Chiropractic care in the United States has evolved from its controversial origins to become a widely used option for pain management, particularly for lower back pain. An estimated 11% of American adults sought chiropractic treatment in 2022, and many prominent health systems now include chiropractic services. National guidelines often recommend spinal manipulation as a first-line treatment for certain types of back pain, supported by evidence indicating moderate effectiveness.

Chiropractors in the U.S. undergo specialized training, typically completing a four-year program covering basic sciences, nutrition, and manual adjustment techniques. Afterward, they must pass a national board exam to obtain state licensure. Their practice centers around manual spinal adjustments, which involve applying pressure to joints and muscles around the spine, often accompanied by a characteristic "popping" sound caused by gas release from joint fluid. Although the sound is common during treatment, it is not the intended therapeutic effect.

Research supports chiropractic manipulation as at least as effective as other non-pharmacological treatments such as acupuncture and massage therapy for lower back pain. An analysis of 47 randomized controlled trials found spinal manipulation to offer mild to moderate relief with fewer side effects than common alternatives like anti-inflammatory drugs or corticosteroid injections. Serious complications, such as fractures, are extremely rare, occurring in approximately one out of every two million manipulations. Consequently, organizations such as the World Health Organization and the U.S. Department of Veterans Affairs have incorporated recommendations for spinal manipulation in managing lower back pain.

Evidence for chiropractic treatment of neck pain is less definitive. Some studies suggest that manual adjustments may reduce acute neck pain, but due to small sample sizes and methodological limitations, further investigation is necessary. Caution is often advised because of potential, though rare, risks such as arterial dissection—a serious vascular injury linked in some analyses to neck manipulation that could lead to stroke or death. The causal relationship between neck adjustments and such injuries remains uncertain.

Chiropractic practice varies widely, with some providers strictly adhering to evidence-based techniques, while others promote unproven treatments or supplements. Consumers are advised to scrutinize claims, especially those promising cures for non-musculoskeletal conditions, as these often lack scientific support. Patients should also be cautious of chiropractors who encourage immediate subscription plans or continuous treatments without clear justification. While the sale of vitamins or supplements is not inherently problematic, skepticism is warranted when high-priced products claim exaggerated benefits.

Overall, chiropractic care remains a viable option for certain musculoskeletal issues when practiced responsibly, but patients are encouraged to seek providers who align their offerings with established scientific evidence.