How Does Chiropractic Work?

Written by: James Demetrious, DC, DABCO

Why, What, and How?

Why do we adjust patients? What is the elementary purpose to move bones with High Velocity-Low Amplitude Spinal Manipulation (HV-LA SM) or Low Velocity-Low Amplitude techniques (LV-LA)? I am not asking about the effect of those interventions. I am asking HOW chiropractic works?

A fundamental purpose of chiropractic adjustments is to improve segmental mobility, bone to bone. In this regard, I have codified segmental hypo-mobility as intra-articular, extra-articular, and neurogenic causes. Under each of these headings, I have acknowledged quantifiable causes of segmental hypo-mobility.

Recognition of contributory causes affecting respective patients offers insight into patient management, clinical expectations, therapeutic approaches, and dosing:

  • Intra-articular causes of hypo-mobility:
    • Synovitis/facet joint edema,
    • Synovial hypertrophy,
    • Meniscoid/plical entrapment,
    • Intra-articular debris,
    • Intra-articular adhesions.

  • Extra-articular causes of hypo-mobility:
    • Capsular thickening,
    • Extra-articular adhesions, DJD, and discogenic contributors,
    • Disuse atrophy,
    • Denervation atrophy,
    • Myofascial adhesions.

  • Neurogenic causes of hypo-mobility:
    • Neurogenic hypertonicity,
    • Trigger points,
    • Pain – fear avoidance,
    • Psychosocial issues,
    • Iatragenic denervation.

Clinical Utility

These headings are interrelated and represent a practical clinical tool. All of these factors are quantifiable, objective, and observable. Highly skilled chiropractic spinal adjustments positively affect these causative factors in a manner that is reflected by the overwhelming safety and efficacy reported in the literature.

I discuss each of these topics in my continuing education coursework available at:

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a nationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. For current, evidence-based, and clinically intuitive CE Coursework, attain your advanced training at