Chiropractic care is a commonly used nonpharmacological approach for managing musculoskeletal conditions, particularly those involving the spine. As healthcare increasingly emphasizes conservative treatment, patient-centered care, and appropriate use of medications and other interventions, researchers continue to examine the role chiropractic care may play in managing spine-related pain.
A substantial body of scientific literature now addresses spinal manipulation and other treatments commonly used in chiropractic practice. The strength of evidence varies by condition, intervention, and outcome. Taken together, this research provides useful context for patients, healthcare professionals, policymakers, and others evaluating chiropractic care as part of modern musculoskeletal healthcare.
Understanding the Scope of Chiropractic Research
Research relevant to chiropractic care focuses largely on musculoskeletal conditions, especially low back pain, neck pain, and certain types of headache.
Studies frequently examine interventions that may form part of chiropractic management, including spinal manipulation or mobilization, therapeutic exercise, soft-tissue techniques, patient education, and self-management strategies.
It is important to distinguish between research evaluating spinal manipulation as a specific treatment and research evaluating chiropractic care as a broader clinical approach. Chiropractic care may involve several interventions, and treatment plans vary according to the patient's condition, needs, preferences, and clinical findings.
Low Back Pain
Low back pain is one of the most extensively studied conditions in the literature on spinal manipulation.
A 2017 systematic review and meta-analysis published in JAMA found that spinal manipulative therapy was associated with statistically significant, though generally modest, improvements in pain and function among patients with acute low back pain.[1]
For chronic low back pain, a 2019 systematic review and meta-analysis published in The BMJ concluded that spinal manipulative therapy produced outcomes similar to other recommended therapies for short-term pain relief and slightly better improvement in function in some comparisons.[2]
Clinical practice guidelines also include spinal manipulation among nonpharmacological treatment options. The American College of Physicians recommends that clinicians and patients consider nonpharmacological approaches for acute, subacute, and chronic low back pain, with spinal manipulation among the available options.[3]
More recent chiropractic clinical practice guidance similarly supports a patient-centered, evidence-informed approach to mechanical low back pain that may incorporate manipulation, exercise, education, and other conservative interventions as clinically appropriate.[4]
Overall, the evidence suggests that spinal manipulation can be a reasonable treatment option for many patients with nonspecific or mechanical low back pain.
Neck Pain
Evidence also supports manual therapy as one option in the management of certain forms of neck pain, particularly when used as part of a broader treatment plan.
Clinical practice guidelines have supported multimodal approaches that combine manual therapy with exercise, education, and self-management strategies for both recent-onset and persistent neck pain.[5]
Evidence favors matching treatment to the individual patient and, in many cases, combining manual therapy with active care such as exercise. Modern chiropractic management of neck pain is not necessarily limited to spinal manipulation and may incorporate rehabilitation, exercise, education, and referral or co-management when indicated.
Headaches
Some headache disorders may involve structures of the cervical spine and surrounding musculoskeletal system.
A 2026 clinical practice guideline addressing chiropractic management of adults with cervicogenic headache and tension-type headache reviewed 31 systematic reviews and one prior clinical practice guideline. The guideline supports spinal manipulation as an option for cervicogenic headache and recommends that it be used within multimodal care for tension-type headache.[6]
Function, Activity, and Patient-Centered Outcomes
Pain reduction is only one measure of treatment effectiveness. Studies of musculoskeletal care commonly evaluate function, disability, activity levels, quality of life, and patient-reported improvement.
For example, systematic reviews of spinal manipulation for low back pain have demonstrated improvements in functional outcomes as well as pain, although the magnitude of benefit and comparison with other treatments varies among studies.[1,2]
Modern evidence-informed care therefore places emphasis not simply on reducing symptoms but on helping patients regain function, remain active, and participate in normal daily activities.
Safety of Chiropractic and Manual Therapy
Every healthcare intervention has potential benefits and risks, and safety should be considered alongside effectiveness.
The most commonly reported adverse effects following spinal manipulation and other manual therapies are transient musculoskeletal symptoms such as soreness, stiffness, increased discomfort, or headache.[1,7,8] These reactions generally resolve without additional treatment.
A large population-based study examining vertebrobasilar stroke found similar associations between stroke and prior visits to chiropractors and primary care physicians. The authors concluded that patients with an evolving arterial dissection may seek care for neck pain or headache before the stroke occurs and found no evidence of excess risk associated with chiropractic care compared with primary care.[9]
More recent reviews continue to emphasize the importance of careful clinical assessment and screening for signs or symptoms that may indicate vascular or other serious pathology before cervical treatment is provided.[10]
Accordingly, the strongest safety message is not that chiropractic care is risk-free. It is that serious adverse events are uncommon, minor transient reactions are more common, and appropriate patient assessment and clinical decision-making are essential.
Chiropractic Care and Opioid Use
The relationship between chiropractic care and prescription opioid use has received increasing research attention.
A 2019 systematic review and meta-analysis found that patients with spinal pain who used chiropractic care had lower odds of receiving an opioid prescription than those who did not.[11]
A larger systematic review and meta-analysis published in 2025 included two randomized trials and 18 cohort studies involving more than six million participants. It similarly found an association between receipt of chiropractic care and lower odds of prescription opioid use, with a stronger association when chiropractic care occurred earlier in the course of spine-related pain.[12]
These findings therefore support continued study of chiropractic care as one component of nonpharmacological pain management.
