What Is the Secret to Pain-Free Living in St. Petersburg? Discover Chiropractor Solutions Today!

In science-based medicine, the term "subluxation" refers to an incomplete or partial dislocation of a joint, from the Latin luxare for 'dislocate'.^[41][42] While medical doctors use the term exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word subluxation with a metaphysical and philosophical meaning drawn from pseudoscientific traditions such as Vitalism.^[43]

Palmer claimed that vertebral subluxations interfered with the body's function and its inborn ability to heal itself.^[44] D. D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ.^[43] He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.^[43] This concept was later expanded upon by his son, B. J. Palmer, and was instrumental in providing the legal basis of differentiating chiropractic from conventional medicine.

Vertebral subluxation, a core concept of traditional chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.^[45] In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.^[45] This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions.^[46][47]

In 2005, the chiropractic subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact.^[48] It is essentially a functional entity, which may influence biomechanical and neural integrity."^[48] This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays.^[48] The use of X-ray imaging in the case of vertebral subluxation exposes patients to harmful ionizing radiation for no evidentially supported reason.^[49][50] The 2008 book Trick or Treatment states "X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist."^[51] Attorney David Chapman-Smith, Secretary-General of the World Federation of Chiropractic, has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on X-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static X-ray than a limp or headache or any other functional problem."^[52] The General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, states that the chiropractic vertebral subluxation complex "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease."^[53]

As of 2014, the US National Board of Chiropractic Examiners states "The specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction. A subluxation is a health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness."^[54][26]

By 1914,^[55] chiropractors had begun to divide into two groups: "Straights", adherents of the Palmers' supernatural vitalist beliefs, and "Mixers" who sought to integrate Chiropractic into science-based mainstream medicine.^[56]: 172

Range of belief perspectives in chiropractic

Perspective attribute	Potential belief endpoints
Scope of practice:	narrow ("straight") ←	→ broad ("mixer")
Philosophic orientation:	vitalistic ←	→ materialistic
Falsifiability:	untestable Cannot be proven or disproven	testable Lends itself to scientific inquiry
Taken from Mootz & Phillips 1997[34]

Originally, Straight chiropractors adhered to pseudoscientific Vitalist ideas set forth by D. D. and B. J. Palmer, and even modern "straights" often retain metaphysical definitions and vitalistic qualities.^[57] Straight chiropractors believed that vertebral subluxation leads to interference with an "innate intelligence" exerted via the human nervous system and is a primary underlying risk factor for many diseases.^[57] Straights view the medical diagnosis of patient complaints, which they consider to be the "secondary effects" of subluxations, to be unnecessary for chiropractic treatment.^[57] Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies into their practice style.^[57] Their philosophy and explanations were metaphysical in nature and they prefered to use traditional chiropractic lexicon terminology such as "perform spinal analysis", "detect subluxation", "correct with adjustment".^[20] They prefered to remain separate and distinct from mainstream health care.^[20] Modernly, "Straights" are a minority among Chiropractors, though "they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers."^[20]

Mixers, who make up the majority of chiropractors, "mix" chiropractic with diagnostic and treatment approaches from mainstream medical and osteopathic practices.^[20] Unlike straight chiropractors, mixers believe subluxation is just one of many causes of disease, and mixers are open to mainstream medicine.^[20] Many mixers incorporate mainstream medical diagnostics and employ conventional medical treatments including techniques of physical therapy such as exercise, stretching, massage, ice packs, electrical muscle stimulation, therapeutic ultrasound, and moist heat.^[20] But some mixers also use techniques from pseudoscientific alternative medicine, including unnecessary nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback.^[20] Author Holly Folk writes that "Few Mixer chiropractors use the term anymore. Today, one is more likely to hear this side described as 'holistic,' 'wellness-oriented,' or 'integrative' practitioners."^[56]: 114 Folk argues that "osteopathy underwent a 'Straight-Mixer' debate between traditional vitalists and a faction that embraced the new medical science".^: 172

Although mixers are the majority group, many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1,100 North American chiropractors, which found that 88 percent wanted to retain the term "vertebral subluxation complex", and that when asked to estimate the percent of disorders of internal organs that subluxation significantly contributes to, the mean response was 62 percent.^[58] A 2008 survey of 6,000 American chiropractors demonstrated that most chiropractors seem to believe that a subluxation-based clinical approach may be of limited utility for addressing visceral disorders, and greatly favored non-subluxation-based clinical approaches for such conditions.^[59] The same survey showed that most chiropractors generally believed that the majority of their clinical approach for addressing musculoskeletal/biomechanical disorders such as back pain was based on subluxation.^[59] Chiropractors often offer conventional therapies such as physical therapy and lifestyle counseling, and it may for the lay person be difficult to distinguish the unscientific from the scientific.^[60]

While some chiropractors limit their practice to short-term treatment of musculoskeletal conditions, many falsely claim to be able treat a myriad of other conditions.^[61][62] Some dissuade patients from seeking medical care, others have pretended to be qualified to act as a family doctor.^[61]

Quackwatch, an alternative medicine watchdog, cautions against seeing chiropractors who:^[61][63]

• Treat young children
• Discourage immunization
• Pretend to be a family doctor
• Take full spine X-rays
• Promote unproven dietary supplements
• Are antagonistic to scientific medicine
• Claim to treat non-musculoskeletal problems

Writing for the Skeptical Inquirer, one physician cautioned against seeing even chiropractors who solely claim to treat musculoskeletal conditions:

I think Spinal Manipulation Therapy (SMT) is a reasonable option for patients to try ... But I could not in good conscience refer a patient to a chiropractor... When chiropractic is effective, what is effective is not 'chiropractic': it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers ... If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider.^[61]

Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,^[48] with special emphasis on the spine.^[2] Back and neck pain are the specialties of chiropractic but many chiropractors treat ailments other than musculoskeletal issues.^[7] There is a range of opinions among chiropractors: some believed that treatment should be confined to the spine, or back and neck pain; others disagreed.^[64] For example, while one 2009 survey of American chiropractors had found that 73% classified themselves as "back pain/musculoskeletal specialists", the label "back and neck pain specialists" was regarded by 47% of them as a least desirable description in a 2005 international survey.^[64] Chiropractic combines aspects from mainstream and alternative medicine, and there is no agreement about how to define the profession: although chiropractors have many attributes of primary care providers, chiropractic has more attributes of a medical specialty like dentistry or podiatry.^[65] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems,^[35][65] but the more expansive view of chiropractic is still widespread.^[66]

Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);^[1] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.^[67] Many chiropractors believe they are primary care providers,^[7][8] including US^[68] and UK chiropractors,^[69] but the length, breadth, and depth of chiropractic clinical training do not support the requirements to be considered primary care providers,^[2] so their role on primary care is limited and disputed.^[2][8]

Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.^[18][70] Chiropractic is autonomous from and competitive with mainstream medicine,^[71] and osteopathy outside the US remains primarily a manual medical system;^[72] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.^[71] Practitioners may distinguish these competing approaches through claims that, compared to other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.^[18]

Chiropractic diagnosis may involve a range of methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation.^[48] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.^[65] Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle advice.^[4]

Chiropractors are not normally licensed to write medical prescriptions or perform major surgery in the United States^[73] (although New Mexico has become the first US state to allow "advanced practice" trained chiropractors to prescribe certain medications^[74][75]). In the US, their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa, broadly allow treatment of "human ailments"; some, such as Delaware, use vague concepts such as "transition of nerve energy" to define scope of practice; others, such as New Jersey, specify a severely narrowed scope.^[76] US states also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements, or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth.^[73] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.^[58] A 2010 survey found that 72% of Swiss chiropractors considered their ability to prescribe nonprescription medication as an advantage for chiropractic treatment.^[77]

A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in many US states,^[78] but is not recognized by the American Chiropractic Association as being chiropractic.^[79] It remains controversial within certain segments of the veterinary and chiropractic professions.^[80]

No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors.^[81] A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.^[81] Two US states (Washington and Arkansas) prohibit physical therapists from performing SM,^[82] some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.^[83]

Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care.^[84] Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint.^[85] Its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion.^[85] High-velocity, low-amplitude spinal manipulation (HVLA-SM) thrusts have physiological effects that signal neural discharge from paraspinal muscle tissues, depending on duration and amplitude of the thrust are factors of the degree in paraspinal muscle spindles activation.^[86] Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and magnitude of the load.^[86] More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.^[85]

There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools. The following adjustive procedures were received by more than 10% of patients of licensed US chiropractors in a 2003 survey:^[84] Diversified technique (full-spine manipulation, employing various techniques), extremity adjusting, Activator technique (which uses a spring-loaded tool to deliver precise adjustments to the spine), Thompson Technique (which relies on a drop table and detailed procedural protocols), Gonstead (which emphasizes evaluating the spine along with specific adjustment that avoids rotational vectors), Cox/flexion-distraction (a gentle, low-force adjusting procedure which mixes chiropractic with osteopathic principles and utilizes specialized adjusting tables with movable parts), adjustive instrument, Sacro-Occipital Technique (which models the spine as a torsion bar), Nimmo Receptor-Tonus Technique, applied kinesiology (which emphasises "muscle testing" as a diagnostic tool), and cranial.^[87] Chiropractic biophysics technique uses inverse functions of rotations during spinal manipulation.^[88] Koren Specific Technique (KST) may use their hands, or they may use an electric device known as an "ArthroStim" for assessment and spinal manipulations.^[89] Insurers in the US and UK that cover other chiropractic techniques exclude KST from coverage because they consider it to be "experimental and investigational".^{[89][90][91][92]} Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain.^[93]

Many other procedures are used by chiropractors for treating the spine, other joints and tissues, and general health issues. The following procedures were received by more than one-third of patients of licensed US chiropractors in a 2003 survey: Diversified technique (full-spine manipulation; mentioned in previous paragraph), physical fitness/exercise promotion, corrective or therapeutic exercise, ergonomic/postural advice, self-care strategies, activities of daily living, changing risky/unhealthy behaviors, nutritional/dietary recommendations, relaxation/stress reduction recommendations, ice pack/cryotherapy, extremity adjusting (also mentioned in previous paragraph), trigger point therapy, and disease prevention/early screening advice.^[84]

