With so much information on Google these days, it’s almost impossible to separate fact from fiction. Today we want to share with you seven hard truths behind a spinal adjustment. References included, of course.

Before we begin, what is a chiropractic adjustment?

Chiropractic or spinal adjustments refer to a HVLA (high-velocity, low amplitude) thrust that is applied to spinal joints. It is known as spinal manipulative therapy in academic literature.

Now that we are all clear on that, let’s go!

#1 Adjustments do not move your spine back into alignment

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Award winning bodybuilder Desmond Lee from Hercules Fitness Gym receiving a lumbar spinal manipulation from chiropractor Jesse Cai.

Many Singapore chiropractors claim that their methods of chiropractic adjustments can move your spine back into place. There are two things to note:

You can’t change alignment with a little (or big) thrust

If a little nudge into the spine can move a bone back into place, what do you think happens when you trip and fall? You’d be completely paralysed!

It only takes as little as 6.8 kilogram force (66 newtons) to perform a chiropractic adjustment. For heavy thrusts, about 33 kilogram force or 322 Newtons. Guess how much force you exert into the ground while running? Over 110 kilogram force!

Imagine Usain Bolt’s 100m race. That is 41 steps at a presumably higher ground reaction force. If a chiropractor’s thrust can move your vertebra back into place, Usain Bolt’s spine will be in pieces at the end of his 100m event!

Look, if getting adjusted can change your spinal alignment, people who crack their knuckles daily will end up with deformed fingers. No?

Good alignment doesn’t even matter

We are not going to talk about this again. For information about the history of posture, how ‘text neck’ is not new, and why neck pain is not related to posture, check out our blog entry: Text Neck & Neck Pain.

For how posture doesn’t cause lower back pain, check out Anterior Pelvic Tilt: The Reason for Your Back Pain?

The bottom line? Good posture and good alignment are social constructs that change with time. They have nothing to do with spinal health!

(Some may even argue they are marketing strategies to get you to buy more chiropractic packages.)

What is the popping sound then?

You may think the popping sound associated with a spinal adjustment is the sound of your bone moving back into place. Many people do. However, this is not the case. As with your knuckles, your phalanges doesn’t shift back into place when you crack it.

The popping sound is a cavitation. It is a phenomenon in which a gas bubble forms in response to the increase in joint volume as a result of the adjustment manoeuvre.

So in a chiropractic manipulation:

  1. Thrust is applied to a spinal joint
  2. The distraction applied to the joint causes an increase in joint space
  3. In response to the increase in volume, an air bubble is formed from the dissolved gas in the joint fluid (no different from when you open a bottle of coke, really)
  4. You hear a popping sound

Why does my spine feel out of place?

It’s normal for pain patients to feel that your spine is out of place.

A study in 2008 found that patients with chronic pain were “unable to clearly delineate the outline of their trunk and stated that they could not “find it””. The controls, or individuals who are pain-free, had no issues doing it.

Interestingly enough, patients with pain only on one side, drew their vertebrae to be “out of place” towards that side. Their spine, however, had no deviations.

The takeaway here really is that a chiropractor can’t move your bone back into place or realign your spine. It’s common for chiropractors in Singapore to use this rationale to upsell you chiropractic sessions. Truth is that science and common sense just doesn’t support it!


#2 Spinal adjustments do not remove subluxations or interferences to the nervous system

Singapore chiropractors often claim that spinal adjustments can restore the body’s natural healing abilities. Because adjustments remove the interference or the blockage in your spine. Based on their dogma, regular adjustments will keep you healthy and prevent illnesses and sickness from infertility to cancer.

That’s a lie.

Chiropractic subluxations don’t even exist and many chiropractors around the world have spoken about it.

Check out An epidemiological examination of the subluxation construct using Hill’s criteria of causation and Subluxation: dogma or science. Both published by chiropractors!

Side note: parents of a boy who died after they treated earache with homoeopathy were found guilty of manslaughter.

If you think evidence is not important, think again. Children die receiving useless treatments for real problems.

Science matters.

Be responsible for your own health.

#3 Spinal manipulation on its own doesn’t work

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Celebrity host and actor Paul Foster receiving a chiropractic neck adjustment before his rehabilitative exercise program.

Study 1 (published 2012): spinal manipulative therapy is MORE effective than medication both short and long term. Sounds good yea?

The study also found two one-hour sessions with a clinician and a home exercise program achieved the same results as spinal manipulative therapy.

In that case, having your spine adjusted is just as effective as clinical rehabilitation. Well, no. The patients who underwent spinal manipulation visited the chiropractor 15 times on average.

If you looked closer into the study, they also didn’t just receive chiropractic manipulation. They also received soft tissue therapy, assisted stretching, cold and heat therapy.

Either way, this is a terrible study cos if you wanted to study the effects of adjustments, you wouldn’t include the other treatments!

Study 2 (published 2004): “Done alone, manipulation and/or mobilisation were not beneficial”

That’s over 10 years ago. We already know over 10 years ago that chiropractic adjustments doesn’t work. Yet most chiropractors in Singapore offer only adjustments.

