A chiropractor is a licensed healthcare professional who diagnoses and treats problems with the musculoskeletal system, primarily through hands-on spinal manipulation and other manual therapies. Chiropractors hold a Doctor of Chiropractic (DC) degree and are licensed in all 50 U.S. states. The profession is built around the idea that proper alignment of the spine and joints supports the body’s ability to heal itself, often reducing pain without medication or surgery.
What Chiropractors Actually Do
The core of chiropractic care is manual therapy, most commonly spinal manipulation (also called an “adjustment”). During an adjustment, the chiropractor applies a controlled, quick thrust to a joint in the spine or elsewhere in the body. This is the technique that often produces the popping or cracking sound people associate with chiropractic visits. The goal is to restore proper joint movement, reduce pain, and improve physical function.
Beyond spinal adjustments, many chiropractors also treat joints in the shoulders, wrists, elbows, hips, and knees. Some use additional tools like ultrasound, electrical muscle stimulation, or laser therapy. Many also counsel patients on posture, exercise, nutrition, and stress management as part of a broader approach to health.
How Chiropractors Are Trained
Becoming a chiropractor requires completing a four-year Doctor of Chiropractic program at an accredited college, on top of undergraduate coursework that typically includes at least 24 credits in life and physical sciences (half with a lab component). The DC program covers anatomy, physiology, radiology, diagnosis, and hands-on clinical training.
After graduating, chiropractors must pass a series of national board exams administered by the National Board of Chiropractic Examiners. These exams have four parts covering basic sciences, clinical sciences, clinical competency, and a practical component where candidates perform assessments similar to what they’d encounter in practice. All 50 states either accept or require these exams for licensure. As of 2023, the Bureau of Labor Statistics counted roughly 41,500 employed chiropractors in the U.S., though that figure excludes self-employed practitioners, who make up a significant portion of the profession.
What Happens at Your First Visit
A first chiropractic appointment looks more like a medical evaluation than most people expect. The chiropractor will take a full health history and run general tests including blood pressure, pulse, respiration, and reflexes. From there, they’ll typically perform orthopedic and neurological tests to assess your range of motion, muscle tone, muscle strength, and neurological function in the affected area. They may also analyze your posture and ask you to move in specific ways.
X-rays are not routine for every patient, but they may be ordered if there’s been recent trauma, if a spinal deformity like scoliosis needs monitoring, or if a condition like spondyloarthritis is suspected. When the chiropractor suspects soft tissue damage, such as a disc problem, torn muscle, or nerve compression, they’ll typically recommend an MRI instead. After the evaluation, you’ll discuss a treatment plan, which usually involves a series of visits over several weeks.
Common Adjustment Techniques
Not all chiropractic adjustments feel the same. The most widely used approach is the Diversified Technique, which involves precise, high-velocity, low-force thrusts designed to release gas bubbles in the joints and restore normal spinal alignment. This is what most people picture when they think of a chiropractic adjustment.
Other common methods include:
- Cox Flexion (decompression): Uses a specialized table that gently flexes the spine forward, often used for disc herniations and scoliosis.
- Thompson Technique: Uses a table with drop-away segments that assist the thrust, reducing the force needed for the adjustment.
- Gonstead Technique: Similar to Diversified but focuses on a different angle of adjustment, targeting specific problem areas with high precision.
- Activator Method: A handheld device delivers a light, quick impulse to the spine. This gentler approach is suitable for patients who prefer less forceful treatment.
Your chiropractor will choose techniques based on your condition, comfort level, and body type. It’s reasonable to ask which method they plan to use and why.
Conditions With Strong Evidence
Chiropractic care has the strongest research support for low back pain. Spinal manipulation is considered an effective treatment for acute, subacute, and chronic low back pain, and it’s one of the most common reasons people seek chiropractic care in the first place.
Neck pain also responds well, particularly acute and subacute cases. For chronic neck pain and acute whiplash injuries, spinal manipulation combined with exercise has shown clear effectiveness. Migraine headaches and headaches originating from neck problems (cervicogenic headaches) also have positive evidence, though the results for tension-type headaches remain inconclusive.
Beyond the spine, research supports chiropractic treatment for a range of joint conditions: shoulder girdle pain, frozen shoulder, tennis elbow, hip and knee osteoarthritis, kneecap pain, and plantar fasciitis. Evidence is less definitive but still promising for rotator cuff pain, carpal tunnel syndrome, and ankle sprains.
For non-musculoskeletal conditions like asthma, high blood pressure, or menstrual pain, the evidence does not support spinal manipulation as an effective treatment. The one exception is cervicogenic dizziness (dizziness caused by neck problems), which does have positive evidence.
How Adjustments Affect the Body
When a chiropractor adjusts your spine, the physical movement stimulates sensory receptors in the muscles and tendons around the joint. These receptors send signals to the central nervous system that can change how your brain processes pain in that area. Multiple studies show that spinal manipulation raises pain tolerance and pain thresholds, meaning your nervous system becomes less reactive to stimuli that were previously causing discomfort.
One theory behind this involves a concept called central facilitation, where the nervous system becomes overly sensitive and starts interpreting normal signals as pain. Spinal manipulation may help by removing low-level mechanical or chemical irritants from the tissues around the spine, essentially turning down the volume on those amplified pain signals. The adjustment also triggers reflexive responses in the surrounding muscles, which can both relax tense areas and improve how well the muscles support the joint.
Safety and Side Effects
Most chiropractic treatment is safe. The most common side effects are mild and temporary: soreness, stiffness, or aching in the treated area after an adjustment. Transient side effects like these occur in about 55% of cervical (neck) manipulations, similar to the soreness you might feel after a deep tissue massage.
Serious complications are rare. For cervical spine manipulation, serious adverse events have been estimated to occur somewhere between 1 in 50,000 and 1 in 5.85 million manipulations. The most commonly reported serious complication is arterial dissection (a tear in an artery wall in the neck), which accounted for about 37% of reported adverse events in a review of 134 case reports. Deaths are very rare but have occurred, representing about 5% of cases in that same review, mostly related to arterial dissection. These statistics come from case reports rather than large population studies, which makes precise risk calculations difficult.
Certain conditions increase the risk of complications, including severe osteoporosis, spinal cord compression, inflammatory arthritis, and blood-clotting disorders. A thorough initial evaluation helps chiropractors identify patients who may not be good candidates for manipulation.
Chiropractors vs. Physical Therapists
People often wonder whether they should see a chiropractor or a physical therapist, and the answer depends on what you need. Chiropractors focus on diagnosing and treating mechanical disorders of the spine and joints, primarily through hands-on adjustments performed over a series of visits. They tend to take a whole-body approach that includes joint health, posture, neurological function, nutrition, and stress.
Physical therapists focus more specifically on improving joint function and movement through guided exercises and rehabilitation programs. PT treatment often includes an at-home exercise routine and typically lasts a few weeks to a few months. Physical therapy is more likely to require a referral from another doctor, while chiropractic care generally does not. Both professions can use tools like ultrasound and electrical stimulation, and in many cases, the two complement each other well for complex musculoskeletal problems.