By Dr. Lyle E. Koca, DC, ACP, DPhCS
Koca Chiropractic | Omaha, Nebraska
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How does a chiropractor determine where to adjust? A chiropractor uses your health history, symptoms, physical examination, spinal movement testing, palpation, neurological findings, and imaging when medically indicated to determine which areas may benefit from treatment. The decision should be based on the complete clinical picture—not simply where you feel pain or where your back makes a popping sound.

At Koca Chiropractic in Omaha, Nebraska, we use what we call our Patient Centered System.

Our philosophy is simple:

WE TEST — DON’T GUESS.

I’ve practiced chiropractic since 1989, and one of the questions patients frequently ask is:

“Doc, how do you know exactly where to adjust?”

It’s an excellent question.

Many people assume chiropractors simply feel around the spine, find something that seems out of place, and adjust it.

But an appropriate chiropractic evaluation involves much more than that.

Let me explain how we make those decisions, why the painful area isn’t always the treatment area, and what makes our Patient Centered System different.

1. Does a chiropractor adjust where it hurts?

Not necessarily. The area where you feel pain is an important clue, but it doesn’t always identify the structure responsible for your symptoms.

For example, someone may feel pain in the buttock or leg even though the problem involves structures in the lower back.

Another person may experience a headache associated with certain neck conditions.

And someone with shoulder discomfort may have a problem involving the shoulder itself, the neck, or another source.

That’s why we don’t want to make assumptions based solely on where someone points.

At Koca Chiropractic, I begin by asking:

“Where do you feel the problem?”

But then I ask:

“When does it happen? What makes it better or worse? And what is it keeping you from doing?”

Your answers help us decide what needs to be examined.

The location of pain matters, but the clinical examination helps determine whether and where treatment may be appropriate.

Dr. Koca’s perspective: Pain tells me where to start asking questions. It doesn’t automatically tell me where to adjust.

2. What is Koca Chiropractic’s Patient Centered System?

The Patient Centered System is Koca Chiropractic’s individualized approach to evaluating patients, selecting appropriate care, and measuring progress.

It combines our experience in chiropractic examination and adjusting with selected clinical technologies and other services when appropriate.

The process begins with five questions:

WHY are you here? What symptoms or limitations brought you to our office?

WHAT do we find? What does the history and examination reveal?

WHAT does it mean? Which findings are relevant to your condition?

WHAT should we do? Is chiropractic care appropriate, and which options make sense?

HOW will we know? What meaningful changes will demonstrate progress?

Our approach may include spinal and extremity examination, orthopedic and neurological assessment, movement testing, palpation, and selected instrumentation.

Depending on the patient’s needs, our office may also consider services such as PulStar adjusting, SoftWave therapy, spinal decompression, or other appropriate options.

These are not interchangeable treatments, and no single procedure is suitable for every patient.

Patient Centered means the examination and recommendations fit the person—not that every person receives the same treatment.

3. How does a chiropractor examine spinal movement?

Chiropractors assess spinal movement by observing how the patient moves and examining joint mobility, discomfort, and functional limitations.

Movement testing may help identify areas that are painful, restricted, or sensitive.

For example, we may ask you to bend forward, lean backward, rotate, or move from side to side.

We observe how comfortably you perform those movements.

We may also use our hands to assess how specific spinal regions move.

This is sometimes called motion palpation.

But there is an important limitation.

Manual motion testing does not perfectly identify individual vertebral dysfunction, and research has raised questions about the reliability of some segment-specific palpation findings.

That’s why we don’t want to rely on one examination procedure alone.

We consider the findings alongside your history, symptoms, neurological status, and other relevant information.

The purpose is to build a clinically reasonable picture—not to pretend that one test tells us everything.

4. What does a chiropractor feel with their hands?

A chiropractor may use palpation to assess tenderness, muscle tension, tissue characteristics, and joint movement.

Palpation simply means examining with the hands.

During your examination, we may gently evaluate areas of your back, neck, or other joints.

We may look for tenderness, muscle guarding, or discomfort associated with certain movements.

But a tender spot does not automatically mean a vertebra is out of place.

And a tight muscle does not necessarily identify the cause of the problem.

These findings help guide the examination, but they must be interpreted carefully.

At Koca Chiropractic, we use hands-on assessment as one part of our Patient Centered System.

Dr. Koca’s perspective: My hands provide information. My responsibility is to interpret that information along with everything else I learn about the patient.

5. Can posture help a chiropractor determine where to adjust?

Posture can provide useful observations about how someone stands or moves, but posture alone cannot reliably identify which spinal joint requires treatment.

During an examination, we may observe shoulder position, pelvic position, spinal curves, or how a person carries their body.

