I get this question from new patients almost every week, usually phrased more bluntly than the search engines would allow. Somebody's cousin told them an adjustment "puts a bone back in place." Somebody's neurologist told them not to let anyone touch their neck. Both of those positions are reactions to a real problem in this profession: the word "chiropractor" covers an enormous range of practice styles, and the profession itself has never fully agreed on what it's treating or why it works when it does.

I'm going to answer this the way I'd answer it for a colleague, not the way it usually gets answered on a clinic website. That means naming the parts of chiropractic theory that don't hold up, being specific about what an adjustment does physiologically, and drawing a clear line between general adjustment-based practice and the structural, scoliosis-specific rehabilitation I actually do at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC.

ELI5: What does a Chiropractor actually do?

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What a Chiropractic Adjustment Actually Does

A spinal adjustment (technically, high-velocity low-amplitude manipulation, or HVLA) is a controlled, quick-thrust force applied to a joint, usually a facet joint in the spine, that takes the joint slightly past its normal passive range of motion. The audible "crack" most people associate with an adjustment is joint cavitation, gas bubble formation and collapse inside the synovial fluid, not bone moving into or out of position. Nothing is being "put back."

What the adjustment does do, mechanistically, is stimulate mechanoreceptors and proprioceptors in and around the joint capsule. That triggers a reflexive change in muscle tone (often a reduction in paraspinal muscle guarding), a transient increase in joint range of motion, and in some patients a measurable analgesic effect tied to changes in pain processing at the spinal cord and cortical level. This is fairly well established in the manual therapy literature and it's a real, mechanistically grounded effect. It is not evidence that a vertebra was misaligned and got corrected.

The Subluxation Question

Traditional chiropractic theory, going back to D.D. Palmer, describes a "vertebral subluxation" as a joint that is out of alignment and interfering with nerve function, causing downstream effects on organ health and general wellness. I'll say plainly what the evidence actually shows: this specific construct, subluxation as a cause of disease requiring correction, has no accepted radiographic, histological, or biomechanical correlate. A 2009 epidemiological review in Chiropractic & Osteopathy by Mirtz, Morgan, Wyatt, and Greene applied Hill's criteria of causation (the standard framework for establishing that one thing causes another) to the subluxation construct and found the evidence insufficient on every criterion. Their conclusion was that the construct remains, in their words, unsupported speculation with no demonstrated clinical applicability.

That doesn't mean nothing is happening on an X-ray when a joint is restricted or when a curve exists. It means the specific causal story, misaligned bone causes nerve interference causes disease, isn't supported. What imaging does reliably show is joint positional relationships, segmental alignment, and structural deformity, which is a different and much more defensible claim set. That distinction is the whole basis for how I practice.

Cervical Manipulation and Stroke Risk, Stated Honestly

Because this question always comes up alongside the first two: yes, there is a real association between cervical spine manipulation and vertebrobasilar artery dissection leading to stroke. The most cited population-based analysis, Cassidy et al., published in Spine in 2008, found a similar association between vertebrobasilar stroke and visits to a chiropractor and visits to a primary care physician, and proposed that patients with an already-dissecting artery seek care for neck pain and headache from both types of providers before the stroke occurs, which complicates simple causal attribution to the manipulation itself. Independent incidence estimates put the risk at roughly 1.3 cases attributable to cervical manipulation per 100,000 patients under 45 receiving manipulation within one week of treatment. That is a low absolute number, but it is not zero, and I don't think it's honest to wave it away as pure coincidence given the anatomical proximity of the vertebral arteries to the cervical facet joints during rotation and extension.

I don't perform high-velocity rotational cervical manipulation in my practice. That's a clinical preference based on the risk profile above combined with the fact that the structural rehabilitation work I do doesn't require it to achieve the outcomes I'm measuring.

Where Scoliosis-Specific Structural Rehab Is a Different Clinical Category

Everything above describes general chiropractic care aimed at joint restriction and musculoskeletal pain. What I do at Clear Life is a different clinical category, built on the CLEAR Institute protocol, and it's worth being precise about why.

General chiropractic care doesn't typically quantify outcomes on imaging beyond noting restriction or alignment change. Scoliosis-specific structural rehabilitation is built around a measurable deformity, a Cobb angle on standing radiograph, and the treatment goal is a documented change in that angle, in sagittal and coronal alignment, and in postural and rotational metrics tracked over a course of care. That's a mechanistically different claim than "the subluxation was corrected." It's closer to "here is the pre-treatment film, here is the post-treatment film, and here is the measured change," which is falsifiable in a way the classical subluxation model isn't.

