Short answer: yes, for most people. For most healthy adults, chiropractic adjustments are a safe and evidence-based treatment option for back pain, neck pain, and certain types of headaches when delivered by a properly trained chiropractor following an appropriate examination. Research shows that chiropractic adjustments can improve joint movement, reduce pain, decrease muscle tension, and […]
Short answer: yes, for most people.
For most healthy adults, chiropractic adjustments are a safe and evidence-based treatment option for back pain, neck pain, and certain types of headaches when delivered by a properly trained chiropractor following an appropriate examination. Research shows that chiropractic adjustments can improve joint movement, reduce pain, decrease muscle tension, and improve function.
Like any healthcare intervention, chiropractic adjustments are not appropriate for everyone. The key is making sure the right patient receives the right treatment at the right time.
A chiropractic adjustment is a precise manual procedure used to restore movement to a joint that is not moving normally.
Most commonly, chiropractors adjust the small synovial joints of the spine. During an adjustment, a controlled force is applied to a restricted joint. Sometimes this creates a popping or cracking sound.
Contrary to popular belief, this sound is not bones being “put back into place.” The sound occurs when dissolved gases within the joint fluid rapidly form a bubble as the joint surfaces separate.
The purpose of an adjustment is not to create a popping sound. The goal is to restore normal movement, improve function, and reduce irritation within the surrounding muscles and nervous system.
When a restricted spinal joint begins moving normally again, several things happen:
Joint range of motion often increases.
Small muscles around the spine are stretched.
Joint and muscle receptors send information to the brain.
The nervous system receives updated information about movement and position.
Muscle control around the area often improves.
Pain sensitivity may decrease.
Researchers believe many of the effects of spinal manipulation occur because it changes the information travelling from the joints and muscles to the brain, helping the nervous system better coordinate movement. In simple terms, an adjustment may help the body “recalibrate” how a spinal segment moves and functions.
Lower back pain is one of the most researched conditions in chiropractic care. A systematic review published in the BMJ analyzed 47 randomized controlled trials involving more than 9,000 patients and concluded that spinal manipulative therapy provides improvements in pain and function comparable to other recommended treatments for chronic low back pain.
Research has shown that spinal manipulation and mobilization can reduce neck pain and improve function in many patients with mechanical neck pain. Outcomes are generally comparable to other recommended conservative treatments.
The evidence is strongest for cervicogenic headaches, which are headaches originating from structures in the neck. Research suggests that spinal manipulation can reduce headache frequency and intensity in many patients with cervicogenic headaches.
One of the most immediate effects of an adjustment is often an increase in joint mobility. Many patients report feeling less stiff and moving more freely immediately after treatment, a finding that is consistent with research on spinal manipulation.
No.
This is one of the most common myths about chiropractic care and joint cracking in general. A study by DeWeber and colleagues investigated whether habitual knuckle cracking was associated with hand osteoarthritis. They found no association between knuckle cracking and arthritis, even among people who had cracked their knuckles for many years.
The researchers concluded that habitual knuckle cracking does not appear to be a risk factor for hand osteoarthritis. In fact, people who already have arthritis may be more likely to crack their joints because movement and joint cavitation can temporarily relieve feelings of stiffness and discomfort.
The same principle applies to chiropractic adjustments: there is no evidence that the popping sound produced during an adjustment causes arthritis.
For the vast majority of people, yes.
Most side effects are mild and temporary. The most common reaction is mild muscle soreness or stiffness lasting 24 to 48 hours after treatment, similar to what many people experience after exercise.
However, chiropractic adjustments are not suitable for everyone. Certain conditions require modification of treatment or avoidance of spinal manipulation altogether, including:
Certain fractures
Active spinal infections
Some cancers affecting bone
Severe osteoporosis
Significant ligament instability
Certain inflammatory diseases
One important example is rheumatoid arthritis affecting the upper cervical spine. In some patients, this condition can weaken the ligaments that stabilize the upper neck. Manipulation in these cases may be dangerous and should be avoided. This is why thorough examination and diagnosis are essential before treatment begins.
