Answers to Questions about Chiropractic:
What are the Warning Signs of a Bad Chiropractor?

Samuel Homola, D.C.

Question

I have been visiting a chiropractor in Tennessee. I did not know that it was a warning sign, until reading about it on the Internet and in your article at Chirobase.org, but after two visits to this chiropractor, I have noticed that he has posters all around his clinic that support the theory of "maintenance adjustments" even after a patient feels good. In addition, he also has posters with information stating that "subluxations" should be corrected. However, this is not what alarmed me most. On the first visit, he took two x-rays of my lower back; one was a frontal view, the other a left side view, as I have been having pain in my left hip.

After looking at the x-rays, he did not tell me what was causing my ailment, but proceeded to do an adjustment to my lower back area. After questioning him as to what he saw on the x-rays, he told me that he would need to study the x-rays and for me to come back the next day for a diagnosis. When I went back the next day, he said he didn't have time to show me the x-rays or go over them with me, but proceeded to tell me that it was one of three things: a ruptured disc, some kind of muscle problem in my left buttocks, or some other joint that I could not pronounce again (or spell). Then he gave another adjustment and said I should come back again the next day.

What I don't understand is why he couldn't tell from the x-ray whether or not I had a ruptured disc. Wouldn't that kind of injury be obvious? And how is it that he was able to give me adjustments when he didn't even know for sure what he was treating?

The adjustments haven't helped. The pain is now beginning to spread further from my left hip over to the middle of my lower back.

Any insight you have as to whether or not this chiropractor is a "quack" would be greatly appreciated. If he is not a legitimate chiropractor, I would like to stop seeing him now before it is too late and he does irreparable damage to me.

Answer

There is no scientific rationale for adjusting the spine regularly to correct "subluxations" or for ongoing "maintenance therapy" when there are no symptoms. When a chiropractor uses such an approach, there is reason to be concerned about the validity of any advice he or she might offer.

Failure of a chiropractor to provide you with a diagnosis and refusing to discuss the x-rays with you, while insisting on giving you daily chiropractic adjustments, is inappropriate protocol and stems from an irrational focus on finding and correcting "subluxations." You are correct in interpreting this as a warning sign.

A ruptured disc is not visible on an x-ray film. It's not likely that you have a herniated disc if you do not have radiation of pain and other symptoms down one of your legs. If such symptoms should develop, a CT or MRI scan would be needed to locate and confirm disc herniation. Drastic thinning of a lumbar disc without degenerative changes, seen on a plain x-ray, might be an indication of disc herniation causing back pain, but if the disc protrusion is not pressing against a spinal nerve to cause leg pain, surgery is not an option. In either case, disc herniation cannot be corrected with spinal manipulation.

If you are having back pain for the first time as a result of a muscle or joint problem, the symptoms will usually resolve with time. Appropriate manipulation might provide symptomatic relief. If symptoms worsen after a few adjustments, however, the treatment should be discontinued. If the pain persists for three or four weeks, collect your x-rays and make an appointment with an orthopedic specialist for another opinion. If you have a mechanical-type back problem that might benefit from manipulation, the orthopedist might be able to recommend a good chiropractor who works with the medical community.

I would not see any chiropractor who pitches daily treatment, "subluxations," and "maintenance care"—especially when pain worsens after treatment.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on June 5, 2002.