Chiropractors claim to hold the cure for an extraordinary range of health problems.
Through the hands-on manipulation of the spine and surrounding bones, muscles and soft tissue, practitioners promise patients a way to treat back, shoulder and neck pain.
Some go further, touting it as a treatment for everything from asthma and allergies to infant colic.
There are more than 3,800 chiropractors registered in the UK and 15 per cent of American adults visit one every year.
But while chiropractic treatment boasts an army of ardent supporters, a string of high-profile cases have highlighted the potentially serious – and even life-threatening – risks.
Among the most vocal critics is Professor Edzard Ernst, emeritus professor of complementary medicine at the Peninsula Medical School, University of Exeter, and author of Chiropractic: Not All It’s Cracked Up To Be.
‘My advice would be to avoid chiropractors,’ he said, explaining that the ‘risks outweigh the benefits’.
Broken bones, stroke, and even death are some of the rare but devastating consequences that can result from chiropractic, which is classed as a ‘complementary and alternative medicine’ by the NHS.
Some experts advise: ‘Avoid chiropractors…the risks outweigh the benefits’
Even successful treatments are not without their side-effects. UK-based industry body The Royal College of Chiropractors estimates that up to 50 per cent of patients experience ‘mild or moderate adverse effects after manual therapy, such as soreness or stiffness’.
The treatment recently made headlines after a coroner returned a verdict in the death of Joanna Kowalczyk, 29, who suffered a fatal tear of her blood vessels after having her neck ‘adjusted’ by a chiropractor.
Ms Kowalczyk, of Gateshead, Tyne and Wear, sought out the alternative treatment after injuring herself during a PT session. She had initially attended A&E but later discharged herself from hospital.
Coroner Leila Benyounes raised concerns that chiropractors are not required to request medical records before assessing a patient and called on the General Chiropractic Council, the UK’s independent statutory body, to introduce new rules.
Ms Kowalczyk’s medical history showed she regularly suffered migraines and joint hypermobility issues, the inquest heard.
The mother-of-one also had an undiagnosed connective tissue disorder which made her susceptible to arterial dissections, one of the most serious chiropractic injuries, in which the blood vessels that supply blood from the heart to the brain are torn.
It is thought Ms Kowalczyk suffered an arterial dissection when she injured her neck in the gym and that she suffered acute dissections to the same location when the chiropractor manipulated her neck. She later died in hospital.
In response to the coroner’s comments, the General Chiropractic Council said in a statement that it expects ‘chiropractors to provide good quality care that is patient-centred, safe and effective’ and that it will give careful consideration to the ‘important concerns raised by the coroner in her report’.
Polish-born mother-of-one Joanna Kowalczyk, who lived in Gateshead, Tyne and Wear, suffered a fatal tear of her blood vessels after having her neck ‘adjusted’ by a chiropractor.
The death of Ms Kowalczyk is tragic but not unprecedented.
In 2016 American Playboy model Katie May died after experiencing a stroke caused by an artery that ruptured during a neck manipulation by a chiropractor.
In 2022, American graduate student Caitlin Jensen suffered a stroke and cardiac arrest when four blood vessels were torn during a chiropractic appointment. The right side of her body was paralysed.
There are also risks to the mechanics of the body: in 2017 John Lawler, 80, of York, died after his neck was broken and he suffered ‘irreversible’ spinal damage which left him a quadriplegic.
Despite these well-documented case studies, the risks posed by chiropractic are difficult to quantify.
Professor Ernst said the lack of formal reporting procedures means it’s impossible to quantify exactly how many injuries there are.
‘As there is no post-marketing surveillance, like in conventional medicine, nobody knows how frequent serious complications after chiropractic treatments truly are,’ he explained. ‘Chiropractors, of course, claim they are extreme rarities, but I very much doubt it.’
According to one estimate, an arterial dissection occurs in one out of 1,000 neck manipulations.
Ms Kowalczyk died on October 19, 2021 at Gateshead’s Queen Elizabeth Hospital (pictured)
Another authored by chiropractors puts the figure at one in 5.8 million. The Royal College of Chiropractors notes that ‘cases of serious adverse events, including spinal or neurological problems and strokes caused by damage to arteries in the neck’ are ‘rare’ with estimates ranging from ‘one in 2 million manipulations to 13 per 10,000 patients’.
The NHS describes chiropractic as ‘generally safe when performed correctly by a trained and registered chiropractor’.
An arterial dissection, like the one suffered by Ms Kowalczyk, is among the most serious injuries a patient can sustain. A dissection can occur during manipulation of the neck, which is more susceptible to injury than the lower spine.
‘The neck contains the arteries that supply the brain,’ explained Professor Ernst, who specialises in subjecting alternative medicines to thorough scientific scrutiny.
‘Since the neck is so very movable in all directions, chiropractic manipulations can over-stretch an artery; this can then cause a blood clot to develop, and if the clot shoots along the bloodstream into the brain, we have a stroke.’
Symptoms of an arterial dissection include headaches, dizziness and vertigo. In the least severe cases, a patient might be unaware that any damage has occurred and will heal without medical intervention.
Caitlin Jensen, 28, could only communicate with her eyes and portions of the left side of her body as she languished in a hospital bed after suffering a stroke and cardiac arrest as a result of a chiropractic appointment.
The 28-year-old, who read chemistry and biology at college, is said to have visited the unnamed practice for a neck adjustment
Jensen was rushed to hospital in Savannah, Georgia, where it was revealed four arteries in her neck had been dissected during the appointment.
However, they can also lead to a stroke or even death.The potential for life-threatening damage means some chiropractors refuse to perform significant manipulations of the neck.
In online material, The Royal College of Chiropractors notes the profession is most closely associated with the treatment of ‘low back pain’.
Many chiropractors also dispute the claim that their treatments can cause such significant harm.
The Royal College of Chiropractors, which was incorporated in 2012 to ‘to promote quality, safety and professionalism’, points to research that suggests the ‘risk of stroke has been found to be similar after seeing a primary care physician’.
The NHS recommends patients should notify their GP before booking an appointment with a chiropractor. Treatment is rarely available on the NHS.
Professor Ernst urged patients to consider seeking alternative treatment options.
‘The benefits of neck manipulations are either minor or even non-existent, while risks are clearly real,’ he said. ‘It follows unquestionably that the risks outweigh the benefits.’
