Jordan Loewenstein, D.C. | La Jolla Chiropractor
Quick answer: yes, spinal adjustments work, for a specific list of problems. The best evidence is for low back pain, neck pain, and headaches that start in the neck, where spinal manipulation performs about as well as the other recommended treatments and is recommended as a first-line, non-drug option in major guidelines. Adjustments do not cure disease, do not boost your immune system, and are not putting bones “back in place.” What they do is restore motion to a stiff joint and change how the nervous system is processing pain from that area, which is why people usually feel looser and less guarded immediately afterwards.
A chiropractic adjustment, or spinal manipulation, is a quick, controlled, small-amplitude movement applied to a joint at the end of its available range. The technical term is high-velocity, low-amplitude thrust. It usually produces an audible pop, which is gas releasing inside the joint capsule as the pressure drops, not bone moving onto bone. Some techniques, including the flexion-distraction I use for disc problems and the lower-force methods I use for people who need a gentler approach, produce no sound at all and are still adjustments.
The old explanation, that a vertebra is “out” and the adjustment puts it back, does not survive contact with imaging: joints do not visibly move position after manipulation. The current understanding involves three overlapping effects. First, a mechanical one: stretching the joint capsule and surrounding tissue restores range of motion to a joint that had become stiff, and the improvement in movement is measurable. Second, a neurological one: the sudden stretch resets the activity of the small muscles around the joint, which is why muscle spasm often lets go immediately. Third, a pain-processing one: manipulation produces a short-term reduction in pain sensitivity both at the treated area and elsewhere in the body, which points to an effect on how the spinal cord and brain are handling pain signals. That last effect is real, measurable, and temporary, which is exactly why adjustments are paired with exercise that produces lasting change.
The largest body of evidence. A 2019 systematic review in the BMJ pooling 47 trials found spinal manipulation for chronic low back pain produced similar improvements in pain and function to other recommended therapies such as exercise, and better results than non-recommended care. The American College of Physicians guideline recommends spinal manipulation as one of the first-line non-drug treatments for acute and chronic low back pain, ahead of medication. For acute episodes, manipulation speeds recovery modestly; for chronic pain, it performs as well as anything else that works.
Cochrane reviews and later trials show manipulation and mobilisation improve neck pain and function in the short and medium term, and that the combination of manual therapy with exercise outperforms either alone. A well-known trial comparing manipulation, medication and home exercise for acute and subacute neck pain found manipulation and exercise both beat medication at twelve weeks.
For cervicogenic headaches, the ones that start in the upper neck and refer to the head, manipulation has consistent supporting evidence. For tension-type headache the evidence is more mixed, and for migraine, manipulation may reduce frequency for some people but is not a primary treatment. I am clear about this distinction with headache patients; the headache page goes into detail.
Hips, shoulders, ankles and the rib joints can also be adjusted, and manipulation of these joints is part of care for a wide range of sports and overuse injuries, usually alongside soft tissue work and loading exercises.
Adjustments do not treat asthma, ear infections, colic, blood pressure, digestive problems or immune function. Claims that they do are based on the outdated idea that spinal misalignments cause organ disease, and the trials that have tested those claims have been negative. If you have been told adjustments will prevent illness, you have been told something that is not true. I treat musculoskeletal problems, and I say so plainly.
The common side effects are mild and short-lived: soreness, stiffness or a mild headache in the first day or two, which a sizeable minority of people experience after early visits. Serious complications are rare. The one that gets the most attention, stroke from injury to a neck artery after cervical manipulation, has been studied closely; the best evidence indicates the association exists mainly because people with an artery dissection already underway present with neck pain and headache and seek care, rather than the adjustment causing the injury. I screen for it regardless, and there are people I do not adjust: those with severe osteoporosis, recent fractures, certain inflammatory conditions, bone infection or tumour, or signs of nerve compression that need urgent care. More on the neck question in my piece on cracking your own neck.
On your first visit (45 minutes) I work out whether an adjustment is the right tool for your problem and which joints actually need it. That decision comes from range of motion, orthopaedic and neurological testing and palpation, not from a routine of adjusting the same segments on everyone. I do not need an X-ray to adjust you; imaging is for red flags and cases that are not progressing, as I explain in the guide to X-rays and MRIs for back pain.
Adjustments are almost always paired with something else: soft tissue work on the muscles that have been guarding the joint, heat or electrical stimulation when spasm is significant, and exercise that keeps the new range of motion. The adjustment opens the window; the exercise keeps it open.
Follow-ups are 30 minutes. I modify technique for pregnant patients, children from age five, and older adults, using lower-force methods where a thrust is not appropriate. If you are nervous about being adjusted, tell me; there is always a gentler way to start.
Do chiropractic adjustments actually work?
For low back pain, neck pain and cervicogenic headaches, yes. Systematic reviews show spinal manipulation performs about as well as other recommended treatments, and major guidelines recommend it as a first-line non-drug option for low back pain.
What does an adjustment do to the spine?
It restores motion to a stiff joint, releases the small muscles around it, and temporarily reduces pain sensitivity through effects on the nervous system. It does not move bones back into place.
Can adjustments boost immunity or treat other health conditions?
No. There is no good evidence that spinal adjustments treat asthma, infections, blood pressure, digestive problems or immune function. Adjustments treat musculoskeletal problems.
Are spinal adjustments safe?
For most people, yes. Temporary soreness is the most common side effect. Serious complications are rare, and a proper history and examination identify people who should not be adjusted or need a modified approach.
Why do adjustments feel good but the pain comes back?
The immediate relief comes from restored joint motion and a short-term drop in pain sensitivity. Lasting change requires the strengthening and mobility exercises that address why the joint stiffened in the first place.
Dealing with back pain, neck pain or headaches? Book a first visit at my UTC San Diego office; I am open Sundays.
Dr. Loewenstein diagnoses the actual source of your pain before treating it — soft tissue work, adjustment, and rehab in one visit. Most major insurance accepted, no packages or contracts.