How Do Chiropractors Know Where to Adjust?

Chiropractic adjustments vary in technique. There may be more than one hundred different kinds of chiropractic techniques, but the most common method is a very quick, short thrust, imparted to a joint, to get the joint to make a popping sound. This method can free-up joint restrictions in joints that are stuck and not moving freely, and provide immediate relief.

Less common methods of chiropractic adjustments may use small percussive tools that provide a more subtle method of adjustment. Both doctors and patients have different preferences for different techniques of chiropractic adjustment. Chiropractors also have many other methods of treatment besides the adjustment, and some, such as myself do not use the adjustment method often.

How Do Chiropractors Know Where to Adjust?

There are many criteria that different chiropractors may use to decide where to adjust a patient’s spine.


Some chiropractors use palpation of the joints to decide where to adjust the spine. Using this method, a chiropractor will usually have you lie on your abdomen and then, push the joints down to evaluate whether the joints are moving freely as they should. If a restriction of movement is felt, he/she may perform an adjustment of the joint to get it to move better again. Restrictions are usually painful joints, hence the rationale to adjust them.

2. X-Rays

Other chiropractors use x-rays to decide where to adjust the spine. In this method x-rays may be taken and various lines drawn on the x-rays to evaluate asymmetries and deviations from the idealized posture. But this method of analysis is falling out of favor for several good reasons.

3. Other

And some chiropractors, like myself, seldom do adjustments of individual joints to treat patients. I have always been more medically oriented and do not use this conceptual model of spinal pain for all problems. In fact, many chiropractors have migrated away from this kind of conceptual model of spinal pain.

The concept of chiropractic adjustments started in 1895, and it was a reasonable way to understand, and explain, why adjustments helped some patients. It was a mechanical way to understand the spine and the spine is, in part, a mechanical structure. This conception is still a fine way to explain the pathology of some kinds of problems of the spine, such as restricted movement.. But medicine has a broader conception of spinal problems, and, hence, other treatment approaches.

My central approach to spinal problems is not to administer adjustments most of the time. Instead, I evaluate spinal problems the way that a medical doctor does. Further, I have a treatment bias that centers on the natural history of the spinal disc as a degenerating tissue, that gives rise to intermittent spinal pain. And rather than imparting adjustments to spinal joints, I find it more effective to decompress the region of the spine that is the source of pain. I find this conception, and approach to treatment, to be a much more effective way to treat spinal pain. So I rely upon the patient’s history, examination, and diagnostic imaging to decide which region to treat.

Some Ways a Chiropractor Determines Where to Adjust

Chiropractors have many different methods to determine where to adjust your spine. These can include palpating your spinal joints, x-rays and MRI scans, your history and physical examination, of course. And other methods such as thermoscopes which detect asymmetric heat patterns emanating from your spine. The most common method is to palpate your spine while you are lying on your abdomen, but neck problems may also be palpated while you are lying on your back, and the chiropractor moves your neck passively to determine how your neck joints are moving.

Some chiropractors specialize in techniques that rely upon x-rays to decide where to adjust, but that method of analysis is less common, and unpopular with many chiropractors.

What to Expect After a Chiropractic Adjustment?

Depending upon your problem, the adjustment, and the chiropractor, your experience may vary. Sometimes there is immediate and dramatic pain relief. Other times the relief is later that day or the next day. Other times the treatment may not help, and you should tell your doctor whatever your experience. Your response to the adjustment will inform him or her how to proceed.

Because you are seeing the chiropractor for a painful condition, there is usually inflammation present, and you may have more pain during or after treatment for a short while. But you should get progressively improved from the beginning, with less pain, improved range of motion, and better tolerance for your normal activities and postures. Many patients feel much better right after their adjustments and this is why many patients choose to do maintenance treatment after their problem is resolved.

What Should You Avoid After a Chiropractic Adjustment?

