The Chiropractic Adjustment

Posted by Bill Esteb on May 25th 2017

Close Up of Pisaform

I do not know how to adjust.

I suppose sometime over the last three or four decades, someone would have shown me had I asked. But I have far too much respect for the adjustment to taint it with my own attempts.

Please keep that in mind as you contemplate the points below.

Undoubtedly, you’ve heard the old saw, “Those who can’t, teach.” That’s what’s going on here. However, I have been on the receiving end of a wide variety of chiropractic adjusting techniques over the years. Like you, I have my favorites. But I want to rise above technique and explore what B. J. Palmer observed as “the adjustment with that extra something.”

Manipulation or Adjustment?

I can guarantee that if you are casual with the language you use to describe or refer to this important thing you do, then the outcomes you experience will be equally pedestrian and unremarkable. So let’s start there.

An adjustment is not a manipulation. An adjustment is not a treatment. And so it stands to reason that an adjustment is not a spinal manipulative treatment.

If you wish, you can call a zebra a horse. But doing so reveals either your ignorance or stunted intellectual development. Blurring the distinction may be convenient (fewer animals to categorize) or a streamlined generalization. But when you use adjustments and manipulations interchangeably, you make a similar error.

For my purpose here, I’d define manipulation and its derivatives as a general, nonspecific joint mobilization. Manipulation is also an attempt to get someone else (or a spine) to do your bidding, justified as being in his or her best interests. In other words, shaming or guilting a patient into a care plan is as much a manipulation as is attempting to remake a patient’s spine into what you think it should be—ignoring the intelligence of their body that created the spinal pattern.

While some may disagree, I’d define an adjustment as a precise and specific force applied to a patient’s body at opportune times and places with the intent of arousing or reviving the body’s self-healing capacity. That “force” may be a thrust or a touch, delivered by hand or an instrument, or by relying on the effect of gravity, but there is some type of energy consciously added to the patient’s body. Granted, to an uninformed bystander, a manipulation may appear to be identical to an adjustment. The more profound distinction is the intention of the person delivering the force.

The Intention Connection

For some who have little appreciation for “art” or metaphysical nuance, this may feel a bit woo-woo, but here goes. Your thoughts, your energy level and your intention affect what happens when you touch another human being. If this doesn’t resonate with you, ask any dancer, musician or artist if their mental state affects their expression.

This reminds me of the worst pizza I’ve ever had. I was in Bondi Beach, Australia. I was exploring this suburb of Sydney the night before my seminar and happened upon a walk-up pizza shop. While the fellow was making my pizza, I peppered him with questions about the area, things to see and do and the seasonality of the beach town.

As our conversation continued, my questions became more personal. How long had he been employed at the shop? (“Four months.”) What was the best part of his job? (“Going home.”)


Later, as I was consuming his handiwork, which was the worst pizza I’ve ever eaten, it occurred to me that one of the things that make fast food so unhealthy is not the fat, salt or sugar, but the fact that it is often assembled devoid of love. Which, by the way, is probably one reason home-cooked meals are so tasty.

Same thing here. Your mental state, your sense of peace, your fears, your confidence, your purpose, all these and more are communicated on some level to the recipient of the adjustment. They’ll unlikely have a conscious awareness, but they can tell.

Patients as Partners

An adjustment is a tango, a dance. It’s not a one-way street. Patients communicate in a variety of ways through their respiration, muscle tone and even their willingness to give you access to their spine.

That’s the physical communication. However, there’s another far more important communication going on, and that’s the meaning patients make of your adjustment. In other words, what do they think you’re actually doing?

Most patients are allowed to suffer from two hallucinations. They make assumptions and have expectations that are rarely addressed or neutralized by the chiropractor.

The first is that you’re “putting the bone back where it belongs.” If that were true, it would only take one adjustment! Secondly, that your adjustments are treating their particular ache, pain or symptom. In particular, that your cervical adjustments are treating their headaches or neck pain, and your lumbar adjustments are treating their sciatica or lower back pain.

