What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Evidence Based Rating Scale

What Is It?

The best known and most widely used alternative therapy in the United States today, chiropractic focuses on the manipulation of the spine and other joints to help treat a variety of problems involving bones, joints, muscles, ligaments, and tendons.

Chiropractors primarily use their hands to apply pressure to a joint or group of joints. (In fact, the name "chiropractic" is derived from Greek words meaning "done by hand.") This treatment is known as an "adjustment" or a "manipulation." The aim of using manipulation is to provide relief for pain or stiffness, and to improve posture as well as the function of nerves, joints, and muscles.

Spinal manipulation has been practiced for thousands of years; there are records of it from ancient Egypt and China. The birth of modern chiropractic, however, is often cited as September 18, 1895, the date that Daniel David ("D. D.") Palmer, a grocer and apprentice of magnetic healing in Davenport, Iowa, reportedly restored hearing to a man who had been deaf for 17 years, simply by adjusting his misaligned vertebrae.

In the years that followed, Palmer founded the first chiropractic school and refined his discipline, becoming convinced that pinched nerves caused by misalignments of the vertebrae were responsible for nearly all disease. His work remains the foundation of many aspects of chiropractic today.

How Does It Work?

Chiropractic takes a structural, nutritional, and emotional approach to health care. The chiropractor aims to gently restore the natural and delicate balance that exists in all healthy individuals.

To do this, a chiropractor examines the bones of the vertebrae, and locates those that do not move properly or are out of alignment. These areas, called subluxations, can cause pain and dysfunction not only in the surrounding nerves and muscles, but also in the internal organs located within the body at the same level as the subluxation. Chiropractors treat subluxations by adjusting the vertebrae (and the associated muscles, tendons, and ligaments) gently with their hands. When misalignments are corrected, according to chiropractic theory, the integrity of the nervous system is restored, ensuring optimal function of the entire body.

After reviewing your medical history, the chiropractor will ask you about your general health and conduct a thorough physical examination, which will include orthopedic and neurological evaluations. The session might include a review of past X rays and new ones may be requested. The course of treatment will likely include a series of adjustments to help realign your spine, neck, or other problem areas.

The chiropractor may ask you to lie down on a padded massage-type table for spinal adjustments or you may be seated on a stool or in a chair that allows access to your back. You may remain fully clothed or be asked to undress and wear a hospital gown.

Before beginning any manipulation, the chiropractor should explain exactly what the process involves. Typically, chiropractic is performed using very little force, although techniques vary. As the chiropractor applies pressure to your spine, you may hear (and feel) a popping sound, like a knuckle cracking. You should not feel any serious discomfort from the adjustment, however. If you do, it is important to let the chiropractor know immediately. Many patients find the experience of chiropractic treatment quite relaxing. Afterward, most describe feeling reduced pain, less tension, and more flexibility in the areas that were adjusted.

Some chiropractors (those known as "straight" chiropractors) adhere strictly to D.D. Palmer's theories, using only spinal adjustments to treat problems. Others (known as "mixers") combine spinal adjustments with adjunct therapies such as massage, heat or ice treatments, rehabilitative exercises, acupuncture, cranial manipulation, and nutritional counseling.

An initial visit usually lasts at least an hour. Subsequent visits may take only 10 to 30 minutes. Sometimes one session with a chiropractor is all that is required to relieve pain. For an acute problem, an average course of treatment involves three to five visits per week for two weeks.

Chiropractors generally have working relationships with M.D.s and D.O.s (doctors of osteopathy) and will refer you--often to an internist or a neurologist--if your condition persists and further testing or treatment appears necessary.

Health Benefits

Chiropractic has been shown to be a particularly useful treatment for the relief of acute (or temporary) low back pain. In 1994, the United States Agency for Health Care Policy and Research recommended chiropractic manipulation as a safe initial form of treatment for acute low back pain in adults. The agency urged most patients to try conservative treatment such as chiropractic first, before opting for more aggressive measures such as drugs and surgery.

Chiropractic care can also ease pain in the mid-back and neck, and in the joints of the arms, hands, and legs. Although scientific research has not conclusively prooved its effectiveness, many people report that chiropractic provides relief from the pain of migraine and other headaches, muscle spasms, and nerve inflammation that can cause numbness and tingling.

Specifically chiropractic therapy can help to:

·         Alleviate migraine and tension type headaches. The study data is not conclusive on whether or not these improvements can be attributed to the chiropractic care alone, and high quality studies are difficult to conduct because of a lack of good placebo. However, a review including 9 trials on spinal manipulation for headache relief proved favorable (1). Other reviews however called the existing evidence inconclusive (2,3). More research must be conducted to determine whether chiropractic therapy is an effective long term treatment for these debilitating conditions.

