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Decode

No Medical Degree Or License: Anybody Can Be A Chiropractor In India

Indian Association of Chiropractic Doctors say there are only 12 real chiropractors in India. The rest are marketing on the buzzword.

By - Titha Ghosh | 7 Nov 2023 6:14 AM GMT

A video of a man laying on a table while two male “chiropractors” literally knead his stomach, is going viral online. The account has over 250,000 followers and almost all videos show individuals lying on a table while one or two others hover over them, either bending their hips or necks until it cracks. Viewers laud the efforts of the chiropractor while other comments find the event funny. Another chiropractor with over 80,000 followers, does regular social media “live” chats, and hundreds of comments come flooding in, asking for rates of sessions and availability.

In recent times, chiropractors have seen a steady increase in followers not just online, but also in staunch believers of the method. For his gnawing sciatic pain, Himmat, a 46-year-old male from Delhi, visited his neighbourhood chiro practitioner. And in his words, “he never looked back.” Himmat believes that not only has he found relief from constant aching, but he’s also managed to stretch out his body enough to be able to exercise regularly without much pain.

But who are chiropractors and are the ones you see on the internet legitimate? And as doctors claim, if chiropractic principles are based on pseudoscience, what is the explanation for its steady-growing popularity? Decode spoke to popular chiropractors on social media, who boast hundreds of regular customers. We also had these practitioners’ claims verified by licensed doctors, to see whether people’s faith in chiropractic is truly rooted in “cult” beliefs.

Who are chiropractors?

According to the United States National Center for Complementary and Integrative Health, Chiropractic is a healthcare profession that emphasizes the body’s ability to heal itself. It involves manual therapy and manipulation of the spine.

The manual treatment methods used by chiropractors range from stretching and sustained pressure to specific joint manipulations, which are usually delivered by hand and involve a quick and gentle thrust. The purpose of the manipulations is to improve joint motion and function. Manipulations are most commonly done on the spine, but other parts of the body may also be treated in this way.

To practice in the United States, chiropractors must earn a Doctor of Chiropractic degree after an undergraduate degree, then pass the National Board of Chiropractic Examiners exam, and finally get a state license.

However, while it is a licensed treatment in the US, in India, neither are there licenses for chiropractors nor is there any accredited institution that provides legitimate chiropractic training.

WHO’s guidelines from 2005, considered chiropractic as one of the most popularly used forms of manual therapy. “There is a need to develop guidelines on chiropractic education and safe practice, including information on contraindications for such care,” it stated. The guidelines add that regulations for chiropractic practice vary from country to country.

However, many countries have not yet developed chiropractic education or established laws to regulate the qualified practice of chiropractic. In India, no such formalised pathway is predesigned for chiropractors. Dr. Sanjay Agarwala, Medical Director and head of Orthopedics at Hinduja Hospital explained, “These doctors are not MBBS at least in India. Chiropractic is essentially manipulative treatment with a medical-sounding cover, without the rigours of training in India.”

No degree or license needed for Indian Chiropractors 

Since 2005, the Indian Association of Chiropractic Doctors has been a member of the World Federation of Chiropractic (WFC) and it works in the field of developing their service. WFC is looked after by the World Health Organisation (WHO). According to the Constitution of the WFC, IACD vets chiropractic activities in India. In fact, IACD was launched in 2006, in the presence of ministers from the Health and Family Welfare department, and it announced chiropractic as an established form of healthcare in India.

Dr. Prathap Addageethala, IACD VP, clarified, “In India, because of the lack of legislation, there are a lot of people sprouting up as chiropractors, who have no right to call themselves one.” Addageethala continued that a large majority of chiropractors are actually physiotherapists who make themselves popular by jumping on social media trends of “bone cracking”. “So people who then look at these videos and then learn some techniques off YouTube, enrol themselves in a short course and then start a practice of chiropractic.” According to Addageethala, these “fake” practitioners bring disrepute to certified chiropractors.

This means that any individual or clinic that is not recognised by the IACD, is not a legitimate chiropractor.

IACD is legally represented and is sending out FIRs on citizen’s behalf so that the profession is protected and authenticated. “It doesn’t matter if tomorrow, University A starts a chiropractic degree unless the university is accredited for chiropractic training.” A key determinant of a true chiropractor is whether these online practitioners would ever be allowed to practice in other countries that have formalised chiropractic education.

Addageethala has undergone 7998 hours of training to become a chiropractor. According to him, the time of training is the biggest difference between real chiropractors and pseudo-chiropractors. “A three-month or two-weekend course does not compare to our 7998 hours of training,” he explained.

Pseudo-chiropractors popular on social

Taiyab Patel, who runs the Reset Clinic in Pune, says that there are chiropractors who target different patients who may have a varied range of pains and aches. “A part of my practice is to spread awareness about chiropractic as a method.” In the US and outside, chiropractic is a general practice, whereas in India there is no push for the industry. “In India, people would work as “bone setters” for hundreds of years. We would be the “missing link” between physiotherapists and orthopaedics in India.”

Along with his clinic, Patel also runs an Instagram page which he hopes to grow on. “I post my patient testimonials on social media to grow my business,” Patel mentioned having over one crore views on his Instagram, with between 4-10 lakh views per month.

