Chiropractic: education and what happens at an appointment

Chiropractic is a health profession concerned with the diagnosis and treatment of pain and disease in the nervous, muscular and skeletal systems [1]. The chiropractor takes the history, carries out functional testing and assesses what may lie behind the symptoms [1].

Treatment can consist of several elements. Utdanning.no mentions joint adjustment, trigger point therapy, massage, shockwave therapy, stretching and exercises, as well as advice on diet and lifestyle [1]. What is used depends on the symptoms and on the examination.

Norway has no chiropractic education, so those who want to work as chiropractors in Norway must train abroad [2][6]. Most complete a five-year master's degree, for example in Denmark, the USA, the United Kingdom or Australia, followed by one year of internship in Norway [1].

One route used by Norwegian students is a three-year bachelor's degree in biomedicine at Kristiania University College, followed by a two-and-a-half-year master's at the University of Southern Denmark in Odense [1]. Chiropractor is a protected title that requires authorisation from the Norwegian Directorate of Health [1], and chiropractors are authorised healthcare personnel covered by the Health Personnel Act [6].

Utdanning.no lists pain in the head, neck, jaw and shoulders, sciatica, whiplash, and back and sports injuries, among others [1]. Many chiropractors work in private clinics alongside other professional groups, and often collaborate with doctors and physiotherapists [1].

Several specialise further, for example in diagnostic ultrasound, children and adolescents, neurology or sports [1].

The appointment usually starts with a conversation about the history. A clinical examination follows, which often includes posture, movement patterns and orthopaedic tests [8]. The chiropractor may also use their hands to look for sources of pain in muscles, tendon attachments and joints [8].

After the examination the chiropractor makes a diagnosis and explains it. If in doubt, a referral for imaging or to a specialist may be made [1][8]. The treatment plan is made together with the patient and may include exercises and guidance [8].

Spinal manipulation is the technique chiropractors are best known for [8]. It has been studied in many trials, particularly in low back pain.

A 2019 review pooled 47 randomised trials with a total of 9,211 adults with long-term low back pain. The authors concluded that manipulation gives about the same effect as other recommended treatments, such as exercise [3]. Compared with treatments that are not recommended, for example light massage, the effect on pain was too small to be regarded as clinically meaningful, while function was somewhat better in the short term [3]. Many of the trials had a risk of bias, and the results must be read with caution [3].

In acute low back pain, an update of a Cochrane review from 2013 found that manipulation was not better than other recommended treatments. The number of trials was small, and the authors write that new trials may change the estimates [4].

Adverse events in the trials were mostly mild to moderate, short-lived and musculoskeletal. Serious adverse events were rare in the large review [3], and were not observed in the update for acute pain [4].

Most people with acute back pain recover within one to two weeks without treatment, and NHI writes that people usually recover faster by staying physically active [5]. Contact a doctor nonetheless in case of severe pain, one-sided pain that radiates below the knee, or symptoms that do not improve with self-care [5].

Other signs a doctor looks out for are pain at rest or at night, pain that increases, fever, unexplained weight loss, known cancer, marked weakness or loss of sensation in the legs [5].

A chiropractor can examine your symptoms, explain what the examination shows and plan follow-up together with you. You do not need a referral from a doctor to book an appointment [9]. If you have problems from the lower back, you can read more about low back pain, and for a stiff neck about neck kink. See also the page about chiropractors.

What does a chiropractor do?

A chiropractor diagnoses and treats pain and disease in the nervous, muscular and skeletal systems, among other things with joint adjustment, massage, exercises and advice [1].

Do I need a referral to see a chiropractor?

No, you do not need a referral from a doctor to book an appointment with a chiropractor at Dr.Dropin [9].

Can a chiropractor issue a sick note?

Yes. Chiropractors can issue sick notes for up to 12 weeks, refer to specialist health services and request X-ray, MRI and other imaging [7][8].

Is spinal manipulation dangerous?

In the trials the adverse events were mostly mild to moderate and short-lived, and serious adverse events were rare [3]. The authors recommend that the practitioner informs patients of possible risks [3].

How long is chiropractic education?

Most complete a five-year master's degree abroad followed by one year of internship in Norway [1]. Norway has no chiropractic education [2].

You can read more about chiropractors and about low back pain. You can find more articles in the overview of articles.

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

2. Ofte stilte spørsmål - Kiropraktor (FAQ for chiropractors). Norwegian Directorate of Health. Last updated 8 May 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. Link

4. Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low back pain: an update of the Cochrane review. Spine. 2013;38(3):E158-E177. Link

5. Korsryggsmerter, veiviser (Low back pain guide). NHI.no. Last updated 5 October 2020. Link

6. Rundskriv til folketrygdloven § 5-9 kiropraktor (Circular on the National Insurance Act, chiropractors). Norwegian Directorate of Health. Last professionally revised 1 July 2025. Link

7. Refusjonsordninga for behandling hos kiropraktor fell bort frå nyttår (News item on the chiropractor reimbursement scheme). Norwegian Directorate of Health. Published 18 December 2024. Link

8. Undersøkelse og behandling hos kiropraktor (Examination and treatment by a chiropractor). Dr.Dropin Fysikalske. Link

9. Kiropraktor Mari Dalaker Jaeger (Chiropractor Mari Dalaker Jaeger). Dr.Dropin Fysikalske. Link