Is Chiropractic Effective?

What the Evidence Shows
When You Zoom Out Is Frightening!


Lower back pain is now recognised as a chronic public health failure, not a simple injury problem.


Despite decades of increased medication use, medical imaging, injections, and spinal surgery:


  • Disability rates continue to rise
  • Chronic pain prevalence continues to increase
  • Healthcare costs continue to escalate


This forces an uncomfortable but necessary question:

If conventional approaches were effective long-term, why are outcomes getting worse?

Chiropractic and Lower Back Pain: The Strongest Evidence Base


Lower back pain is the most studied condition in Chiropractic research.

Evidence is out that Chiropractic consistently produces better results for chronic lower back pain than both conventional medical care and physiotherapy in not just peer reviewed literature but systemic reviews. If you're like us and love diving into research you can read all about it on this page. We've included references at the bottom of the page if you want to dig deeper too.


Randomised Controlled Trials


Bishop et al. (2010) demonstrated that patients receiving Chiropractic spinal manipulation in addition to usual medical care experienced significantly greater improvement in function than those receiving medical care alone.


Crucially, medication reliance differed dramatically:

  • 78% of usual-care patients were still using narcotics at 16 weeks
  • Only 6% of patients in the Chiropractic-guideline group received spinal manipulation


This highlights that Chiropractic care does not merely reduce pain, it changes the trajectory of recovery.

Chiropractic vs Medical Care: Outcomes That Matter

Large population-based studies consistently show that when compared to medical care, Chiropractic care is associated with:


  • Lower opioid use
  • Reduced likelihood of surgery
  • Lower overall healthcare costs
  • Shorter disability duration


Cifuentes et al. (2011) found that patients primarily managed by Chiropractors had:

  • Lower medical expenditure
  • Shorter work disability episodes
  • Fewer invasive procedures


Goertz et al. (2018), published in JAMA Network Open, confirmed that adding Chiropractic care to usual medical care resulted in greater reductions in pain intensity and disability than medical care alone.

Dose-Response: Why Frequency and Duration Matter


One of the most important findings in Chiropractic research is dose-response.


Haas et al. (2014) demonstrated that:


  • Clinical outcomes improve as visit frequency increases
  • Approximately 12 visits represents the best current estimate for meaningful improvement in chronic lower back pain


“Twelve sessions of spinal manipulation therapy is the current best estimate for use in comparative effectiveness trials.”

- Haas et al., 2014


This mirrors what we understand about all biological systems:



  • Strength requires repeated load
  • Mobility requires repeated movement
  • Neurological adaptation requires repeated input


A single adjustment cannot undo years of reduced motion.

Why Specific Adjustments Matter


Not all spinal manipulation is the same.


A major limitation of earlier research is that mobilisation and manipulation were often grouped together, despite very different neurophysiological effects. Recent research clarifies this.


Niazi et al. (2024) demonstrated that:


  • Adjustments applied to dysfunctional (subluxated) spinal segments produce
    significantly greater changes in sensorimotor integration.
  • Non-specific or general manipulation produces weaker effects


This confirms that segmental specificity matters,
and supports the clinical relevance of detecting and addressing spinal dysfunction.



Effectiveness Depends on Proper Application


Chiropractic care is effective when applied correctly.

Clinical guidelines emphasise that spinal manipulation must be preceded by:

  • Thorough examination
  • Identification of segmental dysfunction
  • Exclusion of red flags

(Bronfort et al., 2008)


This is why the practitioner skill matters as much as the selected treatment modality itself.

At Adjusting to Health, all of our doctors hold a Masters Degree and have undergone significant and continued post-graduate education as a part of our Chiropractors Professional Development Program.

Brain-Based Effects of Chiropractic Care


Pain is now understood as a brain-mediated experience, not simply tissue damage.

Several studies have demonstrated that Chiropractic care produces measurable neurological changes.


