Before, in almost every case. A muscle that is guarding will resist an adjustment and pull the joint back toward where it started, so warming and releasing the soft tissue first makes the adjustment easier to deliver, more comfortable to receive, and more likely to hold. Booking a massage after an adjustment is not wrong, it is just a worse use of the same hour. The exception is deep tissue work, which can leave you sore enough that an adjustment immediately afterward is unpleasant.
Most people never get told this, because at most clinics the two services live in separate buildings with separate schedules. When they are under one roof, the sequencing becomes a real decision.
Why the order makes a difference
An adjustment restores motion to a joint that has stopped moving through its normal range. The joint does not exist in isolation. It sits inside a sleeve of muscle and connective tissue that has been holding a protective pattern, sometimes for months.
Try to move the joint while that sleeve is locked down and two things happen. The adjustment takes more force than it should, which is uncomfortable. And the tissue immediately begins pulling the joint back toward the restricted position, which means the change does not last.
Release the tissue first and the joint moves with much less effort. That is the whole argument, and it is why our office runs physical therapy modalities before every adjustment rather than as an optional add-on.
What actually happens before an adjustment here
Three things, depending on what the examination turns up.
The rolling massage table. Patients call it the rolly table. Clinically it is intersegmental traction, and it works through the spine segment by segment to restore range of motion before any hands-on work begins. It is also, by a wide margin, the part of the visit people ask to do again.
Interferential e-stim. Electrode pads deliver a current that helps reduce inflammation and release pressure from trigger points. It feels like a deep buzzing or tapping. If a specific knot is the thing keeping a joint locked up, this is usually what addresses it.
Massage therapy. For some patients the modalities are enough. For others, hands are what the tissue needs, which is where a licensed therapist comes in.
Then the adjustment. Dr. Marshall uses several techniques depending on what the joint and the patient need: manual diversified adjusting, the Thompson drop table, or instrument adjusting with an activator when speed matters more than force or when someone is not a candidate for manual work. The full list is on the chiropractic techniques and therapies page.
Massage therapy versus physical therapy modalities
These get used interchangeably in conversation and they are not the same thing.
PT modalities (rolly table, e-stim)Massage therapyWho delivers itClinic staff under the doctor's directionA licensed massage therapistTypical lengthA few minutes, built into the visit40, 60, or 90 minutes, booked separatelyWhat it is good atPrepping a specific region right before an adjustmentBroad tissue work, chronic tension, stress, recoveryCostPart of the visitPriced separatelyInsuranceOften covered as part of careSometimes covered when medically necessary; ask first
The modalities are targeted and quick. Massage is the longer, broader version. Most people doing active care need the first. People carrying months of accumulated tension, or training hard, often want both.
Which type of massage goes with which problem
Our therapist, Ronda, offers four styles, and they are not interchangeable either.
- Deep tissue. Deeper, slower strokes for stubborn chronic tension. Effective, and the most likely to leave you sore for a day.
- Sports. Targets specific muscle groups around a demand you are placing on your body. Useful before or after a competitive season, and for the young athletes we see in the fall.
- Trigger point. Focused work on specific knots and bound-up tension. If you can point to the spot with one finger, this is probably the right call.
- Swedish. Lighter and more relaxing. Better for stress and general tension than for a specific mechanical problem.
Sessions run 40, 60, or 90 minutes, and you can book one the same day as your adjustment or entirely on its own.
The one time to flip the order
Deep tissue is the exception.
Serious deep tissue work can leave the muscle genuinely sore, sometimes for a day or two. Getting adjusted while the tissue is in that state is not dangerous, it is just uncomfortable, and the tenderness can make it harder for you to relax into the adjustment. If you are booking a 90-minute deep tissue session, putting the adjustment first, or on a different day, usually makes for a better experience.
Trigger point and Swedish do not create the same problem, and sports massage sits somewhere in between depending on how aggressive it is.
When massage alone is the better choice
We would rather send you to the right service than sell you the wrong one.
Book massage without an adjustment when what you are dealing with is muscular and diffuse rather than mechanical and specific. Stress-driven shoulder and neck tension, general tightness after a hard training block, sleep that has been poor for weeks, or the sense that you are carrying tension everywhere rather than hurting in one place. There is no joint restriction to correct in those situations, and an adjustment is not the tool.
Book an adjustment when the pain is localized, changes with position, started after a specific event, or comes with a sense that something is stuck.
Get both when a specific mechanical problem is sitting inside a broader pattern of tension, which honestly describes a large share of what walks through the door.
And skip both, for now, if you have numbness, tingling, or weakness traveling down an arm or leg. That needs an examination first, because the answer may be spinal decompression or a referral rather than soft tissue work. More on that in low back pain that travels down your leg.
Will insurance cover the massage?
Sometimes, when it is medically necessary and your plan includes it. It varies more than most benefits, so the honest answer is to call and let us check rather than guess.
Flex spending and HSA accounts can be used for massage therapy here, which is often the simpler route. What will not cover it: SoonerCare does not include massage therapy as a chiropractic benefit, though some SoonerSelect plans offer massage through separate alternatives-to-opioids benefits worth asking your plan about. Details in does SoonerCare cover a chiropractor in Tulsa.
Frequently asked questions
Should I get a massage before or after a chiropractic adjustment?Before, in most cases. Soft tissue work relaxes the muscles guarding a restricted joint, which makes the adjustment easier, more comfortable, and more likely to hold. The exception is deep tissue massage, which can leave you sore enough that an adjustment right afterward is uncomfortable.
Can I get a massage and an adjustment on the same day?Yes. You can schedule a massage the same day as your chiropractic appointment or book one on its own. The doctor and therapist coordinate so the two pieces work together rather than duplicating each other.
What is the rolly table at a chiropractor's office?It is an intersegmental traction table. Rollers move along the spine to restore range of motion segment by segment, and it is typically used before the adjustment to loosen things up. Most patients find it the most comfortable part of the visit.
Does e-stim actually do anything?Interferential e-stim delivers a current aimed at reducing inflammation and releasing pressure from trigger points. It is used as preparation for an adjustment rather than as a standalone treatment, and it works best on a specific area rather than broad tension.
Is massage therapy covered by insurance?Some plans cover it when it is medically necessary, and coverage varies widely. Flex spending and HSA accounts can also be used. SoonerCare does not cover massage as a chiropractic service. Call ahead and have your benefits checked rather than assuming either way.
Do I need to see the chiropractor to book a massage?No. You can book a massage on its own. If what you are dealing with is diffuse muscular tension rather than a specific mechanical problem, massage alone may be exactly the right choice.
Not sure which you need? Call (918) 494-0929 and describe what you are feeling. We will point you to the right one, even when that is the shorter appointment. We are at 6703 E. 81st Street, Suite E, near 81st and Sheridan in South Tulsa, Monday through Thursday, 9AM to 6PM.
