Multiple systematic reviews have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for lower back pain. A critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition. There is not sufficient data to establish the safety of chiropractic manipulations. The rate of adverse events is unknown as they are under–reported. Chiropractic is frequently associated with mild to moderate adverse effects. The incidence of serious complications which can lead to permanent disability or death is probably rare. There is controversy regarding the degree of risk of stroke and death from cervical manipulation. Several deaths have been associated with this technique and it is suggested that the relationship is causative, a claim which is disputed by many chiropractors.
Chiropractic is widely established in the United States, Canada, and Australia. It has had a strong political base and sustained demand for services; in recent decades gaining increased acceptance among conventional physicians and health plans in the U.S., and evidence-based medicine has been used to review research studies and generate practice guidelines. Most who seek chiropractic care do so for low back pain, and back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues. Many chiropractors describe themselves as primary care providers, despite chiropractic clinical training not supporting the requirements to perform such care, with their role in primary care being limited and disputed. Attitudes towards mainstream medicine vary among chiropractors, who often offer conventional treatments such as physical therapy and lifestyle counseling as well, and it may be difficult for the lay person to distinguish the unscientific from the scientific