A 2010 study describing Belgian chiropractors and their patients found chiropractors in Belgium mostly focus on neuromusculoskeletal complaints in adult patients, with emphasis on the spine.^[94] The diversified technique is the most often applied technique at 93%, followed by the Activator mechanical-assisted technique at 41%.^[94] A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a United States chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods.^[95]

Reviews of research studies within the chiropractic community have been used to generate practice guidelines outlining standards that specify which chiropractic treatments are legitimate (i.e. supported by evidence) and conceivably reimbursable under managed care health payment systems.^[81] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and makes unsubstantiated claims.^{[2][26][45][96][97]} Chiropractic remains at a crossroads, and that in order to progress it would need to embrace science; the promotion by some for it to be a cure-all was both "misguided and irrational".^[98] A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.^[99] Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries.^[100]

Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with varied results.^[7] There is no conclusive evidence that chiropractic manipulative treatment is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.^[7][9]

Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.^[101][102] Research published by chiropractors is distinctly biased: reviews of SM for back pain tended to find positive conclusions when authored by chiropractors, while reviews by mainstream authors did not.^[7]

There is a wide range of ways to measure treatment outcomes.^[103] Chiropractic care benefits from the placebo response,^[104] but it is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT).^[105] The efficacy of maintenance care in chiropractic is unknown.^[106]

Available evidence covers the following conditions:

• Low back pain. A 2013 Cochrane review found very low to moderate evidence that SMT was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain.^[107] The same review found that SMT appears to be no better than other recommended therapies.^[107] A 2012 overview of systematic reviews found that collectively, SM failed to show it is an effective intervention for pain.^[108] A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between SMT and other treatments for reducing pain and improving function for chronic low back pain.^[109] A 2010 Cochrane review found no difference between the effects of combined chiropractic treatments and other treatments for chronic or mixed duration low back pain.^[110] A 2010 systematic review found that most studies suggest SMT achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.^[111]
• Radiculopathy. A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following SM, when compared to usual care, and suggested that SM may be considered.^[112] There is moderate quality evidence to support the use of SM for the treatment of acute lumbar radiculopathy^[113] and acute lumbar disc herniation with associated radiculopathy.^[114] There is low or very low evidence supporting SM for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration and no evidence exists for the treatment of thoracic radiculopathy.^[113]
• Whiplash and other neck pain. There is no consensus on the effectiveness of manual therapies for neck pain.^[115] A 2013 systematic review found that the data suggests that there are minimal short- and long-term treatment differences when comparing manipulation or mobilization of the cervical spine to physical therapy or exercise for neck pain improvement.^[116] A 2013 systematic review found that although there is insufficient evidence that thoracic SM is more effective than other treatments, it is a suitable intervention to treat some patients with non-specific neck pain.^[117] A 2011 systematic review found that thoracic SM may offer short-term improvement for the treatment of acute or subacute mechanical neck pain; although the body of literature is still weak.^[118] A 2010 Cochrane review found low quality evidence that suggests cervical manipulation may offer better short-term pain relief than a control for neck pain, and moderate evidence that cervical manipulation and mobilization produced similar effects on pain, function and patient satisfaction.^[119] A 2010 systematic review found low level evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash.^[120]
• Headache. There is conflicting evidence surrounding the use of chiropractic SMT for the treatment and prevention of migraine headaches.^[121][122] A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache.^[123] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.^[124]
• Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief than a supervised exercise program alone and suggested that manual therapists consider adding manual mobilization to optimize supervised active exercise programs.^[125] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.^[126] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,^[127] limited to low level evidence supporting chiropractic management of shoulder pain^[128] and limited or fair evidence supporting chiropractic management of leg conditions.^[129]
• Other. A 2012 systematic review found insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension.^[130] A 2011 systematic review found moderate evidence to support the use of manual therapy for cervicogenic dizziness.^[131] There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine)^[132] and no scientific data for idiopathic adolescent scoliosis.^[133] A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions.^[134] Other reviews have found no evidence of significant benefit for asthma,^[135][136] baby colic,^[137][138] bedwetting,^[139] carpal tunnel syndrome,^[140] fibromyalgia,^[141] gastrointestinal disorders,^[142] kinetic imbalance due to suboccipital strain (KISS) in infants,^[137][143] menstrual cramps,^[144] insomnia,^[145] postmenopausal symptoms,^[145] or pelvic and back pain during pregnancy.^[146] As there is no evidence of effectiveness or safety for cervical manipulation for baby colic, it is not endorsed.^[147]

The World Health Organization found chiropractic care in general is safe when employed skillfully and appropriately.^[48] There is not sufficient data to establish the safety of chiropractic manipulations.^[12] Manipulation is regarded as relatively safe but complications can arise, and it has known adverse effects, risks and contraindications.^[48] Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints.^[48] Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.^[48] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.^[148] Indirect risks of chiropractic involve delayed or missed diagnoses through consulting a chiropractor.^[7]

Spinal manipulation is associated with frequent, mild and temporary adverse effects,^[13][148] including new or worsening pain or stiffness in the affected region.^[149] They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours;^[12] adverse reactions appear to be more common following manipulation than mobilization.^[150] The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue.^[151] Chiropractic is correlated with a very high incidence of minor adverse effects.^[7] Rarely,^[48] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults^[13] and children.^[152] Estimates vary widely for the incidence of these complications,^[12] and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern.^[13] Adverse effects are poorly reported in recent studies investigating chiropractic manipulations.^[153] A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable.^[154] Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region.^[155] Estimates for serious adverse events vary from 5 strokes per 100,000 manipulations to 1.46 serious adverse events per 10 million manipulations and 2.68 deaths per 10 million manipulations, though it was determined that there was inadequate data to be conclusive.^[12] Several case reports show temporal associations between interventions and potentially serious complications.^[156] The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.^[16]

Vertebrobasilar artery stroke (VAS) is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.^[156][157] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (CMT) and VAS.^[158] There is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.^[14] While the biomechanical evidence is not sufficient to support the statement that CMT causes cervical artery dissection (CD), clinical reports suggest that mechanical forces have a part in a substantial number of CDs and the majority of population controlled studies found an association between CMT and VAS in young people.^[159] It is strongly recommended that practitioners consider the plausibility of CD as a symptom, and people can be informed of the association between CD and CMT before administering manipulation of the cervical spine.^[159] There is controversy regarding the degree of risk of stroke from cervical manipulation.^[14] Many chiropractors state that, the association between chiropractic therapy and vertebral arterial dissection is not proven.^[16] However, it has been suggested that the causality between chiropractic cervical manipulation beyond the normal range of motion and vascular accidents is probable^[16] or definite.^[15] There is very low evidence supporting a small association between internal carotid artery dissection and chiropractic neck manipulation.^[160] The incidence of internal carotid artery dissection following cervical spine manipulation is unknown.^[161] The literature infrequently reports helpful data to better understand the association between cervical manipulative therapy, cervical artery dissection and stroke.^[162] The limited evidence is inconclusive that chiropractic spinal manipulation therapy is not a cause of intracranial hypotension.^[163] Cervical intradural disc herniation is very rare following spinal manipulation therapy.^[164]

Chiropractors sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation.^[165] Although there is no clear evidence to justify the practice, some chiropractors still X-ray a patient several times a year.^[51] Practice guidelines aim to reduce unnecessary radiation exposure,^[165] which increases cancer risk in proportion to the amount of radiation received.^[166] Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based.^[50] Although, there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain.^[50]

A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.^[14] A 2010 systematic review stated that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggested a precautionary principle in healthcare for chiropractic intervention even if a causality with vertebral artery dissection after neck manipulation were merely a remote possibility.^[16] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.^[16] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.^[167] Edzard Ernst stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors across the world."^[167] A 1999 review of 177 previously reported cases published between 1925 and 1997 in which injuries were attributed to manipulation of the cervical spine (MCS) concluded that "The literature does not demonstrate that the benefits of MCS outweigh the risks." The professions associated with each injury were assessed. Physical therapists (PT) were involved in less than 2% of all cases, with no deaths caused by PTs. Chiropractors were involved in a little more than 60% of all cases, including 32 deaths.^[168]

A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is associated with considerable harm and no compelling evidence exists to indicate that it adequately prevents symptoms or diseases, thus the risk-benefit is not evidently favorable.^[11]

A 2012 systematic review suggested that the use of spine manipulation in clinical practice is a cost-effective treatment when used alone or in combination with other treatment approaches.^[169] A 2011 systematic review found evidence supporting the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain; the results for acute low back pain were insufficient.^[10]

A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of spinal manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without placebo controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.^[170] A 2005 American systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.^[171] The cost-effectiveness of maintenance chiropractic care is unknown.^{[106][non-primary source needed]}

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) which looked the chiropractic services utilization found that the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient costs associate with the following use of services by 60% for in-hospital admissions, 59% for hospital days, 62% for outpatient surgeries and procedures, and 85% for pharmaceutical costs when compared with conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame.^[172]

Requirements vary between countries. In the U.S. chiropractors obtain a non-medical accredited diploma in the field of chiropractic.^[173] Chiropractic education in the U.S. has been criticized for failing to meet generally accepted standards of evidence-based medicine.^[174] The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has little similarity, both in the kinds of subjects offered and in the time assigned to each subject.^[175] Accredited chiropractic programs in the U.S. require that applicants have 90 semester hours of undergraduate education with a grade point average of at least 3.0 on a 4.0 scale. Many programs require at least three years of undergraduate education, and more are requiring a bachelor's degree.^[176] Canada requires a minimum three years of undergraduate education for applicants, and at least 4200 instructional hours (or the equivalent) of full-time chiropractic education for matriculation through an accredited chiropractic program.^[177] Graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education.^[178][179] The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.^[48]

Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.^[180][181] Depending on the location, continuing education may be required to renew these licenses.^[182][183] Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics.^[184]

In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK.^[185][186] The U.S. CCE requires a mixing curriculum, which means a straight-educated chiropractor may not be eligible for licensing in states requiring CCE accreditation.^[76] CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally.^[187] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,^[188] 2 in Canada,^[189] 6 in Australasia,^[190] and 5 in Europe.^[191] All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges.^[24] Of the two chiropractic colleges in Canada, one is publicly funded (UQTR) and one is privately funded (CMCC). In 2005, CMCC was granted the privilege of offering a professional health care degree under the Post-secondary Education Choice and Excellence Act, which sets the program within the hierarchy of education in Canada as comparable to that of other primary contact health care professions such as medicine, dentistry and optometry.^[178][179]