Granted, if you’re suffering from this incorrect belief yourself, then patients will never know the truth. However, allowing patients to hold this belief without challenge produces some unhelpful side effects:

1. Patients discontinue care as soon as their symptoms are relieved.
2. Patients make you responsible for the speed of their recovery.
3. Patients remain passive, expecting you to do all the heavy lifting.

When you have greater clarity about what you’re doing (and not doing), you may see why confronting these wrongheaded beliefs are so important. Doing so will make your care more effective and less stressful, and you will no longer feel responsible for things beyond your control.

Your Head, Heart and Hands

Even though I have never adjusted a spine, in my conversations with chiropractors who do, I’ve accumulated some insights that might remind you of what you already know (or take for granted) and incline you to be more mindful as you deliver your next adjustment.

Have clear intention: As previously mentioned, having an appropriate intention when delivering an adjustment is part of what makes an adjustment something other than a manipulation. Reducing interference to the nervous system to better permit a patient’s body to fully express itself differs greatly from forcing a joint into a better biomechanical relationship with the one above and below it.

Be fully present: Distracted by the goings on in the practice, worrying about your car payment or occupied by other ruminations diminish your focus. If adjusting has become rote or routine, hurting someone or overlooking a contraindication is far more likely. At the very least, visualize the ripple effect of how your connection will reverberate throughout the patient’s life.

No talking: Chatterboxes rarely deliver extraordinary care. Maybe that’s why they talk so much—to distract the patient so they don’t raise objections or other concerns. Speaking puts patients into their left hemisphere, which does little to enhance healing or connection. Chattering away is usually the sign of insecurity and a lack of confidence. Make sure every new patient understands that your silence is not arrogance or aloofness, but rather concentration and expanded awareness.

Reverence: There’s no need to bring the adjustment into the realm of being a sacrament. However, be mindful that the value you place on the adjustment is communicated to each patient. If you see it as uninspired, common and perfunctory, patients will quickly follow suit. The reverse is true as well. Make sure the patient is a willing partner and has not asked you to compromise your values, procedures or even the expectation of payment. Never use your adjustments to convince or win over a skeptic or doubter.

Spiritual rather than mechanical: D. D. Palmer observed that “the purpose of chiropractic is to connect man the physical with man the spiritual.” And while adding energy at opportune times and places along the spine is clearly a physical event, the objective is to make it a spiritual event. Remember, everything manifests spiritually before showing up physically. Thus, patients don’t need to be fixed. They’re not broken, but merely disconnected from their true selves.

Stay connected: Once you touch a patient, remain connected until you have completed your adjusting procedure. The stop/start of touching and withdrawing, retouching and revoking your connection significantly reduces the amplitude of your intention. Stay connected, even if it means changing to the other side of the table, until you are through.

Less is more: Thrusting into every spinal articulation, playing the spine like a xylophone, reveals a glaring misunderstanding, as does spending a lot of time with a patient. Neither improves the desired outcome. This is a rookie mistake. It is often a sign of a lack of confidence.

Manage your state: Many chiropractors abuse their intent in two ways. The first is not adequately preparing for the first adjustment of the day. Arrive early enough before your first patient to get into a healing consciousness. The second is mixing adjusting times with admin work. Seeing three or four patients and then entertaining yourself on the Internet or paying bills during the lull takes you out of state. Instead, reserve sacred time in which all you do is adjust. No patients to adjust? Then become still, close your eyes and contemplate the other patients you’ll be seeing later in the day. This is the real practice of practice.

No Hope. No Healing.

Kudos for choosing the hard, difficult, uphill path of chiropractic. You pursued your career knowing that chiropractic is misunderstood, that you’d be marginalized and become an outcast. Thanks for that.

So there’s no need to make it harder than it already is by contributing to its misunderstanding or marginalization. And that begins with having great clarity about your adjustments. When you do, it projects the certainty and confidence that patients find so vital because of the hope it generates. Moreover, it means you’ve left the world of being a technician and entered the world of unlimited possibilities of being a healer.