Discovering Allentowns Top Chiropractic Talent

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 preferred to use traditional chiropractic lexicon terminology such as "perform spinal analysis", "detect subluxation", "correct with adjustment".^[20] They preferred 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

 

Coordinates: 40°36′06″N 75°28′38″W / 40.60167°N 75.47722°W / 40.60167; -75.47722Country United StatesState PennsylvaniaCountyLehighSettled1751 (1751)Founded1762 (1762)IncorporatedMarch 12, 1867 (1867-03-12)Founded byWilliam AllenNamed afterWilliam AllenGovernment

 • TypeMayor-council • MayorMatthew Tuerk (D) • City SolicitorMatt Kloiber • City ControllerJeff Glazier • SenateJarrett Coleman (R)
Nick Miller (D)Area

18.01 sq mi (46.64 km²) • Land17.56 sq mi (45.49 km²) • Water0.44 sq mi (1.15 km²) • Urban

261.55 sq mi (677.4 km²) • Metro

730.0 sq mi (1,174.82 km²)Elevation

338 ft (103 m)Highest elevation

440 ft (130 m)Lowest elevation

255 ft (78 m)Population

125,845 • Rank1st in the Lehigh Valley
3rd in Pennsylvania • Density7,164.94/sq mi (2,766.35/km²) • Urban

621,703 (US: 68th) • Urban density2,377.0/sq mi (917.8/km²) • Metro

865,310 (US: 68th) • Metro density1,117.8/sq mi (431.6/km²) • Demonym

AllentonianTime zoneUTC−5 (EST) • Summer (DST)UTC−4 (EDT)ZIP Codes

Area codes610 and 484FIPS code42-02000GNIS feature ID1202899^[8]Primary airportLehigh Valley International Airport- ABE (Major/International)Secondary airportAllentown Queen City Municipal Airport- XLL (Minor)School districtAllentownMajor hospitalLehigh Valley–Cedar CrestWebsitewww.allentownpa.gov

Allentown (Pennsylvania Dutch: Allenschteddel, Allenschtadt, or Ellsdaun) is a city in eastern Pennsylvania, United States. The county seat of Lehigh County,^[9] it is the third-most populous city in Pennsylvania, with a population of 125,845 as of the 2020 census. It is also the most populous city in the Lehigh Valley metropolitan area, which had a population of 861,899 and was the 68th-most populous metropolitan area in the nation as of 2020.^[10][11][12]

Founded in 1762, Allentown is located on the Lehigh River, a 109-mile-long (175 km) tributary of the Delaware River. It is the largest of three adjacent cities, including Bethlehem and Easton in Lehigh and Northampton counties, in the Lehigh Valley region.^[13] Allentown is located 48 miles (77 km) north of Philadelphia and 78 miles (126 km) west of New York City.

In the early 18th century, the area that is present-day Allentown was a wilderness of scrub oak, where the Lenape, an Indigenous tribe, fished for trout and hunted for deer, grouse, and other game.

On May 18, 1732, the land was deeded by Thomas Penn, one of three sons of William Penn, founder of the colonial era Province of Pennsylvania, to Joseph Turner, a Philadelphia-based iron manufacturer and politician. Two years later, on September 10, 1735, a 5,000-acre (20 km²) portion of this land was purchased from Turner's business partner by William Allen, a wealthy shipping merchant who became mayor of Philadelphia the following month.^[14][15]

In 1737, as part of the Walking Purchase, a large area north of Philadelphia, including present-day Allentown, was deeded by 23 chiefs of the Five Civilized Tribes to three sons of William Penn, John, Thomas, and Richard, in exchange for shoes, buckles, hats, shirts, knives, scissors, combs, needles, looking glasses, rum, and pipes.^[16]

The land was surveyed in 1736 and again in 1753 as part of an effort to construct a road from Easton to the city's east to Reading to its west.^[14] The 1753 survey reported that a log house, owned by Allen and built around 1740, existed near the western banks of Jordan Creek. The house was used primarily as a hunting and fishing lodge by Allen, but he also entertained prominent guests there, including James Hamilton, his brother-in-law, and John Penn, then governor of the Province of Pennsylvania.^[14] In 1752, Northampton and Berks counties were formed; Easton was named the county seat of Northampton County, and Reading the county seat of Berks County.

In 1762, the land, including present-day Allentown, was named and laid out by Allen, and the city was founded.^[17] A rivalry between the Penns and Allen may have inspired Allen to acquire the land and found the city.^[16] The following year, in 1763, Allen and others sought to relocate the county seat from Easton to Allentown, but the Penns' influence prevailed and the county seat remained in Easton.^[16]

The city's original organization, whose archives are now housed at the Historical Society of Pennsylvania in Philadelphia, included 42 city blocks and 756 lots, most of which were 60 feet (18 m) in width and 230 feet (70 m) in depth and was initially located between present-day 4th and 10th streets and Union and Liberty streets. The city was initially named Northampton Towne.

Many streets on the original plan were named for Allen's children, including Margaret (now 5th Street), William (now 6th Street), James (now 8th Street), Ann (now 9th Street), and John (now Walnut Street). Allen Street (now 7th Street), the city's main street, was named for Allen himself. Hamilton Street was named for James Hamilton, deputy governor of colonial era Pennsylvania from 1748 to 1754. Gordon Street was named for Patrick Gordon, an earlier deputy governor of colonial Pennsylvania. Chew Street was named for Benjamin Chew, and Turner Street was named for Allen's business partner Joseph Turner.^[14]

Allen initially hoped the city would displace Easton as the seat of Northampton County and become a major national center for commerce due to its location along the Lehigh River and its proximity to Philadelphia, which was then the largest and most influential city in British America and the second-most populous city in the entire British Empire after London.^[18] In 1767, Allen granted the land to his son James.^[19]

Allentown played a central role in inspiring and supporting the American Revolution and Revolutionary War. Some of the first Patriot resistance to British colonialism in the Thirteen Colonies began in and around present-day Allentown. On December 21, 1774, a Committee of Observation was formed by Allentown-area patriots, who expanded their resistance to British governance and drove Tories out of the city. The burden of supplying the local militias fell on the people, and requisitions for food, grain, cattle, horses, and cloth were common.^[20]

In June 1775, after the Revolutionary War was launched with the Battles of Lexington and Concord, the Second Continental Congress incorporated Patriot militias, including those in present-day Allentown, into the Continental Army and unanimously selected George Washington as its commander. During the Revolutionary War, Hessian prisoners of war were kept in Allentown in the vicinity of present-day 7th and Gordon streets, and the city housed four hospitals for wounded Continental Army troops, including one in Zion Reformed Church and one on the grounds of the present-day Farr Building.

After crossing the Delaware and prevailing in the Battle of Trenton on December 26, 1776, Continental Army commander George Washington and his staff traveled through Allentown, where they proceeded up Water Street, which is present-day Lehigh Street. On the grounds of present-day Wire Mill on Lehigh Street, Washington and his staff stopped at the foot of the street, where they rested and watered their horses, and then proceeded to their post of duty.^[21]

In 1777, a manufacturer of paper cartridges and muskets for the Continental Army relocated to Allentown from neighboring Bethlehem, and a shop of 16 armourers was established on Little Lehigh Creek, which was used to repair Continental Army weapons and manufacture saddles and scabbards.^[14]

Allentown holds historical significance as the location where the Liberty Bell, then known as the State House Bell, was successfully hidden from September 1777 to June 1778, during the Revolutionary War by American patriots, who sought to avoid its capture by the British Army during their nine-month occupation of Philadelphia.

