What Do Chiropractic Web Sites Tell Us?

Stephen Barrett, M.D.
April 21, 2010

When chiropractors are criticized by quoting sources within the profession or giving examples of improper practice, they typically claim that the examples used are not representative. They may say, for example, that the examples given are outdated or do not reflect the chiropractic mainstream. Whenever a survey is done by some by an outsider, they claim that the critic is biased.

One way to judge what chiropractors do is to see what they say on their Web sites. When inspecting a site, I ask six questions:

  1. Does the site state or imply that vertebral subluxations are a major underlying cause of ill health?
  2. Does the site suggest that regular spinal adjustments will promote general health?
  3. Does the site suggest that spinal adjustment is or may be helpful in dealing with the whole spectrum of health problems.
  4. Do the chiropractors offer services such as applied kinesiology that are unsubstantiated and lack a scientifically plausible rationale?
  5. Does the site reflect other evidence of unscientific practice?
  6. Or does the site suggest that the practice is limited to conservative care of musculoskeletal ailments and is within our guidelines for appropriate chiropractic practice?

As of this writing, I have located more than 200 sites run by an individual chiropractor or by a few chiropractors who share an office or belong to a small group. Of these, only two reflect what I believe to be appropriate practice.

Assuming that my judgment is correct, does this mean that 99% of chiropractors are practicing improperly? Or is it possible that quacky sites are over-represented because (a) my selection process is more apt to find them, or that (b) chiropractors engaged in improper practices are more likely to have Web sites?

My (educated) guess is that chiropractors who espouse subluxation theory are more likely to maintain Web sites because they are more evangelical than their colleagues. But I do not believe that these sites reflect a minority viewpoint. A 1998 survey conducted by the National Board of Chiropractic Examiners [1] clearly indicates that most chiropractors do things we consider improper. These practices and percentages of chiropractors doing them include: activator methods (62.8%), applied kinesiology (43.2%), homeopathy (53.1%), Palmer upper cervical/HIO (28.8%), Meric System (19.9%), and Sacro-Occiptal Technique (49%). Thus there is good reason to believe that the Web sites we list reflect the beliefs and practices of a substantial majority of chiropractors.

A recent systematic survey has found that unsubstantiated claims are very common among chiropractic Web sites. In 2008, the researchers looked at the sites of 200 chiropractors and 9 chiropractic associations in Australia, Canada, New Zealand, the United Kingdom, and the United States. The researchers used Google searches to identified 40 sites in each these countries that presumably were viewed often. Each site was examined for claims which suggested that chiropractic treatment was appropriate for asthma, headache/migraine, colic, ear infection/earache/otitis media, neck pain, whiplash, and lower back pain. Spinal manipulation for back pain can be effective but has not been demonstrated to be superior to other standard treatments. Published evidence of effectiveness for the other conditions ranges from slim to none. The study found that 95% of the surveyed sites made unsubstantiated claims for at least one of these conditions and 38% of the sites made unsubstantiated claims for all of them. The authors concluded:

The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, while only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue [2].

I have also located a few sites run by chiropractors who have medical degrees.

The links below will take you to indexes that contain either a representative quote or a brief description of what to look for on each site. The sites are sorted alphabetically and by country.

  1. Christensen, MG and others. Job Analysis of Chiropractic: A project report, survey analysis and summary of the practice of chiropractic within the United States. Greeley CO: National Board of Chiropractic Examiners, 2000.
  2. Ernst E, Gilbey A. Chiropractic claims in the English-speaking world. New Zealand Medical Journal, 123:36-44, 2010.

This page was revised on April 21, 2010.