Why We Don’t Adjust You Every Visit: What “Holding” Means in Upper Cervical Care

By Dr. Rusty Lavender, D.C. — upper cervical chiropractor, Lavender Family Chiropractic, Sarasota, FL. Reviewed and updated November 2026.

Our complete guide to upper cervical chiropractic care in Sarasota explains what the top two vertebrae control, how we measure them with 3D imaging, and what a correction feels like.

In short: At most chiropractic offices you are adjusted every visit, because that is what the visit is. At Lavender Family Chiropractic in Sarasota, some of the best visits end without a correction. If your thermography scan shows the pattern we established as your balanced baseline, your atlas is “holding,” and adjusting it would undo work the body is doing on its own. This page explains what holding means, how we decide, why over-adjusting the upper neck is a real problem, and why a visit where nothing is adjusted is a visit where something important was measured. Call (941) 243-3729.

The idea most patients have never heard

The goal of upper cervical care is not to adjust you. It is for your atlas to stay in its corrected position, so that the nervous system can function without interference long enough for the body to heal and for the ligaments and muscles to adapt to the new alignment. Every day the correction holds is a day of that work. A correction delivered to an atlas that is already in position does not add anything; it interrupts the adaptation and asks the body to start again. So the central clinical question at every visit is not “where do I adjust?” but “does this patient need an adjustment at all?” Answering it requires a measurement, and that is what the pre-visit scan is for.

What “holding” means

When the atlas is misaligned, the small muscles around it guard, the nerves from the top of the neck send distorted signals into the brainstem, and the autonomic nervous system regulates unevenly. One visible result is a side-to-side difference in skin temperature along the spine, because skin blood flow is controlled by the sympathetic nervous system. We measure that difference with paraspinal infrared thermography at your first visit, before any correction, and that scan becomes your pattern. After a correction, the pattern changes toward balance; that post-correction scan becomes your baseline. At every later visit we scan first and compare to the baseline. If the scan matches it, you are holding: the correction is in place and the nervous system is regulating evenly. We do not adjust. If the scan has returned toward your original pattern, the atlas has shifted, and we correct it.

This only works if the measurement is reliable, so that is the first thing to establish. A 2011 study in PLoS One had two clinicians scan 100 people with a commercially available infrared scanner and found intra- and inter-examiner correlation coefficients of 0.959 to 0.976, which the authors described as excellent reproducibility. A 2004 study in the Journal of Manipulative and Physiological Therapeutics, using the same Tytron scanner we use, found coefficients between 0.91 and 0.98 and concluded that changes seen on properly performed scans are most likely real physiological changes rather than equipment error. In other words, when today’s scan differs from your baseline, the difference is in you, not in the instrument.

Why not just adjust anyway?

Three reasons. First, the atlas is the most mobile joint in the spine, held by ligaments rather than by a disc and interlocking bone. Ligaments adapt slowly. An atlas that is corrected and then re-corrected before the ligaments have adapted never gets the chance to stabilize, which is the pattern behind the patient who has been adjusted hundreds of times and “never holds.” Second, every correction is an input to the nervous system. In a patient whose system is already sensitized, whether by fibromyalgia, concussion, POTS, or long-standing pain, unnecessary input is not neutral. Third, it is honest. A patient should be able to trust that a correction was made because a measurement called for it, not because it was on the schedule.

This is a defining feature of upper cervical practice rather than a quirk of ours. A 2015 narrative review in the Journal of the Canadian Chiropractic Association describes the upper cervical techniques as sharing a paradigm in which assessments are used to determine whether spinal intervention is necessary and whether it was successful once delivered. The check comes before the correction and after it, every time.

What a holding visit looks like

You arrive, you sit, and the scan is taken along your neck and spine without touching the skin. We compare it to your baseline on the screen. If you are holding, we tell you so, we may check posture and balance, and you leave. The visit takes a few minutes. Patients new to this sometimes feel short-changed; patients who have been with us a while recognize it as the best news of the week, because a holding visit means the correction is lasting longer, and the interval to the next visit can be extended. Over a course of care the goal is for the holding visits to outnumber the correcting ones, and then for the visits themselves to spread out.

How the imaging fits

The 3D CBCT image is taken once, at the start of care, to measure the position of the atlas and axis and calculate the line of correction. It is not repeated to check holding; thermography does that without radiation and at every visit. A 2022 review in Dose-Response on CBCT of the craniocervical junction in upper cervical practice found the junction visualized in superior detail compared with plain films at an effective dose equal to or less than conventional radiographs, and taking it once is part of keeping that dose low. Structure is measured once; function is measured every time.

Serving Sarasota, Bradenton, Lakewood Ranch, and Venice

Our office is at 5899 Whitfield Avenue, Suite 107, Sarasota, FL 34243, at University Parkway and Whitfield Avenue. Hours are Monday through Thursday 10:00 am to 1:00 pm and 3:00 pm to 6:00 pm, and Friday 9:00 am to 12:00 pm. Read how the Knee Chest correction itself is performed, and what a first visit involves on our what to expect page.

Common questions about holding and not being adjusted

Why didn’t you adjust me today? Because your thermography scan matched your balanced baseline, which means your atlas is in position and the nervous system is regulating evenly. Adjusting an atlas that is holding would interrupt the adaptation that is the point of care.

How do you know I am holding? By comparing today’s scan to the baseline taken after your correction. The scan has been shown to be highly reproducible between visits and examiners, so a change is a real change in you.

Isn’t a visit without an adjustment a wasted visit? No. It is the measurement that tells us the correction is lasting, and it is how we decide to space your visits further apart. A holding visit is the outcome we are working toward.

Can being adjusted too often cause problems? In the upper neck, yes. The atlas is held by ligaments that adapt slowly, and re-correcting before they have adapted is the pattern behind corrections that never hold. Unnecessary input also matters in a sensitized nervous system.

Does every upper cervical office work this way? The check-before-and-after approach is a defining feature of upper cervical techniques generally. The specific tools vary; we use thermography and 3D CBCT.

How quickly can I be seen? We hold time for same-day and next-day new patient visits. See our same-day chiropractor in Sarasota page or call.

Care that is measured, not assumed

Call (941) 243-3729 or book online. Lavender Family Chiropractic in Sarasota, Florida offers a thorough upper cervical evaluation to find out whether we can help.