A chiropractor is a licensed healthcare provider who diagnoses and treats musculoskeletal problems, primarily by using their hands to apply controlled force to joints in your spine and body. The core of what they do is restore normal joint movement, reduce pain, and improve how your nervous system functions. Most people visit a chiropractor for back pain, neck pain, or headaches, but their scope extends to joints throughout the body, including shoulders, knees, hips, and ankles.
How Spinal Adjustments Work
The signature technique in chiropractic care is the spinal adjustment, also called spinal manipulation. A chiropractor identifies a joint that isn’t moving properly, positions you in a specific way, then delivers a quick, precise push to that joint. This is called a high-velocity, low-amplitude thrust. “High velocity” means fast; “low amplitude” means the movement itself is very small. That combination is what produces the popping sound many people associate with chiropractic visits. The pop is just gas bubbles releasing inside the joint capsule, not bones cracking.
The adjustment does more than loosen a stiff joint. Your spine is packed with nerve endings that communicate with your brain and autonomic nervous system, the system that controls heart rate, blood pressure, and other background functions. Adjustments to different regions of the spine trigger different nervous system responses. Manipulating the upper neck, for instance, activates the parasympathetic (“rest and digest”) branch of your nervous system, which can lower heart rate and reduce blood pressure. Adjustments to the mid-back and lower back tend to stimulate the sympathetic (“fight or flight”) branch. This is one reason chiropractic care is used for conditions beyond simple back pain, including tension-type headaches and certain stress-related symptoms.
Techniques Beyond the Traditional Adjustment
Not every visit involves that classic hands-on thrust. Chiropractors use several approaches depending on your condition, age, and comfort level.
- Spinal mobilization: A gentler alternative where the chiropractor moves your joints with slow, oscillating pressure within your natural range of motion. There’s no popping sound, and it’s often used for people who prefer a lighter touch or have conditions that make high-force techniques inappropriate.
- Instrument-assisted adjustments: A small handheld device (the most common brand is called an Activator) delivers a quick, targeted thrust to a specific segment of your spine without the rotation or force of a manual adjustment. It’s precise enough that it doesn’t produce joint cavitation, meaning no pop.
- Soft tissue work: Many chiropractors also address the muscles and connective tissue around your joints through manual stretching, trigger point therapy, or muscle energy techniques where you gently contract a muscle against resistance to release tightness.
Your chiropractor will often combine these with rehabilitative exercises you do at home. Research consistently shows that spinal manipulation paired with exercise provides some of the best outcomes for neck and back pain.
What Happens at Your First Visit
The initial appointment is longer than follow-ups, typically 45 minutes to an hour, because it includes a full assessment before any treatment. Your chiropractor will take a detailed health history covering your current symptoms, past injuries, medications, and lifestyle. Then comes a physical examination that looks a lot like what you’d experience with an orthopedic doctor or physical therapist.
They’ll test your range of motion in the problem area, checking how far you can bend, rotate, and extend. They’ll perform orthopedic tests designed to stress specific structures. For example, if you have lower back pain, the chiropractor might use a test where you extend and bend sideways to see if the movement reproduces your symptoms, pointing toward a disc or joint problem. For neck pain, they might gently bend your neck while pressing down on your shoulder to check whether the nerves exiting your cervical spine are compressed. They’ll also do basic neurological checks like testing your reflexes, muscle strength, and sensation to rule out nerve damage.
X-rays are not routine at most chiropractic offices despite a lingering perception that they are. Current evidence-based guidelines recommend against imaging for most patients under 65 during the first four to six weeks of care unless there are red flags like a history of significant trauma, suspected fracture, prolonged steroid use, or signs of a serious underlying condition. Some chiropractors still take X-rays as standard practice for biomechanical assessment, but the published clinical guidelines consider the red-flags-only approach to be best practice.
What Conditions Chiropractors Treat
Low back pain is by far the most common reason people see a chiropractor, followed by neck pain and headaches. The American College of Physicians includes spinal manipulation in its clinical practice guidelines as a recommended first-line, non-drug treatment for both acute and chronic low back pain, alongside options like massage, acupuncture, and yoga. For chronic low back pain specifically, a meta-analysis found moderate-quality evidence that spinal manipulation significantly reduces pain and disability compared to both exercise and physical therapy alone.
For neck pain, the evidence is similarly supportive. Spinal manipulation performs at least as well as medication and physical therapy across various stages of neck pain, from recent onset to chronic. The combination of manipulation and exercise appears to be particularly effective.
Beyond the spine, chiropractors treat musculoskeletal pain in the jaw, shoulders, elbows, wrists, hips, pelvis, knees, and ankles. These extremity adjustments follow the same principle: restoring normal joint mechanics to reduce pain and improve range of motion. If you’ve rolled an ankle and it still feels stiff weeks later, or your shoulder isn’t moving freely after an injury, a chiropractor can assess and treat those joints directly.
What Side Effects to Expect
Minor side effects after an adjustment are common and temporary. In one large study, 61% of patients reported at least one side effect, most frequently headache (20%), stiffness (20%), local discomfort at the treatment site (15%), radiating discomfort (12%), and fatigue (12%). These reactions typically start within four hours of treatment, and about two-thirds resolve within 24 hours. Think of it like the soreness you might feel after a deep tissue massage or a new workout.
Serious complications are rare. The most discussed risk is vertebral artery dissection, a tear in one of the arteries supplying the brain, which has been estimated to occur in roughly 1 in 20,000 cervical manipulations. The exact incidence is difficult to pin down because the same type of arterial event also occurs spontaneously or after everyday activities like turning your head sharply. This is why your chiropractor will screen for vascular risk factors before performing neck adjustments.
Education and Licensing
Chiropractors earn a Doctor of Chiropractic (DC) degree, which requires about three and a half years of full-time, year-round graduate study after completing undergraduate prerequisites. The curriculum covers anatomy, physiology, radiology, diagnosis, and neurology alongside hands-on clinical training. At Palmer College, the oldest and largest chiropractic school in the U.S., students begin treating patients in supervised clinics during their seventh trimester out of ten. After graduating, chiropractors must pass national board exams and obtain a state license to practice.
Chiropractors are not medical doctors. They cannot prescribe medication or perform surgery. Their training is focused specifically on diagnosing and treating neuromusculoskeletal conditions through manual therapy, rehabilitation, and lifestyle guidance. In most states, they can order diagnostic imaging and refer patients to medical specialists when a condition falls outside their scope.