Buried in a court document mentioning Joe Mercola was the first reference to naprapathy I had ever seen. Joe Mercola has made a fortune selling dietary supplements and publishing health misinformation over the past few decades. The court case did not involve Mercola but rather a woman he had treated. In her lawsuit against a life insurance company, the plaintiff is described as having been bitten by a tick and contracting Lyme disease. After seeing Mercola (who tended to her with “diet and herbal treatments”), she went to see a naprapath. I had to do a double take. What exactly was a naprapath?
Naprapathy is a manual therapy, much like chiropractic, osteopathy, and massage therapy. It’s all about using hands to tug at and massage body parts, although it often also extends to dietary and exercise advice and to non-invasive complements like ultrasound therapy. Its scientific evaluation barely exists, and while some component of it might be salvageable, I’m not sure naprapaths themselves are right for the job.
Picking a bone with chiropractic
Oakley Smith had scarlet fever. His parents were well off, so they brought the young boy, who ended up being sickly for a long time, to a number of doctors, medical or otherwise. When they heard of a newfangled approach called chiropractic, they took him to Davenport, Iowa to see its founder, D.D. Palmer, who claimed to have cured a man of his deafness by realigning his spine. Smith experienced some relief from the chiropractic manipulations, so he stayed on as a student of Palmer’s and he graduated from his school in 1899.
Though Smith became the heir apparent to Palmer’s spine-cracking empire (by one historian’s account), there was a schism. Palmer believed that diseases were caused by subluxations, which he defined as misalignments of the spine. Today, people outside of the chiropractic profession agree that these chiropractic subluxations do not exist. Smith likewise did not believe in them. He did, however, stumble upon his own bugbear: connective tissue. The ligaments that join bones together, the tendons that tie muscles to those bones, and the fascia that covers our muscles and organs like a thin net, those were to blame for our ills, according to him. In 1908, having parted ways with the chiropractic profession, Oakley Smith moved to Chicago and eventually established a school, conveniently named the Oakley Smith School of Naprapathy.
The word “naprapathy” is a curious one and should not be confused with naturopathy. While the suffix “pathos” is common enough, denoting suffering and disease, where does “napra” come from? Iowa, in a manner of speaking. Oakley Smith had met “Bohemian people” in Cedar Rapids in the early 1900s. They showed him techniques to relieve the body of lower back pain, and these techniques were known in the Czech language as “napravit,” from the verb “to correct.” Smith integrated these methods to his practice, which he called “naprapathy,” meaning “to correct suffering.”
From there, naprapathy has had a strange migratory path. For the longest time, its base of operation was in Chicago, Illinois. When Patrick Nuzzo graduated from Smith’s school in 1983, he started organizing retreats to New Mexico, which led to the licensing of the naprapathic profession in that state in 2004 and the creation of Nuzzo’s school there in 2010, with dreams to expand to other states. (To this date, American naprapaths are only licensed in Illinois, New Mexico, Ohio, and Nevada.) Somehow, naprapathy made its way to Scandinavia, where it remains quite popular: there are, in fact, twice as many licensed naprapaths in Sweden than chiropractors. And even more strangely, a technique called naprapathy can also be found in China, where it seems to have become entangled with acupressure. In Canada, naprapaths have a self-governing national association, but naprapathy is not a regulated health profession like medicine or nursing.
In a video Nuzzo made, he explains that naprapathy is the best of two worlds: massage therapy and chiropractic. The former manipulates connective tissue but not bone, and vice versa for chiropractic. Naprapathy does both. It consists in manipulations like rocking, rolling, flicking, pressing-lifting, rubbing, clicking, pinching, kneading, and pushing. One of the central tenets of the practice is that the fascia, a normally viscous and well lubricated surface, can dry up. In drying up, it creates knots, and these knots pull bones out of alignment, leading to pain and an assortment of related problems.
I asked Paul Ingraham about this tenet. He is a former massage therapist who devotes his time to critically appraising the literature on the topic of pain and the many ways in which people say it can be relieved, including hands-on therapies. Is there anything to this theory of the dried-up fascia? “No, there is no truth to that, and I have definitely thought about it,” he wrote to me. Like so many One True Causes of All Diseases, this idea of the fascia drying up and pulling our bones out of alignment is speculative at best and is based on a simplistic view of what fascia is and how it behaves. “Fascia is to massage therapy,” and by extension to naprapathy as well, “what subluxation is to chiropractic.” A convenient villain.
