Chiropractors are spine-care experts with a focus on relieving pain, improving mobility,

optimizing function, and preventing disability.

Chiropractors prescribe conservative interventions such as manual and manipulative therapy as well as education, exercise, education, lifestyle modifications. The primary reason fo seek chiropractic care is for spinal disorders, including low back pain, neck pain, headaches, osteoarthritis, joint pain, and related musculoskeletal conditions. Low back pain and neck pain are the leading and fourth leading causes of global disability. Currently, chiropractic care is regulated and practiced in over 100 countries, however, chiropractors are most prevalent in North America, Australia and parts of Europe. Manual and manipulative therapies are widely used chiropractors, along with exercise, reassurance, education, and health promotion.

Scope of Practice

Chiropractors are licensed to differentially diagnose and communicate a neuromusculoskeletal diagnosis. Chiropractors may use broad diagnostic methods including observational and tactile assessments as well as orthopedic and neurological evaluation. When indicated, advanced diagnostic methods including laboratory and imaging (x-rays, MRI, etc) may be performed depending on the jurisdiction. Chiropractors may also refer a patient to an appropriate specialist, or co-manage with another health care provider such as medical physicians, medical specialists, physiotherapists, and psychologists. In 2005 the WHO published a document, WHO guidelines on basic training and safety in chiropractic that characterized chiropractic as a practice which "emphasizes the conservative management of the neuromusculoskeletal system". Certain jurisdictions allow the practice of animal chiropractic, whereby licensed chiropractors and veterinarians practice manual and manipulative therapies on animals for musculoskeletal disorders.

Education & Training

Chiropractors receive between 7-8 years of training to earn a doctoral degree Doctor of Chiropractic (D.C.) in North America. Outside of North America, chiropractors receive a minimum of 6 years of university at the Masters level. The World Health Organization lists three potential educational paths involving full‐time chiropractic education across the globe.

Foundational Knowledge

Clinical Skills


Communication Skills

The Chiropractor-Patient Relationship

Inter-professional Collaboration

Health Promotion and Disease Prevention

For more details see the CCEI Accreditation & Competency Standards

- Signatories for the clinical and professional chiropractic education statement

Regulation & Accreditation

Regulations for chiropractic practice vary considerably from country to country. In some countries, such as the United States of America, Canada, and some European countries, chiropractic has been legally recognized and formal university degrees have been established. In these countries, the profession is regulated and the prescribed educational qualifications are generally consistent, satisfying the requirements of the respective accrediting agencies. However, many countries have not yet developed chiropractic education or established laws to regulate the qualified practice of chiropractic. In addition, in some countries, other qualified health professionals and lay practitioners may use techniques of spinal manipulation and claim to provide chiropractic services, although they may not have received chiropractic training in an accredited program.

Chiropractic is governed internationally by the Councils on Chiropractic Education International (CCEI). This body is officially recognized by the World Federation of Chiropractic and the World Health Organization as the accrediting agency for schools of chiropractic across the world. The minimum prerequisite for enrollment in a chiropractic college set forth by the CCEI is 90 semester hours, and the minimum cumulative GPA for a student entering is 3.0 on a 4.0 scale. Common prerequisite classes include those of the biological, chemical, & physical sciences, including human anatomy and physiology, embryology, genetics, microbiology, immunology, cellular biology, exercise physiology, kinesiology, general chemistry, organic chemistry, analytical chemistry, biochemistry, toxicology/pharmacology, nutrition, nuclear medicine, physics, biomechanics, and statistics.


The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis, and plan of management of spinal and neuro-musculoskeletal disorders. The Evidence-Based Chiropractic Network endorses the WHO standards for education and training in spinal manipulation of 2200 hours for public health and safety. Manual medicine practitioners, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refer to diagnoses and conditions that put the patient at risk of developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilize joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis, are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindication applies only to the manipulation of the affected region. Mild adverse events may occur in SMT, which include a temporary increase in pain, tenderness, and stiffness. These events typically dissipate within 24–48 hours.

Clinical Practice Guidelines

The mainstream emergence of the chiropractic sciences occurred in 1975 with a growing mainstream acceptance of spinal manipulation in the 1980s. The 1990s resulted in a growing research capacity within the profession resulting in D.C.’s obtaining their PhDs and the establishment of chiropractic scientists. This, combined with the shift towards an evidence-based paradigm in health care, catalyzed efforts to improve service quality, safety, and established clinical practice guidelines. In the current era of evidence-based health care chiropractic scholars have generated evidence-based systematic reviews and practice guidelines concerning the management of acute/chronic low back pain, thoracic pain, neck pain, pain, headache, radiography, and upper/lower extremity conditions, tendinopathy myofascial pain

Reviews of research studies within the chiropractic community have been used to generate practice guidelines outlining standards that specify which chiropractic treatments are “legitimate” (i.e., supported by evidence) and conceivably reimbursable under managed care health payment systems. With the growing mainstream acceptance of spinal manipulation in the 1980s the 1990s resulted in a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines. In the current advent of the evidence-based medicine era, chiropractic scholars have generated evidence-based systematic reviews and practice guidelines concerning the management of acute/chronic low back pain, thoracic pain, neck pain, headache, radiography, and upper/lower extremity conditions. Tendinopathy, myofascial pain/trigger points, and non-musculoskeletal conditions.


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