Regulatory colleges and chiropractic boards in the U.S., Canada, Mexico, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.^[192][193] There are an estimated 49,000 chiropractors in the U.S. (2008),^[194] 6,500 in Canada (2010),^[195] 2,500 in Australia (2000),^[28] and 1,500 in the UK (2000).^[196]

Chiropractors often argue that this education is as good as or better than medical physicians', but most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing.^[76] The fourth year of chiropractic education persistently showed the highest stress levels.^[197] Every student, irrespective of year, experienced different ranges of stress when studying.^[197] The chiropractic leaders and colleges have had internal struggles.^[198] Rather than cooperation, there has been infighting between different factions.^[198] A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.^{[198][clarification needed]}

In 2024, Oregon Public Broadcasting reported on the high debt burden of students who pursued degrees in alternative medicine. Ten different chiropractic programs were ranked among the 47 US graduate programs with highest debt to earnings ratios.^[199][200] Analyses by Quackwatch and the Sunlight Foundation found high rates of default on Health Education Assistance Loan (HEAL) student loans used for chiropractic programs.^{[201][202][203]} Among health professionals who were listed as in default on HEAL loans in 2012, 53% were chiropractors.^[203]

The chiropractic oath is a modern variation of the classical Hippocratic Oath historically taken by physicians and other healthcare professionals swearing to practice their professions ethically.^[204] The American Chiropractic Association (ACA) has an ethical code "based upon the acknowledgement that the social contract dictates the profession's responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the chiropractic doctor's professional services shall be to benefit the patient."^[205] The International Chiropractor's Association (ICA) also has a set of professional canons.^[206]

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians.^[35] According to a 2015 Gallup poll of U.S. adults, the perception of chiropractors is generally favorable; two-thirds of American adults agree that chiropractors have their patient's best interest in mind and more than half also agree that most chiropractors are trustworthy. Less than 10% of US adults disagreed with the statement that chiropractors were trustworthy.^[207][208]

Chiropractors, especially in America, have a reputation for unnecessarily treating patients.^[51] In many circumstances the focus seems to be put on economics instead of health care.^[51] Sustained chiropractic care is promoted as a preventive tool, but unnecessary manipulation could possibly present a risk to patients.^[7] Some chiropractors are concerned by the routine unjustified claims chiropractors have made.^[7] A 2010 analysis of chiropractic websites found the majority of chiropractors and their associations made claims of effectiveness not supported by scientific evidence, while 28% of chiropractor websites advocate lower back pain care, which has some sound evidence.^[211]

The US Office of the Inspector General (OIG) estimated that for calendar year 2013, 82% of payments to chiropractors under Medicare Part B, a total of $359 million, did not comply with Medicare requirements.^[212] There have been at least 15 OIG reports about chiropractic billing irregularities since 1986.^[212]

In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,^[213][214] prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW" and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."^[213] An editorial in Nature suggested that the BCA may have been trying to suppress debate and that this use of English libel law was a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.^[215] The libel case ended with the BCA withdrawing its suit in 2010.^[216][217]

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.^[17] It is viewed as a marginal and non-clinically–proven attempt at complementary and alternative medicine, which has not integrated into mainstream medicine.^[64]

In Australia, there are approximately 2488 chiropractors, or one chiropractor for every 7980 people.^[218] Most private health insurance funds in Australia cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.^[219] In 2014, the chiropractic profession had a registered workforce of 4,684 practitioners in Australia represented by two major organizations – the Chiropractors' Association of Australia (CAA) and the Chiropractic and Osteopathic College of Australasia (COCA).^[220] Annual expenditure on chiropractic care (alone or combined with osteopathy) in Australia is estimated to be between AUD$750–988 million with musculoskeletal complaints such as back and neck pain making up the bulk of consultations; and proportional expenditure is similar to that found in other countries.^[220] While Medicare (the Australian publicly funded universal health care system) coverage of chiropractic services is limited to only those directed by a medical referral to assist chronic disease management, most private health insurers in Australia do provide partial reimbursement for a wider range of chiropractic services in addition to limited third party payments for workers compensation and motor vehicle accidents.^[220]

Of the 2,005 chiropractors who participated in a 2015 survey, 62.4% were male and the average age was 42.1 (SD = 12.1) years.^[220] Nearly all chiropractors (97.1%) had a bachelor's degree or higher, with the majority of chiropractor's highest professional qualification being a bachelor or double bachelor's degree (34.6%), followed by a master's degree (32.7%), Doctor of Chiropractic (28.9%) or PhD (0.9%).^[220] Only a small number of chiropractor's highest professional qualification was a diploma (2.1%) or advanced diploma (0.8%).^[220]

In Germany, chiropractic may be offered by medical doctors and alternative practitioners. Chiropractors qualified abroad must obtain a German non-medical practitioner license. Authorities have routinely required a comprehensive knowledge test for this, but in the recent past, some administrative courts have ruled that training abroad should be recognised.^[221]

In Switzerland, only trained medical professionals are allowed to offer chiropractic. There are 300 chiropractors in Switzerland.^[222]

In the United Kingdom, there are over 2,000 chiropractors, representing one chiropractor per 29,206 people.^[218] Chiropractic is available on the National Health Service in some areas, such as Cornwall, where the treatment is only available for neck or back pain.^[223]

A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed to patients the serious risk associated with manipulation of the cervical spine and that 46% believed there was possibility patients would refuse treatment if the risks were correctly explained. However 80% acknowledged the ethical/moral responsibility to disclose risk to patients.^[224]

The percentage of the population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada,^[225] with a global high of 20% in Alberta in 2006.^[226] In 2008, chiropractors were reported to be the most common CAM providers for children and adolescents, these patients representing up to 14% of all visits to chiropractors.^[227]

There were around 50,330 chiropractors practicing in North America in 2000.^[218] In 2008, this has increased by almost 20% to around 60,000 chiropractors.^[7] In 2002–03, the majority of those who sought chiropractic did so for relief from back and neck pain and other neuromusculoskeletal complaints;^[19] most do so specifically for low back pain.^[19][225] The majority of U.S. chiropractors participate in some form of managed care.^[8] Although the majority of U.S. chiropractors view themselves as specialists in neuromusculoskeletal conditions, many also consider chiropractic as a type of primary care.^[8] In the majority of cases, the care that chiropractors and physicians provide divides the market, however for some, their care is complementary.^[8]

In the U.S., chiropractors perform over 90% of all manipulative treatments.^[228] Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.^[229]

Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.^[1] The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate.^[230] As of 2007 7% of the U.S. population is being reached by chiropractic.^[231] They were the third largest medical profession in the US in 2002, following physicians and dentists.^[232] Employment of U.S. chiropractors was expected to increase 14% between 2006 and 2016, faster than the average for all occupations.^[194]

In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services.^[227]

Chiropractic's origins lie in the folk medicine practice of bonesetting, in which untrained practitioners engaged in joint manipulation or resetting fractured bones.^[7] Chiropractic was founded in 1895 by Daniel David (D. D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease.^[233] The first chiropractic patient of D. D. Palmer was Harvey Lillard, a worker in the building where Palmer's office was located.^[57] He claimed that he had severely reduced hearing for 17 years, which started shortly following a "pop" in his spine.^[57] A few days following his adjustment, Lillard claimed his hearing was almost completely restored.^[57] Another of Palmer's patients, Samuel Weed, coined the term chiropractic, from Greek χειρο- chiro- 'hand' (itself from χείρ cheir 'hand') and πρακτικός praktikos 'practical'.^[234][235] Chiropractic is classified as a field of pseudomedicine.^[236]

Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health.^[233] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic.^[21] One student, his son Bartlett Joshua (B. J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment.^[21]

Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence, a vitalistic nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions.^[21] D. D. Palmer said he "received chiropractic from the other world".^[22] D. D. and B. J. both seriously considered declaring chiropractic a religion, which might have provided legal protection under the U.S. constitution, but decided against it partly to avoid confusion with Christian Science.^[21][22] Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, among which they included the American Medical Association (AMA).^[21]

Chiropractic has seen considerable controversy and criticism.^[24][25] Although D. D. and B. J. were "straight" and disdained the use of instruments, some early chiropractors, whom B. J. scornfully called "mixers", advocated the use of instruments.^[21] In 1910, B. J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students.^[21] The mixer camp grew until by 1924 B. J. estimated that only 3,000 of the United States' 25,000 chiropractors remained straight.^[21] That year, B. J.'s invention and promotion of the neurocalometer, a temperature-sensing device, was highly controversial among B. J.'s fellow straights. By the 1930s, chiropractic was the largest alternative healing profession in the U.S.^[21]

Chiropractors faced heavy opposition from organized medicine.^[57] D. D. Palmer was jailed in 1907 for practicing medicine without a license.^{[237][full citation needed]} Thousands of chiropractors were prosecuted for practicing medicine without a license, and D. D. and many other chiropractors were jailed.^[57] To defend against medical statutes, B. J. argued that chiropractic was separate and distinct from medicine, asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease.^[57] B. J. cofounded the Universal Chiropractors' Association (UCA) to provide legal services to arrested chiropractors.^[57] Although the UCA won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974.^[57] The longstanding feud between chiropractors and medical doctors continued for decades.

