By the Greenlight Chiropractic & Wellness Lab team. Compiled by Jonathan Tingey, Greenlight CMO. Updated October 13, 2026.
Back pain is the most common reason people walk into a chiropractor's office, and it is one of the most misquoted topics in health care. The same numbers get repeated until nobody remembers where they came from, and some of them never had a source at all. We built this report so our patients, and anyone writing about the topic, can see the real figures and where each one comes from.
Along the way we kept running into what we call the first-line gap: the distance between what clinical guidelines recommend first for back pain, which is non-drug care such as exercise, heat, massage and spinal manipulation, and what often happens first in practice, which can be a scan nobody needed. The 60 statistics below follow that gap from the first twinge to treatment. That includes research that does not flatter chiropractic, because a report that only shows the good news is not worth citing.
Close to 4 in 10 U.S. adults report back pain in a three-month window. Worldwide, low back pain is the leading cause of years lived with disability, and many people who recover have it again within a year.
About 39.0% of U.S. adults reported back pain at some point in the past three months in 2019, according to the CDC's National Center for Health Statistics.
What it means: Back pain is one of the most common health problems adults have. If yours has lasted a few weeks, you are far from alone. These figures are from 2019, the newest national survey that asked about back pain specifically.
Who: U.S. civilian noninstitutionalized adults 18 and older
Sample: 31,997 adults (2019 National Health Interview Survey)
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
About 39.0% of U.S. adults reported back pain at some point in the past three months in 2019, according to the CDC's National Center for Health Statistics. Source: CDC, National Center for Health Statistics (NCHS Data Brief No. 415), "Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019", July 2021. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-1
Back pain becomes more common with age: CDC/NCHS data show 28.4% of adults ages 18 to 29 reported back pain in the past three months, rising to 44.3% at ages 45 to 64 and 45.6% at 65 and older.
What it means: Back pain gets more common with age, but young adults are not immune: more than 1 in 4 adults under 30 reported it.
Sample: 31,997 adults (2019 National Health Interview Survey)
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
Back pain becomes more common with age: CDC/NCHS data show 28.4% of adults ages 18 to 29 reported back pain in the past three months, rising to 44.3% at ages 45 to 64 and 45.6% at 65 and older. Source: CDC, National Center for Health Statistics (NCHS Data Brief No. 415), "Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019", July 2021. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-2
In 2023, 24.3% of U.S. adults had chronic pain and 8.5% had high-impact chronic pain that frequently limited daily life or work, according to the CDC's National Center for Health Statistics.
What it means: About 1 in 4 adults lives with pain on most days, and about 1 in 12 has pain that regularly limits daily life or work. This is all chronic pain, not back pain alone.
Who: U.S. civilian noninstitutionalized adults 18 and older, 2023
Cite this stat
In 2023, 24.3% of U.S. adults had chronic pain and 8.5% had high-impact chronic pain that frequently limited daily life or work, according to the CDC's National Center for Health Statistics. Source: CDC, National Center for Health Statistics (NCHS Data Brief No. 518), "Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023", November 2024. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-3
New cases of chronic pain arose at a rate of 52.4 per 1,000 U.S. adults per year, higher than diabetes, depression or high blood pressure, and 61.4% of adults with chronic pain in 2019 still had it a year later, according to an NIH study using national survey data.
What it means: Chronic pain starts often, and once it starts it tends to stay. This counts all chronic pain, not only back pain.
Who: U.S. adults followed in the National Health Interview Survey longitudinal cohort, 2019 to 2020
Cite this stat
New cases of chronic pain arose at a rate of 52.4 per 1,000 U.S. adults per year, higher than diabetes, depression or high blood pressure, and 61.4% of adults with chronic pain in 2019 still had it a year later, according to an NIH study using national survey data. Source: National Institutes of Health, "NIH study finds high rates of persistent chronic pain among U.S. adults", May 2023. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-4
In a study of 250 patients who had recently recovered from an episode of low back pain, 69% had it come back within 12 months, and 40% had a recurrence that limited their activities, according to research published in the Journal of Physiotherapy in 2019.
What it means: Feeling better is not the same as being done: many people who recover from low back pain have it again within a year. This is a 2019 study of 250 patients, not a national figure.
Who: Patients who had recovered from an episode of low back pain within the prior month (prospective inception cohort)
Sample: 250
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
In a study of 250 patients who had recently recovered from an episode of low back pain, 69% had it come back within 12 months, and 40% had a recurrence that limited their activities, according to research published in the Journal of Physiotherapy in 2019. Source: Journal of Physiotherapy (da Silva et al.), "Recurrence of low back pain is common: a prospective inception cohort study", July 2019. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-5
Low back pain affected 619 million people worldwide in 2020 and remains the leading cause of years lived with disability globally, according to the Global Burden of Disease Study 2021 published in The Lancet Rheumatology.
What it means: Low back pain is the top cause of years lived with disability worldwide. That ranking is global and the figure is an estimate built from many data sources.
Low back pain affected 619 million people worldwide in 2020 and remains the leading cause of years lived with disability globally, according to the Global Burden of Disease Study 2021 published in The Lancet Rheumatology. Source: The Lancet Rheumatology (GBD 2021 Low Back Pain Collaborators), "Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021", June 2023. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-6
The number of people living with low back pain worldwide is projected to reach 843 million by 2050, up from 619 million in 2020, largely because of population growth and aging, according to the World Health Organization.
What it means: The number of people with low back pain worldwide is expected to keep growing as populations age. This is a projection, not a measurement.
The number of people living with low back pain worldwide is projected to reach 843 million by 2050, up from 619 million in 2020, largely because of population growth and aging, according to the World Health Organization. Source: World Health Organization, "Low back pain (fact sheet)", June 2023. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-7
Neck pain affected 203 million people worldwide in 2020 and is projected to reach 269 million cases by 2050, a 32.5% increase, according to the Global Burden of Disease Study 2021 published in The Lancet Rheumatology.
What it means: Neck pain is less common than low back pain but still affects hundreds of millions of people, and the count is projected to grow. The 2050 figure is a projection.
Who: Global population, 2020, with projection to 2050
Cite this stat
Neck pain affected 203 million people worldwide in 2020 and is projected to reach 269 million cases by 2050, a 32.5% increase, according to the Global Burden of Disease Study 2021 published in The Lancet Rheumatology. Source: The Lancet Rheumatology (GBD 2021 Neck Pain Collaborators), "Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021", March 2024. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-8
Stage 2
Back and neck pain cost tens of billions a year
Low back pain ranks among the costliest conditions in U.S. health care. It also shows up in workplace injury reports and disability benefits.
According to an IHME study in JAMA, U.S. health care spending on low back pain was an estimated $52.89 billion in 2019, ranking it 9th among the 50 costliest health conditions, with spending growing about 3.4% a year from 2010 to 2019.
What it means: Low back pain alone accounts for tens of billions of U.S. health care dollars a year. These are estimates of spending in 2019, not out-of-pocket costs for patients.
According to an IHME study in JAMA, U.S. health care spending on low back pain was an estimated $52.89 billion in 2019, ranking it 9th among the 50 costliest health conditions, with spending growing about 3.4% a year from 2010 to 2019. Source: JAMA (Institute for Health Metrics and Evaluation, Dieleman et al.), "Tracking US Health Care Spending by Health Condition and County", February 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-9
The same 2025 JAMA spending study estimated U.S. health care spending on neck pain at $19.42 billion in 2019, placing it 38th among the 50 costliest conditions.
