Show the number, name the likely explanations before the patient guesses at one, and say what you are changing because of it. A single elevated reading is one data point against known variation. A 2026 crossover trial found a set of calf raises alone shifted myotonometry stiffness by about 20%.
Why does a stiffness reading go up between visits?
Usually because something about the measurement conditions changed, not because the tissue got worse. Warneke and colleagues, in a 2026 randomized crossover trial published in BMC Medical Imaging, put 30 healthy adults through cycling, jogging, calf raises, or rest. Myotonometry stiffness rose roughly 20% after calf raises, and the shift was still detectable 10 minutes later.
Temperature, patient position, time of day, and measurement site all add variation on top of that. None of these mean the patient is worse. They mean the two readings were not taken under the same conditions.
What should you say first?
Say the number out loud before the patient reads your face. The worst version of this conversation is the one where the practitioner pauses, frowns, and then hedges. The patient fills the silence with the worst available interpretation, and you spend the rest of the visit arguing against a conclusion they reached on their own.
A workable sequence: state the reading, state the range you consider noise, name the two or three most plausible causes, then name what you are doing differently. That takes about 30 seconds and keeps the patient inside the reasoning instead of outside it.
How much change is actually meaningful?
Enough to clear device error, natural asymmetry, and recent activity combined. A 2025 myotonometry reference values study found healthy people carry roughly 10% to 14% natural left-to-right asymmetry. Layer the 20% activity effect on top and the threshold for calling something real gets high.
| Source of change in a reading | Typical magnitude | Clinically meaningful? |
|---|---|---|
| Recent exercise before the visit | About 20% | No, it is a protocol artifact |
| Natural left-to-right asymmetry | About 10% to 14% | No, it is baseline biology |
| Device and rater error | Small, ICC 0.77 to 0.98 | No |
| Repeated rise across two or three matched re-exams | Varies | Possibly, worth acting on |
What if pain improved but stiffness went up?
Both can be true at once, and saying so builds more credibility than explaining one away. A cross-sectional study of patients with unilateral neck pain found a statistically significant but modest correlation between myofascial stiffness and pain, around r = 0.29. A 2023 systematic review in Clinical Physiology and Functional Imaging found results that varied by study, with some pain groups showing higher stiffness, some lower, and some no difference at all.
Stiffness and pain are separate signals. A reading that may reflect elevated tissue stiffness does not tell you the patient hurts more, and a patient reporting less pain does not tell you the tissue changed.
Survey data: In a 2026 survey of 455 patients who stopped chiropractic care, 58% cited perception-based reasons: 36% felt no progress, and 22% felt better and stopped. Neither group was told their stiffness was still elevated.
Does a bad reading push patients out the door?
Rarely on its own. What pushes them out is a bad reading with nothing attached to it. The dropout survey points at perception, and the perception that does the damage is "nothing is happening." A reading that goes the wrong way and produces a visible change in the plan reads as attentiveness. The same reading followed by "let's keep going as we were" reads as a practitioner who is not paying attention.
This is also why hiding the number backfires. If measurements only appear when they flatter the plan, the patient eventually notices, and the whole objective channel loses its value.
What should you change in the clinic after a rise?
Check the protocol before you change the treatment. Confirm the patient was measured at the same point in the visit, in the same position, at a comparable time of day, and before any in-office exercise or manual work. Re-measure once in the same session, openly, and record both readings.
If conditions were matched and the rise repeats across two or three re-exams, that is a pattern worth responding to. One reading is not. Treating every fluctuation as a signal trains patients to over-read noise, which is the opposite of what an objective measure is for.
Frequently Asked Questions
How do you explain to a chiropractic patient that their stiffness reading went up?
Show the number, name the most likely explanations before the patient guesses at one, and state what you are changing because of it. A single elevated reading is one data point against known variation. A 2026 crossover trial found a set of calf raises alone shifted myotonometry stiffness by roughly 20%.
Should you hide a bad stiffness reading from the patient?
No. If you only show measurements when they favor you, the patient learns the number is a marketing device rather than a measurement. Withholding it also removes your best opportunity to explain variation before the patient invents an explanation of their own.
How much change in a stiffness reading is actually meaningful?
It has to clear both device error and everyday variation. Reference data from 2025 myotonometry work shows healthy people carry roughly 10% to 14% natural left-to-right asymmetry, and recent activity can move a reading about 20%. A change smaller than that is noise, not progress.
What if the patient's pain improved but the stiffness reading went up?
Treat both as real. Research consistently finds that stiffness and pain are only loosely related, with one cross-sectional study reporting a correlation of about r = 0.29 in neck pain patients. Two measures moving in opposite directions is expected, not contradictory.
Does a rising stiffness reading mean the treatment is not working?
Not on its own. Check the protocol first, including time of day, patient position, activity before the visit, and measurement site. If the conditions were matched and the pattern repeats across two or three re-exams, then it may indicate the plan needs changing.
How do you keep a patient from dropping out after a bad reading?
Attach an action to the number. Patients rarely leave because of one bad result. They leave because nothing visibly changes in response to it. Naming a specific adjustment to the plan gives the reading a purpose.
Should you re-measure right away if a reading looks wrong?
Yes, taking a repeat reading in the same session is reasonable and takes under a minute. Do it openly with the patient watching rather than quietly discarding the first result, and record both.
One approach is to add a second channel of objective data alongside subjective pain reports. Options include soft tissue stiffness measurement (such as MuscleMap), range-of-motion testing, and posture analysis. Each gives you something concrete to show the patient rather than asking them to take your word for it.