Merck Manual

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Denise Millstine

, MD, Mayo Clinic

Last full review/revision Oct 2021
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In chiropractic (a manipulative and body-based practice) Manipulative and Body-Based Practices Five categories of complementary or alternative medicine are generally recognized: Whole medical systems Mind-body medicine Biologically based practices not usually used in conventional medicine... read more , the relationship between the structure of the spine and other articulating surfaces and their interaction with the nervous system is thought to be key to maintaining or restoring health. The main method for restoring this relationship is manipulation of the spine, other joints, and soft tissues. Chiropractors may provide physical therapies (eg, heat and cold, electrical stimulation, rehabilitation strategies), massage, or acupressure and may recommend exercises, ergonomic measures, or lifestyle changes. (See also Overview of Integrative, Complementary, and Alternative Medicine Overview of Integrative, Complementary, and Alternative Medicine Integrative medicine and health (IMH) and complementary and alternative medicine (CAM) include healing approaches and therapies that historically have not been included in conventional, mainstream... read more .)

Some chiropractors emphasize vitalistic medicine (the body's ability to heal itself). They use manipulation to correct hypothesized misalignments in the vertebrae in an attempt to restore the flow of a life energy (called innate). They believe that this method can heal most disorders. Other chiropractors reject this notion to various degrees; some of them restrict themselves to evidence-based musculoskeletal treatments.

Uses for Chiropractic

Evidence (moderate quality) for chiropractic manipulation is sufficient for

Some chiropractors treat other disorders (eg, asthma, enuresis, torticollis, and otitis media in children), although very few high-quality studies of chiropractic as treatment for these disorders have been done, and they do not support efficacy.

Possible Adverse Effects

Serious complications resulting from spinal manipulation (eg, low back pain, damage to cervical nerves, damage to arteries in the neck) are rare. Spinal manipulation is not recommended for patients with osteoporosis or symptoms of neuropathy (eg, paresthesias, loss of strength in a limb). Whether it is safe for patients who have had spinal surgery or stroke or who have a vascular disorder is unclear.


  • 1. Coulter ID, Crawford C, Hurwitz EL, et al: Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J18(5):866-879, 2018. doi: 10.1016/j.spinee.2018.01.013

  • 2. Bryans R, Descarreaux M, Duranleau M, et al: Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 34(5):274-89, 2011. doi: 10.1016/j.jmpt.2011.04.008

  • 3. Whalen W, Farabaugh RJ, Hawk C, et al: Best-practice recommendations for chiropractic management of patients with neck pain. J Manipulative Physiol Ther 42(9):635-650, 2019. doi: 10.1016/j.jmpt.2019.08.001

  • 4. Carnes D, Plunkett A, Ellwood J, et al: Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open 8(1):e019040, 2018. doi: 10.1136/bmjopen-2017-019040

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