What it means: Neck pain adds billions more. This comes from the same study as the low back figure, so the two can be compared.
The same 2025 JAMA spending study estimated U.S. health care spending on neck pain at $19.42 billion in 2019, placing it 38th among the 50 costliest conditions. Source: JAMA (Institute for Health Metrics and Evaluation, Dieleman et al.), "Tracking US Health Care Spending by Health Condition and County", February 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-10
According to an earlier IHME analysis published in JAMA, low back and neck pain had the highest U.S. health care spending of the 154 conditions studied in 2016, at an estimated $134.5 billion.
What it means: Measured together, low back and neck pain topped U.S. health spending in this earlier study. It used a different method from the 2025 study, so the two totals should not be read as a trend.
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
According to an earlier IHME analysis published in JAMA, low back and neck pain had the highest U.S. health care spending of the 154 conditions studied in 2016, at an estimated $134.5 billion. Source: JAMA (Institute for Health Metrics and Evaluation, Dieleman et al.), "US Health Care Spending by Payer and Health Condition, 1996-2016", March 2020. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-11
A 2026 conference analysis of federal Medical Expenditure Panel Survey data estimated that treated back problems among U.S. adults accounted for $103 billion in health care spending in 2023 (about 4.5% of total health care spending), with mean spending per affected person rising from an inflation-adjusted $2,158 in 2007 to $4,300 in 2023.
What it means: Spending per person treated for back problems roughly doubled between 2007 and 2023, after adjusting for inflation. This is a conference abstract, and two of its authors work at chiropractic colleges.
Who: U.S. civilian noninstitutionalized adults 18+ with treated back problems
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.
Cite this stat
A 2026 conference analysis of federal Medical Expenditure Panel Survey data estimated that treated back problems among U.S. adults accounted for $103 billion in health care spending in 2023 (about 4.5% of total health care spending), with mean spending per affected person rising from an inflation-adjusted $2,158 in 2007 to $4,300 in 2023. Source: ISPOR 2026 / Value in Health, "Trends in Back Pain Healthcare Utilization and Expenditures Among U.S. Adults: 2007 vs 2023", May 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-12
The Bureau of Labor Statistics reports 248,180 private-industry workplace injury and illness cases involving the back (exterior and musculoskeletal structures of the back) in its most recent biennial data, covering 2023 and 2024 combined.
What it means: Back injuries are a large share of workplace injury cases in U.S. private industry. This is a two-year total, and it does not tell you how many days each person missed.
Who: U.S. private-industry workers (excludes self-employed, government, and small farms)
Cite this stat
The Bureau of Labor Statistics reports 248,180 private-industry workplace injury and illness cases involving the back (exterior and musculoskeletal structures of the back) in its most recent biennial data, covering 2023 and 2024 combined. Source: U.S. Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses, "Injuries, Illnesses, and Fatalities: Latest Numbers", January 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-13
According to California's Department of Industrial Relations, cases involving the back that resulted in days away from work occurred at an annualized rate of 16.0 per 10,000 full-time private-industry workers in California in 2023-2024, compared with 113.9 for all body parts combined.
What it means: In California, the back accounts for a meaningful slice of injuries serious enough to keep people off work. The rate is per 10,000 full-time workers per year.
According to California's Department of Industrial Relations, cases involving the back that resulted in days away from work occurred at an annualized rate of 16.0 per 10,000 full-time private-industry workers in California in 2023-2024, compared with 113.9 for all body parts combined. Source: California Department of Industrial Relations, "Annualized incidence rates for injuries involving days away from work, by part of body, private industry, California, 2023-2024 (Table 15)", May 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-14
According to the Social Security Administration, diseases of the musculoskeletal system and connective tissue were the primary diagnosis for 34.1% of disabled workers receiving Social Security Disability Insurance benefits in December 2024, the largest of the diagnostic groups SSA reports.
What it means: Musculoskeletal conditions, a group that includes back problems, are the most common reason people receive Social Security disability benefits. The figure covers all musculoskeletal conditions, not back pain alone.
According to the Social Security Administration, diseases of the musculoskeletal system and connective tissue were the primary diagnosis for 34.1% of disabled workers receiving Social Security Disability Insurance benefits in December 2024, the largest of the diagnostic groups SSA reports. Source: U.S. Social Security Administration, Office of Retirement and Disability Policy, "Annual Statistical Report on the Social Security Disability Insurance Program, 2024 (Highlights and Trends)", 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-15
Stage 3
Guidelines put non-drug care first. Real-world care often starts with scans.
Physicians' and federal guidelines recommend starting with non-drug care for back pain. Yet unneeded imaging is common, and the first provider someone sees is linked to whether opioids follow.
According to the American College of Physicians, clinicians and patients should start with non-drug treatment for low back pain (superficial heat, massage, acupuncture or spinal manipulation for acute/subacute pain; exercise, multidisciplinary rehabilitation, acupuncture, yoga, spinal manipulation and similar for chronic pain), and should consider opioids only as a last option for chronic low back pain in patients who have failed other therapies.
What it means: The American College of Physicians tells doctors to try non-drug care such as heat, massage, exercise or spinal manipulation first. For chronic back pain it treats opioids as a last option. This is the 2017 guideline, which is still widely cited.
Who: Adults with acute, subacute, or chronic nonradicular low back pain (U.S. guideline)
Sample: Guideline based on a systematic review of randomized controlled trials
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
According to the American College of Physicians, clinicians and patients should start with non-drug treatment for low back pain (superficial heat, massage, acupuncture or spinal manipulation for acute/subacute pain; exercise, multidisciplinary rehabilitation, acupuncture, yoga, spinal manipulation and similar for chronic pain), and should consider opioids only as a last option for chronic low back pain in patients who have failed other therapies. Source: American College of Physicians, "American College of Physicians issues guideline for treating nonradicular low back pain", February 2017. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-16
The CDC's 2022 opioid prescribing guideline states that nonopioid therapies are at least as effective as opioids for many common acute pain conditions, including low back pain, and are preferred for subacute and chronic pain.
What it means: Federal guidance on opioids points the same way: for most back pain, options other than opioids work at least as well and should come first.
Who: U.S. outpatients (adults) with acute, subacute, or chronic pain
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
The CDC's 2022 opioid prescribing guideline states that nonopioid therapies are at least as effective as opioids for many common acute pain conditions, including low back pain, and are preferred for subacute and chronic pain. Source: CDC, MMWR Recommendations and Reports, "CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022", November 2022. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-17
Among commercially insured adults aged 18 to 50 with uncomplicated acute low back pain, 19.5% received imaging judged low-value under the HEDIS measure (16.5% X-ray, 2.5% MRI), according to a Journal of General Internal Medicine study.
What it means: About 1 in 5 adults with uncomplicated new back pain in this study had a scan that guidelines say they did not need. The data are from commercially insured adults ages 18 to 50.
