How Does a Chiropractor Know Where to Adjust?
The chiropractic adjustment is a thrust or quick added force at the end of a joint’s range of motion to help unlock movement, improve surrounding muscle tone, and decrease pain. When performed properly for the right patient, an adjustment can have massive benefits and create giant leaps in injury improvement. It isn’t a necessary part of seeing or getting benefits from the care of a chiropractor and that practitioner should always obtain consent and explain exactly what is going to happen before it does. But, how does a chiropractor know where to adjust? Surely it isn’t just as simple as having a patient point to where it hurts and adjusting those spinal segments or the joint nearest their perceived pain? And youre right, it's not that simple. Pain is only one factor a chiropractor takes into account when figuring out where (or even IF) they need to adjust. Here are all the things I account for when deciding where an adjustment would be beneficial. ⬇️
During an assessment or re-evaluation during a follow-up visit, I take patients through basic range of motion testing, making sure they can flex, extend, side-bend, and rotate through any and all spinal joints, especially those nearest their site of pain. If there is a glaring deficit in their ability to move into one of these ranges and/or the patient has pain getting there, they may be a good candidate for an adjustment to help them unlock and unblock those joints keeping them from utilizing a full range of motion, but that’s not the only factor for us to consider…
Repeated movement testing not only provides an insight into where an adjustment may be needed, it also ensures that any further force added to the joints in the form of an adjustment will be safe to perform and tolerated well by the patient. If a joint or body part is stuck or blocked from accessing one of the aforementioned range of motions, repeated movements done by the patient can often release some or all of the patients lost range and improve their pain during movement. If we can find a repeated movement exercise that helps, using the amount of force that you can produce to move your own body, I feel much more comfortable adding a bit of extra force with an adjustment knowing that your tolerance for that additional force will be good. If repeated movements and low forces aren’t working the way we’d like, we may hold off on a big adjusting force for the day and do some other treatment techniques in place of an adjustment.
Palpation or feeling using our hands is the last assessment I use in figuring out where a patient needs to be adjusted. By feeling the micro-movement or lack of as I take your joints to the end of their range of motion and add a touch of extra force, we can feel if those joints are blocky and may need to be unlocked with a thrust, or if they spring back and move well they could likely be left alone.
Using these 3 main assessment methods, a chiropractor can easily figure out where you may need to be adjusted, how much force will be necessary, and if that adjustment will be tolerated well and get you the relief you’re seeking.
*A quick note on x-rays as an adjustment assessment tool: Some chiropractors may take x-rays to assess where a patient needs to be adjusted and while I have not studied many of these techniques specifically, my general thought is to reserve x-rays for patients with clear physical trauma incidents, red or yellow flags in history or physical exam, or those who are un-responsive or under-responsive after a trial bout of good quality care. X-rays are a static, snapshot image of structures that are meant to be dynamic and moving so any small deviation of these structures shown on an image without the previously mentioned criteria for taking them may be unnecessary.