A chiropractor is a healthcare professional who focuses mainly on the spine and performs spinal adjustments (or spinal manipulation) and other hands-on therapies to try to improve spinal alignment, ease pain, and support overall health.
Chiropractic care is a type of complementary medicine concerned with the relationship between your body’s structure and its functioning, especially the spine’s connection to the nervous system. Back pain, neck pain, and headaches are common reasons that people see a chiropractor.
In 2017, 10% of adults saw a chiropractor in 2017—up from 9% in 2012, according to a report from the Centers for Disease Control and Prevention (CDC). Chiropractic is the fourth most commonly used complementary medical approach used by Americans, according to a 2015 National Health Statistics Report.
Chiropractic got its start in 1895 when a self-taught healer named David Palmer sought a drugless cure for disease. To develop his objective, Palmer turned to the ancient art of manual medicine. (The term chiropractic combines the Greek words cheir (hand) and praxis (practice) to describe a treatment done by hand.)
Nerves that branch from the centrally located spinal cord out to all areas of the body have to pass through the sides of the spinal column. Chiropractors believe that if the spinal bones are misaligned, this may negatively affect overall health because the misalignment impedes nerves.
By the same token, chiropractics believe that a well-aligned spine enhances general health. In other words, the nerves that exit the spine do not experience blockages from nearby structures and can, therefore, transmit their impulses freely.
While some medical doctors view chiropractic as a “controversial” treatment, it has become more mainstream in recent decades. Research collaborations exist between traditional medical disciplines and chiropractic.
Chiropractic services are most often used to treat neuromusculoskeletal issues, but chiropractors also counsel patients on diet, nutrition, exercise, healthy habits, and occupational and lifestyle modification.
Here’s a rundown on the conditions for which most people seek chiropractic care:
The core of chiropractic care usually involves treatment of common lower back pain conditions—both acute (sudden and severe) and chronic—through spinal manipulation. The pain could be related to an injury, caused by a disc problem or pinched nerve, or the result of arthritis.
The biomechanics of the neck, a.k.a. the cervical spine, leave it vulnerable to pain and injury. Common causes of neck pain include whiplash, degenerative disorders like osteoarthritis, disc disease, and poor posture.
Chiropractors often use a neck adjustment to improve the mobility of the spine, restore range of motion, and increase the movement of the adjoining muscles.
Spinal manipulation and other chiropractic therapy options may be effective for treating tension headaches, migraines, and headaches, such as cervicogenic headaches, that originate in the neck. For instance, low-load craniocervical mobilization, which involves a gentler force than that used in spinal manipulation, may ease tension headaches.
There are more than 100 different chiropractic techniques. There’s a significant amount of overlap between them, and many techniques are just slightly different versions of others.
Spinal manipulation is the cornerstone of chiropractic care, but other specialty techniques are also used.
This is what what most people call a chiropractic adjustment. A chiropractor applies a controlled force to the joints in and around the spine either manually (using hands) or mechanically (using a small instrument).
The goal of spinal manipulation is to place the body into a proper position to improve spinal motion and physical function of the entire body.
While the mainstay of the chiropractic profession is the adjustment of the spine, most chiropractors also adjust the pelvis as a routine part of the treatment. Some also regularly adjust other joints, such as the knees, feet, wrists, and more.
Flexion Distraction Therapy
This technique, which involves using a special table that distracts and flexes the spine in an automated and gentle rhythmic motion, helps to increase spinal motion and remove pressure from disc bulges and spinal nerves.
A type of motorized traction, spinal decompression is used most often in the treatment of disc injuries. The goal is to gently separate the vertebrae, creating a vacuum between the targeted vertebrae and relieving painful pressure.
As a result, bulging discs may retract and alleviate pressure on nerves and other structures in your spine.
Manipulation Under Anesthesia
Spinal manipulation under anesthesia (MUA) is a non-invasive procedure that may be recommended to relieve chronic neck and back pain when other treatments haven’t worked. The procedure involves sedating the patient and performing a series of mobilization, stretching, and traction maneuvers that would otherwise be too painful due to muscle spasms and/or excessive scar tissue.
Most chiropractic treatments are also accompanied by treatment complements such as:
- Application of heat or ice
- Electrical stimulation
- Orthotic supports for your shoes
- Rehabilitative exercise
- Counseling about diet, weight loss, and other lifestyle factors
- Nutritional supplements
Keep in mind that healthcare providers of chiropractic are conservative care doctors; their scope of practice does not include the use of drugs or surgery. If your chiropractor diagnoses a condition outside of this conservative scope, such as a fracture or an indication of an organic disease, he or she will refer you to the appropriate medical physician or specialist.
Training and Certification
Admission to a chiropractic college requires a minimum of 90-semester hour credits of undergraduate study, mostly in the sciences.
Doctors of chiropractic (D.C.) are educated in four-year doctoral graduate school programs through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory, and clinical internship. The average D.C. program is equivalent in classroom hours to allopathic (M.D.) and osteopathic (D.O.) medical schools.
Chiropractic is regulated individually by each state and the District of Columbia. All states require completion of a Doctor of Chiropractic degree program from an accredited college.
Examinations administered by the National Board of Chiropractic Examiners (NBCE) are required before obtaining a license to practice. To maintain their license, most states require chiropractors to earn annual continuing education (CE) credits through state-approved CE programs.