The AMA labeled chiropractic an "unscientific cult" in 1966,^[29] and until 1980 advised its members that it was unethical for medical doctors to associate with "unscientific practitioners".^[238] This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.^[8]

Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine.^[57] By the mid-1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain.^[57]

In recent decades chiropractic gained legitimacy and greater acceptance by medical physicians and health plans, and enjoyed a strong political base and sustained demand for services.^[8] However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions.^[8] The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.^[8]

Some chiropractors oppose vaccination and water fluoridation, which are common public health practices.^[35] Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective public health interventions available.^[239] Most chiropractic writings on vaccination focus on its negative aspects,^[27] claiming that it is hazardous, ineffective, and unnecessary.^[28] Some chiropractors have embraced vaccination, but a significant portion of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing.^[28] The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain.^[27] The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease.^[28] The Canadian Chiropractic Association supports vaccination;^[27] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.^[240]

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.^[241] In addition to traditional chiropractic opposition to water fluoridation and vaccination, chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive lifelong chiropractic treatment.^[35]

Throughout its history chiropractic has been the subject of internal and external controversy and criticism.^[20][242] According to Daniel D. Palmer, the founder of chiropractic, subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race.^[7][243] A 2003 profession-wide survey^[58] found "most chiropractors (whether 'straights' or 'mixers') still hold views of innate intelligence and of the cause and cure of disease (not just back pain) consistent with those of the Palmers."^[244] A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today."^[7] Chiropractors, including D. D. Palmer, were jailed for practicing medicine without a license.^[7] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.^[57] Collectively, systematic reviews have not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, is effective for any medical condition, with the possible exception of treatment for back pain.^[7] Chiropractic remains controversial, though to a lesser extent than in past years.^[24]

• Chiropractic education
• Chiropractic schools
• Councils on Chiropractic Education International
• List of topics characterized as pseudoscience
• Toftness device
• World Federation of Chiropractic

• Long PH (2013). Barrett S (ed.). Chiropractic Abuse: An Insider's Lament. American Council on Science & Health. ISBN 978-0-9727094-9-1.
• Homola S (2002). "Chiropractic: Conventional or Alternative Healing?". In Shermer M (ed.). The Skeptic Encyclopedia of Pseudoscience. Vol. 1. ABC-CLIO. pp. 308–. ISBN 978-1-57607-653-8.
• Menke JM (January 2014). "Do Manual Therapies Help Low Back Pain?: A Comparative Effectiveness Meta-Analysis". Spine (Meta-analysis). 39 (7): E463–72. doi:10.1097/BRS.0000000000000230. PMID 24480940. S2CID 25497624.

• World Federation of Chiropractic - website

 

 

St. Petersburg
City
Downtown St. Petersburg Salvador Dali Museum Sunken Gardens St. Petersburg Pier Museum of Fine Arts Sunshine Skyway Bridge Vinoy Park
Flag Seal
Nickname(s):  "St. Pete"; "Florida's Sunshine City"
Motto:  "Always in Season"
Interactive map of St. Petersburg
St. Petersburg   Show map of Florida
Coordinates: 27°46′23″N 82°38′24″W / 27.77306°N 82.64000°W / 27.77306; -82.64000
Country	United States
State	Florida
County	Pinellas
Founded	1888
Incorporated (Town of St. Petersberg)	February 29, 1892
Reincorporated (City of St. Petersburg)	June 6, 1903
Named after	Saint Petersburg, Russia
Government
• Type	Strong Mayor-Commission
• Mayor	Ken Welch (D)
• City Council	Charles Copley Gerdes, Brandi Gabbard, Mike Harting, Lisset Hanewicz, Deborah Figgs-Sanders Gina Driscoll, Corey Givens Jr., and Richie Floyd
• City Administrator	Robert Gerdes
• City Clerk	Chandrahasa Srinivasa
• City Attorney	Jacqueline Kovilaritch
Area [1]
• City	135.49 sq mi (350.93 km2)
• Land	61.87 sq mi (160.24 km2)
• Water	73.63 sq mi (190.69 km2)
Elevation	44 ft (13.4 m)
Population  (2020)
• City	258,308
• Estimate  (2022)	261,256
• Rank	88th
• Density	4,175.08/sq mi (1,612.01/km2)
• Urban	2,441,770 (17th)
• Metro	2,870,569 (18th)
Time zone	UTC−05:00 (Eastern (EST))
• Summer (DST)	UTC−04:00 (EDT)
ZIP Codes	33701-33716, 33729-33734, 33736, 33738, 33740-33743, 33747, 33784
Area code	727
FIPS code	12-63000[2]
GNIS feature ID	290375[3]
Website	www.stpete.org

St. Petersburg is a city in Pinellas County, Florida, United States. As of the 2020 census, the population was 258,308, making it the fifth-most populous city in Florida and the most populous city in the state that is not a county seat (the city of Clearwater is the seat of Pinellas County).^[4] It is the second-most populous city in the Tampa Bay area, which is the second-largest metropolitan area in Florida with an estimated population of about 3.29 million in 2022.^[5]

St. Petersburg is located on the Pinellas peninsula between Tampa Bay and the Gulf of Mexico, and is connected to mainland Florida to the north. Locals often refer to the city as "St. Pete". Neighboring St. Pete Beach formally shortened its name in 1994 after a vote by its residents. St. Petersburg is governed by a mayor and city council.^[6]

With an average of 361 days of sunshine annually, and a Guinness World Record for the most consecutive days of sunshine (768 days between 1967 and 1969),^[7][8] it is nicknamed "The Sunshine City."^[7] Located on the Gulf of Mexico, the average water temperature is typically around 76 °F (24 °C).^[9] Due to its good weather, the city has long been a popular retirement destination, although in recent years the population has moved in a much more youthful direction.^[10]

When the Spanish first arrived in the area of Tampa Bay, they encountered people of the Safety Harbor culture. About 20 sites with temple mounds have been found around Tampa Bay, with several in Pinellas County. Best known of the Safety Harbor people was the chiefdom of Tocobaga, which was likely located at the Safety Harbor site in Philippe Park in northern Pinellas County. The Pánfilo de Narváez expedition landed on the shores of Boca Ciega Bay at the Jungle Prada Site on April 14, 1528. It was the first inland exploration of North America. Of 300 men on the expedition only four survived. One of the survivors of the expedition, Álvar Núñez Cabeza de Vaca, wrote the first book describing the peoples, wildlife, flora and fauna of inland North America in his Relacion, published in Spain in 1542.^[11][12][13]

The city was co-founded by John C. Williams, formerly of Detroit, who purchased the land in 1875, and by Peter Demens, who was instrumental in bringing the terminus of the Orange Belt Railway there in 1888.^[14] St. Petersburg was incorporated as a town on February 29, 1892, when it had a population of 300 people.^{[15][16][page needed]}

Local lore claims John C. Williams and Peter Demens flipped a coin to see who would have the honor of naming the city.^[17][18] When Demens won the coin toss, the city was named after Saint Petersburg, Russia, where Peter Demens had spent half of his youth,^[19] while John C. Williams named the first hotel after his birthplace, Detroit (a hotel built by Demens).^[14][20] The Detroit Hotel still exists downtown on Central Ave, but has been turned into a condominium.^[21]

The oldest operating hotels are the Pier Hotel (formally Hotel Cordova), built in 1921, and The Exchange Hotel (formally The Heritage Hotel), built in 1926.^[22][23]

The first major newspaper to debut in Tampa Bay was the St. Petersburg Times which established in 1884.^[24] Philadelphia publisher F. A. Davis turned on St. Petersburg's first electrical service in 1897.^[25] The city's first major industry was born in 1899 when Henry W. Hibbs (1862–1942), a native of Newport, North Carolina, established his wholesale fish business at the end of the railroad pier, which extended out to the shipping channel. Within a year, Hibbs Fish Company was shipping more than 1,000 pounds (450 kg) of fish each day.^[26]

St. Petersburg was incorporated as a city in June 1903.^[14] With this transition, the development of the downtown waterfront had dredging of a deeper shipping channel from 1906 to 1908 which opened St. Petersburg to larger shipping. Further dredging improved the port facilities through the 1910s.^[27] By then the city's population had quadrupled to a population of 4,127 citizens.^[28] F. A. Davis was instrumental to bringing the first trolley service in 1904.^[25]

 

In 1914, Al Lang invited the St. Louis Browns to move their spring training into the city, then worked tirelessly to make Grapefruit League training in and around St. Petersburg the destination for baseball teams and their fans by the 1920s. Lang eventually became mayor and ambassador for the city, and helped its permanent population grow tenfold in just a decade.^[29]

In 1914 an airplane service across Tampa Bay from St. Petersburg to Tampa and back was initiated, generally considered the first scheduled commercial airline flight. The flight took former mayor Abe Pheil to Tampa.^[30] The company name was the St. Petersburg-Tampa Airboat Line, and the pilot was Tony Jannus flying a Benoist XIV flying boat.^[31] The Tony Jannus Award is presented annually for outstanding achievement in the airline industry.^[32]

St. Petersburg's first library opened on December 1, 1915, which still operates to this day as the Mirror Lake Library.^[14][33]

The city and its tourism industry burgeoned in the 1920s, with up to a quarter million visitors annually coming from Canada, the North and the Midwest by automobile, yacht, and railroad. The city was the principal Gulf Coast destination for long-distance trains of the Atlantic Coast Line Railroad's Southland (from Chicago and Cincinnati) and Gulf Coast Limited^[34] (from New York, succeeded by the West Coast Champion), and Seaboard Air Line Railroad trains such as the Southern States Special^[35] (from New York, succeeded by the Silver Meteor). Travel time from across the bay was cut due to the Gandy Bridge's opening in 1924, allowing direct access to Tampa and the rest of central Florida.

