08/21/2010
When it comes to how often patients should be adjusted, there’s a difference of opinion amongst chiropractors: Is it better to over-adjust or under-adjust? In other words, is a patient better off receiving more adjustments than necessary, or can chiropractors adjust too much?
I’ve met chiropractors who proudly recommend over 100+ adjustments per year! On the opposite end of the spectrum, I know chiropractors who only recommend semi-annual checkups.
Personally, I’m of the opinion that the fewer adjustments a person needs, the better off they’ll be… More importantly, the longer they go without needing to be re-adjusted, the healthier their spine and nervous system are… But let’s see what the developer of the Chiropractic profession had to say about this issue (emphasis his):
Frequently over-adjusting CREATES new conditions which average Chiropractor may alibi as retracing when in fact it is what HE is doing that creates NEW dis-ease growths.”
Bear in mind, the intended audience for this statement was his fellow chiropractor, not patients. So please forgive the technical jargon… Here’s the basic translation: “Doctors, if you adjust patients too often, you’re going to create new problems. When this happens, don’t try and justify it by saying it’s part of the healing process.”
Dr. B.J. Palmer dedicated his life to transforming chiropractic care from a “family secret” into a worldwide healing profession. He succeeded. If anyone has the authority to speak on the efficacy of a chiropractic adjustment, it’s him. At the very least, his opinion is worth considering.
In the decade that I’ve been adjusting patients, I’ve never once thought to myself, “Man, I really should have adjusted that patient more often.”
So why am I sharing this information with you? It’s because many patients think the first question to ask when searching for a chiropractor is, “Do you accept my insurance?” — As a chiropractic insider, I’m here to tell you that should be the last.
Hopefully this demonstrates why it can be more important to ask, “How often do you expect to see me?” or if you’re currently under chiropractic care, “Am I getting adjusted too often?”
Great site, Dr. Tanase! But, I feel confused now after reading this post. Now I’m worried that I’m getting adjusted too often. I see this happening – being adjusted once to twice a week for a few weeks now, and when one issue gets corrected another arises. And, really, is there ever a cure (or even something close) for back pain or are we deluding ourselves? I’m fortunate to have insurance and affordable co-pay, but it definitely adds up. When do we know when to back off with care? I wonder if my chiropractor will give me BS answer or genuinely not know…
Charlotte, many times a patient’s visit frequency is higher in the early stage of care. It’s important, however, that your doctor uses some type of objective assessment to measure your progress. Guessing is not okay in my book. As long as the doctor can demonstrate progress, then I wouldn’t sweat it. If they’re offended by your interest in how they know you’re getting better, then there’s a problem.
Hello Dr. Tanase,
My Name is Rachel and I am 14 years old. I was In a bicycle accident on June 9, 2010. I was knocked out for almost 10 minutes. I suffered from a servere concussion and a broken hand. After a couple weeks went by, I noticed that my headaches were not improving. My doctors thought they were a result of my concussion, so they didn’t do anything for me. A few more weeks went by and I continued to get headaches on a daily basis. I went to a neurologist and he recomended chiropracic care. 3 months after the accident on September 1, 2010, I began chiropractic treatment. I have been getting 3 adjustments a week ever since. I’ve felt little to no improvements with my headaches. Am I being over adjusted? Can you think of anything else that I can try?
Hi Rachel, I’m not an advocate for that many office visits… You might consider checking out the referral directory on http://www.UpCspine.com and seeing if there’s an Upper Cervical specialist in your area. Let me know how it goes!
I have been going to a chiropractor for three times a week for about a month0 it started with allergy tightness in the chest (which he solevd) – then stomach issues (which he solved)…but then I increasingly found it difficult to sleep and then not at all (one night) – can I be overstimulated by the treatments??
(Ps: his correction for the sleeplessness has totally thrown out my neck and back – which is area I never have problems with! I am afraid to go back!!)
Hey Doc Tanase, this is Dr. Bucknell from your graduating class at Logan. Ironically, I got an email about this article from a patient down here in Mobile Alabama asking for my take. While I’m with you that most Chiropractors over-adjust without reason and without direction, I think we have to be real careful about throwing blanket policies on frequency. I could throw out scenarios all day long to argue the point, but some patients do in fact need to start more frequent, NOT determined by symptoms but by evidence. I’ve been doing advanced spinal correction care per mixed CLEAR Institute, Pettibon, Maximized Living, and other protocols for about 6 years now and while we can correct spines faster and cheaper than most could hope to do in the mentioned 100+ visits, there is the occasion where someone starts every day. In fact Dr. Woggon, the world’s current leading authority in scoliosis correction adjusts 6 or more times a day, every day, for weeks to achieve correction. Unless we can prove to do it faster and show it on xray, we’d be tough to argue him with any authority. In my experience, I find it tough to predictably and consistently correct spines without adjustments twice a week minimum and an hour or more of home therapy daily. Many of the best I know say more. We all have had the “patient who miraculously heals” but not with consistency. Side note, we will be releasing the first ever study done on predictable spinal correction protocols in 2012 in collaboration with half a dozen other doctors. This study will make it very hard for the average doctor to justify a 60+ visit care plan.
