Chiropractic Adjustment
What Happens During a Chiropractic Adjustment? The Popping Sound, the Techniques, and What You'll Feel
If you've never been adjusted before, it's normal to wonder what actually happens on the table, what that pop is, and whether it hurts. Here's a plain walkthrough of a chiropractic adjustment, from the first questions we ask to how you might feel the next day.
By Dr. Edward Johns, DC · October 5, 2026 · 7 min read
What a Chiropractic Adjustment Actually Is
An adjustment is a quick, controlled push on a joint that isn't moving the way it should. The National Center for Complementary and Integrative Health describes spinal manipulation as a practitioner using their hands or a device to apply a controlled thrust to a joint of the spine, moving it a little further than it would go on its own.
That's really all it is. It isn't bones being forced back into place or anything being pulled apart. It's a short, precise movement aimed at one specific joint, chosen after we've figured out which joint actually needs it.
At North River, the direction of each adjustment is based on the mirror-image method, which means we're correcting toward where your spine should be, not running every patient through the same routine.
Before Anyone Touches Your Spine: History and Exam
Nobody should adjust you the minute you walk in. A standard first visit starts with your history and a physical exam, so the chiropractor has a working diagnosis before any treatment. Imaging such as X-ray, MRI, or CT may be used when it's needed to confirm what's going on.
Dr. Johns sits down with you first and goes over your health history and goals, so the plan accounts for everything else going on with your body, not just the spot that hurts today. Expect questions like these:
- When the pain started, and whether it followed an injury, a fall, or a car accident
- Where exactly it hurts, and whether it travels anywhere (down an arm or leg, for example)
- What makes it better or worse: sitting, standing, bending, sleeping
- What you've already tried, and what helped or didn't
- Medications you take, especially blood thinners, and any history of osteoporosis, fractures, or surgery
Three Ways an Adjustment Can Be Delivered
Most people picture one style of adjustment, but there are a few, and the right one depends on the person on the table. We use three:
- Manual adjusting: Dr. Johns uses his hands to deliver a quick, targeted force directly to the joint. This is the traditional style most people picture.
- Drop-table adjusting: the table has sections that drop slightly as the adjustment is delivered. That small mechanical assist means less direct force is needed through the joint, and many people find it more comfortable, especially in the low back.
- Instrument adjusting: a small handheld device delivers a precise, low-force impulse to one segment. It's often a better fit for people who are sensitive to manual pressure, including some older adults and young children.
Does the Technique Matter?
A fair question is whether the gentler options are watered down. The research so far suggests they aren't, at least for common complaints. A 2012 systematic review of eight studies on a handheld adjusting instrument found reported benefits for people with spinal pain, and in the studies that compared it with manual adjusting, the results weren't statistically different. The authors were also upfront about real weaknesses, like small sample sizes, short follow up, and no sham or control groups, so it isn't the last word.
In practice, that means the style can change from one visit to the next. Someone with an acutely inflamed low back might do better on the drop table or with an instrument at first, then move to manual adjusting as things calm down.
What That Popping Sound Really Is
The pop is the part everyone asks about. According to Cleveland Clinic, it's gas (oxygen, nitrogen, and carbon dioxide) being released from the fluid inside the joint, the same kind of sound you get when you crack your knuckles. It isn't bone grinding on bone, and it isn't anything breaking.
Researchers actually filmed this happening. A 2015 study used real-time MRI to watch finger joints as they were pulled until they cracked. The sound happened at the moment a gas-filled cavity formed inside the joint as the surfaces separated, and that cavity stayed visible afterward. That overturned the older idea that the noise came from a bubble collapsing.
The other thing worth knowing: you don't need to hear it. A 2022 systematic review looked at whether an audible pop during spinal manipulation made any difference to pain afterward and concluded that the presence or absence of a pop may not be important for pain outcomes. If an adjustment is quiet, it didn't fail.
How It Feels During and After
For most people, the adjustment itself feels like a quick stretch or a burst of pressure, followed by a sense of release. Cleveland Clinic describes the experience as little to no pain, and notes the popping noise may sound uncomfortable even though it doesn't feel that way.
Afterward, mild soreness in the area that was worked on is common, a bit like the day after a new workout. Temporary stiffness, tiredness, or a mild headache can also happen. The NCCIH notes that most of these side effects go away within 24 hours.
Serious complications are rare, but they do exist, which is exactly why the history and exam come first. Let us know about any of the following before your first adjustment:
- You take blood thinning medication, or have a higher risk of bleeding or stroke
- You have very weak or seriously damaged bones or joints (osteoporosis is one common cause)
- You have a condition affecting your nerves, like peripheral neuropathy
What Adjustments Are Good For
The strongest evidence is for back and neck pain. For acute low back pain, research summarized by the NCCIH shows a modest improvement in pain, similar to the benefit people get from anti-inflammatory medications. For chronic low back pain, it's linked to slightly better function than other therapies. The American College of Physicians lists spinal manipulation as one of several options that may help people with acute or chronic low back pain.
For neck pain, manipulation has been shown to help reduce pain intensity in acute cases, with low-to-moderate quality evidence that it may reduce pain and improve function in chronic cases.
That's why an adjustment is usually one piece of a plan here rather than the whole thing. Depending on what's going on, it may be paired with traction, physiotherapy, or posture work so the improvement holds up between visits.
FAQ
Frequently asked questions
Does a chiropractic adjustment hurt?+
Most people feel pressure or a quick stretch, not pain. Mild soreness for a day or so afterward is common, similar to the day after a workout. If a joint is already inflamed or acutely injured, we can use a gentler drop-table or instrument adjustment instead.
What is the popping sound during an adjustment?+
It's gas being released from the fluid inside the joint as the joint surfaces separate, the same thing that happens when you crack your knuckles. It isn't bones grinding or anything breaking.
Does an adjustment have to pop to work?+
No. A 2022 systematic review found that whether or not a joint pops during spinal manipulation may not matter for pain outcomes. A quiet adjustment isn't a failed one.
How long does soreness last after an adjustment?+
Usually not long. Common side effects like soreness, stiffness, or a mild headache typically go away within 24 hours. If something feels worse rather than better after a day or two, call us.
Who shouldn't get a chiropractic adjustment?+
Spinal manipulation may not be safe if you take blood thinners or have a higher risk of bleeding or stroke, have very weak or seriously damaged bones or joints, or have a nerve condition such as peripheral neuropathy. That's why we go over your history and do an exam before any adjustment.
Are gentler adjustment techniques less effective?+
Not necessarily. A 2012 systematic review of studies on a handheld adjusting instrument found that, where it was compared with manual adjusting for spinal pain, the results weren't statistically different, though the studies themselves were small. We choose the method based on your body and comfort.
Sources
- 1. NCCIH (NIH) - Spinal Manipulation: What You Need To Know
- 2. Cleveland Clinic - Chiropractic Adjustment
- 3. Kawchuk et al., Real-Time Visualization of Joint Cavitation, PLOS ONE (2015)
- 4. Moorman & Newell, Impact of audible pops associated with spinal manipulation on perceived pain: a systematic review, Chiropractic & Manual Therapies (2022)
- 5. Huggins et al., Clinical effectiveness of the activator adjusting instrument: a systematic review, J Can Chiropr Assoc (2012)
- 6. United Health Services - Chiropractic Care: What to Expect on Your First Visit
- 7. NHS - Chiropractic
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