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Chiropractors primarily use manipulation ("adjustment") of the spine as a treatment. Such treatments trace back to ancient China, Greece and Egypt. It gained popularity in the late 19th century, with the development of osteopathic and chiropractic medicine in North America.

Spinal manipulation (SMT) became more popular in the 1980s. It includes manipulation and massage to "adjust" the spine and related tissues, and is a primary basis of chiropractic. Systematic reviews have not found evidence that chiropractic manipulation is effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including death, are rare. Chiropractors may use exercise and other treatments and advice.

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