Chiropractic Care · Carrollwood · Tampa Bay
What Is Chiropractic Care?
What an adjustment actually is, the four ways we do it, what the research shows, and how the examination decides which one is right for you.
Chiropractic care is the examination and hands-on treatment of problems with the spine, joints, and muscles. The best-known part is the adjustment: a controlled, precise movement applied to a joint to restore motion and reduce pain. At HealthSpine, every adjustment follows an examination by Dr. Bobby Koser, DC, chiropractic physician, and the examination decides what we do, including whether adjusting is the right tool at all.
Chiropractic Overview
What an adjustment is
A joint that is painful and restricted often moves less than it should. An adjustment applies a quick, controlled movement to that joint, within its normal range, to restore motion. Sometimes there is a popping sound. That sound is gas releasing from the fluid inside the joint, the same thing that happens when a knuckle cracks. It is not bone moving against bone, and a treatment can work with or without it. And to clear up the most common misconception: an adjustment is not putting a bone back into place that has slipped out. Your bones are not out of place. The problem being treated is a joint that is not moving well, and the adjustment is aimed at the movement, not the position.
Which joints get adjusted, in which direction, and with how much force is decided by the examination, not by a routine. Some visits involve no adjustment at all.
The four techniques we use
Dr. Koser matches the technique to your examination, your build, your comfort, and your preference. If you would rather avoid one, say so and we will use another.
Diversified adjusting, by hand
The classic hands-on adjustment, also called HVLA for high velocity, low amplitude: a quick, shallow, precisely aimed impulse delivered by hand to a specific joint. It is the most widely taught chiropractic technique and the one most people picture.
What it feels like: brief pressure, a quick push, and often a pop. Over in a moment. Most people describe relief of stiffness rather than pain during the adjustment itself.
Drop table
The treatment table has sections that release and drop a short distance as the adjustment is delivered, so part of the work is done by the table. This allows a lighter contact with less twisting of the spine.
What it feels like: a light push and a soft clunk as the table section gives way beneath you. Many people find it gentler than a hands-on adjustment, and there is usually no pop.
Instrument-assisted adjusting, with an Activator
A small, spring-loaded handheld instrument delivers a very quick, very light impulse to one precise spot. There is no twisting and no positioning of your neck or back, so you stay in a neutral position throughout.
What it feels like: a small, fast tap, like a light flick. No pop. This is often the technique of choice for people who are nervous about adjusting, and it is a common alternative when someone prefers not to have the neck adjusted by hand.
Flexion-distraction
A specialized table slowly and rhythmically stretches and flexes the lower spine while Dr. Koser applies gentle hand contact. There is no thrust and no impulse. It is a slow technique, used most often for the low back, and also for the neck.
What it feels like: a rhythmic, gentle stretching, more like traction than an adjustment. Most people find it relaxing.
What the research shows
Doctors’ own guideline: try this kind of care before medication
The American College of Physicians, the professional body for internal medicine doctors, took a clear position in its 2017 low back pain guideline: start with non-drug treatment, not pills. Spinal manipulation is one of the treatments it names for both recent and long-lasting back pain, alongside options like heat, massage, exercise, and acupuncture.1 The reasoning matters as much as the recommendation: anti-inflammatories and muscle relaxants carry real side effects, and the guideline reserves opioids for a last resort. Hands-on care earned its place by being worth trying first.
What the trials found for recent low back pain
A 2017 review in JAMA, one of the most rigorous medical journals, pooled 15 randomized trials covering 1,711 adults whose low back pain had started within the past six weeks. Spinal manipulation was associated with meaningful improvement: an average pain reduction of about 10 points on a 100-point scale within six weeks, and across 12 trials with 1,381 people, improved day-to-day function as well.2 The evidence was rated moderate quality, which is comparatively strong for hands-on treatments, where the gold standard of a placebo-blinded trial is close to impossible to run. Not one of the 15 trials reported a serious complication. The common side effects were the minor kind: temporary soreness, stiffness, or a headache for a day or so.
Long-lasting low back pain
Back pain that has been around for months was reviewed in the BMJ in 2019, pooling 47 clinical trials involving 9,211 people. It found moderate quality evidence that spinal manipulative therapy produced similar results to the recommended treatments for chronic low back pain, such as exercise and standard medical care, in the short term, about one month.3 Most side effects reported in those trials were short lived, mild to moderate, and involved muscles or joints. Similar results to recommended care is the headline: adjusting holds its own alongside the treatments guidelines already endorse, which is exactly why the physicians’ guideline above lists it among them.
