Chiropractic Adjustment

Revision From Jocko Podcast

I like to pride myself on being a person who speaks with clarity and specificity. It's a skill that I give purposeful attention to and try to continually refine. Along with that is taking responsibility for when I get it wrong. This is one of those times.

A chiropractor who viewed my recent Jocko Podcast interview sent me a very polite and professional email that made me reconsider how I expressed myself in that moment. Thank you! While I stand by much of what I said in general I wasn't precise in my speech. This short article is me making up for that imprecision.

During the interview Jocko Willink's cohost, Echo Charles, asked me my opinion on chiropractic care. The general answer I gave was that it depends on the chiropractor. I followed with a statement that Andrew Taylor Still was the founder of Chiropractic - first wrong point.

You can see my answer in full for yourself in the video below.

A.T. Still was the founder of Osteopathy, a very well established medical profession that uses proven manipulation of the human body to support healing. David Palmer was the founder of Chiropractic. Palmer's original claim to fame was that he "adjusted" a deaf man and restored his hearing. It's reported that Palmer claimed that the idea for adjusting the spine was given to him by a long dead physician during a seance. Prior to that, Palmer used "magnetic healing" to diagnose and treat ailments of all kinds.

Chiropractic care has gone through multiple periods of reinvention and some skilled practitioners are fully integrated in the highest levels of professional athletics and human performance. I'll leave it up to you to draw your own conclusions about the origins of chiropractic care.

Do's and Can't Do's

In the podcast, I said chiropractic was "debunked," which is a broad and sweeping description that implied no part of chiropractic care has application in health or performance. This statement is also wrong. Using the term debunked is an unfair characterization that doesn't provide the kind of nuance that I prefer to communicate with.

Let's get into some of the science.

A 2016 systematic review published in PLOS ONE looked at pragmatic studies evaluating chiropractic care for low back pain. It concluded that chiropractic care was as effective—and sometimes more cost-effective—than conventional care for short-term relief. A 2024 meta-analysis found that no single intervention, including chiropractic, acupuncture, physical therapy, or medication, stood out as superior across the board for managing chronic back pain. But multimodal approaches that blend these techniques often do better than any one tool alone.

Chiropractors also work on soft tissue, and a 2009 review in JMPT suggested that manual therapy—including techniques commonly used by chiropractors—can help with localized myofascial pain and trigger points. But these aren’t exclusive to chiropractic. Similar results can be achieved through osteopathic manipulation, skilled physical therapy, or even bodywork from other trained manual therapists.

This leads to a more important point: chiropractic’s effects aren’t tied to a single mechanism. They are multifactorial—mechanical, neurological, psychological, and contextual. Some of the benefit is likely due to proprioceptive stimulation or segmental reflex inhibition. But a good chunk of the effect, like in many forms of hands-on care, comes from patient expectation, practitioner confidence, and the overall ritual of care. In plain terms: some of it works, some of it’s placebo, and most of it overlaps with other modalities. That doesn’t make it invalid. But it does make it important to separate the mechanism from the myth.

My Biased Experience

I came up in the health industry as a massage therapist first (another field with its share of both sharp shooters and charlatans). If you want to be a gainfully employed massage therapist one of the best ways to do it is to work for chiropractors. In the course of my career I've worked with many chiropractors and they've shaped my undoubtedly biased opinion.

Some I worked with were some of my greatest mentors. They had profound knowledge of anatomy and physiology, deep mastery over manual medicine, and the best ones-knew the limits of what they could offer. My favorite among them knew whatever contribution they made was part of a bigger picture of pain relief and performance. They were real pros.

I also worked with some who sold people magic negative energy repelling water bottles, convinced patients who were obese that adjustments were more important than diet and exercise for supporting health, and that regular spinal adjustments were necessary to be healthy. Nefarious at worst, negligient at best.

Like everything else, there are good chiros and bad chiros.

One drawback of chiropractic in general, especially here in the U.S., is that it often operates as a very closed community that self-regulates. In Canada, chiropractors are regulated much more tightly and must meet national education standards, pass board exams administered by the Canadian Chiropractic Examining Board, and maintain licensure through provincial regulatory colleges. They are governed under provincial health professions legislation, which holds them to standards comparable to other regulated health professionals like physiotherapists or nurses. There is also more pressure within Canadian chiropractic institutions to align with evidence-based practice and to work collaboratively within the broader healthcare system.

Ironically, the day the podcast aired I had a meeting with a chiro who is part of an interdisciplinary health team. The way he explained what he did made sense to me. "I take dynamite to movement blockades. Then the strength coaches come in and lay down new roads.”

Conclusion (For Now)

Responsible application of joint manipulation is some of the oldest medicine in the world. Soft tissue therapies, joint manipulations, and even spinal adjustments have varying levels of evidence supporting their use. Some of the best practitioners of manual therapy that I've met have been chiropractors—and others have been total kooks. I could say the same about damn near any health field. The world of health and performance is full of myths, bullshit, and nonsense. This should be judged on an individual basis and not based in broad and unconstrained biases in any direction.

Can manual therapy, including chiropractic care, be helpful as part of a multidisciplinary approach to health and performance? Yes. Is it particularly magical? No. If you find that it’s helpful, it doesn’t hurt you, and you can afford it—do it. Like anything, if it sounds too good to be true, it probably is.

To be honest, only one person said a thing about it. I’m basically an unknown in the public eye and this minor imprecision in language would probably slip by with little to no palpable consequence.

Fuck that.

I, for one, am committed to course correcting and holding myself to account when I don’t speak or write with the type of clarity that forces me to examine my own thinking.

Thank you Dr. D for politely writing me and calling me to court for my imprecision.

Onward.

Thanks for reading,

Rob

References

https://www.latimes.com/business/lazarus/la-fi-lazarus-chiropractic-quackery-20170630-story.html

https://pmc.ncbi.nlm.nih.gov/articles/PMC7238904/

J. Boruff et al. "Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies." PLoS ONE, 11 (2016). https://doi.org/10.1371/journal.pone.0160037.

Farhana Nazmin et al. "Effectiveness of Acupuncture, Physiotherapy, Chiropractic and Medication in Chronic Back Pain Management: A Systematic Review and Meta-Analysis." Journal of Advances in Medicine and Medical Research (2024). https://doi.org/10.9734/jammr/2024/v36i75511.

H. Vernon et al. "Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature.." Journal of manipulative and physiological therapeutics, 32 1 (2009): 14-24 . https://doi.org/10.1016/j.jmpt.2008.06.012.