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Introduction To Spinal Manipulation

Chiropractic adjustments

One of the primary therapeutic techniques used by Doctors of Chiropractic (D.C.) is "spinal manipulation", also known as a "chiropractic adjustment". In fact, chiropractors are renowned as experts who specialize in performing spinal manipulations. The term "manipulation" refers to the physical adjustment of the spinal vertebrae. The goal of such spinal manipulation is to reduce vertebral subluxation (see below) and return the spine to a more natural state of health. The word subluxation is derived from the latin terms Sub ("less than" or "slight") and Luxate ("to dislocate" or "be misaligned"). Accordingly, vertebral subluxation means the slight dislocation or misalignment of the spinal vertebrae.

When a patient has a subluxation, chiropractic adjustment can be used to correct the misalignment, which in turn helps enhance joint mobility, reduce pain, reduce muscle spasm, and reduce nerve irritation or impingement. Chiropractic adjustment is a highly refined skill acquired during years of intensive training. The technique involves the manual application of a controlled force into the spinal vertebrae which have become misaligned and hypomobile (limited in their range of motion). This procedure corrects vertebral alignment and is often accompanied by a cracking or popping sound. While this sound might surprise first time chiropractic patients, it is merely the audible release of gas from within the spinal joints.

Furthermore, the procedure rarely causes discomfort or pain. In fact, many patients report a sense of relief associated with the chiropractic adjustment and often note positive changes in their symptoms shortly after receiving treatment. If discomfort is experienced it is typically minor and resolves within a matter of days.

To achieve optimal results patients usually receive several treatments over multiple chiropractic visits. In addition to chiropractic adjustments, the treatment plan may also include massage therapy, physical therapy, and exercise rehabilitation.

Vertebral Subluxation Complex (V.S.C)

Vertebral Subluxation Complex is a degenerative condition that left untreated can worsen and eventually lead to serious medical consequences. The complex has inter-related components which can disrupt communications between the brain and the rest of the body. This disruption can negatively impact the normal functioning of internal organs.

The complex is initiated by either a traumatic event or repetitive stress. The inciting event causes vertebral misalignment and tissue inflammation – both of which are V.S.C. components. Below is a list of the V.S.C. components and a description of how they interact with one another:

  1. VERTEBRAL COMPONENT: Sections of the spinal column can become misaligned due to trauma and repetitive stress. This misalignment can also cause local inflammation which in turn may lead to vertebral hypo-mobility (restriction in the joint's range of motion) due to the formation of fibrotic scar tissue. Such misalignment and hypo-mobility narrows the spine's nerve outlets which compress and irritate the nerve roots (a.k.a. nerve root impingement).
  2. INFLAMMATORY COMPONENT: Tissue around the spinal column becomes inflamed and swollen due to uncorrected misalignment or repetitive stress injuries. With time, this local inflammation results in (i) nerve root inflammation which contributes to the Neural Component of V.S.C., (ii) vertebral hypo-mobility due to the formation of fibrotic scar tissue (see Vertebral Component above), and (iii) irritation and inflammation of local muscle tissue which contributes to the Muscle Component of V.S.C. and can eventually cause fibrotic muscle degeneration.
  3. MUSCLE COMPONENT: Muscles around the spinal column are affected by (i) abnormal nerve signals due to the Neural Component, and (ii) irritation due to the Inflammatory Component. This results in muscle spasms, reduced muscle tone (hypo-tonicity), and muscle weakening (atrophy). These muscular abnormalities further exacerbate the vertebral subluxation and can cause additional misalignments at new vertebral levels.
  4. NEURAL COMPONENT: Nerve roots emerging from the spinal column become compressed and irritated due to vertebral misalignment and local inflammation. This nerve impingement and inflammation results in (i) abnormal neural signals which contribute to the Muscle Component of V.S.C., and (ii) the distortion and disruption of nerve impulses from the brain to the internal organs of the body (see Neuro-Visceral Component below).
  5. NEURO-VISCERAL COMPONENT: Neural information from the brain to the internal organs (a.k.a. viscera) become disrupted or distorted due to nerve impingement and inflammation. This distortion and disruption of nerve impulses can result in a wide range of negative medical consequences.

As you can see, the Vertebral Subluxation Complex is a disorder that progressively worsens. As the disorder progresses it may cause chronic pain, inflammation, arthritis, loss of vertebral joint mobility, muscle spasm, and muscle weakness.

Furthermore, left unchecked V.S.C. can interfere with nerve impulses traveling between the brain and internal organs. In essence, as the complex intensifies it can affect the control and regulation of other parts of your body, which can have devastating medical consequences.

Qualified chiropractors know the dangers of neglecting V.S.C. and are dedicated to the art and science of spinal manipulation. Using Kinetic Chiropractic™ techniques they are experts at detecting and reducing vertebral subluxations.

