If you got off the table feeling looser and then woke up the next morning a little achy, you are in good company. After more than 25 years in practice, this is one of the questions I hear most often from new patients: “Is it normal to be sore after an adjustment?” The short answer is yes, mild soreness is common, and it usually fades within a day. The longer answer is worth knowing, because it helps you tell the difference between ordinary soreness and something you should call about.
How common is soreness after an adjustment?
Quite common. Researchers have studied this question by asking patients to report anything unpleasant they noticed after spinal manipulation, and the numbers are higher than many people expect.
- In a Belgian study of 465 patients on their first visit, about 61% reported at least one reaction afterward. The most frequent were headache, stiffness and local discomfort, and most began within 4 hours and were gone within the next 24 hours (Cagnie and colleagues, Manual Therapy, 2004).
- A Swedish study that followed 625 patients across 66 chiropractic offices found that about two thirds of reactions were local discomfort in the area that was adjusted. Reactions were usually gone by the day after the visit and were reported most often early in a series of visits (Leboeuf-Yde and colleagues, Journal of Manipulative and Physiological Therapeutics, 1997).
- The National Center for Complementary and Integrative Health, part of the NIH, describes the same pattern: mild to moderate side effects such as increased discomfort, stiffness or headache are common, and most go away within 24 hours (NCCIH, Spinal Manipulation: What You Need To Know).
Why you might feel sore
Think about the last time you went back to the gym after a few months off, or spent a Saturday raking leaves. Muscles and joints that have been moving one way for a long time get asked to move a different way, and they let you know about it. An adjustment works on joints and the muscles around them, so a day of tenderness in that area is not surprising.
A few things seem to make soreness more likely. The Swedish study found reactions were more common at the start of a series of visits and in people whose problems had been going on for a long time. Women reported reactions more often than men in both the Swedish and Belgian studies. People who had never seen a chiropractor before did not report more reactions than people who had.
You may have read online that soreness means your body is “releasing toxins.” I have not seen good evidence for that idea, and I would not want you to worry about it. Ordinary muscle and joint soreness is the simpler explanation.
What normal soreness usually looks like
- A dull ache or tenderness in the area that was adjusted
- Some stiffness, especially when you first get up or after sitting
- Starts within a few hours of the visit
- Gets better day by day, and is usually gone in a day or two
- Tends to be less noticeable after the first few visits
What many people find helps
- Keep moving gently. A walk around the block usually feels better than sitting still all evening.
- Drink water and rest well that night, the same way you would after a hard workout.
- Use ice or a heat pack for short stretches if that feels good to you. Many people have a strong preference for one or the other.
- Skip the heavy lifting or intense workout for the rest of the day if you are sore.
- Tell us at your next visit. How you felt afterward is useful information, and we can adjust the plan.
If this is your first time with us, our post on what to expect at your first visit walks through how we start.
When soreness is not the normal kind
Serious problems after spinal manipulation are rare, according to the NCCIH, but they do happen, and the risk may be higher in people with underlying health problems. The NCCIH encourages patients to share their health conditions and medications with any practitioner, and that includes us.
Call us or your doctor if:
- The pain is getting worse instead of better after a couple of days
- You notice new numbness, tingling or weakness in an arm or leg
- The soreness is very different from what you came in with
Call 911 right away for any of these sudden symptoms, which the CDC lists as signs of stroke: numbness or weakness in the face, arm or leg, especially on one side; confusion, trouble speaking or understanding speech; trouble seeing; trouble walking, dizziness or loss of balance; or a severe headache with no known cause.
For more on warning signs in the low back specifically, see 5 red flags that your lower back pain is serious. And if you are weighing the risks of chiropractic care in general, I wrote about that in why some people say not to go to a chiropractor.
A note from our office
At Slovin Chiropractic Center, Dr. Erik Slovin and I see a lot of complex and chronic cases, and personal injury patients after car accidents. With those patients especially, we want to hear how you felt between visits. We speak Spanish, we accept most major insurance, and Saturday visits are available by appointment only.
Frequently asked questions
How long does soreness last after a chiropractic adjustment?
For most people, not long. In published studies, most reactions started within a few hours and were gone within about 24 hours. If soreness lasts more than two or three days or keeps getting worse, call your chiropractor or doctor.
Is it bad if I feel worse after an adjustment?
Mild, short-lived soreness is common and is not a sign that something went wrong. Pain that keeps building, new numbness or weakness, or any sudden stroke symptoms are different, and those need a call to your provider or 911.
What should I avoid after a chiropractic adjustment?
If you are sore, many people find it helps to skip heavy lifting and intense exercise for the rest of the day, stay gently active, and drink water. Let your chiropractor know how you felt so the next visit can be planned around it.
Questions about how you are feeling after a visit, or ready to book? Call us at (203) 840-0000. We are at 99 Main Street, Norwalk, CT 06851.
