Manual Chiropractic Adjustments: What They Are, How They Work, and Why They’re Safe

Manual adjustments are one of the most recognized techniques in chiropractic care, but they’re also one of the most misunderstood. Many people are unsure what actually happens during an adjustment, what the popping noise means, or whether it’s safe. As a chiropractor in Burnaby working with desk workers, active adults, and recreational athletes (I see you pickleballers), it's one of the several tools I use due to its many benefits.

Here’s a clear, friendly breakdown of how they work and what you can expect.

What Are Manual Chiropractic Adjustments and What Do They Do?

A manual adjustment (also know as High-Velocity Low-Amplitude (HVLA) or Spinal Manipulation) is a hands-on technique that is backed by research and used to improve mobility, reduce stiffness, and support healthier movement patterns. When a joint isn’t moving well, from sitting all day, repetitive strain, old injuries, or stress, an adjustment can help in more ways than you may think.

What does HVLA mean?

High-Velocity: The movement is quick and precise.

Low-Amplitude: The movement is extremely small in distance.

Here's what happens during an adjustment:

• Biomechanical Effects: an adjustment targets the joints, muscles, and ligaments to restore proper movement. The quick thrust helps release joint restrictions, break up small adhesions, and improve lubrication within the joint.

• Neurological Effects: an adjustment influences both the central and peripheral nervous system. The quick mechanical input reduces pain by activating mechanoreceptors, relaxes tight muscles through reflex pathways, and modulates how the spinal cord processes sensory signals. By restoring normal joint motion, it also sharpens proprioception and improves overall motor control.

• Neurochemical & inflammatory modulation: an adjustment can trigger the release of natural pain-relieving chemicals like endorphins, lower pro-inflammatory cytokines, and activate the HPA axis, which increases cortisol to help reduce inflammation and stress.

• Vascular & Cerebrospinal Fluid: an adjustment can improve blood flow and oxygenation to the surrounding muscles and soft tissues, supporting healing. They may also enhance cerebrospinal fluid movement, which can help with issues like cervicogenic headaches.

• Psychosocial Effects: a patient’s confidence in the treatment can amplify pain relief through expectation effects, and the relief gained from an adjustment can reduce fear-avoidance behaviours, helping patients move more confidently and prevent chronic pain patterns.

What Causes the Popping Sound During an Adjustment?

That cracking or popping sound is called cavitation, and it’s simply a pressure change in the joint.

Here’s what actually happens:

• Joints contain fluid with dissolved gases.

• When the joint is stretched quickly, pressure drops.

• A tiny bubble forms and collapses, creating the sound.

Important notes:

• It's not bones cracking or anything being "put back into place".

• The sound doesn't indicate success, many effective adjustments make no noise at all.

Why Do People Get Manual Adjustments?

Several factors can restrict how far a joint can move. Muscular tightness or imbalances can block full motion (think tight hip flexors limiting hip extension). Joint stiffness from aging, arthritis, or repetitive postural stress can also reduce mobility. Soft tissue restrictions such as adhesions or scar tissue further limit movement. Structural changes like bone spurs may physically block motion, and pain often leads to guarded movement, creating even more stiffness over time.

Manual adjustments can help improve:

• Stiffness from prolonged sitting

• Neck and back tension

• Headaches

• Nerve pain

• Reduced mobility during workouts or training

• Chronic tightness

• Postural strain

• Discomfort from repetitive movements

While adjustments are often associated with the spine, they’re helpful for many joints in the body and are always tailored to your comfort, your body, and your specific condition.

Common areas that benefit from manual adjustments include:

• Neck and upper back

• Mid-back and ribs

• Lower back

• SI joints and hips

• Feet and ankles

• Shoulders and hips

• Knees, elbows and wrists

In my practice, adjustments are often combined with soft-tissue work, education, and personalized exercises, helping you not just feel better, but stay better.

Are Manual Adjustments Safe?

For the vast majority of people, yes manual chiropractic adjustments are very safe when performed by a trained and licensed chiropractor.

Why they’re considered low-risk:

• Chiropractors complete years of clinical, anatomical, and biomechanical training.

• Every visit includes screening and assessment to ensure techniques are appropriate.

• Adjustments are controlled, targeted, and modified based on your comfort.

Because risks can vary depending on your medical history and the nature of your complaint your chiropractor will discuss anything relevant before treatment begins. Most people feel lighter and more mobile afterward, though some may experience mild, workout-like soreness that usually fades quickly. Overall, chiropractic care is a conservative, low-risk option compared to medication or surgery for musculoskeletal concerns.

If you’re not comfortable with manual adjustments, alternatives like the Activator tool (read more about the activator here), joint mobilizations, drop-table techniques, soft tissue and rehab exercises are also available.

What to Expect During a Manual Adjustment

When you come in for care at my Burnaby chiropractic clinic, we will:

1. Discuss your symptoms, lifestyle, and goals.

2. Assess your movement and identify which joints aren’t moving well.

3. Walk through your treatment options so you can choose what feels right.

4. Use gentle, precise techniques that support your comfort and recovery.

You’re always in control and nothing happens without clear explanation and consent.

Final Thoughts

Manual adjustments are a safe, effective tool for improving mobility and supporting

your overall function. They impact how the body moves, how the brain processes information as well as the chemical reactions that can help with the healing process. Whether you’re dealing with tension from your desk, recovering

from an old injury, or trying to stay active with family and sports you may benefit from chiropractic care.

If you’re curious whether manual adjustments could help you, feel free to reach out or book an appointment. I’m always happy to answer questions and help you choose the approach that best supports your goals.

References

Alanazi, M. S., Degenhardt, B., Kelley-Franklin, G., Cox, J. M., Lipke, L., & Reed, W. R. (2025). Neuromuscular Response to High-Velocity, Low-Amplitude Spinal Manipulation—An Overview. Medicina, 61(2), 187. https://doi.org/10.3390/medicina61020187

Fernández-de-las-Peñas, C., Alonso-Blanco, C., Cleland, J. A., Rodríguez-Blanco, C., & Alburquerque-Sendín, F. (2008). Changes in pressure pain thresholds over C5–C6 zygapophyseal joint after a cervicothoracic-junction manipulation in healthy subjects. Journal of Manipulative and Physiological Therapeutics, 31(5), 332–337. https://doi.org/10.1016/j.jmpt.2008.04.006

Moorman, A. C., & Newell, D. (2022). Impact of audible pops associated with spinal manipulation on perceived pain: A systematic review. Chiropractic & Manual Therapies, 30, 42. https://doi.org/10.1186/s12998-022-00458-5