Hi, I'm Wendy Zuckerman and you're listening to Science Versus.
This is the show that pits facts against the satisfying sound of a back being cracked.
Because today on the show, chiropractors, are they legit?
Music Millions of people have back and neck pain, and it can be pretty hard to treat.
There are drugs that can help, but they can also have some pretty nasty side effects.
And so people are desperately looking for other solutions, like going to the Cairo.
Around one in 10 adult Americans went to the Cairo in 2022, mostly for pain.
That's according to the National Institutes of Health.
And of course, it's not just Americans going to the chiropractor.
Several years ago, producer Caitlin Sorey called up her parents, who are big fans of going to the chiro.
Katie, how is New York going?
It's good.
So you're still riding your bike to work?
Yeah, I do.
Don't worry, I'm safe.
Your mother is worried.
Katie's mum is Chris and her dad is Bill.
And the whole Sorey family had been going to the chiro for years.
So, Katie.
Tell us all about it.
Yeah, so my parents have been going to the chiro for ages and I actually didn't know about this until we called them up to talk to them about it.
But I was actually taken to the chiropractor as a newborn baby.
Wait, why did they want to take you to the chiro?
Because my delivery, my birth was really rough.
They had to really yank me out.
And so the idea was that maybe my bones were misaligned, so they wanted to take me to the chiropractor to see if it could help.
Yeah, because you had such a traumatic birth.
You know, like you had huge marks around your face where the forceps grabbed your cheeks.
So you didn't look too terrific for the first few days because of that.
And mum says visiting the chiro seemed to be good for me.
I slept better.
And so when my brothers were born, they were also taken off to the chiro.
And my parents still go for neck and back pain.
Dad has smashed himself a fair bit over the years.
So I've fallen out of a tree.
I've fallen off a motorbike.
Yeah, dad's been thrown off a motorbike.
He's fallen off a ladder.
So the Cairo makes him feel better.
Same with mum.
My muscles feel a lot more relaxed and my neck feels like it's not so grindy is the best way to describe it.
Wait, so do you remember going as a kid?
Yeah.
So the whole family, we went right up until I was 18, all five of us every six weeks or so.
Okay.
So I've never been to a Cairo.
What do they actually do when you get in there?
Yeah, so the main thing that chiros do is this thing called spinal manipulation.
So they're basically checking your spine, all the little segments in your spine, to see if anything's out of place, and then they're popping it back into place.
And they can use a little tool or they can use their hands, but it's a quick thrust.
It's not like a massage where you're kneading your back.
It's like pop back into place.
Anyway, it was just a thing the whole family did.
I would skip out.
Happy little Vegemite's.
We were happy little Vegemites coming out of the chiropractor's office.
It's an Aussie thing.
So is this thing that we did throughout my childhood total BS?
So tell us about the science.
Come on.
Because not everyone out there reckons that going to the chiro will make you a happy little Vegemite.
People on social media have been calling them out for being dangerous, for having a strange mystic history.
And they're really starting to question whether this is legitimate medicine or a scam.
Why am I only just learning that chiropractors are not real doctors?
Yeah.
Letting a chiropractor touch your neck is a threat to your life.
I don't believe in chiropractors at all.
I think it's 98% horseshit.
We at Science Versus first looked into the science of chiropractors several years ago, but we've cracked open this episode once more, updated the research and today we are going to find out one can chiros help your back and neck pain?
Two, should you take your baby Katie to the chiro?
And three, what are the risks here?
When it comes to chiropractors, there's a lot of happy little vegetables.
But then there's science.
Science versus chiropractors is coming up.
Welcome back.
Today, we've got a cracking episode for you.
We are looking at whether chiropractic can help treat pain.
And yes, chiropractic.
It sounds like an adjective, but it's actually a noun.
It bothers us too.
But moving on.
So why did chiropractors think they could help little baby Katie and everyone else in her family too?
Well, it turns out that you can trace it back to one guy who lived in Iowa more than 100 years ago.
