How big is the market for chiropractic care? According to federal health data, the market for musculoskeletal pain treatment in the U.S. is larger than the entire U.S. market for cancer, heart disease, or diabetes care.
By Dr. Michael Carberry, DC — President, Advanced Medical Integration
Before I became a chiropractor, I had a marketing degree. My first job out of college was selling advertising for a Dun & Bradstreet affiliate. So when I say I know something about markets, I don’t mean social media marketing — I mean understanding the actual size and shape of the market you’re standing in.
Here’s the excuse I hear constantly from doctors: “My patients wouldn’t do that.” “My patients wouldn’t spend that much.” “My patients wouldn’t stick to a care plan.”
Most of the time, they’re right. But that’s not because their patients are cheap or uncommitted. It’s because they’re marketing to the wrong 9% of the population, and leaving the other 91% — including a market worth roughly $722 billion a year — completely untouched.
Numbers Are Big. They’re Also Not All the Same.
It’s easy to hear a number in the billions or trillions and treat them as roughly interchangeable. They aren’t. If you started counting to a million right now, one number per second, you’d finish in about 11 days. Counting to a billion would take you nearly 32 years. Counting to a trillion would take you almost 32,000 years. Keep that scale in mind, because we’re about to talk in trillions.
In 1997, the U.S. filled about 2.5 billion prescriptions. By 2016, that had nearly doubled to 4.4 billion. Today it’s roughly 7 billion. Prescriptions — pharmaceutical management of symptoms — are the dominant treatment model in American healthcare, and have been for decades.
What We’re Buying, and What We’re Getting
The world spends about $9 trillion a year on healthcare. The U.S. accounts for roughly $5.2 trillion of that — even though we’re only 4.2% of the world’s population. We consume more than half the planet’s healthcare spending.
For that money, the outcomes aren’t there. A 2022 health-systems comparison report, “U.S. Health Care from a Global Perspective,” drawing on OECD data, found that the U.S. spends more per person and as a share of GDP than any other high-income country, while posting the lowest life expectancy at birth, the highest death rates from avoidable and treatable conditions, and the worst maternal and infant mortality among its peers. There are countries with far fewer resources where a baby has a better chance of surviving its first year than in the United States.
Medical debt is also widely cited as one of the leading drivers of personal bankruptcy in the U.S. A national study published in the American Journal of Medicine found medical issues were a factor in a majority of personal bankruptcies filed in 2007 — even among families who had insurance (Himmelstein et al., 2009), though the methodology behind that estimate has been debated by other health economists since. Either way, insurance isn’t preventing financial catastrophe so much as steering patients toward a narrow set of treatments.
The human toll shows up elsewhere too. Robert F. Kennedy Jr., now Secretary of Health and Human Services, has pointed out that America’s chronic disease rate has climbed from about 2% in 1961 to over 60% today. Separately, roughly 77% of Americans aged 17–24 are currently ineligible for military service without a medical waiver. Suicide rates have climbed sharply over the past two decades, and the fastest-growing segment in recent years has been kids age 12 to 17 — the same age group the pharmaceutical industry has aggressively marketed antidepressants to.
Expensive and ineffective is a hard combination to defend. It’s also a market opportunity for anyone offering something that actually works.
The Market Hiding in Plain Sight
Ask a chiropractor if they treat arthritis and most will say yes. Fair enough — let’s look at what that market is actually worth.
CDC-funded research puts the direct medical cost of arthritis — office visits, medications, biologics, joint replacement surgery — at roughly $140 billion a year, with total costs (including lost earnings) climbing past $300 billion annually (Murphy et al., 2018). That puts arthritis in the same range as diabetes ($327 billion), cancer ($250 billion), Alzheimer’s ($360 billion), and cardiovascular disease ($400 billion).
Now add spinal pain. A landmark JAMA analysis of U.S. health spending by condition identified low back and neck pain as the single largest driver of healthcare spending of any category tracked — ahead of diabetes and heart disease (Dieleman et al., 2016) — a figure that overlaps with, but isn’t fully captured by, the arthritis numbers above. Combine the two categories and you’re looking at something in the neighborhood of $600 billion.
The Institute for Health Metrics and Evaluation at the University of Washington takes a broader view: they estimate 60–70% of all money spent treating pain in the U.S. goes toward musculoskeletal pain — low back and neck first, then knee, hip, and shoulder. Their number: $722 billion, split roughly between $530.6 billion in direct medical spending and $192 billion in lost work and productivity.
That means the market most chiropractors already treat is larger than the cancer market, the heart disease market, or the diabetes market. Run the math on a mid-sized town — take a conservative $1,500 per person spent annually on pain and arthritis care, and apply it to a city like Chattanooga, Tennessee (population 140,000, where I opened my own practice): that’s $210 million being spent in one town on exactly what we treat.
So why aren’t we capturing more of it?
You’re Not Competing With the Chiropractor Down the Street
Roughly 9% of Americans see a chiropractor. That 9% tends to be price-sensitive and already sold on the idea — they’re comparison shopping against other chiropractors, which keeps fees low and care plans short.
