Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief than a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.[115] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.[116] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,[117] limited to low level evidence supporting chiropractic management of shoulder pain[118] and limited or fair evidence supporting chiropractic management of leg conditions.[119]
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.
Chiropractic was developed by Daniel David Palmer, a self-taught healer in Davenport, Iowa. Palmer wanted to find a cure for disease and illness that did not use drugs. He studied the structure of the spine and the ancient art of moving the body with the hands (manipulation). Palmer started the Palmer School of Chiropractic, which still exists today.
Chiropractic's origins lie in the folk medicine of bonesetting,[4] and as it evolved it incorporated vitalism, spiritual inspiration and rationalism.[30] Its early philosophy was based on deduction from irrefutable doctrine, which helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession.[30] This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method,[30] and relies on deductions from vitalistic first principles rather than on the materialism of science.[31] However, most practitioners tend to incorporate scientific research into chiropractic,[30] and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness.[31] A 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.[32]

All treatment is based on an accurate diagnosis of your back pain. The chiropractor should be well informed regarding your medical history, including ongoing medical conditions, current medications, traumatic/surgical history, and lifestyle factors. Although rare, there have been cases in which treatment worsened a herniated or slipped disc, or neck manipulation resulted spinal cord injury. To be safe, always check with your medical doctor to make sure your condition will benefit from chiropractic or other pain relief alternatives. 
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