And to get this story, we spoke to chiropractic royalty.
Carl S. Cleveland III.
Yes, Carl comes from a long line of chiropractors.
My great-grandmother was a chiropractor.
My grandfather and grandmother were chiropractors.
And my mother and father were chiropractors as a child.
I thought everybody grew up to be a chiropractor.
And he's the president of Cleveland University, Kansas City, which was founded as a chiropractic college.
In fact, his family started it.
And so Carl told us about the birth of chiropractic.
It began with a man called Dee Dee Palmer.
He was Canadian, appeared to be a stocky man, had a full beard.
Dee Dee Palmer was a magnetic healer in the late 1800s.
So he thought he had a personal excess of magnetic energy that he could channel through his fingers to treat people.
It was a thing back then.
But something changed for Didi Palmer, and soon he would switch from magnetic healing to backcracking.
Here's basically how the legend goes.
Didi Palmer met this janitor who was hard of hearing and also had a hump on his back.
And Didi Palmer thought he could help.
So he pushed the janitors back with a big thrust.
And a few days later, the guy came back with some very curious news.
Saying, Mr. Palmer, I hear the racket of the wagons in the street.
A new profession was born, and Didi Palmer named it chiropractic, meaning in Greek a practice done by hand.
And Palmer then thought he found a cure for deafness.
Put out a sign, Dee Dee Palmer, healer of the deaf.
Soon, Dee Dee shifted away from just curing deafness by manipulating spines.
He now wanted to cure practically everything.
And this brings us to the theory behind chiropractic.
Basically, Dee Dee Palmer started to think that the spine was the key to health.
And here's what he thought was going on.
Dee Dee believed that there was energy flowing through the spine to keep us healthy.
He was a spiritual man and he saw that when spinal joints didn't move right, that that in some way obstructed the flow of nerve energy and life force through those nerves to the body parts.
That is, he reckoned that these kind of blockages in the spine, or what he called subluxations, could make you sick by interfering with that mystical energy.
At other times, he said those subluxations tweaked people's nerves.
Didi ultimately thought that 95% of diseases were the result of subluxations.
And in fact, he wrote that it was unjust to blame germs for disease.
And today, Dede Palmer's term subluxation is still used by a lot of chiros.
The word means slightly different things to different chiropractors.
For Carl, a subluxation is basically a joint that doesn't move properly.
And that could result in pathological changes that affect nerves muscles ligaments, the vascular tissue in the area, as well as the connective tissue.
And some other chiros even say that this could lead to things like asthma and high blood pressure.
For Carl.
He reckons that people need to visit the chiro not just when something's sore but for regular checkups, kind of like how you go to the dentist.
A periodic spinal checkup to maintain posture, to maintain function and mobility of those joints.
We think that's important.
Despite the mystical origins of chiropractic, it is actually starting to get some real cred.
In fact, in the US Medicare, the federal health insurance program covers the chiropractic treatment of subluxation.
And in 2017, in the search for better ways to fight back pain, the American College of Physicians included spinal manipulation on their list of suggested treatments, which brings us to this question of how good is the evidence that chiros can help you treat your pain?
And specifically, let's look at back and neck pain, which is why most people go to the chiro.
To get some answers, we called up Anita Gross, a physical therapist and researcher who specializes in neck and back pain at McMaster University in Canada.
Hello, how are you?
Several years ago, Anita and her team combed through almost 40 trials looking into whether spinal manipulation the thing that chiros do can actually help with neck pain.
And a lot of what she found were crappy trials.
So, for example, many of them were small, often involving no more than 30 people.
And by the way, in science, you don't officially call these studies crappy.
Instead, you call them low quality.
Low quality actually is not the worst.
The worst is very low quality.
So low quality, believe it or not, has a little bit of hope in it.
And she did find some hope.
Anita found that for people who had multiple sessions with a chiro well, they actually did tend to have less pain in their neck.
