What’s the Difference Between Manual and Instrument Chiropractic Adjustments?

The two techniques explained

Chiropractic adjustments — also called spinal manipulation — restore motion to joints that have become restricted or misaligned. There are dozens of named techniques in chiropractic practice, but they generally fall into two categories: manual (hands-on) adjustments and instrument-assisted adjustments.

Manual adjustments

In a manual adjustment, the chiropractor uses their hands to apply a specific, controlled force directly to a joint. The most common manual technique is Diversified, taught at nearly all chiropractic colleges — including Palmer College of Chiropractic in Davenport, Iowa, where Ann McAlpine, DC and Phillip Maletta, DC earned their degrees, and Life University in Marietta, Georgia, where Ben De Young, DC graduated.

Other manual techniques include:

• Gonstead — a precise, segment-specific approach often paired with X-ray analysis
• Thompson — uses a specialized table with drop sections to assist the adjustment
• Toggle — focused on upper cervical (neck) adjustments

Manual adjustments typically produce the audible “pop” or “cavitation” sound that patients often associate with chiropractic care. This sound is gas being released from synovial fluid in the joint — it’s not the spine being “cracked,” and the sound itself isn’t required for the adjustment to be effective.

Instrument adjustments

Instrument adjustments use a handheld device that delivers a quick, controlled impulse to the joint. The original handheld instrument is the Activator Adjusting Instrument, developed in the 1960s — a spring-loaded mechanical device that’s still widely used. More recent technology includes computerized instruments like the Impulse IQ (McAlpine’s preferred instrument — see below), the Integrator (used with the Torque Release Technique that Phillip Maletta, DC is certified in), and the ProAdjuster, along with drop tables that use mechanical assist.

Instrument adjustments don’t typically produce the audible pop. The force is gentler and more localized, and the patient remains in a neutral position throughout.

When each is used

A skilled chiropractor doesn’t choose between these based on personal preference alone. The choice depends on what’s clinically appropriate for the patient and the condition being treated.

Manual adjustments are commonly chosen when:

• The patient is comfortable with hands-on care
• A more substantial restoration of motion is needed (deeper segmental dysfunction)
• The patient’s body type and joint mechanics respond well to controlled thrust
• The practitioner wants tactile feedback — feeling the joint move — during the adjustment

Instrument adjustments are commonly chosen when:

• The patient is anxious about manual adjustments or hands-on contact
• The patient has osteoporosis, long-term corticosteroid use, recent fracture history, or other conditions where lower force is preferable
• The patient has rheumatoid arthritis with any suspicion of upper cervical instability — RA can cause laxity in the atlanto-axial joint, where lower-force instrument input is clinically safer than manual cervical thrust
• Specific joints need precise low-force input — for example, the upper cervical spine or rib joints
• The patient is elderly, frail, or pediatric
• The patient simply prefers a gentler experience

What does the research say?

Multiple comparative studies have examined manual vs. instrument adjustments. The general finding: both can produce meaningful outcomes for common musculoskeletal conditions, with relatively comparable results in measurable outcomes like pain reduction and range of motion. This is consistent with the results we see when using manual vs instrument adjustments in Holland, MI chiropractic cases.

A 2014 study published in the Journal of Manipulative and Physiological Therapeutics compared Activator and Diversified adjustments for low back pain and found similar improvements between groups. A 2018 systematic review on chiropractic care for neck pain noted that technique choice often matters less than the practitioner’s clinical reasoning and the patient’s individual response.

That said, manual adjustments do require more years of clinical training to perform safely and effectively. The tactile skill of feeling a joint, identifying the right vector and depth, and applying controlled force is a clinical craft developed over thousands of patient treatments — typically years of practice beyond chiropractic school.

How McAlpine approaches this

McAlpine has been Holland’s hands-on chiropractic practice since 1971. Manual adjustments — refined over decades of practice and thousands of patient treatments per doctor — are the foundation of how we deliver chiropractic care.

We also offer instrument-based adjustments when that’s the right fit for a patient’s specific case. The decision isn’t about which technique is “better” — it’s about which is right for you, given your specific condition and joint mechanics, your comfort level and preferences, your body type, age, and health status, and the clinical assessment of your spinal and musculoskeletal function.

Why we use the Impulse IQ for instrument-based care

When an instrument-based adjustment is the right approach, our preferred instrument is the Impulse IQ by Neuromechanical Innovations. The Impulse IQ is a computerized adjusting instrument that uses an accelerometer to measure the spine’s response in real time and adjusts the thrust frequency accordingly — a capability that older spring-loaded instruments don’t have.

Clinically, that matters in three ways:

• Real-time feedback. The instrument’s patented Auto-Sense technology detects when the joint has achieved maximum mobility and stops the thrust automatically — which helps avoid over-adjusting.
• Speed. The Impulse IQ delivers adjustments roughly twice as fast as traditional spring-loaded instruments. The faster impulse works through tissue before muscles can guard against it, which makes the adjustment more effective on segments that don’t respond well to slower instruments.
• Range. A wider range of force settings lets the practitioner match the impulse to the patient — gentler for fragile or anxious patients, more substantial when the case calls for it.

The Impulse IQ has been studied in over 50 peer-reviewed publications. For patients who prefer or require instrument-based care, it gives us a level of clinical precision that earlier-generation instruments don’t provide.

Whatever approach is right for you, our chiropractic care is part of a coordinated treatment plan that can include spinal decompression, Class IV laser therapy, and clinical massage as your case warrants.

Frequently Asked Questions

Is one method safer than the other?

Both are widely considered safe when performed by a licensed chiropractor. Adverse events from chiropractic adjustments are rare regardless of technique. Manual adjustments require more practitioner skill, but skilled practitioners produce excellent safety records with manual care. Instrument adjustments inherently use less force, which is sometimes preferable for fragile spines or anxious patients.

Will I feel a “pop” with both methods?

Usually only with manual adjustments. Instrument adjustments are typically too quick and low-force to produce cavitation sound. The pop is not required for an adjustment to be effective — it’s a side effect of joint motion, not a measurement of clinical success.

Can I request one or the other?

Absolutely. Tell your chiropractor what you prefer. A good practitioner will adapt to your comfort level and explain why a specific technique might be recommended for your case.

Are instrument adjustments less effective than manual?

No. The force is lower, but precise targeting can be equally effective for many conditions. The difference is in approach and patient experience, not in outcome quality.

How does McAlpine decide which one to use for me?

Your first visit includes a thorough evaluation — health history, posture assessment, and orthopedic and neurological exams. Based on findings, we recommend the approach most appropriate for your case. If you have a strong preference, we accommodate it whenever clinically appropriate.

Schedule an evaluation

If you’re considering chiropractic care and want to discuss which approach is right for you, call 616-392-7031 or schedule online. Your first visit includes a full evaluation and a clear explanation of recommended care — no surprises, no pressure.