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Chiropractic and osteopathy


Chiropractic and osteopathy are both manipulation-based therapies used for treating problems associated with bones, joints and the back. The two therapies have much in common, but chiropractors tend to focus on the joints of the spine and the nervous system, while osteopaths put equal emphasis on the joints and surrounding muscles, tendons and ligaments.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Chiropractors and osteopaths share conventional medicines view that the human body is like a machine and that any disease is due to a breakdown of part of the machine. However, they also believe that many health problems can be traced to poor posture and to misalignment of muscles and joints (and, with chiropractic, particularly the spine). They suggest that, if the structure of the body is improved and the spine put back into alignment, its function will improve, problems will be alleviated and good health restored. Misalignment is usually thought to be due to an external cause, such as a fall or other accident (even one that happened years before), or to long-term poor posture.

Osteopaths and chiropractors both mainly treat back and neck pain. But they are also treat other health problems, such as headaches, migraines, vertigo and tinnitus (ringing in the ears).

Some practitioners also treat a wider range of diseases, including:

  • heart and circulatory problems
  • arthritis
  • sports injuries
  • digestive problems
  • asthma, and
  • period problems

While osteopathy and chiropracty are well accepted by many conventional medical practitioners, the scientific evidence for them is relatively sparse, and very few medical studies have compared the two therapies with each other. However, the evidence is stronger for chiropractic than osteopathy, with a few studies showing that chiropractic is effective in treating lower back pain.

There have also been several studies of spinal manipulation and mobilisation techniques (by osteopaths, chiropractors, physiotherapists and doctors) for lower back pain. They suggest that the techniques, whoever does them, do provide short-term relief from pain, and improvement in mobility. There have not been as many studies of manipulation and mobilisation techniques for neck pain.

A first consultation with a chiropractor or osteopath generally takes about an hour. The chiropractor or osteopath will ask detailed questions about your general health, lifestyle, emotional state, and medical and family history. He or she will also perform a physical examination, with you sitting, standing, walking and possibly carrying out other movements. He or she may test your reflexes with a reflex hammer, and measure your blood pressure. Some chiropractors (but not usually osteopaths) also use X-rays and other conventional medical tests to help them make a diagnosis.

Later sessions usually last about 30 minutes. The number of treatments you will need and how often you need them will depend on your problem. However, the practitioner should give you an idea of this at the first treatment session.

Treatment is usually carried out with you lying down in various positions. Chiropractors mainly use a manipulative technique on the spinal column and pelvic area consisting of short, rapid forceful movements called high-velocity thrusts. These are designed to realign and mobilise the spine, and may result in an audible sound - a clicking similar to knuckles being stretched.

Osteopaths also carry out high velocity thrusts on the spine, but these play a much smaller part in treatment than in chiropractic. Osteopaths also use a wide range of other techniques, from stretching of soft tissues and massage to rhythmic joint movements and manipulation, on other parts of the body as well as the back. And, they may use only gentle release techniques with some people, particularly children and older people. These are called muscle energy techniques and are used to release tension in specific muscles. Some osteopaths also do cranial manipulation (see below).

Physiotherapists and doctors sometimes use spinal manipulation and mobilisation techniques similar to those used by chiropractors and osteopaths.

Some osteopaths do cranial manipulation, also called cranial osteopathy. This consists of gentle manipulative techniques on the cranium (skull). A belief underpinning cranial osteopathy is that childbirth, an accident or long-term muscle tension can cause compression of the cranium. This, in turn, can affect how fluid called cerebrospinal fluid flows in the spine and around the brain, and so can result in disease. Practitioners claim that gently manipulating the bones of the cranium can correct the flow of cerebrospinal fluid, by restoring the skull to its natural shape.

Craniosacral therapy is similar to cranial osteopathy. It differs in believing that the flow of cerebrospinal fluid affects every cell in the body.

The most serious potential risks of chiropracty and osteopathy are spinal cord injury or stroke after manipulation of the neck. These are rare, though there have been calls for research to establish how significant the risk is.

There is a general consensus that osteopathy is less risky in terms of spinal injury because osteopaths usually use less forceful manipulation techniques on the spine.

Less serious, but more common, side effects include discomfort or mild pain at the point of manipulation, mild headaches or tiredness, which should disappear within 24 hours of treatment.

There are certain situations where forceful manipulation can be dangerous and should never be done. These include if you are pregnant or if you have osteoarthritis of the neck, or osteoporosis of the spine.

However, chiropractors and osteopaths are trained to check patients for these and other risk factors.

1. Can chiropractic be used to treat whiplash?

Chiropractic is often used to treat whiplash. However, not enough research has been done to show whether or not it's really effective for treating this condition.

Whiplash injuries are caused when your neck is over-extended, often as a result of a sudden impact forcing your neck forwards. It's a common injury and often occurs as a result of rear-end car crashes. However, whiplash can also be caused by having a fall or any other sudden movement, especially if it's repetitive.  

Whiplash injuries damage your muscles, ligaments, nerves and bones in your neck, forcing them closer together. This can lead to pain and stiffness. Whiplash injuries can vary and the most severe forms can lead to more serious complications.  

