Chiropractic is one of the most widely used forms of care for back and neck pain in Canada, yet many people have only a vague idea of what it involves. Some picture dramatic neck cracking from a video they saw online; others have heard that chiropractors 'put bones back in place'. Neither description is accurate.
This article, written by a Doctor of Chiropractic, explains what happens during an assessment and adjustment, what the evidence says about what adjustments can and cannot do, the real risks and how they are managed, and how chiropractic fits alongside physiotherapy and massage therapy. The goal is to help you make an informed decision, whether or not chiropractic turns out to be right for you.
Who chiropractors are
In Ontario, chiropractors are regulated health professionals governed by the College of Chiropractors of Ontario. They complete undergraduate university study followed by a four-year, full-time Doctor of Chiropractic programme, then national board examinations, before they can register. They are one of the professions in Ontario permitted to communicate a diagnosis and to perform spinal manipulation, and they are trained to recognise conditions that need medical referral.
Chiropractors focus on the musculoskeletal system — joints, muscles and nerves — and especially the spine. Modern chiropractic care is not limited to adjustments; it typically also includes soft-tissue therapy, exercise prescription and advice about activity and posture.
The assessment comes first
Before any treatment, a chiropractor takes a detailed history and performs a physical examination. This includes questions about how the pain started, what makes it better or worse, your general health, medications and past injuries. The examination looks at posture and movement, tests muscle strength, reflexes and sensation, and checks individual joints for stiffness and tenderness.
An important part of the assessment is screening for conditions where manipulation would not be appropriate or that need a physician. Imaging such as X-rays is only requested when there is a specific clinical reason, not routinely. At the end of the assessment, you should receive a clear explanation of the likely diagnosis, the treatment options including alternatives, the expected benefits and risks, and an estimate of how many visits may be needed. Treatment proceeds only with your informed consent.
What an adjustment is
An adjustment, or spinal manipulation, is a high-velocity, low-amplitude thrust: a quick, short, controlled movement applied to a specific joint. The chiropractor positions you so that the joint is taken to the end of its comfortable range, then applies a brief impulse. The whole movement takes a fraction of a second and the distance travelled is small.
Adjustments can be done by hand, with a hand-held instrument that delivers a precise impulse, or on a specialised table with sections that drop slightly. Many people are also treated with mobilisation — slower, gentler, rhythmic movements of a joint without a thrust — which is a good option for people who prefer not to have a manipulation or for whom it is not suitable.
What the cracking sound actually is
The pop or crack that sometimes accompanies an adjustment is called cavitation. Joints are surrounded by a capsule filled with lubricating fluid that contains dissolved gases. When the joint surfaces are separated quickly, the pressure inside the capsule drops and a gas bubble forms, producing the sound. It is the same thing that happens when you crack your knuckles.
The sound is not bones moving back into place, and it does not indicate whether an adjustment was successful. Some effective adjustments make no sound at all. The idea that vertebrae are 'out of place' and need to be put back is outdated; the effects of manipulation are better explained by changes in joint movement, muscle tone and how the nervous system processes pain.
What adjustments can help
The strongest evidence for spinal manipulation is in low back pain and neck pain. Clinical guidelines include it among the recommended options for acute and chronic low back pain, alongside exercise, massage, heat and staying active. The benefit is real but modest, and similar in size to other recommended treatments. It works best as part of a plan that includes exercise and advice, rather than on its own.
Manipulation is also used for some types of headache, particularly headaches arising from the neck, and for stiffness in other joints such as the mid back, ribs and extremities. Claims that adjustments treat conditions outside the musculoskeletal system, such as infections, allergies or digestive disorders, are not supported by evidence.
| Condition | Evidence for manipulation |
|---|---|
| Acute and chronic low back pain | Recommended option; modest benefit, best with exercise |
| Neck pain | Helpful, particularly combined with exercise |
| Cervicogenic headache | Some supporting evidence |
| Mid-back and rib stiffness | Commonly used; supportive evidence |
| Non-musculoskeletal conditions | Not supported |
How it feels and what to expect after
Most people find an adjustment quick and not painful; many describe a feeling of release or increased ease of movement afterwards. You are always told what is about to happen, and you can ask for a gentler technique or for mobilisation instead at any time.
The most common side effect is temporary soreness, stiffness or a mild headache, usually starting within a day and settling within one to two days. This is similar to the soreness after a new exercise. Staying gently active, using heat and drinking enough water are usually all that is needed.
The real risks
Serious complications from spinal manipulation are rare. The one that receives the most attention is the possibility of stroke following neck manipulation, related to a tear in an artery in the neck called a cervical artery dissection. Research suggests that people who have a dissection may visit a chiropractor or a family doctor because the early symptoms — neck pain and headache — are the same symptoms that bring them in, which makes it difficult to show that manipulation causes it. Nonetheless, it is taken seriously.
That is why screening matters. A chiropractor asks about and examines for warning signs of artery problems, such as a sudden severe headache unlike any before, dizziness, double vision, difficulty speaking or swallowing, and numbness. If any are present, manipulation is not performed and you are referred urgently. For people who prefer to avoid neck manipulation, mobilisation and soft-tissue techniques are effective alternatives.
When an adjustment is not appropriate
Manipulation is avoided or modified in certain situations. A good chiropractor will discuss these openly and suggest alternatives.
- Signs of nerve compression with progressive weakness or loss of bladder or bowel control.
- Suspected fracture, infection or tumour.
- Significant osteoporosis.
- Inflammatory arthritis affecting the upper neck, such as rheumatoid arthritis.
- Use of blood thinners or bleeding disorders, for some techniques.
- Warning signs of artery problems in the neck.
- Recent spinal surgery in the area.
How many visits?
For an acute episode of back or neck pain, many people notice improvement within a few visits over two to four weeks. A reasonable plan has clear goals and regular re-assessment, and you should see meaningful progress within that time. Be cautious of any clinic that asks for long prepaid treatment packages at the first visit or recommends indefinite regular adjustments for someone without symptoms. The aim of good care is to get you managing independently, with exercises and strategies to prevent recurrence.
Chiropractic, physiotherapy or massage?
These professions overlap considerably, and many people benefit from more than one. Chiropractic care is well suited to spine-related pain and stiffness, particularly when joint restriction is a major feature. Physiotherapy has a broader rehabilitation focus, including post-surgical care, sports injuries and neurological conditions, and emphasises progressive exercise. Massage therapy focuses on muscle and soft-tissue tension. In a multidisciplinary clinic, the professions can coordinate so that treatment complements rather than duplicates.
Cost and coverage in Ontario
Chiropractic care is not covered by OHIP. It is covered by most extended health plans, usually with an annual maximum per practitioner type, and is also covered under auto insurance after a motor vehicle collision and by WSIB for approved work injuries. Check your plan for the annual limit and whether a referral is required — most do not require one.
Chiropractic care in Woodbridge
At Med Wellness on Ansley Grove Road, chiropractic care starts with a thorough assessment and an honest explanation of the options. Treatment combines gentle, precise adjustments or mobilisation with soft-tissue work and exercise, and we coordinate with our physiotherapists and massage therapists when combined care will help.
We offer direct billing to most extended health plans. Call +1 (905) 605-8889 or book online to arrange an assessment.
References
Written by Babak Panahloo, Chiropractor · Clinically reviewed by Paramjeet Kaur Bassi · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