After Washington and the Continental Army were defeated in the Battle of Brandywine in Chadds Ford Township, Pennsylvania on September 11, 1777, Philadelphia was left defenseless and American patriots began preparing for what they saw as an imminent British attack on the colonial capital. Pennsylvania's Supreme Executive Council ordered that 11 bells, including the Liberty Bell and ten bells then housed at Christ Church and St. Peter's Church in Philadelphia, be taken down and moved out of Philadelphia to protect them from the British, fearing their being melted down and cast into munitions. Two farmers and wagon masters, John Snyder and Henry Bartholomew, then transported the Liberty Bell north to present-day Allentown, where it was hidden under floorboards in the basement of Zion Reformed Church at 622 Hamilton Street in Center City Allentown, just prior to Philadelphia's September 1777 fall to the British.

In 1803, the city, whose mail was previously received in neighboring Bethlehem, had a post office established inside Compass and Square Hotel inside the present-day Penn National Bank building at 645 Hamilton Street in Allentown. In the 1810 U.S. census, the city's population exceeded 700 residents, and the Commonwealth of Pennsylvania granted the city legal standing on March 18, 1811, incorporating it initially as the Borough of Northampton in what was then Northampton County. The new borough's first undertaking was ordering that cows be moved from public streets to pastures, which proved unpopular with residents. The following year, in 1812, the city became part of Lehigh County, which was partitioned from a western section of Northampton County.^[16][23]

Throughout the early 1800s, the city grew primarily as a court and market town. Northampton Bank, the city's first bank located at the northeast corner of Center Square, was chartered in July 1814, and the first Hamilton Street Bridge, a 530 feet (160 m)-long chain structure, was constructed to cross Lehigh River in the city. The bridge featured two suspended lanes, one for east and one for westbound traffic, and a toll house at the bridge's western end.^[16][23][24]

In 1829, Lehigh Canal, a 46.6 miles (75.0 km)-long canal on Lehigh River's east side, was completed for both ascending and descending navigation, which proved influential in expanding the transport of anthracite coal, then one of the most important domestic and industrial fuels, from Allentown to New York City, Philadelphia, and other major industrial centers.^[16][25] In 1855, the city's first railroad was built on the west side of the Lehigh River, and rail soon began surpassing river transport as the primary means for transporting anthracite through the city.^[16][25]

In 1838, the city's name was officially changed to Allentown. The city soon faced major challenges. In 1841, a flood swept away Hamilton Street Bridge, inflicting substantial damage near Lehigh River. Two years later, in 1843, excessive speculation by Northampton Bank led to the bank's failure, resulting in financial ruin for many bank customers. Five years later, on June 1, 1848, the city's central business district burned down in a large fire between 7th and 8th streets on Hamilton Street.

During the 1850s, however, the city began recovering. A new bridge was built across the Lehigh River, and brick buildings were constructed to replace wooden ones that burned down in the 1848 fire. In 1852, the first Allentown Fair, now one of the nation's longest continual annual fairs, was held.^[16][24]

On April 13, 1861, with tensions between the North and South intensifying following the South's secession, residents of Lehigh and Northampton counties called a public meeting in Easton to discuss steps that could be taken to support the federal government.^[26] In the meeting, citizens voted to establish and equip the 1st Pennsylvania Volunteer Infantry, a new military unit, and placed Captain Samuel Yohe of Easton and Thomas W. Lynn in charge of it, awarding them the respective ranks of colonel and major. Tilghman H. Good of South Whitehall Township, previously captain of Allen Rifles, an Allentown-based militia, and commander of the 4th Pennsylvania Infantry Regiment, was placed in charge of the 1st Pennsylvania's Company I, which included his former Allen Rifles subordinates and members of Jordan Artillerist, another Allentown-based militia.

In April 1861, following the Confederate bombardment of Fort Sumter, these Allentown units were deployed in response to President Lincoln's call for 75,000 volunteers to defend the national capital of Washington, D.C. from Confederate attack.^[27] After protecting the nation's capital from April to July 1861, these volunteers were honorably discharged and returned home, though a significant number reenlisted to defend the Union as the Civil War escalated.^[16][28] After the Civil War's end, many of these soldiers were named Pennsylvania First Defenders in recognition of their role as one of the first five units to answer Lincoln's call for volunteers to defend the nation's capital.

On August 5, 1861, Andrew Gregg Curtin, the Civil War-era Pennsylvania governor, granted Tilghman H. Good authority to create the 47th Pennsylvania Infantry Regiment, a new unit commonly known as the 47th Pennsylvania Volunteers.^[29] Good secured the assistance of William H. Gausler of Allentown, who was commissioned as a major with the regiment's central command staff, and John Peter Shindel Gobin, a senior officer with Sunbury Guards in Northumberland County, who was repeatedly cited for valor and was promoted to colonel and ultimately as commanding officer of the regiment.^[30][31] Companies A and E of the regiment were recruited primarily from Easton and Northampton County; Companies B, G, I, and K were largely recruited from Allentown; Company C was recruited from Northumberland and Juniata counties; Company F was primarily composed of men from the Allentown suburb of Catasaqua; and Companies D and H were recruited from Perry County. The 47th Pennsylvania Volunteers achieved Union victories at the Battle of St. Johns Bluff in Florida (October 1–3, 1862) before suffering a costly defeat in the Second Battle of Pocotaligo in South Carolina (October 21–23, 1862). They were the only Pennsylvania regiment to fight in the Union army's Red River campaign across Louisiana in 1864.^[32]

While sustaining numerous casualties during the Red River campaign, the 47th Pennsylvania helped turn the Civil War in the Union's favor, contributing to influential military victories in General Sheridan's 1864 Shenandoah Valley campaign across Virginia, including in the Battles of Berryville, Opequan, Fisher's Hill, and Cedar Creek, and then again contributing to the nation's defense following Lincoln's assassination on April 15, 1865.^[30][33][34] Other known Union military units from Allentown included the 5th, 41st, 128th, and 176th Pennsylvania Infantries.^[16][24]

On October 19, 1899, Allentown erected and dedicated Soldiers and Sailors Monument, at Hamilton and S. 7th streets in Center City, where it still stands, in honor of these Union soldiers from Allentown and local Lehigh Valley towns and boroughs who were killed in defense of the Union during the Civil War.^[16][24][35]

In the late 18th century, Allentown began growing slowly as a hub for commerce and industrialization and as a colonial era population center. Prior to the American Revolution, there were 54 homes and approximately 330 residents. In 1782, there were 59 houses and over 100 cows. In 1783, the town was described by a visitor, "One gets a glimpse of many good stone houses, many of them very neat, and everything about the premises shows good order and attention. The people are mainly German who speak bad English and distressing German." In 1795, Gazette of the United States described Allentown as:

A handsome and flourishing town of Northampton County, pleasantly situated on the point of land formed by the junction of the Jordan Creek and Little Lehigh. It is regularly laid out and contains about ninety dwellings, a German Lutheran and a Calvinist (Zion) Church, an Academy and three merchant mills.^[16]

In 1792, land north of Allentown was purchased by Lehigh Coal & Navigation Company for coal mining, but it initially proved difficult to transport the region's high quality anthracite coal over what was then a primitive trail system. Only a limited amount of anthracite was mined until 1818, when the company began constructing Lehigh Canal, which allowed coal to be transported from Mauch Chunk, later renamed Jim Thorpe, down the Lehigh River to the river's confluence with the Delaware River in Easton.

In the late 18th century, Allentown's industrial development accelerated. David Deshler, Allentown's first shopkeeper, opened a sawmill in the city in 1782. By 1814, industrial plants in Allentown included flour mills, sawmills, two saddle makers, a tannery and tan yard, a woolen mill, a card weaving plant, two gunsmiths, two tobacconists, two clockmakers, and two printers.^[16] In 1818, the opening of Lehigh Canal transformed Allentown and the surrounding Lehigh Valley from a rural agricultural area dominated by German-speaking people into one of the nation's first urbanized industrialized areas, expanding the city's commercial and industrial capacity. Allentown underwent significant industrialization, and the city began evolving into a major national center for heavy industry and manufacturing.

