Chiropractic: what does the research say about effect and side effects?

NHI describes chiropractic as a method for examining, diagnosing, treating and preventing disorders in muscles, nerves, the skeleton and joints. The word means doing something with the hand. Manipulation, meaning specific manual techniques performed quickly and with little force, is a central part of the treatment [1].

Chiropractors treat patients of all ages. Some have a special interest in fields such as diagnostic ultrasound, paediatrics, sports and neurology [1]. Utdanning.no states that the profession deals with problems in the nervous, muscular and skeletal systems, for example pain in the head, neck, jaw and shoulders, sciatica, whiplash and back or sports injuries [2].

You need authorisation from the Norwegian Directorate of Health to call yourself a chiropractor. Most complete a five-year master's degree in Norway, Denmark, the USA, the UK or Australia, and in Norway a year of internship is added [2]. The internship is practical service under supervision of an authorised chiropractor, and the Directorate of Health assesses whether an applicant educated abroad must complete it [5].

NHI states that you do not need a referral from a doctor to see a chiropractor, and that chiropractors can issue sick notes for up to twelve weeks and refer to X-ray, MRI, CT, specialists and physiotherapy [1]. The right to issue sick notes and refer requires a course in national insurance topics [5].

Most enquiries concern back and neck problems [1]. That a problem falls within the chiropractor's field of work does not mean that the treatment has been shown to work for every condition. According to NHI there are too few good studies to assess the effect for many other conditions [1].

For sciatica caused by a disc herniation, NHI writes that research has not shown that general physical therapy or chiropractic leads to improvement. Exercise and strengthening of the abdominal and back muscles can still help people get going again [4].

The appointment starts with a conversation about your history. The chiropractor maps where the pain or discomfort is located and tests the function of the nervous, muscular and skeletal systems [2]. The treatment is adapted to history, symptoms and the effect of earlier treatment. NHI states that the first appointment usually lasts 30 to 40 minutes and later appointments about 15 minutes, but the length can vary between clinics [1].

Chiropractors often use several methods in combination: manipulation and mobilisation of joints, soft tissue treatment, adapted exercises and guidance [1]. According to NHI, guidance and education can help reduce fear and give better self-insight. When needed, the chiropractor can refer to imaging such as X-ray, MRI and CT [2].

A review from 2019 pooled 47 randomised trials with a total of 9,211 adults with long-lasting low back pain. Spinal manipulation had effects on pain and function similar to other recommended treatments, and the evidence was of moderate quality. Compared with treatments that are not recommended, manipulation gave small pain reductions that were not clinically meaningful, while the effect on function was small to moderate [3].

NHI refers to older Cochrane reviews from 2010 and 2011. For acute and subacute back pain, chiropractic gave slightly better pain and function in the short term, but no clinically meaningful advantages over other treatments. For migraine and neck pain, some studies suggest a benefit, but more good-quality studies are needed. How manipulation works in the body is largely unknown [1].

The most common side effects are mild and temporary, such as discomfort in the treated area, stiffness, headache and fatigue. Serious side effects are regarded as very rare with treatment by authorised chiropractors [1]. Some case reports have linked neck manipulation to arterial dissection and stroke, but a systematic review from 2016 found no confirmed association [1]. The 2019 review describes most reported events as mild to moderate and temporary, and advises that patients are informed about possible risks [3].

Loss of control over urination or bowel movements together with back pain can be a sign that the nerves to the bladder and bowel are compressed, a condition called cauda equina syndrome. You should then seek help immediately, for example at an emergency clinic or emergency department [4].

You can book an appointment with a chiropractor without a referral from a doctor. The chiropractor takes your history, examines you and explains the findings, and can refer further when needed. Read more about chiropractors at Dr.Dropin. If you have back problems, you can read about low back pain. When the diagnosis is uncertain, diagnostic ultrasound can be part of the examination.

What does a chiropractor do?

A chiropractor examines, diagnoses and treats pain and disease in the nervous, muscular and skeletal systems. Treatment can include joint manipulation, soft tissue treatment, exercises and guidance [1][2].

Do I need a referral to see a chiropractor?

No. NHI states that you do not need a referral from a doctor to see a chiropractor [1].

Can a chiropractor issue a sick note?

Yes, for up to twelve weeks [1]. The right requires that the chiropractor has completed a course in national insurance topics [5].

Is manipulation safe?

Side effects are usually mild and temporary, and serious side effects are regarded as very rare with treatment by authorised chiropractors [1]. You should still be informed about possible risks before treatment [3].

You can find more articles in the overview of articles. The page about chiropractors describes what the examination involves at our clinics.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Kiropraktikk (Chiropractic). NHI.no. Last updated 17 November 2020 (the page is marked as more than two years old). Link

2. Kiropraktor (Chiropractor). utdanning.no. Reviewed in cooperation with the Norwegian Chiropractors' Association 6 June 2025. Link

3. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. doi:10.1136/bmj.l689. Link

4. Isjias (prolaps) (Sciatica, disc herniation). NHI.no. Last updated 15 January 2026. Link

5. Turnus for kiropraktorer (Internship for chiropractors). Norwegian Directorate of Health. Last professional change 23 October 2024. Link