No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors.[70] A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.[70] Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM,[71] some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.[72]

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There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.[4][10] Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.[89][90] Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results.[4] Research published by chiropractors is distinctly biased.[4] For reviews of SM for back pain chiropractic authors tend to have positive conclusions, while others did not show any effectiveness.[4]
Determining a treatment strategy depends mainly on identifying the location and cause of the irritated nerve root. Although neck pain can be quite debilitating and painful, nonsurgical management can alleviate many symptoms. The doctor may prescribe medications to reduce the pain or inflammation and muscle relaxants to allow time for healing to occur. Reducing physical activities or wearing a cervical collar may help provide support for the spine, reduce mobility and decrease pain and irritation. Trigger point injection, including corticosteroids, can temporarily relieve pain. Occasionally, epidural steroids may be recommended. Conservative treatment options may continue for up to six or eight weeks.
"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory, their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality – too much or not enough action – which is disease."[42]

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.[223] In addition to traditional chiropractic opposition to water fluoridation and vaccination, chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive lifelong chiropractic treatment.[32]
Chiropractors use hands-on spinal manipulation and other alternative treatments, the theory being that proper alignment of the body's musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication. Manipulation is used to restore mobility to joints restricted by tissue injury caused by a traumatic event, such as falling, or repetitive stress, such as sitting without proper back support.
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