chiropractic - Ask Dr. P

Is it OK to Adjust Yourself and Others?

by Pain Doc | Oct 23, 2019 | Uncategorized

If you’ve ever had a kink in your neck, or felt your upper or lower back needed some “cracking” because you sensed restricted movement, then you are probably familiar with the benefits of spinal adjustments; also called manipulation.

So what exactly is a spinal adjustment?

Basically, it is a hand-delivered force into an improperly moving joint done to make it move normally. Vertebrae can get “stuck” in a rotated or bent position by numerous ways, such as sleeping on your stomach with neck twisted or a sports injury. This can feel very uncomfortable and may even cause sharp pain, arm numbness or headaches.

It is roughly estimated that about one million adjustments are done in the U.S. every business day, mostly by chiropractors. It is their “bread and butter” treatment because chiropractic is based on the belief that abnormal spinal alignment contributes to poor health, and manually correcting the alignment can improve health. Because they do it the most, chiropractors are considered the specialists most proficient at spinal adjustments/ manipulation.

According to ShareCare, about 30 million people see a chiropractor each year, mostly for various types of musculoskeletal pain and dysfunction. The benefit is improved range of motion (flexibility) and decreased discomfort/pain. Some patients experience other symptomatic improvement such as cessation of a headache or clearance of congested sinuses (there are medical models to explain this, but this isn’t the focus for this particular article). While there are pockets of naysayers, it is fair to say that getting your neck and back adjusted can be good for you.

Are You Actually “Adjusting” Yourself When You Crack Your Neck Yourself?

If you or someone you know “crack” your joints by twisting your neck or low back until you hear a pop. I personally know someone who has a daily routine for this, using her hands to forcibly twist her neck by grabbing the top of her head and chin like in the picture above, and rotating her head far to the left, then right; and then twisting her spine while sitting. I noticed that she gets an unusual amount of popping when she does this; seemingly with little effort. This excessive popping indicates that the spinal facet joints have become hypermobile from overstretching—they’ve lost some of the ligamentous support, allowing the joint to move more than it was designed to. Hypermobility of joints accelerates wear and tear, leading to bone spurring and disc thinning, which can eventually press on nerves inside the spine causing pain and weakness in the extremities. Although, as far as I know, there are no conclusive studies on the benefits or harm of cracking your neck often, I believe that it is best not to do it for these reasons.

The next question is, if you are able to pop your own neck or low back by forcibly twisting it, are you essentially adjusting it? Are you getting the same benefit as an actual chiropractic adjustment?

This is not easy to answer, because in order to get a scientific-based answer to this, a large study (many people) is necessary, which hasn’t been done to my knowledge. Also, the outcome (result of cracking vs. adjusting) is difficult to measure. As a chiropractor myself, here is my explanation of the difference between “cracking” your own neck and getting a chiropractic adjustment:

When you “crack” your neck yourself, you are essentially twisting or bending (depending how you do it) all your neck vertebrae at the same time. At some point, you get cavitation—the popping sound made by collapsing pockets of dissolved gases in the small facet joints of the cervical vertebrae, due to the expansion of those joints as you bend your neck to the side. There is a sense of pressure release and improved neck flexibility afterwards. Sometimes it can be verified by checking range of motion before and after; sometimes not. People who do it will typically say “it feels good,” or “it relieves pressure.”

On the other hand, a chiropractic adjustment to the neck targets just one vertebrae—the problematic one identified by palpation and/or x-ray, so it is more precise. It also incorporates an external force—the hand thrust—that forces the vertebrae into the direction where it is deficient; i.e forces it back to its normal range of motion.

Most people will tell you that the feeling after a neck adjustment is very different that the one you get by merely twisting your neck: it is a focused, louder sound and you feel a heightened sense of things immediately afterwards, similar to having a wax earplug removed or clogged nasal sinuses suddenly cleared. This may be explained by improved nerve firing, better circulation and restored neck muscle balance.

