What Does a Chiropractic Adjustment Do?

This is such a common question, it is continually being researched and the answer refined.  It is so rarely answered well, that I thought it would be good to create a full page to answer.  I will also update it periodically?  When I do update it I will create a post about the update so that you can be kept up to date, and the information will be all in one place.

In my first post on this topic.  I decided to leave out some reasons for space limitations (I try to keep my blogs under 400 words, not that I’m always successful), and some for the lack of research, some for  them being controversial, and many others I just don’t know about.

So, here goes…

Chiropractic manipulation is not just joint popping. In fact the audible pop doesn’t even need to occur for a successful manipulation, though it often does, and some patients and doctors like to hear it. Research has found that pop or not, the same benefits are experienced and that trying repeatedly to get a pop can actually cause damage.

The mechanism of why manipulation works is not completely understood. One thing that is understood is that it does work. Most of the simple explanations are incomplete or just plain wrong. The most recent research points to a more complex reason for the therapeutic effects of chiropractic manipulation. It is suggested that many things are occurring at the same time that provide the benefits.

Here are some of the known things that can begin to explain why manipulation works.

1. Positive neuroplastic effects improve the way the brain perceives what is going on in the body and the world around it. The paraspinal muscles are sensors and have more sensors in them per gram than other muscles in the body. These sensors are triggered by adjustments. Interpretation of nervous impulses going to the brain is altered by the manipulation of these joints and muscles, thus expressed sensations such as pain are altered. This alteration can lead to pain relief or other changes in the way that your brain perceives and reacts to reality.

2. Movement provides improved nutrient supply. The cartilage and other structures inside of a joint have no blood supply. These structures get their nutrients through motion. The blood supply goes to the outside of the joint and nutrients move into the synovial fluid of the joint. Joint motion moves this fluid around thus providing fresh nutrients to all parts of the joint, as well as removing waste. If a joint becomes locked down by muscle spasm, scar tissue, a cast, or any other means, for a prolonged period of time the joint begins to feel stiff.You know the feeling of needing to stretch after sitting in the car for a long time.

The facet joints in your spine are particularly vulnerable to this problemskeleton because they work in tandem and because of the body’s amazing ability to compensate. Your facet joints all work together, if one is injured it can become locked down to prevent further injury. When this happens you may get the desire to stretch or move your back. This usually works, but if all of the other joints compensate for the problem joint and take that added stress of movement on themselves then the problem joint stays locked down. Specific manipulation induces full range of motion and synovial fluid movement.

3. Manipulation can reduce pressure on the nerves. Your nervous system is the control center of your body, and it is not without weaknesses.  Nerves and nerve bundles are soft tissue.  They don’t function well under physical pressure.  In fact it has been shown that inflammation, a bulging disc, or fragment floating around can interfere with proper nerve conduction.  The stuck joint as discussed previously can also physically be stuck pressing on a nerve, causing a disc herniation to press on the nerve, or causing inflammation that is pressing on the nerve, or just be moving in a way that rubs the nerve.  In any case.  The adjustment can cause a relief of this pressure through movement of the joint to the correct position, or motion. The pressure needed for that is large, and so though it is one effect of the adjustment it is numerically a very small number of chiropractic cases that are treated through this mechanism.

4. Proprioceptive retraining allows for improved function. The brain also records these proprioceptive signals from the joints motion. Especially for chronic conditions the brain is in need of retraining regarding the motion of that joint. Manipulation takes a joint through its full range of motion. This new input is then stored and replayed in the brain, similar to muscle retraining that physical therapists will do, or physical training of athletes, when the body has done the motion enough times it remembers it. This retraining provides a functional correction that may provide pain relief.

5. Proprioceptive stimulation triggers the release of endorphins. These endorphins cause a near instant and temporary relief similar to pain medication making you less aware of the problem. This trick of the body can cause a secondary benefit, that of relaxing local tissues such as trigger points or tight musculature that may be pinching nerves.

Here are some of the more controversial observations, benefits, and mechanisms of chiropractic. (I must note that just because we don’t know how it works doesn’t mean that it doesn’t.)

Somatovisceral effects – That they exist is not so much controversial as is the predictability.  We know that the spine can effect the visceral organs, but we can’t really say that if you adjust this level this often in this way that you will get the pancreas to produce this much more insulin.  The mechanism, more likely, is one of many things acting on the organs.  As with everything else in the body it is more complicated than one single interaction.

Reduced high blood pressure – WebMD research article more research needed, and mechanism unknown.

Improved immune system response – I have yet to see a great side by side study of people who receive chiropractic care next to a control group who doesn’t, to see who gets a cold and how long they last.  However there are articles and case studies out there.  Even if chiropractic does benefit the immune system, we don’t know the mechanism of how.

Decreased colic in babies – I’ve seen an association, and I’ve read studies that show that there is an effect.  I don’t know the mechanism, and I’ve not seen anything more than theories.

