Chiropractic: An Introduction

© Matthew Lester

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.

Key Points 

• Most research on chiropractic has focused on spinal 

manipulation. Spinal manipulation appears to benefit some 

people with low-back pain and may also be helpful for 

headaches, neck pain, upper- and lower-extremity joint 

conditions, and whiplash-associated disorders.

• 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, but whether spinal manipulation 

actually causes these complications is unclear. Safety remains 

an important focus of ongoing research.

• Tell all your health care providers about any complementary health 

practices you use. Give them a full picture of what you do to manage 

your health. This will help ensure coordinated and safe care.

Overview and History 

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,
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and other health care providers (e.g., physical therapists or some osteopathic physicians) may 

use spinal manipulation.

Use in the United States

In the United States, chiropractic is often considered a complementary health practice. 

According to the 2007 National Health Interview Survey (NHIS), which included a comprehensive 

survey of the use of complementary health practices 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-ofpocket 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 practices 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.

Treatment 

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 followup 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.
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What the Science Says 

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. (For more information, see the Spinal 

Manipulation for Low-Back Pain fact sheet at nccam.nih.gov/health/pain/spinemanipulation.htm).

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 lowerextremity 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, midback pain, premenstrual syndrome, sciatica, and temporomandibular joint disorders).

Safety 

• 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:

o 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.

o 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.

Practitioners: Education and Licensure

Chiropractic colleges accredited by the Council on Chiropractic Education (CCE) offer Doctor of 

Chiropractic (D.C.) degree programs. (CCE is the agency certified by the U.S. Department of 

Education to accredit chiropractic colleges in the United States.) Admission to a chiropractic college 

requires a minimum of 90 semester hour credits of undergraduate study, mostly in the sciences.

Chiropractic training is a 4-year academic program that includes both classroom work and 

direct experience caring for patients. Coursework typically includes instruction in the 

biomedical sciences, as well as in public health and research methods. Some chiropractors 

pursue a 2- to 3-year residency for training in specialized fields.
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Chiropractic is regulated individually by each state and the District of Columbia. All states 

require completion of a Doctor of Chiropractic degree program from a CCE-accredited college. 

Examinations administered by the National Board of Chiropractic Examiners are required for 

licensing and include a mock patient encounter. Most states require chiropractors to earn 

annual continuing education credits to maintain their licenses. Chiropractors’ scope of 

practice varies by state in areas such as the dispensing or selling of dietary supplements and 

the use of other complementary health practices such as acupuncture or homeopathy.

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 practices you use. 

Give them a full picture of what you do to manage your health. This will help ensure 

coordinated and safe care. For tips about talking with your health care providers about 

complementary and alternative medicine, see NCCAM’s Time to Talk campaign at 

nccam.nih.gov/timetotalk/. 

NCCAM-Funded Research

NCCAM-supported research on chiropractic care includes projects that have focused on:

• Spinal manipulation for back pain, neck pain, and headache, as well as for other health 

conditions such as temporomandibular disorders

• Development of a curriculum to increase the understanding of evidence-informed practice 

in chiropractic educational institutions

• Influence of patients’ satisfaction with care on their response to treatment, in a study that 

compared chiropractic and medical care in a group of back-pain patients.

NCCAM also funded establishment of a developmental center for research in chiropractic at 

the Palmer Center for Chiropractic Research. Investigators at Palmer and at other partnering 

institutions conduct basic and clinical research on chiropractic treatment approaches, how 

they might work, and diseases and conditions for which they may be most helpful.
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References 

Agency for Health Care Policy and Research. Chiropractic in the United States: Training, Practice, and Research. Rockville, 

MD: Agency for Health Care Policy and Research; 1997. AHCPR publication no. 98-N002.

Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United 

States, 2007. CDC National Health Statistics Report #12. 2008.

Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy.

2010;18(3):1-33.

Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based 

case-control and case-crossover study. Journal of Manipulative and Physiological Therapeutics. 2009;32(2 Suppl):S201-

S208. (Republished from Spine. 2008;33(4 Suppl):S176-S183.)

Coulter ID, Hurwitz EL, Adams AH, et al. Patients using chiropractors in North America: who are they, and why are 

they in chiropractic care? Spine. 2002;27(3):291-296.

The Council on Chiropractic Education. Standards for Doctor of Chiropractic Programs and Requirements for Institutional 

Status January, 2007. The Council on Chiropractic Education Web site. Accessed at http://www.cceusa.org/Publications.html on November 23, 2009.

Dagenais S, Haldeman S. Chiropractic. Primary Care. 2002;29(2):419-437.

Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of 

Internal Medicine. 2002;137(12):965-973.

Ernst E. Chiropractic: a critical evaluation. Journal of Pain and Symptom Management. 2008;35(5):544-562.

Gouveia LO, Castanho P, Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine. 2009; 34(11):E405-E413.

Kanodia AK, Legedza AT, Davis RB, et al. Perceived benefit of complementary and alternative medicine (CAM) for back 

pain: a national survey. Journal of the American Board of Family Medicine. 2010;23(3):354-362.

Kaptchuk TJ, Eisenberg DM. Chiropractic: origins, controversies, and contributions. Archives of Internal Medicine. 

1998;158(20):2215-2224.

Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Annals 

of Internal Medicine. 2002;136(3):216-227.

Nahin RL, Barnes PM, Stussman BJ, et al. Costs of complementary and alternative medicine (CAM) and frequency of 

visits to CAM practitioners: United States, 2007. CDC National Health Statistics Report #18. 2009.

Theil HW, Bolton JE, Docherty S, et al. Safety of chiropractic manipulation of the cervical spine: a prospective national 

survey. Spine. 2007;32(21):2375-2378.

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on NCCAM and complementary health 

practices, including publications and searches of Federal databases of scientific and medical 

literature. The Clearinghouse does not provide medical advice, treatment recommendations, 

or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

TTY (for deaf and hard-of-hearing callers): 1-866-464-3615

Web site: nccam.nih.gov

E-mail: info@nccam.nih.gov
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A service of the National Library of Medicine, PubMed contains publication information and (in 

most cases) brief summaries of articles from scientific and medical journals.

Web site: www.ncbi.nlm.nih.gov/sites/entrez

ClinicalTrials.gov

ClinicalTrials.gov is a database of information on federally and privately supported clinical 

trials (research studies in people) for a wide range of diseases and conditions. It is sponsored 

by the National Institutes of Health and the U.S. Food and Drug Administration.

Web site: www.clinicaltrials.gov

Research Portfolio Online Reporting Tools Expenditures & Results (RePORTER)

RePORTER is a database of information on federally funded scientific and medical research 

projects being conducted at research institutions.

Web site: projectreporter.nih.gov/reporter.cfm

Acknowledgments 

NCCAM thanks the following individuals for their technical expertise and review of this 

publication: Gert Bronfort, D.C., Ph.D., Northwestern Health Sciences University; Joel Pickar, 

D.C., Ph.D., Palmer Center for Chiropractic Research; William Meeker, D.C., M.P.H., Palmer 

College-West; and Partap Khalsa, D.C., Ph.D., NCCAM.

This publication is not copyrighted and is in the public domain.

Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the 

medical expertise and advice of your primary health care provider. We encourage you to 

discuss any decisions about treatment or care with your health care provider. The mention of 

any product, service, or therapy is not an endorsement by NCCAM.

National Institutes of Health

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U.S. Department of Health and Human Services

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Created November 2007

Updated May 2012