Tragedy sparks question: How safe is it to see a chiropractor?

Experts have their say on whether this alternative therapy is safe or even useful – and on how to deal with back and neck pain.

The spine and upper vertebrae of the neck are delicate structures, and the use of some chiropractic techniques has raised concerns. Picture: Getty Images

Visiting a chiropractor is often on the list of treatments for those of us with back pain, neck pain and muscle-tension headaches. But just how safe is this alternative treatment?

For many, the manipulations to the spine and cracking of the neck that are characteristic of an appointment provide welcome pain relief. But the spine and upper vertebrae of the neck are delicate structures, and the use of some chiropractic techniques has raised concerns that they can cause harm.

Last week an inquest heard how Joanna Kowalczyk, a 29-year-old from Gateshead, Tyne and Wear, died weeks after visiting a chiropractor to treat a neck injury she had incurred during a personal training session at a gym in 2021.

The inquest heard that she suffered acute arterial dissections in the same location when a chiropractor cracked her neck as part of her treatment.

It’s likely an undiagnosed connective tissue disorder had made Kowalczyk susceptible to life-threatening arterial dissections. The coroner said she “died due to a combination of the consequences of chiropractic treatment following a naturally occurring medical event, on a background of an undiagnosed medical condition”.

Joanna Kowalczyk declined a procedure at hospital for her injury and chose instead to try chiropractic therapy after researching alternative treatments. Picture: Alamy

It is not the first time that chiropractic treatments have been linked with fatal outcomes. In 2019 John Lawler became paralysed during an appointment with a local chiropractor. Lawler, 80, who died in hospital soon afterwards, suffered a broken neck during the treatment.

After Kowalczyk’s inquest, the coroner said the General Chiropractic Council (GCC) should introduce rules to encourage chiropractors to seek a patient’s medical history before treatment. Rob Finch, CEO of the Royal College of Chiropractors (RCC), responded that patient care is paramount.

“We will be working ... to help ensure lessons are learnt from this tragic incident.” Jack Chew, a physiotherapist who specialises in pain and injury rehabilitation and hosts the PhysioMatters podcast, says: “There are plenty of good chiropractors out there, but check credentials and ask questions before opting for treatment.” Here’s what you need to know.

What exactly is chiropractic?

Chiropractic is a healthcare approach that focuses primarily on the function of the spine and musculoskeletal system and the impacts these have on other health issues. According to the NHS, it falls into the category of complementary and alternative medicine, “which means it is not a conventional medical treatment”.

The NHS says it may be helpful for muscle and joint pain, but “there’s little evidence it can help with more serious conditions or problems not affecting muscles and joints such as asthma, allergies and mental health problems”. Chiropractic treatment is generally not available on the NHS: privately sessions cost £30-£100 ($60-$200).

Major arteries supplying blood to the heart and brain run through the neck.

Risks of neck manipulation

The NHS says that “chiropractic is generally safe if performed by a trained and registered chiropractor”. But it also says it is not without risks. It is chiropractic neck manipulations which present the greatest risk. “The neck is highly mobile and not well supported, making it the most vulnerable region of the spine to injury,” Chew says.

Major arteries supplying blood to the heart and brain run through the neck and, as in the recent coroner’s case, chiropractic manipulation of the neck has been shown to cause “vertebral artery dissection”, a tearing of the vertebral artery leading to the brain that causes stroke and symptoms including dizziness, migraines and numbness.

How do you find a qualified practitioner?

There are 3,432 registered chiropractors in the UK. Chiropractic students typically study for four years to gain an MChiro, MSci or MSc degree. It is a regulated profession and, once qualified, all chiropractors practising in the UK must be registered with the GCC and adhere to its strict codes of practice. You can check if a chiropractor is registered on the GCC’s website. In Australia, chiropractors must be registered with the Australian Health Practitioner Registration Agency.

What should you expect from a session?

Any reputable manipulative therapist, including a chiropractor, should first assess your symptoms and your medical history to determine if the treatment is suitable. Some chiropractors may use x-rays to help them to make a diagnosis.

Treatment is generally painless although you may hear a clicking or popping noise during the manipulation, which is a result of changes of pressure within a joint space as surfaces of the joint are moved rapidly. The “pop” is a bubble of gas bursting and the GCC says it “is perfectly normal and commonplace with chiropractic treatment”.

Is there any evidence that it works?

A growing number of people are turning to chiropractors to manage everything from digestive issues and asthma, but the NHS says there is little evidence for this. “A very popular but misinformed theory is that malalignment of the spine is linked to many health problems and that by correcting it, you alleviate these issues,” Chew says, “but this has not been justified scientifically.”

What should you do about back and neck pain?

The National Institute for Health and Care Excellence does recommend manual therapies as a treatment option for back pain – including spinal manipulation practised by chiropractors, osteopaths and some physiotherapists – but alongside exercise.

Physiotherapists, who are usually the first port of call for GPs referring patients for back pain, will always recommend exercise when appropriate.

“Most hands-on treatments are unlikely to have much effect on pain in isolation,” Chew says. “They can act as a sort of short-term mechanical paracetamol, but physical activity needs to be included for long-term effects.”

The Times