Perhaps the most commonly discussed concern regarding chiropractic care is the risk of stroke following a neck adjustment. A landmark Canadian study led by Cassidy and colleagues evaluated vertebrobasilar artery strokes across more than 100 million person-years of healthcare data. The researchers found that younger stroke patients were approximately equally likely to have visited a chiropractor or a medical doctor before their stroke.
The authors concluded that patients were most likely seeking care for neck pain and headache caused by an already developing arterial dissection, rather than the healthcare visit causing the stroke itself. This finding reinforces an important point: healthcare providers treating neck pain should be able to recognize the warning signs of serious vascular conditions and refer patients for urgent medical evaluation when appropriate.
Scientific research is essential when evaluating the benefits and risks of healthcare treatment. Equally important is understanding what happens in everyday clinical practice.
“Since graduating in 2009, I have worked across multiple chiropractic clinics and have been involved in the delivery of hundreds of thousands of chiropractic adjustments.
In my experience, the most common side effect of chiropractic care is mild to moderate muscle soreness lasting 24 to 48 hours. This generally resolves without intervention. The only significant complications I have personally encountered have been temporary flare-ups of disc herniation injuries and occasional rib fractures.
Disc flare-ups occur when an already irritated disc becomes more painful before it improves. In my clinical experience, this occurs in roughly 1 in 1,000 patients presenting with disc-related conditions. Although symptoms may temporarily worsen, the vast majority of these patients subsequently recover and improve.
Rib fractures are very uncommon. In my experience, they occur approximately once every 40,000 adjustments. Almost every case I have encountered has involved previously undiagnosed osteoporosis or significantly reduced bone density. While painful, every patient I have personally seen with this complication has gone on to make a full recovery within a matter of weeks.
These experiences have reinforced a principle that every good chiropractor learns early in their career: the most important part of an adjustment is often deciding when not to perform one. Thorough history-taking, examination, risk assessment, and selecting the right technique for the right patient are critical for safe and effective care.”
(Note: These figures represent the author’s personal clinical observations and should not be interpreted as published incidence rates.)
Common: Mild soreness, temporary stiffness, fatigue, increased awareness of the treated area.
Uncommon: Temporary aggravation of symptoms, disc flare-ups before improvement.
Rare: Rib fractures (usually associated with weakened bone density), serious complications associated with underlying conditions that were not identified before treatment.
For most people, the answer is yes.
Research supports chiropractic adjustments as an effective treatment option for many cases of:
Lower back pain
Neck pain
Cervicogenic headaches
Joint stiffness and reduced mobility
Ultimately, chiropractic is not about making joints crack. It is about restoring movement, improving function, and helping people move through life with less pain and greater confidence.
Rubinstein SM, de Zoete A, van Middelkoop M, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689.
Gross A, Miller J, D’Sylva J, et al. Manipulation and mobilisation for neck disorders. Cochrane Database of Systematic Reviews. 2015.
Cassidy JD, Boyle E, Côté P, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Spine. 2008;33(Suppl):S176-S183.
DeWeber K, Olszewski M, Ortolano R. Knuckle Cracking and Hand Osteoarthritis. Journal of the American Board of Family Medicine. 2011;24(2):169-174.
Haas M, Spegman A, Peterson D, Aickin M, Vavrek D. Dose-Response and Efficacy of Spinal Manipulation for Chronic Cervicogenic Headache: A Pilot Randomized Controlled Trial. Spine Journal. 2010;10(2):117-128.
Xu X, Ling Y. Comparative Safety and Efficacy of Manual Therapy Interventions for Cervicogenic Headache: A Systematic Review and Network Meta-analysis. Frontiers in Neurology. 2025.
Pankrath N, Nilsson S, Ballenberger N. Adverse Events After Cervical Spinal Manipulation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Pain Physician. 2024.
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