The city took on a Mediterranean flair, with Old Spanish Trail style architecture promoted by Snell Isle founder Perry Snell, whose new country club island homes adopted many elements of Moorish design. Those same elements^[14] were echoed in the city's new Vinoy, Jungle Country Club, Don Cesar and other fine hotels, as well as in Snell's new skyscraper office building downtown.^[36] The 1926 opening of the Million Dollar Pier marked the peak of the boom, adding an attraction that brought both tourists and townspeople together to enjoy fishing, amusements, trolley access and even a local radio station.^[37]

The St. Petersburg flag was created in 1927 and was designed by Mayor C.J. Maurer along with a committee of other public officials. It featured an array of colors symbolic of St. Pete's culture including the sunshine, water and land. The idea came after officials called for a new logo which later became the design for the flag. The pelican featured in the center became a symbol for the "Feed the Pelican Fund" which has supported the birds during the winter months.^[38]

Tourism declined by the late 1920s and early 1930s due to the Great Depression. The city recovered later in the 1930s with the help of the Public Works Administration, including a $10 million investment plan in 1939 which helped build the St. Petersburg City Hall.^[14] The second World War brought renewed growth, as the city's Bayboro Harbor became a training base for the U.S. Coast Guard^[26] and the Army Air Force chose the city as their technical service training station.^[39] The hotels filled for the first time in years, as up to 100,000 troops came to St. Petersburg.^[40] After the war, many of those troops who were stationed in St. Petersburg returned as residents or tourists.^[14]

In the 1950s, St. Petersburg experienced another population boom, with the return of retiree resettlement to the city. In 1954 the original Sunshine Skyway Bridge opened its first span to link St. Petersburg with Manatee County, connecting the next year to U.S. Route 19 in the city. With a large influx of car traffic, it was decided to remove the city's streetcar lines.^[43][44]

From 1955 to 1959, Black residents led concerted swim-ins of the segregated Spa Beach & Spa pool. The St. Petersburg government continually fought this, closing the beach repeatedly and arresting protesters. This continued up to & after the Alsup v. St. Petersburg ruling in April 1957 that St. Petersburg could not segregate the beach or pool. After continued pressure from residents through swim-in's, on January 6, 1959, the government officially reopened them as an integrated beach and pool.^[42]

The development of major transportation continued into the 1960s with the completion of the Howard Frankland Bridge in 1960, creating another connection between St. Petersburg and Tampa.^[44] St. Petersburg also received its first stadium named the Bayfront Center which hosted the first professional hockey league in Tampa Bay.^[45][46] A new municipal marina and the Museum of Fine Arts were also built downtown.^[14] St. Petersburg is home to one of the world's largest reclaimed water systems that was built in the 1970s which flows 37 million gallons of water per day to provide for customers located throughout the city.^[47][48]

Filmed footage
Film of 1968 St.Pete Sanitation Workers’ Strike

From May to August 1968, 211 city's sanitation workers struck in the city for higher wages.^[49] The strike began approximately one month after Martin Luther King, Jr.'s assassination in Memphis, Tennessee while supporting that city's sanitation workers strike.^[50]

In 1984, a full-scale flying replica of the Benoist XIV flying boat was constructed by Florida Aviation Historical Society for the 70th anniversary of the flight. This aircraft is now on loan to the St. Petersburg Museum of History in St. Petersburg, Florida.^[51][52]

Development of the first Major League Baseball team to be located in the Tampa Bay area began in St. Petersburg throughout the 1970s. The city tried to encourage numerous teams through the United States to make St. Petersburg their new home.^[14] Designs for a ballpark were first presented in 1983 and construction for a permanent dome stadium began in 1986.^[53] This process controversially required the demolition of the mostly-Black Gas Plant neighborhood. The stadium opened in 1990 as the Florida Suncoast Dome, renamed the Thunderdome in 1993. After many attempts to attract tenants to the new stadium, Major League Baseball gave St. Petersburg a franchise in 1995. In 1996, the dome was renamed a third time to Tropicana Field after naming rights were established with Tropicana Dole Beverages.^[54] The Tampa Bay Devil Rays was then established in 1998 after the stadium's renovation and the new team played their first game on March 31, 1998, giving the Tampa Bay area their first professional baseball team.^[55]

I-275 was expanded across the bay from Tampa through St. Petersburg in the 1970s. Additional spurs I-175 and I-375 were built afterward, extending from the main highway to the northern and southern edges of the downtown area. The city population continued to multiply during the 20th century, booming through the 1970s as a retirement destination for Americans from midwestern cities, reaching 238,647 in the 1980 census. Racial tensions persisted, and t1996 riots were sparked by the shooting of a black teenager by a white St. Pete police officer. Growth stagnated in the subsequent decade and a half, but since the Great Recession, renewed interest in urban living by family-aged residents and the expansion of the downtown university and related services has led to growth.^{[citation needed]}

According to the United States Census Bureau, the city has a total area of 137.6 square miles (356.4 km²). 61.7 square miles (159.9 km²) of it is land, and 75.9 square miles (196.5 km²) of it (55.13%) is water.^[56] St. Petersburg is bordered by Tampa Bay's three sections, Old, Middle and Lower Tampa Bay.^[57][58]

Downtown St. Petersburg is the Central Business District, containing high rises for office use. The Tampa Bay Times newspaper is headquartered in the downtown area.^[59][60] The Poynter Institute, which owns the paper, is located on 3rd Street South.^[61]

The Mahaffey Theater complex, the Morean Arts Center, dozens of other art galleries, The Coliseum, Palladium Theatre, and Jannus Live are among the galleries and cultural venues featured downtown.^[62] Several prominent museums are located in the perimeter. Many of them have received notable accolades, including the Chihuly Collection presented by the Morean Arts Center, the Museum of Fine Arts, the Salvador Dalí Museum, the now-closed Florida International Museum, the St. Petersburg Museum of History, Florida Holocaust Museum, and the James Museum of Western and Wildlife Art.^[62] The city hosts many outdoor festivals throughout the year.^[63]

Jutting a half mile into the bay is the St. Petersburg Pier, a major tourist attraction that offers various activities. "The Lens" design which was chosen by the International Design Competition Jury and accepted by City Council later had its contract terminated by a citywide election during the summer of 2013.^[64][65] Following this, the "Pier Park" was chosen out of the 16 new design teams that submitted work in late 2014 and in 2015 the Pier Park was set for construction in early 2017.^[37] The new Pier District opened on July 6, 2020, and contains green space, the Marketplace, playground, splash pad, and several public art installations, including Janet Echelman's aerial net sculpture, Bending Art.^[66]

Downtown also contains the University of South Florida St. Petersburg and a downtown branch of St. Petersburg College.^[67][68] The downtown perimeter includes several parks, most of which are waterfront or lakefront. Straub Park is nearly a half mile long, boasts a waterfront location, and is home of the St. Petersburg Museum of Fine Arts.^[69] Because of the number of parks in the downtown area, The Trust for Public Land ranks St. Petersburg 1st in Florida and 15th out of 100 of the largest cities in the U.S.^[70] The Vinoy Park Hotel has a bayfront location, a spot on the National Register of Historic Places,^[71] and an AAA Four-Diamond rating.^[72] It fronts Vinoy Park, which holds music festivals, including the Warped Tour. Nearby is the historic Tramor Cafeteria building, now part of the Tampa Bay Times. The city is connected via the Looper Trolley.^[73]

Many dining and nightlife locations can be found downtown on or near Central Avenue extending to 34th Street in the west or Beach Drive along the waterfront. Venues include Jannus Live and the State Theatre. The active nightlife scene is credited to recent demographic and regulatory changes.^[74][75] In 2010, the city council voted to extend bar hours until 3 A.M., identical to cross-bay "rival" Tampa.^[76][77]

Tropicana Field, home of Major League Baseball's Tampa Bay Rays, is located in the western part of downtown. Until 2008, the team played its spring training games at nearby Progress Energy Park. This setup was unique, making St. Petersburg the first city that played host to its baseball team during spring training as well as the regular season since the 1919 Philadelphia Athletics.^[78] At the end of 2007, there was a debate over a new stadium to be built on the downtown waterfront at the current Progress Energy Park site. Tropicana Field would be demolished and replaced with prime residential and retail space. Completion of the stadium was planned for 2012; however, the proposal was tabled indefinitely while a community-based organization investigates all alternatives for new stadium construction.^[79][80][81] In 2022, the Rays organization and the city came to an agreement over redevelopment; the Trop will be demolished by 2027, to be replaced by a new stadium and a restored Gas Plant neighborhood surrounding it.^[82]

St. Petersburg has the third-largest dedicated public waterfront park system in North America,^[83] with a waterfront park system that stretches 7 miles (11 km) and is used year-round for public events, festivals and other activities.^[84] In the early 20th century, citizens and city leaders engaged in a long and boisterous debate over the future of the young city's waterfront space, with one side advocating for commercial, port and industrial development and the other side advocating for a long-term commitment to parks and public access to the waterfront. The public access and park contingent won the debate when, on Christmas Eve 1909, the city announced the acquisition of the waterfront land that is encompassed by the waterfront park system.^[85]

The city is also becoming one of the largest destinations in Florida for kiteboarding with locations such as Fort De Soto Park, Pass-a-Grille, and Ten-Cent.^[86]

The St. Petersburg Shuffleboard Club was established in 1924 and gained attention as the "World's Largest Shuffleboard Club" with 110 courts and over 5,000 members in the 1950s and 1960s.^[87]

Northshore Aquatic Complex is a public pool and small water park located downtown on the St. Petersburg waterfront. Northshore contains a 50-meter pool with diving board, 25 meter training pool with zero depth entry, a play pool, and is home to both Saint Petersburg Aquatics swim club and Saint Petersburg Masters swim club.^[88]

St. Petersburg is home to more than 100 neighborhoods,^[89] with most of the historic districts located near the bay.^[90] On the central Eastern edge of the city is Downtown St. Petersburg, which includes the city's residential and commercial skyscrapers, art galleries, museums, and parks.^[91]

The downtown area is home to the central business district and to many start-up companies, corporate branches, banks, law firms, and restaurants.^[92][93] Apart from downtown's business and cultural offerings, the area also includes a branch of St. Petersburg College and the campus of the University of South Florida-St. Petersburg.^[91] The downtown district is home to two professional sports teams, the Tampa Bay Rays, which play in the western part of downtown at Tropicana Field, and the Tampa Bay Rowdies, which play along the downtown waterfront at Al Lang Stadium.^[91] The emerging Edge district on the western edge of downtown is rapidly growing as development spreads down Central Avenue.

North of downtown lie the Historic Old Northeast and Snell Isle, which both have Mediterranean style historic and waterfront homes, parks, and recreational areas.^[94][95] Old Northeast is home to a shopping district, city landmarks, beaches, and small shops as well as small residential high rises.^[94] Snell Isle was founded by C. Perry Snell who bought up the land to develop upscale properties in the 1900s, and helped create some of St. Petersburg's resorts such as the Vinoy Park Hotel and the St. Petersburg Woman's Club,^[96] both of which are listed on the U.S. National Register of Historic Places.^[97] The far north consists of the Gateway area which overlaps part of Pinellas Park, home to major employers such as Home Shopping Network and currently the site of much construction of residential and business buildings and of new toll roads.

The central portion of St. Petersburg includes the Grand Central District and Historic Kenwood. The Grand Central District houses many of the city's cafes, art galleries, restaurants, and bars all owing to the Craftsman style architecture.^[98][99] Historic Kenwood is filled with art studios and galleries similarly to the Grand Central District.^[100]

South of downtown is Historic Roser Park, which houses historic Mediterranean and Eclectic style housing, parks, and museums.^[101] The neighborhood is divided by Booker Creek which flows into Bayboro Harbor.^[102][103]

In far western St. Petersburg, north of the separate city of South Pasadena, Florida, is the neighborhood of Pasadena, which includes the intersection of State Road 693 (Pasadena Avenue) and County Road 150 (Central Avenue).

