Tag Archives: manipulation

What Does Chiropractic Adjustment Do?

This is a common question to chiropractors.  Chiropractic manipulation is not just joint popping. In fact the audible pop doesn’t even need to occur for a successful adjustment, though it often does, and some patients and doctors like to hear it. Research has found that “pop” or not, the same benefits are experienced.

The mechanism of why manipulation works is not fully understood. One thing that is understood is that it does work. Most of the simple explanations are incomplete or just plain wrong. The most recent research points to a more complex reason for the therapeutic effects of chiropractic manipulation. Many things are occurring at the same time that provide the benefits. There are some known things that can begin to explain why manipulation works. Here they are presented in no particular order.

1. Manipulation can reduce pressure on the nerves. Your nervous system is the control center of your body, and it is not without weaknesses.  Nerves and nerve bundles are soft tissue.  They don’t function well under physical pressure.  In fact it has been shown that inflammation, a bulging disc, or fragment floating around can interfere with proper nerve conduction.  The stuck joint as discussed previously can also physically be stuck pressing on a nerve, or could be causing inflammation that is pressing on the nerve, or could just be moving in a way that rubs the nerve.  In any case.  The adjustment can cause a relief of this pressure. through movement of the joint to the correct position, or motion.

2. Proprioceptive stimulation triggers the release of endorphins. These endorphins cause a near instant and temporary relief similar to pain medication making you less aware of the problem. This “trick” of the body can cause a secondary benefit, that of relaxing local tissues such as trigger points or tight musculature that may be “pinching” nerves.

Image by: Luis Solis

3. Manipulation provides improved nutrient supply. The cartilage and other structures inside of a joint have no blood supply. These structures get their nutrients through motion. The blood supply goes to the outside of the joint and nutrients move into the synovial fluid of the joint. Joint motion moves this fluid around thus providing fresh nutrients to all parts of the joint. If a joint becomes “locked down” by muscle spasm, scar tissue, a cast, or any other means for a prolonged period of time the joint begins to feel stiff. You know the feeling of needing to stretch after sitting in the car for a long time.

The facet joints in your spine are particularly vulnerable to this problem because they work in tandem and because of the body’s amazing ability to compensate. Your facet joints all work together, if one is injured it can become locked down to prevent further injury. When this happens you may get the desire to stretch or move your back. This usually works, but if all of the other joints compensate for the problem joint and take that added stress of movement on themselves then the problem joint stays locked down. Specific manipulation induces full range of motion and synovial fluid movement.

4. Neuromuscular retraining.  The brain also records these proprioceptive signals from the joints motion. Especially for chronic conditions the brain is in need of retraining regarding the motion of that joint. Manipulation takes a joint through its full range of motion. This new input is then stored and replayed in the brain, similar to muscle retraining that physical therapists will do, or physical training of athletes, when the body has done the motion enough times it “remembers” it.This retraining provides a functional correction that may provide pain relief.

Many other benefits have been observed, and still others suspected.Research is still going on and much more is needed.

Utah Spinal Care

USClogo2I’m back in Utah.  I have decided that rather than opening up my own private practice that I would instead work at an already established practice.  I am now the primary treating doctor at Utah Spinal Care.  Utah Spinal Care is a family practice office in Sandy Utah just up the road from Rio Tinto Stadium and the South Towne Expo Center.  We are located at 880 E 9400 S Sandy, UT 84094.  For directions, maps, pricing, etc.  please visit the website or our Facebook page.  Come visit us and pass the word along.  If you or anyone you know is in need of some Spinal Care give us a call to set up an appointment at 801-523-0073.

Physical Therapists Want to Be Chiropractors

This has been an ongoing discussion in this country over the last few years.  Despite what they sometimes tell the public physical therapists (PTs) know that chiropractic manipulation works, which is why they want to be allowed to do it.  The most recent story about this came yesterday as PTs in Washington state  have a bill submitted to their legislature that would give PTs the ability to perform spinal manipulation if it passes.

The primary problem with allowing PTs to adjust is one of public safety.  initialsIn most studies conducted about manipulation the reports of injuries are disproportionately caused by non-chiropractors. To begin with not all physical therapy schools teach manipulation as part of their curriculum.  Yet this bill would allow all PTs who graduate this year or later to adjust regardless of their education in the subject.  Of those schools that do teach manipulation most of them include it in the form of a single integrated science course.  Some offer it as a weekend seminar, and some offer a single dedicated course in adjusting.  The best I found offered by a physical therapy school was about 100 hours of training in manipulation.  (Please tell me if you find one with more.)

“…the WHO has established a minimum of 2,200 hours of additional training for any other regulated health care professional, whose scope of practice includes the controlled act of manipulation, and who wishes to become proficient in the assessment and diagnosis of neuromusculoskeletal conditions and the application of spinal manipulation to address those conditions.”

The full guide is here if you’d like to read it, but essentially, in order to practice manipulation safely the World Heatlh Organization (WHO) says that even fully trained medical professionals of other professions who want to utilize manipulation should have at least 1000 supervised clinical hours of training in that subject.  No PT school offers that.

