Chiropractic Care for Joint Health: What to Know Before You Go

Key Takeaways

• Chiropractic care shows moderate evidence for low back pain and neck pain
• Evidence for peripheral joints (knees, hips, shoulders) is limited
• Chiropractic is generally safe when performed by licensed practitioners
• It works best as part of a comprehensive treatment plan
• Not all chiropractors practice the same way—approaches vary widely
• Communication with your regular doctor about chiropractic care is important

Chiropractic care is one of the most commonly used complementary therapies, with millions of visits each year. For people with joint and spine pain, it can be an appealing option. But what does the evidence actually show, and what should you know before making an appointment?

This guide provides a balanced look at chiropractic care for joint health.

What Is Chiropractic Care?

The Foundation

Chiropractic focuses on the relationship between the spine, the nervous system, and overall health. Traditional chiropractic theory holds that misalignments of the spine (“subluxations”) can affect health and that correcting these misalignments improves function.

Modern Practice

Many chiropractors today take an evidence-based approach that focuses on:

• Musculoskeletal pain and function
• Joint mobility
• Muscle tension and balance
• Movement patterns
• Patient education and self-care

Common Techniques

Spinal manipulation (adjustment):

• High-velocity, low-amplitude thrust to joints
• Often produces a “popping” sound
• Aims to improve joint mobility

Mobilization:

• Gentler, low-velocity movements
• Gradually increases joint range of motion
• May be preferred for sensitive patients

Soft tissue techniques:

• Massage-like techniques
• Muscle release methods
• Trigger point therapy

Additional therapies (vary by practitioner):

• Electrical stimulation
• Ultrasound
• Heat and ice
• Exercise instruction
• Ergonomic advice

What Does Evidence Show?

For Low Back Pain

Evidence summary:

• Moderate evidence supports spinal manipulation for acute and chronic low back pain
• Benefits are similar to other conservative treatments (physical therapy, exercise, medications)
• Multiple guidelines include manipulation as a reasonable option

What this means:

• Chiropractic can help back pain for many people
• It’s not necessarily better than other treatments
• Individual response varies

For Neck Pain

Evidence summary:

• Moderate evidence for mechanical neck pain
• Similar effectiveness to physical therapy approaches
• May help with certain types of headaches

For Peripheral Joints (Knees, Hips, Shoulders)

Evidence summary:

• Limited research available
• Some studies suggest potential benefit
• Not as well-established as spine-related treatments
• Often combined with exercise and other approaches

For knee osteoarthritis specifically:

• Some chiropractors use manipulation and mobilization for knees
• Evidence is insufficient to strongly recommend or discourage
• May be worth trying if conventional approaches haven’t helped

Safety Considerations

Overall Safety Profile

Chiropractic manipulation is considered safe when performed by licensed practitioners:

Common minor effects:

• Temporary soreness in treated area
• Fatigue
• Headache
• Stiffness

Rare serious complications:

• Stroke after neck manipulation (very rare, estimated 1 in 1-2 million)
• Disc herniation worsening
• Fractures (mainly in people with osteoporosis)

Who Should Be Cautious

Relative contraindications:

• Osteoporosis or osteopenia
• Inflammatory arthritis (RA, ankylosing spondylitis)
• Recent fractures
• Blood clotting disorders or anticoagulant use
• Certain spine conditions (stenosis, instability)
• Arterial disease affecting neck vessels

Important: Tell the chiropractor about ALL health conditions, medications, and previous diagnoses.

Red Flags Requiring Medical Evaluation First

See a medical doctor before seeking chiropractic if you have:

• Unexplained weight loss
• Fever with back pain
• Recent significant trauma
• Progressive neurological symptoms
• Bladder or bowel dysfunction
• History of cancer
• Pain that wakes you from sleep

Finding a Chiropractor

Credentials

All US chiropractors must:

• Graduate from an accredited chiropractic college
• Pass national board exams
• Be licensed by the state

Choosing Wisely

Look for:

• Evidence-based approach
• Willing to coordinate with your other doctors
• Doesn’t promise to “cure” diseases
• Recommends limited treatment course with reassessment
• Includes exercise and self-care in treatment plan

Be cautious of:

• Long-term treatment contracts requiring upfront payment
• Claims to treat conditions unrelated to musculoskeletal system
• Excessive X-rays
• Discouraging medical care for serious conditions
• Refusing to communicate with other healthcare providers

Questions to Ask

1. What is your treatment approach?
2. How many sessions do you typically recommend?
3. What other treatments do you use besides manipulation?
4. Will you coordinate with my other doctors?
5. What signs would indicate I need different treatment?

