Chiropractic care is a non-invasive, hands-on health discipline focused on the body’s musculoskeletal system, particularly the spine. Practitioners use manual techniques, known as adjustments or spinal manipulation, to restore proper function and mobility to joints with restricted movement. The primary area of focus for many patients is the lumbar spine, or lower back, which supports the majority of the body’s weight and is highly susceptible to mechanical issues. The goal of the adjustment is to apply a controlled force to a specific joint to alleviate pain and improve overall function.
Determining the Need for Adjustment
Before any physical manipulation takes place, the chiropractor conducts a thorough assessment to pinpoint the exact location and nature of the issue. This process begins with a detailed patient history, covering symptoms, lifestyle factors, and previous injuries. The practitioner performs a visual assessment, observing the patient’s posture while standing and their gait while walking to identify any imbalances or compensatory movement patterns.
Range-of-motion testing is used to quantify the degree of movement restriction in the lumbar spine and pelvis. The chiropractor then uses a hands-on method called palpation to evaluate the tissues surrounding the spine. Static palpation involves feeling the area for muscle tension, tenderness, and signs of swelling while the patient is still.
Motion palpation is performed by gently moving the patient’s spine to feel for specific segments that exhibit reduced or restricted movement. By combining the data from the patient interview, visual observation, and palpation, the chiropractor determines which vertebral joint—or motion segment—requires a targeted adjustment.
The High-Velocity, Low-Amplitude Thrust
The most common manual technique used for a lower back adjustment is the High-Velocity, Low-Amplitude (HVLA) thrust. A frequent HVLA procedure for the lumbar area is the side-lying “lumbar roll” adjustment. The patient lies on their side with the affected side facing up, and the chiropractor carefully positions the patient’s upper body and legs to stabilize, or “lock,” the vertebrae above and below the target segment.
This specific positioning creates a controlled tension barrier that isolates the dysfunctional joint. The practitioner then uses their forearm or a specific hand contact point to deliver a rapid, shallow thrust into the targeted joint. The term “low-amplitude” means the physical movement of the joint during the thrust is typically only about three to four millimeters, completed in a fraction of a second.
This controlled, quick motion causes the joint surfaces to separate briefly, which may produce an audible “pop” or “crack” known as cavitation. This sound is caused by the sudden release of gas, including nitrogen, oxygen, and carbon dioxide, that forms a temporary bubble within the synovial fluid of the joint. The speed of the thrust overcomes the reflex resistance of the surrounding muscles, allowing the joint to move beyond its restricted range and restoring normal mechanics.
Alternative Low-Force Methods
Chiropractors often employ alternative, low-force techniques when a patient is sensitive or has certain underlying conditions. One method involves instrument adjusting, using a handheld, spring-loaded device like the Activator. This instrument delivers a quick, precise, and light impulse directly onto the joint or bone structure.
The speed of the instrument’s impulse is so high that surrounding muscles do not have time to tense up and resist the force, making the adjustment effective with minimal physical effort. Another technique utilizes specialized tables, such as the drop table, which has segments that can be raised slightly. When the chiropractor applies a gentle force, the section of the table underneath the patient drops a short distance.
This drop uses gravity and the patient’s momentum to assist the adjustment, reducing the manual force required from the practitioner. Flexion-distraction is another non-thrusting method, where the patient lies on a segmented table that gently flexes and extends the spine. This rhythmic movement is helpful for decompressing the lower back and taking pressure off the spinal discs and nerves.
Immediate Post-Adjustment Experience
Following a lower back adjustment, patients often report an immediate feeling of relief and improved flexibility in the adjusted area. This sensation is due to the restoration of joint motion and the temporary reduction in muscle tension. It is common to experience some temporary soreness or mild aching in the surrounding muscles for the next 12 to 48 hours.
This short-term discomfort is a normal response, similar to the feeling after a moderate workout, as the body adapts to the new joint alignment and the stretching of previously tight soft tissues. Chiropractors advise patients to increase their water intake following a session. Gentle movement, such as a short walk, is also recommended to help the body integrate the changes and prevent stiffness.