Wondering When To See a Chiropractor? Here’s What to Know Before You Go

Chiropractic adjustment, or spinal manipulation, is a popular form of complementary and alternative treatment. Each year, millions of people in the U.S. see a chiropractor for help with back, shoulder, and neck pain. 

But when should you see a chiropractor and are chiropractic adjustments safe? Do they really work?  If you’re thinking about seeing a chiropractor, here’s what you should know about spinal manipulation.  

What does a chiropractor do?

Chiropractors are medical professionals who treat musculoskeletal problems. They’re trained to perform chiropractic adjustments (spinal manipulation), a hands-on therapy that can relieve pain and restore function and range of motion. 

During spinal manipulation, a chiropractor applies a short, controlled force — a “thrust” — to move a joint beyond its normal range of motion. This is the type of therapy that sometimes results in a cracking or popping sound.

Chiropractic adjustments are usually what people think of when talking about chiropractors. But chiropractors use other tools to help people with musculoskeletal problems:

• Spinal mobilization: This hands-on therapy uses less force than spinal manipulation. It gently moves a joint within its range of motion.

• Lifestyle coaching: This is counseling on nutrition, exercise, and sleep habits.

• Soft-tissue therapy: This includes massage therapy and heat therapy with therapeutic ultrasound or cold therapy with cold lasers.

• Nerve stimulation: This uses transcutaneous electrical nerve stimulation (TENS) therapy and interferential current and electronic muscle stimulation.

Are chiropractors doctors? 

Chiropractors have a doctorate of chiropractic degree (DC). This means they have the title of doctor. To work as a chiropractor, they must complete a 4-year DC program and pass an exam from the state’s board of chiropractors. 

But they’re not medical doctors like a doctor of allopathic medicine (MD) or doctor of osteopathic medicine (DO). Unlike MDs or DOs, chiropractors generally can’t prescribe medications, perform surgery, or manage diseases outside of the neuromusculoskeletal system. The types of care a chiropractor can provide vary from state to state. 

If you decide to visit a chiropractor, make sure they have a doctorate of chiropractic and are licensed in your state. 

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When should you see a chiropractor?

If you have a history of musculoskeletal pain, you may be interested in working with a chiropractor. Spinal manipulation can relieve pain and let you get back to your normal life. 

Most people use spinal manipulation along with other types of medical treatment, like physical therapy, exercise, and medication. As a complementary and alternative treatment (CAM), spinal manipulation can offer extra support. People often use it with other types of CAM, like massage therapy, meditation, and biofeedback. 

Spinal manipulation can be a helpful tool for certain issues. Let’s review some common ones.

Low back pain 

Spinal manipulation is an effective treatment for nonspecific low back pain. It works just as well as other forms of treatment, such as physical therapy, pain medication, and home exercise. 

Studies show that after 6 weeks of treatment, people who received spinal manipulation for low back pain reported having less pain and an easier time moving around. For people with chronic low back pain, studies show that spinal manipulation can help reduce back pain so people can get back to work and their usual activities.

Neck pain

Spinal manipulation can help relieve pain for people who have mechanical neck pain. Mechanical neck pain, or non-radicular neck pain, means the cause of pain isn’t a pinched nerve in the neck or other nerve problem. 

In one study, spinal manipulation was as effective as home exercise for treating mechanical neck pain. Other studies suggest spinal manipulation works better for neck pain when paired with exercise and physical therapy. 

Headache

Spinal manipulation may help people who get migraines or cervicogenic headaches. There’s some evidence that people who receive spinal manipulation have more migraine-free days. For cervicogenic headaches, there’s evidence that spinal manipulation may be more effective for pain relief than other types of manual therapies.

Experts point out that spinal manipulation can be a helpful option for people who want to try something besides medications to help them manage their headaches. 

Shoulder pain

There’s some evidence that spinal manipulation can help relieve shoulder pain. In one study, people who received spinal manipulation for 6 weeks reported better shoulder movement after 3 months and were more likely to be pain free even up to 1 year later.

Who should not see a chiropractor?

Spinal manipulation isn’t right for everyone. Chiropractic treatments can safely treat some types of muscle injuries. But it can be hard to tell if neck or back pain is from a muscle injury or something more serious. 

In general, you shouldn’t see a chiropractor if you have:

• Weakness in the arms or legs

• Numbness anywhere in the body

• Pain shooting down both legs

• Trouble urinating or moving your bowels

• Fever or an infection

• A recent injury (especially a head or neck injury)

• A broken bone

• New headaches that a physician hasn’t diagnosed as a migraine or cervicogenic headache

Some chiropractors offer chiropractic adjustment to address other problems like allergies, asthma, high blood pressure, and painful menstrual cramps. But there’s no evidence that spinal manipulation can help these conditions.

If you have certain medical conditions, you shouldn’t see a chiropractor even for treatment of back or neck pain. Certain medical conditions raise the risk of serious side effects from chiropractic adjustment.

Avoid spinal manipulation if you have:

• Disc herniation

• Internal fixation and stabilization devices in the back or neck

• A tumor or cancer in the muscles, soft tissue, or spine

• Osteoporosis 

• Cauda equina syndrome

• Inflammatory conditions that affect the spine, like rheumatoid arthritis or spondylopathy

• Atlantoaxial instability

• Vertebrobasilar insufficiency syndrome

• A history of stroke or transient ischemic attack (TIA)

• A bleeding disorder

• A history of aortic aneurysm and dissection

It’s also important to skip spinal manipulation if you’re taking long-term anticoagulation therapy. 

Are chiropractors safe?

Chiropractic adjustment performed by a licensed provider is generally safe. Many people will notice mild side effects, such as stiffness or muscle ache after spinal manipulation. But serious side effects are rare. 

Although they’re uncommon, it’s important to be aware of possible risks of spinal manipulation, like:

• Cervical artery dissection: Spinal manipulation of the neck is associated with cervical artery dissection. Cervical artery dissection is a serious problem that can lead to stroke, long-term disability, and even death. There is debate about whether or not cervical spine manipulation actually causes cervical artery dissection. 

• Spinal cord injury: It’s extremely rare, but there have been cases of people developing weakness, numbness, and paralysis after spinal manipulation due to spinal cord injury. 

Experts agree that chiropractors should inform people of the risk of serious adverse events before performing chiropractic adjustment. If you have a condition that increases your risk for these issues, it’s likely your chiropractor will recommend that you seek alternative options to manage your pain.  

When should you see a chiropractor vs. another type of doctor? 

When you have back or neck pain, it can be difficult to decide who to go to for help. Here’s a breakdown of some of the people you can see for back pain and the treatments they usually provide: 

• MDs: MDs typically do not receive training in hand-on therapies like spinal manipulation. They manage musculoskeletal issues by prescribing medication, home exercise, or work with a physical therapist. 

• DOs: DOs complete the same training as an MD, and their license to practice medicine is the same. But, unlike MDs, they have training in osteopathic manipulative medicine (OMM), too. OMM uses techniques that are similar to chiropractic adjustment to address musculoskeletal problems. 

• Physical therapists: A physical therapist has a doctorate of physical therapy. They teach people how to perform physical exercises to relieve pain, improve mobility, and build muscle strength. They also perform hands-on treatment like massage, heat and cold therapy, and nerve stimulation. 

• Subspecialists: Some MDs and DOs are specialized to treat problems in the spine. Orthopedists, neurosurgeons, interventional radiologists, anesthesiologists, and physical medicine and rehabilitation doctors may offer additional treatments such as injections, nerve stimulation, or even surgery. You may get a referral to one of these doctors if other types of treatment for back pain haven’t worked for you.

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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