What chiropractic is

Chiropractic is one of several professions people turn to for back and neck pain. This page explains, neutrally, what the profession is, what its practitioners commonly do, and how they are educated and licensed in the United States. It does not recommend chiropractic or any other kind of care.

A licensed health care profession

The National Center for Complementary and Integrative Health, part of the National Institutes of Health, describes chiropractic in its fact sheet Chiropractic: In Depth as a licensed health care profession. It explains that treatment typically involves manual therapy, often including spinal manipulation, and that other forms of treatment, such as exercise and nutritional counselling, may be used as well.

MedlinePlus, in its overview of chiropractic, gives a similar description: chiropractors perform adjustments, which are manipulations, to the spine or other parts of the body. It lists other methods chiropractors may use, including heat and ice, electrical stimulation, relaxation techniques, rehabilitative and general exercise, and counselling about diet and other lifestyle factors. MedlinePlus also notes that many people visit chiropractors for low back pain, neck pain and headaches.

What practitioners commonly do

NCCIH explains that chiropractors approach patient care in a manner similar to that used in conventional medicine. According to its fact sheet, they:

• interview the patient;
• take a detailed health history;
• perform an examination;
• do tests;
• develop a working diagnosis;
• develop a management plan and start treatment;
• monitor the patient's progress.

NCCIH adds that chiropractors often treat problems related to the musculoskeletal system, meaning the muscles, bones, joints and connective tissues.

The manual methods, NCCIH explains, range from stretching and sustained pressure to specific joint manipulations, which are usually delivered by hand and involve a quick and gentle thrust. It describes the purpose of manipulation as improving joint motion and function, and notes that manipulation is most commonly done on the spine, although other parts of the body may be treated in the same way. The spinal manipulation page explains the terms and summarises what NCCIH says about safety.

Education and licensure

NCCIH summarises the requirements for practising chiropractic in the United States. Chiropractors must earn a Doctor of Chiropractic degree, pass the National Board of Chiropractic Examiners exam, and hold a state license. Many states also require an exam about state-specific laws, and all states require practising chiropractors to take continuing education. Entry to a Doctor of Chiropractic programme requires several years of undergraduate education first. Rules differ in other countries, and anyone can check a practitioner's license with the relevant state or national licensing board.

Where chiropractic sits among other kinds of care

People with back and neck pain may see many different professionals: their regular physician, physical therapists, osteopathic physicians, orthopaedic surgeons, pain specialists, massage therapists and chiropractors among them. Several of these professions overlap in the methods they use. NCCIH notes, for example, that although most spinal manipulations are done by chiropractors, other licensed professionals, including osteopathic physicians and physical therapists, also use the technique.

This handbook does not rank these professions or suggest which to choose. Which kind of care is right depends on the problem, on the person, and on how the different options fit together. A reasonable starting point for many people is their regular health care provider, who can examine them, look for anything that needs urgent attention, and talk through the choices.

Telling everyone involved

If you do see more than one kind of practitioner, it helps for each to know about the others. NCCIH emphasises that people should share information about their health conditions and medications with any practitioner who uses spinal manipulation, because some health problems may raise the risks. It is equally sensible to tell your regular doctor about any other care you are receiving. The before a first visit page has a list of questions to ask any back or neck practitioner.

Finding out more

NCCIH's fact sheet on chiropractic and MedlinePlus's overview are both written for the public, and both point to further reading on how the profession works and on the research into it. They are good places to start if you want to understand the evidence in more depth, or to prepare questions before seeing any practitioner. A regular health care provider can help put that reading into the context of your own health.

A note on words

Chiropractors sometimes use terms of their own, such as "adjustment" for a manipulation or "subluxation" in a sense that differs from its use in general medicine. The glossary explains these words. If a practitioner uses a term you do not understand, it is always reasonable to ask what it means and how they reached that conclusion.