Chiropractic is a health care profession. Chiropractors perform adjustments (manipulations) to the spine or other parts of the body. The goal is to correct alignment problems, ease pain, and support the body's natural ability to heal itself. They may also use other treatments including

• Heat and ice
• Electrical stimulation
• Relaxation techniques
• Rehabilitative and general exercise
• Counseling about diet, weight loss, and other lifestyle factors
• Dietary supplements

Many people visit chiropractors for treatment of low back pain, neck pain, and headaches.

Chiropractic is a health care profession that focuses on the relationship between the body's structure—mainly the spine—and its functioning. Although practitioners may use a variety of treatment approaches, they primarily perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body's natural ability to heal itself.

The term “chiropractic” combines the Greek words cheir (hand) and praxis (practice) to describe a treatment done by hand. Hands-on therapy—especially adjustment of the spine—is central to chiropractic care. Chiropractic is based on the notion that the relationship between the body’s structure (primarily that of the spine) and its function (as coordinated by the nervous system) affects health.

Spinal adjustment/manipulation is a core treatment in chiropractic care, but it is not synonymous with chiropractic. Chiropractors commonly use other treatments in addition to spinal manipulation, and other health care providers (e.g., physical therapists or some osteopathic physicians) may use spinal manipulation.

In the United States, chiropractic is often considered a complementary health approach. According to the 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of the use of complementary health approaches by Americans, about 8 percent of adults (more than 18 million) and nearly 3 percent of children (more than 2 million) had received chiropractic or osteopathic manipulation in the past 12 months. Additionally, an analysis of NHIS cost data found that adults in the United States spent approximately $11.9 billion out-of-pocket on visits to complementary health practitioners—$3.9 billion of which was spent on visits to practitioners for chiropractic or osteopathic manipulation.

Many people who seek chiropractic care have low-back pain. People also commonly seek chiropractic care for other kinds of musculoskeletal pain (e.g., neck, shoulder), headaches, and extremity (e.g., hand or foot) problems.

An analysis of the use of complementary health approaches for back pain, based on data from the 2002 NHIS, found that chiropractic was by far the most commonly used therapy. Among survey respondents who had used any of these therapies for their back pain, 74 percent (approximately 4 million Americans) had used chiropractic. Among those who had used chiropractic for back pain, 66 percent perceived “great benefit” from their treatments.

During the initial visit, chiropractors typically take a health history and perform a physical examination, with a special emphasis on the spine. Other examinations or tests such as x-rays may also be performed. If chiropractic treatment is considered appropriate, a treatment plan will be developed.

During follow-up visits, practitioners may perform one or more of the many different types of adjustments and other manual therapies used in chiropractic care. Given mainly to the spine, a chiropractic adjustment involves using the hands or a device to apply a controlled, rapid force to a joint. The goal is to increase the range and quality of motion in the area being treated and to aid in restoring health. Joint mobilization is another type of manual therapy that may be used.

Chiropractors may combine the use of spinal adjustments and other manual therapies with several other treatments and approaches such as:

• Heat and ice
• Electrical stimulation
• Relaxation techniques
• Rehabilitative and general exercise
• Counseling about diet, weight loss, and other lifestyle factors
• Dietary supplements.

• Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated.
• There have been rare reports of serious complications such as stroke, cauda equina syndrome (a condition involving pinched nerves in the lower part of the spinal canal), and worsening of herniated discs, although cause and effect are unclear.
• Safety remains an important focus of ongoing research:
  • A 2007 study of treatment outcomes for 19,722 chiropractic patients in the United Kingdom concluded that minor side effects (such as temporary soreness) after cervical spine manipulation were relatively common, but that the risk of a serious adverse event was “low to very low” immediately or up to 7 days after treatment.
  • A 2009 study that drew on 9 years of hospitalization records for the population of Ontario, Canada analyzed 818 cases of vertebrobasilar artery (VBA) stroke (involving the arteries that supply blood to the back of the brain). The study found an association between visits to a health care practitioner and subsequent VBA stroke, but there was no evidence that visiting a chiropractor put people at greater risk than visiting a primary care physician. The researchers attributed the association between health care visits and VBA stroke to the likelihood that people with VBA dissection (torn arteries) seek care for related headache and neck pain before their stroke.