Who: Blue Cross Blue Shield of Massachusetts members aged 18-50 diagnosed with uncomplicated acute low back pain in 2018
Sample: 30,892 members eligible for low-value imaging; 6,009 received it
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
Among commercially insured adults aged 18 to 50 with uncomplicated acute low back pain, 19.5% received imaging judged low-value under the HEDIS measure (16.5% X-ray, 2.5% MRI), according to a Journal of General Internal Medicine study. Source: Journal of General Internal Medicine, "Cascade Services and Spending Following Low-Value Imaging for Uncomplicated Low Back Pain among Commercially Insured Adults", September 2022. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-18
The same study found that, compared with similar patients who had no low-value imaging, low-value MRI for uncomplicated low back pain was associated with $1,093 more in narrowly defined cascade-related spending over 12 months (adjusted), versus $220 more for low-value X-ray, according to the Journal of General Internal Medicine.
What it means: An unneeded MRI was linked to more follow-up spending over the next year than an unneeded X-ray. This is an association in insurance claims, not proof the scan caused every dollar.
Who: Blue Cross Blue Shield of Massachusetts members aged 18-50 with uncomplicated acute low back pain, 2018
Sample: 30,892 members (787 received low-value MRI; 5,091 low-value X-ray)
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
The same study found that, compared with similar patients who had no low-value imaging, low-value MRI for uncomplicated low back pain was associated with $1,093 more in narrowly defined cascade-related spending over 12 months (adjusted), versus $220 more for low-value X-ray, according to the Journal of General Internal Medicine. Source: Journal of General Internal Medicine, "Cascade Services and Spending Following Low-Value Imaging for Uncomplicated Low Back Pain among Commercially Insured Adults", September 2022. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-19
Opioid prescribing at U.S. emergency department visits for low back pain fell from 32% in 2016 to 13% in 2022, while X-ray use stayed at 36% to 43% of those visits, according to an Annals of Emergency Medicine study of NHAMCS data reported by the American College of Emergency Physicians.
What it means: Emergency departments now prescribe opioids for back pain much less often, but X-rays at those visits did not drop. The figures cover emergency visits only.
Who: U.S. emergency department visits with low back pain as the primary reason (nationally representative NHAMCS survey)
Cite this stat
Opioid prescribing at U.S. emergency department visits for low back pain fell from 32% in 2016 to 13% in 2022, while X-ray use stayed at 36% to 43% of those visits, according to an Annals of Emergency Medicine study of NHAMCS data reported by the American College of Emergency Physicians. Source: American College of Emergency Physicians (Annals of Emergency Medicine study), "Emergency Physicians Prescribing Fewer Opioids for Low Back Pain, Study Finds", July 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-20
In a study of 2023 encounters at a Utah/Idaho health system, 29% of acute low back pain encounters without red flags in emergency departments and urgent cares included an imaging order, while only 5% included a physical therapy order, according to the American Journal of Emergency Medicine.
What it means: In this health system, a back pain visit to an emergency department or urgent care was far more likely to end with a scan than a referral to physical therapy. The data come from one health system in Utah and Idaho.
Who: Acute low back pain encounters without red flags at 22 EDs and 27 urgent cares in Intermountain Health (Utah and Idaho), Jan-Jun 2023
Sample: 8,047 encounters
Cite this stat
In a study of 2023 encounters at a Utah/Idaho health system, 29% of acute low back pain encounters without red flags in emergency departments and urgent cares included an imaging order, while only 5% included a physical therapy order, according to the American Journal of Emergency Medicine. Source: American Journal of Emergency Medicine, "Guideline concordant care for acute low back pain: A mixed-methods analysis of determinants of implementation", February 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-21
In a national claims study of 216,504 opioid-naive adults with new-onset low back pain, 53.0% first saw a primary care physician, 23.1% a chiropractor, 1.6% a physical therapist and 0.8% an acupuncturist, according to BMJ Open.
What it means: Most people with new low back pain start with a primary care doctor, but nearly 1 in 4 in this study went to a chiropractor first. The data are from insurance claims, and the study was funded in part by the American Physical Therapy Association.
Who: Opioid-naive U.S. adults with new-onset low back pain in OptumLabs claims data (commercial and Medicare Advantage)
Sample: 216,504 adults
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
In a national claims study of 216,504 opioid-naive adults with new-onset low back pain, 53.0% first saw a primary care physician, 23.1% a chiropractor, 1.6% a physical therapist and 0.8% an acupuncturist, according to BMJ Open. Source: BMJ Open, "Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use", September 2019. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-22
The same BMJ Open study found that adults who first saw a chiropractor for new low back pain had 90% lower odds of early opioid use (adjusted OR 0.10) and those who first saw a physical therapist had 85% lower odds (adjusted OR 0.15) than those who first saw a primary care physician; this is an association, not proof of cause.
What it means: People who first saw a chiropractor or physical therapist were much less likely to start opioids early. This is an association. People who choose each path may differ in ways the data cannot fully adjust for.
Who: Opioid-naive U.S. adults with new-onset low back pain in OptumLabs claims data
Sample: 216,504 adults
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
The same BMJ Open study found that adults who first saw a chiropractor for new low back pain had 90% lower odds of early opioid use (adjusted OR 0.10) and those who first saw a physical therapist had 85% lower odds (adjusted OR 0.15) than those who first saw a primary care physician; this is an association, not proof of cause. Source: BMJ Open, "Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use", September 2019. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-23
In a matched U.S. cohort of adults with new low back pain, those who received spinal manipulative therapy had a lower two-year rate of opioid use disorder (0.24%) than those prescribed ibuprofen (1.51%), and fewer received opioid prescriptions (30.96% vs 45.00%), according to Health Science Reports; this is an association, not proof of cause.
What it means: In this matched cohort, people who had spinal manipulation were less likely to receive an opioid prescription or develop opioid use disorder over two years. This is an association, and the lead author directs chiropractic care at a hospital system.
Who: U.S. adults with new low back pain with or without sciatica, no prior opioid prescription or OUD (TriNetX electronic health records)
Sample: 24,993 patients per matched group
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.
Cite this stat
In a matched U.S. cohort of adults with new low back pain, those who received spinal manipulative therapy had a lower two-year rate of opioid use disorder (0.24%) than those prescribed ibuprofen (1.51%), and fewer received opioid prescriptions (30.96% vs 45.00%), according to Health Science Reports; this is an association, not proof of cause. Source: Health Science Reports, "Association Between Spinal Manipulative Therapy for Low Back Pain With or Without Sciatica and Opioid Use Disorder: A Retrospective Cohort Study", September 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-24
Stage 4
Adults sit for hours, and heavy phone use is linked to neck pain
Many people now work from home, sit for close to six hours a day and fall short of activity guidelines. Research links heavy smartphone use with neck pain, though links are not proof of cause.
According to the Bureau of Labor Statistics, 22.6 percent of U.S. workers teleworked or worked at home for pay in March 2026, a rate that ranged from 21.5 to 23.0 percent over the prior year.
What it means: About 1 in 5 U.S. workers does at least some paid work from home.
Who: Employed people in the U.S. during the CPS reference week
Sample: Current Population Survey (monthly household survey), not seasonally adjusted
Cite this stat
According to the Bureau of Labor Statistics, 22.6 percent of U.S. workers teleworked or worked at home for pay in March 2026, a rate that ranged from 21.5 to 23.0 percent over the prior year. Source: U.S. Bureau of Labor Statistics (The Economics Daily), "22.6 percent of workers teleworked in March 2026", April 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-25
According to CDC's National Center for Health Statistics, 47.2 percent of U.S. adults met federal aerobic physical activity guidelines in 2024, meaning more than half did not; men (52.3 percent) were more likely than women (42.4 percent) to meet them.
