Chiropractic Research & Facts — The Evidence Behind Your Care
What is chiropractic? It’s a health care discipline focused on the relationship between your spine and your nervous system, using hands-on treatment instead of drugs or surgery. Here’s the profession’s own official definition, and what it actually looks like in practice at our office.
The Official Definition
“Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery. The practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. In addition, Doctors of Chiropractic recognize the value and responsibility of working in cooperation with other health care practitioners when in the best interest of the patient.”
— The Association of Chiropractic Colleges, Position Paper (1996)
In practical terms, the practice of chiropractic includes establishing a diagnosis, facilitating neurological and biomechanical integrity through appropriate case management, and educating patients on spinal hygiene, rehabilitative exercise, nutrition, and healthful living practices.
Source: Association of Chiropractic Colleges
What Is a Subluxation?
“A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.”
— The Association of Chiropractic Colleges, Position Paper
In plain terms, this describes a spinal joint that isn’t moving or functioning the way it should, potentially affecting the nerves that pass through it. It’s the specific finding chiropractic adjustment is designed to address. For a deeper look at the actual research behind spinal manipulation, see our Chiropractic Research & Evidence page.
How This Works at West Los Angeles Chiropractic®
At our office, this is exactly how Dr. Karr practices: thorough diagnosis first, with in-office digital X-rays when needed, followed by hands-on treatment and honest guidance on exercise, nutrition, and long-term spinal health. When it serves the patient best, Dr. Karr works in cooperation with other health care providers rather than in place of them. For more on the safety profile of this approach, see Is Chiropractic Care Safe?
Frequently Asked Questions
What is chiropractic?
A health care discipline focused on the relationship between the spine and the nervous system, using hands-on treatment rather than drugs or surgery to support the body’s own ability to heal.
What is a subluxation?
A spinal joint that isn’t moving or functioning properly, which may affect nearby nerves and, in turn, other body systems.
Do chiropractors work with other doctors?
Yes. Doctors of Chiropractic recognize the value of working in cooperation with other health care practitioners whenever it’s in the patient’s best interest.
Chiropractic Facts
How much training actually stands behind a chiropractic license? More than most people assume. Earning a Doctor of Chiropractic (D.C.) degree takes a four-year doctoral program with a minimum of 4,200 instructional hours, according to the Council on Chiropractic Education (CCE) — the accrediting body officially recognized by the U.S. Department of Education. That coursework spans anatomy, physiology, radiology, biochemistry, biomechanics, nutrition, diagnosis, and physical examination, combined with supervised clinical training on real patients.
Did You Know?
- Every D.C. must pass the National Board of Chiropractic Examiners’ board exams and obtain a state license before earning the right to practice. Every state also requires ongoing continuing education to keep that license active.
- Doctors of chiropractic are licensed in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands — and all 50 states include chiropractic care in their workers’ compensation statutes.
- Chiropractic services have been included in Medicare since 1972, along with Federal Workers’ Compensation, the Federal Employees Health Benefits Program, the Railroad Retirement Act, the Longshore and Harbor Workers’ Compensation Act, the VA, and TRICARE.
- Most commercial insurance carriers include chiropractic benefits, and the IRS recognizes chiropractic care as a valid medical tax deduction.
- Doctors of chiropractic treat approximately 35 million Americans every year.
- Chiropractic is the third-largest primary health care profession in the United States, behind only medicine and dentistry.
- An estimated 1 in 3 people with low back pain are treated by a doctor of chiropractic.
Source: CCE accreditation standards · National Board of Chiropractic Examiners
How does this translate to your care at West Los Angeles Chiropractic®?
Dr. Michael C. Karr is a UCLA Kinesiology graduate who has treated West LA patients for over 35 years. He also completed a postgraduate program in radiology, which is why he reviews and reads your digital X-rays himself, the same day you’re seen — the same rigorous, evidence-based training standard described above, applied directly to your case.
Chiropractic Effectiveness
What does the actual research say about chiropractic care? Major medical bodies — including the American College of Physicians, JAMA, The Lancet, and the Cochrane Collaboration — recognize spinal manipulation as a reasonable, evidence-based option for back pain, neck pain, and headaches. It isn’t a cure-all, and it isn’t a substitute for medical care when surgery or medication is truly needed. Here’s the full picture: current research, the training standing behind it, and the historical record that built the profession’s foundation.
