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Discussing the Chiropractic Adjustment

Discussing the Chiropractic Adjustment

Getting adjusted by a chiropractor can be one of the most therapeutic, relaxing, and beneficial treatments anyone can receive. But what is a chiropractic adjustment? How does it work? What symptoms do we need to look out for and refer out for? The topic of the chiropractic adjustment is certainly an interesting one worth delving into.


 The term chiropractic adjustment needs definition and some clarification for sure. When we say chiropractic adjustment, we mean spinal or extremity manipulation performed by a chiropractor. This is necessary to mention because, for one, chiropractic is a profession and not a modality as often confused. “I had chiropractic done,” or “The purpose of this study is to compare chiropractic manipulative therapy to this modality” are phrases either spoken or written in research articles, respectively. 

Chiropractic means more than just an adjustment, it also means therapeutic exercise, neuromuscular reeducation, non-surgical decompression, nutritional counselling, cryotherapy, electric stimulation, soft tissue treatments, and spinal or joint mobilization and manipulation are all performed by a chiropractic physician, then everything listed can be considered chiropractic because it was done by a practitioner of the chiropractic profession. 

In addition, the term “adjustment” refers to manipulation or mobilization done only by a chiropractor; no other professional who performs joint manipulation, such as a medical doctor, osteopath, or physical therapist, is allowed to use this word when describing the manipulation that they do. Whether I agree or disagree with a profession’s ownership to a word is a completely different story altogether, but I felt it needed to be explained to the readers. 

So how does it work? Chiropractic adjustments or joint manipulations work by having the practitioner take the patient’s synovial joint to the end of its available range of motion and quickly move the joint beyond its full range into what we call the paraphysiological space. This is exactly what manipulation is, and this is done quickly and safely without compromising the anatomical integrity of the joint so that excess mobility does not happen as a result. If the joint was taken to its limit or anywhere before the limit, then we can call it a mobilization. 

Every synovial joint in the body is enveloped by a capsule that is highly enervated and provides joint stability, similarly to how a ligament does. When manipulation occurs, the joint capsule is stretched very fast; due to its high nerve supply, the speed of that stretch happens influences a sending of a reflex up the spinal cord to reach the periaqueductal gray of the midbrain, where pain modulation ultimately happens. 

The fast stretch to the spindles of the muscles of the joint being manipulated could also be contributing to pain decrease by getting the muscles to relax. This is one of the two major effects that spinal manipulation has on our body; the ability to decrease pain. 

The other major effect that manipulation has on our body is to restore the range of motion to a joint. Claiming that our spine is out of alignment and that we need to be adjusted to be realigned is a dispelled myth. As chiropractors, we would only take an x-ray of a patient prior to treatment, not to use it as a tool as to where and how to adjust, but rather to rule out fracture post-trauma or other problems such as cancers that could have spread to the bone. 

Examining a patient’s range of motion before and after the treatment is an effective way to quantify the efficacy of the adjustment by showing the patient the mobility they regained, as well as using subjective rating scores to quantity the decreases in pain from when they first came in.

Now a grim subject that must be addressed; there could be some region-specific symptoms I have to watch out for before I even think of adjusting a patient. There is a very minor correlation between cervical manipulation to vertebral artery dissection, but the headache from it caused the visit to the chiropractor and not the other way around. 

Symptoms would include double vision, difficulty speaking, difficulty swallowing, drop attacks, dizziness, difficulty balancing while walking, nausea, uncontrollable eye movements, or numbness in the face, neck, or down the arm. Symptoms such as these, coupled with the worse headache they have ever felt in their life that came on out of nowhere, would refrain me from performing a manipulation and sending them out to the emergency room. Even though I would not have caused the dissection, I would certainly be blamed for it had I performed the manipulation. 

 Another region-specific set of symptoms I look out for when evaluating a patient with low back pain is excruciating low back pain coupled with pain shooting down both legs, weakness in both legs, a loss of sexual function, loss of bowel and bladder control, as well as what we call saddle paresthesia where the equestrian would feel numbness in his buttock, groin and inner thigh that would contact the saddle. 

This is an emergency known as cauda equina syndrome, where the lumbar and sacral nerve roots are compressed. The patient will need to be sent to the hospital for emergency decompression surgery within 24 hours at the onset of symptoms. Otherwise, they will need to wear a colostomy bag for the rest of their life. These are examples of symptoms we as chiropractors must look out for when dealing with neck pain, headache, or low back pain in our office.

Getting adjusted ultimately can be beneficial to your musculoskeletal health. Assuming all red flags have been ruled out, It’s a non-surgical, non-invasive, cost-effective way to relieve pain and increase range of motion to stiff painful joints in the body. If you’re feeling stiff, if you have been dealing with acute or chronic pain, or even hope to prevent a future surgery, now that you have a better understanding of what the chiropractic adjustment is and how it works, consider getting adjusted by a professional, because it could be worth your while.

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