What it means: More than half of U.S. adults do not get the recommended amount of aerobic activity, and regular movement is one of the first things guidelines suggest for back pain.
Who: U.S. civilian noninstitutionalized adults 18+
Sample: 2024 National Health Interview Survey (nationally representative household survey)
Cite this stat
According to CDC's National Center for Health Statistics, 47.2 percent of U.S. adults met federal aerobic physical activity guidelines in 2024, meaning more than half did not; men (52.3 percent) were more likely than women (42.4 percent) to meet them. Source: CDC National Center for Health Statistics, "Aerobic Physical Activity Among Adults Age 18 and Older: United States, 2024 (NCHS Data Brief No. 555)", April 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-26
U.S. adults reported a mean of 351 minutes of sitting per day in 2017/2018, up 19 minutes from 332 minutes in 2007/2008, with a peak of 426 minutes in 2013/2014 followed by a decline, according to an NHANES analysis by CDC, NCI and Pennington researchers.
What it means: Adults sit for close to six hours a day on average. This figure uses 2017 to 2018 survey data and is self-reported.
Sample: 34,303 adults aged 18+, NHANES 2007/2008 to 2017/2018, self-reported sitting time
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
U.S. adults reported a mean of 351 minutes of sitting per day in 2017/2018, up 19 minutes from 332 minutes in 2007/2008, with a peak of 426 minutes in 2013/2014 followed by a decline, according to an NHANES analysis by CDC, NCI and Pennington researchers. Source: Journal of Physical Activity and Health, "Trends in self-reported sitting time by physical activity levels among US adults, NHANES 2007/2008-2017/2018", August 2021. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-27
A 2025 meta-analysis in the Postgraduate Medical Journal, pooling 7 studies with 10,715 participants, found smartphone overuse was associated with significantly higher odds of neck pain (pooled adjusted odds ratio 2.34).
What it means: Heavy smartphone use is linked to higher odds of neck pain. The studies pooled here show a link, not proof that phones cause neck pain.
Who: Participants in 7 observational studies (mixed countries and ages)
Sample: 7 studies, 10,715 participants
Cite this stat
A 2025 meta-analysis in the Postgraduate Medical Journal, pooling 7 studies with 10,715 participants, found smartphone overuse was associated with significantly higher odds of neck pain (pooled adjusted odds ratio 2.34). Source: Postgraduate Medical Journal (Oxford University Press); Chen Y-J et al., "Association of smartphone overuse and neck pain: a systematic review and meta-analysis", January 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-28
A 2023 systematic review of 25 studies on teleworking and musculoskeletal disorders found lower back and neck pain were the most commonly reported problems, though results were mixed, with some studies finding more pain among teleworkers and others not.
What it means: When people work from home, low back and neck pain are the problems researchers find most often. The results across studies were mixed, so working from home does not always mean more pain.
Who: Teleworkers in 25 studies (largely COVID-19 era, international)
Sample: 25 studies included of 205 identified
Cite this stat
A 2023 systematic review of 25 studies on teleworking and musculoskeletal disorders found lower back and neck pain were the most commonly reported problems, though results were mixed, with some studies finding more pain among teleworkers and others not. Source: International Journal of Environmental Research and Public Health, "Teleworking and Musculoskeletal Disorders: A Systematic Review", March 2023. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-29
The World Health Organization estimates that headache disorders affect approximately 40 percent of the global population, or 3.1 billion people in 2021, and that episodic tension-type headache is reported by more than 70 percent of some populations.
What it means: Headaches are among the most common health problems on earth, and tension-type headache is the most common kind.
Sample: WHO fact sheet drawing on Global Burden of Disease 2021 estimates
Cite this stat
The World Health Organization estimates that headache disorders affect approximately 40 percent of the global population, or 3.1 billion people in 2021, and that episodic tension-type headache is reported by more than 70 percent of some populations. Source: World Health Organization, "Headache disorders (fact sheet)", October 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-30
Stage 5
About 1 in 9 U.S. adults sees a chiropractor, mostly for pain
Chiropractic use has grown by about half since 2002. Nearly everyone who goes is looking for pain relief, and satisfaction is high, though trust in the profession is mixed.
According to NIH's National Center for Complementary and Integrative Health, analyzing National Health Interview Survey data, 11.0 percent of U.S. adults used chiropractic care in 2022, compared with 7.4 percent in 2002.
What it means: About 1 in 9 U.S. adults used chiropractic care in 2022, up by about half since 2002. This is the most recent national figure.
Who: U.S. adults aged 18 and over (civilian noninstitutionalized)
Sample: National Health Interview Survey 2002 (n=31,044) and 2022 (n=27,651), per Nahin RL, Rhee A, Stussman B. JAMA. 2024;331(7):613-615 (doi:10.1001/jama.2023.26775)
Cite this stat
According to NIH's National Center for Complementary and Integrative Health, analyzing National Health Interview Survey data, 11.0 percent of U.S. adults used chiropractic care in 2022, compared with 7.4 percent in 2002. Source: NIH National Center for Complementary and Integrative Health, "Use of Complementary Health Approaches: 20-Year Trends", February 2024. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-31
According to NIH's National Center for Complementary and Integrative Health, 85.7 percent of adults who used chiropractic in 2022 did so for pain, up from 78.6 percent in 2002, the highest share of any complementary approach studied.
What it means: Nearly everyone who uses chiropractic does so for pain. Few use it for general wellness alone.
Who: U.S. adults who used chiropractic in the past 12 months
Sample: National Health Interview Survey 2002 (n=31,044) and 2022 (n=27,651)
Cite this stat
According to NIH's National Center for Complementary and Integrative Health, 85.7 percent of adults who used chiropractic in 2022 did so for pain, up from 78.6 percent in 2002, the highest share of any complementary approach studied. Source: NIH National Center for Complementary and Integrative Health, "Use of Complementary Health Approaches for Pain: 20-Year Trends", February 2024. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-32
For comparison, NIH's National Center for Complementary and Integrative Health reports that 10.9 percent of U.S. adults used massage in 2022, up from 4.8 percent in 2002, nearly the same share as chiropractic (11.0 percent).
What it means: Massage use grew even faster and is now about as common as chiropractic. Many people use more than one hands-on approach.
Sample: National Health Interview Survey 2002 (n=31,044) and 2022 (n=27,651)
Cite this stat
For comparison, NIH's National Center for Complementary and Integrative Health reports that 10.9 percent of U.S. adults used massage in 2022, up from 4.8 percent in 2002, nearly the same share as chiropractic (11.0 percent). Source: NIH National Center for Complementary and Integrative Health, "Massage Use: 20-Year Trends", February 2024. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-33
The CDC's National Center for Health Statistics found that in 2017 women were more likely than men to have seen a chiropractor in the past year (11.1% vs. 9.4%, age-adjusted), adults 45 to 64 were the most likely age group (11.4%, vs. 9.9% for 18 to 44 and 9.5% for 65 and over), and non-Hispanic white adults (12.7%) were more likely than Hispanic (6.6%) or non-Hispanic Black (5.5%) adults.
What it means: Chiropractic use varies by sex, age and race or ethnicity. These are 2017 figures, the newest federal breakdowns available.