Didehdar et al. (2020) showed:


  • Reduced pain intensity
  • Improved functional scores
  • Measurable changes in brain metabolites (including N-acetyl aspartate)


Haavik et al. (2024) further demonstrated neuroplastic changes associated with improvements in:


  • Pain
  • Mood
  • Sleep
  • Cognitive processing


These findings help explain why most patients report benefits far beyond just the pain relief they were originally seeking to get. This is due to the effects of specific Chiropractic adjustments to the brain and nervous system.


Chiropractic vs Common First-Line Treatments


Systematic reviews consistently show limited effectiveness for common medical interventions:


  • Paracetamol has no meaningful benefit for acute or chronic
    lower back pain (Davies et al., 2008; Machado et al., 2015)
  • NSAIDs show low-quality evidence with known risks (Enthoven et al., 2016)
  • Surgery for non-specific lower back pain shows poor long-term outcomes
    unless red flags are present (Nguyen et al., 2011; Don & Caragee, 2008)


In contrast, Chiropractic care demonstrates:

  • Comparable or superior effectiveness
  • Better long-term cost-effectiveness
  • Significantly lower risk

(Manga et al., 1993; Bronfort et al., 2014)


If you're ready to find relief for lower back pain and want to take a proactive approach under the most effective and evidence based method with modern systems and procedures, research shows we are your best option.

Click below to schedule your first appointment!

Why Chiropractic Is Often Used Too Late


Many patients arrive at Chiropractic care after:


  • Years of medication
  • Failed rehabilitation
  • Escalating imaging
  • Consideration of surgery


Research suggests this delay worsens prognosis.

Maintained spinal manipulation has been shown to:


  • Sustain improvements
  • Reduce recurrence
  • Prevent regression to baseline pain levels

(Senna & Machaly, 2011)

Bottom Line


When assessed objectively, the evidence shows that Chiropractic care:


  • Is one of the most effective treatments for lower back pain
  • Reduces reliance on medication and surgery
  • Produces meaningful neurological changes
  • Delivers superior long-term value


The question is no longer whether Chiropractic works.

The question is, why wasn't it used earlier?

What are you waiting for, we're here and ready to help at a location near you.

References


Bishop, P.B., et al. (2010). A randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. The Spine Journal, 10(12), pp.1055–1064.

Bronfort, G., et al. (2008). Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal, 8(1), pp.213–225.


Bronfort, G., et al. (2014). Effectiveness of spinal manipulation and exercise for chronic low back pain. Annals of Internal Medicine, 160(6), pp.381–391.

Cifuentes, M., et al. (2011). Health maintenance care and disability recurrence among low back pain patients. Occupational and Environmental Medicine, 53(7), pp.770–777.

Davies, R.A., et al. (2008). A systematic review of paracetamol for non-specific low back pain. European Spine Journal, 17(11), pp.1423–1430.

Didehdar, D., et al. (2020). Effect of spinal manipulation on brain neurometabolites in chronic low back pain. Irish Journal of Medical Science, 189(2), pp.543–550.


Don, A.S. and Caragee, E.J. (2008). A systematic review of lumbar fusion surgery for chronic low back pain. The Spine Journal, 8(2), pp.258–265.

Goertz, C.M., et al. (2018). Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability. JAMA Network Open, 1(1), e180105.



Haas, M., et al. (2014). Dose-response and efficacy of spinal manipulation therapy for chronic low back pain. The Spine Journal, 14(7), pp.1106–1116.


Machado, G.C., et al. (2015). Efficacy and safety of paracetamol for spinal pain and osteoarthritis. The Lancet, 385(9978), pp.1586–1596.


Manga, P., et al. (1993). The effectiveness and cost-effectiveness of chiropractic management of low back pain. Ontario Ministry of Health, Canada.


Niazi, I.K., et al. (2024). A randomized controlled trial comparing site-specific spinal manipulation on sensorimotor integration. Nature Scientific Reports, 14, 1159.


Nguyen, T.H., et al. (2011). Long-term outcomes of lumbar fusion among workers’ compensation subjects. Spine, 36(4), pp.320–331.


Senna, M.K. and Machaly, S.A. (2011). Does maintained spinal manipulation therapy result in better long-term outcome? Spine, 36(18), pp.1427–1437.