Manipulation is usually pain free. The point of manipulation is to reduce pain, not cause it. A relaxed patient is adjusted the most easily. Occasionally, extreme tension on behalf of the patient can make manipulation more difficult. If the patient is suffering from a fresh injury, it may sometimes be recommended to wait until the following day to adjust to reduce discomfort due to soreness. With injury, adjustment can speed the recovery process, so same-day adjustment may be recommended in spite of some mild discomfort.
While adjustments are not usually painful, some patients do experience some soreness after the first treatment as the body learns to adapt to proper positioning.