Who practices spinal manipulation and mobilization?

Spinal manipulation and mobilization are most commonly utilized by doctors of chiropractic but can also be part of treatment offered by the following providers:

• Osteopathic physicians
• Naturopathic physicians
• Physical therapists
• Some medical doctors

Future pocket guides will examine these professions.

What does chiropractic spinal manipulation treat?

Manipulating (“adjusting” is the term many chiropractors use) the spine is typically used to help joints to function better by inducing mobility, realigning joint and surrounding soft tissues, and reducing pain sensation and/or inflammation. The goal is often to correct how your spine functions, relieve pain and improve the overall well-being of the body.

Much of the research on chiropractic focuses on the practice of joint manipulation for low back pain, but it may also be helpful for the following conditions ⁵:

• Back, neck and shoulder pain
• Carpal tunnel syndrome
• Whiplash-associated disorders
• Headaches
• Sports injuries
• Other joint- and muscle-related pain conditions

What can I expect to happen at my chiropractic appointment?

Your first appointment will typically include a discussion of your health history and symptoms, an exam and sometimes diagnostic studies such as X-ray. At the end of it, the provider typically explains your diagnosis and recommends an individualized treatment plan that includes how long he or she believes you will need care.

Tips to make sure you receive the best treatment:

• Before you make an appointment, ask if your provider has specific training and expertise in evaluating and treating the symptoms you are experiencing.
• Be sure they hold a license in good standing in the state in which you live. This can often be confirmed online through a state licensing website.
• Tell your provider of any medical conditions you have and all medications you take – including prescription, over the counter, and/or supplements (to avoid any negative interactions between medications/supplements).
• It is best to give your provider as much information as you can about your personal health practices to help ensure that the care you receive is safe and appropriate.
• Review the “Choosing Wisely” patient handout http://consumerhealthchoices.org/wp-content/uploads/2017/11/ChoosingWiselySpinalCareACA-ER.pdf or visit SpineIQ.Org to learn more about chiropractic.

Is there evidence that chiropractic works?

The evidence supporting chiropractic has become stronger in recent years. A 2017 systematic review published in JAMA evaluated 15 randomized, controlled trials involving more than 1,700 patients. The authors found that spinal manipulation resulted in an objective, clinically significant improvement in pain by about 10 points on a 100-point scale – a treatment response similar to that seen with non-steroidal anti-inflammatory medications. ⁶ Another review published that year in Annals of Internal Medicine found similar results. ⁷ Neither found any evidence of serious adverse events.

In February 2017, the American College of Physicians released new guidelines for the treatment of acute, subacute and chronic back pain, recommending that patients use non-pharmacologic therapies (including massage, acupuncture and/ or spinal manipulation) before trying medication or more invasive procedures. ⁸

If you or your health care provider would like to read more research about how chiropractic can influence a particular health condition, see the National Center for Complementary and Integrative Health, U.S. National Institutes of Health (NIH) report on the effectiveness of chiropractic.

Are there precautions, side effects or safety concerns I should be aware of before I start chiropractic?

Spinal manipulation is widely considered a safe practice when performed by a trained and qualified chiropractor. Nevertheless, any treatment with the potential to help also carries some potential risk.

Precautions

Spinal manipulation alone may not be appropriate for certain conditions. Other therapies may also be needed. In some cases, spinal manipulation may simply be the wrong treatment. Examples where spinal manipulation is typically not appropriate include:

• A spinal infection
• Around a known bone tumor
• Problems with visceral organs
• Congenital scoliosis
• Surgical hardware placed into your body

Caution should be used if you are seeking only the care of a single provider, including a chiropractor, to treat a complex or serious condition. Examples of situations where a multidisciplinary team is often needed include:

• Cardiovascular problems
• Bone weakness (osteoporosis)
• Infections and major injuries
• Certain pain problems
• Congenital disease

Be wary of recommendations for intensive, long-term therapy, e.g., three times a week for months. These recommendations are not based in scientific evidence. Also, X-rays are not always necessary before beginning chiropractic.

Side Effects

Common side effects include:

• Temporary headache
• Tiredness
• Temporary soreness or discomfort in the parts of the body that were treated

Although there has been some concern about the risk of vertebrobasilar artery injury (VBA) leading to stroke after
chiropractic care, current research evidence finds no significant association with spinal manipulation. ⁹

What training/certifications do chiropractors have?

In the U.S., a doctor of chiropractic (DC) has completed four to five years of doctoral level training in a nationally accredited program that requires at least 4,200 hours of classroom, laboratory and clinical experience. Most will also have completed a pre-med or similar program in undergraduate school – in all, at least seven academic years of higher education after high school.

Students must fulfill strict academic requirements for science-based coursework prior to entering a chiropractic doctorate program. Chiropractic training programs are dually accredited by the Council on Chiropractic Education (recognized by the U.S. Department of Education) and a regional accrediting body such as the Higher Learning Commission of the North Central Association of Colleges and Schools.

All states license chiropractors and most states designate DCs as physician-level providers. The National Board of Chiropractic Examiners (NBCE) four-part test must be passed prior to licensing, and chiropractors must complete continuing education hours each year to maintain their licenses. Some chiropractors undergo additional formal training and receive advanced certifications in radiology, sports, nutrition, pediatrics and other specialties.

Although chiropractors are licensed, in most states they cannot write prescriptions for drugs or perform surgery.

While the chiropractic profession is strongly associated with the spine and extremities, students also receive training in physical diagnosis, including abdominal, lung, heart and even reproductive exams, as some systemic conditions can mimic musculoskeletal complaints.

How do I find a chiropractor near me?

The following websites can help you locate a chiropractor in your area:

• American Chiropractic Association
• Spine-health
• U.S. Chiropractic Directory
• Chirofind.com

You may also want to check your insurance company’s website for a searchable database of chiropractors within their network that are covered by your insurance.

Does my insurance company cover chiropractic?

Most insurance plans, including Medicare and some Medicaid plans, as well as most military and federal employee plans, cover chiropractic. ¹⁰

Should I inform my physician that I am seeing a chiropractor?

If your physician does not know you are receiving treatment from a chiropractor, you should inform him or her. Any health care provider is better equipped to help you if they are aware of other treatments you are receiving.

References

1. Clarke T, Black LI, Stussman BJ, et al. Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002–2012. Centers for Disease Control and Prevention,;2015.
2. Gallup Pain Management Research Brief, released Sept. 12, 2017 http://news.gallup.com/poll/184910/majority-say-chiropractic-works-neck-back-pain.aspx Accessed November 15, 2017.
3. Martin BI, Gerkovich MM, Deyo RA, et al. The association of complementary and alternative medicine use and health care expenditures for back and neck problems. Med Care. 2012;50(12):1029-1036.
4. Consum Rep. March 17, 2017. http://www.consumerreports.org/cro/2013/01/relief-for-your-aching-back/index.htm. Accessed June 12, 2017.
5. National Center for Complementary and Integrative Health. Chiropractic: In Depth. 2017; https://nccih.nih.gov/health/chiropractic/introduction.htm. Accessed October 17, 2017.
6. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
7. Chou R, Deyo R, Friedly J, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(7):493-505.
8. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514- 530.
9. Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015;23:19.
10. American Chiropractic Association. Insurance Coverage of Chiropractic: Quick Facts. https://www.acatoday.org