Naprapathy: education, methods and what the research says

Naprapathy is a manual medical treatment. A naprapath assesses and treats pain and problems in muscles and joints, especially in the back, neck, tendons and muscles [1].

The name comes from Czech and Greek and means to correct the cause of disease. The treatment was developed by Oakley Smith in the USA, who started the first college for it in Chicago in 1907 [1].

According to NHI, all practising naprapaths in Norway were educated at Naprapathögskolan in Stockholm. Many take further education after college, for example in ultrasound, shockwave therapy and needling of trigger points [1]. The education takes four years [5].

Naprapathy was regulated as alternative treatment until 2022. Since May 2022, naprapaths are authorised healthcare professionals [1]. Naprapaths who completed their education before 1 May 2022 are covered by a transitional arrangement at the Norwegian Directorate of Health, and the requirement for supervised practice has been removed for them [2]. In Sweden and Finland, naprapaths have been authorised since 1994 [1].

NHI mentions stiff neck, back pain, sciatica, headache, tennis elbow and sports injuries, in addition to problems in the shoulder, knee and Achilles tendon and pregnancy-related problems. Patients can be young or old, recreational exercisers or elite athletes [1].

The methods described are manipulation, mobilisation, trigger point treatment, muscle stretching, massage and articulation. Manipulation is a quick movement with little force, while mobilisation consists of slow movements with little force. The methods are combined, and the treatment can include home exercises, ergonomic advice and an exercise programme [1].

According to NAFKAM, as of March 2020 there were no meta-studies of the effect of naprapathy in the sources they had reviewed [1]. Naprapathy as a combined treatment has thus been little studied in summarising studies.

Some of the methods have been studied individually. A review in the BMJ from 2019 included 47 randomised trials with 9,211 participants and looked at spinal manipulation for long-lasting low back pain. Manipulation gave about the same effect on pain as recommended treatments, for example exercise, and a small improvement in function in the short term. The authors judged the effect to be modest on average, and many of the studies had a high risk of bias [3].

The review concerns spinal manipulation in general and not naprapathy as a form of treatment. NHI writes that chiropractic or other manual treatment can help in some situations in low back pain, and that it is less relevant in chronic problems [4].

Naprapathy is classified in risk class 2 by the Norwegian System of Patient Injury Compensation and the Ministry of Health and Care Services, which means low risk. Manipulation of the back and neck is regarded as carrying more risk [1]. Most adverse effects in the studies of manipulation were musculoskeletal, transient and mild to moderate [3].

The appointment starts with a mapping of the problems to find the cause. The treatment can combine joint mobilisation and manipulation with massage and stretching, and when needed trigger point treatment and needling. The naprapath also gives guidance with rehabilitation exercises and ergonomic advice, and explains what may be behind the pain. If imaging is needed, or if a doctor or physiotherapist is a better fit, you are referred on [5].

People with osteoporosis, cancer, infectious disease or bleeding disorders should consult a doctor before manual treatment [1].

For back pain there is extra reason to see a doctor in case of pain at rest, constant or steadily worsening pain, fever, unexplained weight loss, known cancer, severe loss of muscle strength or loss of sensation. The same applies to one-sided pain radiating below the knee, and long-lasting problems that do not improve with self-care [6].

A naprapath can examine where the problems are and what triggers them, and together with you set up a plan with manual techniques, exercises and advice. You can read more about naprapathy at Dr.Dropin and about low back pain.

Is a naprapath an authorised healthcare professional?

Yes. Naprapathy was regulated as alternative treatment until 2022, and since May 2022 naprapaths are authorised healthcare professionals in Norway [1][2].

What does a naprapath treat?

NHI mentions stiff neck, back pain, sciatica, headache, tennis elbow, sports injuries and pregnancy-related problems, in addition to problems in the shoulder, knee and Achilles tendon [1].

Which methods does a naprapath use?

Manipulation, mobilisation, trigger point treatment, muscle stretching, massage and articulation. The methods are combined, and the treatment can include home exercises and ergonomic advice [1].

Is naprapathy safe?

Naprapathy is classified in risk class 2, which means low risk. Manipulation of the back and neck is regarded as carrying more risk, and people with osteoporosis, cancer, infectious disease or bleeding disorders should consult a doctor first [1].

Is naprapathy documented as effective?

Naprapathy as a combined treatment has been little studied in summarising studies [1]. For individual methods such as spinal manipulation there are studies in long-lasting low back pain, with a modest effect on average [3].

The page about low back pain describes one of the most common reasons patients see a naprapath. 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. Naprapati (Naprapathy). NHI.no. Last updated 15 January 2026. Link

2. Endring i praksiskravet for autorisasjon til naprapater (Change in the practice requirement for authorisation of naprapaths). Norwegian Directorate of Health. Published 7 February 2024. 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. Korsryggsmerter, vedvarende: behandling (Persistent low back pain: treatment). NHI.no. Last updated 20 January 2023. Link

5. Naprapat (Naprapath). Dr.Dropin Fysikalske, drdropin.no. Accessed 22 October 2026. Link

6. Korsryggsmerter, lave ryggsmerter: veiviser (Low back pain: symptom guide). NHI.no. Last updated 5 October 2020. Link