In the 1840s, iron ore beds were discovered in hills around Allentown, and a furnace was constructed in 1846 by Allentown Iron Core Company for production of pig iron, a vital component used in the manufacturing of steel. The furnace opened in 1847 under supervision of Samuel Lewis, an expert in iron production, and was followed by the opening of other Allentown plants for production of a wide variety of metal products. In 1860, several smaller iron companies merged to create Allentown Rolling Mill Company, which became Allentown's largest iron company and contributed to the region's emergence as a major national source for iron ore.^[16][23]

In 1850, Leh's, a shoe and ready-to-wear clothing store, was opened in the city by Henry Leh. By 1861, as the Civil War commenced, Leh's emerged as a major source of military boots for Union troops. In addition to Leh's, eight brick yards, a saw mill, a paint factory, two additional shoe factories, a piano factory, flour mills, breweries, and distilleries opened in Allentown during the Civil War era.^[16][23][24] In 1855, the first railroads to reach Allentown opened, representing direct competition to Lehigh Canal for coal transport. Lehigh and Susquehanna Railroad ordered four locomotives, and train stations were built in Allentown, Easton, and Mauch Chunk. In September 1855, the railroad became operational with Central Railroad of New Jersey providing transport between Allentown and New York City. Transport between Allentown and Philadelphia also became available over Perkiomen Railroad, which operated between Norristown and Freemansburg.^[16][23]

With industrialization, Allentown emerged as a major regional and national center for banking and finance. In 1860, William H. Ainey founded Allentown Savings and served as its first president. In 1864, Second National Bank of Allentown was formed, and Ainey was elected its first president, a position he held until his death. Ainey contributed to Allentown's industrial and retail growth, helping finance Iowa Barb Wire Company, which was later absorbed by American Steel & Wire, Pioneer Silk Factory, Palace Silk Mill, and Allentown Spinning Company.^[24]

In the late 1870s, however, Allentown's iron industry collapsed, leaving the city economically depressed. Efforts were made to diversify the city's industrial base, including convincing Phoenix Manufacturing Company to open a silk mill in the city. In 1886, Adelaide Mill at Race and Court streets prompted the opening of Pioneer Silk Mill, and the city quickly emerged as a national leader in silk manufacturing. By the late 19th century, the silk industry emerged as Allentown's largest industry, and it remained the city's largest industry through the end of the 20th century. In 1914, there were 26 silk mills in the city. By 1928, with the introduction of rayon, the number of Allentown silk mills grew to 85. In the 1940s, during the height of Allentown's silk industry, over 10,000 people were employed in the industry in the city.^[16][24]

In 1883, Allentown Boiler Works was founded in Allentown by Charles Collum, whose partner, John D. Knouse, built a large facility at 3rd and Gordon streets in Allentown's First Ward near Lehigh Valley Railroad's yard, which later became Kline's Island. The company manufactured iron products, some of which were used in high-profile construction projects, including construction of the White House in Washington, D.C., and the U.S. Military Academy at West Point. The company's boilers and kilns were used in the production of iron products, which were sold nationally and internationally to customers in Canada, Cuba, and the Philippines.^[16][23]

Through the end of World War I, brickworks flourished in Allentown. Clay unearthed in various sections of the city and its suburbs was used in manufacturing building brick and fire brick, the first Allentown products shipped by rail and sold nationally.^[16][23] A vibrant food processing industry also began emerging, due largely to the arrival of predominantly German immigrant bakers, who were among the city's first settlers. In 1887, Wilson Arbogast and Morris C. Bastian formed Arbogast and Bastian, which provided large scale commercial slaughtering.^[16][24]

In 1896, Max Hess, a retailer from Perth Amboy, New Jersey, visited Allentown and began developing the city's first department store. He and his brother Charles opened Hess Brothers at 9th and Hamilton streets. Hess's developed a reputation for flamboyance, offering the latest European fashion apparel. Hess's opening was followed by the opening of the city's second major department store, Zollinger-Harned Company, located in the Zollinger-Harned Company Building on Hamilton Street.^[16][24]

Allentown also began emerging as a major national center for beer brewing. Notable Allentown-based breweries included Horlacher Brewery (founded 1897, closed 1978),^[36] Neuweiler Brewery (founded 1875, closed 1968),^[37] and Schaefer Beer, whose brewery was later acquired by Pabst and Guinness^[38] and is now owned by Boston Beer Company, brewer of Samuel Adams beer.^[39]

In 1905, Jack and Gus Mack moved Mack Trucks, their motor company, from Brooklyn to Allentown, taking over the foundries of Weaver-Hirsh on S. 10th Street. By 1914, Mack Trucks developed a global reputation for manufacturing sturdy and reliable trucks and vehicles. Many were sent to Western Front battlefields in France just before the U.S. entered World War I in April 1917. The British Army nicknamed Mack AC's five and seven-ton trucks the "Bulldog", which was later adopted as the company's corporate brand. Throughout the 20th century, Mack Trucks grew substantially, ultimately including eight Allentown-based manufacturing plants.^[16][24]

In the early 20th century, largely as a result of Pennsylvania missionaries, Christians from Wadi al-Nasara in Syria began settling in Allentown. Syrian Christians ultimately developed a significant presence in the city, based largely in Allentown's Sixth Ward.^[40] As of 2015, there were an estimated 5,200 Syrian Americans in Allentown and surrounding Lehigh Valley cities and towns.^[41]

Like several other regions in Pennsylvania, Pennsylvania German-speaking residents existed in Allentown into the early 20th century. Pennsylvania Guide, compiled during the Great Depression by the Writers' Project of the Works Progress Administration, described the impact of the Pennsylvania Dutch on Allentown's linguistic landscape, reporting in 1940 that:^[42]

Allentown is among the few large Pennsylvania cities where newspapers still carry columns written in the dialect. Although English predominates on the streets, there is a tendency to enunciate the 'v' with open lips, to soften the hard 'g' into 'ch,' and to use too frequently such words as 'already,' 'yet,' and 'once.' Here also are heard such colloquialisms as 'the pie is all,' (all gone) and 'it wonders (mystifies) me.'

— Federal Writers' Project, "Part II: Cities and Towns", Pennsylvania: A Guide to the Keystone State (1940)

In October 1945, following the end of World War II, Western Electric opened a plant on Union Boulevard in Allentown. Six years later, in October 1951, the company manufactured and released the world's first transistor, produced at the Allentown-based plant, and the Allentown-based company emerged as a leader in the nation's post-war electronics revolution.^[43]

By the mid-20th century, Allentown was a major retailing and entertainment center distinct and separate from Philadelphia and New York City. Hess's, Leh's, and Zollinger department stores led to retail sector growth in the city, and dozens of smaller retail stores, restaurants, hotels, banks, and professional offices emerged in present-day Center City, which was then referred to as downtown Allentown. At least seven cinemas and stage theaters were developed on Hamilton Street between 5th and 10th streets.^[16][24]

By the mid-1960s, Allentown's economy was booming for decades, but the city's rising taxes and regulations prohibited the city's expansion, leading many Allentown residents, especially those from the post-World War II baby boom generation, to flee Allentown for its suburbs. Salisbury, South Whitehall, and Whitehall townships each had large areas of farmland, which were prime locations for residential real estate development. A significant portion of Allentown's working class began migrating to the newer and more affordable housing developments in these suburbs, which offered lower taxes, more green space, less crime, and newer schools.

