“Chiropractors are my kind of people.”
Not certain who was more insulted, although it appears both sides considered it a compliment. He went on to say,
The people who are drawn to this field are people who do critical thinking, who are willing to question orthodoxies and have the courage to stand up against these orthodoxies.
Well, critical thinking and chiropractic go together the proverbial water and oil. It appears from this article that RFK Jr.’s ascent has been a huge opportunity for the cult of chiropractic.
It makes me miss the old days of SBM, when SCAMs were the fringe, not the establishment.
But I thought it would be fun. Yes, fun. I actually enjoy this sort of thing: review the medical literature from the last year, the first RFK Jr. year, and see what these courageous critical thinking orthodoxy questioners have come up with in their pursuit of making America healthy again. Here’s a hint: ain’t vaccines.
A couple of things. First, I am going to focus on clinical trials and some reviews, as there are 441 plus hits in the last year for references on the Pubmeds using ‘chiropractic’. So I will choose articles that I find relevant or amusing.
Second, in interpreting the articles, keep in mind that being hands on, chiropractic has both the potential for both a massive placebo effect and a real physical effect. And when I say chiropractic, he says in his best Humpty Dumpty voice, I am specifically mean fixing mythical subluxations to improve the flow of the equally mythical inane, er I mean innate intelligence. Neither more nor less.
Third. chiropractic practice is variable, from the reasonable and thoughtful Sam Homola to subluxation adjusting wackaloons. So one often never knows from the literature where a chiropractor lands on the spectrum.
Fourth, I would suppose that the medical literature tilts towards the more reasonable end of the spectrum. For example, there are no papers on chiropractic and vaccines, despite the cult’s usual opposition to vaccines. It is likely the more respectable factions of the cult that will likely be represented in the Pubmeds. But not always.
Time to take a trip down old school SBM.
Reviews
As of April 2026, the song remains the same. For issues a spine surgeon might see
Variability in practice standards, inconsistent informed consent, and poor adverse event reporting limit clarity on Chiropractic lacks an outcomes registry true effectiveness and safety.
Which, given the basics of chiropractic, is how it will always be. Which is why they really need to stop repeating versions of
More robust clinical trials in this area of healthcare are needed.
trials evaluating the efficacy and safety of MM such as osteopathic manipulation, chiropractic manipulation, myofascial release, craniosacral therapy, as monotherapy or adjunctive therapies in older people (age ≥65 years) with musculoskeletal disorders.
You know the authors are not particularly interested in reality, as there are few SCAMs as wackallon as craniosacral therapy. And they didn’t find much:
This review provides limited and inconclusive evidence about MM to improve quality of life, pain management and functional status in older adults with musculoskeletal disorders. However, MM appears to be generally safe and well-tolerated.
Limited meaning most of the time for most issues, no effect.
Exploring Manual Interventions for Infantile Colic: A Scoping Review of the Evidence suggested that
Low-force manual therapies may offer modest short-term relief for colicky infants and improve parental experience
And what were these therapies?
abdominal massage, paediatric Tuina, craniosacral therapy, chiropractic manipulation, osteopathic light touch, reflexology, and acupressure
Really? All different in their treatment and underlying pseudoscience. Suggests colic just gets better with time:
self-limiting nature of the illness as most of the babies grow out of it by the age of 3 to 4 months.
Back in 2024 a systematic review and meta-analysis of randomized clinical trials of SMT for migraines showed no benefit and only harms, demonstrating
The effectiveness of SMT for the treatment of migraines remains unproven.
Now there are over 500 hits on PubMed on how evidence needs to guide chiropractic practice. At least until the evidence is against chiropractic. In Critical limitations compromise the conclusions of a recent meta-analysis regarding spinal manipulation and migraine: a commentary, the authors concluded
Given these concerns, patients, clinicians, and stakeholders should be cautious when interpreting the study and determining whether SMT is effective or safe for migraines.
Although, for virtually any illness, there is no reason to think SMT would help, so I would expect the river in Egypt to get wider as the evidence flows in.
Clinical Trials
Chiropractic lacks an outcomes registry, making it difficult to evaluate the efficacy of chiropractic. There was one, Spine IQ, that failed, Hm. Probably don’t want to really know outcomes. Handling of truth and all that.
Chiropractic has tried to get on the treatment alternative to opioid bandwagon. Is it effective? Hard to be definitive since interventions are never just chiropractic (see definition above). For example, in Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis, chiropractic care was
receipt of chiropractic care, defined as care provided by a chiropractor, including, but not limited to, spinal manipulation, soft-tissue therapy, education, reassurance, and self-care advice (eg, icing, stretching, and strengthening exercises).
Making it impossible to know if their raison d’etre, spinal manipulation to fix subluxations, does anything. They unimpressively concluded
Our systematic review found very low certainty evidence that receipt of chiropractic care may be associated with lower odds of receiving prescription opioids or initiating long-term opioid use among adults with noncancer spine pain, particularly when chiropractic care is provided earlier vs later. Low certainty evidence shows that receipt of chiropractic care may increase the risk of nonserious adverse events, such as transient stiffness or muscle soreness; however, very low certainty evidence suggests the likelihood of serious opioid-related harms may be reduced.
recommendation to use of spinal manipulation for CGH, and for TTH only within multimodal care.
