What does WHO says about chiropractic adjustments for back pain?

There is a lot of misunderstanding with where chiropractors fit into the healthcare landscape in Singapore. Yes, there is a lot of chatter about how it is pseudoscience and not recognised in Singapore. However, that doesn’t mean chiropractors provide no value to people living with chronic pain.

I don’t deny that there are quack chiropractors in Singapore. This is more to do with a failure to regulate on the government’s part than to do with the illegitimacy of chiropractic as a healthcare profession.

Today, we will discuss what World Health Organisation’s recent low back pain guidelines have to say about chiropractic adjustments and how chiropractors can fit within an evidence-based healthcare system.

Not all chiropractors are quacks

Chiropractic is not inherently pseudoscience and not all chiropractors are quacks. Out of the 25-member working panel involved in the development of the WHO guidelines, two of them are chiropractors! The truth of the matter is chiropractors are still relevant in today’s healthcare and still provide value, especially to the management of spinal pain.

jesse cai, chiropractor singapore, chiropractic adjustment
Celebrity host and actor Paul Foster receiving a chiropractic neck adjustment back in 2018. We have since stopped offering chiropractic adjustments due to its temporary effects (i.e., our clients had to keep coming back).

If you follow back pain research, you would be very familiar with Jan Hartvigsen. Not only did he contributed to the WHO low back pain guidelines, he was the deputy-chair of the landmark Lancet Low Back Pain Series published in 2018. In 2020, he was appointed Knight of the Order of Dannebrog by Her Majesty Queen Margrethe II of Denmark.

Geoff Outerbridge graduated from Canadian Memorial Chiropractic College in 2001 and ran a successful multidisciplinary clinic in Ottawa until 2011. After selling his practice, he moved to Botswana to open the World Spine Care flagship clinic. Since then, he had also developed and opened healthcare clinics in India, the Dominican Republic, and Ghana.

What is spinal manipulative therapy?

Virtually all of us would be familiar with spinal manipulation thanks to the trending chiropractic videos we see on social media. While often performed by chiropractors, spinal adjustments is a technique also utilised by osteopaths and even physiotherapists to treat conditions of the spine.

Part of the allure of chiropractic adjustments is the ASMR experience associated with it. During an adjustment, a chiropractor will use their hands to apply a quick but controlled thrust to the spine. The manipulation often, but not always, produce a popping or cracking sound, no different from that if you were to crack your own knucks.

The sound is not always necessary for the treatment to be effective.

According to World Health Organisation:

Spinal manipulative therapy is considered any “hands-on” treatment that involves movement of the spinal joints. Mobilization uses low-grade velocity (relative to manipulation) and small or large amplitude passive movement techniques within the person’s spinal joint range of motion and control, while manipulation uses a high-velocity impulse or thrust applied to a synovial joint over a short amplitude.

Is chiropractic adjustments effective for back pain?

On its own? Unlikely. The WHO guidelines acknowledged this: Spinal manipulation should not be offered as a single intervention in isolation. Specifically, it should only be offered together with other effective treatments.

back pain singapore, who low back pain guidelines
World Health Organisation does indeed endorse spinal manipulation for treatment for chronic low back pain. However, the results are often only temporary.

This is congruent with what many low back pain guidelines. Spinal manipulative therapy is often classified as “adjunctive” treatment. In other words, you can choose to include them if you want but they are not essential.

Chiropractic adjustments can, to some extent, be helpful for back pain

Nonetheless, the guidelines did suggest that spinal manipulative therapy does have a role in management of back pain in providing short-term pain relief.

This is the primary reason why we stop offering spinal adjustments as a treatment option for our clients. The truth of the matter is that the results are very short-lived. Anyone who has gone for an adjustment sesion can tell you that. Feels super shiok for that moment, and maybe with some reduction of pain after. That’s it!

Why do you think chiropractic clinic often ask their clients to come thrice-weekly and also to continue to come even after their patients’ symptoms have completely resolved? The results are temporary!

The guidelines also identified massage, dry needling, and acupuncture as other treatments offering short-term relief only.

Should I see a chiropractor or a physiotherapist to have my spine adjusted?

Spinal manipulative can be provided by a chiropractor, physiotherapist or osteopath. Clinical guidelines don’t differentiate treatments based on who provided it as long as the person is trained and qualified to do so.

Have a think about it, the effectiveness of a paracetamol doesn’t change just because you bought it yourself off the counter or was prescribed by your family doctor. Similarly, the effectiveness of chiropractic adjustments or spinal manipulation does not change based on who provided the treatment.

Yes, it is possible for results to differ from practitioner to practitioner due to competency and/or the therapeutic relationship you have with your chiropractor. At the end of the day, it is best to choose the practitioner whom you are most comfortable to work with.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.