Sample: National Health Interview Survey 2017 (n=26,742 adults)
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
The CDC's National Center for Health Statistics found that in 2017 women were more likely than men to have seen a chiropractor in the past year (11.1% vs. 9.4%, age-adjusted), adults 45 to 64 were the most likely age group (11.4%, vs. 9.9% for 18 to 44 and 9.5% for 65 and over), and non-Hispanic white adults (12.7%) were more likely than Hispanic (6.6%) or non-Hispanic Black (5.5%) adults. Source: National Center for Health Statistics (CDC), "Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Over (NCHS Data Brief No. 325)", November 2018. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-34
According to the CDC's National Center for Health Statistics, 3.4% of U.S. children aged 4 to 17 saw a chiropractor in the past 12 months in 2017, statistically unchanged from 3.5% in 2012, with teens 12 to 17 (5.1%) more likely than children 4 to 11 (2.1%).
What it means: A small share of U.S. children see a chiropractor, mostly teens. These are 2017 figures.
Sample: National Health Interview Survey 2012 and 2017
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
According to the CDC's National Center for Health Statistics, 3.4% of U.S. children aged 4 to 17 saw a chiropractor in the past 12 months in 2017, statistically unchanged from 3.5% in 2012, with teens 12 to 17 (5.1%) more likely than children 4 to 11 (2.1%). Source: National Center for Health Statistics (CDC), "Use of Yoga, Meditation, and Chiropractors Among U.S. Children Aged 4-17 Years (NCHS Data Brief No. 324)", November 2018. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-35
A Gallup survey commissioned by Palmer College of Chiropractic found that 14% of U.S. adults, an estimated 33.5 million people, had seen a chiropractor in the previous 12 months, with those recent patients averaging 11 visits, while 49% had never seen one.
What it means: This survey put chiropractic use higher than federal surveys for similar years, and those who went averaged 11 visits a year. It is a 2015 survey commissioned by a chiropractic college.
Sample: Gallup Panel, 5,442 U.S. adults, web and mail, Feb 16 to May 6, 2015; margin of error +/-2 points
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
A Gallup survey commissioned by Palmer College of Chiropractic found that 14% of U.S. adults, an estimated 33.5 million people, had seen a chiropractor in the previous 12 months, with those recent patients averaging 11 visits, while 49% had never seen one. Source: Gallup (commissioned by Palmer College of Chiropractic), "Majority in U.S. Say Chiropractic Works for Neck, Back Pain", September 2015. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-36
In the 2016 Gallup-Palmer College of Chiropractic report, 77% of adults who saw a chiropractor in the last year described the treatment they received as very effective, and 87% agreed their chiropractor really cares about them.
What it means: People who see a chiropractor tend to rate their care highly. Satisfaction is not the same as measured clinical results, and the survey was commissioned by a chiropractic college.
Who: U.S. adults who saw a chiropractor in the prior 12 months
Sample: Gallup Panel web and mail study, 7,645 U.S. adults, Feb 8 to Mar 11, 2016; margin of error +/-1.8 points (full sample); past-year user subgroup N not stated
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
In the 2016 Gallup-Palmer College of Chiropractic report, 77% of adults who saw a chiropractor in the last year described the treatment they received as very effective, and 87% agreed their chiropractor really cares about them. Source: Gallup / Palmer College of Chiropractic, "Gallup-Palmer College of Chiropractic Annual Report: Americans' Perceptions of Chiropractic (2016)", 2016. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-37
Gallup's 2015 survey for Palmer College found 61% of U.S. adults agreed chiropractic is effective for neck and back pain (23% strongly, 38% somewhat), 63% agreed most chiropractors have patients' best interest in mind, and slightly more than half agreed most chiropractors are trustworthy.
What it means: Most U.S. adults believe chiropractic helps neck and back pain, but trust is mixed: only about half find chiropractors trustworthy. This is a 2015 survey commissioned by a chiropractic college.
Sample: Gallup Panel, 5,442 U.S. adults, 2015; margin of error +/-2 points
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
Gallup's 2015 survey for Palmer College found 61% of U.S. adults agreed chiropractic is effective for neck and back pain (23% strongly, 38% somewhat), 63% agreed most chiropractors have patients' best interest in mind, and slightly more than half agreed most chiropractors are trustworthy. Source: Gallup (commissioned by Palmer College of Chiropractic), "Majority in U.S. Say Chiropractic Works for Neck, Back Pain", September 2015. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-38
Stage 6
Spinal manipulation performs about as well as other recommended care, and most side effects are mild
The best reviews find spinal manipulation helps chronic low back pain about as much as other recommended treatments, with small effects. Serious side effects are rare in trials, but many trials do not report side effects at all.
According to the 2026 Cochrane update covering 76 trials, spinal manipulation for chronic low back pain may result in little to no difference in pain compared with other conservative treatments (mean difference of 4.72 points on a 0 to 100 scale at one month, below the 10-point difference considered meaningful to patients; low-certainty evidence), and may result in a small improvement in function.
What it means: For chronic low back pain, the newest Cochrane review found that spinal manipulation performs about the same as other conservative treatments for pain. That is useful to know: it is one reasonable option among several, not a standout. The evidence is low certainty.
Who: Adults with chronic low back pain in randomized controlled trials
Sample: 76 RCTs, 11,866 participants (pain comparison vs other conservative interventions: 31 studies, 4,109 participants)
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.
Cite this stat
According to the 2026 Cochrane update covering 76 trials, spinal manipulation for chronic low back pain may result in little to no difference in pain compared with other conservative treatments (mean difference of 4.72 points on a 0 to 100 scale at one month, below the 10-point difference considered meaningful to patients; low-certainty evidence), and may result in a small improvement in function. Source: Cochrane Database of Systematic Reviews, "Spinal manipulative therapy for adults with chronic low back pain", January 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-39
According to the 2026 Cochrane review of spinal manipulation for chronic low back pain, fewer than half of the included trials (47%) reported on adverse events; those that did described muscle soreness, stiffness or a temporary increase in pain, and none registered serious complications related to treatment. The reviewers rate the evidence on adverse effects as very uncertain.
What it means: Trials often skip reporting side effects. When they do report them, the usual ones are soreness, stiffness or a short-term rise in pain.
Who: Adults with chronic low back pain in randomized controlled trials
Sample: 76 RCTs, 11,866 participants
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.
Cite this stat
According to the 2026 Cochrane review of spinal manipulation for chronic low back pain, fewer than half of the included trials (47%) reported on adverse events; those that did described muscle soreness, stiffness or a temporary increase in pain, and none registered serious complications related to treatment. The reviewers rate the evidence on adverse effects as very uncertain. Source: Cochrane Database of Systematic Reviews, "Spinal manipulative therapy for adults with chronic low back pain", January 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-40
A 2019 BMJ systematic review and meta-analysis of 47 trials found moderate-quality evidence that spinal manipulation has similar effects to other guideline-recommended therapies for short-term relief of chronic low back pain, and reported that most observed adverse events were musculoskeletal, transient and mild to moderate in severity.
What it means: For chronic low back pain, spinal manipulation gave short-term relief similar to other guideline-recommended treatments, and most side effects were mild and short-lived.
Who: Adults with chronic low back pain in randomized controlled trials
Sample: 47 RCTs, 9,211 participants
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
A 2019 BMJ systematic review and meta-analysis of 47 trials found moderate-quality evidence that spinal manipulation has similar effects to other guideline-recommended therapies for short-term relief of chronic low back pain, and reported that most observed adverse events were musculoskeletal, transient and mild to moderate in severity. Source: The BMJ, "Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials", March 2019. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-41
In a 750-person pragmatic trial of active-duty US service members with low back pain, adding chiropractic care to usual medical care produced moderate short-term improvements at 6 weeks (adjusted mean difference of -1.1 points in pain intensity on a 0 to 10 scale and -2.2 points on the 0 to 24 Roland-Morris disability questionnaire) compared with usual medical care alone, with no serious related adverse events reported, according to Goertz et al. in JAMA Network Open.
