Many people use fitness trackers to gain insight into their habits and routines. Despite some limitations in the accuracy of many of these devices, the more reliable ones can be valuable tools for observing trends in our habits and routines, as well as how they relate to our overall functioning and well-being. HRV can be a useful measurement tool, but let’s talk about what it actually means.
When most people think about pain or injury—especially back pain—they imagine something “wrong” with a muscle, joint, or disc. While tissues do matter, we now understand that pain is as much about how the nervous system is functioning as it is about structure. This is where heart rate variability (HRV) becomes a valuable tool.
HRV refers to the small variations in time between heartbeats. Contrary to what many assume, a healthy heart does not beat like a metronome. Instead, a higher degree of variability reflects a nervous system that is adaptable, resilient, and able to shift smoothly between stress and recovery.
HRV is closely linked to the autonomic nervous system, which has two main branches:
Higher HRV generally reflects stronger parasympathetic influence and better balance between these systems. Lower HRV suggests the body is stuck in a more protective, stress-dominant state.
This matters because pain—especially persistent or recurring pain—is often associated with reduced nervous system flexibility. (1)
People with chronic low back pain, neck pain, or widespread pain often show lower baseline HRV compared to pain-free individuals (1). This does not mean pain is “all in your head,” but it does indicate that the nervous system may be operating in a heightened protective mode.
When this happens:
This helps explain why pain can persist even when scans appear “normal,” or why stress, poor sleep, or fatigue can trigger flare-ups without a clear mechanical cause.
HRV often drops before pain or injury appears.
Common triggers include:
If HRV remains suppressed:
Tracking HRV allows clinicians and patients to better understand readiness, recovery, and resilience, rather than focusing solely on pain intensity.
Chiropractic care does not “fix” HRV directly, but it can positively influence the nervous system in a way that supports healthier HRV patterns.
Research suggests that manual therapy and recovery guidance can:
For some patients, this is reflected in short-term improvements in HRV following care—especially when chiropractic treatment is combined with breathwork, sleep support, and attention to the stressors a patient is exposed to.
In other words, chiropractic care can help create the conditions for the nervous system to shift out of constant protection and into recovery, making it a useful tool in the process.
Many patients report sleeping deeply for the first time in weeks or months after their initial chiropractic treatments.
HRV is not a diagnosis, and it is not a pain score. It is a contextual signal, one that helps us understand how stress, lifestyle, movement, and care are influencing the body as a whole.
If you are dealing with persistent pain, frequent flare-ups, or slow recovery, understanding your nervous system state may be just as important as understanding your spine.
1. Fernández-Morales, C., Espejo-Antúnez, L., Albornoz-Cabello, M., Yáñez-Álvarez, Á. R., & Cardero-Durán, M. d. l. Á. (2025). Autonomic Balance Differences Through Heart Rate Variability Between Adults with and Without Chronic Low Back Pain. Healthcare, 13(5), 509. https://doi.org/10.3390/healthcare13050509