Throughout the late 20th century, the departure of Allentown residents for its suburbs began representing a major challenge to the city's government and school district, both of which began experiencing significantly diminished resources. Allentown School District's financial challenges, in turn, further increased working class flight to the city's suburbs, creating a sea change in the city's demographics. With the departure of many working class families from older Center City neighborhoods, many of the city's homes were sold to landlords who converted them into inexpensive multifamily apartments, a considerable portion of which were transformed into government-subsidized housing projects, which was then permitted under the city's lax zoning and city codes.

With Allentown's neighborhoods and school system declining, the city focused on attempting to develop its Hamilton Street retail district, largely ignoring Allentown neighborhoods not located in Center City. This, in turn, further increased the flight of Allentown residents to the city's suburbs, leading to the development of a growing number of suburban shopping centers and services, which were built to accommodate these expanding suburban communities. In 1966, Whitehall Mall, the first closed shopping mall north of Philadelphia, opened in Whitehall Township. Ten years later, in 1976, Lehigh Valley Mall, a second suburban closed mall even larger than Whitehall Mall, opened north of U.S. Route 22 in Fullerton. Stores in Allentown's downtown shopping district began closing, replaced with stores whose customers were less affluent and large downtown areas that were razed and replaced with parking lots. In an attempt to compete with fast-growing and newer suburban shopping areas, the downtown Allentown business district was rebuilt with a multiblock row of stores known as Hamilton Mall, featuring newly covered sidewalks and managed traffic patterns. The city's economic plight began being citing as a prominent example of a Rust Belt city. In 1982, Billy Joel released the single "Allentown", the lead song on The Nylon Curtain album, which addressed the city's economic plight in the late 20th century.

The effort to rebuild the downtown shopping district ultimately proved unsuccessful, and two of the city's major department stores, Leh's and Zollingers, closed by 1990. The third, Hess's, was sold to The Bon-Ton in 1994, which closed its Hamilton Mall location two years later, in 1996.^[44] In 1993, Corporate Center, the city's new flagship business center on N. 7th Street, fell victim to a large sinkhole, leading to its condemnation and ultimate demolition. Combined with challenges confronting Center City, Allentown also was heavily impacted by a significant downturn in manufacturing throughout the U.S. Northeast, which began undergoing and suffering from deindustrialization, a product of foreign competition, trade policies, and relatively higher U.S.-based manufacturing costs. Many Allentown factories and corporations began closing or relocating.

Responding to the late 20th century economic downturn in the city, Allentown began seeking to diversify its economy in the early 21st century. Allentown's economy saw growth in its service, health care, transportation, warehousing, and some manufacturing industries. In 2009, the Neighborhood Improvement Zone (NIZ), created by the Pennsylvania General Assembly, sought to address Allentown's economic challenges and encourage the city's development and revitalization. The NIZ includes approximately 128 acres (52 hectares) in Center City and the city's riverfront district on the west side of the Lehigh River.

In 2006, Agere Systems, formerly Western Electric, was acquired by LSI Corporation, and the company relocated to San Jose, California. Three years later, in 2009, Mack Trucks relocated to Greensboro, North Carolina, and many Allentown-based factories downsized considerably or ceased operations entirely.

In 2014, Center City underwent major restructuring, including constructing and opening PPL Center, a 10,500-capacity indoor arena, which hosts the Lehigh Valley Phantoms, a professional American Hockey League ice hockey team, and other sports, entertainment, and concert events. A full-service Renaissance Hotel also opened in Center City, and older office buildings were redeveloped.^[45]

In 2024, U.S. News & World Report ranked Allentown as one of the "150 Best Places to Live in the U.S." and the nation's fifth-best city to retire.^[46]

Allentown's geographic boundaries include a total area of 18.0 square miles (46.6 km²). Of this, 17.8 square miles (46.1 km²) is land and 0.2 square miles (0.5 km²) is water, according to the U.S. Census Bureau. Bodies of water include Jordan Creek and its tributary, Little Lehigh Creek, which join in the city and empty into Lehigh River. Other bodies of water in Allentown include Lake Muhlenberg in Cedar Creek Parkway and a pond in Trexler Park.

Allentown is located in the Lehigh Valley, an eastern Pennsylvania geographic valley located between two Appalachian mountain ridges, Blue Mountain, which varies from 1,000 feet (300 m) to 1,600 feet (490 m) in height about 17 miles (27 km) north of the city, and South Mountain, a ridge of 500 feet (150 m) to 1,000 feet (300 m) in height bordering the city's southern edge. The Lehigh Valley includes both Lehigh and Northampton counties.

The Lehigh Valley's adjacent counties are Carbon and Monroe counties to its north, Bucks County to its southeast, Montgomery County to its south, Berks and Schuylkill counties to its west, and Warren County, New Jersey to its east.

Center City Allentown includes the downtown area and its 7th Street retail and residential corridor, which is the city's central business district and the location of most of its city, county, and federal government buildings. To the east of Center City are The Wards, residential areas developed during the late 19th century and early 20th century industrial boom. Just east of the Lehigh River are the city's East Side residential neighborhoods, most of which border various routes to neighboring Bethlehem. South of Center City across Little Lehigh Creek are the city's South Side neighborhoods, which border Emmaus. Allentown's West End, with a mix of commercial corridors, cultural centers, and larger single-family residences, begins approximately west of 15th Street.

Center City's tallest building is the PPL Building at 322 feet (98 m). In addition to the PPL Building, Center City commercial office buildings include the Dime Savings and Trust Company building, which features the city's Art Deco architecture, which was highly popular in Allentown and New York City in the 1920s and 1930s. One City Center, Two City Center,^[47][48] and other commercial buildings are located in Center City.

An 8,500-seat indoor arena, PPL Center, which hosts the Lehigh Valley Phantoms of the American Hockey League, opened in August 2014 at 701 Hamilton Street in Center City.^[49] Other Center City historic and recreational landmarks include Allentown Art Museum, Baum School of Art, Lehigh County Historical Society, and Miller Symphony Hall.

In January 2015, two major hotels, Americus Hotel and a Marriott, opened in Center City.^[50][51]

Allentown is characterized by a large stock of historic homes, commercial structures, and century-old industrial buildings reflecting its standing as one of the nation's earliest urban centers. Center City's neighborhoods include Victorian and terraced rowhouses. West Park includes mostly Victorian and American Craftsman-style architecture. Houses on Allentown's tree-lined streets in the West End were built mostly between the 1920s and 1940s. Houses in Allentown's East and South Sides are a mixture of architectural styles and are generally single and twin family homes built between the 1940s and 1960s; both areas include some older Victorian homes. Allentown has many loft apartments in converted mills and historic brick manufacturing buildings and modern and historic high-rise apartment buildings in Center City.

Allentown has three primary historic districts: Old Allentown, the Old Fairgrounds, and West Park. Old Allentown and Old Fairgrounds are Center City neighborhoods, which hold a joint house tour organized by the Old Allentown Preservation Association (OAPA) annually in September. West Park also offers a tour of its Victorian and Craftsman-style homes.^[52]

The PPL Building, at 2 N. 9th Street, is Allentown's tallest building at 322 feet (98 m). The building, which opened on July 16, 1928, was designed by New York City architectural firm Helme, Corbett, and Harrison, and Wallace Harrison, one of the firm's partners, served as the building's primary designer. The building was later a prototype for Art Deco architecture in Manhattan, including Rockefeller Center and other building structures. Built between 1926 and 1928, the PPL Building's exterior decorative friezes were designed by Alexander Archipenko. The building has been illuminated every night since its opening in 1928.^[53] In clear weather at night, the PPL Building's nighttime illumination is visible as far north as the Blue Mountain Ski Area in Palmerton. The building's exterior is featured in multiple scenes in the 1954 movie Executive Suite.^[54]

Miller Symphony Hall at 23 N. 6th Street opened in 1896 and served initially as the city's public market; the 1,100 seat facility is now home to the Allentown Symphony Orchestra. The structure was converted to a theater in 1899 by architect J. B. McElfatrick's firm, and was initially named the Lyric Theater. Miller Symphony Hall, one of roughly a dozen famous McElfatrick designs still standing in the nation, has been used for burlesque shows, vaudeville, silent films, symphony orchestras, and other entertainment for over a century.^[55] Other Allentown-based performing arts facilities and programs include Pennsylvania Sinfonia, Community Concerts of Allentown, Allentown Band, and Community Music School of the Lehigh Valley.

