The first visit most often lasts 30 to 60 minutes. Your chiropractor will ask about your goals for treatment and your health history. You will be asked about your:

• Past injuries and illnesses
• Current health problems
• Any medicines you are taking
• Lifestyle
• Diet
• Sleep habits
• Exercise
• Mental stresses you might have
• Use of alcohol, drugs, or tobacco

Tell your chiropractor about any physical problems you may have that make it hard for you to do certain things. Also tell your chiropractor if you have any numbness, tingling, weakness, or any other nerve problems.

After asking you about your health, your chiropractor will do a physical exam. This will include testing your spinal mobility (how well your spine moves). Your chiropractor may also do some tests, such as checking your blood pressure and taking x-rays. These tests look for problems that might be adding to your back pain.

Treatment begins at the first or second visit in most cases.

• You may be asked to lie on a special table, where the chiropractor does the spinal manipulations.
• The most common treatment is manipulation done by hand. It involves moving a joint in your spine to the end of its range, followed by a light thrust. This is often called an "adjustment." It realigns the bones of your spine to place them in a better position.
• The chiropractor may also do other treatments, like massage and other work on soft tissues.

Some people are a little achy, stiff, and tired for a few days after their manipulations. This is because their bodies are adjusting to their new alignment. You should not feel any pain from the manipulation.

More than one session is most often needed to correct a problem. Treatments generally last several weeks. Your chiropractor may suggest 2 or 3 short sessions a week at first. These would last only about 10 to 20 minutes each. Once you start improving, your treatments may be just once a week. You and your chiropractor will talk about how effective the treatment is based on the goals you discussed in your first session.

Chiropractic treatment is most effective for:

• Subacute back pain (pain that has been present for 3 months or less)
• Flare-ups of chronic (long-term) back pain
• Chronic neck pain

People should not have chiropractic treatment in the parts of their bodies that are affected by:

• Bone fractures or bone tumors
• Severe arthritis
• Bone or joint infections
• Severe osteoporosis (thinning bones)
• Severely pinched nerves with numbness, tingling, and weakness in your arms or legs
• Acute neck pain with symptoms of pinched nerves

Very rarely, manipulation of the neck may damage blood vessels or cause strokes. It is also very rare that manipulation may worsen a condition, but it can. The screening process your chiropractor does at your first visit is meant to see if you might be at high risk for these problems. Make sure to discuss all of your symptoms and past medical history with the chiropractor. If you are at high risk, your chiropractor will not do neck manipulation.

Atchison JW, Tolchin RB, Ross BS, Eubanks JE. Manipulation, traction, and massage. In: Cifu DX, ed. Braddom's Physical Medicine and Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 16.

Lemmon R, Roseen EJ. Chronic low back pain. In: Rakel D, Minichiello VJ, eds. Integrative Medicine. 5th ed. Philadelphia, PA: Elsevier; 2023:chap 99.

Puentedrua LE. Spinal manipulation. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 78.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.