What are the disadvantages of going to a chiropractor

There is no doubt that going to a chiropractor can be helpful for various health conditions such as back pain and neck pain. However, there is a ton of criticism against chiropractors. Today, we discuss what is chiropractic and the disadvantages of going for chiropractic treatments, from a perspective of a chiropractor.

What is chiropractic?

We have to agree that chiropractic means different things to different people. The reason why this occurs is because the training of chiropractic vary vastly from country to country.

Regulation also differ. For example, in Singapore, chiropractic is completely unregulated. In other words, what a chiropractor can do in something may not be something that can be done if they were practising in the United States or Australia where chiropractic is regulated.

In Singapore, chiropractic is considered as complementary and alternative medicine. Chiropractors, like myself, are not considered as allied health professionals. How that affects us is that we are not allowed to make claims to treat or cure diseases or medical conditions. Yet at the same time, many insurance in Singapore do cover chiropractic and do reimburse chiropractic claims for conditions such as back pain, etc.

Chiropractic in Australia

In Australia, where I was trained, chiropractors are considered primary health providers. This means you do not need a referral letter to see a chiropractor. It is also widely accepted that treatments such as exercise, rehabilitation, dietary and lifestyle advice are part of the treatments provided by chiropractors.

The major difference between chiropractors in Singapore and Australia is that chiropractors are regulated in Australia, and considered an allied health professional. Regulation means chiropractors have to adhere to a code of conduct and aberrant chiropractors can be disciplined under the law. This inevitably result in higher standard of care.

Examples of disciplinary actions include Ian Rossborough banned from treating children after his video of cracking a baby’s neck gone viral. Ian Rossborough who went viral for claiming to treat a bedridden teen, Muntathair Altaii, to successfully walk again.

One of the greatest criticism against such viral videos is that it seems to suggest that chiropractic is a miracle cure for extreme conditions. However, the cases of such extreme success rate is few and far between. In other words, these are more outlier cases than an industry norm. By using these case studies to suggest chiropractic works, prospective patients can be mislead and have misguided expectations about the potential treatment outcomes.

Chiropractic in the United States

Although chiropractic is regulated in the United States, the profession is rather heterogeneous over there. As such, there are many different types of chiropractors and some of them rather extreme. Most of the high volume chiropractic setups (i.e., five minute per patient, crack-and-go) seem to originate from America.

Compared to what I see from Australian and Canadian chiropractors, chiropractors in the US seems a lot more focused on the manual aspect of chiropractic aka spinal manipulation or chiropractic adjustments. This is evident from US health organisations such as the Mayo Clinic and Johns Hopkins. Neither websites acknowledged the scope of chiropractic outside of manual therapy.

This is not to say that chiropractic in the United States are always about getting adjusted. Craig Liebenson, an American chiropractor is very much focused on using exercises to help people move and function better. This is very much aligned to what we do a Square One Active Recovery.

What are the disadvantages of going to a chiropractor in Singapore?

While chiropractic care can offer benefits for many people, it is by no means a perfect treatment or a miracle cure. At the end of the day, there are people who will not respond to chiropractic treatments. There are also conditions that may render a person unsuitable for chiropractic adjustments. It is important to be clear of the limitations of chiropractic care before proceeding with treatments.

Chiropractic care can only treat musculoskeletal conditions

If you subscribe to the notion that chiropractors are quacks and absolutely does nothing, I respect that, and this section is definitely not for you. The reason I say this is because chiropractic means vastly differently things to different people in Singapore. This is because it is not regulated and it does cause a lot of confusion to what chiropractic is.

If we were to take the perspective of other first world countries where chiropractic is recognised (e.g., the United States, Australia, Canada), chiropractic is slated in these countries to help with musculoskeletal conditions.

Musculoskeletal conditions are a wide range of disorders that affect the muscles, bones, joints, ligaments, tendons, and other connective tissues in the body. These conditions can cause pain, stiffness, and impaired function. The causes can be due to injury, overuse, aging, or underlying diseases.

Chiropractors are trained to and can treat and/or manage conditions such as back pain, neck pain, disc herniations, arthritis, ACL tears, ligamentous instability, flat foot, plantar fasciitis, etc. It is true that most people tend to see chiropractor for spinal conditions. However, our scope is bigger than that.

Conditions that chiropractors cannot treat

Chiropractors cannot treat neurological and cardiorespiratory conditions. Examples of neurological conditions include Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, cerebral palsy, etc. Cardiorespiratory conditions that chiropractors do not treat include chronic obstructive pulmonary disease (COPD), asthma, pneumonia, heart failure.

If you have any of the above treatments are looking at conservative treatments, physiotherapists will be the right healthcare profession to consider.

Potential for over-treatment

Over-treatment is largely unique to chain clinics or chiropractors who use very aggressive marketing tactics. If you avoid these chiropractors, you would reduce of your risk of over-treatment.

Some chiropractors in Singapore may recommend frequent up to thrice a week. Beyond cost of treatment, it is also a waste of time and can reduce a patient’s self-efficacy over time (e.g., over-dependence). Ongoing treatments may also be encouraged even after symptoms have improved.

In these clinics, unnecessary treatments are marketed as a long-term, maintenance therapy. The financial burden of frequent visits  and life-long treatment is highly unjustified, especially if a patient’s condition has already improved or if the symptoms are mild.

Not covered by Singapore government subsidies

In SIngapore, chiropractic care is generally considered complementary rather than mainstream medical care. As a result of this policy, chiropractic treatments are not covered by government health schemes such as MediSave or MediShield.

Chiropractic services are also not available in public hospitals and polyclinics. This makes chiropractic care less accessible for people without private insurance or those who are unable to afford out-of-pocket expenses.

Chiropractic is covered by almost all insurance companies in Singapore

Many insurance providers offer coverage for chiropractic treatments as part of their personal accident plans. The extent of coverage and claim requirements can vary between insurers and policies. For example, an insurance policy may have a claim limit per session (e.g., can claim up to $150 per session) or a specific dollar amount (e.g., $1,000 per accident) for chiropractic treatments.

Some insurance policies may require a referral letter from a medical doctor.

Chiropractic coverage offered by insurance companies in Singapore tend to be extremely generous. As such, they have a tendency to be abused. A chiropractor was jailed for eight months in Singapore for defrauding Manulife Singapore. The two insurance agents involved in the case also received jail term and was barred from working in financial services for six years.

Spinal manipulation is dangerous for some conditions

This is only applicable if you are looking at seeking care from another chiropractor. At Square One Active Recovery, we do not offer any form of chiropractic adjustments or manipulative therapy.

This section discuss contraindications specific to spinal manipulation and not chiropractic care per se. In other words, patients with the conditions can still see a chiropractor to receive non-manipulative treatments such as exercise rehabilitation.

People with conditions listed under the absolute contraindications should never receive chiropractic adjustments or any form of spinal manipulations. This is not limited to adjustments by chiropractors and should also avoid other manipulative therapy such as neck manipulations commonly offered as part of thai massage.

According to the World Health Organization guidelines, anomalies associated with cervical instability (e.g., dens hypoplasia, unstable os odontoideum), acute fractures, spinal cord tumours, infection of the spine, cancer of the spine, cauda equina syndrome are examples of conditions that are not suitable for manipulation-type treatments.

Relative contraindications include conditions such as arthritis, metabolic conditions with associated bone weakening, certain neurological conditions, as well as psychological factors. In this group of conditions, spinal manipulation is not inherently life threatening but may cause harm by delaying patients from helpful treatments.