Chiropractic: what it is and what is known

Chiropractic is a hands-on approach to back, neck and joint problems built mainly around spinal manipulation. Most people try it for low-back pain, neck pain or headaches. The research suggests small benefits for low-back pain, about as large as other recommended options, while the evidence for other uses is limited.

What it is

The chiropractic profession began in the United States in 1895, founded by D.D. Palmer, who went on to form what became Palmer College of Chiropractic. In 2022, 11 percent of US adults had seen a chiropractor in the past year, up from 7.4 percent in 2002.

A chiropractor’s main tool is spinal manipulation. The practitioner applies a controlled thrust with the hands or a small device to a spinal joint, moving it a little further than it would go on its own. A gentler method, mobilization, uses no thrust and stays within the joint’s natural range. Chiropractors also suggest exercises and give advice on lifestyle and diet. Osteopathic physicians and physical therapists use manipulation too.

Practitioners say a chiropractic adjustment improves how the spine moves, eases pain and helps keep bones, joints and muscles healthy. The profession focuses on disorders of the musculoskeletal and nervous systems. Many chiropractors also hold that these problems affect general health, so their care can support overall wellbeing.

What a session is like

Your first visit usually starts with questions about your health history and a physical exam focused on your spine. Sometimes the chiropractor orders X-rays or other tests. For the adjustment itself, you usually lie face down on a padded table. The chiropractor positions you and applies a controlled force to one joint at a time, by hand or with a small instrument.

You may hear popping or cracking sounds. Mild soreness or stiffness afterward is common. For low-back pain, several sessions may be needed.

Questions worth asking before you book:

• What is your education and licensure, and how much experience do you have with my condition?
• How many sessions do you expect, and what should I notice if it is helping?
• What will it cost, and does my insurance cover it?
• Can you use mobilization instead of thrust techniques, especially on my neck?

What research says

The clearest evidence is for low-back pain. The US National Center for Complementary and Integrative Health (NCCIH) reports that, for recent-onset low-back pain, a 2017 analysis found moderate-quality evidence of a modest improvement in pain and function, similar to common anti-inflammatory medicines. For long-lasting low-back pain, a 2019 review of 47 studies found pain relief at one month similar to other recommended approaches such as exercise, with slightly better function. A 2017 American College of Physicians guideline lists manipulation as one of several options for low-back pain but rates the strength of the evidence as low. NCCIH’s bottom line is that spinal manipulation may lead to small improvements in pain and function for low-back pain.

Elsewhere the support is weaker. For neck pain, the studies are small and inconsistent. For headaches that start in the neck, and for migraine, the results are preliminary. Studies on sciatica had many limitations. For conditions outside muscles and joints, such as high blood pressure or menstrual cramps, a 2021 review found only six adequate studies, and none showed a clear benefit.

Who should be careful

Most side effects are mild: soreness, stiffness, headache or tiredness that usually fade within a day or a few days. Rarely, people have had a herniated disk or a worsened one, nerve compression in the lower spine, or strokes involving the neck arteries. Neck manipulation has been linked to tears in neck arteries. Whether manipulation causes these tears is disputed, but you should be told about the risk.

Avoid adjustments if you have severe osteoporosis, cancer in the spine, a higher risk of stroke, a known problem with the bones of the upper neck, or numbness, tingling or weakness in an arm or leg. The NHS adds blood-thinning medicines or a bleeding tendency, very weak or damaged bones or joints, and nerve conditions such as peripheral neuropathy. If you are pregnant, talk to your provider first. Tell the chiropractor about your medicines and supplements, and do not let visits delay a proper medical assessment.

If you have back or neck symptoms that are new, severe or not improving, see a doctor or other licensed clinician rather than relying on chiropractic alone.

How it fits with the pillars

Chiropractic sits firmly in the body pillar. It is a hands-on, joint-focused approach to back and neck problems, and chiropractors are also trained to recommend therapeutic and rehabilitative exercises.

If you want something gentle to do at home, a morning stretch routine is a simple complement, whether or not you decide to see a chiropractor.