Why do some patients feel worse right after chiropractic care starts working, and how should a chiropractor explain it?

Question

Accepted Answer

A patient with big findings and a small complaint may have stopped feeling their body (the freeze response). As adjustments let the brain reconnect, they feel more, sometimes going from 2 out of 10 to 10 out of 10. Tell them before it happens, and rule out that you did too much.

Often it is the brain reconnecting with the body. What they feel gets louder because they can finally feel it.

Some patients come in with a subluxation pattern that makes you ask, how are you not complaining of so much more? They rate it a two out of 10.

Then you start adjusting, and they wake up. The symptoms can go from a two to a 10 in the beginning, because the brain can finally reconnect with the body.

Why it happens

Fight or flight has a third F: freeze. When the input from the body is overwhelming, the nervous system stops checking in. The patient isn't noticing what is happening in the body.

So a disconnect between what you find and what they say is a telltale sign that they are dissociating. That can come from years of subluxation. It can also come from trauma. Either way, the low number was never the real picture.

As care works, the sensation comes back. The patient notices things they had stopped noticing.

Rule out the other kind of worse

Not every bad day after an adjustment is reconnection. Every patient has a metabolic threshold. Push past it, correct one thing too many, and they shut down on you.

Kids compensate well and then crash hard, and the cliff is bigger in pediatrics. Parents report the baby is fussy, doesn't sleep, has a hard time.

That one is on you. On the table, it feels like doing the technique on a cadaver: very little feedback. When you feel that, stop, and leave what you cannot correct today.

What to say, and when

Say it before the first adjustment. When you tell patients what they will experience before they experience it, it is not an objection.

Two things to tell them. What you found is bigger than what they feel. And as you start adjusting, some patients feel more in the beginning, because the brain is reconnecting with the body.

What to do Monday

When findings are large and the complaint is small, write that gap in the chart.

Tell that patient, on day one, that symptoms may get louder first.

Keep clear, specific indicators for each visit so you know when one more correction is too much.

With highly subluxated patients, stop after one good correction if that is all the system can take.