It’s never been trendier to see a chiropractor—but are they all they’re cracked up to be?

Recently, I’ve noticed that a growing number of my friends won’t stop talking about their chiropractor:

I went to the chiropractor yesterday and I feel so good now.

The chiropractor totally cleared up my brain fog. Seriously, he’s amazing.

My posture is so much better thanks to my chiropractor. I literally stand up straighter.

All of the above statements are real gushing accolades from my literally cracked out friends. Even Shut The Kale Up blogger Jeannette Ogden often Instagram stories her QT with her DC. But it’s not just an influencer thing: According to the National Center for Complementary Integrated Health (NCCIH), chiropractor use has risen from 9.1 percent of U.S. adults in 2012 to 10.3 percent in 2017, the latest year statistics are available. The Bureau of Labor Statistics (BLS) estimates that employment of chiropractors will rise 12 percent between the years 2016 and 2026. So yes, chiros are a trend here to stay.

Here’s the thing: I’ve always been skeptical of chiropractors. I had always assumed that they were just the people who cracked backs and helped with posture, yet many popular chiropractors, like model-favorite and Pure Change founder Charles Passler, DC and Perfect Keto founder Austin Gustin, DC, have built careers preaching about nutrition. It’s never been clear to me what chiropractors are qualified to do, and how they’re different (or potentially superior) to physical therapists or traditional doctors. Because it’s my job to investigate wellness topics—and honestly, because I really was very curious—I decided to do some digging into the world of chiropractic treatment to understand where it fits in the larger wellness world.

What it takes to become a chiropractor

The bare bones definition of a chiropractor (no pun intended): According to the American Chiropractic Association (ACA), they are healthcare professionals that specialize in the muscular and skeletal system and how those systems can impact overall health. They focus on holistic methods, not prescription medication, so treatment primarily involves manual therapy, manipulating muscles, joints, and the spine, per the NCCIH.

Chiropractic treatment has primarily been found to relieve back pain, particularly lower back pain—especially when combined with other treatments. There’s also some evidence that chiropractic care can help with migraines (although it might be a placebo effect) and neck pain. However, Josh Axe, DNM, DC, CNS, founder of Ancient Nutrition, argues that since the spine is connected to all parts of the body, the health and care of one’s spine can greatly impact overall health. While many people don’t associate brain health and chiropractic care, for example, Dr. Axe says the latter can benefit the former because the spine is an integral part of the central nervous system. “The spinal cord has a key role [in learning and memory] because it is the final common pathway for all behavior and is a site of substantial plasticity,” one study says of the (quite literal) connection. Thus, improving spine health can help overall brain health, he argues. Some chiropractors also argue that improved spinal health can potentially help with mood, better cognitive function (including later in life), and better respiratory function. (These potential benefits of chiropractic care are not as well-backed by research, so take them with a grain of salt.)

Per the NCIHH and ACA, many chiropractors also incorporate nutrition and exercise counseling into their training and practices. “Ten to 15 years ago, the medical community laughed at the idea that nutrition mattered, but now so many doctors are talking about how important it actually is,” Dr. Axe says. While nutrition doesn’t technically have to do with the spine, Dr. Axe emphasizes that as holistic practitioners, many chiropractors will ask about food and health to help treat the whole patient (although not all choose to do this).

In order to become a DC, Dr. Axe says a person must attend four years of chiropractor college, earning a Doctor of Chiropractic (D.C.) degree and passing the National Board of Chiropractic Examiners exam. This is all after undergrad, though it should be noted that while some college coursework is required, the Bureau of Labor Statistics says only three years of undergrad education (not an undergraduate degree) are required to go to chiropractor school. Chiropractors-in-training take between two to five dedicated courses in anatomy and physiology, depending on the program. Then, they learn how to do actual spinal adjustments and other treatments. After all this, chiropractors do a residency—just like MDs and DOs—for two to three years. Most states also require chiropractors to obtain licensing before they can practice—in New York, for example, chiropractors must reregister with the state licensing board every three years in order to continue practicing.

It’s fairly rigorous training, much like a medical doctor, although there are some differences in focus. Again, chiros are all about the spine and how it’s connected to overall health, which affects the type of coursework chiropractors complete. “Medical doctors spend more time studying microbiology and medicine whereas chiropractors spend more time studying anatomy and nutrition,” Dr. Axe says. (The average doctor only gets a total of 19.6 hours of nutrition education in medical school compared to on average two required courses dedicated to nutrition in chiropractic school. Medical doctors study spinal anatomy but it’s in addition to the rest of the body and is not the primary focus of their care.) However, chiropractors can’t write prescriptions or do surgery, so people with more serious injuries should see an MD or DO, not a DC, for help.

The focus on anatomy and alignment might also sound like physical therapy, but there are some key differences between the two fields as well, says physical therapist Danielle Weis, DPT. While both DCs and physical therapists work to minimize pain without the use of prescription meds, physical therapists, Dr. Weis explains, are movement experts who focus on hands-on treatment, prescribed exercise, and patient education. A person becomes a physical therapist (as of 2016, the designation is Doctorate of Physical Therapy, or DPT) after completing a three-year program post-undergrad that focuses primarily on anatomy, movement, and strength.

“There is some overlap in the training, but physical therapists focus more on the range of motion in the joints and muscle strength, seeing how everything is working together,” Dr. Weis says.

