Saturday 4th June, 2022

What do chiropractic adjustments do

Dr Graeme's comments
Dr Graeme's comments

As a Chiropractor for over 27 years a lot of information I’ve seen about chiropractic adjustments has been misleading or just plain wrong. So, for this article I’ve used plain language and easy to understand diagrams to show what chiropractic adjustments do and answer most of the questions you may have.


The basic spinal problems adustments correct
The issues these problems cause
How adjustments are used to correct them

TThe basic spinal problems adjustments help correct

Most descriptions are misleading or wrong.

To understand what chiropractic adjustments do it helps to understand the spinal problems they correct. Chiropractors have used descriptions ranging from a simple “bone out of place” or “misaligned vertebrae” through to lengthy descriptions of “vertebral subluxation complexes”. The simplistic descriptions are just plain wrong, while the lengthy descriptions tend to be a long list of causes, symptoms and effects that make it almost impossible to get a clear picture of what’s actually going on.

What really happens to your spine

In this section we look at:

  • what actually happens to the movement and position of your spine, then
  • the problems this causes.

What happens to the movement and position of your spine

The best way to describe what happens is by showing you what spines normally do, then how this changes when problems develop.

Normal spine movement
Normal spinal movement

As this diagram shows in a normal spine the vertebrae balanced in a neutral position, and when the spine bends they should all move about the same amount.

Abnormal spine movement
The problems that occur

Rather than going out of place or becoming misaligned, what actually happens is individual joints become stiffened, and often tilted or twisted slightly. In this typical example the bottom joint has stiffened and tilted to the left. Let’s look at what happens as a result

Bending to the left

When the spine is bending to the left everything looks completely normal because the problem vertebrae is already tilted this way.


When the spine is neutral you can see the bottom vertebrae cannot straighten normally and is sitting slightly tilted to the left. The joint above is tilted back the other way to compensate.

Bending to the right

With the bottom joint stiffened and still tilting slightly to the left the joints above the problem vertebrae above are forced to move a lot more in compensation.

What this is called

This condition is called a “dysfunction” which is the technical term meaning functioning abnormally. To keep things easy to understand we’ll just use the simple term “functioning abnormally”.

What causes the joints to stiffen

There are many ways a spinal joint can stiffen up and possibly become slightly tilted or twisted.

  • trauma (individual or repeated)
  • repeated abnormal stress (eg. bending and twisting)
  • prolonged stress (eg. abnormal postures)
  • prolonged muscle tightness (eg. sitting at a computer, emotional stress)
  • disuse (not getting enough movement and exercise to maintain movement)

The problems abnormal function causes

In this section we will look at the secondary problems this abnormal function causes.

Basic anatomy of your spine
Pressure on joints
Protective muscle spasm
Tension on muscles
Disc problems
x/ray changes: degeneration and arthritis

The basic anatomy of your spine

Spinal anatomy

Pressure on the joints

As you can see from this diagram the tilting of a vertebrae puts a lot of extra pressure on the two small sliding joints marked with the red dots. This causes the following (1,2)⁠:

  • irritation and inflammation of the joints
  • makes the joints more prone to being injured
  • increases wear in the joints, causing long term degenerative (arthritic) changes.
The consequences of abnormal spine movement

Implications for treatment

Over time these joints usually become irritated, inflamed or injured, and when this happens you will start getting pain in your spine. This often becomes sharp and pinching when you move around. Too often this pain is just treated with rest, anti-inflammatory drugs and maybe injections. These give temporary relief, but of course do absolutely nothing to relieve the abnormal pressure so further pain and long term deterioration of your spine is usually inevitable.

Protective muscle spasm

Your nervous system will detect this damage and automatically tighten your back muscles like a splint to restrict movement.

Implications for treatment

The muscle tightness can do a great job protecting your spine so you get no pain from your spine, but the muscle tightness itself becomes a painful spasm. Doctors will treat this by prescribing muscle relaxant drugs. This can give relief from the painful muscle spasm, but of course the protection for your spine is removed and damage continues.

Tension on muscles to maintain balance

A tilted vertebrae will cause the spine above lean to that side. As shown in the diagram above, to maintain balance and so you do not topple over the muscles on the opposite side will automatically tighten to straighten and balance your spine.  Those muscles will be constantly tight. As discussed in this article ,  constant tightness causes continual stress and a restriction of blood flow which leads to muscular pain and deterioration.

Implications for treatment

When those tight muscles eventually become painful massage and stretching are often used to relieve them. However, as long as a vertebrae is tilted your body will automatically re-tighten the muscles to straighten and balance.


As shown in this diagram, with one joint stiffened and possibly tilted or twisted the joints above and below are forced to move extra to compensate. Often they can be forced to bend or twist far more than they were ever designed to, which leads to rapid deterioration and possibly injury.

Trying to correct with exercise

Implications for treatment- exercises will cause damage

Spines with these problems usually have some loss of movement or function. Doctors and therapists will try and address this by prescribing exercises. The problem is that when doing these exercises the stiffened or seized joints will remain stiffened and the compensating joints will be forced to do extra work. Long term this will:

  • increase the wear in the compensating joints leading to severe joint degeneration,
  • possibly resulting in catastrophic failure.

