Chiropractic is getting popular in Singapore. There are chiropractic clinics is pretty much every neighbourhood. Before you start spending thousands of dollars on chiropractic adjustments, you would want to know the science behind it, if it’s a quack treatment, and what can spinal manipulation do for your recovery.
What is a chiropractic adjustment?
You’d probably seen how spinal adjustments work. Afterall, there are many videos of chiropractors performing adjustments that have gone viral. Not only that, you can even find compilation spinal manipulation ASMR clips!
By definition, a chiropractic adjustment is a procedure where a chiropractor apply a thrust to a joint with the intention of restoring normal function to the joint. Adjustments are usually done by hand, though instruments are available.
During an adjustment, the chiropractor will typically position the body in a way that allows them to apply force to a specific joint. For example, if the chiropractor is adjusting the lower back, the patient may lie face down on a chiropractic table. The chiropractor will then use their hands or an adjusting tool to apply a controlled force to the joint.
Adjustments are usually painless and may produce a feeling of relief or relaxation. Some people may experience minor side effects, such as soreness or achiness, after an adjustment, but these symptoms typically resolve quickly.
What is a HVLA adjustment?
Sometimes, you will hear chiropractors talking about HVLA adjustments. HVLA spends for high velocity, low amplitude. In layman terms, it means a very high speed adjustment but over a very short distance.
When it comes to spinal manipulation, people to think it’s about strength and twisting of a joint. But with very proficient technique, it is about speed. With more speed, you don’t have to move the joint as much. This is more comfortable for the patient, and potentially also safer.
What are the side effects of a chiropractic adjustment?
The reported side effects of a chiropractic adjustment include headache, stiffness, local discomfort, radiating pain or shooting sensation and fatigue. Over 60% of patients report experiencing at least one side effect after spinal manipulation.
As most of the adverse outcomes associated with adjustments are transient and benign, chiropractic manipulation is still largely considered safe. However, it is unclear if the benefits of being adjusted outweigh the potential harm.
Can a spinal manipulation cause stroke?
This is a wildly contentious topics. Many chiropractors would assert that adjustments, even those to the cervical spine, are safe. While medical doctors and neurosurgeons would strongly contest that and insist chiropractic manipulation is unsafe.
Empirically, the association between chiropractic adjustment and stroke is extremely poor. However, that is not to say that it cannot happen. Stroke is a very possible serious adverse event that can occur in individuals with at-risk health conditions.
Some types of adjustments do not make sense to me. From an anatomical perspective, I find it hard to accept y-strap adjustments as safe. Unfortunately, y-strap adjustments are very popular among chronic pain patients. They are also commonly performed at tui na and other bone setting services.
Deaths related to chiropractic manipulation
In 2021, Joanna Kowalczyk died after seeing a chiropractor. For her case, it seems that she may potentially have a connective tissue disorder that predispose her to artery dissections. According to the coroner, Joanna’s first vertebral artery dissection was likely during weight training with a personal trainer in Sep 2021.
Following that, she received multiple chiropractic adjustments, which the coroner believed cause further injury to her vertebral arteries, which eventually led to her demise.
Joanna was not an isolated accident. Playboy model Katie May passed away in 2016 after being adjusted by a chiropractor for a pinched nerve.
Closer to home, Jakarta woman Allya Siska Nadya passed away after receiving chiropractic treatment at Chiropractic First. This was in Indonesia and health authorities shut down the popular chiropractic chain.
Are chiropractic results permanent?
One of the reasons I stopped offering adjustments at my practice is because the results are short-term. They are pretty good for money in the sense that your patients have to always come back. That’s recurring revenue. The best type of revenue!
Beyond that, it’s also pretty fast to perform a manipulation. It literally only take seconds. So, the time per appointment tends to be shorter, which means better revenue per hour.
All of this is only possible because the pain relief from chiropractic adjustment is only short-lived.
The short-term results of traditional chiropractic treatments is very well documented even in chiropractic clinics in Singapore. You’d see that most of them would have some sort of maintenance or wellness package. Those services are targeted at getting you to come back even after you are pain-free.
Again, it points to that the results are short-term and you have to keep up with your chiropractic sessions if you want to stay pain-free.
In my personal opinion, this is somewhat akin to taking medication. You feel relief for as long as you you take it. Once you stopped, the pain may come back again.
Who invented chiropractic adjustments?