Why see anyone at all, then? Most recent back pain does settle over a few weeks. What you cannot know on day one is whether yours is that kind, because the episode that settles and the one that is hiding something else look identical at the start. Finding that out is the examination’s job. And the weeks in between do not have to be toughed out: care during them is about comfort and getting you moving sooner.
1. Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. PubMed
2. Paige NM, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460. PubMed
3. Rubinstein SM, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. PubMed
What to expect after an adjustment
Some people feel soreness, stiffness, or a mild headache for a day or two afterward, the way muscles feel after a workout. It settles on its own.
Every treatment has less common risks as well. After your history and examination, Dr. Koser goes over anything that applies to you and answers your questions before treatment begins, so nothing that happens at the table is a surprise.
If you would rather we not adjust a particular joint, just say so. We treat the area you came in for, and where that area does need work there is more than one way to do it: instrument adjusting, drop table, soft-tissue work, and dry needling. Declining an adjustment does not change the rest of your care.
Who adjusting is for, and who it is not
Often a good fit
- Back pain that started in the last few weeks
- Neck and mid-back stiffness with restricted movement
- Joint pain the examination traces to a mechanical source
- People who want to try a non-drug option first
- People who want the gentler techniques: instrument adjusting, drop table, flexion-distraction
Not a candidate, or not today
- Signs of fracture, infection, or nerve compression found on the examination
- A history of cancer with new, unexplained back pain, until it is worked up
- New loss of bowel or bladder control, or rapidly worsening weakness or numbness: that is an emergency, not a chiropractic visit
- Severe osteoporosis, for thrust techniques
- Anyone whose examination points somewhere else. We refer out and explain why.
The screening is the examination itself. A 2017 review in the journal Pain looked at the 13 warning signs guidelines use to spot cancer behind back pain, which is a rare cause, appearing in at most about 7 of every 1,000 primary care back pain visits. Only two of the 13 proved genuinely useful: a previous history of cancer, and the clinician’s overall judgment after taking a proper history.4 That is why every course of care here starts with a physician taking your history, and why we would rather examine you and tell you adjusting is not the right tool than adjust first and ask questions later.
4. Henschke N, et al. Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review. Pain. 2017;158(10):1860-1868. PubMed
Frequently Asked Questions
Does an adjustment hurt?
The adjustment itself is usually quick and not painful, though the area being treated may already be tender. Afterward, some people feel soreness, stiffness, or a mild headache for a day or two. It usually settles on its own, and Dr. Koser will tell you what to expect before anything happens.
What is the popping sound?
Gas releasing from the fluid inside the joint, the same thing that happens when a knuckle cracks. It is not bone on bone, and an adjustment can work with or without it.
Do I have to have my neck adjusted?
Only if it is part of what you came in for. If you are here for active low back pain, we treat the low back; we are not adjusting your neck because you happen to be on the table. Where an area does need attention, whether that is the neck or any other joint, adjusting is one option among several. Tender joints and stiff range of motion can be worked on with instrument adjusting, drop table, soft-tissue work, or dry needling. Tell Dr. Koser you would rather not have a particular joint adjusted and he will use something else. It does not change the rest of your care.
Do you adjust everyone who comes in?
No. The examination decides. Some visits involve no adjustment at all, and when the examination points to something that belongs with a different kind of provider, we refer you out and explain why.
Which technique will you use on me?
Whichever one fits your examination, your build, and your comfort. Dr. Koser uses Diversified hands-on adjusting, drop table, instrument-assisted adjusting with an Activator, and flexion-distraction, and he will tell you what he recommends and why before anything happens.
Is chiropractic care evidence-based?
Yes, and this page shows its work. For low back pain, the most-studied use, a 2017 JAMA review of randomized trials found spinal manipulation associated with improved pain and function, and the American College of Physicians recommends non-drug care, naming spinal manipulation among the options, before medication. Every study we rely on is cited on this page with a link, so you can read it yourself.
How is this different from what happens at a walk-in chain?
The examination. Here a chiropractic physician examines you before anything is treated, your findings are explained the same day, and the technique is chosen to fit what was found. If you want the longer answer, read our page on how the walk-in chain model works. If a monthly rhythm is what you want, our membership keeps it, with the same doctor and an examination behind every visit.
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This page is general health information and is not medical advice for any individual. Whether chiropractic care is appropriate for you depends on your examination. The studies summarized above are about spinal manipulation as a procedure, studied mostly for recent low back pain in outpatient settings; they do not apply to fracture, infection, cancer, or nerve compression, and they say nothing about any particular course or number of visits. Talk to Dr. Bobby Koser, DC, about your own situation.
Start with the examination
Pain has a source. The Pain Source Exam looks for where yours is coming from, and what happens after that follows from what it finds.