What Does a Chiropractic Adjustment Actually Do? Part 3

This post is part 2 of a 3 part post, if you have not already read part 1 or part 2 please do so

Is chiropractic manipulation safe?

For most appropriately selected people, spinal manipulation appears to have a relatively great safety profile.

Temporary soreness, stiffness, discomfort, or a temporary increase in pain can occur. The National Center for Complementary and Integrative Health (NCCIH) notes that these effects are usually mild to moderate and generally resolve within about 24 hours. These symptoms are similar to a nice workout in the gym and the next-day soreness that can accompany exercise.

Serious complications appear to be rare, although they are difficult to study because very large numbers of people would be needed to reliably detect extremely uncommon events. Research has also identified inconsistent reporting of adverse events in clinical trials. 

Here is a debated topic that I probably should not include in this post due to the amount of misinformation and historical smearing that has been allowed to go on. That being said – here we go…

Cervical manipulation has been associated with rare cases of cervical artery dissection in some of the medical literature, although the causal relationship remains debated because artery dissections can also occur spontaneously or after other types of sudden neck movements. Essentially, to my knowledge, there has never been a truly causal link of a cervical spine manipulation 100% causing an arterial dissection. There has never truly been a confirmed case that I am aware of, yet this story continues to be told around the “campfire”.  The latest statistic is that more arterial dissections occur after a primary care doctor visit than a chiropractor visit. Does this mean the PCP caused the dissection, I would think not. And so the debate continues without resolution. 

A qualified practitioner should therefore take a medical history and consider conditions that could make manipulation inappropriate / contraindicated.

What an adjustment probably does—and doesn't do

Based on current evidence, a reasonable way to describe a chiropractic adjustment is:

It is a controlled mechanical stimulus to the spine that can influence joint movement, sensory input, muscle activity, and pain processing. For some people with headaches, neck, mid-back and / or low-back pain, this can produce an improvement in pain and physical function.

What the evidence does not establish is that routine back pain is generally caused by vertebrae being “out of alignment,” or that an adjustment permanently places those vertebrae back into a correct position.

That doesn't make chiropractic manipulation useless. It simply puts its effects into a more scientifically defensible framework. We are taking the old story-time chiropractic and shining a modern more evidence-based light on the subject.

The bigger picture

The strongest evidence supports thinking of an adjustment as addressing root causes, symptom-management and movement intervention, rather than a permanent structural repair.

For someone with uncomplicated low-back pain, manipulation can be a reasonable option, particularly when it is combined with approaches that help the person remain active and improve physical capacity.

The World Health Organization (WHO) includes spinal manipulative therapy among the treatments that may be offered for chronic primary low-back pain, while also recommending broader, integrated care rather than relying on a single intervention. 

Ultimately, the goal shouldn't be to keep a spine “in alignment.”

The goal should be to help a person hurt less, move better, function better, and get back to the activities that matter to them.

And according to the medical evidence, chiropractic manipulation can sometimes be one part of achieving that goal, but it isn't magic, it isn't a universal solution, and its benefits should be judged by the same standard as any other treatment: does it meaningfully help the individual patient?

Now, there is a growing populus of chiropractors who care for various types of animals. I personally have never adjusted an animal before but that does not mean I never will  😉 This end of the chiropractic spectrum is of importance in that medical research loves to use “control” groups and have patients enrolled in studies not know what they are getting, say a “placebo” group.  The part I love is that veterinary chiropractors tell me they see amazing results with the animals they treat.  Animals do not fake symptoms, they do not fake responses to care so the responses we observe tend to be truly objective observations that are a clue into the true efficacy of chiropractic care and the relative safety of the care chiropractors deliver day in and day out.

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.