Manual or Instrument Adjustment

What is a manual chiropractic adjustment?

During a manual adjustment, the chiropractor positions the patient and applies a controlled force to a selected spinal or extremity joint. The specific technique, amount of force, and positioning depend on the area being addressed and the individual patient's examination.

Some manual techniques can produce a popping or cracking sound. That sound is not required for every adjustment and is not, by itself, a measure of whether the treatment was successful.

What is an instrument-assisted adjustment?

An instrument-assisted adjustment uses a handheld chiropractic adjusting device to deliver a brief, targeted physical impulse. The Activator adjusting instrument is one well-known example and traditionally uses a spring-loaded mechanical mechanism. Other modern adjusting instruments may use cordless or electronic mechanisms to create a similarly quick, controlled impulse.

Because the impulse is fast and localized, the doctor can target a specific area with controlled force and often with less twisting, bending, or broad joint positioning than some manual techniques. This can be useful when a patient prefers a lower-impact experience or when the examination supports a lower-force, precise approach. Instrument-assisted adjustments also commonly produce little or no audible popping because the impulse is brief and localized.

Instrument-assisted care is not automatically appropriate for every person or condition. The doctor considers health history, bone and joint health, examination findings, comfort, and treatment goals before selecting a technique.

What is a drop-table adjustment?

A chiropractic drop table has one or more sections that can be raised slightly and then release a short, controlled distance when the doctor applies a directed force. The gravity-assisted movement of the table works with that directed force to assist the adjustment and can allow the doctor to use a focused technique with less overall force or body rotation in selected areas.

Drop-table techniques may be used by themselves or alongside manual and instrument-assisted methods. As with every adjustment approach, the choice is based on the individual examination and the doctor's clinical judgment.

How is the technique chosen?

There is not one adjustment technique that is best for every patient. The doctor may consider factors such as:

• Your health history and current symptoms
• Physical and neurologic examination findings
• The joint or body region being evaluated
• Prior injuries, surgeries, or imaging findings
• Bone health and other medical conditions
• Your comfort and prior experience with chiropractic care
• How you respond to treatment over time

The doctor may use more than one technique during a course of care or change the approach as your condition and examination findings change.

What might I notice afterward?

Some people experience temporary soreness, stiffness, headache, or tiredness after a chiropractic adjustment. If symptoms are severe, unusual, worsening, or do not resolve as expected, contact an appropriate healthcare professional.

Serious complications are uncommon, but no procedure is risk-free. The doctor should know about important medical conditions and neurologic symptoms before deciding whether an adjustment is appropriate.

When may an adjustment require additional medical review?

Tell the doctor about your complete health history, including severe osteoporosis, recent fractures or major trauma, spinal cancer, significant numbness or weakness, known spinal instability, prior spine surgery, vascular or stroke risk concerns, and other serious medical conditions.

Depending on the history and examination, the doctor may recommend a lower-force technique, a different treatment approach, imaging, medical evaluation, or referral instead of an adjustment.

Common questions about manual, instrument, and drop-table adjustments