I want to be equally honest about the limits of that evidence. My own published work, including a retrospective cross-sectional analysis of cervical mechanics in adolescents with idiopathic scoliosis (Dick JM, Cureus, 2025, DOI 10.7759/cureus.91098), and the broader CLEAR Institute literature, is case-series and cohort level evidence, not large randomized controlled trials across every curve type and severity. That's an honest limitation of the field, not just my own practice, and I'd distrust any provider who tells you otherwise. Full details are on our research and evidence page.

General Chiropractic vs. Structural Scoliosis Rehab

Dimension	General Adjustment-Based Chiropractic	CLEAR-Based Structural Scoliosis Rehab (Clear Life)
Primary theoretical claim	Correcting vertebral subluxation to restore nerve function	Reducing measurable curve, improving alignment and postural control
Diagnostic basis	Palpation, motion restriction assessment	Standing radiograph, Cobb angle, sagittal/coronal alignment
Primary technique	High-velocity low-amplitude manipulation	Scoliosis-specific corrective exercise, bracing (ScoliBrace, SpineCor), neuromuscular re-education
Outcome measured	Symptom relief, range of motion	Cobb angle change, radiographic alignment, functional and postural metrics
Evidence level	Mixed, subluxation construct not epidemiologically supported	Case series and cohort level, published in Cureus/PubMed, not yet RCT across all curve types

Research

Relevant published work referenced above:

Mirtz TA, Morgan L, Wyatt LH, Greene L. An epidemiological examination of the subluxation construct using Hill's criteria of causation. Chiropractic & Osteopathy. 2009;17:13. PubMed
Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008;33(4S):S176-183.
Dick JM. A Retrospective Cross-Sectional Analysis of Abnormal Cervical Mechanics in Patients With Scoliosis. Cureus. 2025;17(8):e91098. PubMed PMID: 41018459

Dr. Dick's full research portfolio is available on the research page.

Frequently Asked Questions

Does a chiropractor actually put a bone back into place?
No. A chiropractic adjustment is a controlled thrust that moves a joint slightly past its passive range, producing joint cavitation (the "crack") and a reflexive change in muscle tone and pain processing. Imaging does not show bones being relocated by the adjustment itself.

Is vertebral subluxation a real, evidence-supported diagnosis?
The classical subluxation construct, a misaligned vertebra causing nerve interference and disease, has been reviewed against standard epidemiological criteria for causation and found unsupported. Restricted joint motion and structural misalignment visible on imaging are real findings; the disease-causing subluxation theory is not established.

Is cervical manipulation dangerous?
There is a documented, low but nonzero association between cervical spine manipulation and vertebral artery dissection leading to stroke, estimated at roughly 1.3 cases per 100,000 manipulations in patients under 45 within one week of treatment. Dr. Justin Dick, DC, at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC, does not perform high-velocity rotational cervical manipulation as part of his clinical approach.

What can a chiropractor do that a physical therapist cannot?
Scope overlaps substantially. Both professions treat musculoskeletal pain and joint dysfunction. Chiropractors are trained in spinal manipulation and, depending on state license and individual training, spinal radiograph interpretation. Physical therapists are trained in broader rehabilitation and movement-based progressions. Neither profession's general scope covers scoliosis-specific structural correction protocols, which require additional certification (CLEAR Institute, Schroth, or CBP training).

How is scoliosis treatment at Clear Life different from general chiropractic care?
Clear Life Scoliosis and Chiropractic Center, led by Dr. Justin Dick, DC, in Charlotte, NC, uses the CLEAR Institute protocol, which measures outcomes against Cobb angle and radiographic alignment rather than relying on subluxation theory. Dr. Dick holds a CLEAR Institute Fellowship and Board seat and has authored multiple peer-reviewed publications indexed in PubMed on scoliosis-related structural mechanics.

Where is Clear Life Scoliosis and Chiropractic Center located?
Clear Life Scoliosis and Chiropractic Center is located at 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278. The practice serves patients throughout Charlotte and the surrounding Carolinas region.

Service Area

Clear Life Scoliosis and Chiropractic Center serves patients in Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.