It depends what for. The research is fairly solid on low back pain, thinner on other joint and muscle problems, and it does not support some of the bigger claims you may have heard.
Low back pain
Most of the research is here.
For back pain that has just started, a 2017 review in the Journal of the American Medical Association pooled 26 trials. Spinal manipulation was linked to modest improvements in pain and in how well people could move, over a period of up to six weeks. On a pain scale of 0 to 100, the average improvement was about 10 points1.
For back pain that has gone on for months, a 2019 review in the BMJ looked at 47 trials with 9,211 people. Manipulation did about as well as the treatments that guidelines already recommend, such as exercise. It did better than treatments the guidelines don't recommend, mainly in how well people could function in the short term2.
The guideline writers have taken note. The American College of Physicians lists spinal manipulation among the non-drug treatments to try first for low back pain3. The World Health Organization's 2023 guideline on long-lasting low back pain recommends it too, next to exercise, education and some psychological therapies4. The WHO's recommendation is what it calls conditional, which means the benefits probably outweigh the harms but the evidence behind it is not strong.
"Modest" is the word that keeps coming up, and it is the accurate one. Manipulation is a reasonable option for back pain. It is about as good as the other good options, and it is no miracle.
Alongside other things
A 2020 review of clinical guidelines for muscle and joint pain found eleven points the best guidelines agree on. One of them is that hands-on treatment should be used together with other treatment, mainly exercise and good information, and not by itself5. That matches what the back pain trials show. If a Chiropractor gives you exercises and expects you to do them, that is a good sign.
Where the evidence runs out
In 2019 an international group of researchers met in Toronto to review every trial they could find of spinal manipulation for conditions that have nothing to do with muscles and joints: colic in babies, childhood asthma, high blood pressure, period pain and migraine. They found no evidence that it works for any of them6. Be cautious of anyone who promises that treating your spine will fix problems like those.
The same goes for sports performance in healthy people. A 2019 review found no significant improvement after manipulation in adults who had no symptoms to begin with7.
Is it safe?
Minor side effects are common. In the larger studies covered by the 2017 review, more than half of patients reported something like extra soreness, stiffness or a headache afterwards. These passed quickly1.
The worry people raise most is stroke after treatment to the neck. The best-known study on it used nine years of hospital records from Ontario, Canada. This kind of stroke turned out to be very rare. People under 45 who had one were more likely than others to have visited a Chiropractor shortly beforehand. But the same kind of link showed up for visits to a GP. The researchers' explanation is that a tear in a neck artery causes neck pain and headache before it causes a stroke, and those symptoms send people to whoever they normally see. They found no evidence that Chiropractic care carried more risk than a GP visit8.
That is one reason a Chiropractor asks about headaches, dizziness and your medical history before treating your neck. It is also why you should mention anything unusual, even if it seems unrelated.
What you are entitled to
South African law is clear about this. Under the National Health Act, any health care provider has to tell you about your condition, the treatment options, what each one is likely to cost and achieve, the risks, and your right to say no. They may not treat you without your informed consent, and what you tell them is confidential9. Chiropractors also work under the Allied Health Professions Council's code of ethics, which covers how they may advertise as well as how they practise10.
So ask. What do you think is wrong? What are my options? How many visits is this likely to take, and what happens if I'm not getting better? A Chiropractor who knows their work will be glad to answer.
This article is general information and not a diagnosis. If you are in pain, come in for an assessment.
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. pmc.ncbi.nlm.nih.gov
- 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. bmj.com
- 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.
- World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: WHO; 2023. who.int
- Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. bjsm.bmj.com
- Côté P, Hartvigsen J, Axén I, et al. The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature. Chiropr Man Therap. 2021;29:8.
- Corso M, Mior SA, Batley S, et al. The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence. Chiropr Man Therap. 2019;27:25. pmc.ncbi.nlm.nih.gov
- 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. pubmed.ncbi.nlm.nih.gov
- National Health Act 61 of 2003 (South Africa), sections 6, 7 and 14. gov.za
- Allied Health Professions Council of South Africa. Code of ethics, including guidelines for good practice and advertising guidelines. Board Notice 128 of 2014, Government Gazette 38125, 30 October 2014.