There has long been tension between medical doctors and chiropractors. Many medical doctors view chiropractors as pseudoscientific and believe chiropractic treatments lack evidence to support their use. There are several reasons why medical doctors tend to look down on chiropractors.
Differing Views on Health and Medicine
Medical doctors and chiropractors have fundamentally different philosophies regarding health and medicine. Medical doctors practice allopathic medicine, which focuses on treating disease and injury using drugs, surgery, radiation and other conventional medical treatments. The goal of allopathic medicine is to address or suppress symptoms.
In contrast, chiropractors practice a form of alternative medicine and focus on the body’s innate ability to heal itself. Chiropractic theory posits that proper alignment of the spine and other joints facilitates healing. The goal of chiropractic is to address the root cause of pain and illness, rather than merely treat the symptoms.
Medical Doctors View the Body Differently
Medical doctors are trained to view the body and its functions through the lens of biology, anatomy and physiology. They view the body as a machine and use a structural approach to understand what is wrong and how to fix it.
Chiropractors view the body in a more holistic way. They focus on the body’s innate intelligence and view the spine as central to health and proper body functioning. Chiropractors use spinal manipulations to remove interference to the nervous system.
This differing philosophical approach of chiropractors is viewed as unscientific by many traditionally-trained doctors.
Different Education and Training
Medical doctors undergo rigorous academic and clinical training to obtain their medical degrees and become licensed physicians. This includes:
- Completing a 4-year undergraduate degree with extensive science prerequisites
- Four years of medical school and graduation with a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree
- Three to seven years of hands-on residency training in a medical specialty
- Passing national and state licensing exams
The education to become a chiropractor does include science-based coursework, but not to the depth required for a medical degree. Chiropractors attend 4 years of chiropractic college and receive a Doctor of Chiropractic (DC) degree. Their education emphasizes manual therapy techniques and spinal manipulation.
Many medical doctors feel the training and clinical experience required to become a chiropractor lacks appropriate rigor compared to medical training.
Scope of Practice Concerns
Medical doctors have more extensive clinical training and a broader legally defined scope of practice than chiropractors. Medical doctors can prescribe medication, perform surgery, order labs and diagnostic imaging, and treat a wide range of medical conditions.
Chiropractors focus mainly on conservative manual treatments to address neuromusculoskeletal issues. They cannot prescribe drugs or perform surgery. The primary technique used by chiropractors is spinal manipulation therapy.
Some medical doctors argue that chiropractors overreach in attempting to treat conditions beyond their training and scope of practice. There are concerns that some chiropractic treatments for issues like asthma, digestive problems, ear infections, and autism in children may not be appropriate or sufficiently evidence-based.
Concerns About Safety and Effectiveness of Chiropractic
Many conventionally trained physicians express concerns about the safety and efficacy of some chiropractic practices. Some specific concerns include:
Risk of Artery Damage from Neck Manipulation
There is an association between chiropractic neck manipulation and vertebral artery dissection, which can cause a stroke. Patients over age 55 face the highest risk.
A 2018 systematic review found studies reporting the incidence of vertebral artery dissection following cervical spinal manipulation ranged from 1 in 20,000 to 1 in several million cervical spinal manipulations. However, the review noted the quality of reports was low.
Radiation from X-rays
Chiropractors often use x-rays to evaluate patients’ spine health during initial evaluations. This exposes patients to ionizing radiation. Medical doctors argue the overuse of spine x-rays by some chiropractors is unnecessary and potentially risky.
Risk of Herniated Disc or Cauda Equina Syndrome
There are rare reports of chiropractic treatments causing a herniated disc in the spine or cauda equina syndrome from excessive spinal manipulation. This can cause severe back pain and neurological problems from nerve damage.
Lack of High-Quality Clinical Evidence
Medical doctors argue there is a lack of well-designed clinical trials demonstrating the effectiveness of chiropractic manipulation for many conditions it is used to treat. Some physicians believe claims about the benefits of chiropractic are exaggerated beyond what current research can substantiate.