Under the Köppen climate classification, Allentown falls within the hot-summer humid continental climate (Dfa) if the 0 °C (32 °F) isotherm is used or the humid subtropical climate (Cfa) if the −3 °C (27 °F) isotherm is used. Summers are typically warm and muggy. Fall and spring are generally mild. Winter is cool to cold. Precipitation is almost uniformly distributed throughout the year.

The average temperature in January is 30.1 °F (−1.1 °C) and the lowest officially-recorded temperature was −15 °F (−26 °C) on January 21, 1994.^[56] July averages 75.6 °F (24.2 °C) and the highest temperature on record was 105 °F (41 °C) on July 3, 1966.^[56][57] January temperatures average below freezing. Seven months average above 50 °F (10.0 °C), and two months average above 71.6 °F (22.0 °C).

Snowfall is variable with some winters bringing light snow and others bringing multiple and significant snowstorms. Average snowfall is 33.1 inches (84 cm) seasonally^[58] with February receiving the highest snowfall at just under 11 inches (280 mm). Rainfall is generally spread throughout the year with eight to 12 days of precipitation monthly^[59] at an average annual rate of 43.5 inches (110.5 cm).^[60] Allentown falls under the U.S. Department of Agriculture's 6b Plant hardiness zone.^[61]

Historical population

Census	Pop.	Note	%±
1790	486		—
1800	573		17.9%
1810	710		23.9%
1820	1,132		59.4%
1830	1,757		55.2%
1840	2,493		41.9%
1850	3,703		48.5%
1860	8,025		116.7%
1870	13,884		73.0%
1880	18,063		30.1%
1890	25,288		40.0%
1900	35,416		40.1%
1910	51,913		46.6%
1920	73,502		41.6%
1930	92,563		25.9%
1940	96,904		4.7%
1950	106,756		10.2%
1960	108,347		1.5%
1970	109,871		1.4%
1980	103,758		−5.6%
1990	105,090		1.3%
2000	106,632		1.5%
2010	118,032		10.7%
2020	125,845		6.6%
2021 (est.)	125,944		0.1%
U.S. Decennial Census[65][7]

As of the 2020 U.S. census, Allentown had a population of 125,845, making it the third-most populous city in the state after Philadelphia and Pittsburgh. As of 2020, 54.2% were Hispanic/Latino, 30.2% non-Hispanic White, 10.4% non-Hispanic Black, 1.9% Asian, 0.1% Native American or Pacific Islander, and 3.2% were mixed race or other.^[66] A decade earlier, in 2010, Allentown had 42,032 households, including 28.8% with children under age 18, 39.4% who were married couples living together, 15.1% who had a female householder with no husband present, and 40.2% who were non-families. Among all households as of 2010, 33.1% were made up of individuals and 12.8% had someone living alone who was 65 years of age or older. The city's average household size is 2.42 and average family size is 3.09. As of 2000, the city's population density was 6,011.5 inhabitants per square mile (2,321.1/km²), and there were 45,960 housing units at an average density of 2,591.1 per square mile (1,000.4/km²).

As of 2010, Allentown's population broken down by age ranges was: 24.8% under 18, 11.2% from 18 to 24, 29.8% from 25 to 44, 19.1% from 45 to 64, and 15.1% 65 years or older. The median age was 34 years. For every 100 females, there were 91.8 males. For every 100 females age 18 and over, there were 87.7 males. The median income for a household in the city was $52,449. Males had a median income of $30,426 versus $23,882 for females. Per capita income in Allentown, as of 2010, was $16,282 with 18.5% of the total city population and 14.6% of families in the city below the poverty line. As of 2010, city residents living beneath the poverty line included 29.4% of those under age 18 and 10% of those over age age 65. As of February 2010, the unemployment rate for the larger Lehigh Valley metropolitan area was 9.8%, and Allentown's unemployment rate was slightly higher at over 10%.^[67]

In 2020, according to the city, there were 4,283 Part 1 crimes, including homicides, non-fatal shootings, rapes, robberies, burglary, larcenies, motor vehicle thefts, and acts of arson. In 2020, reported non-fatal shootings, rapes, robberies, burglaries, and larcenies in the city fell compared to 2019. Motor vehicle thefts and arsons, however, increased. In 2020, there were nine homicides, unchanged from those in 2019.^[68]

On June 20, 2019, two rival gangs, the Bloods and Latin Kings, shot 10 people when the two gangs exchanged gunfire outside Deja Vu nightclub on Hamilton Street.^[69]

The city's Hispanic population, comprised primarily of Dominicans and Puerto Ricans, has grown notably over the past three decades from an estimated 12 percent of the city's population in 1990 to an estimated 55 percent as of 2024.^[70]

Allentown city, Pennsylvania – 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 1980[71]	Pop 1990[72]	Pop 2000[73]	Pop 2010[74]	Pop 2020[75]	% 1980	% 1990	% 2000	% 2010	% 2020
White alone (NH)	94,508	86,510	68,621	50,964	38,033	91.09%	82.32%	64.35%	43.18%	30.22%
Black or African American alone (NH)	3,047	4,639	7,284	11,336	13,193	2.94%	4.41%	6.83%	9.60%	10.48%
Native American or Alaska Native alone (NH)	111	126	165	200	150	0.11%	0.12%	0.15%	0.17%	0.12%
Asian alone (NH)	693	1,363	2,375	2,452	2,498	0.67%	1.30%	2.23%	2.08%	1.98%
Native Hawaiian or Pacific Islander alone (NH)	N/A	N/A	49	11	28	N/A	N/A	0.05%	0.01%	0.02%
Other race alone (NH)	105	178	136	224	805	0.10%	0.17%	0.13%	0.19%	0.64%
Mixed race or Multiracial (NH)	N/A	N/A	1,944	2,384	2,906	N/A	N/A	1.82%	2.02%	2.31%
Hispanic or Latino (any race)	5,294	12,274	26,058	50,461	68,232	5.10%	11.68%	24.44%	42.75%	54.22%
Total	103,758	105,090	106,632	118,032	125,845	100.00%	100.00%	100.00%	100.00%	100.00%

Allentown historically was a hub for the nation's earliest industrialization, and its economy was heavily manufacturing-based. Beginning in the late 20th century, the city evolved into a more service-oriented economy, due largely to Rust Belt decline in heavy industry, which began around 1980 and accelerated through the 20th century's last two decades. Allentown is corporate headquarters for several large companies, including Air Products,^[76] PPL Corporation, and others.^[77] The city's largest employer, as of 2007, is Lehigh Valley Health Network with over 7,800 employees.^[78] Lehigh Valley Health Network's flagship hospital, Lehigh Valley Hospital–Cedar Crest, is Pennsylvania's third-largest hospital with 877 licensed beds and 46 operating rooms.

Center City, located largely on Hamilton Street between 5th and 10th streets, was the primary shopping district in Allentown for most of the 20th century. During the 1960s and 1970s, however, several shopping malls, including South Mall in Salisbury Township^[79] and Lehigh Valley Mall and Whitehall Mall, both in Whitehall Township, were built in Allentown's suburbs and now represent the most popular shopping destinations.^[80] In October 2006, Promenade Saucon Valley opened south of Allentown in Upper Saucon Township.