Disc problems

Herniated disc
Ruptured disc pressing on a nerve

Discs sit between your vertebrae to provide some cushioning, and some flexibility to allow you to bend. As this diagram shows they are a bit like car tires only filled with jelly rather than air. Like a car tyre abnormal stress and wear can cause the outer casing to weaken and rupture. This can an cause two main problems.

  • It can cause pain as the jelly breaks through the outer part of the disc, and
  • as it shows in the diagram it can can press on a nerve.

There are two ways abnormal spinal function can cause disc problems.

Overloading the compensating joints

The first is really obvious. The compensating joints are forced to bend way more than they were meant to which puts tremendous stress on the fibres in the walls of the discs, so over time they will weaken and fail.

Lack of movement

The not so obvious way a stiffened joint can destroy a disc is through a lack of movement. There are no blood vessels inside a disc so it relies on movement to pump through nutrients. If it’s not moving there’s no pumping. With no pumping there’s no nutrients. With no nutrients the inside of the disc dies (2–4)⁠.

X/ray changes: degeneration and arthritic changes

We’ve mentioned how abnormal spinal function puts extra pressure on individual sliding joints and causes discs to deteriorate. Over time this causes changes that can be seen on x-rays.

X-ray of spine with degenerative changes

An example

This x-ray shows a typical example where the stress caused by abnormal function has caused severe degeneration and arthritic changes to one joint while the other joints look in excellent condition.
In the deteriorated joint the space between the rectangular blocks (vertebrae) has become thinner, and the things that look like parrot beaks are bone spurs.

Doctor explaining x-ray results
Some things you are told about x-rays are incorrect

Implications for treatment

The easiest way to see the treatment implications is by using a simple analogy of having a car with one worn tyre while the rest are normal. A tyre shop would advise you that you had a wheel alignment problem causing that tyre to wear abnormally. Instead when doctors see an x-ray with some joints badly worn while the others are in excellent condition they often do the following.

Tell you that the worn joint is the cause of your problems

While a degenerated arthritic joint can become a problem in its own right it is still secondary to the underlying functional problem.

Tell you that it is due to your age

The normal joints are the same age, yet they are fine. The arthritic changes are caused by abnormal stresses over time as a result of functional problems.

Do surgical repairs without correcting the cause of abnormal wear

This is like the tyre repair shop just changing the tyre but not correcting the wheel alignment.

Nerve interference

The autonomic nervous system
Your nervous system helps control most of your body's functions

The final issue caused by abnormal spinal function is interference to your nervous system. The original Chiropractors described this as pressure on a nerve causing a blockage. It is now known that interference to your nervous system is much more complex, but the principles are very simple. Issues with your spine can cause:

  1. blockages (eg. numbness and loss of control), or
  2. extra signals “static” (eg. pain such as sciatica).

We used examples of interference to the nerves that allow feeling and control of your muscles. These are well understood. However, as this diagram shows your nervous system helps control every function in your body so the same blockages or “static” can cause a wide range of problems including potentially wide reaching and seemingly unrelated effects. For more info please see Dr Graeme’s brief summary video below.

Chiropractic adjustments and spinal correction

The goal of chiropractic adjustments and spinal correction

The goal of chiropractic adjustments and spinal correct is simple. If the normal movement is restored to those individual stiffened tilted/twisted joints then your spine is free to re-balance and function normally. Then:

  • your muscles no longer need to be tight,
  • the pressure comes of the over-stressed small joints at the back of your spine,
  • the overworked compensating joints no longer need to compensate,
  • nerves may not longer be interfered with, and
  • without interference your body's inbuilt mechanisms will heal and recover.

How chiropractic adjustments help restore movement.

Correction using a chiropractic adjustment
A chiropractic adjustment directs specific force to the restricted joint

What is a chiropractic adjustment

We have seen when a spine has a stiffened joint and functions abnormally attempts at restoring movement such as exercises result in the compensating joints moving rather than the stiffened joints. As shown in this diagram a chiropractic adjustment is a very specific force directed at the stiffened joint, designed to restore movement in this joint only.

The difference between an adjustment and a manipulation

An adjustment

The joints of your spine are complex and the overworked compensating joints are generally very close to the stiffened joints. It takes a huge amount of training and practice to be able to analyse the individual joint movements, then deliver the exact thrust in the exact direction without adversely affecting the often damaged adjacent joints. This is an adjustment.

Non-specific spinal manipulations
Without extensive training the force will affect the wrong place
A manipulation

There are a lot of people ranging from “back yard” practitioners through to medical practitioners who have done a week end course that deliver thrusts to spines. They can often make impressive cracking noises and sometimes give short term relief.

Unfortunately as this diagram shows, without the extensive training of a professional such as a Chiropractor, Osteopath of a Physiotherapist with specialist post graduate training (5–8)⁠ these forces will most likely be non-specific. The force will most likely have it’s greatest affect at the already over stressed compensating joint. These are manipulations

A spinal correction program

The changed that occur to spines

Chiropractic adjustments often give instantaneous and dramatic relief. However, the abnormal spinal function will have caused changes that make it impossible for the spine to just return to normal straight away. You need a correction program to help reverse these changes over time. The following are examples of these changes.