Chiropractic adjustments were developed by Daniel David Palmer, the founder of chiropractic care. Palmer was born in Canada in 1845 and moved to the United States in the 1870s. In 1895, Palmer performed the first chiropractic adjustment on a man named Harvey Lillard, who had lost his hearing 17 years earlier. According to Palmer, Lillard’s hearing was restored after the adjustment.
Palmer believed that many health problems were caused by misalignments of the spine, which he referred to as subluxations. He believed that these subluxations interfered with the flow of “innate intelligence,” or the body’s natural healing ability, and that by correcting these misalignments through chiropractic adjustments, he could restore the body’s innate intelligence and promote healing.
Do chiropractors really move bones?
Many Singapore chiropractors claim that their methods are “special”. Some consider themselves integrative health experts and that spinal adjustments can move your spine back into place. There are a few things to note here:
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?
What does an adjustment really do?
When a chiropractic applies a thrust to your spine, you may hear a popping sound. The popping sound is a release of gas from the synovial fluid in your joint. This phenomenon occurs as the mechanical thrust increases the joint volume, which leads to the release of gas.
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:
- Thrust is applied to a spinal joint
- The distraction applied to the joint causes an increase in joint space
- 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)
- You hear a popping sound
This is no different from opening a can or a bottle of soda. The hissing sound occurs when the dissolved gas in the soda is released from the liquid, resulting in the formation of the gas bubbles, which also gives the hissing sound.
It’s important to note that there is no changes in alignment that occurs with this phenomenon.
Spinal manipulation was thought to improve the range of motion in the joint, reduce pain and muscle tension, and improve overall function and performance. However, recent studies by chiropractors have found manipulations to be no different from sham adjustments. This suggest that the relief experienced by patients who receive a manipulation could be due to placebo effects.
Spinal manipulation on its own doesn’t work
Study 1 (Aug 2020): “neither spinal manipulation nor spinal mobilisation appeared to be effective treatments”
This is serious news because the Journal of the American Medical Association just published a study to compare spinal manipulation (i.e. chiropractic adjustments) to spinal mobilisations (i.e. moving your joints, a popular technique among physiotherapists) and placebo.
Guess what? The researchers found that chiropractic adjustments are useless (my words).
In their study of 162 low back pain patients, there is no difference between:
• Spinal manipulation vs spinal mobilisation
• Spinal manipulation vs placebo
• Spinal mobilisation vs placebo
No difference in both pain scores and disability scores.
So if you are paying a chiropractor thousands of dollars for a package, you may want to think twice about renewing current package when it ends.
Study 2 (Oct 2019): no short-term effects with chiropractic adjustments
A lot of chiropractic fans would insist that they feel better after each sessions. What if your feeling better is just a sudden, overwhelming shiokness?
Because a study published by a team of chiropractors — yes, chiropractors — found that there’s no difference between real adjustments and fake adjustments immediately after treatment, 15 minutes after treatment, or 30 minutes after treatments.
This study used a specific measuring tool to measure pressure pain threshold and they took measurements not just from the lower back but also calves, shoulders, hands, and feet.
What does it tell you?
Have a think about it. What does this tell you?
Study 3 (published 2012): spinal manipulative therapy is MORE effective than medication both short and long term. Sounds good yea?
A study found that a two one-hour sessions with a clinician + a home exercise programme achieved the same results as spinal manipulative therapy.
It sounds like having your spine adjusted is just as effective as clinical rehabilitation, right?
Well, no!
The patients who underwent spinal manipulation visited the chiropractor 15 times on average.
That’s 2 sessions vs 15 sessions leh. Not fair right?
If you dig into the study, they also didn’t just receive chiropractic manipulation. Their treatment also included soft tissue therapy, assisted stretching, cold and heat therapy.
This is a terrible study cos if you genuinely wanted to investigate the effects of adjustments, you would never include the other treatments!
Study 4 (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!
Even if it works, spinal manipulative therapy is a short-term solution
I blogged about this paper (Feb 2019) 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.
Our client Raymond booked in to see chiropractor Jesse expecting to be adjusted. He shared his initial thoughts about our approach and how he managed to achieve full symptom resolution despite a very rocky beginning. Must watch!
Public Service Announcement: Adjustments CANNOT protect you against the coronavirus
There’s quite a bit of chatter and content circulating around to suggest that adjustments can help you stay projected against coronavirus. This is unequivocally FALSE.
These false claims have been citing “research” reports from International Chiropractors Association (ICA) to support their stance.
