As a child of a chiropractor, I have received adjustments (or high velocity, low amplitude “spinal manipulations” as the medical community calls them) regularly growing up. At the time, adjustments were kind of a mystery that were both scary and exhilarating. My understanding of the purpose of adjustments was to “realign the spine” and chiropractors were the experts. However, while earning my Doctorate of Physical Therapy, I learned the bigger picture of spinal manipulation treatment and continue to do so both academically through the latest research and clinically while working with patients. Let’s start with busting some myths.
Myth #1: only chiropractors adjust or manipulate the spine.
FALSE. Chiropractors, sports or orthopedic specialized physical therapists, and osteopathic physicians all perform spinal manipulations (as well as other joints like ankles, wrists, hips).
Myth #2: spinal manipulations require high skill, specificity and precision.
FALSE. A systematic review published in 2021 interpreted the results of 10 randomized control trials comparing outcomes of joint segment specific vs non-specific spinal manipulations. They found no clinically relevant difference between the groups.1 Joint manipulations are not joint specific! That being said, manual skill is not extraordinarily high to manipulate the spine. Have you ever had your spouse give you a good squeeze and your back “pops”? The skill comes in during subjective history intake and identifying who is appropriate and when.
Myth #3: spinal manipulations “put the spinal segment back in place”.
FALSE. If spinal manipulations are not joint-segment specific, how could we possibly claim to be mechanically altering the position of a specific joint? The fact of the matter is: we don’t. The benefit lies in neuromuscular, biomechanics, and/or contextual. In plain English, this means the real magic may be in a reset to the nervous system, the feel-good hormones and chemicals released from being physically touched and “treated”, getting parts of the body moving may help reduce pressure and pain in other parts or a combination of all of these things.1
So what is actually making that crack and pop sound? It’s called The Cavitation Phenomenon which describes a change in fluid pressure within the joints of your spine, called facet joints. Facet joints contain a fluid, called synovial fluid, which forms gas bubbles when gapping occurs in the joint space during a manipulation. It’s kind of like opening a can of soda!2
Myth #4: spinal manipulations are dangerous.
There is a certain level of risk to everything we do. The question lies in how much risk are we willing to absorb versus benefit we gain, such as reduced pain and improved function. Personally, I have been in neck pain so badly I was willing to take a fair amount of risk to make it stop (and it did!). Although adverse events from spinal manipulations are rare (incredibly rare for thoracic and lumbar regions), there is risk such as vertebral artery compromise resulting in stroke, cauda equina syndrome, fracture, or muscle bruising/strain. Keep in mind, there are also risks for taking medication like NSAIDs, muscle relaxers, and pain killers. Arguably, there is more risk taking opioids than spinal manipulations. That being said, you should know the risks before agreeing to any treatment.3,4
Spinal manipulations are a great tool, in combination with other tools such as therapeutic exercise and neuromuscular reeducation, to help you manage pain and get back to living your life. They are not for everyone, and shouldn’t be performed excessively. However, in certain situations with the right people, this treatment can be incredibly helpful. I have come a long way since receiving adjustments as a child with my limited understanding to now utilizing spinal manipulations as a tool to improve the lives of my own clients.
Great resources here:
留言