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What is it about chiropractic care that makes it so effective? Patients swear by the spinal adjustments they receive from their chiropractor, but often don't know how the manipulation is helping, other than a general knowledge that their backs have been "cracked."

Adhesions in the hinge joints of the vertebrae, called the facet joints, may be one reason for back pain.

Adhesions, or joints being improperly stuck together, can be caused by reduced mobility from injury or inactivity. Chiropractic spinal manipulation theoretically separates the facet joints and increases the space between them, breaking adhesions and restoring motion. One of the most common spinal adjustments performed by chiropractors - the side-posture adjustment - involves positioning a patient on his or her side, then rotating the upper body using the shoulder and hip as levers. From here, an adjustment is made with a slight twisting of the spine.

In a study in the journal Spine, 64 men and women ages 22-30 without back pain were divided into four groups for varying treatment interventions, involving placing patients in side-posture position only (without performing an adjustment), providing actual side-posture spinal adjusting, or leaving patients in a neutral position. MRI scans were taken before and after interventions, in side-posture position or with people lying on their backs, and compared for each individual.

People given side-posture adjustments followed by MRI in side-posture position showed the greatest separation in the facet joints. Those in side-posture position alone, without adjustments, showed the second-greatest separation before and during MRI. Side-posture adjusting clearly created greater separation than no adjustments. The average difference in separation between neutral group subjects' facet joints and the group receiving side-posture adjustments was only a few millimeters, but the authors called this amount "not only significant," but also "clinically relevant."


Cramer GD, Gregerson DM, et al. The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: A randomized controlled trial with sixty-four subjects. Spine 2002:27(22), pp. 2459-2466.

To read more studies on back pain treatment, go to


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