Healthcare Utilization and Cost
The economic evidence surrounding chiropractic care is complex. A systematic review of U.S. studies found that claims-based analyses frequently reported lower healthcare costs among chiropractic patients, although studies that simultaneously examined clinical outcomes produced more variable findings.[14]
More recently, a 2024 systematic review examining chiropractic versus medical management for spine-related musculoskeletal pain reported lower downstream healthcare utilization among patients who initially consulted chiropractors, including fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals, and injection procedures.[15]
The economic evidence is therefore promising. Costs and utilization vary according to patient characteristics, health plan design, clinical condition, provider access, treatment patterns, and the healthcare services being compared.
Chiropractic Care Within an Integrated Healthcare System
Musculoskeletal conditions often benefit from coordinated care rather than a single treatment approach.
Depending on a patient's needs, chiropractic management may include conservative treatment within the chiropractic office as well as communication, referral, or co-management with primary care clinicians, physical therapists, specialists, and other healthcare professionals.
Evidence-based chiropractic care should include recognition of conditions that are appropriate for conservative management as well as those requiring diagnostic evaluation, referral, or another form of treatment.
Integration therefore does not mean that every patient needs multiple providers. It means that chiropractic care can function as one component of a broader healthcare system in which patients receive the right level of care for their individual circumstances.
The Importance of Evidence-Informed Practice
Evidence-informed practice combines the best available research with clinical expertise and the needs, values, and preferences of the individual patient.
For doctors of chiropractic, this includes remaining current with clinical guidelines and emerging research, using appropriate examination and clinical decision-making, recognizing when referral or co-management is warranted, and discussing reasonable treatment options with patients.
The New York State Chiropractic Association supports continued professional education, clinical research awareness, and responsible application of evidence within chiropractic practice.
Conclusion
Current research supports chiropractic care, including spinal manipulation and other conservative interventions commonly used by chiropractors, as an option for the management of several musculoskeletal conditions, particularly low back pain and selected forms of neck pain and headache.
Research supports modest improvements in pain and function for some conditions, generally favorable safety findings when care is appropriately provided, and associations between chiropractic utilization and reduced use of some healthcare services, including prescription opioids.
Explore the Research
Readers interested in reviewing individual studies, systematic reviews, and clinical practice guidelines can visit NYSCA's Chiropractic Research resource, where research is organized by clinical topic, including low back pain, neck pain, headache, safety, healthcare utilization, and opioid use.
References
- Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086.
- Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. doi:10.1136/bmj.l689.
- Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367.
- Whalen WM, Farabaugh RJ, Hawk C, et al. Best practices for chiropractic management of adult patients with mechanical low back pain: a clinical practice guideline for chiropractors in the United States. J Manipulative Physiol Ther. 2022;45(8):551-565. doi:10.1016/j.jmpt.2023.04.010.
- Bussières AE, Stewart G, Al-Zoubi F, et al. The treatment of neck pain-associated disorders and whiplash-associated disorders: a clinical practice guideline. J Manipulative Physiol Ther. 2016;39(8):523-564.e27. doi:10.1016/j.jmpt.2016.08.007.
- Trager RJ, Daniels CJ, Hawk C, et al. Chiropractic management of adults with cervicogenic or tension-type headaches: development of a clinical practice guideline. J Integr Complement Med. 2026;32(4). doi:10.1177/27683605251397769.
- Carnes D, Mars TS, Mullinger B, Froud R, Underwood M. Adverse events and manual therapy: a systematic review. Man Ther. 2010;15(4):355-363. doi:10.1016/j.math.2009.12.006.
- Paanalahti K, Holm LW, Nordin M, et al. Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2014;15:77. doi:10.1186/1471-2474-15-77.
- Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008;33(4 Suppl):S176-S183. doi:10.1097/BRS.0b013e3181644600.
- Peters R, et al. Recommendations for mobilization and manipulation treatment and screening for vascular complications in clinical practice guidelines for neck pain: a systematic review. Phys Ther. 2025;105(2):pzae179. doi:10.1093/ptj/pzae179.
- Corcoran KL, Bastian LA, Gunderson CG, Steffens C, Brackett A, Lisi AJ. Association between chiropractic use and opioid receipt among patients with spinal pain: a systematic review and meta-analysis. Pain Med. 2020;21(2):e139-e145. doi:10.1093/pm/pnz219.
- Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis. Pain. 2025. PMID: 41404361.
- Blanchette MA, Stochkendahl MJ, Borges Da Silva R, Boruff J, Harrison P, Bussières A. Effectiveness and economic evaluation of chiropractic care for the treatment of low back pain: a systematic review of pragmatic studies. PLoS One. 2016;11(8):e0160037. doi:10.1371/journal.pone.0160037.
- Dagenais S, Brady O, Haldeman S, Manga P. A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States. BMC Health Serv Res. 2015;15:474. doi:10.1186/s12913-015-1102-7.
- Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review. 2024. PMID: 38448998.