Allentown Symphony Orchestra performs at Miller Symphony Hall, located on N. 6th Street in Center City. The city has a musical heritage of civilian concert bands and is home to Allentown Band, the nation's oldest civilian concert band, founded in 1828.^[81] Allentown houses a collection of public sculptures, including the DaVinci Horse, located on 5th Street, which is one of only three da Vinci sculptures in the world. Allentown Art Museum, located on N. 5th Street in Center City, is home to a collection of over 13,000 pieces of art and an associated library. Baum School of Art at 5th and Linden streets offers credit and non-credit classes in painting, drawing, ceramics, fashion design, jewelry making, and other arts-related curriculum.

Civic Theatre of Allentown, founded in 1928, has an 90-plus year history of producing theater in the Lehigh Valley. Initially named Civic Little Theater, Civic Theatre of Allentown today has paid professional staff, a volunteer board of directors from the community, and volunteer staff. The theater operates the Lehigh Valley's only full-time cinema, showing art, independent and foreign films, and offers a theater school that has served the Valley's youth for over 50 years. The theatre is professionally directed and managed and utilizes community actors in its live theater productions.

Vestiges of Allentown's Pennsylvania Dutch heritage are prominent in Pennsylvania Dutch cuisine in the city. Foodstuffs, including scrapple, chow-chow, Lebanon bologna, cole slaw, and apple butter, are often found in local diners and the Allentown Farmer's Market. Shoofly pie, birch beer, and funnel cakes are regularly available at local fairs. Several local churches make and sell fastnachts in fundraisers for Fastnacht Day, the day before Lent's commencement.

Due in part to Allentown's proximity to Philadelphia, cheesesteaks are immensely popular. Yocco's Hot Dogs, a regionally well-known hot dog and cheesesteak establishment with five area locations, three of which are in Allentown, was founded in 1922 by Theodore Iacocca, uncle of former Chrysler chairman and president Lee Iacocca. A-Treat Bottling Company, a regionally-popular soft drink beverage company, has been based in Allentown since its 1918 founding.

Soldiers and Sailors monument, dedicated and unveiled on October 19, 1899, on Allentown's Center Square at 7th and Hamilton streets, honors Union army volunteers from Allentown and the Lehigh Valley metropolitan area who were killed during the American Civil War. The monument is topped by a statue representing the Goddess of Liberty.^[84] In 1957, the statue atop the monument, then in a state of disrepair, was removed; it was replaced in 1964.^[85] Allentown's motto is Sic semper tyrannis, which, translated from Latin, means "thus always to tyrants", suggesting that bad but justified outcomes will ultimately befall tyrants.

Allentown Band, Marine Band of Allentown, Municipal Band of Allentown, and Pioneer Band of Allentown all perform regularly at the bandshell in the city's West Park. Allentown's J. Birney Crum Stadium, the largest high school football field in the Mid-Atlantic U.S and 15th-largest in the nation, hosts Drum Corps International's Eastern Classic, which annually brings together the world's top junior drum and bugle corps for a two-day event. Allentown is home to a full symphony orchestra, Allentown Symphony Orchestra, which performs at Miller Symphony Hall at 23 N. 6th Street.

Much of Allentown's park system is a product of industrialist Harry Clay Trexler's efforts. Inspired by the City Beautiful movement in the early 20th century, Trexler helped create West Park, a 6.59-acre (26,700 m²) park in what was then a community trash pit and sandlot baseball field in an upscale area of the city.^[86] The park, which opened in 1909, features a bandshell designed by Philadelphia architect Horace Trumbauer and has long been home to the Allentown Band and other community bands.^[86] Trexler also facilitated the development of Trexler Park, Cedar Parkway, Allentown Municipal Golf Course, and Trout Nursery in Lehigh Parkway and was responsible for the development of the Trexler Trust, which provides ongoing private funding for Allentown's park system's maintenance and development.^[87]

Allentown's parks include Bicentennial Park, a 4,600 seat mini-stadium built for sporting events, the 127-acre Cedar Creek Parkway, which includes Lake Muhlenberg, Cedar Beach, and Malcolm W. Gross Memorial Rose Garden, East Side Reservoir (15 acres), Irving Street Park, Kimmets Lock Park (5 acres), Lehigh Canal Park (55 acres), Lehigh Parkway (999 acres), Old Allentown Cemetery (4 acres), Jordan Park, South Mountain Reservoir (157 acres), Trexler Park (134 acres), Trout Creek Parkway (100 acres), Joe Daddona Park (19 acres), Keck Park, Percy Ruhe Park, also known as Alton Park, and West Park (6.59 acres).^[87]

Allentown is home to Dorney Park & Wildwater Kingdom, the nation's fifth-longest continuously operating amusement park,^[89] and one the largest amusement and water parks in the United States. Dorney Park's Steel Force roller coaster is the eighth-longest steel rollercoaster in the world.

The Great Allentown Fair runs annually the end of August and early September on the grounds of the Allentown Fairgrounds on N. 17th Street, where it has been held continuously since 1889.^[90] The first Allentown Fair was held in 1852. Prior to moving to the Allentown Fairgrounds in 1889, it was held at the Old Allentown Fairgrounds north of Liberty Street between 5th and 6th streets.

Blues, Brews, and Barbeque, a blues festival launched in 2014, is held annually in June on Hamilton Street in Center City.^[91] Annually in May, Mayfair Festival of the Arts, a three-day arts festival, is held on Cedar Crest College campus in Allentown.

Both Cedar Crest College and Muhlenberg College in Allentown have collegiate athletic programs in most sports. The Muhlenberg Mules play their home football games at Scotty Wood Stadium on the Muhlenberg campus in Allentown.

Allentown and its surrounding Lehigh Valley region are known for high quality high school-level athletics, and the region has been the starting ground for a considerable number of professional and Olympic-level athletes.

Allentown's three large high schools, Allen, Dieruff, and Central Catholic, each compete in the Eastern Pennsylvania Conference, one of the nation's premier high school athletic divisions. All three Allentown high schools play their home football games at the 15,000 capacity J. Birney Crum Stadium at 2027 Linden Street, the largest high school football stadium in the Mid-Atlantic region of the nation.

Professional baseball has a rich history in Allentown dating back to 1884. The city is home to the Lehigh Valley IronPigs, the Triple-A Minor League affiliate of the Philadelphia Phillies who play at Coca-Cola Park, a $50.25 million, 8,200-seat stadium on Allentown's east-side.^[92]

Allentown is home to the Lehigh Valley Phantoms, the primary development team of the Philadelphia Flyers, which compete in the American Hockey League and play at PPL Center, an 8,500-seat indoor arena in Center City.

Allentown is home to the Parkettes National Gymnastics Training Center, which has been the training ground for several Olympians and U.S. national gymnastics champions. In 2003, the program was the subject of an immensely critical CNN documentary, Achieving the Perfect 10, which depicted it as a hugely demanding and competitive gymnastics training center.

Allentown hosted the Allentown Jets, a Continental Basketball Association team that played in Rockne Hall at Allentown Central Catholic High School from 1958 to 1981. The Jets were one of the most dominant franchises in the league's history, winning eight playoff championships and twelve division titles. Allentown has been home to two professional soccer teams, the Pennsylvania Stoners (2007–2009)^[93] and Northampton Laurels (2005–2008) of the now defunct Women's Premier Soccer League. The Pennsylvania ValleyDawgs of the now defunct U.S. Basketball League played their home games at William Allen High School during the league's existence from 1999 to 2006.

