A PRAGMATIC randomised controlled trial suggests that 12 weeks of chiropractic care can modulate biomarkers linked to neuroplasticity, stress regulation, and immune function in adults with subclinical spinal pain.
Chiropractic Care and Neuroplasticity Signals
Chiropractic care was associated with measurable changes in biomarkers related to neuroplasticity, notably brain-derived neurotrophic factor (BDNF). In this parallel-group trial conducted in Pakistan, adults aged 20–60 years with subclinical spinal pain were randomised to receive either chiropractic or sham care for 12 weeks, with follow-up at 16 weeks. Blood BDNF was the primary outcome, reflecting interest in whether manual interventions may influence central nervous system adaptability. After 12 weeks, participants in the chiropractic care group showed significantly higher blood BDNF levels compared with sham care, suggesting a potential enhancement of neuroplastic processes. These findings add to growing interest in non-pharmacological interventions that may influence brain-related pathways beyond symptom relief.
Chiropractic Care Effects on Stress Biomarkers
Stress-related biomarkers were also affected by chiropractic care, with cortisol measured across saliva, blood, and hair samples. At 12 weeks, salivary cortisol levels were significantly higher in the chiropractic group compared with controls, while within-group analyses showed a non-significant reduction in hair cortisol, a marker of longer-term stress exposure. By contrast, at the 16-week follow-up, the sham group demonstrated increases in blood cortisol. The authors interpret these findings as evidence that chiropractic care may influence hypothalamic–pituitary–adrenal axis activity, although the clinical relevance of transient cortisol changes remains uncertain and warrants further investigation.
Chiropractic Care and Immune and Inflammatory Markers
The trial also explored immune and inflammatory responses, including interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and lymphocyte subsets. After 12 weeks, IL-6 levels were significantly higher in the chiropractic care group, alongside increases in CD4, CD8, and CD19 cells. Notably, TNF-α levels decreased, suggesting a potential regulatory effect on systemic inflammation. At follow-up, increases in IFN-γ and TNF-α were observed in the sham group, highlighting divergent immune trajectories between groups.
Overall, this trial indicates that chiropractic care may modulate neuroplastic, stress, and immune biomarkers in people with subclinical spinal pain. Larger studies are needed to clarify the durability of these effects and their implications for clinical outcomes.
Reference
Amjad I et al. The effects of 12 weeks of chiropractic spinal adjustments on physiological biomarkers in adults: A pragmatic randomized controlled trial. PloS One. 2025;20(12):e0338730.
