Chiropractic Adjustments
Episodes covering chiropractic adjustments — protocols, research, and expert discussions.
Spinal manipulation therapy performed by chiropractors - supported by multiple meta-analyses for low back pain and neck pain, with modest but real benefits and a strong safety profile across nearly a million documented sessions
Evidence-Based Take:
Chiropractic spinal manipulation therapy (SMT) has a surprisingly solid evidence base for certain musculoskeletal conditions. Multiple meta-analyses in top-tier journals (BMJ, JAMA) show statistically significant benefits for low back pain, though effect sizes are modest.
What the Evidence Shows:
- Chronic low back pain: Small but real improvements in pain and function vs controls (Rubinstein 2019, BMJ)
- Acute low back pain: Modest short-term pain reduction (Paige 2017, JAMA)
- Neck pain: Moderate evidence of benefit, particularly combined with exercise (Minnucci 2023, JOSPT)
- Cervicogenic headache: Moderate short-term benefit (Fernandez 2021)
- Safety: Very low serious adverse event rate across 960,000+ sessions (Chu 2023)
The Limitations:
GRADE certainty for most outcomes is "low to very low" - not because the research is bad, but because blinding is nearly impossible (patients know if someone cracked their back). Effect sizes are modest: typically 5-10 points on a 100-point pain scale. Not dramatically better than other conservative treatments like exercise therapy.
Honest Assessment:
Chiropractic SMT is a reasonable option for musculoskeletal pain, especially low back and neck pain. It's not a miracle cure, the benefits are modest, and exercise therapy often performs comparably. But it's safe, many people find it helpful, and guidelines from multiple countries include it as a treatment option. The biggest concern isn't safety - it's practitioners who oversell maintenance visits or claim to treat non-musculoskeletal conditions.
Science & Mechanisms
How Spinal Manipulation Works:
Biomechanical Effects:
- High-velocity, low-amplitude (HVLA) thrust applied to spinal joints
- Cavitation: The "crack" is gas bubbles releasing from synovial fluid
- Temporarily increases joint range of motion
- May reduce muscle guarding and spasm around the joint
Neurophysiological Mechanisms:
- Stimulates mechanoreceptors in joint capsules and paraspinal muscles
- Activates descending pain inhibition pathways
- Temporary reduction in spinal cord excitability
- Changes in muscle spindle activity and motor neuron firing
- May modulate pain perception through gate control mechanisms
Inflammatory Response:
- Brief inflammatory marker changes post-manipulation
- Some evidence of reduced local inflammatory cytokines
- Effects on substance P and other pain mediators
What the Meta-Analyses Say:
Low Back Pain (Strongest Evidence):
Rubinstein et al. 2019 (BMJ): Cochrane-quality meta-analysis found SMT produces small improvements in pain (mean difference -12.0 on 100-point scale) and function for chronic low back pain vs controls. Benefits were similar regardless of the comparison treatment. GRADE certainty: low to very low.
Paige et al. 2017 (JAMA): Meta-analysis found modest improvements in pain (-9.95 on 100-point scale) and function for acute low back pain. Short-term benefits only; no long-term superiority.
Neck Pain:
Minnucci et al. 2023 (JOSPT): Systematic review found moderate evidence that SMT combined with exercise provides better outcomes than SMT alone for neck pain. Multimodal approach is key.
Headache:
Fernandez et al. 2021: Meta-analysis showed moderate short-term benefit for cervicogenic headache intensity and frequency. Evidence weaker for tension-type and migraine headaches.
Safety Data:
Chu et al. 2023: Analysis of 960,000+ chiropractic sessions found very low rates of serious adverse events. Most common side effects were transient soreness and stiffness. Vertebral artery dissection risk is extremely rare and causation is debated.
Key Limitations Across Studies:
- Blinding is nearly impossible (sham manipulation doesn't fully replicate the experience)
- Heterogeneity in techniques, dosing, and comparators
- Many studies have high risk of bias
- Effect sizes are consistently modest
- Hard to separate specific effects from therapeutic context
Episodes
Shawn Stevenson sits down with chiropractor Dr. Xavier Tipler to explore why chiropractic care goes far beyond treating back pain. Dr. Tipler explains that chiropractic focuses ...
Dr. Jeff Langmaid breaks down a 2024 retrospective cohort study examining whether chiropractic spinal manipulation reduces fall risk in older adults with spinal pain. The resear...
Dr. Robert Prather and co-host Lisa Prather discuss why chiropractic care extends well beyond spinal adjustments to include extremity work on wrists, elbows, shoulders, knees, f...
Dr. Jeff Langmaid reviews a brand new study on the efficacy of combining physiotherapeutic scoliosis-specific exercises with manual therapy (including spinal adjustments) for ad...
Dr. Stacey Merlot, a chiropractor specializing in prenatal and pediatric care for 11 years, joins the Preggie Pals panel to discuss chiropractic care during pregnancy. She expla...
Dr. Jeff Langmaid dives into a cutting-edge study published in Chiropractic and Manual Therapies examining how different force levels of spinal adjustments affect blood biomarke...
Dr. Dean Smith interviews Dr. Bernadette Murphy, a leading chiropractic neurophysiology researcher at the University of Ontario Institute of Technology. Dr. Murphy describes how...
Ross and Carrie from their investigative podcast tackle chiropractic in part one of a three-part series. Ross, dealing with increasing back pain in his early 40s, decides to vis...
Pediatrician Dr. Mona (a DO/osteopathic doctor) sits down with Dr. Richard Schoonmaker, a former chiropractor now in osteopathic medical school, for a nuanced conversation about...
Host Blake interviews Dr. Courtney Kahla, owner of Our Well House, a nervous system-centered chiropractic practice. Dr. Kahla explains the distinction between traditional "crack...
Robert Evans and comedian Billy Wayne Davis explore the bizarre origins of chiropractic medicine, founded by D.D. Palmer in the 1890s. Palmer, a magnetic healer in Davenport, Io...
Spencer Henry of Cult Liter dives into the controversial and strange origins of chiropractic care, covering D.D. Palmer's journey from magnetic healer to chiropractic founder. P...