The World Federation of Chiropractic (WFC) and American Chiropractic Associations had both dismissed ICA’s claims (i.e. they are junk science).
In WFC’s official statement, they asserted that suggesting spinal manipulation may protect patients from COVID-19 is dangerous to public health.
A group of over 150 chiropractic researchers from 11 countries have also jointly published that “ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system“.
Unfortunately chiropractors in Singapore are not regulated. This allows for aberrant clinicians to promote pseudoscience treatments for health conditions. When in doubt, please seek professional advice from an evidence-based health care provider.
Please note that these advisories and publications are coming from chiropractors and chiropractic academics. It is not a case of anti-chiropractic medical professionals trying to undermine the work of chiropractors.
Good alignment doesn’t even matter
I am 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 my previous blog post on 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.)
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!
Research tells us that adjustments are only accurate 50% of the time!
We know this for a while now. The esteem Stuart McGill published a paper in 2004 that spinal manipulation are only accurate half of the time.
The average error is about 5 cm away from the targeted segment and can be up to 14 cm – almost three spinal levels — away.
With this in mind, it comes as no surprise that a paper that was just published last year in 2019 found targeted and non-targeted adjustments to have similar effects.
Both approaches — specific or general — are just as effective at reducing patient’s pain scores.
The next time you see a chiropractor making some fancy-schmancy during an adjustment, just keep that in mind that it’s just theatrics!
With our no-adjustment approach to treatment, our clients are NOT reliant on us to achieve freedom from pain. Hear what our client DY has to say about her recovery with us. You do not need regular chiropractic care!
0:00 – What is the low back knot?
0:50 – Is the knot real?
2:00 – Is my spine out of alignment?
?:?? – ??? ???? ???????! // ?? ?????? ??? ???? (?? ???????)
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 articles were published by chiropractors condemning the subluxation junk science.
Side note: parents of a boy who died after they treated earache with homeopathy were found guilty of manslaughter.
If you think evidence is not important, think again. Children have die receiving useless treatments for real medical conditions.
When in doubt, seek medical advice or a second opinion from an evidence-based chiropractor.
Science matters.
Be responsible for your own health.
p.s. If you have been misled to buy into a treatment plan, please lodge a complaint with CASE. They may be able to help. Example of false claims are chiropractic helping with blood pressure, infertility, acid reflux, etc.
Teaching a brand new exercise from scratch via online video:
“Point your toes away, does your symptoms go away?”
1:14 – “Actually. Wow. Ya.”
2:31 – “Oh? Actually doesn’t hurt already. Yeah, wow.”
Spinal manipulation doesn’t increase performance
Some chiropractors try to sell you treatment plans 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.
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 earlier, 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. Evidence-based chiropractors are well-trained across treatment modalities to manage conditions and diseases of the musculoskeletal system (i.e. joints and muscles).
You don’t need regular chiropractic adjustments
I also blogged about this before so I am not going to go into too much details on how often should you see a chiropractor,
In my opinion, four to seven times is sufficient for the average patient. For more complex cases, you still shouldn’t need more than 12 visits in a given year.
Of course there are chiropractors who will sell you 20, 40 session packages. They just want your money lah!
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.
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 physiotherapy, 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.
Chiropractic DOES work
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, quality of life, and even sports injuries. I can help you achieve your full potential without pain killers and their unnecessary side effects.
Evidence-based chiropractors treat muscle and joints pain or injury with evidence and education. This is the first line of treatment according to major clinical guidelines around the world.
Like it is common for chiropractors to offer only spinal manipulation, physiotherapists and osteopaths in Singapore are also just as guilty of focusing manual therapy (e.g. soft tissue work, dry needling, stretching). All of these modalities are no longer considered first-line treatment across all musculoskeletal conditions.
There is also research published to suggest that chiropractic patients recover faster than those undergoing physiotherapy. Other studies have also supported that when it comes to treating lower back pain, chiropractors are more guideline-adherent than other healthcare providers.
Unfortunately, there is still a small group of chiropractors who refuse to align themselves to best clinical practices. This is why chiropractic is still considered complementary medicine or alternative medicine in Singapore.
If you would like to contest any part of this blog post, please do reach out to me AND include an adequate reference. I will 100% look into it and get back to you accordingly.
“In God we trust, all others must bring data.”
p.s. can you believe how much spinal health and posture information is actually garbage?!
Want to learn more? Check out:
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Our goal? To make our own services redundant to you.
*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.