Among the reasons that the original article gives for allowing PTs to adjust is, “Washington is one of only two states (Arkansas is the other state) in the nation that prohibits physical therapists from performing this procedure.”  This is false.  Here in Utah, and about half of the other states PTs are strictly prohibited from performing spinal adjustments.  Though they are allowed to do mobilization which is probably what they are refering to.  Mobilization is limited by range of motion and velocity.  It is not manipulation.

Utah is not immune from this issue.  In years past PTs in Utah have attempted similar legislation and were unsuccessful, however this is a new year and a new legislature.  For those of you in Washington please contact your legislator and let them know of your concern for public safety with this bill.  If you are in Utah, know that the PTs are submitting new legislation this year.  I don’t know what is in that legislation.  We need to keep our eyes open.  They have tried to get this before and they may try again.

Don’t get me wrong.  I want people to be adjusted.  I think that any person dealing with health care should be adjusting people, if they have the training to do it safely.  But if they had the training they’d be chiropractors. -sigh-

M.A.S.H. Tribute to Chiropractic

M.A.S.H. is one of my favorite TV shows. I don’t think that there is an episode that I haven’t seen. Yet M.A.S.H. played for so many episodes that I love to rewatch them, as there are still things that I didn’t get the first 10 or so times. I also remember as a kid growing up that M.A.S.H. came on after bedtime, and my Dad would stay up to watch it. When I got old enough that my bedtime was useless I enjoyed this bonding time with my father.

I also love the show because the humor is thoughtful. Sure there’s some base toilet humor, and slapstick, but the majority of the humor you have to be thoughtful to get. You have to be really interested in the show to catch it all. I also liked the show because it was a reasonable protest. M.A.S.H. made people think. It forced you to look at war from a new perspective, and despite all the humor in the show. it got a message across that war is a terrible thing. It was a lasting and thought provoking protest.

I also took note that even in the main character of “Hawkeye” Pierce, who was adamantly against war and fighting, there were things that he was willing to fight for. When someone would not let him save a life he was willing to fight. Some things are worth fighting for.

I know, you’re asking yourself what does this have to do with chiropractic. Well, there are 3 episodes of M.A.S.H. that I have found where spinal manipulations are represented. Not only that but they are shown to be beneficial to the people who received them. I thought it interesting that Alan Alda was actually one of the actors to portray giving an adjustment. Well enough talk. Here is one of the clips:

How is a Chiropractic Adjustment Performed?

Ahh, now that I can’t tell you. It’s a trade secret…just kidding.

No really, if you want to know the best way to learn is to go to chiropractic school. We have somewhere around 350 hours of class on this topic.  (Divide that up into 2 hour segments 3-5 times a week.) So, you can see that it’s probably not a good idea to let your medical doctor adjust your spine (or any other untrained person), even though that’s in their scope of practice. (I’m not sure why that is.) It takes a lot of practice. It’s kind of like a concert pianist. They make it look easy, and to them it may be. It’s only because they have practiced for years and years so that they don’t even have to think about it anymore.

Now general adjustments can be done by yourself, or someone giving you a big hug. That is motion in your joints, and they just happen to pop, that’s great. A chiropractic adjustment should be more specific. I hope I can summarize this. Your doctor will try to isolate the pain generating joint, and determine the vector of thrust required to take that joint through the corrective motion. Then, through body positioning, he will attempt to lock out all the joints around it so that they aren’t moving when he applies force. At that time he will deliver a high velocity low amplitude thrust with the appropriate contact in the appropriate location and in the appropriate vector to enable the correction. Adjustments can be rotational, gapping, flexing, etc., or any combination. Basically what ever way your joint can move it has the possibility to be adjusted in that range of motion.

I hope you followed that. After all it was your question. I hope I explained it well enough. Please comment if you have more to add, or still have questions. If you want to experience an adjustment feel free to set up an appointment. My contact info is always at my site over in the links (just to the right up there on the main blog page).

Back To The Questions: Does It Hurt To Get Adjusted?

Not usually. For some people it can be uncomfortable. There are also some people who don’t like getting massage. The majority of patients report that the actual adjustment to feels good. Chiropractic in general has the highest satisfaction rating in healthcare.

I actually have patients who come to me because they say other chiropractors are too rough. Chiropractic is different than medicine, in that the medicine still works no matter which MD you see. With chiropractic the treatment depends on the hands giving it, and because every body is different your body will respond differently to different hands. You would probably benefit from any chiropractor, but finding the one doctor for you is going to give you a better treatment. In my office I practice under the theory that the more specific you can be the less force you will need to use. I also feel that the body wants to function properly. I find that if I can pinpoint the pain generator and isolate it then it will usually fall back into place with very minimal intervention.

I often get comments that my adjustments are more comfortable than most. I think it’s just turning a weakness into a strength, because I don’t like forceful adjustments on myself. I have learned to make them effective without a lot of force. If you’re in Utah, come try me out. My contact info is on my website DrDuncanChiropractic.com

So, the answer is that chiropractic adjustments don’t usually hurt, and with the right practitioner they hurt even less often. There is always the possibility of negative side effects which is usually a little soreness in the area, but that is a topic for my next question. Come back to see that post…