On top of that, the same study clearly stated that chiropractic manipulation is only useful when done in conjunction with exercise. Take that!

#4 Even if it works, spinal manipulative therapy is a short-term solution

We blogged about this paper at Breaking News: Prestigious Medical Journal Endorses Chiropractic Care?

SMT seems to be better than non-recommended interventions for improvement in function in the short term.

In conclusion, the benefits of chiropractic adjustments are for the short term improvement only. That is if you compared to NON-recommended treatments. I’m not impressed, are you?

Disclaimer: spinal adjustments work as well as other form of (recommended) manual therapy – no matter, no worse. For studies that compares that, go to 6 things an experienced orthopaedic surgeon got wrong.

#5 Spinal manipulation doesn’t increase performance

Some chiropractors try to sell you chiropractic treatments by suggesting adjustments can help you. Even if you have no pain!

(That is a big red flag, imo, when it comes to choosing a good chiropractor.)

They label such treatments as wellness or maintenance care.

Their argument is that our lifestyle is demanding on our body. (Wait a minute, isn’t physical inactivity and not exercising enough the current health problem?) And that you will develop problems in the future if you don’t get adjusted.

Um. Well.

Chiropractic manipulation doesn’t help with:

  • Physiological markers at both rest or during exercise
  • Doesn’t help with scapular movement pattern or transversus abdominus thickness

When it comes to muscle activation, three studies claim it helped while two studies published it didn’t.

The bottom line is that adjustments don’t help with performance.

Reference: The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence

#6 Chiropractors are trained in more than adjusting your spine

I know it seems like chiropractors are trained in ONLY cracking backs because that’s what bulk of the Singapore chiropractors do.

This is not true. In the 2012 study mentioned under #3, over two-thirds of the chiropractors performed soft tissue therapy and stretch therapy. There are different chiropractic methods.

At Murdoch, chiropractic students are trained in soft tissue therapy from active release technique to IASTM, dry needling, rehabilitative exercises from the different schools including Janda, McKenzie, McGill, motor control, functional movement, etc.

Our training is solid, to say the least.

#7 You don’t need regular spinal adjustments

We also blogged about this before so we are not going to go into too much details. How often should you see a chiropractor?

In our opinion, four to seven times if you are after long term results and no more than 12 times in a given year.

You know those chiropractors selling you 20, 40 session packages? They just want your money lah!

p.s. we have started offering unlimited chiropractic adjustments on a subscription plan basis as an adjunct to our core exercise/movement therapy. This is a 100% business decision. We realised many Singaporeans would choose regular chiropractic adjustments over long-term results despite our strong recommendation against that. Nonetheless, our position remain the same – exercise, education, and advice are the first line treatment when it comes to chronic muscles and joints conditions.

If all you say is true, why do people feel better an adjustment?

While spinal manipulation alone are unlikely to result in any long term benefits, there are transient improvements associated with the treatment.

These changes are likely to be due to a neurophysiological effect and they tend to be temporary. Some commonly cited improvements are pain relief, better function, and even increase in range of motion.

But do you know even ineffective treatments can seem helpful? This could be due to how most symptoms improve with time (i.e. natural history).

Also, if you are in a lot, a lot of pain, it can only get better. This is known as regression to mean.

Of course there is the famous placebo effect.

All of this are well discussed in the paper above. Highly recommend a read if you want to understand the details.

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Bukit Pasoh Road (Outram Park): Our chiropractic clinic is equipped with weights and kettlebells from Again Faster. We believe movement is medicine and the long term solution for your aches and soreness.

The problem with the chiropractic Industry in Singapore

True chiropractic care is about getting people long-term results as fast as reasonably possible without medication or pain killers.

Unfortunately, there are many Singapore chiropractic clinic, arguably also physiotheraphy, who are out to make a quick buck. Their approach to your care is not about your welling as a patient first.

It is about maximising profits.

There are TONS of peer reviewed clinical trials publishing hard data that spinal adjustments alone are not the way to go. This is not news. We have known it for decades. Yet no one talks about it.

Choose chiropractic first

Now that you know the truth behind chiropractic adjustments and the chiropractic industry, you know how to discern between the bad and the good chiropractors in Singapore. Remember, there are different types of chiropractors around.

Chiropractors are trained musculoskeletal healthcare experts and can help with your day to day back pain, neck pain, shoulder pain, and even sports injuries. We can help you achieve your full potential without pain killers and their unnecessary side effects.

While most chiropractors and physiotherapists offer manual therapies as their core service, seek out a rehabilitative exercise chiropractor.

Why? Because research tells us they are the best chiropractors.

p.s. we know many of you will find this new – some of you may even find it offensive. We do not apologise and we also do not expect you to agree with us. We have included tons of references so you can do some fact checking to form your own informed opinion about chiropractic adjustment.

If you would like to contest any part of this blog post, please do reach out to us AND include an adequate reference. We will 100% look into it.

“In God we trust, all others must bring data.”

p.p.s. can you believe how much spinal health and posture information is actually garbage?!

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