Researchers have studied spinal manipulation for a number of conditions ranging from back, neck, and shoulder pain to asthma, carpal tunnel syndrome, fibromyalgia, and headaches. Much of the research has focused on low-back pain, and has shown that spinal manipulation appears to benefit some people with this condition.

A 2010 review of scientific evidence on manual therapies for a range of conditions concluded that spinal manipulation/mobilization may be helpful for several conditions in addition to back pain, including migraine and cervicogenic (neck-related) headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders. The review also identified a number of conditions for which spinal manipulation/mobilization appears not to be helpful (including asthma, hypertension, and menstrual pain) or the evidence is inconclusive (e.g., fibromyalgia, mid-back pain, premenstrual syndrome, sciatica, and temporomandibular joint disorders).

If You Are Thinking About Seeking Chiropractic Care

• Ask about the chiropractor’s education and licensure.
• Mention any medical conditions you have, and ask whether the chiropractor has specialized training or experience in the condition for which you are seeking care.
• Ask about typical out-of-pocket costs and insurance coverage. (Chiropractic is covered by many health maintenance organizations and private health plans, Medicare, and state workers’ compensation systems.)
• Tell the chiropractor about any medications (prescription or over-the-counter) and dietary supplements you take. If the chiropractor suggests a dietary supplement, ask about potential interactions with your medications or other supplements.
• Tell all of your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

If you’re looking for a complementary health practitioner to help treat a medical problem, it is important to be as careful and thorough in your search as you are when looking for conventional care.

Here are some tips to help you in your search:

1. If you need names of practitioners in your area, first check with your doctor or other health care provider. A nearby hospital or medical school, professional organizations, state regulatory agencies or licensing boards, or even your health insurance provider may be helpful. Unfortunately, the National Center for Complementary and Integrative Health (NCCIH) cannot refer you to practitioners.

2. Find out as much as you can about any potential practitioner, including education, training, licensing, and certifications. The credentials required for complementary health practitioners vary tremendously from state to state and from discipline to discipline.

   Once you have found a possible practitioner, here are some tips about deciding whether he or she is right for you:

3. Find out whether the practitioner is willing to work together with your conventional health care providers. For safe, coordinated care, it’s important for all of the professionals involved in your health to communicate and cooperate.

4. Explain all of your health conditions to the practitioner, and find out about the practitioner’s training and experience in working with people who have your conditions. Choose a practitioner who understands how to work with people with your specific needs, even if general well-being is your goal. And, remember that health conditions can affect the safety of complementary approaches; for example, if you have glaucoma, some yoga poses may not be safe for you.

5. Don’t assume that your health insurance will cover the practitioner’s services. Contact your health insurance provider and ask. Insurance plans differ greatly in what complementary health approaches they cover, and even if they cover a particular approach, restrictions may apply.

6. Tell all your health care providers about the complementary approaches you use and about all practitioners who are treating you. Keeping your health care providers fully informed helps you to stay in control and effectively manage your health.

What is spinal manipulation?

• Spinal manipulation is also called spinal manipulative therapy. It’s a technique where practitioners use their hands or a device to apply a controlled thrust (that is, a force of a specific magnitude or degree in a specific direction) to a joint of your spine. The amount of force can vary, but the thrust moves the joint more than it would on its own. Spinal manipulation is different from spinal mobilization, which doesn’t involve a thrust (and is performed within a joint’s natural range of motion and can be controlled by the patient).
• Most spinal manipulations are done by chiropractors (chiropractic treatment often involves spinal manipulation), although other licensed professionals including osteopathic physicians and physical therapists also do spinal manipulations.
• Spinal manipulation is one of the most common complementary health approaches used by adults and children in the United States, the 2012 National Health Interview Survey (NHIS) showed.

Why do people use spinal manipulation?

Among U.S. adults who used chiropractic or osteopathic manipulation, about 67 percent used it to treat a specific health condition, and 53 percent used it for wellness, the 2012 NHIS found. Specifically:

• 43 percent used it for general wellness or disease prevention
• 25 percent used it because it focuses on the whole person—their mind, body, and spirit
• 16 percent used it for improved energy
• 11 percent used it for better immune function
• 5 percent used it to improve memory or concentration.

Previous research found that people report positive experiences and reduced pain as a result of receiving spinal manipulation, the NHIS authors noted.

