What the research says about chiropractic care

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The strongest evidence comes from systematic reviews that pool many randomised trials. Where a review rates its evidence as low or moderate quality, that means the results vary between people and better trials could change the picture. Where we say the evidence is early, we mean small, short-term or laboratory studies that do not support clinical claims.

Across all of it, one theme is consistent: hands-on treatment works best alongside exercise and advice, not instead of them. That is how we practise.

The evidence by area

Back pain

Research has found that adding chiropractic care to usual medical care can reduce low back pain and make everyday activities easier. A trial involving 750 US military personnel found better pain and disability scores after six weeks compared with usual medical care alone. Chiropractic care included manipulation and other treatments, such as rehabilitation exercises.

Research has found that spinal manipulation produces similar improvements to other recommended treatments for persistent low back pain. A review of 47 randomised trials found similar pain relief and a small advantage in short-term improvements in daily function compared with other recommended therapies.

• Goertz, C. M., Long, C. R., Vining, R. D., Pohlman, K. A., Walter, J., & Coulter, I. (2018). Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: A comparative effectiveness clinical trial. JAMA Network Open, 1(1), e180105. doi.org/10.1001/jamanetworkopen.2018.0105
• Rubinstein, S. M., de Zoete, A., van Middelkoop, M., Assendelft, W. J. J., de Boer, M. R., & van Tulder, M. W. (2019). 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, 364, l689. doi.org/10.1136/bmj.l689

Neck pain

Research has found that spinal manipulation can reduce recent-onset neck pain more effectively than medication. In a trial involving 272 adults with neck pain lasting two to 12 weeks, manipulation produced better pain outcomes than medication at several follow-ups. Home exercises and advice produced similar outcomes to manipulation at most time points.

• Bronfort, G., Evans, R., Anderson, A. V., Svendsen, K. H., Bracha, Y., & Grimm, R. H. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: A randomized trial. Annals of Internal Medicine, 156(1 Pt 1), 1-10. doi.org/10.7326/0003-4819-156-1-201201030-00002

Headaches

Research has found that chiropractic spinal manipulation can reduce the number of headache days in people with headaches originating from the neck, called cervicogenic headaches. A trial involving 256 adults found that the group receiving 18 manipulation sessions over six weeks experienced approximately three fewer headache days per four weeks than the light-massage control group at the main follow-ups.

• Haas, M., Bronfort, G., Evans, R., Schulz, C., Vavrek, D., Takaki, L., Hanson, L., Leininger, B., & Neradilek, M. B. (2018). Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: A dual-center randomized controlled trial. The Spine Journal, 18(10), 1741-1754. doi.org/10.1016/j.spinee.2018.02.019

Sciatica

Research has found that chiropractic manipulation can reduce pain in some people with acute sciatica caused by a protruding disc. In a trial involving 102 people, 55 percent receiving real manipulation became free of radiating pain, compared with 20 percent receiving simulated manipulation. The findings apply to the particular patients studied, rather than every cause of sciatica.

• Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: A randomized double-blind clinical trial of active and simulated spinal manipulations. The Spine Journal, 6(2), 131-137. doi.org/10.1016/j.spinee.2005.08.001

Shoulder pain

Research has found that adding manipulation and mobilisation to usual medical care can help some people recover from shoulder pain more quickly. In a trial involving 150 people with shoulder symptoms and associated shoulder-girdle dysfunction, 43 percent receiving additional manual treatment reported full recovery at 12 weeks, compared with 21 percent receiving usual medical care alone.

• Bergman, G. J. D., Winters, J. C., Groenier, K. H., Pool, J. J. M., Meyboom-de Jong, B., Postema, K., & van der Heijden, G. J. M. G. (2004). Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: A randomized, controlled trial. Annals of Internal Medicine, 141(6), 432-439. doi.org/10.7326/0003-4819-141-6-200409210-00008

Hip pain

Research has found that manual therapy delivered by a chiropractor, combined with patient education, can reduce pain from hip osteoarthritis. A trial involving 118 people found that this combination reduced pain more than a minimal intervention involving home stretching. The difference was approximately 1.9 points on a 0 to 10 pain scale after six weeks.

• Poulsen, E., Hartvigsen, J., Christensen, H. W., Roos, E. M., Vach, W., & Overgaard, S. (2013). Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial. Osteoarthritis and Cartilage, 21(10), 1494-1503. doi.org/10.1016/j.joca.2013.06.009

Posture

Research has found that upper-back mobilisation combined with exercises can improve forward-head posture and associated neck symptoms in the short term. A small trial involving 32 people found better improvements in standing head posture, neck movement, pain and disability than a programme targeting the upper neck.

• Cho, J., Lee, E., & Lee, S. (2017). Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: A randomized clinical trial. BMC Musculoskeletal Disorders, 18, Article 525. doi.org/10.1186/s12891-017-1889-2

Sports injuries

Research has found that hands-on joint treatment combined with exercises can improve pain and function after an ankle sprain more than a home exercise programme alone. In a trial involving 74 people, the combined treatment produced better results after four weeks and six months, including better ability to perform sporting activities.

• Cleland, J. A., Mintken, P. E., McDevitt, A., Bieniek, M. L., Carpenter, K. J., Kulp, K., & Whitman, J. M. (2013). Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: A multicenter randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy, 43(7), 443-455. doi.org/10.2519/jospt.2013.4792