And one of the studies she looked at even compared spinal manipulation to conventional medication, like taking anti-inflammatory drugs, muscle relaxants and even opioids.
And it ultimately found that going to the chiro turned out to be more helpful than drugs.
That is, after a year.
The people going to the chiropractor had less pain than those who are on the meds.
Now, we do need more data here to see if this holds up.
But for now, it sounds pretty impressive.
So the studies are showing that spinal manipulation actually does help.
It's valuable, yeah.
And just this year, in 2025, another review on whether spinal manipulation helps neck pain came out, and ultimately they found the same thing.
Low-quality evidence that, for some people, it helps.
So those were studies in neck pain, and then when you look at back pain, the research is pretty similar.
So again, we don't have great studies, but what we do have suggests that spinal manipulation can help.
And when patients walk through Anita's door...
She'll sometimes give spinal manipulation a go.
So it's something that I use clinically in my own practice.
Since you do these big reviews and you find that there's low quality evidence that it helps, how come you give it to your patients?
To do nothing with your patients isn't of any value either.
You're getting them better in their everyday life, their function and being able to actually do their activities better.
Ultimately, Anita says that mainstream medicine just doesn't have a lot of great options for treating this kind of pain.
And so spinal manipulation is sometimes useful.
And she did point out that she typically doesn't just use spinal manipulation on its own.
She also likes to combine it with these other exercises that can help make people stronger and move their bodies better.
So going to the chiro might help you with pain along your spine.
But some chiros reckon that it should be used for way more than that.
And one of the most controversial claims is that even kids should be going to the chiro.
The American Chiropractic Association openly encourages this.
And, according to the National Institutes of Health, chiropractic is one of the most common forms of nontraditional medicine used in kids in the US.
Which takes us back to little baby Katie getting her tiny little spine aligned.
Can you describe how they did it?
Like what was actually happening?
Kind of just massage your head and then they would just lift you up by your ankles and just swing you.
But just really gently, really, really gently and then just lay you back down again.
I'm so nervous for me in retrospect.
LAUGHTER
They recommended I did that every day, which I did for about three months, I think.
And then why did you stop at three months?
Because you're getting a bit heavy.
And I was like, hmm, this is not good.
And recently, there's been quite a bit of controversy about taking kids to the chiro.
A few years ago, a video of an Australian chiropractor holding a baby up from its ankles and using a tool to manipulate its spine started making the rounds on social media and in the news.
A two week old baby squirms as he's dangled upside down before a spring loaded instrument is used to prod the newborn's neck.
We're going to come into here.
The video sparked widespread condemnation, particularly from the medical community.
If I had a child in this age group right now, I would not let this happen to them.
It caused such a scare that Australia temporarily banned spinal manipulation in kids, while experts tried to figure out what the hell was going on here.
They ultimately came to the conclusion that there just isn't any good evidence that supports taking your kids to the Cairo.
And while they pointed out that really scary outcomes from doing this are very rare, they still didn't think it was worth the risk.
And right now in Australia, there is a ban on kids under two going to the Cairo.
And it's not just Australia that's having this conversation.
An international team of researchers, including Anita Gross, recently did this big review looking at chiropractic treatments for kids on a bunch of conditions from asthma to autism, to breastfeeding difficulties, excessive crying, bed wetting, and ultimately concluded that there is quote no good evidence to explicitly support the effectiveness of spinal manipulation or mobilization for any condition in pediatric populations.
End quote.
And when I asked Carl about that study, he acknowledged that when it comes to kids in Cairo, the research is not there.
Currently, there's insufficient research available to either support or refute the use of manual therapy in children.
But if there's limited evidence that chiropractic can help, why would you take your child to a chiropractor for those things?
Because those patients respond to care.
And I think it's a matter of time before we have formal evidence.
But from a practical standpoint where the satisfied patient that sees the child, that is pain-free, that's improvement.
It's just a period of time before those studies, in my opinion, that those studies will be completed.
