If you search ‘adjustment’ on YouTube, you will get video after video of backs being cracked, necks being yanked with straps, and bodies being hammered and chiselled.

You might hear therapists say they are correcting misalignments and subluxations, or they are breaking up scar tissue and adhesions. You might also hear them say that the ‘click’ you heard was them putting the spine back into place. What if all of that was not true?

Spinal adjustment, or any other form of manual therapy (e.g., soft-tissue massage), can have positive effects on your pain, stiffness and function.

However, this is ‘not’ because body tissues are being realigned, put back into place, broken up, or released:

• The spine is neither weak nor unstable.
• Joints do not just pop in and out that easily (the sound you hear may just be the change of pressure within the joint—like cracking your knuckles).
• Muscles and fasciae do not loosen, nor do they go anywhere.

How manual therapy works is complex. We still do not know how it works exactly but based on current research, ‘neuromodulation’ could play one part. That is, manual therapy could affect the body and nervous system’s processing and perception of pain, rather than physically change tissue.

Although research does show that manual therapy can be effective for pain, it is only short-lasting. So, active treatments such as exercise should be the focus of rehabilitation since they have more research for longer-lasting improvements in pain and function.

Manual therapy can feel good and it can be helpful, but you do not 'need' it to get better.