St. Petersburg has a humid subtropical climate (Köppen Cfa) with some characteristics of a tropical monsoon climate (Am), with a defined rainy season from June through September. Many portions of St. Petersburg, especially along the bay and in south St. Petersburg, have tropical microclimates due to the maritime influence of the Gulf of Mexico and Tampa Bay.^{[citation needed]} As a result, tropical flora like coconut palms and royal palms can be found throughout the city, and the city is home to the Gizella Kopsick Palm Arboretum, a 2-acre (0.81 ha) park which houses over 500 palms and cycads,^[104] including a pair of large Jamaican Tall coconut palms which predate the freeze of 1989. St. Petersburg, like the rest of the Tampa Bay area, is occasionally affected by tropical storms and hurricanes. There were 2 hurricanes in 2024 that impacted St. Petersburg within 2 weeks of each other: Hurricane Helene followed by Hurricane Milton. Prior to this, the last time a hurricane directly struck the city was in 1946.

Historical population

Census	Pop.	Note	%±
1890	273		—
1900	1,575		476.9%
1910	4,127		162.0%
1920	14,237		245.0%
1930	40,425		183.9%
1940	60,812		50.4%
1950	96,738		59.1%
1960	181,298		87.4%
1970	216,159		19.2%
1980	238,647		10.4%
1990	238,629		0.0%
2000	248,232		4.0%
2010	244,769		−1.4%
2020	258,308		5.5%
2023 (est.)	263,553	[107]	2.0%
U.S. Decennial Census[108]

St. Petersburg, Florida – Racial and ethnic composition
Note: the US Census treats Hispanic/Latino as an ethnic category. This table excludes Latinos from the racial categories and assigns them to a separate category. Hispanics/Latinos may be of any race.

Race / Ethnicity (NH = Non-Hispanic)	Pop 2000[109]	Pop 2010[110]	Pop 2020[111]	% 2000	% 2010	% 2020
White (NH)	170,396	157,409	159,792	68.64%	64.31%	61.86%
Black or African American (NH)	54,884	57,489	53,345	22.11%	23.49%	20.65%
Native American or Alaska Native (NH)	684	567	520	0.28%	0.23%	0.20%
Asian (NH)	6,569	7,672	8,942	2.65%	3.13%	3.46%
Pacific Islander or Native Hawaiian (NH)	110	106	121	0.04%	0.04%	0.05%
Some other race (NH)	550	539	1,441	0.22%	0.22%	0.56%
Two or more races or Multiracial (NH)	4,537	4,773	10,858	1.83%	1.95%	4.20%
Hispanic or Latino (any race)	10,502	16,214	23,289	4.23%	6.62%	9.02%
Total	248,232	244,769	258,308	100.00%	100.00%	100.00%

As of the 2020 United States census, there were 258,308 people, 111,957 households, and 59,448 families residing in the city.^[112]

As of the 2010 United States census, there were 244,769 people, 106,755 households, and 58,353 families residing in the city.^[113]

In 2010, of all Asian residents, 0.8% were Vietnamese, 0.5% were Filipino, 0.5% were Indian, 0.3% were Chinese, 0.1% were Korean, 0.1% were Japanese, and 1.0% were other Asians.^[114] Also in 2010, of all Hispanic or Latino people within the city, 5,272 (2.2%) were Puerto Rican, 2,855 (1.2%) were Mexican, 2,835 (1.2%) were Cuban, and other Hispanic or Latino residents made up 5,252 (2.1%) of the population.^[114]

According to the 2010 census, the city population density was 3,964.4 inhabitants per square mile (1,530.7/km²).^[114] 84.1% of households were occupied while 15.9% were not occupied. 3,888 (1.6%) lived in non-institutionalized group-quarters and 2,719 (1.1%) were institutionalized. As of 2010, 23,304 (21.4%) had children under the age of 18 living in them, 37,847 (34.8%) were opposite-sex married couples living together, 16,425 (15.1%) had a female householder with no husband present, 4,849 (4.5%) had a male householder with no wife present. There were 9,453 (3.9%) unmarried partnerships. 39,397 households (36.2%) were made up of individuals, and 28,267 (26.0%) had someone living alone who was 65 years of age or older. The average household size was 2.19. In 2010, families made up 54.3% while non-families made up 45.7%; the average family size was 2.88. The median age of the city was 41.6 years.^[114]

As of 2000, 23.85% of households had children under the age of 18 living with them, 37.295% were married couples living together, 13.8% had a female householder with no adult living partner present, and 43.8% were non-families. 35.6% of all households were made up of individuals, and 13.3% had someone living alone who was 65 years of age or older. The average household size was 2.10 and the average family size was 2.865.

In 2000, the city's population was spread out, with 21.5% under the age of 18, 7.7% from 18 to 24, 30.2% from 25 to 44, 23.1% from 45 to 64, and 17.4% who were 65 years of age or older. The median age was 39.24 years. For every 100 females, there were 91.2 males. For every 100 females age 18 and over, there were 87.7 males.

As of 2000, the median income for a household in the city was $34,597, and the median income for a family was $43,198. Males had a median income of $30,794 versus $27,860 for females. The per capita income for the city was $21,107. About 9.2% of families and 13.3% of the population were below the poverty line, including 19.1% of those under age 18 and 10.8% of those age 65 or over. In 2010, 17.8% of the population was under the poverty line, including 32.2% of those under age 18 and 14.1% of those age 65 or over.

As of 2000, those who spoke only English as a first language at home accounted were 88.53% of residents, while Spanish was spoken by 4.43%, German by 0.78%, French by 0.72% of speakers, Vietnamese by 0.67%, Serbo-Croatian by 0.52%, and Laotian by 0.51% of the population.^[115]

As of 2012, it ranked 58th highest in the United States when it comes to violent crime.^[116] In 2013, St. Petersburg ranks in the bottom tenth for safety among cities in Florida.^[117] Evidence of the social unrest and the schism within the city, particularly between South St. Petersburg and the rest of the city came with the St. Petersburg, Florida riots of 1996. Police Officer David Crawford was murdered in February 2011 by then-teenager Nicholas Lindsey.^[118]

As of 2020, 35.9% of St. Petersburg residents consider themselves religious. Catholics make up the largest group at 14 percent followed by Methodists and Baptists, each of which compose of about four percent of the religious community.^[119] The Diocese of St. Petersburg governs 74 Catholic parishes as well as 46 schools and 480,000 Catholics in the Tampa Bay area. Bishop Gregory Parkes currently leads the Diocese of St. Petersburg which covers five counties in the state of Florida.^[120]

Much economic activity is concentrated in the Gateway area, which overlaps St. Petersburg and Pinellas Park. The median household income is $55,134. Health care, retail and professional services are the largest industries.^[121] The most common positions in St. Petersburg are Office and Administrative Support, Sales, and Management.^[122]

According to the City of St. Petersburg, Florida's 2019 Comprehensive Annual Financial Report, the largest private-sector (non-government, non-school) employers in the city are (with trends since 2010):^[123]

#	Employer	Industry	Employees
1		Investment	4,700
2	Johns Hopkins All Children's Hospital	Healthcare	3,700
3	Home Shopping Network	Retail	2,200
4	St. Anthony's Hospital	Healthcare	2,100
5	Publix Super Markets	Retail	2,000
6	Jabil Circuit	Electronics manufacturing services	2,000
7	Fidelity National Information Services	Financial sector	1,800
8	Bayfront Medical	Healthcare	1,500
9	The Continental Group	Realtor	1,200
10	Spectrum	Communications	1,100

In 2022, the city of St. Petersburg had an operating budget of $711.2 million for all funds, excluding internal service funds and dependent districts.^[124]

The Commercial Revitalization Program of 2020 provided grants to commercial developments providing future work to the city. Grants are provided to commercial buildings and developments outside of downtown and are provided as matching grants.^[125]

One of the first of many major events of the year that takes place is the Dr. Martin Luther King Jr. Parade, in January.^[126][127] The parade hosts a Battle of the Bands, and drum line extravaganzas that have been duplicated in other cities.^[128]

In March the city hosts the annual Firestone Grand Prix of St. Petersburg. This is located in downtown St. Petersburg and is the first round of the IndyCar Series.^[129] It usually lasts three days with practice rounds, qualifications, and two main races.^[130][131] The 100 lap Grand Prix's circuit has included a section of the Albert Whitted Airport.^[132]

Bluesfest, hosted in the Vinoy Park,^[133] hosts multiple live blues artists, offers views of the Tampa Bay waters from the park, and provides drinks and free food.^[134][135]

One of the many art festivals, called the Mainsail Art Festival, is a free entry art exhibition at the Vinoy Park, which offers art sold by local artists. It also provides live music, awards, and food courts.^[136][137]

The Saint Petersburg Art Festival takes place every February.^[138]

The downtown triathlon event is hosted by St. Anthony's Hospital and involves a 1.5k swim through Tampa Bay, a 40k bike along the waterways, and a 10k run through the neighborhoods.^[139][140]

The Green Thumb Festival, which originated in 1986 to promote tree beautification and planting in the city of St. Petersburg, is currently held in Walter Fuller Park.^[141][142]

A major event that takes place in June is the St. Pete Pride weekend, when the LGBT community and supporters celebrate in the streets with festivals, the 27/82 concert, and an LGBT pride parade.^[143][144] The weekend also hosts a variety of block parties, food stands, DJ stands, art festivals, local hosted parties, and the LGBT welcoming center.^[145][146]

In July, the 4th of July firework celebration invites the citizens to downtown St. Petersburg.^[147]

Greenhouse and USF St. Pete's College of Business host an annual event known as "St. Pete Pitch Night" in October that hosts judges and business pitches.^[148]

In November, the annual Ribfest is held at Vinoy Park.^[149] It includes family fun zones, drinking vendors, and two stages hosting many country music artists.^[150]

SHINE St. Pete Mural Festival is an annual event hosted by the St. Petersburg Arts Alliance. The event began in 2015 and since has contributed to nearly 93 murals designed by artists from across the globe. 2020 marked the first event entirely composed of Florida-based artists, more specifically from the Tampa Bay area.^[151]