Many of these alternatives to medicine (now sold to us as needing to be integrated to medicine) are the wild fantasies of one man who, in days of yore, decided to build an entire profession on top of a strange experience he had. See: homeopathy and chiropractic. And these fanciful notions—that often entail one cause of every disease and one proprietary cure-all—are based on eminence, not evidence. Nuzzo himself admits to it in a video from 2022: “If we can prove that those methods work, you know, and scientifically prove it in our studies and in our research, we really solidify naprapathic medicine.” The operating word here is not “medicine,” but rather “if.”
The published literature on naprapathy is bone-dry. The three trials done so far have all been conducted by the same Swedish research team, and although two of them are large studies, they all have major flaws. In the first trial, comparing naprapathy to staying active and receiving pain coping strategies for neck or back pain, the participants in the first group received much more time and attention than the people in the other group, which probably had an effect on the reported benefits. In the second trial, aiming to identify what types of techniques in naprapathy really help with neck and back pain, there was no placebo arm, so we don’t know what would have naturally happened (especially since participants were eligible if they had had the pain for a minimum of a single week, and we know that there is substantial improvement of, for example, low back pain within six weeks). By the way, in this trial, there was no difference in outcomes if the naprapaths withheld the spinal manipulations or the stretching from their interventions, which makes me wonder what, if anything, is benefitting the participants.
The third trial was quite small and the two groups (naprapathy versus control) were not comparable. The studies I could find on Chinese naprapathy were very limited, with one trial having been subsequently retracted due to evidence of systematic manipulation of the publication and peer review process. Manipulations on the body are key to naprapathy, but clearly these authors took the manipulations a bit too far.
Another salvage operation
As I dug into papers, websites, and videos dedicated to studying and promoting naprapathy, I noticed a number of old friends, i.e. red flags for pseudoscience. The Southwest University of Naprapathic Medicine website claims the goal of the practice is “to enhance the body’s ability to heal,” and helping the body heal itself is how pseudomedical practices are often sold. It goes on to say that unlike other methods, naprapathy treats the root cause of the pain, a common falsehood that asserts that medicine only addresses symptoms. Naprapaths are said to formulate a personalized treatment plan, in opposition to the perception that medical doctors prescribe universal solutions that fail because they are not properly tailored to the individual.
I have written before about osteopathy, a more popular cousin of naprapathy which was rehabilitated in the United States and turned into an equivalent of medicine. In fact, Oakley Smith saw an osteopath before being treated by D.D. Palmer and was thus aware of the practice of osteopathy. Although there are so many problems with these types of manual therapies—from the potential dangers of rapid thrusts of the head to the common unscientific belief that these techniques help the flow of a mystical life force, to the disappointing studies—I suspect that there is something to be rescued here. Paul Ingraham, who shares my sizeable skepticism, agrees. “There probably is a signal somewhere in all that noise,” he admits. Putting aside their pseudoscientific baggage, manual therapies feel good and massage can ease depression and anxiety, “one of its only proven benefits, which should not be underestimated,” he adds. Laying hands on the body and moving things around probably has some sort of systemic benefit—transient, perhaps, and maybe a bit unpredictable—but it will be hard, in my opinion, to properly tease these apart from the pseudoscientific sludge when the people doing the studies believe in the wild theories of Oakley Smith.
To make things worse, when Swedish naprapaths were recently asked if the treatments they offer lack evidence from clinical trials, two-thirds of them said no. And yet, the sum of three flawed trials is far from enough support for an entire practice. Getting a clear-headed evaluation of what might work in naprapathy is thus even harder when its practitioners believe in evidence that simply doesn’t exist.
Take-home message:
- Naprapathy is a hands-on therapy that focuses on massaging connective tissue to address a number of health problems and it was created by an American named Oakley Smith after he split from chiropractic in the early 1900s
- Although many naprapaths believe their practice is supported by clinical trials, the results of only three have been published and these studies contain major flaws
- Manual therapies like naprapathy may offer some benefits, but it is challenging to separate them from the overhyped claims and the pseudoscientific theories they rely on
Note: An earlier version of this article stated that American naprapaths were only licensed in Illinois and New Mexico. At the time of publication, they were also licensed in Ohio and Nevada. The article has been corrected.