But there’s another group — people facing surgery or long-term opioid use who don’t want either option and don’t know what else to do. They’re not in your funnel because they’re not searching for “chiropractor.” They’re searching for a way out of surgery. And when you reach them, they’re not comparing your price to the practice down the street — they’re comparing it to the cost of an operation. A $10,000 care plan, which isn’t unusual in an integrated practice model, doesn’t even cover what an anesthesiologist charges to put someone under for surgery.
This is also where outcomes matter most. Every dollar spent in an integrated clinic that combines chiropractic and physical medicine — focused on restoring function rather than managing symptoms — saves the broader medical system thousands of dollars downstream. That’s the real difference between the two models: traditional medicine is built to manage symptoms (97% of every drug ever developed targets a symptom, not a cause), while functional, integrative care is built to correct what’s actually failing.
Surgery often illustrates the gap. One orthopedic surgeon told me that roughly 75% of back surgeries have to be repeated within two years — because surgery addresses the pressure on a nerve, not the functional breakdown that caused the disc to fail in the first place. Multiple clinical trials, including well-known knee surgery studies, have compared real procedures to sham surgery (real anesthesia, real incisions, no actual repair). In one, 74% of patients who received the fake surgery reported improvement — and in half of those cases, the improvement matched or beat the patients who had the real procedure. Similar findings have come out of studies in Europe. When fake surgery performs on par with real surgery, it’s worth asking what a purely mechanical, symptom-focused model is actually accomplishing.
Least Invasive to Most Invasive — In That Order
The principle chiropractic was built on is simple: start with the least invasive option and escalate only if you have to. Try physical medicine, chiropractic care, rehab, and exercise first. Not opioids first. Not surgery first, with more opioids added during recovery.
That’s the model we built Advanced Medical Integration around — disrupting a healthcare industry organized backwards, and uniting medical professionals who want to correct the underlying cause of a patient’s condition instead of managing it indefinitely. Done well, it’s also a better business: patients who get their lives back refer other patients, because most of them have never experienced a provider actually correcting their problem instead of managing it.
The market is already there — bigger than cancer, bigger than heart disease, bigger than diabetes — and it’s underserved by a healthcare system that has proven, repeatedly and expensively, that it isn’t built to solve it. America needs a better option now more than ever.
Frequently Asked Questions
How big is the market for chiropractic and pain-related care in the U.S.?
Estimates vary depending on what’s counted, but health economists have placed the U.S. market for musculoskeletal pain care — low back, neck, knee, hip, and shoulder pain combined — between $500 billion and $722 billion a year, larger than the U.S. markets for cancer, heart disease, or diabetes treatment.
Why don’t more people see a chiropractor for arthritis or chronic pain?
Only around 9–10% of the U.S. population currently sees a chiropractor, and that group tends to already be sold on the idea and price-sensitive. A much larger group — people actively trying to avoid surgery or long-term opioid use — isn’t in that funnel, because they’re not searching for “chiropractor.” They’re searching for an alternative to surgery.
Is chiropractic care actually cheaper than surgery?
A full chiropractic and physical medicine care plan, even one priced around $10,000, typically costs less than the anesthesia alone for a single surgical procedure. For patients trying to avoid surgery, the relevant comparison isn’t a competitor’s rate down the street — it’s the cost of the operation itself.
Does spending more on healthcare lead to better outcomes in the U.S.?
Not according to international comparisons. The U.S. spends more per person on healthcare than any other high-income country while recording the lowest life expectancy, the highest rates of avoidable and treatable death, and the worst maternal and infant mortality among its peers.
What do “sham surgery” studies show?
In several clinical trials, patients who received a fake surgical procedure — real anesthesia and incisions, no actual repair — reported improvement rates comparable to, and sometimes better than, patients who had the real surgery. It’s one of the more debated findings in orthopedic research, and it raises real questions about how much of some surgical outcomes come from the procedure itself versus other factors.
Want to talk about what this looks like in your practice? Reach out to Advanced Medical Integration at www.amidoctors.com or discover@amidoctors.com, or find us on YouTube at Advanced Medical Integration.
Sources
- Himmelstein DU, Thorne D, Warren E, Woolhandler S. “Medical Bankruptcy in the United States, 2007: Results of a National Study.” American Journal of Medicine, 2009. org/10.1016/j.amjmed.2009.04.012
- Murphy LB, et al. “Medical Expenditures and Earnings Losses Among US Adults With Arthritis in 2013.” Arthritis Care & Research, 2018. org/10.1002/acr.23425
- Dieleman JL, et al. “US Spending on Personal Health Care and Public Health, 1996–2013.” JAMA, 2016. org/10.1001/jama.2016.16885
- Institute for Health Metrics and Evaluation, University of Washington — musculoskeletal pain spending estimates (source link to be confirmed before publishing)
- “U.S. Health Care from a Global Perspective, 2022” — health-systems comparison report using OECD data (publisher link to be confirmed before publishing)
- CDC prescription volume trends, 1997–2026 (source link to be confirmed before publishing)
About the Author
Dr. Michael Carberry, DC, is President and founder of Advanced Medical Integration (AMI), which has grown to more than 1,000 independent practices across the U.S. and has been named to the Inc. 5000 for five consecutive years. Dr. Carberry holds a B.S. in Marketing from Stockton University and a Doctor of Chiropractic from Life University, and is the author of The Death of American Healthcare. He speaks nationally on healthcare, business, economics, and the opioid crisis, and serves as a trustee for Delphi Schools Inc.