From the end of November through December are holiday events. A tree lighting ceremony starts the celebrations. The Santa Parade is followed by Snowfest with "glice" skating, toboggan slides, and Kiddyland.^[152] Kids meet Santa and ice skate in the North Straub Park. North and South Straub Park are decorated with holiday lights and decorations while the Vinoy Park is decorated with large greeting cards created by the recreational centers in St. Petersburg.^[152]

In mid-December, the city hosts an annual NCAA football game in Tropicana Field entitled the St. Petersburg Bowl.^[153]

On December 31, St. Petersburg has the year's last event, First Night St. Petersburg, where people celebrate the arts from venues across the city.^[154]

The American Stage in the Park hosts many different shows at the Demens Landing Park throughout the year.^[155][156]

St. Petersburg hosted the Miss Florida Pageant eleven consecutive years from 2004 to 2015, until the pageant was moved to Lakeland.^[157]

The city hosts a year-round event known as the "Second Saturday ArtWalk".^[158]

The city hosted the 2024 Royal Rumble on January 27, 2024, on the Tropicana Field^[159][160]

Pride month takes place annually throughout the month of June to celebrate and recognize the identities of LGBTQ+ persons.^[161] The city of St. Petersburg hosts a variety of events to celebrate Pride Month including the annual Pride Parade.^[162]

The annual Women's March in the month of January typically takes place in Williams Park where thousands of individuals gather to march for female rights and equality. The last documented Women's March in St. Pete dates back to 2018 following the resurgence of the #MeToo Movement.^[163]

Demonstrations and protests began following the murder of George Floyd.^[164]

The arts are a major contributor to the region's tourism. The Salvador Dalí Museum houses the largest collection of Dalí's works outside of Europe, including a number of famous and large-scale paintings such as The Discovery of America by Christopher Columbus.^[165] The Salvador Dali Museum received more than 400,000 visitors annually prior to the COVID-19 pandemic, 75% of which were not local to the Tampa Bay Area.^[166] Other art museums in the city include a Museum of Fine Arts and The Chihuly Collection, located on Central Avenue, which houses glass sculptures of Dale Chihuly.^[167][168] The Museum of the American Arts and Crafts Movement was expected to open in 2017, and after delays opened to the public in September 2021.^[169]

Beyond the arts, St. Petersburg is home to a children's museum (Great Explorations), Holocaust Museum, as well as the Dr. Carter G. Woodson African American Museum which highlights the life of Carter G. Woodson who founded the Associated Publishers and is the author of nearly 30 books still prevalent today.^[170] Past exhibits and events featured in the museum include the Ray McLendon Exhibit, a discussion of race and politics series, and a seminar on the conviction of Michael Morgan.^[171] The St. Petersburg Museum of History has a full-size replica of the Benoist XIV seaplane and is located near the approximate spot by the St. Petersburg Pier where the first scheduled commercial flight departed.^[172]

There are various other smaller art galleries and entertainment venues, especially in the downtown area, which has seen a boom in development since the mid-1990s; these include the Mahaffey Theater complex, American Stage (an equity regional theater), The Coliseum, Palladium Theatre, the Arts Center, and the Florida Craftsmen Gallery.^[173][174]

The old St. Petersburg Pier was a popular tourist attraction which closed in May 2013, and has been replaced with a new pier that opened in late 2020.^[175] The Bounty, a replica of HMS Bounty that was used in the 1962 Technicolor remake of Mutiny on the Bounty, starring Marlon Brando, was permanently docked near the pier for many years until the ship was sold to Ted Turner in 1986.^[176] The Bounty, however, sometimes visited St. Petersburg for the winter in the following years before its sinking in 2012.^[177] In 2010, the St. Petersburg City Council voted to demolish and rebuild the pier.^[178] The new pier will be opening "in phases" in 2020. A ceremony celebrating the opening is scheduled for the 4th of July.^[179]

The city had a Madame Tussaud Wax Museum between 1963 and 1989.^[180][181]

The downtown Sundial shopping complex opened in May 2014, sitting on the renovated site of a shopping and entertainment complex formerly called BayWalk that originally opened in 2000.^[182] It contains a 12-screen movie theater originally owned by Muvico and now owned by AMC Theatres, as well as many chain restaurants and retail shops. The Sundial St. Pete has nightlife destinations, as does the block surrounding Jannus Live. Restaurants serving ethnic and domestic culinary specialties can be found throughout the downtown area.

Every Saturday morning from October to May, the downtown area hosts a farmers' market in the parking area of Al Lang Stadium (formerly Progress Energy Park). Local vendors sell the fruits of their labors (whether edible or decorative) alongside artists of all kinds including live music.^[183]

West of downtown on Central Avenue is the 600 Block Arts District, which contains Bohemian art and clothing stores.^[184] The eve-N-odd gallery is located in the historic Crislip Arcade built in 1925.^[185] The refurbished shopping arcade is one of 13 original city arcades built in the city. Only three are left, and only the Crislip arcade is still being used as a place for small businesses to set up shop.^[186] Further west is the Grand Central District located within Historic Kenwood District. It is known for its artistic community, LGBT presence, and the annual St. Pete Pride parade.^[187] Haslam's Bookstore, closed since 2020, can also be found in the Grand Central District. It was the largest independent bookstore in Florida, with over 30,000 square feet.^[188] As its name implies, Old Northeast is adjacent to downtown from the northeast. It is known for its historic status and eclectic architecture.^[189][190]

St. Petersburg boasts two historic neighborhoods: Roser Park, located just south of the downtown area, and Grenada Terrace, in the Old Northeast Neighborhood. Both are known for stately architecture, and together comprise the urban core of St. Petersburg.^[191][192]

A bronze statue in honor of St. Pete resident Elder Jordan stands on 22nd Street and Seventh Avenue as of October 2020. Jordan was a slave from birth up until the age of 15 when he bought his freedom and moved to St. Petersburg where he created a successful business.^[193]

North of downtown is the Great Explorations Children's Museum, an interactive museum featuring a Children's Village with giant pretend stores, fire house and pet vet clinic, and preschool, science, music, art, and water exhibits. It is located next to Sunken Gardens.^[194]

4th Street as a whole, from Downtown up to Gandy Boulevard, is home to many restaurants and bars running the gamut from fast food to haute cuisine. This area is called the "Garden District", although as of 2010 this name is not widely in use.^[195]

Boyd Hill Nature Park, located on Lake Maggiore, is a 245-acre (0.99 km²) preserve where one can see many of the endangered plants and rare wildlife of Tampa Bay.^[196] A bird exhibit houses bald eagles, owls, hawks, and other species.^[197]

The area's main shopping mall is Tyrone Square Mall, constructed in 1972 and is located in the northwestern part of the city.^[198]

St. Petersburg has been used as a filming location for films over the years, including Once Upon a Time in America (1984), Summer Rental (1985), Cocoon (1985), Ocean's Eleven (2001), Loren Cass (2006), Dolphin Tale (2011), Magic Mike (2012), Spring Breakers (2013), Dolphin Tale 2 (2014), and Miss Peregrine's Home for Peculiar Children (2016).^{[citation needed]}

Bernie the Dolphin (2018) and Garden Party (2019) were filmed around St. Petersburg.^[199][200]

The St. Petersburg Library System consists of seven branch locations:

• President Barack Obama Library
• Childs Park Library
• James Weldon Johnson Community Library
• Mirror Lake Library
• North Community Library
• South Community Library
• West Community Library

The Mirror Lake Library, built in 1915, is one of only two Carnegie libraries still operating in Florida.

Professional sports clubs in the Tampa Bay area

Club	Sport	League	Venue
Tampa Bay Buccaneers	Football	National Football League	Raymond James Stadium, Tampa
Tampa Bay Lightning	Ice hockey	National Hockey League	Amalie Arena, Tampa
Tampa Bay Rays	Baseball	Major League Baseball	George M. Steinbrenner Field, Tampa
Tampa Bay Rowdies	Soccer	United Soccer League	Al Lang Stadium, St. Petersburg
Bay Area Pelicans	Rugby	USA Rugby Union	Sawgrass Park, St. Petersburg
Grand Prix of St. Petersburg	Auto racing	IndyCar	Downtown Waterfront

The Tampa-St. Petersburg area is represented by teams in four major professional sports (soccer, football, baseball, and hockey). Two teams, the Tampa Bay Rays of Major League Baseball and Tampa Bay Rowdies of the North American Soccer League, play in St. Petersburg proper, while the other two teams play across the bay in Tampa. As their names suggest, all of the teams represent the entire Tampa Bay area and seek to draw fans from both sides of Tampa Bay.

The Tampa-St. Petersburg area hosted the Super Bowl LV, where the Tampa Bay Buccaneers took on the Kansas City Chiefs at Raymond James Stadium on February 7, 2021.^[201]

The Rays began play in 1998, finishing last in the American League's East Division in nine of the first ten seasons they played,^[202] including their last year known as the "Devil Rays": 2007.^[203] In 2008, their 11th season, they held off the Boston Red Sox and won the AL East Division Championship for the first time.^[204] In the playoffs, they again faced the Red Sox in the ALCS.^[205][206] They defeated Boston and won the American League Pennant.^[207] However, they lost to the Philadelphia Phillies in the 2008 World Series.^[208][209] The Rays also made an appearance in the 2020 World Series where they faced the Los Angeles Dodgers.^[210]

From their inception until 2008, the Rays played their regular season games at Tropicana Field and their spring training games at historic Al Lang Stadium, formerly Progress Energy Park, giving them the unique distinction of being the only team in Major League Baseball that played its spring training games in their home city in more than 70 years. Beginning in 2009, the Rays have held spring training at Charlotte Sports Park in Port Charlotte, ending a 94-year streak of springtime baseball in the city.^[211][212] Tropicana Field, the home venue of the Rays, played host to the 1999 Final Four.^[213] Despite not having a team in the city since 2000 (with the St. Petersburg Devil Rays), St. Petersburg is home to Minor League Baseball's main headquarters.^[214] Due to the damage on Tropicana Field caused by Hurricane Milton, the Rays spent the 2025 season at George M. Steinbrenner Field in Tampa.

