Most patients walk into my office expecting one thing: the adjustment. They want to hear that crack, feel the release, and walk out fixed.

I get it. After 30 years of practice and treating over 1,000 patients annually, I understand that expectation. But here's what three decades of clinical pattern recognition has taught me:

The adjustment is only half the equation.

The real difference between a good result and a great one happens before I ever touch your spine. It happens when we address your soft tissue first.

What Patients Get Wrong About Adjustments

When you think "chiropractor," you probably think "back cracking." That's the most common misconception I encounter.

Yes, during adjustments your neck or back may crack. But that sound isn't the goal. It's a byproduct.

What I'm actually doing is realigning your vertebrae to take pressure off pinched nerves. The adjustment is a precise mechanical intervention designed to restore proper spinal positioning and nerve function.

The crack you hear? That's just gas bubbles releasing from the joint space. It's not your bones grinding together or anything breaking. It's physics, not damage.

But here's what most people miss: your spine doesn't exist in isolation. It's surrounded by muscles, fascia, ligaments, and soft tissue that directly influence how well an adjustment works.

The Clinical Signs That Tell Me You Need Massage First

Before you even lie down on my table, I'm already assessing whether you need soft tissue work before your adjustment.

The signals show up in three ways:

What you tell me: If you mention tightness, stiffness, or muscle tension before we start, that's my first indicator. Your body is already telling me the muscles are locked up.

What I see: Your posture reveals compensation patterns. When I watch you walk in, sit down, or stand, I'm noting how your body has adapted around pain or dysfunction. Poor natural posture indicates muscles pulling your structure out of alignment.

What I feel: During examination, I'm palpating your back and checking range of motion. Limited ROM is a big sign. If you can't rotate, bend, or extend normally, your muscles are restricting movement before we even address the skeletal component.

These aren't subtle signs. After treating thousands of patients, these patterns become immediately obvious.

Why Tight Muscles Block Good Adjustments

Here's how I explain this to patients who think they just need their "back cracked":

Your body operates through two connected but distinct systems. One is your muscular system. The other is your skeletal system.

Yes, they're connected. But they can both have problems that need to be solved in two different ways.

Your muscles can pull your spine out of alignment. When soft tissue is chronically tight, it creates constant tension that literally drags vertebrae out of position. I can adjust that vertebra back into place, but if the muscle is still pulling on it, the misalignment returns quickly.

Your misaligned spine can create muscle tension. When a vertebra is out of position and pinching a nerve, your muscles respond by guarding and tightening to protect the area. It's a defensive mechanism that makes the problem worse.

This is why the sequence matters.

If I adjust you without addressing the soft tissue first, I'm fighting against muscles that are actively resisting the correction. The adjustment might work temporarily, but it won't hold as well or as long.

When we relax the muscles first through massage, your body is prepared to accept the adjustment. The tissue isn't fighting me. The correction happens more easily, more comfortably, and with better lasting results.

What Actually Happens During a Combined Care Visit

Let me walk you through the exact sequence of a visit that includes both massage and adjustment.

Check-in: You arrive and check in at the front desk. We confirm your treatment plan and any specific areas of concern you're experiencing that day.

30-minute massage: You start with one of our in-house massage therapists. This isn't a relaxation massage. It's therapeutic work focused on the areas we're about to adjust. The therapist is targeting tight muscles, releasing fascial restrictions, and improving tissue mobility around your spine.

Transition to adjustment room: After massage, you move directly into the adjustment phase. There's no waiting period. We want to adjust you while your tissue is still warm and relaxed.

Stim and ice: Before I adjust you, we apply electrical stimulation and ice. The stim helps stimulate the muscle tissue and maintain the relaxation we achieved during massage. The ice reduces any swelling around the nerves in your back. This phase typically takes 10-15 minutes.

The adjustment: Now your body is prepared. Muscles are relaxed, inflammation is reduced, and tissue is mobile. I perform the spinal adjustment with your body in an optimal state to receive and hold the correction.

Total time: You're in and out in a little under an hour.

This isn't a rushed process, but it's efficient. Every phase serves a specific clinical purpose in the sequence.

Why I Changed My Approach

I didn't always structure care this way. Like most chiropractors, I started my career primarily focused on adjustments.

But volume creates velocity. When you see over 1,000 patients annually for three decades, patterns become impossible to ignore.

I started noticing that patients who received both treatments—in the right sequence—recovered faster and stayed better longer.

My primary metric? Patient satisfaction.

At the end of the day, treatment is only as good as the patient says it is. I kept getting good reviews from people who went through combined care. They reported feeling better, staying better, and experiencing less discomfort during adjustments.

That feedback loop changed how I practice.

I'm not interested in what sounds good theoretically. I'm interested in what works clinically, measured by real patient outcomes over time.

The data was clear: massage before adjustment produces better results. So that became the standard approach in my practice.

What This Means for Your Treatment

If you come into my office expecting just an adjustment, I might recommend adding massage first. That's not upselling. It's clinical judgment based on 30 years of pattern recognition.

When I see limited range of motion, poor posture, or you report significant tightness, I know your body needs preparation before adjustment.

The goal isn't to crack your back. The goal is to correct the underlying structural problem and have that correction hold.

Soft tissue work creates the conditions for successful adjustments. It's not a luxury add-on. It's foundational preparation that determines how well your treatment works and how long the results last.

Your body will tell me what it needs. My job is to listen to those signals and structure your care accordingly.

After three decades and thousands of patients, I've learned to trust what the body reveals before you can articulate it. And what it reveals most often is this: relaxed tissue accepts correction better than tight tissue.

That's not theory. That's clinical reality, proven one patient at a time.