Allentown is legally classified as a Pennsylvania third-class city and has operated with the strong-mayor version of the mayor-council form of government since 1970. The mayor serves as the city's chief executive and administrative officer, and Allentown City Council serves as the legislative branch.^[94] Elected at-large, the mayor serves a four-year term under the city's home rule charter.^[95] The current city mayor is Matthew Tuerk, a Democrat. Allentown City Council has seven council members who are elected at large for four-year staggered terms.^[95] The city council holds regular public meetings and enacts city legislation, including ordinances and resolutions. Allentown City Council's current president is Daryl Hendricks.^[96] The city controller, who is responsible for oversight of the city's finances, is elected and serves a four-year term.^[97]

On the federal level, Allentown is part of Pennsylvania's 7th congressional district in the U.S. House Representatives, represented since January 2025 by Republican Ryan MacKenzie. In the U.S. Senate, the city and state are represented by Democrat John Fetterman and Republican Dave McCormick. Since January 2023, Pennsylvania's governor is Democrat Josh Shapiro.

United States presidential election results for Allentown, Pennsylvania^[98][99]

Year	Republican		Democratic		Third party(ies)
	No.	%	No.	%	No.	%
2024	16,066	38.03%	25,761	60.97%	424	1.00%
2020	13,479	31.90%	28,338	67.06%	443	1.05%
2016	11,013	27.54%	27,783	69.47%	1,196	2.99%
2012	10,077	27.25%	26,508	71.67%	400	1.08%
2008	10,761	26.79%	28,895	71.93%	514	1.28%
2004	14,131	36.96%	23,882	62.46%	221	0.58%

Allentown School District, founded in 1828 and currently Pennsylvania's fourth-largest school district, manages the city's public school system with the exception of a small portion of the city near Trexler Park, which is in Parkland School District.^[100] As of the 2023-24 school year, Allentown School District had 16,510 students and 1,050 teachers for a student-teacher ratio of 15.72 on a full-time equivalent basis, and an annual school district budget of $414.939 million, according to National Center for Education Statistics data.^[101]

Allentown has two large public high schools for ninth through 12th grades, William Allen High School, which serves students from Allentown's southern and western sections, and Louis E. Dieruff High School, which serves students from the eastern and northern parts. Each of the city's high schools competes athletically in the Eastern Pennsylvania Conference, an elite high school athletic conference, which includes the 18 largest high schools in the Lehigh Valley and Pocono Mountain regions of the state. Both schools and Allentown Central Catholic High School, the city's parochial high school, play their home football games at J. Birney Crum Stadium, a 15,000 capacity stadium, which is the largest high school stadium in the state and among the largest in the nation.

Allentown School District's four middle schools, for grades 6–8, are: Francis D. Raub Middle School, Harrison-Morton Middle School, South Mountain Middle School, and Trexler Middle School. The city district has 16 elementary schools for kindergarten through fifth grade: Central, Cleveland, Hiram W. Dodd, Jefferson, Lehigh Parkway, Lincoln, Luis A. Ramos, McKinley, Midway Manor, Mosser, Muhlenberg, Ritter, Roosevelt, Sheridan, Union Terrace, and Washington.

Allentown also has two public charter schools, Roberto Clemente Charter School, located at 4th and Walnut streets in Allentown, which is a Title I charter school that provides educational services to mainly Hispanic students in grades 6 through 12, and Lincoln Leadership Academy Charter School, located at 1414 E. Cedar Street, which serves students K to 12 students.

Other Allentown-based parochial schools serving K to 8 students include Saint John Vianney Regional School, Holy Spirit School, Lehigh Christian Academy, Mercy Special Learning Center, Our Lady Help of Christians School, Sacred Heart School, and Saint Thomas More School. Roman Catholic-affiliated parochial schools in Allentown are operated by the Roman Catholic Diocese of Allentown. Grace Montessori School is a pre-school and early elementary Montessori school run as an outreach of Grace Episcopal Church. Allentown has one private Jewish school, Jewish Day School, and two independent day schools, Salvaggio Academy, an independent day school, and The Swain School, which is associated with Moravian Academy. Newcomer Academy at Midway Manor and Allentown School District Virtual Academy are parochial schools serving grades 8 to 12.

Two four-year colleges, Cedar Crest College and Muhlenberg College, are based in Allentown. The city is also home to a satellite campus of Lehigh Carbon Community College (LCCC), a comprehensive community college that offers two-year and four-year degree programs, continuing education, and industry training whose main campus is in Schnecksville.^[102]

Allentown also has a public library.

Allentown is part of the Philadelphia media market, the fourth-largest television market in the nation. Major Philadelphia-based network stations serving Allentown include KYW-TV Channel 3 (CBS), WCAU Channel 10 (NBC), WPVI Channel 6 (ABC), and WTXF Channel 29 (Fox).^{[103][104][105]} Two television stations are located in Allentown: WFMZ-TV Channel 69, based in Allentown with studios and a transmitting site atop South Mountain, is an independent station, and WLVT-TV Channel 39, the regional PBS affiliate, is licensed to Allentown with studios in neighboring Bethlehem.

Nielsen Audio ranks Allentown the nation's 74th-largest radio market as of 2022.^[106] Stations licensed to Allentown include WAEB-AM (talk, news, and sports), WAEB-FM (contemporary hits), WDIY (NPR public radio), WHOL (rhythmic contemporary), WLEV (adult contemporary), WMUH (Muhlenberg College freeform campus radio), WSAN (oldies and Philadelphia Phillies broadcasts), WZZO (classic rock), and others. In addition, many stations from New York City, the nation's largest radio market, and Philadelphia, the nation's fourth-largest radio market, are received in Allentown.

Allentown has two daily newspapers, The Morning Call and The Express-Times. The Times News, based in Lehighton, also covers the city. Several weekly and monthly print publications are based in Allentown or cover the city's news and people.

The city's primary commercial airport, Lehigh Valley International Airport, is located 3 miles (4.8 km) northeast of Allentown in Hanover Township and is operated by Lehigh–Northampton Airport Authority. The airport has direct flights to Atlanta, Charlotte, Chicago–O'Hare, Detroit, Philadelphia, and several cities in Florida. The region is also served by Allentown Queen City Municipal Airport, a two-runway facility located on Lehigh Street in South Allentown used predominantly by private aircraft.

There are 314.10 miles (505.49 km) of public roads in Allentown, 26.16 miles (42.10 km) of which are maintained by the Pennsylvania Department of Transportation (PennDOT) and 287.94 miles (463.39 km) that are maintained by the city as of 2022.^[107]

The most prominent highway passing through Allentown is Interstate 78, which runs concurrently with Pennsylvania Route 309 along an east–west alignment across the southern portion of the city. I-78 runs from Lebanon County in the west to the Holland Tunnel and Lower Manhattan in the east, while PA 309 runs from Philadelphia in the south to the Wyoming Valley in the north. U.S. Route 22 briefly passes through the northwestern corner of the city as it follows the Lehigh Valley Thruway along an east–west alignment; it runs from Cincinnati, Ohio in the west to Newark, New Jersey in the east.

There are nine major inbound roads to Center City: Airport Road, Cedar Crest Boulevard, Fullerton Avenue, Hamilton Boulevard, Lehigh Street, Mauch Chunk Road, MacArthur Road, Tilghman Street, and Union Boulevard. Interstate 476, the Northeast Extension of the Pennsylvania Turnpike, passes to the west of the Allentown city limits. It runs from Plymouth Meeting outside Philadelphia in the south to Interstate 81 at Clarks Summit in the north.

Public buses in Allentown are provided by LANta, a bus system serving Lehigh and Northampton counties. Allentown Transportation Center, located on N. 7th Street, serves as a major hub for LANTA buses.^[108]

Multiple private bus lines serve Allentown at the intercity terminal at 325 Hamilton Street, including Trans-Bridge Lines and Greyhound Lines, offering direct bus service throughout the day to Port Authority Bus Terminal in Manhattan and intermediate points,^[109][110] and Fullington Trailways, which offers direct service to Williamsport, Hazleton, Philadelphia, and intermediate points.^[111] Martz Trailways stops in Allentown as part of its route between Scranton/Wilkes-Barre and Philadelphia and its commuter routes to New York City, which are part of the Amtrak Thruway that connects Amtrak trains at 30th Street Station in Philadelphia with the Lehigh Valley and Northeastern Pennsylvania.^[112] Public parking in the city is managed by the Allentown Parking Authority.

