The Evidence Shows Benefits for Most, Not All Patients

This is perhaps the most important point.

Clinical research does support spinal manipulation as a treatment option for low-back pain, among other ailments. And the benefits vary from mild pain reduction to quite dramatic pain reduction depending on many, many factors.

The National Center for Complementary and Integrative Health summarizes the evidence as showing that spinal manipulation may produce improvements in both pain and function for acute and chronic low-back pain.

A large systematic review and meta-analysis published in The BMJ examined 47 randomized controlled trials involving 9,211 people with chronic low-back pain. It found that spinal manipulation produced outcomes broadly similar to other recommended treatments. Compared with those treatments, improvements in pain were observed, while also noting improvement in physical function. Now, you may be thinking, if chiropractic adjustments produce similar results compared to other recommended treatments then why bother with the chiropractor. Well, because chiropractic care is safe, cost effective and efficacious plus we are talking about a conservative approach to pain control without the use of drugs, invasive procedures and surgery. Seems pretty legit to me…

Chiropractic manipulative therapy works. Now, when combined with other types of treatment / modalities the results can be even more effective at controlling pain, healing injuries and improving function.

For many people with back pain, exercise, physical therapy, education, self-management, medication when appropriate, and other approaches can also help. Spinal manipulation is a tool that can be combined with other tools. In our clinic we try to mix and match many of the various therapy types into one care plan to ensure the fastest, most cost effective and safe approach to controlling pain and healing injuries.

What about the “crack”?

The audible pop can make an adjustment feel like something significant has happened.

But the sound itself isn't the therapeutic target.

The crack is generally associated with a rapid change in pressure within a joint and dissolved gas coming out of and back into a dissolved state. There is no good evidence that the sound itself means a vertebra has been “put back in place.”

In fact, an adjustment can sometimes be therapeutically useful without producing an audible crack.

So if you get an adjustment and don't hear anything, that doesn't necessarily mean the treatment “didn't work.”

Does an adjustment fix the underlying problem?

Usually, but that's too strong a claim.

Low-back pain is often nonspecific, meaning there isn't one identifiable damaged structure responsible for the symptoms. Pain can be influenced by muscles, joints, discs, nerves, physical activity, sleep, stress, previous injuries, and many other factors. Plus, what if there is an underlying issue with an organ for example. Lots of various diseases present as back pain but the back is not the pain generator, an organ like a kidney for example could be the pain generator. There are many examples of “organic” pain generators that we will not get into in this post.

Consequently, treating back pain isn't always about finding one misplaced vertebra and correcting it.

An adjustment may help decrease symptoms enough to make movement easier. That can potentially make it easier for someone to exercise, return to normal activities, and gradually build confidence in using their back again.

This is one reason current guidelines tend to view spinal manipulation as part of a broader approach rather than as a standalone “structural correction.” The World Health Organization, for example, says spinal manipulative therapy may be offered to adults with chronic primary low-back pain, but its recommendation is conditional. The WHO also emphasizes person-centered care and combinations of interventions such as education and exercise among many other treatments. This is why I am a proponent of a mixed approach to care where we can custom taylor different types of treatments / modalities to use simultaneously and not rely on any one treatment when the pain can be generated by numerous causative factors.

How long do the effects last?

This varies considerably from person to person and case to case. This question is impossible to answer with 100% certainty

Some people experience noticeable relief after one treatment. Others notice little or no change after visit #1 and require multiple treatments over a time-frame. What I have seen in practice depends on many factors with the person’s state of health, if an injury is involved or what the pain generator(s) is / are.

The appropriate frequency and duration of treatment should instead depend on whether the person is actually improving and whether continued treatment provides meaningful benefits for their situation.

Stay tuned for part 3 – to be continued…

This article is for general educational purposes and does not replace an individualized medical evaluation. Persistent, severe, or unexplained back pain—particularly pain accompanied by significant weakness, numbness, fever, trauma, or bowel or bladder changes—warrants medical assessment.