For over 30 years, I’ve had the privilege of helping thousands of patients as a chiropractor. What began as a personal discovery during my time as a competitive athlete—where chiropractic care kept me injury-free and enhanced my performance—has grown into a lifelong passion. However, stepping into this profession, I quickly realized that chiropractic had a history that was as controversial as it was fascinating. I found myself navigating skepticism from the scientific community and philosophical divides within the field, all while striving to deliver real results for my patients.
What drives me, and many others in this profession, is the undeniable impact chiropractic care has on people’s lives. Yet, the question of how and why it works has always intrigued me. Through decades of research and innovation, we’ve moved beyond tradition to uncover many of the biomechanical and neurophysiological mechanisms behind spinal manipulative therapy (SMT). This article explores how chiropractic has evolved from its misunderstood origins to a dynamic, evidence-based profession that is reshaping MSK healthcare.
Article Index
The Historical Evolution of Chiropractic
Chiropractic’s history is as colorful and complex as the profession itself. Founded in 1895 by D.D. Palmer, it began with the bold assertion that spinal adjustments could restore health by correcting “nerve flow.” To fully understand the context, it’s important to recognize the state of medical science at the time. This was an era when questionable practices like bloodletting, the use of mercury-based treatments, and even trepanation (drilling holes into the skull) were still widely used, despite their often harmful or fatal consequences. Against this backdrop, Palmer’s ideas of “innate intelligence” and non-invasive spinal care offered a compelling alternative to the public, many of whom were disillusioned with conventional medicine. However, while innovative, Palmer’s theories were largely speculative and lacked the scientific evidence necessary to satisfy the rigorous scrutiny of the medical community. (Paget, 1867; Palmer, 1910)
The profession’s early years were marked by a mix of ambition, controversy, and showmanship. Perhaps no figure embodied this more than Palmer’s son, B.J. Palmer, who inherited both the chiropractic mantle and his father’s flair for spectacle. B.J. famously claimed to have adjusted Old Tom, the prized elephant of the Barnum and Bailey circus, and later displayed the animal's bones at his school as a testament to chiropractic’s potential. While entertaining, such theatrics often reinforced skepticism among the medical community, further isolating chiropractic from mainstream healthcare. (Keating, 1997)
But the greatest challenge to chiropractic’s legitimacy often came from within. Fierce internal debates erupted between those clinging to Palmer’s original philosophy and those advocating for a more evidence-based approach. This ideological divide slowed progress and created confusion about chiropractic’s identity. Critics outside the profession, including the medical establishment, dismissed chiropractic as pseudoscience—a perception that chiropractors have worked tirelessly to overcome.
Despite these obstacles, chiropractic has shown remarkable resilience, fueled by the undeniable benefits experienced by patients. Over the past century, the profession has gradually shifted from philosophy to science, embracing biomechanics, neurophysiology, and evidence-based practices. Modern research has validated spinal manipulative therapy (SMT) for conditions like low back and neck pain, helping chiropractic shed its historical misconceptions. (Chou et al., 2017; Gevers-Montoro et al., 2021; Wong et al., 2017)
Today, chiropractic stands at a crossroads. By confronting its past and embracing science, the profession is carving out a new role in healthcare—one defined not by spectacle or dogma but by evidence, collaboration, and patient-centered care. The lessons of history remind us of the importance of progress, ensuring chiropractic continues to evolve into a dynamic, science-driven discipline.
The Current Scientific Foundation of Chiropractic
Modern chiropractic care is firmly rooted in science, with research providing a deeper understanding of its effectiveness in treating musculoskeletal conditions like low back and neck pain. Spinal manipulative therapy (SMT), a cornerstone of chiropractic care, is supported by evidence that highlights its impact on joint function, pain reduction, and overall quality of life.
Biomechanical Effects of SMT
Scientific studies, including those using advanced imaging techniques like MRI, have shown how SMT improves joint health and function:
Restoration of Joint Motion:
MRI studies demonstrate that spinal manipulative therapy (SMT) increases joint mobility by alleviating stiffness in regions affected by hypomobility, characterized by restricted movement and altered joint mechanics. SMT achieves this by addressing joint fixation and reducing intra-articular adhesions, thereby restoring normal kinematics. This improved mobility re-establishes physiological movement patterns essential for functional activities of daily living. (Cramer et al., 2013; Millan et al., 2012)
Joint Separation and Adhesion Release:
Research shows that spinal manipulative therapy (SMT) facilitates the gentle separation of articular surfaces within the spine's zygapophyseal (facet) joints, effectively disrupting fibrous adhesions that develop due to immobility or injury. By breaking down these adhesions, SMT enhances joint glide, promoting smoother and more efficient movement while alleviating discomfort associated with restricted motion.