What to Expect

First Visit

Consultation:

• Health history review
• Discussion of your symptoms
• Questions about previous treatments

Examination:

• Physical examination
• Movement assessment
• Possibly X-rays (though routine X-rays aren’t necessary for most)

First treatment:

• May occur on first visit
• Or may be scheduled for follow-up after evaluation

Treatment Session

Typical session includes:

• Discussion of how you’re doing
• Manual therapy (adjustment and/or mobilization)
• Additional therapies as appropriate
• Exercise recommendations
• Duration: 15-30 minutes after initial visit

What Adjustments Feel Like

• You may hear popping or cracking sounds (release of gas in joints)
• Brief pressure or movement
• Shouldn’t be painful (speak up if it is)
• May feel immediate relief, or effects may take time

Treatment Course

Evidence-based approach:

• Initial course of 4-8 sessions
• Reassessment of progress
• If helping, may continue or space out
• If not helping after adequate trial, consider other options

Red flag: Chiropractors recommending indefinite ongoing treatment without clear rationale

Combining with Other Care

Works Well With

• Exercise and physical therapy
• Massage therapy
• Pain medications (can potentially reduce need)
• Medical care for arthritis

Important Coordination

• Tell your chiropractor about all medical conditions and medications
• Tell your medical doctor about chiropractic treatment
• Integrated care often provides best results
• Don’t delay necessary medical treatment for chiropractic

Cost and Insurance

Typical Costs

• Initial visit: $75-$200
• Follow-up visits: $50-$100
• Package deals: Often offered (evaluate carefully)

Insurance Coverage

• Many plans: Include chiropractic with visit limits
• Medicare: Covers spinal manipulation only (not exams, X-rays, or other therapies)
• HSA/FSA: Generally eligible

Value Considerations

• Does relief justify cost?
• Are fewer sessions of other treatment more cost-effective?
• Is improvement maintained or only with ongoing visits?

Frequently Asked Questions

Is the “cracking” sound harmful?

No. The sound is caused by gas being released from joint fluid during manipulation. It’s similar to cracking your knuckles—not harmful in itself.

How is chiropractic different from physical therapy?

Both can help musculoskeletal pain. Chiropractors typically focus more on joint manipulation and adjustments. Physical therapists typically emphasize exercise, movement patterns, and rehabilitation. Many patients benefit from both. Some conditions are better suited to one approach than the other.

Can chiropractic help my knee arthritis?

Possibly. While evidence is limited, some people with knee OA report benefit from chiropractic treatment that includes mobilization and soft tissue work. It’s reasonable to try if you’re interested, but ensure you’re also following established OA treatments (exercise, weight management, etc.).

How many visits should I need?

For most musculoskeletal conditions, you should see improvement within 4-8 visits. If there’s no improvement after adequate trial, the approach may not be right for you. Be wary of recommendations for extensive ongoing treatment without clear improvement.

Is chiropractic safe with osteoporosis?

Caution is needed. Traditional high-velocity manipulation may not be appropriate. However, gentler techniques (mobilization, soft tissue work) can often be used safely. Discuss your bone density with the chiropractor and ensure they modify techniques appropriately.

Can chiropractic cause a stroke?

There is a very rare association between neck manipulation and stroke, estimated at about 1 in 1-2 million manipulations. Some experts believe this risk may be related to pre-existing arterial problems. If you have risk factors for stroke or vascular disease, discuss neck manipulation carefully with both your doctor and chiropractor.

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Exploring treatment options? Learn about massage therapy for arthritis or read about physical therapy for knee osteoarthritis.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Discuss chiropractic care with your healthcare provider, especially if you have osteoporosis, inflammatory arthritis, or other health conditions.