Back and neck pain are among the most common musculoskeletal complaints worldwide, often affecting productivity, sport performance, and quality of life. For many individuals, chiropractic adjustment is sought as a treatment option to reduce pain, improve mobility, and enhance well‑being. However, patients, physiotherapy students, and even healthcare professionals often have questions regarding the science, safety, and clinical value of this treatment approach.
This article provides an evidence-based, clinically accurate, and easy-to-understand overview of chiropractic adjustments—what they are, how they work, their benefits, limitations, and current guideline recommendations.
What is a Chiropractic Adjustment?
A chiropractic adjustment (also called spinal manipulation or manual thrust technique) is a controlled, high-velocity, low-amplitude (HVLA) therapeutic maneuver applied to a joint, most commonly within the spine, but also sometimes to peripheral joints such as the shoulder or ankle.
The primary intent is to:
- Improve joint mobility
- Reduce pain
- Restore function
- Influence muscle activity and nervous system responses
During an adjustment, you may hear a “popping” or “cracking” sound. This is typically caused by cavitation—a process in which gases dissolved in joint fluid form bubbles that collapse, leading to an audible release. Contrary to popular belief, the sound is not bones being cracked but a pressure change within the joint.
Physiological Mechanisms of Chiropractic Adjustment
While research continues to explore the exact mechanisms, several theories provide insight into why spinal manipulations may be effective:
- Neurophysiological Effects – Stimulation of joint receptors and mechanoreceptors influences spinal cord and brain activity, leading to reduced pain perception.
- Muscle Reflex Modulation – Adjustments can reduce muscle spasm, alter muscle tone, and improve coordination.
- Biomechanical Effects – Restoring joint play and movement reduces stiffness and increases range of motion.
- Psychological and Placebo Effects – The hands-on therapeutic encounter, patient expectations, and trust in the practitioner also contribute to clinical outcomes.
Evidence-Based Benefits of Chiropractic Adjustment
Research evidence for spinal manipulation has grown substantially over the past two decades. Here is what current clinical guidelines and systematic reviews suggest:
1. Low Back Pain
- Acute and subacute low back pain: Multiple guidelines (including American College of Physicians, 2017) recommend spinal manipulation as a first-line non-pharmacological option.
- Chronic low back pain: Moderate evidence shows spinal manipulation provides small-to-moderate improvements in pain and function, particularly when combined with exercise.
2. Neck Pain
- Evidence is mixed, but spinal manipulation combined with exercise and education may be more beneficial than exercise alone.
- Cervical manipulation should always be delivered by trained clinicians due to higher potential risks.
3. Headaches
- Evidence supports spinal manipulation, particularly for tension-type headaches and some cases of cervicogenic headaches (headaches originating from the neck).
- Migraine improvement is less consistent, though some patients report perceived benefit.
4. Sports Performance
- Some athletes seek chiropractic adjustment for mobility, recovery, and injury prevention. While evidence on direct performance enhancement is limited, musculoskeletal recovery and symptom relief may indirectly support performance.
Risks and Safety Considerations
When performed by a well-trained and licensed chiropractor or physiotherapist skilled in manual therapy, adjustments are generally considered safe. However, like any intervention, risks exist:
- Mild side effects: Temporary soreness, stiffness, or fatigue (lasting 24–48 hours).
- Rare but serious risks: Vascular injury, stroke (primarily linked to neck adjustments), nerve injury, or fracture in at-risk populations (e.g., osteoporosis).
Safety Guidelines:
- Proper screening for red flags (fracture, malignancy, severe osteoporosis, spinal instability).
- Avoidance of cervical manipulation in patients with vascular risk factors or connective tissue disorders.
- Informed consent with clear explanation of risks and benefits.
Chiropractic Adjustment vs. Physiotherapy
While chiropractic adjustments are one form of manual therapy, physiotherapy encompasses a broader range of evidence-based interventions including:
- Therapeutic exercise
- Patient education
- Electrotherapy modalities
- Soft tissue techniques
- Functional rehabilitation
Best Practice Recommendation: Evidence strongly supports combining spinal manipulation with exercise therapy and self-management strategies for lasting results, rather than relying on adjustments alone.
Who Can Benefit from Chiropractic Adjustments?
Chiropractic adjustment may be beneficial for:
- Adults with non-specific low back or neck pain
- Patients with joint stiffness and movement restrictions
- Individuals with cervicogenic headaches or tension-type headaches
- Athletes experiencing mobility limitations
- People seeking non-drug alternatives for pain management
Who Should Avoid Chiropractic Adjustment?
Contraindications include:
- Spinal malignancy or infection
- Severe osteoporosis
- Acute fractures
- Cauda equina syndrome or significant neurological deficit
- Unstable vascular conditions (such as arterial dissection)
Current Consensus & Clinical Guidelines
- National Institute for Health and Care Excellence (NICE, UK): Recommends spinal manipulation as part of a multimodal package of care for low back pain.
- American College of Physicians (2017): Manual therapy, including spinal manipulation, is advised before medications for acute low back pain.
- World Health Organization (WHO): Recognizes spinal manipulation as part of integrative care for musculoskeletal conditions, provided safety is prioritized.
Summary for Different Audiences
- For Patients: Chiropractic adjustment can relieve pain and improve movement when delivered by a trained professional, especially when combined with exercise and lifestyle changes.
- For Physiotherapy Students: Understanding both the biomechanical and neurophysiological effects is crucial. Evidence supports its role, but integration with active rehabilitation is key.
- For Sports Coaches: Adjustments may aid mobility and recovery but should not replace physiotherapy-led exercise, conditioning, and injury prevention strategies.
- For Healthcare Professionals: Evidence supports spinal manipulation as part of a multidisciplinary, guidelines-driven approach to musculoskeletal pain, not a stand-alone solution.
Conclusion
Chiropractic adjustment is an evidence-supported, hands-on treatment method that can provide meaningful relief for selected musculoskeletal conditions, especially back pain, neck pain, and certain headaches. When applied safely and integrated into a holistic care plan that includes exercise, education, and lifestyle modification, adjustments can help improve pain, function, and quality of life.
At MY PAIN CLINIC Global, we combine the latest evidence-based manual therapy techniques with rehabilitation strategies to deliver safe, lasting, and patient-centered solutions.
Take the first step towards pain-free movement. Book your consultation at MY PAIN CLINIC Global today and experience expert care tailored to your needs.