I know what you’re getting at, and while I agree 95%, there is exception when the Chiropractor knows what they’re doing and can PROVE results. Important for someone stumbling on this and reading into it. Bottom line for patients, know your Chiropractor’s credentials.
Thanks for commenting, Mike. Glad to hear from you!
Hi,
I just started seeing a chiropractor for lower back pain. I was told that I have pretty severe forward head posture (nearly 60cm more forward than what is considered normal). I was also told that one of my hips is about 20cm higher than the other. My chiropractor has recommended that I get adjusted three times a week. While my lower back pain is interfering quite a bit with my daily functioning, I’m worried that this may be a bit excessive. I was recommended that I have three adjustments a week for a four week period and then have my x-rays taken again to see how the adjustments are working. I’m thinking of asking to only have adjustments 1-2 times per week instead.
Any input would be greatly appreciated!
One additional point– This doctor is also closed on Fridays– So I would be receiving three adjustments per week during Monday-Thursday. This also added to my concern, as three adjustments in a four day period for four weeks really seemed to be a lot!
Mel, a chiropractor’s treatment recommendations often depend on which adjusting technique they’re using. In many “full spine” offices across the country, 3X per week for 4-weeks is a common recommendation. Whether or not 3 adjustments per week is “better” than 1-2 adjustments per week is debatable. Some chiropractors might suggest this is too frequent and that the body needs time to respond to an adjustment before subsequent treatments are given. But you will also find DCs who want you to come in 5x per week because that’s what their treatment protocols recommend.
If you’re unsure, I don’t think it would be a problem for you to receive an adjustment once per week to test the waters.
Sorry doc to break in on this conversation again but since I replied earlier I got it in my email too. But this is a case where it’s appropriate for one of the “high frequency” docs to give a response I think will clarify greatly.
Mel, it’s time the patients start holding the Chiropractors to the test. If we all love Chiropractic, the best way to advance it is to make sure Chiropractors are held to standards. Ask the questions like, “what is my expected correction ON XRAY in that time frame”, “what training and certification in spinal correction protocols do you have” (ask for references and websites, I’d be glad to review credibility if you need), “what will I be doing besides adjustments to achieve that correction” (can’t do it with predictable results adjustments alone, again glad to review), etc. If they can’t answer these questions with clear certainty than you are in one of those stencil 3x a week offices both Dr. Tanase and myself disapprove of. If however you are in a corrective office, be glad because they’re rare.
When Chiropractors get these questions enough and have enough angry patients expecting corrective results visible on xray and not getting it, they’ll seek to get better. Our profession, and the patients most, deserve all of us Chiropractors to constantly strive to get better at doing what we claim, as the number one specialists of the spine and nerve system and their optimal correction and function. Do us all a favor and ask the questions before you accept care. Do yourself a favor and don’t use this as a reason to abandon Chiropractic altogether, but find the right doctor instead. Hope this helps.
Thank you for sharing, doc. The more info and perspective she has, the better.
Hi,
I have been seeing a NUCCA chiropractor for about 5 years now. It took me almost 8 months of care before seeing consistent improvement and had a really difficult time holding my adjustment during that time (was getting adjusted twice per week for about 6 months). I was able to hold my adjustment over time for about 3 weeks typically. I got pregnant and had a baby in May of 2010 and shortly after that I started having problems holding my adjustment again. My symtoms are dizziness and balance problems so it’s difficult to not get adjusted frequently so i’m back to being adjusted once or twice weekly. I’m still having a lot of problems holding and was wondering if pregnancy and nursing contribute to muscle laxness (that is what my current chiropractors thinks) Any suggestions?
Emotional stress can wreak havoc on a person’s ability to hold their adjustments. Anxiety, fear, anger, worry, distress, etc… Would that be something you’ve had a lot of over the past 5 years?
I had a lot of stress in the beginning when I first started care 5 years ago because of the dizziness. Once the symptoms were better the stress was gone but I still wasn’t able to hold for more than 3 weeks at a time? Have you ever seen that before? There was stress once I had the baby and definitely a lot more now. Part of the problem is that though I’m getting adjusted often, I don’t think i’m getting fully aligned. My hips and legs are definitely level when I leave the office, but I have a twist in my hips and a neck lean that the doctor is not able to correct even right after the adjustment. She recognizes that and is trying to sort it out but cannot understand why the adjustments are not correcting the problem. Any suggestions?
