Two Ways Your Patients Are Defeating Your Adjustments

As we all know, patients don’t always follow our guidance. From what they consume to living a toxic lifestyle, many patients survive their bad habits until they are forced to seek care, expecting some magic pill or a single adjustment will fix their self-imposed illnesses.

But many people just don’t know any better. They believe what the media (and the media’s sponsors) tell them. Patients’ ignorance hampers our ability to provide them with the care they need. Here are two examples:

Headaches & Neck Pain – The Nighttime Culprit

A good night’s sleep provides many benefits including increased longevity. But most people just don’t get the sleep they need. A survey conducted by the National Sleep Foundation found that six out of 10 adults don’t get enough sleep and only 7% give their sleep satisfaction an “A” rating.¹ As one study noted: “Many participants appear to have made poor pillow choices, as poor sleep quality, low pillow comfort, and waking symptoms were common.”²

While insufficient sleep can have many causes, an uncomfortable, non-supporting pillow is among the most frequently cited. A randomized, controlled trial published in the Journal of Clinical Sleep Medicine demonstrated that ergonomic pillows significantly reduced neck pain and improved sleep efficiency in patients with chronic pain.³

An earlier study compared orthopedic pillows to both feather and memory-foam pillows. The authors found that the orthopedic pillows provided users greater cervical curve and a significantly lower degree of temperature increase. The visual analog scale (VAS) score used in the study found pillow comfort also was significantly higher for the orthopedic pillow.⁴

Unless you have addressed the issue, your patients’ pillows are likely a primary factor not only in their lack of sufficient sleep, but also their headaches, chronic neck pain and other issues. Needless to say, a weekly or monthly adjustment is no match for the impact of a non-supportive pillow.

Offering cervical pillows is essential if you want to provide complete chiropractic care. There is no way to overcome the repercussions of eight hours of sleeping on a bad pillow every night.

You have two choices when offering therapeutic pillows to your patients. The one you are probably most familiar with is a cervical pillow developed especially for the needs of chiropractic patients. These come in various sizes and are designed for both back and neck sleepers.

The other choice is a custom pillow created using a scan of the patient’s head, neck and shoulders. These are crafted specifically for each patient, providing more individualized cervical support, and require no inventory.

Instability & Poor Posture – Supporting the Kinetic Chain

It’s well-known that dysfunction in one part of the kinetic chain can cause pain and compensatory problems in another part. The feet are the initial point of contact and the mechanical trigger for the entire kinetic chain. Any dysfunction or asymmetry in the feet will lead to a series of offsetting changes in the ankles, knees, hips, and spine.

Researchers have found that people with pronated feet experience increased movement in the pelvis, knees and feet during walking, along with changes in foot pressure distribution. These kinematic alterations increase the risk of developing musculoskeletal disorders, highlighting the importance of assessing foot function in patients with lower-limb and back pain.⁵

In a study published in 2019, researchers found that people with overpronation experienced noticeably different muscle engagement during walking, with their back, hip flexor, and stomach muscles working harder and more intensely than people without overpronation.⁶ Patients with pronation typically have reduced balance and proprioception requiring support in all three arches of the foot.

Without proper support for the feet, your adjustments will likely provide only fleeting results. That is why proper custom orthotics are so important. Once you establish a proper foundation in the feet, you can address the remaining issues with confidence.

There are a number of ways to formulate custom orthotics, from casting kits to advanced scanning that measures hundreds of thousands of datapoints just in the feet. These datapoints are used to formulate a custom prescription designed to support the patient at their foundation – the feet.

Clinical Pearls

As clinicians, we are more accustomed to examining the spine as the source of our patients’ pain. Considering the interconnectedness of the musculoskeletal system, examining the feet early in care may help eliminate complications that originate there. Likewise, we should ask every patient to bring in their pillow on the first or second visit to evaluate its ability to provide necessary cervical support. Eliminating these two confounders paves the way for more impactful chiropractic adjustments.

References

1. National Sleep Foundation’s 2025 Sleep in America Poll. Conducted March 6, 2025.
2. Gordon SJ, Grimmer-Somers K. Your pillow may not guarantee a good night's sleep or symptom-free waking. Physiother Can, 2011 Spring;63(2):183-90.
3. Lee JY, et al. Effect of ergonomic pillows on sleep quality and cervical pain: A randomized controlled trial. J Clin Sleep Med, 2021;17(3):345-352.
4. Jeon MY, et al. Improving the quality of sleep with an optimal pillow: a randomized, comparative study. Tohoku J Exp Med, 2014 Jul;233(3):183-8.
5. Chen Z, Ye X, Chen W, et al. Effect of pronated foot posture on proprioception and postural stability based on foot posture index. Chinese J Tiss Eng Res, 2021;25(9):1324-1328.
6. Yazdani F, Razeghi M, Karimi MT, et al. Foot hyperpronation alters lumbopelvic muscle function during the stance phase of gait. Gait & Posture, 2019;74:102-107.