Chiropractic care for back pain

Chiropractic care is a way to diagnose and treat health problems that affect the nerves, muscles, bones, and joints of the body. A health care provider who provides chiropractic care is called a chiropractor.

Hands-on adjustment of the spine, called spinal manipulation, is the basis of chiropractic care. Most chiropractors also use other types of treatments as well.

What Happens During a Visit to a Chiropractor?

The first visit most often lasts 30 to 60 minutes. Your chiropractor will ask about your goals for treatment and your health history. You will be asked about your:

Past injuries and illnesses
Current health problems
Any medicines you are taking
Lifestyle
Diet
Sleep habits
Exercise
Mental stresses you might have
Use of alcohol, drugs, or tobacco

Tell your chiropractor about any physical problems you may have that make it hard for you to do certain things. Also tell your chiropractor if you have any numbness, tingling, weakness, or any other nerve problems.

After asking you about your health, your chiropractor will do a physical exam. This will include testing your spinal mobility (how well your spine moves). Your chiropractor may also do some tests, such as checking your blood pressure and taking x-rays. These tests look for problems that might be adding to your back pain.

Treatment begins at the first or second visit in most cases.

You may be asked to lie on a special table, where the chiropractor does the spinal manipulations.
The most common treatment is manipulation done by hand. It involves moving a joint in your spine to the end of its range, followed by a light thrust. This is often called an "adjustment." It realigns the bones of your spine to make them straighter.
The chiropractor may also do other treatments, like massage and other work on soft tissues.

Some people are a little achy, stiff, and tired for a few days after their manipulations. This is because their bodies are adjusting to their new alignment. You should not feel any pain from the manipulation.

How Many Treatments Will You Need?

More than one session is most often needed to correct a problem. Treatments generally last several weeks. Your chiropractor may suggest 2 or 3 short sessions a week at first. These would last only about 10 to 20 minutes each. Once you start improving, your treatments may be just once a week. You and your chiropractor will talk about how effective the treatment is based on the goals you discussed in your first session.

What Conditions Does Chiropractic Treat Best?

Chiropractic treatment is most effective for:

Subacute back pain (pain that has been present for 3 months or less)
Flare-ups of chronic (long-term) back pain
Neck pain

Who Should Not Be Treated with Chiropractic?

People should not have chiropractic treatment in the parts of their bodies that are affected by:

Bone fractures or bone tumors
Severe arthritis
Bone or joint infections
Severe osteoporosis (thinning bones)
Severely pinched nerves

Very rarely, manipulation of the neck may damage blood vessels or cause strokes. It is also very rare that manipulation may worsen a condition. But the screening process your chiropractor does at your first visit is meant to see if you might be at high risk for these problems. If you are, your chiropractor will not do neck manipulation.

References

Lemmon R, Roseen EJ. Chronic low back pain. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 67.

Perlman A. Complementary and alternative medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 39.

Puentedrua E. Spinal manipulation. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier;2018:chap 78.

Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011;(2):CD008112. PMID: 21328304 www.ncbi.nlm.nih.gov/pubmed/21328304.

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database Syst Rev. 2010;(4):CD005427. PMID: 20393942 www.ncbi.nlm.nih.gov/pubmed/20393942.

Review Date 9/7/2017

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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