Chiropractors adjust hips using quick, controlled thrusts applied to the hip joint or the sacroiliac joint (where the spine meets the pelvis) to restore mobility and reduce pain. The specific technique depends on which joint is causing problems, how severe the restriction is, and what the patient can comfortably tolerate. Most hip adjustments involve positioning the body to isolate the joint, then applying a precise force to move it through its restricted range.
Which Joints Are Actually Being Adjusted
When people say “hip adjustment,” they’re usually talking about one of two joints. The first is the sacroiliac (SI) joint, which connects the base of the spine to the pelvis. This is the most common target. SI joint dysfunction causes deep, aching pain in the lower back and buttocks that can radiate down the leg and mimic sciatica. The second is the hip joint itself, the ball-and-socket where the thigh bone meets the pelvis. Problems here tend to show up as groin pain, stiffness when walking, or limited range of motion when rotating the leg.
Chiropractors assess both joints before deciding where to focus. The distinction matters because the techniques, positioning, and goals differ for each one.
What Happens Before the Adjustment
Before any hands-on work, a chiropractor runs through a series of physical tests to pinpoint which joint is restricted and rule out conditions that would make an adjustment unsafe. One of the most common is the FABER test: you lie on your back while the chiropractor flexes your hip, rotates your leg outward, and presses down on the knee. Pain in the buttock area points to the SI joint, while pain in the groin suggests the hip joint itself.
Other assessments include rolling the straight leg from side to side to check for fractures, flexing the hip and knee past 90 degrees while rotating to test range of motion, and pressing on the leg to transmit force toward the hip. The chiropractor is looking for asymmetry between sides, restricted movement, and where exactly the pain reproduces. If imaging has already been done (X-rays or MRI), they’ll review that too.
The Side-Lying SI Joint Adjustment
The most common hip adjustment targets the SI joint and is performed with you lying on your side. Your top knee is bent and pulled toward your chest, and your bottom shoulder is rolled forward. This position creates a stretch across the lower back and pelvis that isolates the SI joint. The chiropractor places one hand directly over the SI joint, then pushes your upper shoulder backward while guiding your bent knee toward the floor. This creates a controlled twist through the pelvis.
Once the chiropractor feels the slack taken out of the joint (meaning the tissues are taut but not forced), they deliver a quick, small thrust. This is called a high-velocity, low-amplitude adjustment. The force is fast but shallow, covering only a few millimeters of movement. You’ll often hear a popping or cracking sound during this moment. That noise comes from a rapid pressure change inside the joint that releases small gas bubbles from the fluid lubricating the joint, the same mechanism as cracking your knuckles. It’s not bones grinding or snapping.
The Drop-Table Technique
Some chiropractors use a specialized table instead of (or in addition to) manual thrusts. The Thompson drop-table technique uses a table divided into segments that correspond to different body regions, including the pelvis. Each segment can be raised slightly and locked into position. When the chiropractor applies a quick downward thrust to the pelvis, the corresponding table section drops a fraction of an inch at the same moment.
This drop lets gravity assist the adjustment, which means less overall force is needed. For patients who are nervous about traditional adjustments or who find the twisting side-lying position uncomfortable, the drop-table approach can feel gentler. You simply lie face down, and the adjustment happens through a series of quick pushes with the table doing part of the work.
Gentle Mobilization for Sensitive Cases
Not every hip adjustment involves a forceful thrust. Spinal mobilization uses slow, low-force movements to gradually coax a restricted joint through its range of motion. The chiropractor applies steady, rhythmic pressure rather than a quick pop. There’s typically no cracking sound with this approach. It’s often chosen for older patients, people with inflammatory conditions, or anyone who simply prefers a less intense treatment. The trade-off is that mobilization may require more sessions to achieve the same degree of improvement.
What You’ll Feel During and After
During the adjustment itself, you’ll feel pressure building in the hip or lower back as the chiropractor positions you, followed by a quick push. Some people feel immediate relief, as if something “unlocked.” Others feel sore for a day or two afterward, similar to the tenderness you’d get after a deep-tissue massage. This is normal and typically fades within 24 to 48 hours.
Most treatment plans for hip pain follow a predictable timeline. During the first two weeks, appointments are frequent (two to three times per week) and focused on reducing pain and inflammation. By weeks three and four, visits drop to once or twice a week as the focus shifts to improving mobility. Around the two-month mark, the chiropractor reassesses progress and adjusts the plan. By three to four months, the goal is restoring full function, retraining movement patterns, and building enough stability that the problem doesn’t return. Some people feel significantly better after just a few visits, while chronic or complex cases take longer.
Who Should Avoid Hip Adjustments
Chiropractic hip adjustments are not appropriate for everyone. People with severe osteoporosis face a real risk of fracture from the forces involved. Cancer affecting the spine or pelvis is another clear contraindication, since tumors can weaken bone to the point where even moderate pressure causes damage. Active infections in the joint, recent fractures, and certain inflammatory conditions like advanced rheumatoid arthritis also warrant caution. A chiropractor should screen for these before performing any adjustment, but it’s worth mentioning these conditions upfront if they apply to you.
Adjunctive Therapies That Often Accompany Adjustments
Hip adjustments rarely happen in isolation. Chiropractors commonly pair them with soft tissue work to release tight muscles around the hip, particularly the piriformis (a deep muscle in the buttock that can compress the sciatic nerve). Stretching protocols, strengthening exercises for the glutes and core, and ice or heat therapy are standard additions. The adjustment addresses the joint restriction, but the surrounding muscles need attention too, otherwise they can pull the joint back out of alignment within days. The exercise component is what bridges the gap between short-term relief and lasting improvement.