Red Flags to Look Out for in Chiropractors: What’s Real and What’s Rubbish?
Article: Red Flags to Look Out for in Chiropractors – If you’ve ever been told “your hip is out” or “one leg is shorter than the other,” you’re not alone. These phrases are commonly thrown around by chiropractors—but many are based on outdated theories, fear-based marketing, or just plain nonsense.
Let’s dive into the Red Flags to Look Out for in Chiropractors, and what evidence-based, ethical chiropractic care actually looks like.
1. 🚩 “You need a 12-month treatment package.”
What they say:
“Your spine is misaligned. We’ll need 3 sessions a week for 12 weeks, then monthly adjustments for life.”
The reality:
This is a sales pitch, not healthcare. No ethical practitioner can predict your body’s healing response a year in advance. Long-term packages often pressure patients into committing financially before seeing results.
What the evidence says:
- Care should be individualized, not templated.
- Most musculoskeletal issues respond within 6–12 visits depending on the severity.
- Regular “maintenance” visits might help some, but they should be patient-driven, not prescribed by fear.
✅ What to look for instead:
A chiropractor who reassesses regularly, adjusts the plan based on your progress, and works toward helping you self-manage your condition.
2. 🚩 “Let’s take some X-rays before we start.”
What they say:
“We need to check your alignment on X-ray before doing anything.”
The reality:
Unless you’ve had trauma (like a car accident or serious fall), have red flags (e.g. cancer, infection, fracture), or neurological symptoms, routine imaging is not necessary—and in many cases, it’s harmful or misleading.
What the evidence says:
- Guidelines from organizations like Choosing Wisely, NICE, and The Lancet strongly advise against routine imaging for nonspecific back pain.
- X-rays don’t show pain. They often find “abnormalities” that are completely normal for age and don’t need treatment.
✅ What to look for instead:
A chiropractor who uses a thorough history and physical exam to guide treatment, and only refers for imaging when clinically justified.
3. 🚩 “Your one leg is shorter than the other. That’s why you’re in pain.”
What they say:
“We need to fix this leg length difference to realign your spine.”
The reality:
Slight differences in leg length are extremely common—and usually functionally caused by muscle tightness or pelvic tilt, not an actual bone length discrepancy.
What the evidence says:
- True leg length discrepancies >2cm are rare.
- “Pelvic rotation” or “misalignment” is a common myth and not a reliable pain generator.
- Manual leg checks for length are wildly unreliable.
✅ What to look for instead:
A clinician who acknowledges the natural asymmetry of the human body and focuses on improving your movement, strength, and pain—not chasing symmetry.
4. 🚩 “Your posture is terrible. That’s why you’re injured.”
What they say:
“We need to fix your posture to prevent long-term damage.”
The reality:
The idea that there’s one perfect posture is outdated. Posture does not directly cause pain, and blaming it often leads to unnecessary fear and hyper-vigilance.
What the evidence says:
- Pain is multifactorial: stress, sleep, load management, and movement quality all play a role.
- Good posture is varied posture—the ability to move and adapt, not stay rigidly upright.
✅ What to look for instead:
A chiro who empowers you to move more, not sit still like a statue. Movement variability, strength, and tissue capacity matter more than the “perfect” desk setup.
5. 🚩 “Your hip is out. I’ll just click it back in.”
What they say:
“You’re misaligned. Your SI joint is out. I’ll fix it.”
The reality:
Your joints don’t “go out” and your pelvis doesn’t dislocate from sitting funny. The audible “click” is gas releasing from the joint—not bones snapping into place.
What the evidence says:
- Spinal manipulation may help with pain relief and mobility—but it doesn’t “realign” anything.
- Structural changes on imaging before/after adjustments are not significant or clinically meaningful.
✅ What to look for instead:
A practitioner who uses adjustments as part of a broader plan—including education, exercise, load management, and strategies that don’t create dependency.
6. 🚩 The “Activator” is their only tool
What they say:
“We use the Activator Method—it’s gentler and just as effective.”
The reality:
The Activator is a spring-loaded tool that delivers light taps. While it can be useful in specific populations (e.g. those with osteoporosis), it’s not magic—and when used exclusively, it often replaces more meaningful intervention.
What the evidence says:
- There’s limited high-quality evidence supporting the Activator as superior.
- Patient preference, clinical context, and the overall treatment plan matter more than the tool itself.
✅ What to look for instead:
A chiro who has multiple tools in their toolkit: exercise rehab, education, hands-on therapy, movement assessments, and knows when to refer out.
Final Thoughts: Trust Your Gut—and the Science
If your chiropractor is selling you fear, alignment fairytales, or lifetime memberships, it might be time to walk away.
What should care look like?
✅ A clear diagnosis
✅ A treatment plan that evolves
✅ Pain education and reassurance
✅ Movement, strength, and self-management
✅ Referral if you’re not improving
Need evidence-based care in Cape Town?
I’m Dr Tristan Koekemoer, aka @thecapetownchiro. No gimmicks. No nonsense. Just real solutions that work. Book your consult here.
🔍 FAQ: Spotting Chiropractic Red Flags
❓Do chiropractors really “put things back into place”?
No. The spine doesn’t “go out” the way some claim. What you’re hearing during an adjustment is joint cavitation (gas release), not bones being “realigned.” Chiropractic care can help with mobility and pain, but not by magically repositioning bones.
❓Is it normal to be sold a 6-month or 12-month care plan?
Red flag. Unless you’re working on a long-term rehab goal (like athletic performance or chronic injury rehab), there’s no reason to commit upfront to extended packages. Care should evolve with your progress—not be pre-packaged.
❓What’s the deal with “one leg shorter than the other”?
In most people, this is either a measurement error or functional (caused by tight muscles). True structural leg length differences are rare and usually not clinically significant unless >2cm. You don’t need weekly visits to “fix” it.
❓Are X-rays necessary before starting treatment?
Only if medically indicated. Routine imaging without trauma, red flags, or neurological signs goes against best practice guidelines. Unnecessary X-rays can lead to overdiagnosis, fear, and wasted time.
❓Should I be worried about my posture?
Probably not. There’s no perfect posture—varied movement matters more. Posture is not the root of most pain, and blaming it can cause unhelpful fear and stiffness. Strength, mobility, and load tolerance are far more important.
❓Is the Activator tool legit?
It’s not useless—but it’s also not magical. It delivers very low-force impulses, which may help some patients. But if it’s the only treatment tool used, you may be missing out on more effective interventions like exercise and movementstrategies.
❓How many sessions should it take to feel better?
It depends on the condition, but many people see improvement within 4–6 visits. If you’re not progressing, your chiropractor should reassess and potentially refer out. You shouldn’t need care forever to manage a simple issue.
❓What makes a good chiropractor?
- Listens and explains clearly
- Uses evidence-based care
- Doesn’t rely on fear or gimmicks
- Offers a variety of treatment options
- Empowers you to self-manage and move better
Tags: #ChiropractorCapeTown #EvidenceBasedChiro #ChiropracticRedFlags #MythsBusted #PostureMyths #ActivatorTool #OneLegShorter #NoMoreFear