hawaii.

Hurwitz states that more severe reactions were “very rare,” and most patients didn’t experience any severe effects at all. “But we can’t predict who will or won’t experience an adverse event,” he adds.

“There’s some risk involved,” Haldeman agrees. “But there’s also risk from surgery or from taking medications.” Compared to dangerous opioids—a type of prescription painkillers regularly prescribed for back and neck pain, and one also linked to dependence and death due to overdose—that compared to potential aches and pain from being sore seems minuscule, he adds.

Schneider states his agreement and brings attention to the fact that malpractice and liability insurance premiums for chiropractors are much less hefty than for physicians or surgeons. “Insurance actuaries aren’t dumb,” he says. “They know that based on the malpractice data, chiropractic is very safe.”

Maybe the largest unsolved conspiracy about chiropractic treatment is how spinal manipulation actually reduces back or neck pain. “Increased mobility of the spinal vertebrae and muscle relaxation probably has a lot to do with it,” Haldeman says. “But the actual fact is that the concept is not well understood, just as back and neck pain are not well understood.”5 Moves to Prevent Back PainShare

A study was recently published in The Lancet which found low back pain was the most known cause of disability around the world. Despite its known presence, back pain—like many other forms of pain—is difficult to explain. “We know some things that cause it, but not exactly where it comes from or why it persists,” Haldeman says. Perceived from this point of view, he says, it’s not odd that he and other researchers who have studied chiropractic can’t pinpoint why their treatment is effective. What’s most important is that for many patients, it does work, he says.

“Chiropractors tend to have very high patient satisfaction rates,” Schneider says. “And from a public health perspective, we’d see a lot fewer unnecessary tests and hospitalizations and opioid prescriptions if people visited chiropractors for their back and neck pain.”