What You Should Know About Chiropractic Adjustments

Of the many remedies for chronic back pain, chiropractic adjustments, also known as spinal manipulation, may be the best known, but least understood. When you hear people talking about going to their chiropractor for a "back adjustment," they're referring to a type of manual therapy (i.e., a treatment delivered through the physician’s hands) for spinal realignment, specifically to realign joint subluxations.

The most common goal is a pain-free, well-performing spine, but people also seek chiropractic care for headaches, neck and shoulder issues, hip alignment, and drug-free pain maintenance.

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What Is a Subluxation?

While a subluxation is considered a partial dislocation by all, it has unique nuance to different health professionals.

Medical doctors use X-ray imaging to detect a subluxation, which they consider a very obvious disconnect between joint bones. Chiropractors, on the other hand, typically detect subluxations during a regular patient evaluation and classify even subtle position changes in the joints and accompanying soft tissue problems as such.

For chiropractors, these areas become the focus of their adjustments.

Types of Adjustments

Although a number of chiropractic techniques exist, the most common type of adjustment involves a controlled but fast directional thrust into the joint. (Other names for a chiropractic adjustment are "spinal manipulation" and "Grade 5 mobilization.")

The goal is to bring the bones of a joint back to their normal, natural fit. It may take just one adjustment to achieve this (where the adjustment "sticks") or it may take several.

While it's true the mainstay of the chiropractic profession is adjustment of the spine, most also adjust the pelvis as a routine part of treatment. Some also adjust knees, feet, and wrists. 

Grade 1 to 4 mobilizations are less forceful and direct than Grade 5, and they're typically used by other types of practitioners.

Use and Efficacy

According to the National Center for Complementary and Integrative Health (NCCIH), spinal manipulation is among several holistic therapies that have been proven to provide relief for mild and moderate low back pain.

Other holistic therapies that the NCCIH says yield similar results: massage therapy and exercise. Physical therapy is on this list, as well, even though many people think of it as prescribed medical treatment rather than a complementary or integrative health field.

There's more: A review of medical studies published in the journal PLoS ONE found spinal manipulation to be just as effective for back pain as physical therapy, exercise therapy, and medical care.

Who Can Give Chiropractic Adjustments?

Chiropractors can, of course, but physical therapists and osteopathic physicians are sometimes trained and licensed to give a Grade 5 mobilization treatment as well.

Grade 1 to 4 mobilizations tend to be used more by physical therapists, massage therapists, and some holistic therapists and educators such as Feldenkrais practitioners and Alexander teachers.

Massage therapists, athletic trainers, personal trainers, and holistic practitioners are, in general, not licensed to give Grade 5 spinal manipulation therapy.

What to Expect

Like most visits with a medical professional, a chiropractor will ask you about your problem, review your medical history, perform a physical exam, and possibly use medical imaging to help arrive at or confirm a diagnosis.

You will lie down on a chiropractic table so your practitioner can administer treatment. Depending on the problem/diagnosis, your position on the table can vary (face-down is common), as can the amount of force required to make an effective adjustment.

The controlled, directional thrust can require two hands and is designed to move the joint beyond its natural range of motion. This helps repair the subluxation.

While it's true that the mainstay of the chiropractic profession is adjustment of the spine, most chiropractors adjust the pelvis as a routine part of treatment. Some also adjust knees, feet, and wrists. 

You may require multiple visits to get the desired results.

More Cracking, Better Adjustment?

Many associate cracking and popping with a successful chiropractic adjustment. In reality, these sounds may have nothing to do with an accurate realignment of your joints. Rather, they are thought to be a result of cavitation—when gasses in the joint's lubricating fluid are released into the "joint space" between the bones.


Overall, chiropractic adjustment is considered safe. A 2017 review of 250 studies found that adverse events associated with chiropractic adjustments can be common, but that may sound worse than it really is.

Benign adverse events, which are minor and temporary, affect 23% to 83% of adult patients. They can include:

  • Headache
  • Sore joints or muscles
  • Fatigue
  • Dizziness

Serious adverse events that can be debilitating or life-threatening are rare, ranging from one per two million adjustments and 13 per 10,000 patients. These include:

  • Stroke
  • Spinal cord injury
  • Spinal disk injury
  • Cauda equina syndrome, a condition involving pinched nerves in the lower part of the spinal canal

Insurance Coverage of Chiropractic Care

According to the American Chiropractic Association, care is covered under Medicare and Medicaid for U.S. federal employees, and for other types of employees in virtually all traditional insurance policies. In addition, all 50 states include chiropractic care under state workers' compensation laws.

Chiropractic care is also available to military personnel at 60 military installations and 60 VA medical facilities in the U.S.

Still, it can't hurt to contact your carrier before seeking treatment.

A Word From Verywell

While chiropractic care is generally safe and effective, it's up to you to find the best chiropractor for your problem. Be sure to ask for referrals from your current doctors and research area practitioners, read patient reviews, and prepare for an initial consultation with any questions you have about treatment. An engaged, educated patient often gets the best results.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Henderson CN. The basis for spinal manipulation: Chiropractic perspective of indications and theory. Journal of Electromyography and Kinesiology. 2012 Oct;22(5):632-42. doi:10.1016/j.jelekin.2012.03.008

  2. American Chiropractic Association. About chiropractic.

  3. National Center for Complementary and Integrative Health. Spinal manipulation: What you need to know.

  4. Blanchette MA, Stochkendahl MJ, Borges da silva R, Boruff J, Harrison P, Bussières A. Effectiveness and economic evaluation of chiropractic care for the treatment of low back pain: A systematic review of pragmatic studies. PLoS ONE. 2016;11(8):e0160037. doi:10.1371/journal.pone.0160037

  5. Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for cliniciansChiropr Man Therap. 2017;25:37. doi:10.1186/s12998-017-0168-5

Additional Reading

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.