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]
Many states also require applicants to pass a background check and state-specific law exams, called jurisprudence exams. All states require a practicing chiropractor to take continuing education classes to maintain his or her chiropractic license. Check with your state’s board of chiropractic examiners or health department for more specific information on licensure.
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Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[1] The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate.[212] As of 2007 7% of the U.S. population is being reached by chiropractic.[213] They were the third largest profession in the US in 2002, following doctors and dentists.[214] Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[185]
Whiplash and other neck pain. There is no consensus on the effectiveness of manual therapies for neck pain.[104] A 2013 systematic review found that the data suggests that there are minimal short- and long-term treatment differences when comparing manipulation or mobilization of the cervical spine to physical therapy or exercise for neck pain improvement.[105] A 2013 systematic review found that although there is insufficient evidence that thoracic SM is more effective than other treatments, it is a suitable intervention to treat some patients with non-specific neck pain.[106] A 2011 systematic review found that thoracic SM may offer short-term improvement for the treatment of acute or subacute mechanical neck pain; although the body of literature is still weak.[107] A 2010 Cochrane review found low quality evidence that suggests cervical manipulation may offer better short-term pain relief than a control for neck pain, and moderate evidence that cervical manipulation and mobilization produced similar effects on pain, function and patient satisfaction.[108] A 2010 systematic review found low level evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash.[109]
Cervical stenosis occurs when the spinal canal narrows and compresses the spinal cord and is most frequently caused by aging. The discs in the spine that separate and cushion vertebrae may dry out. As a result, the space between the vertebrae shrinks, and the discs lose their ability to act as shock absorbers. At the same time, the bones and ligaments that make up the spine become less pliable and thicken. These changes result in a narrowing of the spinal canal. In addition, the degenerative changes associated with cervical stenosis can affect the vertebrae by contributing to the growth of bone spurs that compress the nerve roots. Mild stenosis can be treated conservatively for extended periods of time as long as the symptoms are restricted to neck pain. Severe stenosis requires referral to a neurosurgeon.
The patients were put into two groups. One group received traditional medical care for back pain along with chiropractic care; the other group only received traditional care. While traditional care can include medication, the chiropractic care included spinal manipulation adjustments along with manual therapies such as ice, heat, cryotherapy, and rehabilitative exercises.
“The current study provides the strongest evidence to date that chiropractic care is safe, effective, and results in high levels of patient satisfaction and perceived treatment benefit, thus strengthening our knowledge regarding this conservative nondrug option for low back pain,” Christine M. Goertz, DC, PhD, a chiropractor with the Spine Institute for Quality in Iowa, told Healthline.
A large number of chiropractors fear that if they do not separate themselves from the traditional vitalistic concept of innate intelligence, chiropractic will continue to be seen as a fringe profession.[22] A variant of chiropractic called naprapathy originated in Chicago in the early twentieth century.[35][36] It holds that manual manipulation of soft tissue can reduce "interference" in the body and thus improve health.[36]
Headache. A 2011 systematic review found evidence that suggests that chiropractic SMT might be as effective as propranolol or topiramate in the prevention of migraine headaches.[110] A 2011 systematic review found evidence that does not support the use of SM for the treatment of migraine headaches.[111] A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache.[112] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[113] A 2004 Cochrane review found evidence that suggests SM may be effective for migraine, tension headache and cervicogenic headache.[114]
Before I left, the office gave me a cold pack to use in case of any soreness. I didn’t have a need to use it, but everyone is different. “A cold pack can be a great tool to add to your wellness toolkit, since it can help control soreness, bruising and inflammation,” says Dr. Greg Doer, DC. Plus, it doesn’t just come in handy after a chiropractic adjustment. You can reuse it again and again.

Self care: Neck pain often resolves with rest, ice or heat, massage, pain relievers, and gentle stretches. Reduce muscle inflammation and pain using an ice pack for 20 minutes several times a day during the first 48 to 72 hours. Thereafter, a warm shower or heating pad on low setting may be added to relax the muscles. A short period of bed rest is okay, but more than a couple of days does more harm than good. If self-care treatments aren't working within the first couple of days, see your doctor.
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.
Finally, it’s important to know that it’s okay to change chiropractors if the doctor you find just isn’t a good fit. They may be perfectly qualified and capable, but if you aren’t comfortable with them, treatment may be less effective. Some patients love doctors who are straight and to the point, while others prefer someone who provides lots of explanation both before and during a procedure. Likewise, they may not be the best doctor to treat your specific pain condition. As with other doctors, chiropractors understand this and are happy to transfer your records to a different doctor.
Chiropractic adjustment rarely causes discomfort. However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) that usually resolves within 12 to 48 hours. Compared to other common treatments for pain, such as over-the-counter and prescription pain medications, chiropractic's conservative approach offers a safe and effective option.
There are several different surgical procedures which can be utilized, the choice of which is influenced by the severity of each case. In a small percentage of patients, spinal instability may require that spinal fusion be performed, a decision that is generally determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. Various devices (like screws or plates) may be used to enhance fusion and support unstable areas of the cervical spine. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic neck pain.
Chiropractic is well established in the United States, Canada, and Australia.[18] It overlaps with other manual-therapy professions such as osteopathy and physical therapy.[19] Most who seek chiropractic care do so for low back pain.[20] Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues.[4] Many chiropractors describe themselves as primary care providers,[4][21] but the chiropractic clinical training does not support the requirements to be considered primary care providers,[2] so their role on primary care is limited and disputed.[2][21] Chiropractic has two main groups: "straights", now the minority, emphasize vitalism, "innate intelligence", and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[22]
Jump up ^ Brantingham, James W.; Bonnefin, Debra; Perle, Stephen M.; Cassa, Tammy Kay; Globe, Gary; Pribicevic, Mario; Hicks, Marian; Korporaal, Charmaine (2012). "Manipulative Therapy for Lower Extremity Conditions: Update of a Literature Review". Journal of Manipulative and Physiological Therapeutics. 35 (2): 127–66. doi:10.1016/j.jmpt.2012.01.001. ISSN 0161-4754. PMID 22325966.
“When your neck muscles become weak and you try to turn your head, the joint no longer moves smoothly because it’s now out of place,” Dr. Bang says. “Often the joint catches on something, either pulling a muscle or hitting the nerve irregularly, or maybe both. Then you’ll have instant pain and your body has a protective spasm. Your body doesn’t want you to get hurt more, so it will clench, causing you to feel like you can’t even move — and leaving you wondering what you did to injure yourself.”
Seriously, learn from me on this one. No one wants to wear those medical shorts when starting a new treatment plan with a new healthcare professional—they do not build your confidence! I found athletic/workout clothes and sneakers to be the most comfortable option for me, especially when performing the exercises and getting an adjustment. I was able to move comfortably without feeling too restricted. Try not to wear clothes that are really thick like a sweatshirt. Instead, opt for thinly lined clothing or wear layers so that the chiropractor can easily perform the adjustment and assess how you’re moving.
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