Between-group differences in resting-state functional connectivity within the brain’s extended triple-network following genuine and sham chiropractic adjustments: a quasi-experimental pilot trial

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Introduction Chiropractic research has traditionally focused on subjective, pain-related outcomes; however, emerging evidence suggests that chiropractic care may also influence neurophysiological functioning. This pilot study aimed to assess the feasibility of a neurophysiological assessment battery and explore differences in brain and autonomic nervous system (ANS) responses following genuine versus sham chiropractic adjustments. Methods In this pilot quasi-experimental, sham-controlled trial, 30 adults received a single session of either genuine or sham instrument-assisted chiropractic care. Resting-state electroencephalography (EEG) and electrocardiography (ECG) were collected at baseline, immediately post-intervention, and one week later. Feasibility outcomes included study procedures and participant blinding. Exploratory outcomes included changes in EEG functional connectivity (FC) and heart rate variability (HRV). Results The study protocol was feasible to implement, and participant blinding was successful. Compared with sham care, genuine chiropractic care was associated with increased resting-state FC within a broadly distributed cluster spanning cortical regions of the brain’s extended triple-network, including the medial frontoparietal, dorsolateral frontoparietal, and mid-cingulo-insular networks, in the delta and theta frequency bands. No between-group differences were observed for HRV measures. Discussion These findings suggest that genuine chiropractic adjustments may differentially influence resting-state functional connectivity within large-scale brain networks compared with sham care. Although no effects on HRV were observed, the neurophysiological findings support further investigation in a fully powered randomized controlled trial to confirm these effects and determine their clinical significance. Trial registration and funding This trial was prospectively registered at ClinicalTrials.gov (NCT05249530) and funded by Life University (Marietta, GA, USA).