Some chiropractors pursue an additional two- to three-year residency for training in specialized fields. These fields include:
- Radiology: This specialty focuses on diagnostic imaging. It involve training to read and interpret X-rays, magnetic resonance imaging (MRI), computed tomography (CT), sonography, and positron emission tomography (PET scan). Certified chiropractic radiologists often focus on the musculoskeletal system and share their interpretations of scans with other chiropractors or referring healthcare providers.
- Rehabilitation: This involves techniques to help people recover from injuries, especially those to the back, legs, feet, or arms. Goals can include increasing strength and endurance, and improving muscular imbalances and motor control.
- Clinical nutrition: Nutrition courses are taken to obtain a certificate from either the American Clinical Board of Nutrition or Chiropractic Board of Clinical Nutrition so that the chiropractor can offer more involved nutritional and dietary advice for patients.
- Internist: This specialty focuses on the diagnosis and treatment of a variety of conditions that go beyond joints and muscles. It can include study of autoimmune diseases, gastrointestinal disorders, eczema, and infections. Lifestyle and dietary interventions are often the focus of a treatment plan.
- Neurology: This focuses on the brain and nervous system and involves nonsurgical treatment options for neuromuscular, biomechanical, and orthopedic issues. It can involve using spine and extremity manipulation as a way to send messages to specific areas of the brain. There are also subspecialties of chiropractic neurology, such as childhood developmental disorders, brain injury rehabilitation, and vestibular rehabilitation (therapy to improve balance) that require an additional two years of training.
- Forensics: The field focuses on conducting examinations and evaluations for investigations and legal matters, and to offer an expert opinion in court.
- Sports medicine: This involves studying sports-related injuries and focuses on injury recovery and prevention without surgeries or pharmaceutical treatments.
- Acupuncture: Training is in acupuncture, a traditional Chinese medicine (TCM) modality that typically involves inserting small needles into specific points throughout the body.
- Pediatrics and pregnancy: This specialty involves treating children and their growing spines, as well as prenatal and postnatal spinal care.
Your healthcare provider may refer you to a chiropractor if you’re suffering from back, neck, or other joint aches and pains. Many insurance plans cover chiropractic care. Depending on your plan, you may be able to consult with a chiropractor directly without a practitioner referral.
If your healthcare provider can’t refer you to a specific chiropractor, ask family and friends for recommendations. You can also use the American Chiropractic Association’s online tool to find a practitioner in your area.
To check a certain chiropractor’s standing (e.g., if they are currently licensed, if there have been any complaints filed against them), search their name on your state licensing board’s website. The NCBE has a helpful list of links to state boards to get you started.
Compared with other types of complementary or alternative care, such as acupuncture or massage, chiropractic coverage by insurance plans is common and much more extensive.
According to a 2012 study led by the National Center for Complementary and Integrative Health, about 60% of adults seeing a chiropractor have health insurance coverage for their care. Although, partial coverage (41%) is more common than complete coverage (19%).
Prior to your appointment, check with your insurance to see if chiropractic services and tests are covered or partially covered, if there are referral requirements, and if there are any limits on the number visits or overall costs.
In addition, Medicare (Part B) covers chiropractic visits. However, it will not cover other services or tests that may be ordered by a chiropractor, such as X-rays. At least two dozen states cover chiropractic treatment under Medicaid.
To prepare for your assessment, it’s important to dress in clothing that won’t restrict movement or otherwise get in the way:
- Wear comfortable clothing (T-shirt, athletic pants, leggings)
- Wear sneakers or sturdy flats
- Avoid skirts and dresses
- Avoid stiff jeans or dress clothes that are hard to bend in
- Remove all jewelry (It can get caught during treatment.)
As pressure will be applied to your body during treatment, you may want to make sure you use the restroom before your appointment. You might also want to avoid eating just before your visit.
What to Expect
Visiting a chiropractor is similar to visiting other healthcare providers, but it does have some unique elements.
While the office setting and intake procedures will likely be quite familiar, the chiropractic treatment table is distinctive. These tables are often quite elaborate to allow specific positioning and movement during spinal adjustments.
The chiropractor will start by taking your history, then perform a routine physical examination, followed by an exam of your whole spine. For example, if you have low back pain, the chiropractor will likely also examine your neck because the adaptations resulting from injury or misalignment of spinal bones (subluxations) in one area can result in secondary irritations somewhere else in the spine.
Imaging or lab tests (such as MRI, CT scan, or X-ray) may be required to confirm a diagnosis before proceeding with treatment.
The physical exam typically includes a variety of assessments, such as range of motion tests, palpation, reflex testing, muscle strength comparisons, and neurological and orthopedic tests focused on the main complaint.
Based on the extent, timing, or severity of your condition, chiropractic interventions may require several visits. If you have a chronic issue, such as back pain, ongoing appointments known as maintenance care may be recommended even if symptoms improve or resolve.
There aren’t established standards for maintenance care, so what is recommended will vary based on the chiropractor, your health conditions, and your overall response to treatments. It may range from two appointments per year to monthly sessions or more.
Research on maintenance care is limited and there are mixed results, but some studies suggest better outcomes—including fewer painful days—for people with back pain who do preventative appointments compared to those who only see a chiropractor when symptoms recur or worsen.