Key Insight: Fibrous adhesions, if untreated, can contribute to persistent stiffness, altered joint mechanics, and even degenerative changes over time, underscoring the importance of addressing these restrictions early. (Cramer et al., 2010; Cramer et al., 2002; Kawchuk et al., 2015)
Improved Range of Motion:
Studies highlight that SMT results in measurable improvements in joint translation (slight gliding movements) and rotation, which are critical for maintaining proper spinal function. (Millan et al., 2012; Cramer et al., 2013)
Neurophysiological Effects of SMT
In addition to its biomechanical benefits, SMT influences the nervous system in ways that significantly reduce pain and improve overall function:
Pain Modulation:
Spinal manipulative therapy (SMT) has been shown to activate descending inhibitory pathways in both the brain and spinal cord, effectively reducing pain perception. This mechanism involves the periaqueductal gray (PAG) in the midbrain and the rostroventromedial medulla (RVM) in the brainstem, which modulate pain by releasing key neurotransmitters such as serotonin (5-HT) and norepinephrine (NE). These neurotransmitters act to suppress nociceptive signal transmission at the level of the dorsal horn in the spinal cord, thereby diminishing pain. Nociceptive signal transmission is the process by which pain signals travel from injured tissues to the brain, alerting the body to potential harm. (Skyba et al., 2003; Gevers-Montoro et al., 2021)
Scientific Evidence: A 2020 study demonstrated that spinal manipulative therapy (SMT) reduces pain sensitivity, as evidenced by functional imaging showing decreased activation in brain regions critical to pain processing, including the anterior cingulate cortex (ACC), insular cortex, and primary somatosensory cortex (S1). These findings highlight SMT's role in modulating central nociceptive pathways. (Nim et al., 2020)
Proprioceptive Benefits:
Spinal manipulative therapy (SMT) enhances the body's ability to sense and coordinate movement by modulating proprioceptive input from mechanoreceptors located in the muscles (muscle spindles), tendons (Golgi tendon organs), and joint capsules.
This modulation happens when sensory signals (afferent signals) from the body travel through specific pathways in the spinal cord, called the dorsal columns and spinocerebellar tracts, to reach the central nervous system. These pathways carry detailed information about body position, movement, and balance to areas in the brain such as the cerebellum (which helps coordinate movement) and the motor cortex (responsible for planning and controlling voluntary movements). By improving how these brain areas integrate and respond to sensory information, spinal manipulative therapy (SMT) can enhance movement control and stability. (Pickar et al., 2007; Gevers-Montoro et al., 2021)
Central Sensitization:
Spinal manipulative therapy (SMT) has been shown to reduce central sensitization, a condition where the nervous system becomes overly sensitive, amplifying pain signals even when there’s no significant injury. This happens because pain pathways in the central nervous system, including the spinal cord and brain, become hyperactive, making the body feel more pain than it normally would. Central sensitization is often seen in people with chronic pain conditions, and SMT helps by calming these overactive pathways.
Spinal manipulative therapy (SMT) calms overactive pain pathways by reducing excitatory neurotransmitter release (e.g., glutamate) and decreasing nerve hyperactivity in the spinal cord's dorsal horn. It also alters activity in pain-related brain regions, including the anterior cingulate cortex (ACC), located along the inner frontal lobe, and the insular cortex, found within the brain's lateral sulcus. Together, these effects provide lasting pain relief. (Skyba et al., 2003; Gevers-Montoro et al., 2021; Martínez-Segura et al., 2012)
Clinical Practice Guidelines and Validation
Chiropractic care, and SMT in particular, is now widely endorsed by international clinical practice guidelines:
Low Back Pain:
SMT is recommended as a first-line treatment, alongside exercise and physical therapy, for both acute and chronic low back pain. Studies suggest that SMT not only reduces pain but also improves mobility and functional capacity. (Chou et al., 2017; Wong et al., 2017; Bussières et al., 2016)
Neck Pain:
SMT is a key intervention for managing persistent or recent-onset neck pain when combined with other conservative approaches, such as rehabilitation exercises and massage. (Chou et al., 2017; Wong et al., 2017; Bussières et al., 2016)
Building Credibility Through Evidence
The integration of advanced imaging techniques like MRI and randomized controlled trials has solidified the scientific foundation of chiropractic care. Studies consistently demonstrate that SMT is safe, with forces applied during treatment well within physiological thresholds and comparable to everyday movements like bending or lifting.