So it's also possible that in the future, as we do clinical trials, those trials will show that it doesn't help.
That's a possibility.
This is an area where we require additional research.
Carl told us that since the risks for children are low and you know if chiros are doing this gentle manipulation the risks are low.
And since Carl told us that a lot of parents report being happy with the chiro they get for their kids, he reckons there's still a role for chiropractic in kids.
But we spoke to Katie's parents about the research here.
Do you want the science on the kids?
Do you want to know that?
Yeah.
Yeah, there's pretty much no good science that it works for anything when it comes to kids.
Yeah, we got sucked in.
Wait, what did your dad just say?
He said they got sucked in.
They just trusted the chiropractor.
Back in the day, everyone was going.
So like everyone was the same sort of thing.
So we didn't question as much.
It feels a little bit like you're sort of sucked into this vortex almost of believing everything they say.
After the break, we go further into the vortex.
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Now we go to AI Bytes, our segment about the way scientists are using AI in their work.
Dr Ryan Carney from the University of South Florida is using AI to improve our surveillance of mosquitoes that carry diseases.
It is actually the mosquito that is the deadliest animal on the planet.
Especially because of malaria, which every year kills over half a million people.
But Ryan says not all mosquitoes are equal.
Only some species are known to transmit malaria.
And one of them that's particularly good at it is called the Anopheles stevensi.
Not only does Anopheles stevensi really thrive in urban places, but it's also resistant to insecticides and temperature extremes.
Anopheles stevensi is the perfect malaria supervillain.
And this mosquito has been spreading.
It's native to South Asia and the Arabian Peninsula, but it's been popping up in parts of Africa.
So scientists like Ryan have been trying to keep track of it.
And one way they do this is through citizen science apps.
These are apps where people post photos of animals or bugs or other stuff they see in nature.
But it can be hard to identify mosquitoes from just a photo and the naked eye.
Like Ryan's colleague came across an old photo of a mosquito larva taking in Madagascar.
They suspected it was Anopheles stephensi, but there have been no recorded sightings of it there before.
Plus, multiple entomologists couldn't identify the photo to species.
And since the specimen was long gone, it was AI to the rescue.
AI was really our only hope of cracking the case.
So Ryan and his team started training in AI by feeding it thousands of confirmed photos of the Anopheles stevensii.
Where we'll flip and rotate and modify the images as well to give some variability to the dataset.
And then the algorithm essentially figures out what the features or patterns are that are tied to each species.
So basically says okay, this image is Classified as Anopheles stevensi.
These are the pixels that were most important in making that prediction.
And the AI did end up identifying pixels unique to this species.
Like.
One area that really stood out were these tiny dots in the male larvae, which turned out to be pigmented testes.
And while, with the final models, Ryan's team identified the mystery larva as very likely to be Anopheles stevensi, which they say would be the first detection of this species in Madagascar.
Now we have our artificial intelligence algorithms running on a daily basis for all of the citizen science platforms, looking for any potential stevensi that may come up.
They hope that finding more of these mosquitoes will help activate malaria prevention efforts and ultimately save lives.
That is the goal.
That is exactly what we're trying to do.
Once again, today's AI Bites was brought to you by ServiceNow.
Learn how ServiceNow puts AI to work for people at servicenow.com.
Welcome back.
So today we're talking about chiropractors and this thing they do called spinal manipulation.
And we just heard that it may help with back and neck pain, but there's no good science behind taking kids to the chiro.
Now we're going to dive right into the core beliefs of chiropractic to see if the idea of spinal manipulation holds up.
Now, a lot of people might have heard about a spine being out of alignment or misaligned, and that's why you go to the Cairo.
But what exactly is a misaligned spine?
Well, to understand that we have to go back to old Iowa.
Didi Palmer, the guy who came up with chiropractic, thought that a lot of our health issues could be traced back to a misaligned spine.
And the thing that was making your spine misaligned was what he called subluxations.