So these are the differences between cracking your own neck and having a chiropractor adjust your neck. But again, there are no studies I can reference that proves the superiority of one over the other. Currently, the evidence is subjective, or anecdotal.

Is It Easy to Do Adjustments Yourself?

If you have ever been to a chiropractor, you know that it does not take long for the chiropractor to do an adjustment – about 5 seconds total, including the palpation (feeling for the joint’s movement) and set-up of the thrust. On the surface, an adjustment seems like a relatively simple procedure to do (although more subtleties are involved that you don’t notice). In other words, it’s not brain surgery. This apparent simplicity is what encourages some people to try it on themselves or their housemate, partner or friend. They take note of what their chiropractor does and perhaps watch YouTube videos of chiropractors adjusting patients to see how it’s done. I even made a video on chiropractic adjusting a couple of years ago which you can see here. I will venture to guess that a lot of “adjusting” occurs outside of chiropractic and physical therapy offices.

So, is self-adjusting, or adjusting a housemate safe? Can it be beneficial? Most would say no, for the obvious reasons—you need to get proper training, it could be dangerous and you could hurt someone, etc.

There can also be legal implications to this, such as practicing without a license.

Obviously, the best solution is to seek the services of a licensed, experienced chiropractor who knows the ins and outs of adjusting. However, I do understand that some people cannot afford to see a chiropractor, or don’t have access to one; or simply don’t want to see one for personal reasons but still desire to obtain the benefits of spinal adjustments. As a big believer and advocate of self-care for managing musculoskeletal pain, I have an atypical perspective on this, which I’m sure most chiropractors won’t agree with. My view is that, with proper guidance, every day people can learn to do modified adjustments, or joint mobilizations to relieve pain and discomfort on themselves and others. These are basically targeted stretches that have elements of joint mobilization. Before I describe them, I will explain the distinctions between adjustments, joint mobilization and stretches.

An adjustment is a short lever, high velocity manual thrust into a joint. Short lever means that you contact a small protuberance of a bone and use it as a lever to move the whole bone (see diagram below). If it’s a spinal vertebra, you can use the bone’s transverse processes or spinal process as a lever to move the whole vertebra. You locate these structures, contact them with your hands, decide which direction you wish to move the bone, and thrust in the appropriate angle and depth.

The term joint mobilization is used to describe longer lever, lower velocity force applied to a joint; for instance, using the femur bone for leverage to manually circumduct the hip joint.

Stretches of course apply to the soft tissues—muscles, ligaments and tendons. They are done to elongate contracted fibers to increase flexibility, and are done by isolating the muscle and elongating it with movement. Stretching ligaments requires you to move the joint to its end range of motion, and then a few degrees past it.

Together, adjustments, joint mobilization and stretches are the three, primary tools of manual therapy for the musculoskeletal system. Note, however, that soft tissue mobilization is a term used to describe various forms of deep tissue/sports massage, and can also be considered manual therapy.

In my opinion, it is fine for someone to learn how to do modified forms of adjustments. Manual therapy is one of the safest forms of therapeutic intervention; even safer than taking aspirin. So if you’re an athletic trainer, massage therapist, acupuncturist or anyone else who is interested in learning how to adjust yourself or someone else, know that there are options. I believe the time has come for people to learn how to do basic manual therapy for the benefit of others. The trend may lead to a dramatic decline in neck and back pain in the population, much like how the fitness craze starting in the 80’s made people more lean and fit.

In the coming days, I will explain how to do some basic adjustments and joint mobilization moves that you can try—on yourself, and others. The key to doing these is to do them slowly and stay focused on what you are doing. Avoid sudden jerks especially to the neck. It’s not an issue when people stretch themselves and help stretch others. The techniques that I believe are safe and appropriate for non-trained people to do are similar in scope and complexity, but with some focus on moving the joints. Stay tuned!

