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Chiropractic Care Pocket Guide

Fast Facts

  • Chiropractic is one of the most popular forms of integrative health care in the United States. 1
  • National survey data show that 11 percent of U.S. adults used chiropractic care in 2022. Of the adults who used chiropractic care, 8 out of 10 used it for pain management. 2
  • According to the American Chiropractic Association, there are more than 70,000 active chiropractic licenses in the United States.
  • A survey by Gallup found that about 30% of patients with back or neck pain significant enough to seek care from a health professional sought care from a doctor of chiropractic. 3
  • A survey by Consumer Reports found that a year after treatment, 59 percent were highly satisfied with chiropractic treatment compared to 55 percent who saw a physical therapist and 34 percent who saw primary care physician.
  • Chiropractors are officially recognized and licensed in all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands.

What is Chiropractic?

Chiropractic focuses on the relationship between the structure of the body, mainly the spine, and its function. Chiropractors provide myofascial manual treatments for conditions affecting muscles, joints and nerves. 4

Chiropractors do not prescribe medication or perform surgery. The most common approach they use is spinal manipulation – applying a controlled, specific force to the spine and sometimes other joints to enhance joint motion, alignment and general flexibility.

  • Thermal therapies (heat, ice, paraffin bath, diathermy)
  • Therapeutic ultrasound
  • Cold laser or low-level laser therapy
  • Soft tissue friction, stretching, or strengthening techniques (active release technique, Graston, release, proprioceptive neuromuscular facilitation)
  • Electrotherapies (interferential current, microcurrent)
  • Relaxation and rehabilitation procedures
  • Neural mobilization
  • Corrective and general exercise
  • Taping/bracing
  • Counseling about diet, weight loss, smoking cessation and other lifestyle factors.

Increasingly, chiropractors can be found in conventional health delivery systems, including hospitals, multidisciplinary clinics, military and veteran’s health care facilities, and employee clinics.

Who practices spinal manipulation and mobilization?

Chiropractors are the most common practitioners of spinal manipulation and mobilization. Other providers using the techniques can include:

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

What does chiropractic spinal manipulation treat?

Much of the research on chiropractic focuses on joint manipulation for low back pain, 6 but it may also be helpful for the following conditions:

  • Back, neck and shoulder pain
  • Whiplash-associated disorders
  • Tension headaches
  • Sports injuries
  • Other joint- and muscle-related pain conditions

The main conditions for which experts recommend chiropractic treatment are low back and neck pain. 7

A global summit of experts in 2021 found that there is not yet much evidence that chiropractic care is effective for treating nonmusculoskeletal (muscle, bone and joint) conditions. The experts specifically looked at chiropractic care for colic in babies, asthma in children, high blood pressure, menstrual cramps, and migraine. Talk with your primary doctor or other primary health care provider about the best treatments for these conditions. 8

Can chiropractic care help with cancer?

While there has been some research on chiropractic care for cancer patients in recent years, the evidence is still limited. However, some studies suggest that it can improve quality of life and help manage symptoms. One study from Europe showed potential benefits for relieving pain, increasing mobility, and improving sleep patterns. 9

Chiropractic care is often used as part of whole person health by people with cancer. People with cancers of the bone or spinal cord, leukemia, myeloma or bone thinning and some who are taking blood thinners or steroid medications should not use chiropractic care. 10

Talk with your cancer care team about any chiropractic care you receive and make sure there are no reasons to stop or avoid chiropractic treatment. Researchers are still studying exactly how safe and effective this form of treatment can be for people with cancer.

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-rays. At the end, the provider typically explains your diagnosis and recommends a 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 supplements. This helps avoid any negative interactions between medications and 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 handouts at www.acatoday.org/Practice-Resources/Choosing-Wisely 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. 11 Another review published that year in Annals of Internal Medicine found similar results. Later studies have also found benefits. 12 Neither found any evidence of serious adverse events.

In 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 or spinal manipulation) before trying medication or more invasive procedures such as surgery. 13 Updated information is available from American Family Physician. 14

Chiropractic care for US military and veterans

Chiropractic care is among the services available to members of the US military. A 2024 directive from the US Veterans Administration specifies that military veterans can also receive chiropractic care, either at a VA health care facility or at a location in their community. 15 This is especially important because musculoskeletal pain is common among veterans.

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:

  • Cancer
  • Cardiovascular problems
  • Infections and major injuries
  • Certain pain problems
  • Congenital disease

Be wary of recommendations for intensive, long-term therapy, such as 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. 16

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. They must pass the National Board of Chiropractic Examiners (NBCE) four-part test before licensing and 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:

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. The Veterans Health Administration covers chiropractic care at veterans’ health centers and in the community. 17, 18

Should I tell my health care provider that I am seeing a chiropractor?

Yes, if he or she does not know already. This is especially true if you have any chronic health conditions or are being treated for cancer. Any health care provider is better equipped to help you if they are aware of other treatments you are receiving, and whole person health works best when your providers can work together.

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. National Center for Complementary and Integrative Health. Chiropractic: In depth. Available at www.nccih.nih.gov/health/chiropractic-in-depth. Accessed October 24, 2024.
  3. English, C. One in four adults sought care for neck/back pain last year. Gallup News. August 26, 2016. Available at https://news.gallup.com/poll/194984/one-four-adults-sought-care-neck-back-pain-last-year.aspx?g_source=Well-Being&g_medium=newsfeed&g_campaign=tiles. Accessed February 11, 2025.
  4. National Center for Complementary and Integrative Health. Chiropractic: In Depth. 2017; https://nccih.nih.gov/health/chiropractic/introduction.htm. Accessed October 28, 2024.
  5. 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.
  6. 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.
  7. Trager RJ, Bejarano G, Perfecto RT, Blackwood ER, Goertz CM. Chiropractic and spinal manipulation: a review of research trends, evidence gaps, and guideline recommendations. J Clin Med. 2024 Sep 24;13(19):5668. doi:10.3390/jcm13195668.
  8. Côté P, Hartvigsen J, Axén I, et al. The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature. Chiropr Man Therap. 2021 Feb 17;29(1):8. doi:10.1186/s12998-021-00362-Erratum in: Chiropr Man Therap. 2021 Mar 8;29(1):11. doi: 10.1186/s12998-021-00368-3.
  9. Laoudikou MT, McCarthy PW. Patients with cancer. Is there a role for chiropractic? J Can Chiropr Assoc. 2020 Apr;64(1):32-42. PMID: 32476666; PMCID: PMC7250516.
  10. Cancer Research UK. Chiropractic. Reviewed August 22, 2022. Available at www.cancerresearchuk.org/about-ancer/treatment/complementaryalternative-therapies/individual-therapies/chiropractic-care . Accessed October 29, 2024.
  11. 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.
  12. 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.
  13. 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.
  14. Smith MS, Olivas J, Smith K. Manipulative therapies: What works. Am Fam Physician. 2019 Feb 15;99(4):248-252. PMID: 30763049. www.aafp.org/pubs/afp/issues/2019/0215/p248.html
  15. Department of Veterans Affairs Veterans Health Administration. VA Directive 1210. March 8, 2024.
  16. 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.
  17. American Chiropractic Association. Insurance Coverage of Chiropractic: Quick Facts. www.acatoday.org/Patients/Access-Coverage/Insurance-Coverage. Accessed June 11, 2017.
  18. US Department of Veterans Affairs. VA’s Chiropractic Program. Available at www.rehab.va.gov/chiro. Accessed February 11, 2025.

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Topics: Back Pain | Chiropractic | Chronic Pain | Complementary Medicine | Headaches | Integrative Health

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