What is chiropractic?
Chiropractic (which comes from the Greek word meaning “done by hand”) concentrates on manipulating the spine and other joints to treat illnesses. It is based on the belief that because the nervous system controls the body, correcting the spine can treat a variety of illness. Daniel David Palmer founded chiropractic in 1895. Palmer was a self taught healer who was studying spinal structure and manipulative techniques when he reportedly restored the hearing of a deaf man by realigning a displaced vertebra in his back. Palmer believed that most diseases were a result of abnormal nerve signals, caused by “vertebral subluxation” (misalignment of the spine). Although today most chiropractors use other therapies as well, spinal manipulation remains at the center of chiropractic. There are more than 60,000 active human chiropractic licenses in the United States, and acceptance among the population is increasing. According to a study in 2010, the total number of U.S. adults who visited a chiropractor jumped 57%, from 7.7 million in 2000 to 12.1 million in 2003. This is a higher percentage than yoga, massage, acupuncture, or other diet based therapies.
What conditions are treated effectively with chiropractic?
Chiropractic has been shown to be effective for acute and chronic back pain, neck pain, and join paint. In humans, preliminary evidence suggests it may also help treat frozen shoulder, tennis elbow and other sports injuries, carpal tunnel syndrome, otitis media (ear infection), digestive problems, menstrual and premenstrual pain, attention deficit hyperactivity disorder (ADHD), and asthma. Many people also use chiropractic to treat headaches, fatigue, and other health issues.
Use in the United States
In the United States, chiropractic is 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.
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.
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.
What the Science Says
Researchers have studied spinal manipulation for a number of conditions in humans 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 on human use, see the Spinal Manipulation for Low-Back Pain fact sheet.
A 2010 review of scientific evidence on manual therapies in humans 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 lower-extremity 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, mid-back pain, premenstrual syndrome, sciatica, and temporomandibular joint 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, 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:
- A 2007 study of treatment outcomes for 19,722 human 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.
US Government Funded Research
The National Center Complementary and Alternative-Medicine of the National Institutes of Health is supporting research on chiropractic care in humans that includes projects focusing 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.
References (in human medicine)
- 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 www.cce-usa.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.
Alcantara J, Davis J. The chiropractic care of children with attention-deficit/hyperactivity disorder: a retrospective case series. Explore (NY). 2010;6(3):173-82.
Alcantara J, Cossette M. Intractable migraine headaches during pregnancy under chiropractic care. Complement Ther Clin Pract. 2009;15(4):192-7.
Bakris G, Dickholtz M Sr, Meyer PM, et al., Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens. 2007;21(5):347-52.
Balon JW, Mior SA. Chiropractic care in asthma and allergy. Ann Allergy Asthma Immunol. 2004;93(2 Suppl 1):S55-60.
Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. J Manipulative Physiol Ther. 2006;29(2):107-14.
Davis MA, Sirovich BE, Weeks WB. Utilization and expenditures on chiropractice care in the United States from 1997 to 2006. Health Serv Res. 2010;45(3):748-61.
DeVocht JW. History and overview of theories and methods of chiropractic: a counterpoint. Clin Orthop Relat Res. 2006;444:243-9.
Erfanian P, Tenzif S, Guerriero RC. Assessing effects of a semi-customized experimental cervical pillow on symptomatic adults with chronic neck pain with and without headache. JCCA J Can Chiropr Assoc. 2004;48(1):20-8.
Ernst E. Chiropractic manipulation for non-spinal pain–a systematic review. N Z Med J. 2003;116(1179):U539.
Ernst E. Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials. Int J Clin Pract. 2009 Sep;63(9):1351-3.
Ernst E. Chiropractic treatment for fibromyalgia: a systematic review. Clin Rheumatol. 2009 Oct;28(10):1175-8.
Fernandez-de-las-Penas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC. Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache. J Orthop Sports Phys Ther. 2006;36(3):160-9.
Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol. 2007;118(2):391-402.
Haneline MT. Chiropractic manipulation and acute neck pain: a review of the evidence. J Manipulative Physiol Ther. 2005;28(7):520-5.
Hawk C, Cambron J. Chiropractic care for older adults: effects on balance, dizziness, and chronic pain. J Manipulative Physiol Ther. 2009 Jul-Aug;32(6):431-7.
Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW. Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med. 2007;13(5):491-512.
Hawk C, Rupert RL, Colonvega M, Boyd J, Hall S. Comparison of bioenergetic synchronization technique and customary chiropractic care for older adults with chronic musculoskeletal pain. J Manipulative PhysiolTher. 2006;29(7):540-9.
Hertzman-Miller RP, Morgenstern H, Hurwitz EL, et al. Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low back pain study. Am J Public Health. 2002;92(10):1628-1633.
Hoskins W, McHardy A, Pollard H, Windsham R, Onley R. Chiropractic treatment of lower extremity conditions: a literature review. J Manipulative Physiol Ther. 2006;29(8):658-71.
Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6 month follow-up outcomes from the UCLA low back pain study. Spine. 2002;27(20):2193-2204.
Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health. 2002;92(10):1634-1641.
Hurwitz EL, Morgenstern H, Kominski GF, Yu F, Chiang LM. A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study.Spine. 2006;31(6):611-21; discussion 622.
Leaver AM, Refshauge KM, Maher CG, Latimer J, Herbert RD, Jull G, McAuley JH. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial. BMC Musculoskelet Disord. 2007;8:18.
Lenssinck ML, Damen L, Verhagen AP, et al., The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain. 2004;112(3):381-8.
Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Ann Intern Med. 2002;136(3):216-227.
Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal manipulation for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2006;3:CD002119.
Radpasand M, Owens E. Combined multimodal therapies for chronic tennis elbow: pilot study to test protocols for a randomized clinical trial. J Manipulative Physiol Ther. 2009 Sep;32(7):571-85.
Ricotti V, Delanty N. Use of complementary and alternative medicine in epilepsy. Curr Neurol Neurosci Rep. 2006;6(4):347-53.
Rowe DE, Feise RJ, Crowther ER, et al., Chiropractic manipulation in adolescent idiopathic scoliosis: a pilot study. Chiropr Osteopat. 2006;14:15.
Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6(2):131-7.
Shearar KA, Colloca CJ, White HL. A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. J Manipulative Physiol Ther. 2005;28(7):493-501.
Smith DL, Dainoff MJ, Smith JP. The effect of chiropractic adjustments on movement time: a pilot study using Fitts Law. J Manipulative Physiol Ther. 2006;29(4):257-66.
Stuber KJ. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. JCCA J Can Chiropr Assoc. 2007;51(1):30-41.
Stuber K, Sajko S, Kristmanson K. Chiropractic treatment of lumbar spinal stenosis: a review of the literature. J Chiropr Med. 2009 Jun;8(2):77-85.
Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005;11(1):42-9.
Verhagen AP, Karels C, Bierma-Zeinstra SM, et al., Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database Syst Rev. 2006;3:CD003471.
Vohra S, Johnston BC, Cramer K, Humphreys K. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007;119(1):e275-83.