A chiropractic adjustment is a quick, controlled movement applied by hand to a joint in the spine or elsewhere in the body. Short-lived soreness or stiffness afterwards is common. Serious complications are reported rarely, but they can happen, and their exact frequency isn’t known. That is why an assessment and informed consent come first.
What happens during an adjustment?
Your chiropractor will first assess you to decide whether an adjustment is suitable. If you agree to go ahead, you will be positioned on a treatment table, usually lying down or on your side. The chiropractor then moves the joint to the end of its comfortable range and applies a short, fast, controlled thrust. The research literature calls this high-velocity, low-amplitude manipulation.
The movement takes a moment. Some people feel pressure or a brief release, and some feel a short period of discomfort. Tell your chiropractor if you feel uneasy or want them to stop.
Adjustments aren’t the only option. Slower joint mobilisation, soft tissue therapy and rehab exercises may suit you better or be what you prefer. Our guide to what a chiropractor does explains these options.
What causes the popping sound?
The pop is generally thought to come from a rapid pressure change inside the joint, involving gas in the joint fluid. Researchers still debate the exact mechanism, including whether the sound comes from a gas bubble forming or collapsing. A study in BMC Musculoskeletal Disorders notes that its origin during spinal manipulation remains relatively unknown.
The sound isn’t a bone moving back into place. Researchers in this field also caution against treating a pop as proof that a manipulation worked.
What does the evidence say about adjustments?
The evidence varies by condition. For chronic primary lower back pain, the World Health Organization’s 2023 guideline includes spinal manipulative therapy among its recommended non-surgical options, alongside education, exercise and other approaches. The recommendation is conditional and the certainty of the evidence is low, so results will differ from person to person.
Adjustments should therefore be seen as one possible part of care, and not as a stand-alone answer. See our articles on lower back pain and headaches linked to the neck for more detail.
Are chiropractic adjustments safe?
You should be able to weigh up the benefits and risks for your own situation.
- Common, short-lived effects: mild to moderate side effects such as local soreness, stiffness, headache or tiredness are often reported. These usually settle within a day or two.
- Rare, serious events: published reports include disc problems and, after neck manipulation, tears in an artery in the neck (cervical artery dissection), which can lead to stroke.
- What isn’t known: a review of published adverse events found that the true incidence is unknown. Researchers also disagree about how far manipulation causes artery tears, as they can occur spontaneously, and people may seek care for neck pain caused by a tear that has already started.
Screening has limits too. A systematic review of neck manipulation and mobilisation found that pre-treatment tests appear unreliable at identifying who is at risk. A full history matters for this reason, and it’s also why you are entitled to decline neck manipulation and ask about alternatives.
What should you tell your chiropractor first?
Mention any of the following before treatment:
- Osteoporosis or a previous fracture
- Blood-thinning medication or a bleeding disorder
- Cancer, past or present
- Recent surgery, a recent accident or a recent neck injury
- A previous stroke, or any blood vessel or connective tissue condition
- Numbness, weakness or pins and needles
- Pregnancy
Under the AHPCSA Code of Ethics, you should be told about your options and their benefits, risks and costs before treatment starts. You can refuse treatment, stop it, or ask for a second opinion.
When should you get urgent help after treatment?
Go to an emergency unit immediately if you develop any of these after a neck or back treatment, or at any other time:
- A sudden, severe headache or severe new neck pain
- Dizziness, double vision, slurred speech or difficulty swallowing
- Weakness, numbness or a drooping face
- Loss of bladder or bowel control
Frequently asked questions
Do adjustments hurt?
Many people feel pressure rather than pain, although some discomfort during or after treatment is possible. Tell your chiropractor if something hurts so they can change or stop the technique.
Does it matter if there’s no pop?
Current research doesn’t support using the sound to judge whether a manipulation was successful.
Should I crack my own back or neck?
If you often feel the urge to do this, or the relief doesn’t last, have the underlying stiffness or pain assessed by a registered health professional.
You can read our frequently asked questions for more information, or get in touch with questions about your care.
This article is general information and doesn’t replace an individual assessment by a registered healthcare practitioner.