Current Guidelines and Recent Research
In 2017, the American College of Physicians published new clinical guidelines in the Annals of Internal Medicine, recommending spinal manipulation as a first-line, non-drug option for both acute and chronic low back pain. That same year, a systematic review in JAMA analyzed 26 randomized trials and found spinal manipulative therapy produced real, if modest, improvements in pain and function for acute low back pain.
In 2018, The Lancet published a three-part series naming low back pain the leading cause of disability worldwide, calling for a shift away from medication, injections, and surgery as first-line treatments. The most recent Cochrane review, updated in 2026, analyzed 76 studies covering nearly 12,000 people and found spinal manipulation may moderately improve function and slightly reduce pain compared with no treatment, with no serious adverse effects observed.
One more finding matters for a different reason entirely: a 2019 study in BMJ Open found that patients who saw a chiropractor first for new low back pain had 90% lower odds of both early and long-term opioid use. Adverse events from spinal manipulation itself are rare — recent research places the rate at roughly 2 per million treatments. For a closer look at safety specifically, see our Is Chiropractic Care Safe? page.
- American College of Physicians guideline, 2017
- JAMA systematic review, 2017
- The Lancet Low Back Pain Series, 2018
- Cochrane review, updated 2026
- BMJ Open, 2019 (opioid use)
That research doesn’t happen in a vacuum — it’s backed by a level of training most patients never think to ask about.
How Rigorous Is Chiropractic Education?
Earning a Doctor of Chiropractic (D.C.) degree takes a four-year doctoral program with a minimum of 4,200 instructional hours, according to the Council on Chiropractic Education (CCE) — the accrediting body officially recognized by the U.S. Department of Education. That coursework spans anatomy, physiology, radiology, biochemistry, biomechanics, nutrition, diagnosis, and physical examination, combined with supervised clinical training on real patients. Every D.C. must also pass the National Board of Chiropractic Examiners’ board exams and obtain a state license, with ongoing continuing education required to keep that license active — the same standard applied to medical doctors and dentists.
Source: CCE accreditation standards
That training translates into a real, established role across the U.S. health care system.
Chiropractic’s Role in the Health Care System
- Doctors of chiropractic are licensed in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands — and all 50 states include chiropractic care in their workers’ compensation statutes.
- Chiropractic services have been included in Medicare since 1972, along with Federal Workers’ Compensation, the Federal Employees Health Benefits Program, the Railroad Retirement Act, and the Longshore and Harbor Workers’ Compensation Act.
- Most commercial insurance carriers include chiropractic benefits, and the IRS recognizes chiropractic care as a valid medical tax deduction.
- Doctors of chiropractic treat approximately 35 million Americans every year.
- Chiropractic is the third-largest primary health care profession in the United States, behind only medicine and dentistry.
- An estimated 1 in 3 people with low back pain are treated by a doctor of chiropractic.
Source: National Board of Chiropractic Examiners
That standing wasn’t handed to the profession — it was fought for, both in research and in court.
Why Wait for Pain? The Science of Joint Movement
Tooth decay begins well before the first warning sign of pain — which is why dentistry recommends regular check-ups, not just emergency visits. Your spine works the same way. According to chiropractic theory and practice, a loss of normal movement in a spinal joint can lead to degenerative changes, or osteoarthritis, that often progress silently before pain ever appears. Animal research on joint immobilization supports this idea: studies dating back to the 1980s found that immobilized joints developed osteoarthritis-like changes, while remobilization helped joints recover at least partially. The lesson lines up with basic chiropractic principles — restoring and maintaining joint movement, through chiropractic adjustment and regular exercise, may help prevent or slow degenerative change.
Source: Videman T., Experimental Models of Osteoarthritis: The Role of Immobilization
A Profession That Earned Its Place
Chiropractic’s legitimacy was affirmed in federal court. In Wilk v. American Medical Association, a U.S. District Court found — and the Seventh Circuit Court of Appeals affirmed — that the AMA had engaged in a decades-long effort to “destroy a competitor,” motivated by economic concerns rather than patient safety. The ruling ended organized efforts to marginalize chiropractic and opened the door to the cooperation between chiropractors and medical physicians that exists today, including the integrated referral relationships Dr. Karr maintains with physicians and specialists throughout Los Angeles.