Allentown is a regional center for freight transport. Norfolk Southern Railway's primary Northeast hump classification yards are located in Allentown,^[113] and the city is served by R.J. Corman Railroad Group, a commercial railroad company.^[114] Major commercial rail traffic in the city include the Norfolk Southern Lehigh Line, which runs east through the city across the Delaware River, and Norfolk Southern's Reading Line, which runs west through Allentown to Reading.

The last passenger rail service in the city, which was provided by SEPTA, ceased operating in 1979, though one of SEPTA's two main Allentown train stations remains standing. In September 2020, Amtrak, as part of its expansion plan, proposed restoring rail service between Allentown and New York City by 2035.^[115][116] This largely single-track Amtrak route has been opposed by Norfolk Southern Railway, which acquired the Lehigh Line as part of its purchase of federally-founded Conrail in 1999. In November 2008, the Lehigh Valley Economic Development Corporation (LVEDC) and both Lehigh and Northampton counties commissioned a study, exploring restoration of the Black Diamond service, which ran until 1961, which would entail extending New Jersey Transit's Raritan Valley Line to Allentown.^[117]

Allentown was once a passenger rail hub served by the Central Railroad of New Jersey, using the Lehigh and Susquehanna Railroad, Lehigh and New England Railroad, Lehigh Valley Railroad, Reading Railroad, Lehigh Valley Transit Company, and Conrail. Routes served Wilkes-Barre and Scranton to the north, Buffalo and Williamsport to the northwest, Reading and Harrisburg to the west, Jersey City and New York City to the east, and Philadelphia to the south.^[118]

Electricity in Allentown is provided by PPL Corporation, which is headquartered in Allentown.^[119][120] UGI Corporation, headquartered in King of Prussia, supplies natural gas.^[121][122] Two cable companies, RCN Corporation, based in Princeton, New Jersey, and Service Electric, based in Bethlehem, have provided cable service to Allentown since the 1960s.^[123] The area's only landfill, Waste Connections of Canada, is locally headquartered in Bethlehem. Water and sewage, prior to 2013, were controlled by the city and are now managed by Lehigh County, following the end of a 50-year lease agreement. Waste, recycling, and yard waste are each administered by the city.

Lehigh Valley Hospital–Cedar Crest, located on Cedar Crest Boulevard and part of Lehigh Valley Health Network, is Allentown and the Lehigh Valley's largest hospital and the third-largest hospital in Pennsylvania with 877 beds and 46 operating rooms. It is also a Level 1 trauma center. St. Luke's University Health Network, Sacred Heart Hospital, and Good Shepherd Rehabilitation Network also provide hospital and rehabilitation services. In 2010, Allentown State Hospital, a psychiatric hospital in Allentown, was closed as part of a statewide closing of psychiatric hospitals by the Pennsylvania Department of Human Services.

The Allentown Fire Department, established in 1870, operates six fire stations in the city.^[124]

Since its 1762 founding, Allentown has been the birthplace or home to several notable Americans, including:^[125]

Allentown's reputation as a rugged blue-collar Rust Belt is one of several factors that has led it to be referenced broadly in popular culture during the late 20th and early 21st centuries.^[130] The city is often cited as one of the most prominent examples of a U.S. city, which was once a global leader in heavy manufacturing but was subsequently impacted by post-industrialization, offshoring, and the loss of substantial manufacturing-related jobs and companies in the late 20th century.^[131] Allentown has also been used as a backdrop for films depicting mid-20th century Americana.^[132][133] Several prominent examples include:

• In 2019, portions of the movie Glass were filmed at Allentown State Hospital and other Allentown locations.^[134]
• In 2011, Allentown is mentioned in the movie The Hangover Part II as Ed Helms sings a profane, modified version of the Billy Joel song "Allentown" to Zach Galifianakis as they ride down a river in Thailand. The version of the song also appears on the film's soundtrack, The Hangover Part II: Original Motion Picture Soundtrack.^[135]
• In 2009, Allentown is mentioned in the lyrics of indie rock band Say Anything's song "Fed to Death," the opening song on their album Say Anything.^[136]
• In 2008, in the movie The Wrestler, Mickey Rourke mentions Allentown as a location where he wrestled as he trained for his comeback.^[137]
• In 2005, portions of the music video for "Dirty Little Secret", the lead song on the album Move Along by The All-American Rejects were shot at various Allentown locations.^[138]
• In 2002, a primary scene in Season 4, Episode 9 of the HBO series The Sopranos, titled "Whoever Did This", in which character Christopher Moltisanti is ordered by Tony Soprano to dispose of the remains of Ralph Cifaretto after Tony kills him, was filmed in neighboring Lower Nazareth Township.^[133]

• In 1990, the movie I Love You to Death is loosely based on the real story of an attempted 1983 murder in Allentown.^[139]
• In 1988, portions of the movie Hairspray were filmed at Dorney Park & Wildwater Kingdom and other Allentown locations.^[140]
• In 1987, Season 5, Episode 23 of the sit-com Newhart, titled "Good-bye and Good Riddance, Mr. Chips", Dick Loudon, played by Bob Newhart, takes an adult typing class with a teacher who failed him in his sixth grade geography class at Cunningham Elementary in Allentown.^[141]
• In 1982, Allentown is the subject and title of the Billy Joel song, "Allentown," which is the first song on The Nylon Curtain album and uses Allentown as a metaphor for the resilience of working class Americans in distressed industrial cities during the recession of the early 1980s.^[142]
• In 1980, in the Broadway musical 42nd Street, Allentown is the hometown of lead character Peggy Sawyer.^[143]
• In 1975, Frank Zappa references Allentown in his song "200 Years Old," which appears on the album Bongo Fury.^[144]
• In 1968, the film Where Angels Go, Trouble Follows was filmed at Dorney Park & Wildwater Kingdom and other Allentown locations.^[145]
• In 1968, Hiding The Bell, a historical fiction novel by Ruth Nulton Moore, chronicles the hiding of the Liberty Bell in Allentown during fall of Philadelphia during the American Revolutionary War.^[146]
• In 1958, Allentown is mentioned in the Broadway musical Bye Bye Birdie.^[147]
• In 1954, exterior shots of Allentown's PPL Building, the city's tallest building, are featured throughout the movie Executive Suite.^[54]
• In 1934, Allentown is featured in the novel The Thin Man by Dashiell Hammett and the film of the same name. The references involve the apparent suicide attempt of Clyde Wynant in Allentown, but it turns out it was another man who was shot.^[148]

• Adams, Anna. "Perception Matters: Pentecostal Latinas in Allentown, Pennsylvania." in A reader in Latina feminist theology (U of Texas Press, 2021) pp. 98–113
• Lee, George A. "Negroes in a Medium-Sized Metropolis: Allentown, Pennsylvania--A Case Study." Journal of Negro Education 37.4 (1968): 397–405. online
• Marzan, Gilbert. "Still Looking for that Elsewhere: Puerto Rican Poverty and Migration in the Northeast." Centro Journal (2009) 21#1 pp 100–117 online; full coverage on Allentown
• Sandoval, Edgar. The New Face of Small-town America: Snapshots of Latino Life in Allentown, Pennsylvania (Penn State Press, 2010)

• Official website
• Allentown at Discover Lehigh Valley
• Allentown at visitPA
• Allentown news at The Morning Call
• Allentown news at Lehigh Valley Live
• "Famous People from the Lehigh Valley," The Morning Call, August 18, 2006