In his words, his mission is to help people self-diagnose and treat themselves before going to medical professional. “Whenever we go to doctors, we get painkillers, which is not healthy,” Patel said. Besides opening a chain of clinics, his future plans also include growing on social media, so that he’s able to bring in more patients and persuade them of the method.

“Allopathy and orthopaedic surgeons don’t prefer patients to go to chiropractors, because it would eat away their business,” Patel concluded. Patel’s clinic is currently not accepted by the Indian Association of Chiropractic Doctors. In fact, according to IACD’s website, there are no legitimate chiropractors in Pune.

So how does a practitioner who is not a part of an accredited institution become a chiropractor in India?

According to Patel, an aspiring chiropractor can register for a Bachelor of Neuropathy and Yogic Science (BNYS) and do body-alignment therapy. Similarly, one can study ‘bone-setting’ in a Bachelor of Ayurvedic Medicine and Surgery. “Every institution has a different name, but essentially these are all training for chiropractic,” Patel continued.

Fake chiropractors harming people

Maya, a primary school teacher in Gurgaon, complained of crippling back pain for close to half a year. “I tried everything–from regular massages to physiotherapy, just so I can avoid developing a dependence on painkillers.” Maya then decided to give chiropractic a chance, one she now regrets. Her chiropractor claimed that the pains could be cured with realignment therapy on the spine.

After two sessions, Maya felt her pain push upwards to her shoulders. Not able to withstand the continued ache, she discontinued visiting the chiropractor and consulted an orthopaedic. After several consultations, the solution to her problems was gastric surgery. “My back pain was a symptom of an underlying gastric issue, and had nothing to do with the spine,” said Maya.

Similarly, Abhijay, a basketball player in his mid-20s visited a highly-rated chiropractor In Delhi. Having suffered an arm injury during a match, he was looking for supportive relief. But after a few trips to the chiropractor, he continued to feel the same way and decided to visit a doctor for medication. The doctor was quick to discourage his chiropractor's visits stating that these professionals do not have a background in orthopaedic science. 

Rajat* visited a chiropractor after viewing some videos online. Intrigued by the "pops and cracks" he saw in the videos, he decided to switch from regular massages to a chiropractor. The first few sessions went smoothly, but a few weeks in, he started feeling a pressure near his elbows. Unsure what caused the pain, he decided to ask his chiropractor, who denied having done anything to cause it. As the pain intensified, Rajat decided to visit a general physician who diagnosed the issue to be nerves having twisted. 

Cyriac Abby Philips, Hepatologist, who is popularly known as TheLiverDoc on X, cautioned followers to stay away from chiropractic. His post featured a viral video from Instagram, of chiropractors performing “treatment” on a man in order to release gas buildup in his stomach.

Philips argued chiropractic to be pseudoscience and while equating it to “nonsense”, suggested that no one visit chiropractors for ailments. “Their rising popularity is due to the extensive promotion and advertisements, through social, print and visual media on low quality, unscientific, but appealing anecdotes that intentionally mislead people into believing that chiropractic treatments are safer, quicker and better than standard of care.”

Philips confirms that medical literature is replete with multiple publications on adverse, sometimes fatal outcomes associated with chiropractic treatments in people, especially those related to blood vessel injury and stroke.

Dr Sanjay Agarwala adds that the world has been “brainwashed” over millennia about allopathy. Hence the popularity of alternative medicine. “Even opium, hemp, cocaine, can be truly ‘herbal’ and can be construed to be safe! Likewise chiropractic.” A lot goes into learning to be a competent and ethical physician who realizes their limits and refers patients to someone with more expertise, he added.

Practo chiropractors not approved by IACD

Another key element of chiropractic popularity in India comes from advertisements of these practitioners on Practo. While IACD had ascertained only one 'real' chiropractor in Delhi, Practo lists at least 7 in the city. While some bear 'physiotherapist' also in their bio, others claim legitimacy by virtue of having done chiropractic education abroad.

Decode spoke to Practo to see what their eligibility requirements to enlist professionals on the website are. It appears that Practo has formulated its own metric for registering professionals due to a lack of "universally accepted standards."

"In the absence of specific guidelines, licensing, or central governing authority, Practo basis industry research and guidance guidelines include a minimum of a 12-month course and a Bachelor's and Master’s degrees from an international institute," Ka Practo spokerperson said.

Practo claims that they have a meticulous onboarding process for professionals who wish to list themselves on the platform. This process involves the submission of documents by the professionals, which are then reviewed by a dedicated team and medical team to ensure accuracy. "The medical team has decades of experience across different domains in the medical profession."

However, some professionals listed on their website either have only one eligibility criteria met, and others have no clearance from the IACD.

VP of IACD explained that the population is getting misled and tricked by those who use chiropractic as a marketing buzzword. “Sometimes the patient gets injured and they blame the method of therapy and not the fake practitioner.” The IACD has so far been silent in regulating the space. But Addageelatha believes that now with a change in leadership, the institution is trying to be more direct in getting fake practitioners to cease using Chiropractic terminology in their marketing and promotion.

Addageethala defends the practitioners who have been legitimately trained in countries with accepted chiropractic frameworks. “Doctors who claim chiropractic is pseudo-science, discredit 40-50 years of research. Chiropractic is very specific in anatomy and physiology training. We’re given world-class education and we would not be authorised in so many countries if we weren’t legitimate,” he concluded.