What chiropractors can help with – and what patients should know

What Chiropractors Can and Can't Do

Chiropractors often refer to themselves as doctors, but their degree is different from medical doctors. To practice in the United States, for example, chiropractors typically attend a four-year program where they take courses in basic science and lifestyle and nutrition counseling. They also learn how to perform manual adjustments, which involve putting pressure onto the joints and creating a deep stretch in the tiny muscles that connect the spine's vertebrae.

After training, chiropractors must pass a national board exam to be eligible for state licensure. What chiropractors can and can't do depends on where they practice. For example, in Oregon chiropractors are legally allowed to deliver babies (though they do so rarely) and perform very minor surgery, like stitches and removing skin tags. New York, which has stricter laws for chiropractors, requires them to focus on spinal conditions.

Is There Good Evidence That Chiropractic Care Is Helpful?

Chiropractors advertise their services for a wide range of conditions: back pain, arthritis, diabetes, asthma, and ear infections. But what the research says chiropractors are effective at treating doesn't necessarily match up. There's robust evidence that shows chiropractic adjustments can be mildly to moderately effective at managing lower back pain.

An analysis of 47 randomized controlled trials – often considered the gold standard of scientific evidence – determined that manual manipulation was equally effective as treatments like acupuncture or massage therapy. And the risks of side effects are low compared with some other common interventions, like anti-inflammatory medications and corticosteroid injections.

The Risks of Chiropractic Care

Fractures or other serious complications from spinal manipulation are possible but rare, occurring in roughly 1 per 2 million manipulations, according to one study. For that reason, spinal manipulation is often recommended as a first line of treatment for low back pain, including in guidelines from the World Health Organization and the Department of Veterans Affairs.

The Limits of Chiropractic Care

There is less evidence supporting the use of chiropractic treatment for neck pain. A review of six studies found that chiropractic adjustments did improve acute neck pain. However, the researchers noted that more research was needed to draw any firm conclusion, since many of the studies had only a small number of participants and other limitations.

Some doctors advise against manipulating the neck because of the potential risk of arterial dissection, in which vessels that supply blood to the brain are torn. This can lead to stroke or death. Some analyses have suggested an association between neck adjustments and this injury, but it's not clear there is a causal link.