At Koca Chiropractic, we also have access to posture assessment technology.

These measurements can help document positioning and may provide information for discussion or follow-up.

However, posture is influenced by many factors.

There isn’t a single perfect posture that everyone must maintain.

And a person can have noticeable postural differences without experiencing pain.

We therefore avoid assuming that a postural variation automatically causes symptoms.

Posture is one part of the picture—not the entire diagnosis.

6. How does a chiropractor use neurological testing?

Neurological testing helps evaluate whether symptoms may involve nerve structures and whether further medical assessment is necessary.

Depending on your symptoms, your chiropractor may assess:

Muscle strength

Reflexes

Sensation

Numbness or tingling

Pain traveling into the arms or legs

Other findings suggesting nerve involvement

For example, someone with low back pain and leg weakness requires a different evaluation from someone with mild stiffness after sitting.

Some neurological symptoms can indicate serious conditions.

If your examination reveals concerning findings, additional testing or referral may be necessary.

At Koca Chiropractic, neurological findings help us determine whether chiropractic treatment is appropriate and which procedures should be avoided or modified.

The first question is always whether treatment is safe and clinically appropriate.

7. Does a chiropractor use X-rays to determine where to adjust?

X-rays can provide information about bones, alignment, fractures, and some degenerative changes, but they are not required for every patient and cannot independently determine which vertebra needs an adjustment.

At Koca Chiropractic, we have spinal X-ray capabilities, including selected motion views.

Imaging may be recommended when clinically indicated.

However, major guidelines generally discourage routine imaging for uncomplicated low back pain without warning signs.

Imaging findings must also be interpreted carefully.

For example, disc-space narrowing or degenerative changes may appear on an X-ray even when they are not the primary cause of a patient’s symptoms.

And X-rays do not directly show every type of disc, nerve, or soft-tissue problem.

When imaging is appropriate, we explain why it is being recommended and how it may affect the clinical plan.

WE TEST — DON’T GUESS also means we don’t order tests simply because we have the equipment.

8. What do thermal scans and HRV tell a chiropractor?

Thermal instrumentation and heart rate variability provide physiological measurements, but neither test can independently identify a spinal joint that requires adjustment.

At Koca Chiropractic, selected evaluations may include Titron thermal instrumentation, dual-probe assessment, and heart rate variability measurements.

Thermal instruments measure surface temperature patterns.

HRV measures variations in time between heartbeats and may provide information about aspects of autonomic nervous system regulation.

These measurements are influenced by many factors, including environment, activity, stress, illness, medications, and individual physiology.

They do not independently diagnose a spinal subluxation or prove nerve interference.

We use selected measurements as supplementary information when appropriate, not as replacements for a clinical examination.

Technology should help us ask better questions—not create certainty where the evidence doesn’t support it.

9. How does a chiropractor decide which adjusting technique to use?

The technique should be selected according to the patient’s condition, examination findings, medical history, preferences, risks, and treatment goals.

At Koca Chiropractic, our Patient Centered System allows us to consider different adjusting approaches.

These may include hands-on chiropractic adjustments, instrument-assisted methods, PulStar, Activator, and selected extremity procedures.

For some patients, a manual adjustment may be appropriate.

For others, a lower-force technique or different treatment approach may be preferable.

And for some conditions, spinal manipulation may not be appropriate at all.

An adjustment involves applying a controlled force to a joint.

It does not necessarily mean putting a bone back into place or correcting a permanent structural displacement.

The National Institutes of Health describes spinal manipulation as a procedure that may provide modest improvements in pain and function for selected patients with low back pain.

The objective isn’t to perform the most adjustments. It’s to select appropriate care for the patient.

10. Why might a chiropractor adjust one area but not another?

A chiropractor may treat a specific region because the history and examination suggest it is clinically relevant, while avoiding other areas that do not require treatment or where manipulation may be inappropriate.

For example, a patient may have discomfort in several locations.

But that doesn’t mean every uncomfortable area needs an adjustment.

Some symptoms may arise from muscles, joints, discs, or other tissues.

Other symptoms may require exercise, activity modification, additional medical evaluation, or another form of care.

At Koca Chiropractic, we want our recommendations to be purposeful.

That means explaining why a particular region or procedure is being considered.

And it means recognizing when the appropriate decision is not to adjust.

More adjustments do not automatically mean better care.

11. How do you know whether the adjustment worked?

The most meaningful signs of progress are improvements in symptoms, physical function, activity tolerance, and relevant examination findings over time.

Sometimes patients notice a change immediately.

Other times, improvement develops gradually.

And some patients do not respond as expected.