Within multimodal care. Huh. So by itself, chiropractic does nothing? And the multimodal?
Certainty of evidence and strength of recommendations for other nonpharmacological interventions (e.g., acupuncture and exercise) varied. Limitations in evidence precluded strong recommendations for acupuncture, education, meditation/mindfulness, and modalities used in isolation for CGH and electroacupuncture for TTH.
So when chiropractors treat headaches, only use their useless intervention when combined with other equally useless interventions. So much lipstick on a pig.
Remember how chiropractors want to be primary care providers? Taking care of common medical problems like otitis media? There is Misinformation in YouTube Videos About Chiropractic Treatment for Otitis Media to suggest not such a good idea:
Twenty-five videos claimed that chiropractic manipulation could “fix” the Eustachian tube, and 14 videos (28%) asserted nerve correction; none mentioned antibiotics or tympanostomy tubes. Upper‑cervical adjustments (32 videos, 64%) and ear‑massage maneuvers (25 videos, 50%) were the most frequently promoted techniques, despite limited or low‑quality supporting evidence in published literature.
Some studies just leave me unsatisfied. For example, Diagnostic and management concordance between chiropractors and neurosurgeons for patients with low back pain. They made the ever so humorous contention that “chiropractors, known as musculoskeletal experts”, forgetting that the descriptor is self-styled. The omission was whether or not the chiropractors included any of their pseudoscience, like subluxations and leg length discrepancy in the diagnosis. Not mentioned anywhere I could find.
Safety
Safety is important, so it was nice to see Patient safety culture research within the chiropractic profession: a scoping review. The big safety issue we have discussed at SBM is the relationship between neck manipulation and stroke, which chiropractors love to deny, going so far as to suggest a paper that shows an association demonstrates it doesn’t. Ah, that famous chiropractic critical thinking. Instead, they have focused on the rare patient presenting to chiropractors with stroke symptoms. Chiropractors like to brag they have the diagostic acumen of interns.
But the investigations continue.
About 1 in 20 CeAD cases in this registry reported antecedent cervical manipulation. In multivariable binary logistic regression, compared with patients without prior manipulation, those with prior manipulation were younger (OR per year 0.98, 95% CI: 0.97-0.99, P =0.014), more often female (OR: 1.64, 95% CI: 1.21-2.23, P =0.001), less often diabetic (OR: 0.24, 95% CI: 0.08-0.78, P =0.018), presented with neck pain (OR: 2.80, 95% CI: 2.08-3.77, P <0.001), and had higher odds of isolated vertebral artery dissection (OR: 2.15, 95% CI: 1.57-2.94, P <0.001). Recurrent ischemic stroke rates were similar between groups.
Conclusions: Given the very high number of manipulations performed annually, the absolute risk of secondary CeAD is extremely low. Manipulation-associated cases have distinct clinical features, occurring more often in younger women with vertebral dissections. Whether manipulation acts as a precipitating trigger or patients with early CeAD symptoms seek manipulation remains unresolved.
And there was A retrospective search of postmortem examination reports that indicated that death following chiropractic neck manipulation in Australia appears to be a rare event. They found two cases:
This revealed only one case in which chiropractic treatment was considered to have contributed to death. The case was that of an adult male who died from a dissected left vertebral artery following chiropractic manipulation for neck pain. In addition, postmortem records at Forensic Science SA (FSSA) were searched for similar cases over the same time period (approximately 30,000 cases). No cases definitely attributable to chiropractic manipulation of the neck were found, but a case with thrombus in the left vertebral artery would not be entirely excluded as being related to chiropractic treatment. Deaths associated with chiropractic manipulation in Australia therefore appear rare.
I agree it is rare. But death from a useless therapy unhinged from reality seems like a poor way to go.
The results confirmed findings of past reviews with most events being vascular (58%) and mainly arterial dissection or vertebral artery related and the majority involving manipulation (75%). However lesser-known SAES ie neurological (25%), combined vascular/neurological (12%) and others (5%) which included cases such as cerebrospinal fluid leaks, phrenic nerve palsies and retinal detachments were identified. Further, some followed procedures such as vestibular testing, gentle mobilization, exercises, acupuncture or even massage.
Which is interesting, Years ago we had a case where the vertebral artery dissection occurred from hyper-extension of the neck during yoga. I forget the underlying collagen issues she had.
Me? I would never let a chiropractor near my neck.
Case Reports
Pediatric vertebral artery dissection and ischemic stroke following chiropractic manipulation
The patient encountered in our institution was a 20-month-old male who presented nonspecifically with acute onset of lethargy, vomiting, cyanosis, and respiratory distress. Cerebrovascular imaging revealed a luminal irregularity in the V4 segment of the right vertebral artery, consistent with dissection. The patient’s guardian later provided history of taking the child for cervical chiropractic corrections immediately prior to the patient’s presentation to the emergency department. The patient was managed non operatively and was later discharged without neurological deficit.