Accordingly, it is vital that patients with back problems or suspected subluxations seek Kinetic Chiropractic™ care as soon as possible.

Side Effects and Risks


Although chiropractic care is widely recognized as a relatively safe, non-invasive therapeutic modality, no treatment is completely free of potential adverse effects.

Common Side Effects

According to the National Institutes of Health: "Reviews have concluded that spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include temporary discomfort in the treated area, headache, or tiredness. These effects usually go away in 1 to 2 days."¹

Serious Complications

The rate of serious complications from spinal manipulation, although not definitely known, appears to be very low overall and related to the type of adjustment performed and the part of the body treated.

Low-back manipulation - A potential complication from low-back manipulation is cauda equina syndrome, a condition in which nerves in the lower part of the spinal cord become compressed, resulting in pain, weakness, and loss of feeling in one or both legs. Other functions - such as bowel or bladder control - may also be affected. Reports indicate that cauda equina syndrome is an extremely rare complication. In people whose pain is caused by a herniated disc, manipulation of the low back also appears to have a very low chance of either causing or worsening cauda equina syndrome.

Neck manipulation - Some reports have linked upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, but a clear understanding of the relationship has proven to be hard to establish. While we may not know the actual incidence of stroke associated with high-velocity upper neck manipulation, the occurrence appears to be rare - 1 in 5.85 million manipulations.² To put this risk into perspective, if you drive more than a mile to go shopping, you are at greater risk of serious injury from a car accident than from your chiropractic treatment.

It is also worth noting that other common treatments for musculoskeletal pain such as taking non-steroidal anti-inflammatory drugs (NSAIDS) may be associated with significantly greater risks than chiropractic manipulation. In fact, the American Journal of Gastroenterology estimated that 33% of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of painkillers such as aspirin or NSAIDs (e.g. ibuprofen)³

Furthermore, some patients elect to have invasive surgery for conditions that may also be helped by chiropractic manipulation. These surgical procedures may be associated with risk many times great than chiropractic treatment.

  1. National Center for Complementary and Alternative Medicine (NCCAM) Publication No. D409. Created April 2008.
  2. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.
  3. Lanas A, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol 2005;100:1685–1693.

Ongoing Chiropractic Care

Wellness and longevity

There is a widespread myth that receiving chiropractic treatment creates a need for continuous spinal manipulation. In the past, people had misconceptions that chiropractors merely treated a patient's symptoms while neglecting the root medical condition. It was believed that this superficial approach required a patient to return for further treatments on a perpetual basis.

Today, however, many people have realized that chiropractic care is similar to other routine preventative measures such as dental cleanings, optometric exams, periodic blood analysis, and physical examinations. They recognize the spine and the critical nerve impulses it protects are just as important as the other parts of the body. Accordingly, progressive members of society now understand that visiting a chiropractor on a regular basis is a vital component of a healthy lifestyle.

In fact, modern-day chiropractors assert that the spine requires occasional adjustments in order to maintain an optimal state of neuromusculoskeletal health. Patients who receive regular chiropractic care have reported many benefits including pain relief, increased energy, and more restful sleep. These benefits combine with a balanced lifestyle to promote wellness and longevity.

Acknowledgements and Notices

IMPORTANT:  The information on this website is NOT intended to substitute for the expertise and advice of a qualified healthcare professional. We encourage you to discuss any decisions about treatment or care with a qualified healthcare professional.

The mention of any product, service, or therapy is NOT an endorsement.

Neither the author nor the publisher shall be responsible for any damage or harm caused by the improper use of information in this website.

Any diagnostic or treatment options presented herein are for general informational purposes and may NOT necessarily represent tests or treatments that your healthcare professional performs, provides, or would recommend. The information is simply provided for educational purposes and in a good faith effort to help patients make a more informed decision about their healthcare.

Furthermore, any tests or treatments presented herein may NOT be comprehensive with regard to all the diagnostic or therapeutic options that may be available for any given medical condition or disease. Accordingly, you should always discuss any decisions about treatment or care with a qualified healthcare professional.

This website may feature actors, models, or artistic representations.  The actors and models may NOT have actually used or provided any product or service described or promoted in this website. These actors and models may be identified with the notification: "Model" or "Model – not actual patient". If actual patients are featured, they may be identified with the notification: "Actual subject", "Real subject", and/or "Before vs. After".

Artistic renderings of any medical condition, disease, or treatment in this website are for illustrative purposes only and may NOT be a realistic depiction of actual medical conditions, diseases, patients, or treatments. Actual outcomes of any medical condition or actual results achieved by any treatment may be significantly different due to variations in the delivery of healthcare and the individual circumstances of each patient.

"Chiropractic Adjustments"
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