April 16, 2026
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Scholars of the KRRC came together to create a novel index of chiropractic scope of practice regulations to examine the regulatory and health care environment of chiropractic practice and health care access. This is a comprehensive policy brief for chiropractors, particularly detailing the conditions of care and service throughout Pennsylvania.
Download and read the full version of the policy brief at the bottom of the page.
Abstract:
Pennsylvania ranks as the 3 most restrictive state nationally for chiropractic scope-of-practice, with a regulatory restrictiveness index score of 9 compared to a national average of 4.59. This level of restrictiveness, shaped by historical regulatory development rather than modernized scope-of-practice standards, means that chiropractors in Pennsylvania may perform only 1 of 12 evaluated diagnostic or therapeutic procedures without additional licensure or certification. Using a newly constructed national index and county-level workforce data, this brief examines how Pennsylvania’s regulatory framework compares to other states and how scope-of-practice constraints intersect with provider distribution and access to care. Although Pennsylvania maintains a moderate overall supply of chiropractors, substantial rural–urban disparities persist: many central and northern counties exhibit low chiropractor density, compounding existing healthcare workforce shortages and elevated demand for musculoskeletal care. These access challenges are further compounded by Pennsylvania’s limited in-state chiropractic education pipeline, increasing reliance on out-of-state recruitment in a competitive regional labor market. Taken together, the findings suggest that Pennsylvania’s restrictive and ambiguous scope-of-practice environment may constrain workforce mobility, discourage provider entry, and limit access to conservative, non-pharmacological care in underserved communities, with important implications for healthcare access and workforce policy in the Commonwealth.
Citation for use:
Drain, S., Denkyirah, E., Aziz, M., Paranavid, D., Carneal, T., Plemmons, A., & Armbrester, W. (2026). Chiropractic Scope-of-Practice and Provider Distribution in Pennsylvania. Knee Regulatory Research Center. https://knee.wvu.edu/publications/knee-center-research/2026/04/16/chiropractic-scope-of-practice-and-provider-distribution-in-pennsylvania