Doubt it was the manipulation. More likely the underlying morbidities like smoking and hypertension. Yeah, that’s the ticket.
Acute Spinal Epidural Hematoma: A Serious Complication of Chiropractic Therapy-A Case Report
This case report presents a 48-year-old female patient with a medical history of systemic lupus erythematosus, renal transplantation, and hypertension who developed spinal epidural hematoma after chiropractic manipulation, leading to acute quadriplegia
Nuff said on that one.
We report the case of a 20-year-old male who was admitted with altered consciousness and nonspecific neurological symptoms. Magnetic resonance imaging (MRI) demonstrated a characteristic bilateral thalamic infarction consistent with AOP occlusion. Etiological workup revealed hyperhomocysteinemia and a right vertebral artery dissection, the latter suspected to be secondary to chiropractic cervical manipulation. Despite medical treatment and rehabilitation, the patient experienced significant cognitive and motor sequelae.
After chiropractic manipulation, the patient developed severe lumbar and inguinal pain, followed by progressive weakness and sensory impairment of the left lower limb. Imaging revealed a large left iliopsoas hematoma measuring approximately 896 cc, causing femoral nerve compression.
A history of trauma or chiropractic manipulations, intense physical exercise prior to symptom onset, recent influenza-like illness, and recent childbirth in a young female patient were reported as predisposing risk factors.
We present the case of a 70-year-old female who developed acute expressive aphasia following chiropractic neck manipulation. Imaging revealed a proximal right vertebral artery occlusion with findings suggestive of dissection in the setting of vascular hypoplasia.
See a pattern? So many in the world of SCAM are not fond of the precautionary principle.
My practice dealt with a lot of unusual infections. I was always impressed with all the odd ways people could get sick. Add this one to the list: Delayed Cardiac Perforation Caused by Pacemaker Lead Dislodgement During Chiropractic Therapy
Lead dislodgement was suspected to be caused by prior chiropractic therapy for shoulder rehabilitation.
Chiropractors do love their case reports to show alleged efficacy of their interventions. Well, not always.
We describe the multimodal management of a PSPS-2 patient with a CIS implant presenting to a chiropractic clinic. While no clinically meaningful improvement was observed.
Chiropractic management of L5-S1 disc protrusion in an elite speed skater: a case report would appear to be a success. The management was the usual multimodal; a hodgepodge of interventions, although nothing specifically chiropractic. Case reports being unimpressive, especially given the natural history of disc herniation:
The majority of patients suffering from a radiculopathy caused by a herniated nucleus pulposus (HNP) heal spontaneously without surgery or chemonucleolysis. The clinical course of the radiculopathy varies as well as the efficacy of conservative treatment. In some patients the symptoms decline after a week or two; in others the pain may continue for many months or years. Despite an abundant literature there is still a controversy concerning the treatment of radiculopathies related to ruptured lumbar intervertebral discs.
It’s the title that made me snort: Improvement in Chronic Low Back and Intermittent Chronic Neck Pain, Disability, and Improved Spine Parameters Using Chiropractic BioPhysics® Rehabilitation After 5 Years of Failed Chiropractic Manipulation: A Case Report and 1-Year Follow-Up. He kept seeing the chiropractor on and off for 5 years of failure. That is a whole different kind of manipulation. As is so often the case, when a hodgepodge of exercises was added to therapy, he got better.
Oddities
A review of Chiropractic conspiracy theories and how they are foundational to the cult. I particularly like the
chiropractic’s steadfast commitment to the margins of standardised medical care.
Easy to see why RFK Jr. considers chiropractors his kind of people.
Sometimes the papers make me laugh. An example is Chiropractic evaluation in newborn foals: A preliminary study where they did chiropractic assessments and tried to find a relationship between foal disease and their imaginary findings. And they couldn’t!
A relationship between joint hypomobility and sickness was found, but the reasons cannot be determined
I wonder why.
Some papers flabbered my gaster. There is a grade school on Wisconsin that has an onsite chiropractic clinic where they hunt down subluxations to treat:
headaches, postural issues, nocturnal enuresis, neurodevelopmental disorders, and back pain.
This paper is amazing, but not in a good way.
Sometimes you run across a paper where you have to giggle, as the author has it right for all the wrong reasons. Case in point was The bi-directional adjustment? where the author did not use the quotes as I would have:
I was pleased to eventually be given a title of “doctor” indicating my “expertise” and “authority”.
I always think of those terms in scare quotes. Glad to see I am not the only one.
Prevalence of imposter phenomenon among chiropractic students at a South African university: A cross-sectional survey I was surprised it was not 100%. Perhaps more self-reflection?
This showed up in my search, although none of the authors are chiropractors: Effectiveness of epidural amniotic fluid injection for low back pain. Just mull that over.
I’ll end with In Defense of Metaphysics: A Kantian Approach to the Philosophy of Chiropractic, which I found to be gibberish. But I long realized what I lack whatever part of the brain is required for metaphysics or spirituality. Perhaps someone can explain this paper to me in the comments.
Ah. That felt good.