Chronic Neck Pain or Stiffness? Get Your Neck Curvature checked

by Pain Doc | Feb 27, 2015 | Neck Pain

The cervical spine is the thinnest and most flexible part of the human spine. It is tasked with supporting the weight of the head in the upright position while allowing turning in multiple planes — looking left, right, up, down and behind. It also contains structures directly tied to life sustenance, which is why the neck is a logical target when it comes to martial arts/ self-defense and restraint (and unfortunately, murder).

Given all these vital functions, it is wise to take good care of your cervical spine in a proactive way.

The cervical spine is naturally designed to curve, where the apex is at about the level of the Adam’s apple.

This curve behaves much like a spring in a car’s suspension; or the slight upwards curve you see in any bridge design. Long ago, architects discovered that the load capacity of bridges could be dramatically increased simply by integrating curves or arcs into the design. Like a neck curve, a bridge curve or arc distributes weight over a greater area so that gravity cannot concentrate over one small area and cause structural failure.

neck_xr_flat If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?

If you lose your cervical curve over time, which could happen from years of poor posture or trauma like multiple rear-end car collisions, you will probably not notice it until several years pass. The change in biomechanics shifts a greater burden of support to your cervical discs and vertebral end plates. This promotes disc degeneration. The once thick and healthy discs lose fluid content, lose strength, allow the center material to bulge out (herniate, protrude or rupture) and cause bony protuberances called osteophytes to form all around the edges of the vertebrae and facet joints.

For some unfortunate people, the bony projections narrow the passageways where the nerve roots and spinal cord pass through (a condition called spinal stenosis) and neck surgery is necessary to prevent nerve tissue from permanent damage, paralysis and severe paresthesias (numbness, tingling) in both the arms and legs.

So the bottom line: be conscientious about the importance of the health of your cervical spine. Don’t get blind-sided by an MRI diagnosis of “multiple-level, severe degenerative disc disease with advanced neural encroachment.”

I’ve seen such cases where patients were oblivious to what was developing inside their necks. They dismissed their neck stiffness and aches to “getting older” or simple muscle strain. When massage and chiropractic provided only temporary relief, they had a cervical MRI done which revealed the formidable origin behind these symptoms, and the next step was neck surgery. Neck surgery of this nature involves removing the damaged disc, shaving off the osteophytes and inserting a bone graft to promote fusion of adjacent vertebrae.

Prevention is the best approach. You don’t have to have neck problems to start preventive measures. In fact, the vast majority of patients who have early to moderate stage degenerative disc disease have no complaints. It’s like a cavity — you don’t feel anything as the pit erodes the tooth enamel, but as soon as it hits a nerve, you will definitely be aware of its presence. But by that time, you’ll need invasive procedures. In the case of a cavity, it means either a filling or tooth extraction; in the case of a cervical disc, it might mean cervical decompression surgery.

Below is a video that summarizes the importance of maintaining a healthy cervical curve (“lordosis”) and exercises to maintain or restore your neck curve so that it can better withstand the physical demands placed on it and hopefully preclude the need to visit an orthopedic surgeon years down the road.

Also, make sure to check out this site’s Self-Care for Neck Pain video, which demonstrates home care procedures for managing musculoskeletal neck pain and/or stiffness.

Pain With No Apparent Cause

by Pain Doc | Jul 2, 2012 | Uncategorized

It’s strange, but you would think that for someone experiencing neck, back, shoulder or any other type of musculoskeletal pain in his body, he would know exactly when it started, and how.

But surprisingly, this is not the case for a majority of patients I have seen over the years. Most cases of pain I see are idiopathic; meaning, “with no apparent cause (at least in the eyes of the patient).”

A typical history of such a patient goes something like this:

Me: “Ok Sue, I understand you are experiencing pain in your upper back, right side. When did it start, and how, to your knowledge?”

Patient: “At least the past five or so years. I don’t know what started it; it just seemed to have appeared gradually. It is good some days, then bad, and lately it has been getting worse, so I decided to get it checked.”