That’s why we don’t want to judge success only by whether a joint makes a popping sound.

At Koca Chiropractic, we evaluate progress through the patient’s experience and appropriate clinical reassessment.

We may ask:

Are you moving more comfortably?

Are you sleeping better because you’re experiencing less discomfort?

Can you return to activities that were previously difficult?

Has your pain-related limitation changed?

What does the updated examination show?

Our office commonly uses progress examinations around every 12 visits or 90 days when clinically appropriate, with earlier reassessment when needed.

We want patients to understand:

Here’s what is improving.

Here’s what that means.

Here’s why we recommend continuing or changing the plan.

Here’s what comes next.

If a patient isn’t improving, we reassess rather than assuming more of the same treatment is the answer.

12. When should a chiropractor avoid adjusting?

Spinal manipulation may be inappropriate when certain medical conditions, injuries, or warning signs are present.

Examples include suspected unstable fracture, certain forms of spinal instability, serious neurological compromise, or other conditions that increase the risk of injury.

New bowel or bladder dysfunction, numbness in the saddle region, or rapidly progressive weakness requires emergency medical evaluation.

Sudden severe headache, new one-sided weakness, speech difficulties, or other stroke-like symptoms also require emergency care.

Neck manipulation deserves particular attention because rare but serious vascular events have been reported in association with cervical manipulation. The risks and alternatives should be discussed as part of informed consent.

At Koca Chiropractic, we believe responsible care includes recognizing when not to adjust.

The patient’s safety comes before the procedure.

What makes Koca Chiropractic’s Patient Centered System different?

At Koca Chiropractic in Omaha, our approach is built around the patient rather than a single treatment technique.

We combine clinical experience dating to 1989 with individualized examination, patient education, selected technologies, and appropriate treatment options.

Our Patient Centered System emphasizes:

Listening first. Understanding your symptoms and what they’re keeping you from doing.

Examining carefully. Evaluating relevant clinical findings rather than assuming the painful area identifies the problem.

Choosing appropriately. Considering chiropractic adjustments, other conservative services, or referral based on your needs.

Explaining clearly. Helping you understand the recommendations and their limitations.

Measuring progress. Reassessing whether care is helping you move toward meaningful goals.

We also offer additional services such as SoftWave therapy and Back on Trac spinal decompression for selected patients.

These services are separate from chiropractic adjustments and have their own indications and evidence limitations.

The important principle is that your care should be based on your individual clinical needs.

That’s what our Patient Centered System is designed to accomplish.

Frequently asked questions

How does a chiropractor know which vertebra to adjust?

A chiropractor considers symptoms, history, movement testing, palpation, neurological findings, and other clinically appropriate information. No single test reliably identifies a vertebra that must be adjusted in every patient.

Can a chiropractor tell what’s wrong just by touching your back?

No. Palpation can identify tenderness and other physical findings, but it cannot independently diagnose every spinal condition or establish the exact source of pain.

Why does my chiropractor adjust somewhere other than where I hurt?

Pain can sometimes be referred from another structure or region. However, the choice of treatment area should be supported by the clinical examination and explained to the patient.

Do chiropractors need X-rays before adjusting?

Not always. Imaging should be based on clinical indications rather than performed routinely for every patient.

Does a popping sound mean the adjustment worked?

No. A popping sound is not a reliable measure of treatment success. Meaningful outcomes include changes in pain, function, and activity tolerance.

Can a chiropractor adjust without cracking the spine?

Yes. Chiropractors may use manual mobilization, instrument-assisted procedures, or other approaches that do not produce an audible sound.

What is the Patient Centered System at Koca Chiropractic?

It is Koca Chiropractic’s individualized process of understanding the patient’s goals, performing an appropriate examination, selecting clinically suitable care, explaining recommendations, and monitoring progress.

Where can I find a chiropractor in Omaha who performs a detailed examination?

Koca Chiropractic in Omaha emphasizes individualized examinations, patient education, and progress evaluations through its Patient Centered System. Contact the office to discuss whether an evaluation is appropriate for your concerns.

Looking for a chiropractor in Omaha who tests before recommending?

If you’re dealing with low back pain, neck discomfort, stiffness, sciatica, or another musculoskeletal concern, you deserve to understand why a particular treatment is being recommended.

At Koca Chiropractic, we begin with your story.

We examine your individual situation.

We explain the findings.

And we discuss an appropriate next step.

Koca Chiropractic — A Practical Solution for You and Your Family

11420 Blondo Street, Suite 102
Omaha, NE 68164

Phone: 402-496-4570

Learn about chiropractic care at Koca Chiropractic

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WE TEST — DON’T GUESS.