Chiropractor doing adjustment spinal spine on female patient

Neck pain is hardly an unusual symptom in the life of an adult, or indeed in the practice of a chiropractor. We see it all the time, but the effects can be far broader than pain alone. Current research suggests that between one-third and two-thirds of people suffer (and usually recover) from neck pain every year [1]. We also know that neck pain, even subclinical (or below the point at which a person might seek medical or therapeutic help) can impact things like our sense of body position, our ability to integrate multisensory data from our bodies or our ability to complete complex mental tasks [2 – 5].

The study of neck pain is indeed yielding some interesting results and may offer up some more insights yet as we begin to understand what happens when we check and adjust subluxations affecting the upper cervical spine.

A recent case report along these lines followed the case of a 40-year-old female patient who presented at a chiropractic practice due to “chronic, recurring neck pain and headache” which was impacting her ability to take part in daily living activities.

When her chiropractor took her case history, it also revealed that she had suffered from depression and anxiety, the latter of which worsened with the severity of her physical complaints [1]. She complained of constant “tension throughout the upper back and neck. Her pain waxed and waned in severity and worsened when sitting at a desk and driving.” Her headaches occurred on a daily basis and worsened as the day progressed.

At the beginning of her course of care, her chiropractor undertook a thorough examination which included testing salivary cortisol – a common measure of adrenal stress. As the adrenal glands fire up under stress, it is often a good indication of long-term sympathetic drive (the sympathetic nervous system is what governs all of our fight or flight responses, including driving our adrenal glands to create stress hormones like cortisol.)

Full details of the chiropractor’s examinations can be found in the original study [1]. These include the neck pain disability index, the visual analog scale for headache severity, and the PHQ-4, which briefly measures anxiety and depression, and of course, her subluxations found using a battery of tests.

She commenced a course of chiropractic care that lasted for 12 visits over 6 weeks before the post-care tests were run again. The study’s author explained that she “received specific chiropractic adjustments using Diversified Technique (contact-specific, high-velocity, low-amplitude) to corrected identified vertebral subluxations. In addition to chiropractic adjustments, she was treated with Instrument-Assisted Soft-Tissue Mobilization” to deal with myofascial pain and hypertonicity among other things. She also did some home exercises.

The case report goes on to detail a “steady improvement” over the course of care, including a gradual reduction in all her listed symptoms including neck pain, headaches, and anxiety. But a criticism of these models of pain measurement is that they are subjective in that the patient does a self-report on progress.

Salivary cortisol levels, however, are not subjective.  Over the six week course of care, her levels decreased from 0.343 μg/dL to 0.168. This is a significant reduction, which represented a significant difference in adrenal activity over the course of care. Her postural analysis simultaneously revealed a reduction in forward head carriage, cervical (neck area) range of motion, and some remaining hypotonicity and restriction at C1-2 and T3-4. She received chiropractic care for these too. However, she did test negative for cervical syndrome, which was representative of “a further decrease in the indicators for vertebral subluxation.”

What does it mean?

Case reports are never something we can make generalizations with. We require further studies, like randomized controlled trials or clinical studies in order to be able to say “if you do X, you will get Y.” However, they are an interesting exercise in understanding what may be possible and where further research may be directed.

At this point, further research has shown us that neck pain is important for more than just pain and range of motion. Through this case report, we can see that a normalization of adrenal activity, indicated by a significant drop in salivary cortisol has been seen concomitant with chiropractic care.

This study’s author also noted that “a randomized clinical trial to determine the immediate effect of low back pain on cortisol levels in adult males with mechanical low back pain concluded that a neuroendocrine effect can be elicited by spinal manipulation [1].” Spinal manipulation for back pain had a neurological effect and a hormonal one.

There is only limited research indicating that anxiety and depression may benefit under chiropractic care, and there is emerging research indicating that Quality of Life is another measure we can use to assess how chiropractic care may impact a person’s general, including mental and emotional, wellbeing [6].

So while we can’t make any generalizations from this study, we can see that it is consistent with other work that is happening. What we know from this study is that this woman reaped both objectively and subjectively measured benefits from care. And that is an exciting thing!



  1. Hughes F (2020), “Reduction of Cortisol Levels and Perceived Anxiety in a Patient Undergoing Chiropractic Management for Neck Pain and Headache: a Case Report and Review of the Literature,” Journal of Contemporary Chiropractic, Vol 3, Is 1,
  2. Haavik H, and Murphy B (2011), “Subclinical Neck Pain and the Effects of Cervical Manipulation on Elbow Joint Position Sense,” JMPT Vol 34, Iss 2, Feb 2011, pp. 88-97,
  3. Daligadu J, Haavik H, Yielder P, Baarbe J, and Murphy B (2013), “Alterations in Cortical and Cerebellar Motor Processing in Subclinical Neck Pain Patients Following Spinal Manipulation,” JMPT Vol 36, Iss 8, October 2013 pp. 527-537,
  4. Baarbe J, Holmes M, Murphy H, Haavik H, Murphy B (2016), “Influence of Subclinical Neck Pain on the Ability to Perform a Mental Rotation Task: A 4-week Longitudinal Study with a Healthy Control Group Comparison,” JMPT  39, Iss. 1, Jan 2016 pp. 23-30,
  5. Farid B, Yielder P, Holmes M, Haavik H, and Murphy B (2018), “Association of Subclinical Neck Pain With Altered Multisensory Integration at Baseline and 4-Week Follow-up Relative to Asymptomatic Controls,”JMPT  41 Number 2. Feb 2018, pp. 81-91
  6. Russell D, Glucina T. Reduced anxiety symptoms in a patient screened with the PHQ-4 receiving chiropractic care: a case report and review of the literature. J Contemporary Chiropr 2019;2:41-48

    Case Study: Cortisol, anxiety, neck pain and headache

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