There are not absolute contraindications to normal activity after a chiropractic adjustment. But it is probably prudent not to do anything super strenuous or demanding for several hours afterwards. This is probably also advisable so that you can assess your response and improvement from treatment, without confounders like physical demands.

With some exceptions, I generally tell my patients that they can whatever they feel like doing after treatment. But I also tell them that we need to make sure they are improving from treatment as soon as possible. Once we establish improvement, then they can progressively increase their demands and assess their response to each new demand. What we don’t want is to combine many variables, not improve, and then not be sure if the patient is improving from treatment, and how are which variables preventing improvement. But most patients can, and should do their normal activities in order to gauge their improvement, in pain and activity tolerance.

Are There Any Risks Associated With Chiropractic Adjustments?

Yes, there are risks associated with chiropractic adjustments. The risks vary depending on many variables. However, as a preface, I will say that chiropractors have very low malpractic insurance premiums because we don’t do much harm to people.

Some specific contraindications to treatment are fractures, dislocations, infections, tumors, cancer, and severe osteoporosis. But chiropractors know this and should competently be able to rule these out before doing an adjustment to you.

There are a few other concerns that sometimes arise among chiropractors. I will name a few.

First, it is always possible that a patient may go to a chiropractor with spinal pain, and the patient does not know that they have cancer, or an infection, or some other problem, and the chiropractor may miss this diagnosis as the cause of the pain. But chiropractors are trained to diagnose these; however, all humans and doctors can make this mistake. If you don’t improve quickly, you should be re-evaluated. Sometimes chiropractors get in trouble because they treat a problem for too long without re-evaluating, and referring the patient for another medical opinion.

Second, with respect to the neck, chiropractic adjustments can be risky. Very rarely, but catastrophically, a neck adjustment can cause a vascular problem such as a stroke or dissection. While this is very rare, it can be devastating to all involved.

Frequently Asked Question ( FAQs )

Question: How long can a chiropractic adjustment last?

Answer: This varies with the patient, their problem, and the specific treatment provided. I have many patients surprise me with their dramatic improvement. Sometimes one treatment resolves their pain. They may not need to see me again for months or years. Each patient is different. Other times patients may need many treatments, but they are improving, and it just takes more time. Generally in these cases, the patient’s improvement is lasting until their next treatment, and each treatment results in progressive improvement.
Once a patient is improved and, hopefully resolved, of their pain, their improvement can last indefinitely. Of course, people can have a new problem, or a recurrence of their problem, but such is life. Your spine cannot be made younger, with less degeneration. But even older spines can usually get relief from pain that lasts for many months, or several years, or indefinitely.

Question: What toxins are released after a chiropractic adjustment

Answer: The idea that chiropractic adjustments release toxins is not an idea to which I subscribe. There are chiropractors who make all sorts of claims and have a more woo-woo approach than I. When I encounter a patient that is seeking this kind of chiropractor I, respectfully, clarify that I am not that kind of chiropractor.
Instead, I am a very medically-oriented chiropractor with many years experience in orthopedics, physical medicine, physical therapy, and neurosurgery, and what I do well, is exceptional among chiropractors. My diagnostic and treatment skills are unusual and exceptional, but I do not release your toxins.

Question: Are chiropractic adjustments personalized to each patient?

Answer: Absolutely, yes. Although patients and their spines have many things in common, and, hence, often receive similar treatment, all my chiropractic treatment, including adjustments, is personalized to each patient.
The commonalites among patients are discs, muscles, ligaments, tendons, joints, cartilage, nerves, bones, vertebrae, postures, activities, and more. But there are also important and fascinating peculiarities to each patient. The variability in each patient is always interesting, and I have great respect for how all the relevant variables must be considered in treating each patient.
Differences include congenital anomalies, injuries, degeneration, instabilities, bone pathology, bone density, work and personal demands, avocational interests and demands, and all manner of biopsychosocial variables that are considered in treating and talking to patients.

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