What Does a Modern Chiropractor Actually Do?
By Dr. Jason Fidler, DC
Most people picture the same thing when they hear "chiropractor." You walk in, you lie down, somebody cracks your back, you feel loose for a few hours, and you come back on Thursday. Then you come back the Thursday after that. Nobody ever tells you when it stops.
The profession has changed a lot in the last twenty years, and most patients have not heard about it. So here is what a modern chiropractor actually does, what the research says about the adjustment, and what you should expect from anyone you pay to help with your back.
The short answer: A modern chiropractor helps you understand why you hurt, gets you moving again, and builds capacity that holds up after you leave the office. Hands-on care is one tool in that plan. It is not the plan itself, and it is not something you should need forever.
The old school version
In traditional chiropractic, everything is focal to the adjustment.
The adjustment is the treatment. Without regular manipulation, you are told your nervous system cannot function properly. To stay healthy, you need regular care indefinitely, ideally starting in childhood.
That framing is not a strawman. It is still taught and still marketed. A 2018 review of chiropractic programs worldwide found that mentions of "subluxation" in US course catalogues actually rose between 2011 and 2017, and that US schools used the term far more than programs outside North America (Funk et al.). A separate analysis of chiropractic clinic websites in Alberta found a third of them promoting subluxation theory, some of it aimed at children (Marcon et al.).
I want to be careful here. There is no good evidence that spinal manipulation is required for your nervous system to work properly, and no good evidence that regular adjustments prevent disease. That is not the same as saying manipulation does nothing. It does something. It is just not what that story claims.
What the research says about the adjustment
Here is the honest version, and it comes from the largest review we have.
In 2019, a team pooled 47 randomized trials covering 9,211 people with chronic low back pain. Spinal manipulation produced similar results to other recommended treatments for short-term pain relief, with a small edge in function. Better than treatments that are not recommended. About the same as the ones that are (Rubinstein et al., BMJ).
Similar. Not superior.
The American College of Physicians reaches the same place. Their guideline lists spinal manipulation as a reasonable option for back pain, sitting alongside heat, massage, and acupuncture, and it puts exercise and self-management at the front of the line for anything that has become chronic (Qaseem et al.).
So an adjustment is a legitimate tool. It can turn the volume down and get you moving sooner. What it is not is the thing that changes your trajectory over the next year.
What actually changes the trajectory
This is the part nobody puts on a billboard.
The best evidence we have on preventing your next episode of back pain comes from a review of 21 trials and 30,850 people. Exercise combined with education cut the risk of a new episode by roughly half. Exercise alone helped. Education alone did nothing. Back belts did nothing. Shoe insoles did nothing (Steffens et al., JAMA Internal Medicine).
Read that list again. The only intervention that reliably kept people from hurting again was moving, with someone explaining what was going on.
That matches what the global picture shows. Back pain is now the leading cause of disability worldwide, most cases have no single identifiable structural cause, and recurrence is normal rather than a sign of failure (Hartvigsen et al., The Lancet). The companion paper in that series is blunt about where care goes wrong: too much imaging, too much rest, too many injections, too much surgery, and not enough of the boring stuff that works (Foster et al.).
So what does a modern chiropractor do?
Three things carry most of the weight.
We help you understand your pain. Not a scary explanation involving a bone out of place. An accurate one. What is irritated, what makes it worse, what it means, and just as importantly what it does not mean.
We prescribe the right movement at the right dose. Not a printout of generic stretches. Specific loading, matched to what your body is currently tolerating, progressed as you improve.
We build habits that survive a real week. You have a job, a commute, kids, a gym you may or may not get to. A plan that only works on a perfect week is not a plan.
Hands-on work supports all of that. Manipulation, Active Release Techniques, soft tissue work, all of it has a place in getting you comfortable enough to do the work that actually sticks. It is the on-ramp, not the destination.
What about coming in for a tune up?
Fair question, and I want to answer it honestly instead of pretending the answer is convenient for my argument.
There is decent evidence for planned follow-up visits in the right person. A Swedish trial randomized 328 patients with recurrent or persistent back pain who had already responded well to an initial course of care. Half got scheduled maintenance visits, half came in only when symptoms flared. The scheduled group reported 12.8 fewer days of bothersome back pain over the following year, at the cost of about two extra visits (Eklund et al., PLoS One). A follow-up analysis found the benefit was concentrated in a specific subgroup of patients rather than spread evenly across everyone (Eklund et al., 2020).
So yes. For some people, checking in every so often beats waiting for the wheels to come off. You change the oil instead of waiting for the engine to seize.
But notice what that study actually did. It selected people who had a recurring problem, who had already gone through a course of care, and who had responded to it. That is a specific person with a specific reason. It is not everyone who walks in the door, and it is not from birth on.
The difference between a tune up and a subscription is whether anyone can tell you why you are on the schedule and what would get you off it. If your provider can answer that, you are getting care. If the answer is that you will always need this to stay aligned, you are getting a payment plan.
What you should expect from anyone you see
Set the bar here, whether you come to me or not.
You should leave a first visit with a clear explanation of what is going on, in language you can repeat to your partner that night. You should have a plan you understand. You should have something useful to do between visits.
You should know what progress looks like and when it will be reassessed. Not a vague sense that you are getting better, but an actual checkpoint.
And you should know what the finish line looks like, even if the honest answer is that it may include occasional check-ins.
If you are not getting that, ask for it. A good provider will be glad you did.
That is how we practice
Functional Rehab is a movement-based practice in Gowanus, Brooklyn. Most of who I see are people who want to keep doing something: lifting, running, pickleball, sitting through a workday without their neck lighting up, picking up a toddler without bracing for it.
Care is built around what you are trying to get back to, with clear milestones and a point where you do not need me.
If you are dealing with back pain, sciatica, or neck pain that is not moving in the right direction, book a consultation at functionalrehabny.com and let's figure out what is actually going on.
Frequently asked questions
Is chiropractic care safe? For most people with mechanical back pain, yes. In the BMJ review of 47 trials, most reported adverse events were musculoskeletal, temporary, and mild to moderate, things like short-term soreness. Serious events were rare (Rubinstein et al.). Part of a proper exam is screening for the situations where manipulation is not appropriate.
Do I need an X-ray or MRI first? Usually not. Routine imaging for back pain without red flags is one of the clearest examples of overuse in the field, and it often finds age-related changes that are common in people with no pain at all (Foster et al., The Lancet). If imaging would change what we do, we order it. Otherwise it tends to create worry, not answers.
How many visits will I need? It depends on what is going on and how long it has been going on, but you should get an estimate at the first visit and a reassessment point, not an open-ended schedule.
Do you still adjust people? Yes, when it is useful. It is one tool among several, and it is not the reason the plan works.
Do you take insurance? Functional Rehab is an out-of-network provider, so I do not bill your insurance directly. Depending on your plan, you may still be able to get reimbursed for a portion of your care, and HSA and FSA funds can typically be used for chiropractic and rehabilitation services. If you send over a copy of your insurance card before your first appointment, I will look into what your plan may cover.