Source: Wilk v. American Medical Association, 895 F.2d 352 (7th Cir. 1990)
None of this — the research, the training, the legal history — is new. It builds on decades of evidence that predates today’s headlines.
Historical Research Foundation
In 1994, the U.S. Agency for Health Care Policy and Research, a division of the Department of Health and Human Services, included spinal manipulation as a recommended option for acute low back pain in its clinical practice guideline. In 1991, the RAND Corporation, working with UCLA researchers, found spinal manipulation to be an appropriate treatment for most low back pain patients.
A landmark British trial (Meade et al., BMJ, 1990 and 1995) followed 741 patients for three years comparing chiropractic care to hospital outpatient treatment, and found improvement was about 29% greater among patients treated by chiropractors. A 1993 report commissioned by the Ontario Ministry of Health (the Manga Report) reviewed the low back pain literature and concluded there was strong evidence for chiropractic care’s cost-effectiveness. A 2001 Duke University evidence report found spinal manipulation produced immediate improvement in cervicogenic headache severity compared to a placebo control, with effectiveness comparable to common headache medication and a more favorable side-effect profile.
Multiple state workers’ compensation studies from the 1970s through 1991 — including California, Wisconsin, Florida, and Utah — found chiropractic care associated with fewer lost workdays and lower costs compared with medical management for work-related back injuries. Separately, a patient satisfaction study published in the Western Journal of Medicine (1989) found chiropractic patients reported meaningfully higher satisfaction than patients treated by family practice medical doctors.
What This Means for You
Across five decades of research, one thing stays consistent: for most people with back pain, neck pain, or headaches, chiropractic care is a safe, evidence-supported option worth trying — usually before medication or surgery, not instead of medical care when it’s genuinely needed. At West Los Angeles Chiropractic®, Dr. Michael C. Karr has applied this evidence-based approach for over 35 years. He’s a UCLA Kinesiology graduate who completed a postgraduate program in radiology, and he reviews every patient’s history and same-day digital X-rays himself before recommending care — combining chiropractic adjustment with non-surgical spinal decompression (DRX9000), cold laser therapy, and MedX rehabilitation as appropriate.
Frequently Asked Questions
Does research support chiropractic care?
Yes, for many cases of back pain, neck pain, and headaches. The American College of Physicians, JAMA, The Lancet, and Cochrane all recognize spinal manipulation as a reasonable, evidence-based option, particularly compared with more invasive or higher-risk treatments.
Does chiropractic care help patients avoid opioids?
Yes. A 2019 BMJ Open study found patients who saw a chiropractor first for new low back pain had 90% lower odds of both early and long-term opioid use.
How much training does a chiropractor actually have?
A minimum of 4,200 instructional hours over a four-year doctoral program, plus passing national board exams and holding a state license, with ongoing continuing education required to stay licensed.
Is chiropractic care recognized by federal health programs?
Yes. Chiropractic services have been included in Medicare since 1972, along with several other federal programs, and are licensed in all 50 states.
Can chiropractic care replace surgery or medication?
Not always. Chiropractic care is one option among several, best suited to musculoskeletal, non-emergency pain. Your treatment plan should always be based on an individual evaluation.
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Individual results vary. This content is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before beginning any treatment program.
Yours in health,
West Los Angeles Chiropractic®
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Why Starting Conservative Matters
A study published in JAMA in 2003 found that medical injuries occurring during hospital stays were associated with roughly 2.4 million extra hospital days, $9.3 billion in additional charges, and over 32,000 deaths annually in the United States. The point isn’t that hospital care is unsafe — modern medicine saves lives every day, and some conditions genuinely require it. It’s why the conservative-care-first approach covered earlier on this page exists: when a lower-risk option is medically reasonable, trying it first before more invasive care keeps every other option open later.
Source: Zhan C, Miller MR. Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization. JAMA. 2003;290(14):1868-1874.