At this point, I continue with the history by asking questions related to the patient’s occupational, social/recreational, and past medical history. Usually there is something in the history that can be linked to the complaint, like a past car accident, a particular sports activity during college, or something about the physical requirements of her occupation. But in some cases, there still is nothing in the history that can explain the pain.

But where there is a problem, there is an answer. It’s just that sometimes the answer requires some smart detective work.

If you suffer from pain that can’t seem to be traced to a specific cause, realize that musculoskeletal pain, aside from systemic related disorders such as rheumatoid arthritis, lupus, bone disease, and others, develops from some kind of mechanical breakdown in the musculoskeletal system. It can be something obvious like a hard fall that injures and misaligns a joint; something seemingly innocuous like sleeping on your right side for most of your adult life; or something very subtle, like a subluxated heel bone that does its damage via a drip effect.

So, your best bet is to find a practitioner who is very experienced in human biomechanics. Chiropractors or physical therapists such as Craig Liebenson, DC who emphasize body kinematics and targeted exercise rehabilitation will typically have a keen eye for abnormal or dysfunctional movement. The course of treatment will involve identifying and acknowledging the problem; aggressive rehabilitative exercise regimen, and lifestyle modifications. Manual therapies may be employed, such as spinal manipulation; and orthotics may be required, at least during the initial phase of treatment.

This applies to conditions including unilateral hip or knee pain, TMJ pain, neck pain with right or left rotation, rib or sternum pain, and many others. Oftentimes the condition is secondary to a primary cause, so the doctor should not jump to conclusions and direct all treatment to the site of pain. A thorough investigation and inspection is required.

What Should You Do For Neck Pain?

by Pain Doc | Jan 8, 2012 | Neck Pain

A recent study in the Annals of Internal Medicine compared the effectiveness of chiropractic spinal manipulation, pain medications, and home exercise and advice in treating biomechanical neck pain.

The study participants were 272 people between the ages of 18 and 65 who complained of non-specific neck pain for 2-12 weeks. They were divided into three groups, one of which took medicine only; one which received spinal manipulation to the neck only, and a third group that was just given home exercises and self-care advice. Participants were asked to rate their pain at 2 weeks, 1 month, 2 months, 3 months, 6 months, and one year. The method the study used to grade the pain was subjective rating (probably using a visual pain scale between 0 to 10, with 0 being no pain and 10 being the worst pain) and a Health Status questionnaire asking them their level of ability to engage in certain activities.

The patients treated by a chiropractor experienced the highest rate of success with 32 percent saying they were pain free, compared to 30 percent of those who exercised. Only 13 percent of patients treated with medication said they no longer experienced pain.

The conclusion of the study was that for participants with acute (recent onset) and subacute (usually meaning lasting more than two weeks) neck pain, chiropractic spinal adjustments were more effective than medication in both the short and long term. However, a few instructional sessions of home exercises and advice resulted in similar outcomes at most time points.

My comments:

Biomechanical neck pain can lower the quality of life significantly. Imagine having to struggle to turn your neck all the time, and having to avoid exercise, sports and many recreational activities due to neck pain. According to the researchers, neck pain affects 70% of adults at one point in their lives.

From my experience, biomechanical neck pain typically arises from some type of past trauma, and it doesn’t have to be major. Examples include car accidents, sports injuries/impacts, horseplaying as kids; and hard impact generating activities such as running, horseback riding, parachuting, gymnastics, boxing, martial arts, and cheer leading.

A second, possible cause of biomechanical neck pain is ergonomic in nature; meaning, related to positioning of the body. Long hours of desk work keeps the head relatively stationary (static) in a single position, allowing gravity to pull down on the head, over time altering the weight distribution on the joint surfaces of the bones that make up the neck. Such an “activity” also promotes muscle deconditioning around the neck. The term “deconditioned” means that the muscle is slower to respond to nerve commands, so it loses some ability to support, guard and protect the cervical spine (neck).