What it means: Adding chiropractic care to usual medical care led to modest extra improvement at six weeks for active-duty service members. The results may not apply to every population.
Who: Active-duty US military personnel aged 18 to 50 with low back pain at three military sites
Sample: 750 participants
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
In a 750-person pragmatic trial of active-duty US service members with low back pain, adding chiropractic care to usual medical care produced moderate short-term improvements at 6 weeks (adjusted mean difference of -1.1 points in pain intensity on a 0 to 10 scale and -2.2 points on the 0 to 24 Roland-Morris disability questionnaire) compared with usual medical care alone, with no serious related adverse events reported, according to Goertz et al. in JAMA Network Open. Source: JAMA Network Open, "Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial", May 2018. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-42
A 2020 federal AHRQ comparative effectiveness review found spinal manipulation was among treatments associated with improved chronic low back pain at intermediate term (moderate strength of evidence) and improved function (low strength of evidence), while noting effect sizes were generally small.
What it means: A federal review found that spinal manipulation was among the non-drug treatments with some benefit for chronic low back pain over the intermediate term. The effect sizes were generally small.
Who: Adults with chronic low back pain (and other chronic pain conditions) in randomized trials
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
A 2020 federal AHRQ comparative effectiveness review found spinal manipulation was among treatments associated with improved chronic low back pain at intermediate term (moderate strength of evidence) and improved function (low strength of evidence), while noting effect sizes were generally small. Source: Agency for Healthcare Research and Quality, "Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update (Comparative Effectiveness Review No. 227)", April 2020. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-43
A 2015 Cochrane review of neck pain found that multiple sessions of cervical manipulation produced changes similar to cervical mobilisation (moderate- to high-quality evidence), and may provide better pain relief and function than certain medications for acute and subacute neck pain (moderate-quality evidence from single trials).
What it means: For neck pain, spinal manipulation and gentler mobilization produced similar results, and manipulation may help more than certain medications for recent neck pain. This is a 2015 review.
Who: Adults with neck pain in randomized controlled trials
Sample: 51 trials, 2,920 participants overall; manipulation vs mobilisation: 2 trials, 446 participants; manipulation vs medication: one trial each, 182 and 181 participants
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
A 2015 Cochrane review of neck pain found that multiple sessions of cervical manipulation produced changes similar to cervical mobilisation (moderate- to high-quality evidence), and may provide better pain relief and function than certain medications for acute and subacute neck pain (moderate-quality evidence from single trials). Source: Cochrane Database of Systematic Reviews, "Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment", September 2015. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-44
The same 2015 Cochrane neck pain review found low-quality evidence from two trials that multiple sessions of cervical manipulation may be more effective than massage for improving pain and function in chronic cervicogenic headache.
What it means: There is limited, low-quality evidence that neck manipulation may help headaches that start in the neck. More research is needed before drawing firm conclusions.
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
The same 2015 Cochrane neck pain review found low-quality evidence from two trials that multiple sessions of cervical manipulation may be more effective than massage for improving pain and function in chronic cervicogenic headache. Source: Cochrane Database of Systematic Reviews, "Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment", September 2015. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-45
A claims-based cohort study in Pain Medicine found that adults with spinal pain who did not see a chiropractor filled opioid prescriptions at 1.55 times the rate (Connecticut) and 2.03 times the rate (New Hampshire) of those who did, an association rather than proof of cause.
What it means: People with spinal pain who did not see a chiropractor filled opioid prescriptions at a higher rate in two states. This is an association in claims data from Connecticut and New Hampshire, and the study was funded by a chiropractic group.
Who: Adults aged 18 to 84 with spinal pain in health-plan claims from three contiguous US states (including Connecticut and New Hampshire), 2012 to 2017
Sample: 101,221 subjects
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
A claims-based cohort study in Pain Medicine found that adults with spinal pain who did not see a chiropractor filled opioid prescriptions at 1.55 times the rate (Connecticut) and 2.03 times the rate (New Hampshire) of those who did, an association rather than proof of cause. Source: Pain Medicine (Oxford University Press), "Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain", March 2020. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-46
In a prospective study of 1,885 Washington State workers with occupational back injuries, 42.7% of those who first saw a surgeon had lumbar spine surgery within three years, compared with 1.5% of those who first saw a chiropractor, according to Keeney et al. in Spine.
What it means: Who an injured worker sees first was strongly linked to whether they had surgery. This is an association in Washington State workers' compensation claims, not proof that the first provider changed the outcome.
Who: Workers' compensation claimants with back injuries, Washington State
Sample: 1,885 workers; 174 (9.2%) had surgery within 3 years
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
In a prospective study of 1,885 Washington State workers with occupational back injuries, 42.7% of those who first saw a surgeon had lumbar spine surgery within three years, compared with 1.5% of those who first saw a chiropractor, according to Keeney et al. in Spine. Source: Spine (Lippincott Williams & Wilkins); NIOSH-funded, "Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State", May 2013. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-47
A 2016 systematic review and meta-analysis in Cureus found a small statistical association between chiropractic care and cervical artery dissection (odds ratio 1.74), rated the evidence very low quality, and concluded there is no convincing evidence of a causal link.
What it means: This review found a statistical link between chiropractic visits and a rare type of artery tear in the neck, but rated the evidence very low quality and found no convincing proof of cause.
Who: Case-control and related studies of cervical artery dissection
Sample: 6 studies (2 class II, 4 class III) from 253 articles screened
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
A 2016 systematic review and meta-analysis in Cureus found a small statistical association between chiropractic care and cervical artery dissection (odds ratio 1.74), rated the evidence very low quality, and concluded there is no convincing evidence of a causal link. Source: Cureus, "Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation", February 2016. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-48
A population-based Ontario case-control and case-crossover study of 818 hospitalized vertebrobasilar artery (VBA) strokes, published in Spine in 2008, found that patients under 45 were about three times more likely than controls to have seen either a chiropractor or a primary care physician beforehand, and found no evidence of excess VBA stroke risk associated with chiropractic care compared with primary care.
What it means: People with this rare stroke were more likely to have seen a chiropractor or a family doctor beforehand. Researchers think early symptoms lead people to seek care in either setting. It is a 2008 study.
Sample: 818 VBA strokes; 4 matched controls per case
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
A population-based Ontario case-control and case-crossover study of 818 hospitalized vertebrobasilar artery (VBA) strokes, published in Spine in 2008, found that patients under 45 were about three times more likely than controls to have seen either a chiropractor or a primary care physician beforehand, and found no evidence of excess VBA stroke risk associated with chiropractic care compared with primary care. Source: Spine (Lippincott Williams & Wilkins), "Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study", February 2008. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-49
A 2023 BMJ Open review of 154 spinal manipulation trials found that 94 (61.0%) reported on adverse events and none of those reported any serious adverse events, while warning that harms reporting remains low and inconsistent.
What it means: Across trials that reported side effects, none reported a serious event. Many trials still do not report side effects at all.