I have a question in regards to NUCCA as well. I started NUCCA along with ortho work (for the second time) a couple years ago. The chiro care completely eliminated the TMJD symptoms and many other little minor problems. Then I had jaw surgery. They broke and moved my bottom jaw forward 10mm and tipped it upwards to fix an open bite and hopefully the TMJD would be gone forever.
That was 1 1/2 years ago. My neck has not remained in alignment for more than 24 hours since. We tried twice weekly adjustments, re Xrays (involved a change in angle), more time between appointments, two different dental splints made by a very expensive neuromuscular dentist, adjustments of those with the nucca chiro present (involved 3 adjustments over a 3 hour time because I kept popping out) and now physio with Gunn-IMS accupunture.
Nothing as worked and all the pain and issues are bad 100%. Migraines almost daily, nausea, loss of appetite, extreme fatigue, severe jaw, neck and joint/muscle pain over the entire body. I know NUCCA works because it was awesome and I felt the best I ever have!! I want that back but it seems to be getting farther and farther from possible.
We are adjusting once a month to try and give the physio some time to work, initiatally it helped a lot and not so much now. Is this under adjusting or over adjusting since my neck comes out of alignment within 20 minutes?
I know attitude plays a big role in keeping the adjustment but it’s impossible to stay upbeat because I know it’s not going to work. I’m painful, unable to eat properly (both from jaw and severe GERD), tired and really really wish I never had the jaw surgery. I don’t bother stretching any more because it’s too painful and does not help at all – I seem to even tense up afterwards. Any tips would be appreciated.
Dr. Tanase,
I have been seeing a chiropractor for almost 3 months now. On my first visit, I received x-rays and following that, I was adjusted 4x a week for the first 2-3 weeks, then 3x for 2-3 weeks and now down to 2x a week. I should be going to 1x a week here soon. From what it sounds like, this is pretty typical? It sure seems like I am going often, maybe too often? The part I am mostly concerned about is that the appointments last literally 7 minutes, at most. This includes being placed (for about 3 minutes) on rolling massage table and then seeing the doc for just a few minutes to do adjustments to help correct both my scoliosis and neck pain. Should I be asking for another xray to be done at this time to ensure that things are progressing properly? I also do stretching at home using a chin-up bar and stretch over a soft vanity bench against both apexes in order to help the process along. I just want to make sure that I am not being taken advantage of by going this frequent and for such short visits. Friends of mine say that their visits often take 45 minutes to an hour. Thank you for your time!
No way your spine is warmed up in 3 minutes, not with scoliosis. Our patients warm up for 45-55 minutes of intense vibration before adjustment. X-rays should be taken every 8-12 visits IF correction is being communicated as the outcome. For credible correction protocol see the CLEAR Institute website.
Emma, the recommendations you’ve been given are fairly common in conventional (full spine) chiropractic offices.
The amount of time you spend in the office isn’t nearly as important as the doctor’s ability to show you measurable progress. In other words, I’d rather spend 1-minute with a doctor who I know is helping me than 1-hour with one who isn’t.
If your doctor can demonstrate objective improvement through re-evaluations and/or x-rays, then it’s legitimate. But if you’ve gone that many times and he can’t show you any improvements (and you’re not feeling any better), then there’s no shame in shifting gears and consulting with someone else.
I recommend arranging a time to meet with your chiropractor when he can spend more time with you and discuss your concerns. It might be at the end of the day, or during a time that’s not designated for adjusting patients. Ask him to review his care plan with you, and re-explain the direction he’s headed. If he has seen you that many times over 12 weeks he should have definitely performed a progress exam by now, or in the very near future.
If you’d like some assistance finding someone new, email me and I’ll see what I can find.
I have been going to a chiropractor for almost a year now. I was going twice a week at first then once a week, then once a month. I was doing better but not fully healed I have to admit I wasn’t doing the exercises at home either. My left arm has been weak for a while now. Im not getting concerned about the popping noises in my neck. I know I am small framed and don’t have a lot of muscle. I stay stressed a lot the time so I know my muscles are tense They use whats called the pro adjuster on me. I aggravated my neck and back again doing yoga. My question is can chiropractic machines cause weaker muscles and cause a hyper mobile neck or is it possible that my neck is just tense? My neck sometimes pops when I breath. One thing that helps ease the pain is they say I have a rib bone that comes up in between my neck and shoulder. They use the pro adjuster to push it back down. It feels so much better when they do that.
Im sorry I meant Im now getting concerned about the popping noises in my neck.