The worst combination is someone who has a history of impact trauma to the neck who later gets a job that involves working at a desk for long hours at a time. The trauma history sets the stage for neck pain, and the static positioning of the head accelerates the process over time.

The pain in biomechanical neck pain frequently originates in the joint surfaces of one or several cervical vertebrae, commonly the posterior facet joints (also called the zygapophyseal joints). This is where most of the movement occurs when turning and bending the neck. Orthopedic surgeons sometimes prescribe a facet block for neck pain, which is an injection of pain medications directly into the joint, usually guided by video fluoroscopy. If the patient has degenerative disc disease, pain can emanate from the intervertebral discs, either as a disc herniation or internal tear of the disc. If this is the case, neck surgery is typically the last hope. The disc herniation may be able to be reduced by surgery, but if the surgeon feels that the disc is beyond repair, discectomy (total disc removal) with surgical fusion is usually performed. However, this is like trading one evil for another. Surgeons know that when you fuse two vertebrae together, the vertebrae above and below the fusion bear an increased burden of providing the movement lost by the two fused vertebrae. This will lead to accelerated degenerative changes to those areas as well, over time.

Neck pain can also emanate from the surrounding muscles and fascia. Myofascial trigger points are focal, tender spots along a muscle that are believed to develop from trauma or microtrauma. They may actually be a concentration of nerve endings on the muscle that developed following an injury. These are best handled through manual therapies such as chiropractic, massage, exercises and stretches.

Some people get inexplicable muscle spasms of the neck. This is usually accompanied with a migraine or tension headache. A muscle spasm occurs when the nerves that control the muscle misfire, causing the muscle to maintain a constant state of hypertonus (involuntary contraction). This results in muscle pain, fatigue and low grade inflammation. Sometimes the spasm can be so intense that anti-spasmodic medications, ice, heat, and rest have no effect. In cases like this, botox injections are sometimes used. Botox injections are comprised of a weakened strain of the Botox bacteria, which has the effect of muscle paralysis.

Lastly, it should be mentioned that a poor, nutrient-deficient diet and smoking can make neck pain worse by denying the body critical nutrients needed for repair and maintenance of muscles, ligaments, tendons, nerves and bones.

The study, while emphasizing that chiropractic manipulation was superior to medications in reducing neck pain among participants, also mentions that home exercises and advice were just as effective. It therefore seems natural that a combination of spinal manipulation and home exercises would be a good strategy to reduce or eliminate biomechanical neck pain.

If you are experiencing non-specific neck pain (don’t really know what caused it) for over two weeks and desire to try chiropractic, it’s important to choose a good, qualified chiropractor. Some of the signs of a good, reputable chiropractor are:

1. Doesn’t try to convince you to purchase a long-term treatment program involving multiple adjustments per week.

2. Asks you about your complaint: the nature of your symptoms, how they started, how long you’ve had these symptoms, how they affect your ability to do certain things; and questions regarding your general health.

3. Gives you his/her diagnosis and uses standard orthopedic terminology that is consistent with what you are coming in for (doesn’t go off subject). It meshes with the information you provided in #2 above. You feel that the chiropractor listened to you, and responded with a meaningful solution that is clear to you.

4. Gives you a treatment recommendation the same day: the type of treatment and a brief description of it (spinal adjustments, modalities, supports); what to expect from the treatment, and approximately how long it will take. The chiropractor should also disclose potential risks and side effects of the treatment. In my opinion, six treatments followed by a re-evaluation is a sensible treatment approach for most cases of subacute, musculoskeletal pain.

A chiropractor like this may or may not have a lot of reviews on the internet. Use your judgement, ask friends and co-workers for referrals, and by all means, don’t be afraid to change chiropractors if your first choice turned out to be bad.

Regarding home exercises and advice for treating biomechanical neck pain, stay tuned! I will be putting up an information-packed neck pain relief video on this topic shortly.