With ongoing research and increased scientific scrutiny, chiropractic care continues to evolve into a respected, evidence-based profession. By bridging the gap between tradition and modern science, chiropractic is not only improving patient outcomes but also redefining its role within the broader healthcare system. (Cramer et al., 2013; Chou et al., 2017; Herzog, 2010)
Chiropractic in the Age of Evidence
Over the past few decades, chiropractic care has taken significant strides in aligning itself with mainstream healthcare through science and collaboration. By integrating evidence-based practices and fostering interdisciplinary partnerships, the profession is bridging the historical divide between its roots and modern scientific standards.
From Isolation to Integration
Historically, chiropractic was often viewed as an alternative or even fringe therapy, isolated from the broader medical community. Today, this perception is changing:
Collaboration with Other Disciplines:
Chiropractors are working alongside neurologists, physical therapists, dentists, and pain scientists to deepen our understanding of spinal health and musculoskeletal care.
For instance, research into pain modulation pathways, such as descending inhibition, is a joint effort involving chiropractic and neurology.
Biomechanics studies now examine how chiropractic adjustments influence movement patterns and restore function, complementing findings from physical therapy and sports medicine. (Gevers-Montoro et al., 2021; Herzog, 2010; Bialosky et al., 2018)
Research-Driven Practice:
Decades of research into spinal manipulative therapy (SMT) have established it as a clinically validated treatment for conditions like low back and neck pain. Imaging studies and controlled trials have provided measurable evidence of its effects on joint mobility and pain modulation. (Cramer et al., 2013; Chou et al., 2017; Gevers-Montoro et al., 2021)
The Role of Clinical Practice Guidelines
Clinical practice guidelines have played a pivotal role in legitimizing chiropractic care within the healthcare system:
Endorsements for SMT:
Guidelines from respected organizations, such as the American College of Physicians (ACP), recommend SMT as a first-line treatment for low back pain. These endorsements underscore the role of chiropractic care in managing both acute and chronic conditions.
International guidelines similarly advocate for SMT in neck pain management, often recommending it alongside exercise and other conservative therapies. (Chou et al., 2017; Wong et al., 2017; Bussières et al., 2016)
Integration with Multimodal Approaches:
SMT is no longer seen as a standalone intervention but as part of a comprehensive care model:
Exercise Therapy: Improves spinal stability and functional outcomes, enhancing the effects of SMT.
Soft Tissue Techniques: Release myofascial tension, complementing SMT’s impact on joint mobility.
Psychological Interventions: Approaches like mindfulness and cognitive-behavioral therapy address chronic pain’s mental and emotional dimensions. (Chou et al., 2017; Wong et al., 2017; Bussières et al., 2016)
Conclusion
Chiropractic has evolved from a profession rooted in bold ideas and controversy to one firmly grounded in science and evidence-based care. Through decades of research, collaboration, and perseverance, chiropractic has demonstrated its value as a vital component of modern healthcare. The validation of spinal manipulative therapy (SMT) through advanced imaging, clinical trials, and global practice guidelines has redefined its role, proving that it is more than a historical curiosity—it is a dynamic and credible solution for musculoskeletal health.
Yet, as with all scientific fields, the story of chiropractic is far from complete. Science is a dynamic process, always working with the best explanations available at any given time. These explanations, while grounded in evidence, are never final—they evolve as new discoveries are made and as understanding deepens. Chiropractic, like medicine, neurology, and other disciplines, thrives in this environment of continuous inquiry and adaptation. Through a willingness to embrace change, foster collaboration, and prioritize patient care, chiropractic has the privilege and responsibility to shape its future as both a science and an art.
Together, as healthcare professionals, we advance our collective understanding—not through unwavering certainty, but by nurturing curiosity, embracing progress, and continually striving to do better.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
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