Who: Randomized clinical trials of spinal manipulation published March 2016 to May 2022
Sample: 154 trials; spinal manipulation delivered to 7,518 participants
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.
Cite this stat
A 2023 BMJ Open review of 154 spinal manipulation trials found that 94 (61.0%) reported on adverse events and none of those reported any serious adverse events, while warning that harms reporting remains low and inconsistent. Source: BMJ Open, "Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review", May 2023. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-50
Stage 7
A growing profession with narrow Medicare coverage
Chiropractic jobs are projected to grow faster than average. Medicare covers only spinal manipulation to correct a subluxation, and federal reviewers flag many Medicare chiropractic claims for missing documentation.
Chiropractors held about 61,700 jobs in the United States in 2025, and about 36% of them were self-employed, according to the U.S. Bureau of Labor Statistics.
What it means: There are tens of thousands of chiropractors in the U.S., and about a third own or work for themselves.
Chiropractors held about 61,700 jobs in the United States in 2025, and about 36% of them were self-employed, according to the U.S. Bureau of Labor Statistics. Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, "Chiropractors : Occupational Outlook Handbook", August 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-51
The Bureau of Labor Statistics projects chiropractor employment to grow 9% from 2025 to 2035 (from 61,700 to 67,000 jobs), much faster than average, with about 2,600 openings a year.
What it means: Chiropractic jobs are projected to grow faster than average over the next decade. This is a projection.
The Bureau of Labor Statistics projects chiropractor employment to grow 9% from 2025 to 2035 (from 61,700 to 67,000 jobs), much faster than average, with about 2,600 openings a year. Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, "Chiropractors : Occupational Outlook Handbook", August 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-52
California had about 3,900 employed chiropractors in 2024, projected to reach 4,900 by 2034 (26% growth, about 270 openings a year), according to state long-term projections published through Projections Central and shown on the U.S. Department of Labor's O*NET OnLine.
What it means: California's chiropractor workforce is projected to grow faster than the national figure. This is a state projection.
California had about 3,900 employed chiropractors in 2024, projected to reach 4,900 by 2034 (26% growth, about 270 openings a year), according to state long-term projections published through Projections Central and shown on the U.S. Department of Labor's O*NET OnLine. Source: Projections Central via U.S. Department of Labor O*NET OnLine, "California Employment Trends: Chiropractors (29-1011.00)", 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-53
California's Board of Chiropractic Examiners reported 10,763 active Doctor of Chiropractic licenses in fiscal year 2024/25, plus 854 inactive and 405 out-of-state licensees.
What it means: California has far more active chiropractic licenses than chiropractor jobs in the employment data. The two counts measure different things, so they should not be compared directly.
Who: Doctor of Chiropractic licensees, California Board of Chiropractic Examiners
Cite this stat
California's Board of Chiropractic Examiners reported 10,763 active Doctor of Chiropractic licenses in fiscal year 2024/25, plus 854 inactive and 405 out-of-state licensees. Source: California Board of Chiropractic Examiners, "Board of Chiropractic Examiners Sunset Review Report 2026", December 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-54
According to the Bureau of Labor Statistics, a Doctor of Chiropractic program typically takes about 4 years on top of at least 3 years of undergraduate study. The Council on Chiropractic Education's standards call for a DC curriculum of at least 4,200 instructional hours, though as of January 2026 a program may instead demonstrate competency-based equivalence to that hour requirement.
What it means: Chiropractors train for years after college. The 4,200-hour standard is set by the profession's accrediting body.
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.
Cite this stat
According to the Bureau of Labor Statistics, a Doctor of Chiropractic program typically takes about 4 years on top of at least 3 years of undergraduate study. The Council on Chiropractic Education's standards call for a DC curriculum of at least 4,200 instructional hours, though as of January 2026 a program may instead demonstrate competency-based equivalence to that hour requirement. Source: U.S. Bureau of Labor Statistics; Council on Chiropractic Education, "Chiropractors : Occupational Outlook Handbook; CCE Annual Meeting Report (January 16-17, 2026)", 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-55
According to Medicare.gov, Part B covers only adjustments of the spine by a chiropractor to correct a subluxation, done by hand or with an activator device; other services or tests a chiropractor orders, such as X-rays, massage or acupuncture, are not covered, and patients pay 20% of the approved amount after the Part B deductible.
What it means: Medicare pays for chiropractic only in narrow cases. X-rays, massage and other services from a chiropractor are not covered.
According to Medicare.gov, Part B covers only adjustments of the spine by a chiropractor to correct a subluxation, done by hand or with an activator device; other services or tests a chiropractor orders, such as X-rays, massage or acupuncture, are not covered, and patients pay 20% of the approved amount after the Part B deductible. Source: Centers for Medicare & Medicaid Services (Medicare.gov), "Chiropractic services coverage", 2026. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-56
CMS estimated a 30.4% improper payment rate (95% CI 18.7% to 42.2%) for chiropractic services in Medicare fee-for-service Part B for FY 2025, or $144,031,007 in projected improper payments; 89.5% of those improper payments were classified as insufficient documentation, according to its supplemental improper payment data.
What it means: A large share of Medicare chiropractic payments did not meet Medicare rules, mostly because the paperwork was missing or incomplete.
Who: Medicare fee-for-service Part B chiropractic claims submitted July 1, 2023 to June 30, 2024
Sample: CERT program statistical sample (chiropractic sample size not reported)
Cite this stat
CMS estimated a 30.4% improper payment rate (95% CI 18.7% to 42.2%) for chiropractic services in Medicare fee-for-service Part B for FY 2025, or $144,031,007 in projected improper payments; 89.5% of those improper payments were classified as insufficient documentation, according to its supplemental improper payment data. Source: Centers for Medicare & Medicaid Services, "2025 Medicare Fee-for-Service Supplemental Improper Payment Data", November 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-57
The HHS Office of Inspector General estimated, from a sample, that $358.8 million, about 82%, of the $438.1 million Medicare paid for chiropractic services in 2013 was unallowable, citing ineffective controls against medically unnecessary services. It recommended that CMS set a reimbursement limit (for example, 30 services per beneficiary per year), saying such a limit would have prevented a high number of medically unnecessary services.
What it means: An earlier federal audit found most Medicare chiropractic payments in its sample did not meet the rules. It is a 2016 report on 2013 claims.
Sample: Statistical sample of chiropractic services (size not stated on summary page)
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
The HHS Office of Inspector General estimated, from a sample, that $358.8 million, about 82%, of the $438.1 million Medicare paid for chiropractic services in 2013 was unallowable, citing ineffective controls against medically unnecessary services. It recommended that CMS set a reimbursement limit (for example, 30 services per beneficiary per year), saying such a limit would have prevented a high number of medically unnecessary services. Source: U.S. Department of Health and Human Services, Office of Inspector General, "Hundreds of Millions in Medicare Payments for Chiropractic Services Did Not Comply With Medicare Requirements (A-09-14-02033)", October 2016. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-58
A peer-reviewed PLOS ONE study of Veterans Health Administration data found that the share of VA users receiving chiropractic care rose from 1.4% in FY2017 to 3.5% in FY2022, with community care chiropractic spending of $146,578,776 in FY2022, and projected use to more than double by FY2027.
What it means: Use of chiropractic care within the VA more than doubled in five years and is projected to keep rising. One author had grant funding from NCMIC, a chiropractic malpractice insurer.