St. Petersburg is home to the Grand Prix of St. Petersburg, the inaugural race was held in April 2005.^[215] The circuit itself is made of downtown streets passing Al Lang Stadium, the marina, and a runway in Albert Whitted Airport,^[216] and streets are temporarily blocked off for the annual Indy Racing League's IndyCar Series race.^[217] The race was postponed in 2020 due to the spread of the COVID-19 coronavirus, and was rescheduled as the final race of the season, rather than the first race.^[218] In 2012, the road intersecting Turn 10 was renamed Dan Wheldon Way in memory of Dan Wheldon, who won the 2005 race thanks to a move made on that turn.^[219] Wheldon was killed in an accident at the Las Vegas Motor Speedway in the 2011 season finale.^[220]

The Tampa Bay Rowdies of the United Soccer League began play in Tampa in 2010 and moved to Al Lang Stadium in 2011. The long-time baseball venue is named after Al Lang, a former mayor of St. Petersburg who was instrumental in bringing spring training to the city in 1914. The Rowdies initially shared Al Lang Stadium with various amateur baseball events, but eventually took over operation of the facility and has converted it into a soccer-only facility^[221] The Rowdies' ownership has expressed interest in moving up to join Major League Soccer (MLS) and a 2016 referendum gave the club permission to build a larger privately funded stadium at the site of Al Lang Stadium if the move takes place.^[222]

The Bay Area Pelicans Rugby Football Club has made their home in St. Petersburg since 1977.^{[citation needed]}

The city of St. Petersburg has been governed under a strong mayor form of government since 1993. The Mayor of St. Petersburg and the St. Petersburg City Council members are elected to a four-year term, limited to two consecutive terms. Currently the mayor of St. Petersburg is Ken Welch who took office on January 6, 2022. The legislative body consists of eight City Council members representing each of their designated city districts.^[223][224]

St. Petersburg is split between Florida's 13th congressional district, represented in Congress by Republican Anna Paulina Luna, and Florida's 14th congressional district, represented by Democrat Kathy Castor. The city is much more left-leaning than the surrounding county- in 2020, 62.3% percent of voters in St. Pete's metro city boundaries cast their ballots for Democratic candidate Joe Biden.^[225]

St. Petersburg is considered one of the significant art centers and markets in Florida, featuring several art districts, museums, commercial galleries, public artworks, and annual art festivals.^{[226][227][228]} It includes more than five museums and cultural centers dedicated to fine art, with notable examples including the Salvador Dali Museum, the Chihuly Collection, Museum of Fine Arts, St. Petersburg, and the Museum of the American Arts and Crafts Movement (MAACM).^[229][230]

In addition to museums, the art culture of St. Petersburg includes more than 75 art galleries^[226] and seven distinct art districts.^[231] The Warehouse Arts District emerged circa 2009 alongside a significant glass art market that has become known as "the Glass Coast".^[232][233] The Deuces Live District is home to the city of St. Petersburg's African American cultural heritage, and includes locally owned art galleries and other specialty businesses,^[234] as well as historic buildings such as the Royal Theater.^[235] The M.L. King North District includes restaurants and cafes.^[236]

St. Petersburg also features more than 600 public art murals,^[227][237] which are the focus of the city’s annual SHINE Mural Festival. Since its inception in 2015, the SHINE Mural Festival has been responsible for creating more than 150 murals in the city.^[238] Other notable art fairs in the city include the long running St. Petersburg Fine Art Festival and the Mainsail Art Festival.

Public primary and secondary schools in St. Petersburg are administered by Pinellas County Schools. Public high schools within the city limits include:

• Gibbs High School
• Lakewood High School
• Northeast High School
• St. Petersburg High School
• St. Petersburg Collegiate High School

Private high schools include:

• Canterbury School of Florida
• St. Petersburg Catholic High School
• Shorecrest Preparatory School
• Admiral Farragut Academy

High schools located in unincorporated (outside city limits) St. Petersburg:

• Hollins High School
• Keswick Christian School
• Northside Christian School

The non-profit Science Center of Pinellas County educates more than 22,000 school children annually through field trip classes and offers winter, spring and summer workshops for 2,000 more.^[239]

St. Petersburg is home to several institutions of higher education. The University of South Florida St. Petersburg is an autonomous campus in the University of South Florida system.^[240] The University of South Florida St. Petersburg serves 6,500 students. Eckerd College, founded in 1958, is a private four-year liberal arts college.^[241] Also in St. Petersburg is the Poynter Institute, a journalism institute which owns the Tampa Bay Times in a unique arrangement.^[242] Stetson Law School is located in Gulfport, which is adjacent to St. Petersburg between the south beaches. St. Petersburg College, founded in 1927, is a state college within the Florida College System. It has an average of 65,000 students spread across 11 campuses and centers in the Bay area, four of which are in St. Petersburg.^[243]

Other colleges and universities in the wider Tampa Bay Area include the University of South Florida and the University of Tampa located in Tampa and Hillsborough Community College, with campuses across Hillsborough County.^[241]

The city's main daily morning newspaper is the Tampa Bay Times.^[244]

Cable television service is provided by Spectrum (previously Bright House Networks) and Wide Open West (abbreviated "WOW!", previously Knology), as well as fiber optic service provider Frontier Communications (previously Verizon FiOS).^{[245][246][247][248]}

St. Petersburg is in the Tampa-St. Petersburg television and radio markets. WTSP channel 10 (CBS) and WTOG channel 44 (Independent) are licensed to St. Petersburg, with studios in unincorporated Pinellas County in the Gandy Boulevard area just north of the St. Petersburg limits. Spectrum Bay News 9, the local cable TV news service, is based in northeast St. Petersburg. CW owned-and-operated station WTTA is licensed to St. Petersburg, with studios in Tampa.^[249] Official city government programming, known as StPeteTV, can be found on Spectrum on Channel 641, WOW! Cable on Channel 15 or Frontier Channel 20 as well as online.^[250] City government programming previously aired on city-owned WSPF-CD channel 35 until 2012, when the city sold the station to private interests.^[251]

The city is connected to Tampa by the east by causeways and bridges across Tampa Bay,^[252] and to Bradenton in the south by the Sunshine Skyway Bridge (Interstate 275),^[253] which traverses the mouth of the bay. It is also served by Interstates 175 and 375, which branch off I-275 into the southern and northern areas of downtown respectively.^[254][255] The Gandy Bridge, conceived by George Gandy and opened in 1924, was the first causeway to be built across Tampa Bay, connecting St. Petersburg and Tampa cities without a circuitous 43-mile (69 km) trip around the bay through Oldsmar.^[256]

Nearby Tampa International Airport (TPA) provides air transportation for many passengers.^[257] Historically, smaller airlines with service to smaller cities and towns have operated at St. Petersburg-Clearwater International Airport, with a number of air carriers only providing only seasonal services.^[258] The exception at the St. Petersburg-Clearwater International Airport (PIE) is Allegiant Air which currently operates Airbus A319 and A320 mainline jetliners into the airfield with year-round nonstop service from many cities in the eastern U.S.^[259][260] Albert Whitted Airport provides general aviation services near the heart of downtown St. Petersburg.^[261][262]

Mass transit in St. Petersburg is provided by the Pinellas Suncoast Transit Authority (PSTA). A sightseeing trolley, called The Looper, also travels to key downtown destinations daily such as USFSP, Sundial, Vinoy Hotel, and the multiple museums around the city.^{[263][264][265]} Short-term bike sharing is also offered via Coast Bike Share.^[266][267]

In 2022, PSTA launched the SunRunner, a bus rapid transit service connecting downtown St. Petersburg to St. Pete Beach. The SunRunner is the first bus rapid transit line in the Tampa Bay Area and is expected to spur economic development along the Central Avenue corridor in Pinellas County. In its first weekend alone, the SunRunner had over 10,000 passengers.^[268] Ridership continues to be steady; however, PSTA hiked fares, citing a homelessness issue.^[269]

CSX Transportation operates a former Atlantic Coast Line Railroad branch line which sees daily rail traffic from north Tampa though Safety Harbor, Clearwater, and Largo. As of March 2008, the portion that ran into downtown St. Petersburg and the adjacent western industrial areas was abandoned. There is a small rail yard to the northwest of downtown St. Petersburg at the new end of the rail line with several spur lines serving industries in the area.^[270]

The former Seaboard Air Line branch from the western coastal portion of the county was abandoned in the 1980s and converted to a popular recreational trail called the Pinellas Trail.^[271]

Notable former stations include the St. Petersburg ACL station, which became an Amtrak station from 1971 to 1983, St. Petersburg Seaboard Air Line Passenger Station, and the St. Petersburg Seaboard Coast Line station.^[270]

One of the main sea transportation areas in St. Petersburg is the Port of St. Petersburg, which is located in downtown St. Petersburg.^[272] Boat marinas in downtown St. Petersburg are also available such as the Municipal Marina which located in the Southern and Central Yacht Basins,^[273] and Harborage Marina located in the Bayboro Harbor.^[274] The Cross-Bay ferry runs, at a fee, from St. Pete to downtown Tampa.^[275]

The city of St. Petersburg's major electricity system is provided by Duke Energy, the city's major gas system is provided by TECO Energy in the industrial and commercial parts of the city, and the city's water services are provided by the city of St. Petersburg.^[276]

The city of St. Petersburg, Florida is currently a member in the Sister Cities International group that was created in 1956.^[277]

• Takamatsu, Kagawa, Japan (since 1961)^[278]
• Isla Mujeres, Quintana Roo, Mexico (since 2016)^[279]

Every year, the city of St Pete sponsors three high school students to do a summer exchange with Takamatsu, Japan.

• Saint Petersburg, Russia^[280]
• Figueres, Catalonia, Spain (since 2011)^[281]

• Largest metropolitan areas in the Americas
• United States cities by population
• Tallest buildings in St. Petersburg, Florida
• List of parks in St. Petersburg, Florida
• Mayoral elections in St. Petersburg, 2017
• St. Petersburg Bar Association
• List of people from St. Petersburg, Florida

• Hartzell, Scott Taylor (2006). Remembering St. Petersburg, Florida: Sunshine City Stories, Volume 1. Charleston, South Carolina: The History Press. ISBN 1-59629-120-6.
• Anderson, Anne W. (2009). Insiders' Guide to the Greater Tampa Bay Area. United States of America: Rowman & Littlefield. ISBN 978-0-7627-5347-5.

• Official website