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What Effect Does a Chiropractic Adjustment Have on Low Back Stiffness?

man with severe low back painAs with most neuro-musculo-skeletal conditions, identifying the exact nociceptive (or pain inducing) mechanism for low back pain cannot be accurately identified. That’s because low back pain is complex, and is likely not caused by one factor, but rather a combination of lifestyle and person-specific factors. These include things like your age, sex, injury history, medical condition(s), nutrition, activity profile, work demands, past pain experiences, and many others.

Although we cannot directly measure spinal “stiffness”, it’s a common subjective symptom many of our low back pain patients describe during our initial consultations. When assessing your low back pain, we aim to find the movement limitation(s) and/or pain-provoking patterns that may be contributing. Understanding the directionality of your current episode of low back pain is what guides our treatment recommendations.

Remember, every episode of low back pain, even within the same individual, is unique. For example if you have pain or a limitation with bending forwards after lifting your couch, we would describe this as flexion-intolerant mechanical low back pain.

With many low back pain patients, we include spinal manipulative therapy as a part of your plan of management. Here we will briefly describe the theoretical mechanisms of the chiropractic adjustment cited in spinal research:

1) Change in muscle activity – several studies have proposed that changes in muscle activity may affect spinal stiffness, specifically the multifidus muscle. This muscle sits very close to our spinal segments and is highly proprioceptive (gives our nervous system lots of information about position and movement).

2) Increase in mobility – a few studies have linked increases in spinal range of motion following manipulation as a potential moderator on our feelings of “stiffness”.

3) Decrease in pain – spinal manipulative therapy often relieves pain and this may result in feelings of reduced stiffness, specifically the stimulation of mechanoreceptors within our tissues; but the cause-and-effect relationship has not reached a consensus.

4) Increase in pain pressure threshold – reduced pain sensitivity to applied pressure following spinal manipulative therapy may have the potential to reduce your feelings of spinal stiffness.

5) Changes in CNS or reflex pathways – one important feature of spinal manipulative therapy on feelings of stiffness may be related to the activity in our central nervous system and activation of descending inhibitory mechanisms.

Keep in mind that the directionality of these effects remain difficult to ascertain and remain theoretical. Further research is warranted. The effect of spinal manipulative therapy or the chiropractic adjustment tends to be temporary, and so a well rounded treatment approach will involve movement or exercise prescription to better hold on to the effects of treatment for long-lasting results.

Spinal manipulation should be thought of as a tool rather than a treatment approach. At Ottawa Health, we focus on your personal preference and comfort, our clinical experience and available scientific research to offer the best combination of treatments to achieve your goals. Some patients respond well to spinal manipulative therapy, others do not or prefer not to use it. Regardless, the assessment and our clinical discussion with you will formulate a plan that works for you.

If you have questions or would like further clarification, our chiropractors at Ottawa Health offer 15 min complimentary discussions.


Jun P, Pagé I, Vette A, Kawchuk G. Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review. Chiropractic & manual therapies. 2020 Dec;28(1):1-3.

Shum GL, Tsung BY, Lee RY. The immediate effect of Posteroanterior mobilization on reducing Back pain and the stiffness of the lumbar spine. Arch Phys Med Rehabil 2013; 94: 673-9.

Stamos-Papastamos N, Petty NJ, Williams JM. Changes in bending stiffness and lumbar spine range of movement following lumbar mobilization and manipulation. J Manip Physiol Ther 2011; 34: 46-53.

Wong AYL, Parent EC, Dhillon SS, Prasad N, Kawchuk GN. Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine 2015; 40: 1329-37.

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