Who: Veterans Health Administration users, FY2017 to FY2022
Sample: VHA administrative data, all VA users FY2017-FY2022
Vendor research: The publisher, a funder or an author has a stake in chiropractic or a related service.
Cite this stat
A peer-reviewed PLOS ONE study of Veterans Health Administration data found that the share of VA users receiving chiropractic care rose from 1.4% in FY2017 to 3.5% in FY2022, with community care chiropractic spending of $146,578,776 in FY2022, and projected use to more than double by FY2027. Source: PLOS ONE, "Forecasting the use of chiropractic services within the Veterans Health Administration", January 2025. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-59
According to the CDC's National Center for Health Statistics, about 60% of U.S. adults who saw a practitioner for chiropractic care in 2012 had partial (41.4%) or complete (18.7%) insurance coverage for it.
What it means: Most people who saw a chiropractor in 2012 had at least some insurance coverage for it. This is older data, and coverage varies widely by plan.
Who: U.S. adults who used chiropractic care in the past 12 months
Sample: 2012 National Health Interview Survey, Adult Complementary and Alternative Medicine Supplement
Older study: Published before 2023; kept because no newer source measures the same thing.
Cite this stat
According to the CDC's National Center for Health Statistics, about 60% of U.S. adults who saw a practitioner for chiropractic care in 2012 had partial (41.4%) or complete (18.7%) insurance coverage for it. Source: CDC National Center for Health Statistics, "Insurance Coverage for Complementary Health Approaches Among Adult Users: United States, 2002 and 2012 (NCHS Data Brief No. 235)", January 2016. Via Greenlight Chiropractic & Wellness Lab, The First-Line Gap Report: https://gogreenlightchiro.com/chiropractic-statistics/#stat-60
How we built this report
Sources. We used only primary sources: federal agencies (CDC, NIH, BLS, CMS, AHRQ, SSA, HHS-OIG, VA), the World Health Organization, a California state board and agency, peer-reviewed journals and systematic reviews, and professional bodies that state their method. We did not take any number from a statistics roundup or a blog. Every figure was traced to the publisher that produced it.
Independence.43 of the 60 statistics come from sources with no stake in chiropractic. The other 17 are tagged "Vendor research" because the publisher, a funder or an author has a stake in chiropractic or a related service. That includes surveys commissioned by a chiropractic college and studies by chiropractor authors or funded by chiropractic or physical therapy groups. 27 statistics are tagged "Older study" because they were published before 2023; we kept them only where no newer source measures the same thing.
Two-pass verification. Researchers opened and read every source page. A second, separate review then reopened every source and checked the figure, who it describes, the date, the sample size, and that no sentence claims more than the source shows. That pass changed the wording or source details of 43 statistics and cut none.
How we label findings. Survey answers are reported as what people said. Links between two things, such as seeing a chiropractor first and using fewer opioids, are labeled as associations, not proof of cause. Where the source rates the certainty of its evidence, we say so.
When sources disagree. We show both figures with their sources and never average them. For example, Gallup's 2015 survey (stat 36) puts chiropractic use higher than federal surveys for similar years (stat 31).
Claims we left out because we could not trace them to a primary source:
"About 80% of people will have back pain in their lifetime." No single primary measurement; published estimates of lifetime prevalence range widely.
"Back pain causes 264 million lost workdays a year." Found only in news articles and roundups.
"Back pain costs Americans $50 billion a year." No primary source found.
"Back pain is the leading reason for opioid prescriptions." No primary source states this as a measured figure.
"Looking down at a phone puts 60 pounds of force on your neck." Comes from a 2014 computer model, not a measurement; we could not open the original paper.
"35 million Americans see a chiropractor each year." An association figure with no traceable source.
"There are more than 70,000 licensed chiropractors in the U.S." No published count with a stated method.
"Chiropractic patients are 90% less likely to use opioids long term." A misreading: the 90% figure is for early use and is an association (see stat 23).
"The risk of stroke from a neck adjustment is 1 in X." No primary source with a measured rate.
"Most employer health plans cover chiropractic." No independent survey reports this.
Disclosure. Greenlight Chiropractic & Wellness Lab is a chiropractic practice, so we have a stake in this topic. That is why every statistic links to its source, why we tag vendor research and older studies, and why the report includes findings that do not favor chiropractic. The practice and its services appear only in this disclosure, the author box and the final section.
Use and cite this data
This data is free to use under a Creative Commons Attribution 4.0 license (CC BY 4.0 (opens in a new tab)). Please link back to this page.
Cite the report as
Greenlight Chiropractic & Wellness Lab. "The First-Line Gap Report 2026: Chiropractic Statistics." Updated October 13, 2026. https://gogreenlightchiro.com/chiropractic-statistics/
Each statistic has its own link (for example, #stat-31) and its own "Cite this stat" button. The full data set is available as a CSV download.
Frequently asked questions
What percentage of Americans see a chiropractor?
11.0% of U.S. adults used chiropractic care in 2022, up from 7.4% in 2002, according to NIH's National Center for Complementary and Integrative Health, using National Health Interview Survey data (2024).
How common is back pain in the U.S.?
39.0% of U.S. adults reported back pain in the past three months in 2019, according to the CDC's National Center for Health Statistics (2021).
Is chiropractic effective for low back pain?
For chronic low back pain, the 2026 Cochrane review found spinal manipulation may make little to no difference in pain compared with other conservative treatments, a mean difference of 4.72 points on a 0 to 100 scale (low-certainty evidence). A 2019 BMJ review found effects similar to other guideline-recommended therapies, and the American College of Physicians (2017) lists spinal manipulation among the non-drug treatments to try first.
Is chiropractic safe?
Of 94 spinal manipulation trials that reported side effects, none reported a serious adverse event, according to a 2023 BMJ Open review, which also warned that many trials do not report side effects. In the 2026 Cochrane review, trials that reported side effects described muscle soreness, stiffness or a temporary increase in pain. A 2016 review in Cureus found a small statistical link with a rare neck artery tear (odds ratio 1.74) but rated the evidence very low quality and found no convincing proof of cause.
What do doctors recommend first for back pain?
Non-drug treatment, according to the American College of Physicians' 2017 guideline: options such as heat, massage, acupuncture or spinal manipulation for recent pain, and exercise, rehabilitation, yoga or spinal manipulation for chronic pain, with opioids only as a last option for chronic low back pain.
How many chiropractors are there in the U.S.?
Chiropractors held about 61,700 jobs in the U.S. in 2025, according to the Bureau of Labor Statistics (2026). California's Board of Chiropractic Examiners reported 10,763 active licenses in fiscal year 2024/25.
Does Medicare cover chiropractic care?
Only spinal manipulation to correct a subluxation, according to Medicare.gov (2026). X-rays, massage and other services a chiropractor orders are not covered, and patients pay 20% of the approved amount after the Part B deductible.
How much does back pain cost in the U.S.?
$52.89 billion in health care spending on low back pain in 2019, according to an Institute for Health Metrics and Evaluation study in JAMA (2025), with another $19.42 billion for neck pain.
Jonathan Tingey leads marketing for Greenlight Chiropractic & Wellness Lab and compiled this report with the Greenlight team. He traced each statistic to its original publisher and had every source checked a second time before publishing. He is not a clinician; for questions about your own care, talk with one of our doctors.
Close your first-line gap.
If back or neck pain is your first problem, it does not have to start with a scan or a prescription. An exam is the only way to know whether chiropractic care is right for you.