Now, at one point he thought these subluxations could block a mystical force that flowed through the spine, causing disease.
Now, that's clearly not science.
But Dee Dee also had this theory that's shifted a little but has basically stuck around today.
And that is that subluxations are bones out of place or some say stiff joints that then squish against our nerves in some way, making us sick.
And this could lead to things like asthma or high blood pressure.
And now, not every Cairo thinks this way anymore, but a lot of them still do.
A study of several hundred Canadian Cairo's found that almost one in five thought fixing a subluxation was the key to health.
The science behind it is not likely to come because the science behind it is simply not there.
The belief system is entirely contrary to our knowledge of physics and chemistry and biology.
That's Marcello Costa.
He was a professor of neurophysiology at Flinders University in Australia.
And Marcello says that there's no good evidence that problems with your spine are to blame for many of the diseases that some chiros claim to fix.
So let's take asthma, for example.
We don't know exactly what causes asthma.
It's been linked to genetics and immune reactions.
But here's the important thing.
We don't have any good evidence that manipulating the spine could have any effect on asthma.
There's no basis whatsoever that it can cure asthma.
This is a complete nonsense.
Not only there's no evidence that one can believe, but there's no reason whatsoever to assume that manipulating the spine will help the asthma of a young child.
And so, in a sense, it's a complete bongos, it's a complete nonsense.
And maybe this asthma thing is low-hanging fruit, like it kind of seems obvious that it's a bit bonkers.
But Marcello says that even if you just zoom out to this idea that a back could be misaligned and afflicted with subluxations, well he says that even that concept is spineless.
And the subluxations simply do not exist physically.
They don't exist at all?
They don't exist at all. is simply just telling you a complete fib.
The fact that some of them believe this is even more worrying.
And some of them actually don't believe it and they want to ditch this idea of subluxations altogether.
Several papers have now been written by Kairos acknowledging that there is no good evidence behind subluxation.
One paper called it an untested hypothesis and said that it was like quote an albatross around our collective necks end quote.
Now Marcello says that there are clear-cut medical conditions that affect your spine like a slipped disc.
That's where the jelly-like stuff in between the bones of your spine push against the nerves and this can hurt.
But that's often not what chiros are talking about when they talk about misalignments or subluxations.
And Marcello says that if you do have these conditions, You do really need a proper doctor and not a pseudo-doctor.
And if Marcello sounds particularly gnarky, it's because he hates that chiros have this veneer of legitimacy around them.
Like they call themselves doctors, even though they don't have a medical degree.
And so here's a kind of fun fact about chiropractors.
A survey of more than a thousand chiros found that one in four of them agreed with this statement.
Quote.
There is a lack of evidence from clinical trials to support most of the treatments I use in my practice.
Yeah, one in four thought that.
But still, there is evidence that going to a chiro might help you with back and neck pain.
But if chiros aren't fixing subluxations, then what are they doing to help with your pain?
Well, scientists aren't quite sure how spinal manipulation works.
Research into this very question says that it could be that that sharp thrust triggers a chain of events that might block pain receptors, or it could reduce muscle tension or stiffness.
And then there's another explanation, that it's not to do with pain receptors or stiffness.
But actually it's just about someone taking care of you and from that you're expecting to feel better.
It's that thing we call the placebo effect.
We put this to Bill and Chris, Katie's parents.
Would it matter to you if it was placebo and it wasn't sort of aligning your back?
And you know, whatever they say it might be?
No.
No, we'd still go.
Why?
Why?
Because it helps.
The pain, you know.
It's all about whether it feels good for you.
Fair point, right?
If it's making people feel better, what is the problem here?
Well, there are some risks and we talked about them with Anita Gross, the physical therapist, from the start of the show.
Because while she was doing her big assessment on the evidence around chiropractic care and neck pain, she also looked at the risks here.
Because getting a spinal manipulation, particularly the kind that twists and cracks your neck, it does seem scary.
