8 Things You Need to Know Before Visiting a Chiropractor

“Chiropractors treat disorders of the musculoskeletal system, specifically focusing on the spine,” says Caleb Spreiter, D.C., chiropractor at Integrative Chiropractic in Oklahoma. “The practice is founded on the premise that the nervous system controls every other aspect of the human body, so a properly functioning nervous system allows for the body to function optimally.” Besides back and neck pain, chiropractors can help with things like radiating pain, numbness, tingling, burning, and tendonitis.

The primary method of treatment is a chiropractic adjustment, which frees up nerve interference that comes from the spine, says Matt Tanneberg, D.C., chiropractor at Arcadia Health and Wellness Chiropractic in Phoenix, Arizona. Adjustments are done manually (using hands) or mechanically (using a small instrument), and involve applying force to the joints, bones, and muscles in and around your spine to improve overall physical function.

The first question everyone has when considering a chiropractor: Does treatment actually work? It’s tough to tell. The amount of research performed in chiropractic medicine is small compared with that of traditional medicine, says Kimbre Zahn, M.D., family and sports medicine physician at Indiana University Health. While research from the Annals of Internal Medicine shows chiropractic care for musculoskeletal conditions can help back pain (in some cases, more than pain killers), there’s been little to no widely accepted research showing that chiropractic treatments are effective for any other conditions—say, ear infections or insomnia, says cardiologist Tanvir Hussain, M.D., board-certified in integrative and holistic medicine. That said, if it’s something you’re interested in, don’t be afraid to bring it up with your doc—they should at least take the time to consider whether chiropractic care could serve as an appropriatealternative therapyfor your issue, says Zahn.

If you’re suffering from back, neck, or otherjoint aches and pains, you can consult with a chiropractor directly sans doctor referral. “If you’re in quite a bit of pain though, it might be worth going to an M.D. or D.O. to get some meds first, since chiropractors don’t prescribe medication,” advises Spreiter. (Learn how bone broth can help you lose weight with Women’s Health’s Bone Broth Diet.)

There are over 100 named chiropractic methods, according to theUniversity of Minnesota, and each include their own assessment approach and type of adjustment—everything from high velocity spinal adjustments to ‘gentle’ chiropractic adjustments, says Rachel Carlton Abrams, M.D., author ofBodywise: Discovering Your Body’s Intelligence for Lifelong Health and Healing. This can make the process of finding the right chiropractor hella confusing, so if you’re forging ahead without a doctor’s referral, define your parameters before starting your research. For example, would you prefer manual or mechanical adjustments? Firm or low-force manipulation? Knowing the answers to these Qs will help narrow down the search, says Abrams.

And if you’re still not sure who to go with, ask around. Family and friends may have recommendations, or you can use the “find a doctor” feature on theAmerican Chiropractic Association’s website. To look into a certain chiropractor’s standing, check out thechiropractic board’s websitein your state. There, you can find out if they’re currently licensed and if there have been any complaints filed against them, says Spreiter

While chiropractors are not doctors, and they don’t have to go to medical school, all chiropractors have to go through a four-year chiropractic program and pass four national board exams, followed by a state licensure exam, says Spreiter. They’re also required to attend continuing education classes to keep current in their field, says Vincent DeBono, D.C., dean of the College of Chiropractic at Logan University in St. Louis. Don’t hesitate to ask your practioner about his or her qualifications.

Beware of any chiropractor who doesn’t do an initial exam and promises to have you in and out lickety-split. “There are some franchises that allow you to walk in off the street and you’re out in 10 minutes, which isn’t at all in a patient’s best interest,” says Spreiter. Because there are oodles of factors that can contribute to musculoskeletal problems, chiropractors should complete a thorough health history that explores not only the musculoskeletal system, but diet and lifestyle, past medical illnesses or injuries, and any ongoing health issues, as these can all potentially lead to back or neck pain, says DeBono. The initial consultation usually lasts between 30 and 60 minutes, and some chiropractors might perform an adjustment the same day.

Also be wary of providers that have expanded their scope of practice beyond their training. “Some practitioners now provide non-evidence based recommendations on disease management and sell their own herbal supplements and homeopathic remedies,” says Zahn. Choose a chiropractor with a narrow scope of practice that’s focused on treating musculoskeletal conditions, and who’s open to a multidisciplinary approach that includes traditional medicine, physical therapy, and chiropractic care, she suggests.

If you think the chiropractor is a one-and-done kind of visit, you’re wrong. More than one session is usually needed to correct a problem, according to theNational Library of Medicine(NLM). Treatments last an average of several weeks—you may start out with a few short sessions a week, then once your symptoms improve, get bumped down to weekly treatments. But there should always be an end point to your care. “A huge red flag would be if a chiropractor tells you that you need a large number of visits after an initial exam,” says Spreiter. “Your chiropractor should treat you for a brief period of time and then re-assess your progress—they shouldn’t treat you 60 times without doing another exam.” Make sure you’re informed in advance of the expected duration and what to expect in each phase of care, says DeBono. And if they seem to avoid giving an answer your questions, that’s a sign you’re in the wrong place.

Whenever you go in for medical treatment, there’s a risk of complications arising. But “most adverse effects from manipulation are mild and temporary,” says Zahn. Symptoms usually strike in the few days following a chiropractic adjustment, according to theMayo Clinic, and typically include headaches, fatigue, or stiffness in the parts of the body that were treated. And not everyone responds to chiropractic treatment. “If your chiropractor has been treating you for about two weeks and nothing has changed, they should refer you somewhere else and not continue to treat you,” says Spreiter.

In rare cases, adjustments can also make a condition worse, according to theNLM. Spine and rib fractures can occur, says Zahn, and although uncommon, neck adjustments can damage blood vessels, a.k.a. vertebral artery dissection, or cause strokes. (That may be what happened in thedeath of Snapchat star Katie Mayearly last year.) “Vertebral artery dissection occurs in 1 in 100,000 people, and it’s usually the result of trauma causing rapid twisting of the neck,” says Achal Achrol, M.D., director of neurovascular surgery and neurocritical care at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California. “Chiropractic neck manipulation has been shown to increase the risk by six to 10-fold.”

Obviously, the best way to avoid the risk altogether is to never allow a chiropractor or other practitioner to perform a neck manipulation: “It’s specifically the rapid twisting motion that places the patient at unnecessary risk without a proven benefit,” says Achrol