I have taken to recording my own observations and creating case studies of the effects of chiropractic that I have seen. Two new and relatively unstudied benefits that I have found are  an improvement in vocal performance, and a decrease in bed wetting with chiropractic manipulation.  A mechanism for these is not fully understood yet.

Many other benefits have been observed, and still others suspected. Research is still going on and much more is needed.  I will add them and any new or additional documentation as I find them, and as my time permits.

237 thoughts on “What Does a Chiropractic Adjustment Do?

  1. Dina

    I found out I have DDD about two months ago. I do chiropractic treatments twice a week. Every so often I feel the muscles on my lower back throbbing and tighten. I asked my chiropractor why it’s happening she didn’t seem to have an answer. I also have pain on my lower spine it especially hurts when I lay on hard surfaces or push on that area. Is that some how connected to my muscles throbbing

    Thank you in advance

    1. cmnacnud Post author

      I’m sorry Dina. There are too many possibilities to speculate over the internet. With an examination I may know more, but even then symptoms that happen every once in a while are hard to pin down to a particular problem. It could be anything that you’re doing. Laying on hard surfaces or pressing on an inflamed area could be related to the throbbing, but may not be. With more info I may be able to help such as a postural and functional analysis.

  2. Mel

    I’ve seen a chiropractor off and on for a few years. I know from xray that i have compensatory scoliosis, my right leg is 9mm longer than my left. I have to wear an orthotic in my left shoe for this. I have 3 curves in my spine. I don’t have a ton of pain, but most of it is in my lower left back. My chiro used to do the usual routine and then yank my arms very abruptly. I’d feel a sharp pain in that location i have most of my pain and then a lot of relief. Each time he did it, it hurt less and less. Curious what he was doing and why it worked.

    1. cmnacnud Post author

      Your description of his adjustments are very vague. I’m not sure what the usual routine is, and I’m also not sure how he would “yank” your arms. The best thing to do would be to contact him and ask him what he was doing. If he is unavailable please try to get as specific with your description as possible so that I might know what technique he was using. Without knowing that I will be unable to determine what was going on.

  3. Greg Forrester

    I just started going to the chiropractor a few weeks ago. Just for my lower back and neck. And to see if my swollen wrists could be fixed. Gave me electric pulses in both forearms. Forearms worse. After second time both knees are swollen. Sometimes very hard to stand and walk. I workout. BUT HAVEN’T SINCE BEFORE GOING TO THE CHIROPRACTOR. TOES HURT. ANKLE HURTS. BOTH KNEES ARE SWOLLEN. BEEN OVER A WEEK AND A HALF ALMOST TWO WEEKS. Did the chiropractor mess me up? Need help asap. Greg

    1. cmnacnud Post author

      With the limited information that you have given me it is impossible to tell if your chiropractor might be at fault. The only treatment that you mentioned the chiropractor doing was some “electric pulses” (I assume TENS) in your forearms. I don’t see how that would affect your standing, walking, knee swelling, toe or ankle pain. What did your chiropractor say when you asked him why this might be happening? Was there any other treatment done? Can you tell me more about the diagnosis and treatment methods? Were you given any home care to do, and did you do it? Ultimately I would suggest that you speak to your chiropractor about your concerns as he is the one who knows the case. If you would like, then get a second opinion exam through a different doctor. That would be my recommendation. I hope that helps.

    2. Nikki

      Just finding this thread….Greg the SAME thing is happening to me. Been seeing a chiropractor now for 3 weeks. Both of my knees have swollen to where the pressure is so much it’s hard for me to walk. I can’t bend them at all. If I try, it feels as if my knees are going to pop open. The reason I was told (from another form of doctor, not my chiropractor) is that while she has been adjusting me it sounds like she has unblocked a nerve that has allowed more blood flow causing my knees to swell. I will say this….my lower back would go numb and tingle all the time until now. It feels great. I was told to give a little time and the swelling would eventually move out

  4. Anne Stewart

    I went to the Chiropractor with sore knees and she gave me 4 adjustments on my back over two weeks and now my back is so sore after 6 months and is not getting any better – before I did not have back pain and now I can’t get up from lying on my back I have to roll over

    1. cmnacnud Post author

      I’m sorry to hear about your back pain Anne. I would be happy to explain the reason for adjusting the spine in order to treat your knees. If she treated you for two weeks and then discontinued then either you did not finish the full treatment plan or it was a minor issue that was resolved in that period. I’m not sure how you having back pain six months later would be related to the treatment, though if you did not complete the treatment plan and your knees continued to get worse the mechanical stress on the knees can cause you to compensate using your back thus leading to over/misuse of the spine which could understandably lead to back pain.
      If your back pain started during the treatment and was the cause of your ending care then I would have to ask what did the chiropractor say about it when you described your new symptom to her? What led to your decision to not treat it further?