·         Treat chronic low back pain. Not only has chiropractic been shown to be very effective in the management of low back pain (4-6). Recent evidence shows that it is very cost effective too (7). Results can vary from person to person. A Swedish study conducted on 1054 patients reported that 75% of study subjects reported definite improvement at 3 months, and 50% maintained improved status at one year (8).

·         Prevent bed-wetting in children. Only small scale trials have shown efficacy in helping treat nocturnal enuresis (bed wetting) (9). However, because of their success, longer and larger trials are warranted. Parents of children experiencing this embarrassing and perplexing condition may soon be able to offer relief to their children.

·         Prevent menstrual related aches and pains. For the estimated 75% of women who experience pre-menstrual syndrome (PMS), chiropractic manipulation may be an option to reduce the minor aches and pains associated with this monthly syndrome (10).

·         Ease back pain during pregnancy. Pregnant women are warned to stay away from over the counter and prescription drugs during pregnancy. However, this is also one of the most stressful times on a woman’s body. Trying to carry the extra weight gained in pregnancy can cause back muscles to become strained and change your overall posture. Preliminary studies have shown that chiropractic may offer a pharmacology fee way to reduce pain (11,12).

·         Relieve pain associated with carpal tunnel syndrome. Many people suffering from carpal tunnel syndrome are searching for conservative treatments in lieu of surgical options. Chiropractic practitioners conducted a systematic review of 200 articles indicates that chiropractic may be beneficial (13). All results have not been uniformly as positive. You should speak to your doctor before beginning any alternative treatments for your condition.

How To Choose a Practitioner

Chiropractors are licensed in all 50 states and the District of Columbia, and must pass a certification exam with the National Board of Chiropractic Examiners. A Doctor of Chiropractic (D.C.) usually has a bachelor's degree, four to five years of graduate study in chiropractic care, as well as clinical training. Many health insurance policies cover chiropractic.


·  If you have been diagnosed with rheumatoid arthritis, sciatica, or osteoporosis, ask your chiropractor to consult with your primary care

physician before you start treatment. Certain kinds of spinal manipulations could aggravate these conditions.

·  If your back pain is accompanied by a fever, it's important to consult your primary care doctor, or have your chiropractor do so, to rule out conditions that need medical attention.


  1. Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001 Sep;24(7):457-66.
  2. Biondi DM. Physical treatments for headache: a structured review. Headache. 2005 Jun;45(6):738-46.
  3. Astin JA, Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia. 2002 Oct;22(8):617-23.
  4. 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.
  5. Hsieh CY, Adams AH, Tobis J, et al. Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine. 2002;27(11):1142-1148.
  6. Cherkin DC, Deyo RA, Battie M, et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. New England Journal of Medicine. 1998;339(15):1021-1029.
  7. Haas M, Sharma R, Stano M. Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain. J Manipulative Physiol Ther. 2005 Oct;28(8):555-63.
  8. Leboeuf-Yde C, Axen I, Jones JJ, Rosenbaum A, Lovgren PW, Halasz L, Larsen K. The Nordic back pain subpopulation program: the long-term outcome pattern in patients with low back pain treated by chiropractors in Sweden. J Manipulative Physiol Ther. 2005 Sep;28(7):472-8.
  9. Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther. 1994 Nov-Dec;17(9):596-600.
  10. Walsh MJ, Polus BI. A randomized, placebo-controlled clinical trial on the efficacy of chiropractic therapy on premenstrual syndrome. J Manipulative Physiol Ther. 1999 Nov-Dec;22(9):582-5
  11. Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10.
  12. Wang SM, DeZinno P, Fermo L, William K, Caldwell-Andrews AA, Bravemen F, Kain ZN. Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey. J Altern Complement Med. 2005 Jun;11(3):459-64.
  13. Davis PT, Hulbert JR. Carpal tunnel syndrome: conservative and nonconservative treatment. A chiropractic physician's perspective. J Manipulative Physiol Ther. 1998 Jun;21(5):356-62
  14. Bryner P, Staerker PG. Indigestion and heartburn: a descriptive study of prevalence in persons seeking care from chiropractors. J Manipulative Physiol Ther. 1996 Jun;19(5):317-23.

Evidence Based Rating Scale 

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.







Acute Back pain





Evidence from large studies demonstrate benefit. 








Date Published: 04/19/2005
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