It is not clear whether spinal manipulation is useful or safe for patients with sciatica and herniated discs. People with back injury from disease, malformation, or previous surgery should not use chiropractic. When spinal manipulation is performed, a patient first lies on his or her side. The chiropractor grasps the exposed shoulder and either the hip or knee and then presses the upper and lower portions of the body in opposite directions, so that the torso rotates. The shifting vertebrae make a cracking sound.
Chiropractors are more expensive than other health care providers.
Chiropractic treatment does not rule out standard medical therapy, and the patient should be sure that a physician has done a diagnostic work-up for medical conditions that might be causing the low back pain before seeing a chiropractor. It appears to be more beneficial for men than women. One study reported that a course of cognitive-behavioral therapy helped reduce chronic back pain and enhanced the patients' ability to deal with it. The primary goal of cognitive therapy in such cases is to change the distorted perceptions that patients have of themselves and their approach to pain. Using specific tasks and self-observation, patients gradually shift their fixed ideas that they are helpless against the pain that dominates their lives to the perception that pain is only one negative and, to a degree, a manageable experience among many positive ones.