Examples of Conditions Chiropractors Treat and Medical Concerns
Below are some examples of conditions chiropractors commonly treat and medical concerns about the appropriateness of those treatments:
| Condition | Typical Chiropractic Treatments Used | Medical Concerns |
|---|---|---|
| Lower back pain | Spinal manipulation therapy, massage, heat/ice therapy | Limited high-quality evidence for chronic back pain beyond short-term relief |
| Headaches and migraines | Spinal manipulation therapy, trigger point therapy | Lack of evidence manipulations can prevent migraines |
| Asthma | Thoracic spine manipulation | No scientifically plausible mechanism for effectiveness |
| Ear infections (otitis media) | Spinal manipulation, craniosacral therapy | No evidence manipulation can replace antibiotics |
| Colic | Gentle spinal and abdomen touch pressure | Insufficient evidence it is more beneficial than placebo |
Professional Rivalry and Scope of Practice Disputes
There is also a degree of professional rivalry and economic concern that factors into some medical doctors’ skepticism of chiropractic. Some specific issues include:
Overlapping Services
There is an overlap between some services provided by chiropractors and medical doctors, such as treatment for back pain, joint injuries, and headaches. Some doctors see chiropractors as excess competition.
Increased Costs
Doctors express concerns about excessive health care costs from patients seeking both medical and chiropractic care for the same issues. Most insurers cover at least part of chiropractic treatments.
Expanded Scope
The growing popularity of chiropractic care has led some chiropractors to expand the scope conditions they treat. Some medical doctors view this as inappropriate overreach given chiropractors’ training.
Loss of Referrals
Patients who seek chiropractic treatment directly rather than consulting a medical doctor first represent lost referrals and revenue for doctors. If their condition worsens, it can lead to additional work and liability for the medical profession.
Lack of Integration and Communication
Poor integration and communication between chiropractors and medical doctors also contributes to tensions between the professions. Key issues include:
Limited Cross-Training
There are few educational programs aimed at helping chiropractors and medical doctors better understand each other’s field. This perpetuates misconceptions and mistrust on both sides.
Few Shared Guidelines
There is a lack of clinical practice guidelines designed for an integrated approach including both medical and chiropractic professionals. This makes coordinated care difficult.
Territorialism and Rivalry
Some degree of territorialism exists, with both professions sometimes unwilling to refer patients to the other. This limits communication and overall care coordination for patients.
Poor Communication
Lack of communication between doctors and chiropractors about shared patients means lost opportunities to improve continuity of care. Neither gets a full picture of treatments the patient is receiving.
Negative Biases
Preconceived biases of some doctors against chiropractic may inhibit objective evaluation of its appropriate role in patient care. Dismissing it completely could deprive patients of potentially helpful conservative physical treatment options.
Solutions and Improved Integration
While tensions still remain between chiropractors and medical doctors, there are efforts underway to improve integration and understanding between the professions:
Increased Research
More research is helping establish the risks, benefits and appropriate use of chiropractic for different conditions. This provides an objective framework for evaluating chiropractic treatments.
Standards and Guidelines
Development of practice guidelines and standards for chiropractic care and integration with medical care can facilitate coordinated, evidence-based use.
Team-Based Care
Doctors and chiropractors working together in integrated, multidisciplinary care teams can improve patient outcomes. This allows them to leverage their respective expertise.
Cross-Training
Increased cross-training and exposure to each other’s fields during training would build greater understanding between doctors and chiropractors.
Pre-Authorization and Communication
Requiring pre-authorization and better communication for chiropractic care paid by insurance can reduce unnecessary treatments and improve coordination with medical care.
Greater Acceptance
As evidence grows for some chiropractic techniques, medical doctors are increasingly accepting their appropriate complementary role, especially for musculoskeletal and back pain issues.
Conclusion
Tensions between medical doctors and chiropractors have existed for decades, rooted in philosophical differences about health and medicine as well as concerns about education, evidence, and professional rivalry. While integration remains a work in progress, continued efforts towards greater research, communication, and team-based care models can improve understanding and patient care.
An open-minded view recognizing the benefits and limitations of both approaches may allow more effective coordination. This could expand treatment options and provide safer, more holistic integrative care tailored to each patient’s needs.