What to expect from a chiropractor appointment

At the suggestion of Dr. Axe, I booked myself an appointment with his friend Greg Barnes, DC to fully understand the chiropractic experience. When I arrived for my visit at his office in Raleigh, North Carolina, Beyoncé music played over the loud speaker and everyone—from the patients to the staff—seemed legitimately happy to be there. Definitely a different vibe from other medical offices I’d visited in my lifetime.

My intake forms were surprising, too. Sure, there were the expected questions about pain levels, past injuries, and why I was there. But there were also questions about anxiety, depression, and digestion, which don’t always come up at other general medicine practices. “Here, we take a whole-body approach to make someone well,” Dr. Barnes explained. “We’re primary care providers and want to treat the whole person, which can include lifestyle changes. We don’t ‘treat’ anxiety or diabetes, per se, but we do try to support people who have these issues since GPs have very limited time with patients and often can’t talk all of it through.” For example, if one of his patients is interested in healthy weight management or using food to ease their depression symptoms, Dr. Barnes has on staff a registered nurse specializing in nutrition who can help.

I told Dr. Barnes that I had two main pain points that needed help. One: My terrible posture, thanks to being tied to a computer or phone most of the day for my job. Two: I had carried a heavy gym bag on my right shoulder every day for years while living in New York City, and I was curious if that habit had affected my shoulder negatively.

The first thing Dr. Barnes did was to have me stand up as straight as possible against a posture grid chart—which basically looks like a huge grid on the wall—while he looked at my stance to see if he could spot any misalignment. “First, your left shoulder does look higher than your right one,” he said—not surprising, given my past bag-carrying habit. “And second, you have the classic modern-day problem of having your neck and head a bit too far forward, which is likely due to being hunched over a computer.” If left untreated, this could lead to cervical degeneration, which can cause neck and spine pain. He also noticed that I had tightness in my right jaw, something I wasn’t even aware of until he pointed it out.

That’s when I moved to the next part of my appointment: getting x-rays. The x-rays, done to confirm the visual diagnosis, confirmed in black and white what Dr. Barnes noticed just by looking at me in his office.

I got ready for the last part of my appointment: the adjustment. “What’s happening when we’re ‘cracking’ the bones is allowing fluid to flow through better,” Dr. Barnes explained. This is a bit different than cracking your knuckles at home; a trained chiropractor carefully uses their hands to apply force to a joint, making it pop and crack to relieve pressure and allow for better movement and less pain. It only took five minutes for Dr. Barnes to adjust my neck on both sides and my upper shoulders, using his hands to make quick and precise movements.

Afterwards, I was told to stand on a vibrating plate for five minutes while wearing a two-pound head weight. This is apparently for muscle memory, so the body remembers the alignment, Dr. Barnes explained. I wouldn’t say I felt amazing from my adjustment, like so many of my friends claimed, just a little sore. (This is not unusual; per the Mayo Clinic, some people have minor pain, headaches, or fatigue in the first few days after an adjustment.) But Dr. Barnes assured me that if I came for adjustments twice a week for four weeks and then one a week for eight weeks, my posture would be almost completely back to where I should be.

My first appointment came to $96. My treatment plan—16 appointments and monthly x-rays—comes to $968 (or $868 if paid for all at once). The average cost of seeing a chiropractor is $65 per visit, and Dr. Barnes’ follow-up adjustments are a bit lower at $40 a visit. I could use HSA pre-tax money to pay for my treatment, but I currently only have about $300 in my account (I usually don’t need more than that to cover prescriptions and other treatments), so I’d have to either dip into my own bank account to cover the difference or elect to have more money withheld from my paycheck and go into my HSA.

It’s not just a “me” issue. Aetna and Cigna, two of the biggest insurance companies in the country, only cover chiropractic care when it’s considered medically necessary (read: a person has a clearly-documented “neuromusculoskeletal disorder”). For preventive care, the kind that Dr. Barnes and others recommend, patients must use an HSA or pay for it totally out of pocket. While preventive care can help stave off more serious health issues in the long run, I’m not sure that a lot of people—myself included—can afford to pay that kind of cost up-front.

What I think of chiropractors now

Given all that I know about chiropractors now, I know I could probably benefit from the kind of care they offer. Eighty percent of Americans will complain of back pain at some point in their lives, and regular adjustments can help treat this and prevent this in the future. As far as the other claims such as weight management or improved mood, a chiropractor may be able to help, but so could other health professionals with more specific training, such as a dietitian or therapist.

As I found first-hand, accessibility and affordability are big issues with chiropractors (similar to other alternative wellness practitioners). Unless you have a spinal injury, there’s a slim chance that your insurance will cover it. As with any health procedure, chiropractic care also comes with some potential side effects and risks, especially if performed by an untrained, unlicensed practitioner. And the practice is not for everyone—per the Mayo Clinic, people with health conditions like osteoporosis or spinal cancer should not get adjusted.

As for me, I’m moving forward with the same approach I take toward other areas of my wellness routine: affording what I can (which for me means still going but less often) and doing what I can on my own (hello, daily shoulder stretches!). It’s safe to say that I personally am no longer a chiropractor skeptic. But until insurance companies and medicine in general shifts toward making preventative care a priority, the cost and time commitment is going to be out of reach for many.

BTW, these exercises can help improve posture and these yoga poses can help undo “text neck.”