Chiropractic care

Chiropractic care is hands-on treatment for back pain, neck pain and other joint and muscle problems. It is given by a chiropractor, a licensed health professional with a Doctor of Chiropractic (DC) degree.

The best-known treatment is spinal manipulation, often called an adjustment. The chiropractor uses their hands or a small tool to give a quick, controlled push to a joint in the spine. Chiropractors may also use gentler, slower movement of a joint (mobilization), hands-on work on tight muscles, and advice on exercise and daily activity.

Chiropractors are not the only ones who use spinal manipulation. Osteopathic physicians (DOs) and some physical therapists use it too.

No one knows exactly how spinal manipulation eases pain. Researchers think the quick push mainly acts on nerves and muscles. It may help tense, guarding muscles relax and change how the nervous system handles pain signals for a while.

You may hear that manipulation puts bones back in place or corrects a “subluxation.” Research has not shown that manipulation moves bones into a new position, and the subluxation idea has not been confirmed. That does not mean manipulation cannot help. Trials show modest benefits, likely for other reasons.

The pop you may hear is thought to come from a small pocket of gas forming in the fluid inside the joint. It is not a bone cracking, and relief does not seem to depend on hearing it.

Your first visit

The chiropractor usually asks about your pain, your health history and your medicines, and checks how you move. Before treating the neck, careful practitioners ask about headaches, dizziness and other symptoms that could point to a rare blood vessel problem.

X-rays and other scans are not usually needed for back pain without warning signs. If imaging is suggested, it is fair to ask why.

During a session

For a manipulation, you usually lie or sit on a padded table. The chiropractor positions you, then gives a quick, short push to one area.

You can ask for gentler techniques, especially for your neck, and you can ask the chiropractor to stop at any time.

After a session

Many chiropractors give stretches or exercises to do at home. For a new bout of low back pain, staying gently active tends to help more than resting in bed.

Care usually means several visits over a few weeks. It is fair to ask how many visits are planned and how progress will be judged.

Finding a chiropractor

Every state licenses chiropractors. You can check a license on your state licensing board’s website. A good sign is a chiropractor who explains the plan, sets goals with you and works with your other clinicians. The National Institutes of Health has tips on choosing a practitioner (opens in a new tab).

Most new back pain improves a lot over the first several weeks, whatever treatment people choose. The same is often true of neck pain.

The American College of Physicians includes spinal manipulation among the non-drug treatments to try first for low back pain, both new and long-lasting. It rated the evidence as low quality. [20]

For new low back pain, a review of 15 trials found manipulation gave modest improvements in pain and daily function for up to 6 weeks. For long-lasting low back pain, a large review found manipulation worked about as well as other recommended treatments, such as exercise or pain medicines. [1] [2]

On average the benefits are small to moderate, and results vary a lot from person to person. Studies comparing manipulation with a fake (sham) treatment are weak, so it is hard to know how much of the benefit comes from the manipulation itself. [1] [2] [23]

There is less research on neck pain than on low back pain. Gentle mobilization seems to work about as well as quick manipulation, and upper back manipulation may ease neck pain for a short time. [3]

Guidelines put the most weight on exercise and staying active. Hands-on care like manipulation is usually offered alongside those, not instead of them. [22] [24]

Common and short lived

• Soreness, stiffness or a mild headache after a visit. Some people also feel tired.
• In studies, about half of people or more noticed at least one of these. They usually started within hours and faded within a day or two.

Rare but serious

Overall, serious problems after spinal manipulation are rare.

Neck. Very rarely, a tear in an artery in the neck (cervical artery dissection) has been found around the time of neck manipulation. This kind of tear can lead to a stroke. Experts still debate whether manipulation causes these tears. A person may already have an early tear, which can cause neck pain or headache, and seek care for it. A large Canadian study found the same link with visits to primary care doctors. The American Heart Association advises that people be told about this rare risk before neck manipulation.

Low back. Rare cases of serious nerve problems have been reported after manipulation, such as pressure on the nerves at the base of the spine (cauda equina syndrome). In one large US records study, this was no more common after chiropractic care than after a physical therapy visit.

Take extra care

Tell your clinician and the chiropractor if you have had spine surgery, a recent neck injury, a past artery tear or stroke, osteoporosis, a past spinal fracture, cancer, a bleeding problem, a connective tissue condition such as Ehlers-Danlos syndrome, or inflammatory arthritis such as rheumatoid arthritis or ankylosing spondylitis, or if you take a blood thinner. These can make manipulation riskier or call for gentler methods.

Also mention numbness, tingling or weakness in your arms or legs, or trouble with balance or walking. These can be signs of pressure on nerves or the spinal cord that a clinician needs to check first.

Other downsides

• Care often means repeated visits, which take time and money. Coverage varies. Medicare covers some spinal manipulation by chiropractors, but not x-rays or other services they order.
• Relief is often temporary, and back and neck pain often come back.

Get emergency care right away (call 911) for any of these, especially after neck treatment: a sudden, severe headache or neck pain unlike any before, dizziness or loss of balance, double vision or loss of vision, a drooping face, trouble speaking or swallowing, weakness or numbness in the face, arms or legs, or trouble walking. Also get emergency care for new weakness or numbness in the legs, numbness in the groin or inner thighs, or new trouble controlling your bladder or bowels.