Change in length of tissues

In the basic diagrams we see that when a joint is tilted the space between the levers becomes smaller on one side and larger on the other. Over time the tissues change in length to adapt.

Weakening due to disuse

Where a joint is not moving the tissues around that joint stiffen, while the muscles that move that joint weaken with disuse.

Nervous system adaptations

Over time your nervous system will adapt and get used to doing the compensatory movements.

How we overcome those changes

Very simply repeated adjustments are used. Each adjustment adds a small amount to the movement of movement of the stiffened joints. In between the adjustments we need to do things to help maintain that movement and encourage the necessary changes.


We want the spine to start using the restricted joints, but not cause the compensating joint to compensate. Appropriate exercises are usually repeated movements designed to take the spine through comfortable ranges of movement, but not try and force extra movement.

Other therapies

There are many other therapies that can help the muscles and other tissues recover and adapt. An excellent example is massage. As discussed below you will usually benefit from large amounts of this over time, so in the section below we show you the best self care options that will not cost a fortune and require you to make huge numbers of appointments.

Note that this is just an overview. An actual correction program is complex and should be managed by a professional such as a Chiropractor, Osteopath, or a Physiotherapist with specialist post graduate qualifications.

Some guidelines for soft tissue (massage) therapy

Self massage allows the large amount of therapy you will need

Requirements vary, but for a typical spinal correction program it is often good to have a week or two between adjustments to allow time for the tissues to adapt, but have several applications of massage or soft tissue in between. If using professional services this would be prohibitively expensive and time consuming. However, as discussed in our article How to release trigger points yourself there is a highly effective self massage therapy.

The most important muscles are too often overlooked

Also, as discussed below there are critical small muscles around your spine that cannot be massaged with conventional massage, so are too often completely overlooked. However these can easily be treated using the self therapy mentioned above.

The intrinsic muscles of your spine cannot be reached with normal massage
The important muscles for control of your spine are deep where only vibration massage can reach them

As shown in this diagram the really important muscles that control the movement of the individual vertebrae sit very deep between the levers coming out from your spine. As well as being very deep those levers might only be 1cm apart. Because of that it’s physically impossible for a massage therapists examine them or to dig in deep enough to massage them.

Our strategy for examining and treating these muscles

However, they can be easily reached by the vibrations of an effective vibration massager such as our General Purpose Massager . This is how we have used them in practice.

Examining the muscles

You cannot feel these muscles and examine them conventionally. However, when they are tight they restrict the movement of the spinal joints. Professionals like myself can examine for this.

Applying the massage

Once we have identified the restricted movement we can place the vibration massager directly over the muscles involved and leave it on for say 60 seconds. The vibrations will penetrate down deep between the levers and have their therapeutic effects.

Re-examine the muscles

After applying the vibration massage you usually find that the joint movement has improved, indicating the the vibration has relaxed those deep muscles.

Home use

Of course patients cannot do these examinations on their own spines. However, a professional can easily show them where the issues are.

Massage guns or percussion massagers

As discussed in our article Do massage guns actually work percussion massagers are designed to drive their heads into muscles rather than deliver vibrations. Massage guns cannot drive their heads in deep enough to reach the small muscles surrounding the vertebrae, but you could do a lot of damage trying.


DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.


  1. Jaumard N V., Welch WC, Winkelstein BA. Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng. 2011;133(7):1–31.
  2. Merlo JA. Onset, location, and progression of facet joint articular cartilage degeneration following lumbar spinal hypomobility. ProQuest Diss Theses . 2016;30:118.
  3. Saunders HD. Classification of Musculoskeletal Spinal Conditions. J Orthop Sport Phys Ther. 1979;1(1):3–15.
  4. Cramer GD, Fournier JT, Wolcott CC, Henderson CNR. Degenerative changes following spinal fixation in a small animal model. J Manipulative Physiol Ther. 2004;27(3):141–54.
  5. Clealand J et. al. Short-term effects of thrust versus nonthrust mobilisation/manipulation at the thoracic spine in patients with neck pain: a randomised clinical trial. Phys Ther. 2007;87(4):431–40.
  6. Lau HMC, Wing Chiu TT, Lam TH. The effectiveness of thoracic manipulation on patients with chronic mechanical neck pain - A randomized controlled trial. Man Ther . 2011;16(2):141–7.
  7. González-Iglesias J, Fernández-De-Las-Peñas C, Cleland JA, Gutiérrez-Vega MDR. Thoracic spine manipulation for the management of patients with neck pain: A randomized clinical trial. J Orthop Sports Phys Ther. 2009;39(1):20–7.
  8. Krauss J, Creighton D, Ely JD, Podlewska-Ely J. The immediate effects of upper thoracic translatoric spinal manipulation on cervical pain and range of motion: A randomized clinical trial. J Man Manip Ther. 2008;16(2):93–9.

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Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more

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