Spinal manipulation, particularly when used on the upper spine (neck), has been associated with severe complications, such as damage to an artery and stroke. There have been several hundred recorded incidents of upper spinal manipulation being followed by severe complications including deaths.  

It's important to rest your neck for a short time immediately after an injury to it to allow any inflammation to go down. Remember that there isn't enough evidence to show if chiropractic is effective for treating whiplash injuries.

2. Is spinal manipulation safe?

Chiropractors insist that spinal manipulation is extremely safe. However, there is evidence to suggest it can be harmful.


Research has shown that about half of all people who have spinal manipulation get side-effects afterwards, most commonly headaches and tiredness. These are usually mild and only last one or two days. However, spinal manipulation carried out on the neck has led to serious complications in some people, including stroke and severe damage to arteries.  


Some chiropractors also use spinal manipulation to treat conditions that aren't related to the spine, including headaches, colic, asthma and gastrointestinal problems. However, there is no good evidence to show that chiropractic is effective for treating such conditions and it may even be harmful. 

3. Can my child have osteopathy?

Yes, children can have osteopathy.

Children are treated for a number of conditions, including asthma, middle ear infections and colic. However, there is a lack of scientific evidence for the effectiveness of osteopathy for middle ear infections and the research suggests it isn’t effective for colic and asthma.

It's important to ask your osteopath if he or she has experience of treating children. If you have any concerns about your child having osteopathy, speak to your osteopath or your GP.  

If you choose for your child to have osteopathy, your osteopath will examine any problems including those related to your child's growth. Your osteopath can offer your child advice on his or her posture and give exercises that may help to prevent the problems getting worse in later life.  

Further Information


  • About. British Chiropractic, accessed 30 March 2011
  • What is chiropractic? General Chiropractic, published 30 March 2011
  • WHO guidelines on basic training and safety in chiropractic. World Health Organization,
  • Visiting a chiropractor. British Chiropractic, accessed 30 March 2011
  • Low back pain: early management of persistent non-specific low back pain. Full guideline. National Institute for Health and Clinical Excellence (NICE),
  • Walker B, French S, Grant W, et al. Combined chiropractic interventions for low-back pain (review). Cochrane Database of Systematic Reviews 2010, Issue 4. doi: 10.1002/14651858.CD005427.pub2
  • The Musculoskeletal Services Framework for England. Department of Health, July
  • Proctor M, Hing W, Johnson T, et al. Spinal manipulation for dysmenorrhoea. Cochrane Database of Systematic Reviews 2006, Issue 3. doi: 10.1002/14651858.CD002119.pub3
  • Chaibi A, Tuchin P, Russell M. Manual therapies for migraine: a systematic review. J Headache Pain 2011; [Epub ahead of print]. doi: 10.1007/s10194-011-0296-6
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  • Facts on chiropractic - practice. World Federation of, accessed 30 March 2011
  • Hondras M, Linde K, Jones A. Manual therapy for asthma. Cochrane Database of Systematic Reviews 2005, doi:10.1002/14651858.CD001002.pub2
  • Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100(7):330–338. doi:10.1258/jrsm.100.7.330
  • Ernst E. Chiropractic spinal manipulation for back pain. Br J Sports Med 2003; 37:195–96. doi: 10.1136/bjsm.37.3.195
  • Frequently asked questions. General Chiropractic, accessed 5 April 2011
  • Youngson R. The Royal Society of Medicine health encyclopedia. 1st ed. London: Bloomsbury Publishing Plc, 2001:757–58
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  • Shaw L, Descarreaux M, Bryans R, et al. A systematic review of chiropractic management of adults with whiplash-associated disorders: Recommendations for advancing evidence-based practice and research. Work 2010; 35(3):369–94. doi:10.3233/WOR-2010-0996
  • Low back pain: early management of persistent non-specific low back pain. National Institute for Health and Clinical Excellence (NICE),
  • Benchmarks for training in osteopathy. World Health, accessed 14 March 2011
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  • Brønfort G, Nilsson N, Haas M, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database of Systematic Reviews 2004, Issue 3. doi:10.1002/14651858.CD001878.pub2
  • 2010 annual evidence update on cam for asthma - commentary. NHS, accessed 15 February 2011
  • Proctor M, Hing W, Johnson T, et al. Spinal manipulation for dysmenorrhoea. Cochrane Database of Systematic Reviews. 2006, Issue 3. doi:10.1002/14651858.CD002119.pub3
  • Carnes D, Mars T, Mullinger B, et al. Adverse events and manual therapy: a systematic review. Man Ther 2010; 15:355–63. doi:10.1016/j.math.2009.12.006
  • Carnes D, Mullinger B, Underwood M. Defining adverse events in manual therapies: a modified delphi consensus study. Man Ther 2010; 15:2–6. doi:10.1016/j.math.2009.02.003
  • Mills MV, Henley CE, Barnes LB, et al. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Arch Pediatr Adolesc Med 2003; 157: 861–866
  • Clive Hayden, Brenda Mullinger. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complement Ther Clin Prac 2006; 12(2):83-90
  • Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: The UK evidence report. Chiropr Osteopat 2010; 18(3). doi:10.1186/1746-1340-18-3
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