Who uses spinal manipulation and has usage changed?

Between 2012 and 2017, U.S. adults’ use of chiropractic care (which usually involves spinal manipulation) during the past year increased slightly, from 9.1 percent to 10.3 percent, a comparison of NHIS data from the two years showed. The data also show that women were more likely than men to see a chiropractor, and that adults between the ages of 45 and 64 were more likely than people aged 18-44 or 65 and over to have visited one during the past year. According to the same national survey (by the Centers for Disease Control and Prevention’s National Center for Health Statistics), non-Hispanic white adults were much more likely to visit a chiropractor (12.7 percent) than Hispanic (6.6 percent) or non-Hispanic black (5.5 percent) adults.

Among children, there was no significant difference in the use of chiropractic care between 2012 and 2017 (3.5 percent versus 3.4 percent). Older children (age 12 to 17) were more likely than younger ones (age 4 to 11) to have seen a chiropractor, but there was no significant difference in the use of chiropractic care between girls and boys. Non-Hispanic white children were more likely than non-Hispanic black or Hispanic children to have seen a chiropractor.

What are some of the pain conditions for which spinal manipulation has been used?

For Sciatica

• Sciatica is pain associated with the sciatic nerve, which controls muscles in the back of the knee and the lower leg; it also provides feeling to the back of the thigh, part of the lower leg, and the sole of the foot.
• Manipulation isn’t widely used to treat sciatica but it may help, a 2015 research review of a variety of sciatica treatments suggests. However, the studies had many limitations, the authors noted.
• In a 2014 study of 192 people with leg pain associated with back pain, participants who received spinal manipulation, personal instruction, and exercises had less pain after 12 weeks and used less medication a year later than participants who received only personal instruction and exercises. However, leg pain was the same for both groups after 1 year.

For Low-Back Pain

Many noninvasive treatments are available for low-back pain, and these include drugs and nondrug options. In its 2017 clinical guidelines, the American College of Physicians (ACP) suggests that spinal manipulation is one of a number of therapeutic options that may help people with acute or chronic low-back pain (although the ACP says the quality of the evidence is low).

• Spinal manipulation was better than placebo for immediate, short-term relief from acute or subacute low-back and neck pain, a 2010 research review concluded. Manipulation was also better than acupuncture for chronic low-back pain. However, the results of studies comparing spinal manipulation to massage, medication, or physical therapy were mixed.
• A 2011 review of 26 studies concluded that for chronic low-back pain, spinal manipulation works as well as other commonly recommended approaches, including exercise or physical therapy. However, the effect on pain was minimal.
• Twelve sessions of spinal manipulation may be the best “dose,” according to a 2014 NCCIH-funded study of 400 people with chronic low-back pain.
• In a 2014 study of 110 participants with chronic low-back pain, those who received spinal manipulation had less sensitivity to painful stimuli right after getting spinal manipulation, compared to people who got sham spinal manipulation. But after a couple of weeks the two groups had similar amounts of pain and disability, the study showed. The study was supported by NCCIH.
• The Agency for Healthcare Research and Quality (AHRQ) systematic review of noninvasive nonpharmacologic treatment for chronic pain reported that spinal manipulation was associated with slightly greater effects than sham manipulation, usual care, an attention control, or a placebo intervention in the short term (i.e., 1-6 months following treatment) and intermediate term (i.e., 6-12 months). The report concluded the strength of the evidence was low. In addition, the report concluded that there was no evidence of differences between spinal manipulation versus sham manipulation, usual care, an attention control, or a placebo intervention in short-term pain, but manipulation was associated with slightly greater effects than controls on intermediate-term pain. The standard of evidence was considered low for short-term effects and moderate for intermediate-term effects.
• The research on spinal manipulation for acute low-back pain is generally mixed and has many limitations.
  • Spinal manipulation is no more effective for acute low-back pain than sham (fake) spinal manipulation, or when added to another treatment such as standard medical care, a 2012 research review of 20 studies found. Spinal manipulation appeared to be safe when compared to other treatment options.
  • In a 2015 study of 220 people with acute low-back pain, participants who received physical therapy, which included spinal manipulation, fared no better than those who received standard care.
  • However, a 2015 NCCIH-funded study of 107 adults with recent-onset acute and subacute low-back pain found that those receiving spinal manipulation got greater short-term relief, compared to participants getting standard medical care. Furthermore, the study compared two different techniques—manual thrust manipulation (MTM) and mechanical assisted manipulation (MAM)—and found MTM led to greater short-term reductions in self-reported pain and disability than MAM or usual care.
  • A 2017 analysis examined data from 15 randomized controlled trials with almost 1,700 participants. The researchers concluded that spinal manipulative therapy can modestly improve pain and function in people with acute low-back pain.
• Results of a 2018 study with 750 active duty U.S. military personnel with low-back pain found that those who received chiropractic care in addition to usual care had better short-term improvements in low-back pain intensity and pain-related disability than those who only received usual medical care.

