Acupuncture Alongside Physical Therapy and Chiropractic Care

Why this question comes up

People with back, neck or joint pain often see a physical therapist or chiropractor, and some also try acupuncture. Some of those professionals offer needling themselves, and others work alongside a licensed acupuncturist. This page covers two questions: does adding acupuncture to other care help, and who is allowed to do what. It is information only.

What research shows about combining care

The American College of Physicians low back pain guideline, based on a review of trials up to November 2016, suggests acupuncture as one nonpharmacologic option for acute or subacute back pain (low-quality evidence) and for chronic back pain (moderate-quality evidence), alongside exercise, massage and spinal manipulation. [1] That is a statement about each treatment on its own.

On adding one to another, the evidence is thin:

• Athletes with pain. A 2026 review of 8 studies found that needling techniques alone, or combined with exercise or physiotherapy, may reduce pain. The combined approach showed a nonsignificant pain drop in before-and-after comparisons but a significant one in between-group comparisons. The authors called the evidence preliminary. [2] We rate it promising but limited.


• Chiropractic plus acupuncture. We searched PubMed for trials and reviews combining acupuncture with spinal manipulation and did not find a review we could read that tested whether the combination beats either alone. Proper evidence not found.


• Physical therapy plus acupuncture for other conditions. The condition pages report the evidence for each condition, for example knee osteoarthritis.

Many of these studies cannot hide who got which treatment, so expectations can shape results. Treat a combined plan as a reasonable thing to discuss, not as proven to work better.

Chiropractors and acupuncture

Some state chiropractic boards allow acupuncture after extra training.

• Alabama. A chiropractor may not practice acupuncture unless they have at least 100 hours of study and pass an approved exam or the National Board of Chiropractic Examiners acupuncture exam. [7]
• North Dakota. A chiropractor may practice needle acupuncture only if certified by the board, with at least 100 hours of training sponsored by an accredited college of chiropractic. [8]

These hours are far shorter than the training for a licensed acupuncturist in many states. For licensed acupuncturist training, see Acupuncture Practitioner Licensing and Training by Jurisdiction. We did not read the rules of other states or of Canada, so we do not describe them.

United Kingdom

The NHS says chiropractors and osteopaths must be registered by law, while other complementary therapists do not need to be. It suggests choosing a therapist registered with a professional organization accredited by the Professional Standards Authority. [9] We could not read the chartered physiotherapy bodies' acupuncture pages, so we do not describe physiotherapist training.

How to check and what to ask

We do not list practitioners. Ask: what is your license or certification, who regulates it, how many hours of needling training do you have, are needles sterile and single use, and how will you coordinate with my other providers? See Questions to Ask an Acupuncturist Before Starting and Choosing a Qualified Practitioner.