Why do you feel better after a chiropractic adjustment?

As a chiropractor, people often ask why I stopped offering chiropractic adjustments.

The reason is super simple. It doesn’t really drive any meaningful change. I am not contesting that people don’t feel better after each crackling crack session, I am suggesting that these results are short-lived.

I am not agreeable with it because you have to keep coming back for you to remain pain-free. In my opinion, this is ridiculously disempowering.

Sure, it’s good for the pockets but not so good for the soul.

There are at least two recent studies that showed that spinal manipulation doesn’t work better than placebo. This doesn’t mean that you don’t feel good after being cracked. What it’s saying that people who get a fake adjustment feels just as good after.

In short, this change is not real.

Before you start to think that the researchers or experimenters are not qualified, they are actually registered chiropractors. So yes, there are evidence-based chiropractors out there telling us that chiropractic adjustment is a poor value treatment option.

So, if it doesn’t work, why do people feel better? Here are five  possible reasons.

1. The Placebo Effect

The reason that comes to your mind is probably the placebo effect, and you would right!

Placebo effect, in the most accurate sense, can be refer to any improvement in your symptom experience that’s not due to the intervention itself. It doesn’t say that you don’t feel better.

You do.

It’s just that the improvements do not come from the intervention, drug, or treatment itself. So, these are non-specific effects.

When it comes to pain or injury, expecting to feel better is actually a powerful process. We do see that people who expect themselves do actually feel better.

So, if you think that chiropractic adjustments is going to work, you’re more likely to feel better. However, this relief is often short-lived and have no long-term meaningful effect.

Bonus content: If you expect yourself to feel worse, you are more likely to feel worse. The symptom aggravation can also be NOT due to the intervention itself. We refer to this as the nocebo effect.

Bonus content x2, cos we feeling generous, positive self-talk before exercise has been demonstrated to show improvements in pain experience while negative self-talk before exercise actually worsens it.

2. Regression to Mean

This is something that we probably all heard of at some point in our education but just never remember.

Regression to mean is a concept in statistics that suggest that all abnormal events tend to move/regression towards the average baseline. So, if you have a super crazy pain episode and you decided to see a chiropractor . . . you could feel better because of regression to mean (i.e., regressing to your average pain experience).

What happens in such instances is that your normal symptom trajectory is improvement. So, it doesn’t matter what you do. Getting adjusted, going for a walk, sleeping in bed, you would feel better no matter what. The variable in concern here is time.

This is why we love, love, love, love exercise and education. Because you do walk away with a value add. Even if you are feeling better with our treatment because of regression to mean, you do leave with the knowledge and skills to self-manage your future episodes.

The bottom line? You don’t waste money by working with us.

3. Mistaking Correlation with Causation

This is really, really difficult to grasp but if you google for examples, it becomes slightly easier to wrap our heads around.

So, correlation when two events are related but doesn’t actually cause each other. For example, the rooster may crow right before sunrise but that doesn’t mean the sun rise because of the rooster’s crow! This is correlation.

There are some pretty crazy correlations out there like the consumption of ice cream is correlated with increase in murder. That doesn’t mean eating ice cream makes you more likely to become a murder!

Similarly, sometimes we go for an adjustment and we feel better afterwards. That’s totally possible. And we’d like to think that the improvement is from the adjustment. Yes, this experience, again, is possible but it’s really not causation aka you are not feeling better from the adjustment.

We know this because of the two studies that compared real adjustments versus fake treatments. The results show that adjustment don’t have a significant effect to your improving your pain experience.

4. Confirmation Bias

Confirmation bias is a psychology phenomenon where people tend to gather evidence that confirms or supports one’s prior beliefs or values.

For example, if you think exercise is good for weight loss, you may do a google search on “benefits of exercise for weight loss”. If that’s what you search for, then yes, you will only find evidence of how exercise works for weight loss.

Similarly, people may also search “why it is good to be single” or “why is it good to be married” to find evidence to support their life choice. While there’s nothing wrong with being single or being married, this approach to finding evidence to confirms our own bias, beliefs, or values, do not give us a partial understanding of the topic of interest.

In a clinical application situation, you may only choose to recall instances where you feel better after a chiropractic adjustment instead of recalling how you feel every single chiropractic treatment. This can also be considered confirmation bias.

5. Use multiple treatments but only attribute effects to one

This was one of the reason why I decided to give up on offering spinal manipulation!

When I first started Square One Active Recovery (known as Square One Chiropractic then), I offered multiple modalities from adjustments to dry needling to soft tissue therapy such as IASTM, and of course exercise.

The results that clients who did their prescribed exercises were pretty remarkable. However, they always attributed it to the more theatrical treatment such as spinal manipulation or dry needling. They would refer to dry needling as the reason why they were better.

However, there’s also no conclusive evidence to suggest that dry needling helps with chronic pain.

It’s not uncommon for people to receive multiple treatments in their journey to pain-free living. When they do feel better, they tend to attribute the positive effects to one of those treatments.

In such cases, however, it’s impossible to know which treatment exactly worked. Furthermore, it is also possible that two or more of the treatments to produce an interaction effect that was more than the sum of the treatments.

An example of this would be exercise versus education. We know that exercise on its own is not particularly useful at helping people with their recovery. However, when added to exercise, is more effective than exercise alone or education alone!

What does all of this mean for me?

It is true that research can be dry and boring. But yet at the same time, it provides very compelling evidence and explanations to our experiences.

Regardless of our personal experiences, the evidence is clear: spinal manipulation is not a sustainable pain solution. Yet at the same time, our own experiences may differ to what research is saying.

Does that change the evidence? No.

There are robust explanations to why people do feel better after receiving adjustments. And it is not because adjustments work.