For Neck Pain

• For patients with acute neck pain, either spinal manipulation or home exercises appeared to be more effective than medication in the short and long term, an NCCIH-funded study of 272 patients showed in 2012. A 2015 research review that looked at results from 51 trials with 2,920 participants also reported that there’s weak evidence that spinal manipulation may provide short-term relief from acute or chronic neck pain.

For Headache

• For preventing migraines, spinal manipulation may be one of several complementary health approaches (including massage therapy) that’s as helpful as medications used for migraine prevention, but the research isn’t conclusive.
• The AHRQ systematic review of noninvasive nonpharmacologic treatment for chronic pain reported spinal manipulation therapy was associated with slight to moderate improvements in function compared to usual care on the Headache Impact Test and the Headache Disability Inventory (scale 0-100) and in pain over the short term (i.e., 1-6 months) in one trial. The standard of evidence was rated as low.

For Other Conditions

• Researchers have studied spinal manipulation for many other conditions, including fibromyalgia, children’s ear infections, chronic obstructive pulmonary disease (COPD), infant colic, and bedwetting, but there’s too little evidence to know if it helps with these problems.
• Spinal manipulation doesn’t help with asthma, hypertension, or menstrual pain, studies show.

Is spinal manipulation safe?

Spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects of spinal manipulation are temporary muscle soreness, stiffness, or a temporary increase in pain.

Serious complications, deaths, and delays in diagnosis of serious illnesses have been associated with spinal manipulation, including in children, but are very rare.

Strokes and Artery Tears

• A type of spinal manipulation that focuses on the neck has been linked to small, potentially dangerous tears in the artery walls in the neck, called cervical artery dissections (CAD). These tears are rare but can lead to a stroke. Any kind of sudden neck movement, such as playing sports, getting whiplash, and violent vomiting or coughing may also increase the risk of tears. The available evidence suggests that the incidence of CAD in people getting spinal manipulation is low, but patients need to be informed of this potential risk.

Spinal Manipulation and Pregnancy

• There are few reports of spinal manipulation causing problems during pregnancy or in the period after childbirth, a 2012 research review reported. The problems that have been reported ranged from mild, temporary pain to life-threatening injuries. Serious adverse events occurred only after cervical spinal manipulation.

NCCIH-Funded Research

NCCIH-supported studies have been investigating:

• The clinical impact spinal manipulation/chiropractic may have on chronic low-back pain in U.S. veterans
• How spinal manipulation compares with prescription drug therapy for long-term management of chronic low-back pain in older adults
• How to optimize spinal manipulation treatment protocols for patients with low-back pain
• Patients’ experiences and satisfaction with chiropractic care for chronic neck pain
• How to best provide chiropractic care for veterans with musculoskeletal pain and mental health disorders.

More to Consider

• In a 2017 clinical practice guideline, the ACP suggested that spinal manipulation remains a recommended treatment option for chronic low-back pain, saying that it is one of several options that show some evidence of effectiveness.
• Before selecting a chiropractor:
  • Ask about the chiropractor’s education and licensure.
  • Tell the chiropractor about all of your medical conditions.
  • Ask if the chiropractor has specialized training or experience treating your condition.
  • Ask about how many sessions you’ll need and typical out-of-pocket costs and insurance coverage. (Medicare Part B covers manual manipulation of the spine if it is determined to be medically necessary.)
  • Tell the chiropractor about any medications (prescription or over-the-counter) and dietary supplements you take. If the chiropractor suggests a dietary supplement, ask about potential interactions with your medications or other supplements.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.