And what Anita found is that sometimes people said that their neck pain actually got worse after a spinal manipulation.
Other people would get headaches, nausea, or even dizziness.
Here's Anita.
The manipulation happens so quickly, then, ah, you got that dizziness.
Now we don't know how often this happens, because many studies actually don't record the side effects.
Either way, those things that Anita talked about, they tend to go away on their own.
But very rarely, there are more serious problems that can happen.
Bones can fracture.
A twist or a push to the neck can actually dislodge a blood clot or even cause a small tear in the artery.
And there are cases where people have actually died.
May was seeking treatment for what she said was just a pinched nerve.
And less than a week later, she was dead.
Several years ago, Katie May, a 34-year-old model, died soon after going to the chiro, and her family blamed the treatment.
This year a report came out into another death after a 29-year-old woman died after a chiropractor adjusted her neck.
Now we didn't talk about those cases specifically with Anita, but she did tell us that this kind of thing it's rare, really rare, but it can happen.
Yeah, a young person between the age of 20 and 40-something goes, gets their neck manipulated and then they die.
Like we've had a few cases like that.
Oh, my gosh.
What are they dying of?
From aneurysms or the vascular system just being torn in the neck and then they get bleeds into the head.
So what are the chances that this will happen to you if you go to the Cairo?
Some say that one out of every few million manipulations could lead to a death.
Others say it's more common.
And some even question whether chiropractors caused these deaths or something else did.
So when it comes to science versus chiropractors, does it stack up like a nice healthy spine?
Well for people with back or neck pain.
The research shows that getting a spinal adjustment from a chiropractor might help.
But we don't really know why.
As for taking your kids to the chiro, there's no good evidence that it will help them.
And what about the whole point of chiro, that our spines need to be aligned for our overall health, that subluxation thing?
Well, there's no good evidence that it's real.
And finally, this isn't a totally risk-free option.
Very rare but very serious consequences can occur from spinal manipulation.
Bill Sorry, Katie's dad, sees it this way.
It's a bit like religion.
You've got to filter out the bulls**t, I reckon.
Wait, what did your dad just say?
He said, chiropractors are a bit like religion.
You've got to filter out the bulls**t.
Bill's sorry.
I know.
He's so sassy.
That's science versus chiropractors.
This episode has 137 citations in it.
If you want to see them, go to our show notes and click on the link to the transcript.
They're all there.
If you want to get in touch with us, we'd love it.
If you want to say hello, let us know what you thought of the episode.
We're on Instagram, science underscore VS. I'm also on TikTok at Wendy Zuckerman.
We interviewed Marcello Costa for this episode in 2017.
We really appreciated his help and we just wanted to note that he died last year.
This episode was produced by Rose Rimler with help from me, Wendy Zuckerman, Caitlin Sorey, Akedi Foster-Keys, Shruti Ravindran and Heather Rogers.
We're edited by Blythe Terrell.
Fact-checking by Michelle Harris.
Sound design by Martin Peralta and Bobby Lord.
Music written by Bobby Lord.
Recording help from Asha Griffith.
For this episode.
We also spoke to Dr Richard Deo, Professor Tim Mertz, Professor Gregory Whitcomb, Dr Adam Chifu and Julie Knack.
Thank you for your insights.
An extra big thanks to Rachel Ward, Emma Morgenstern, Christina Sullivan, Jasmine Romero and Phoebe Flanagan, as well as Alex Ward Russell Gregg, Fiona Crawl and Judy Adair.
Also a shout out to the Sorys.
Thank you, Bill and Chris.
I'm Wendy Zuckerman.
Back to you next time.
It's a new bike.
It's a good one.
It's got two brakes on it.
Okay.
That has nothing to do with cars colliding with you though, Caitlin.
It doesn't matter the bike you have.
It means I can stop more quickly.
What about your helmet?
Yep.
New helmet.
Okay.
We've got to go.
We'll let you go, okay?
All right.
Love you.
Nice talking with you all.
Bye.