  5. Dustin Patton

    I injured my lower back doing squats. I suffered a lower back strain and after my back pain went away he found that my piriformis was tight and was hitting my sciatic nerve. That has sense loosened up. I was and currently only experiencing pain on my left side. I started going to a chiropractor 3 weeks. The first week I went 3 days, second week I went 2 days. I went back today and he said that my hip is not quite setting in. He set me back in place. I hope that this gets better over time. Any thoughts?

    1. cmnacnud Post author

      That sounds like a reasonable course of action. You’ve had 6 treatments for a strain and the resulting surrounding injuries secondary to that strain, and they seem to be working quite well. At this point I would usually start recommending strengthening exercises to begin the process of stabilization so that you are less likely to have a similar injury in the future. Your chiropractor may have other ideas to help in that process, but it sounds like he is doing well already. Good luck. Let me know how it goes.

  6. Aileen Svec

    I have had severe back problems for the last 20+ years. I have had spondylolisthesis and spondylolysis. First back fusion done from L5-S1 with cages. My next level up went out from all of the torque. I had a fusion with rods and pedical screws from L4-L5. It was great until explosive pain 5 weeks later during my walk program. Multiple calls and complaints to ortho doc. Finally my hubby said enough is enough and made the Doc take an xray. That’s where he saw that the hardware had broken and fell apart. I had been walking around unfused for weeks!!!!!! Doc re operated and fixed multiple broken issues and fused me L4-S1. I’m now fused from L4-S1 with rods, screws and cages but I continue to have really bad pain in my back all over. The worst is in the left SI joint area. Can I get chiropractic manipulations with all of this surgery and metal fusions? I figure with metal rods, cages, screws etc. manipulation is not a great idea, however I
    just hate the pain!
    I’ve never been to a chiropractor. Just wanted to know what you think.

    1. Aileen Svec

      I also forgot to mention that the surgeon placed the left S-1 pedicle screw into the S-1 nerve root. No one believed my pain until many months later when I got a new doctor who finally did a scan which showed the mistake. By the time it was discovered the Boston specialist I saw said that it was too late to take the screw out. He said the scar tissue that had since formed would tether the nerve and pull it out like a piece of spaghetti.He said it’s better to be able to walk than to pull that out!!!!!

      1. cmnacnud Post author

        I’m sorry to hear about your difficult situation. Getting chiropractic after fusion is possible, but must be done with caution. Make sure that you inform any chiropractor that you go to about your situation. They should not adjust the levels with the hardware, but can adjust the surrounding areas to make sure that they move as well as possible and hopefully help to prevent further fusion surgeries.

  7. Camille J. Brown

    Such a great article. And I never really understood that the “pop” isn’t necessary for a manipulation to be successful. I have, however, experienced so many of the benefits you refer to that I continue to go for adjustments. I don’t have allergies and I am rarely sick, so I can’t help but think that keeping things aligned helps with that. Thanks for posting!

  8. Lekeduff

    I am having a sharp pain in my inner right thigh and numbness along my lower right leg down to the toes. I have seen an orthopedic surgeon for over 3 months and I have not had any improvement on the pain and the sensation along my leg.

    From the xray, it looks that the ball head of the right femur is more closer to the pelvic girdle than the left.

    Will a visit to a Chiropractor help?

    1. cmnacnud Post author

      No treatment is 100% effective. That is to say that there is no guarantee. An examination and trial of care is in order. If you have tried other things without improvement then I would recommend visiting a chiropractor to see if they can help your body to return to normal health. If it is a joint dysfunction chiropractic has very good track record with those kind of complaints.

  9. D

    I am wondering if manipulations by a chiropractor can ever cause a herniated disc? Also, if a person already has a herniated disc should the chiropractor manipulate that area?

    1. cmnacnud Post author

      Thanks for your question. To my knowledge chiropractic adjustments have not been found to cause disc herniations, but if a herniation is already present there is a possibility of exacerbating the condition. This is why chiropractors go to school for so long. They are trained to treat disc herniations and adjustments can be very beneficial, and so chiropractors will do all that they can to provide proper treatment so that they improve rather than worsen the situation. Here is a wonderful article on the topic: https://www.ncbi.nlm.nih.gov/pubmed/15129202
      The summary is that Chiropractic care (not always an adjustment) is safer than current standard medical treatments for lumbar disc herniation.

    1. cmnacnud Post author

      In theory, clinical spinal manipulations could lead to a herniated disc, but would not be the cause. The cause would be a weakened Annulus Fibrosis. If it is weakend then any increased pressure could lead to herniation. Most of the time chiropractic adjustments decrease pressure on the joints being adjusted, there are of course exceptions. The rapidly decreased pressure is what is thought to lead to the cavitation or popping sound. Spinal manipulation may be contraindicated for certain cases, but most cases will benefit from chiropractic care, even though that is not always manipulation.


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