Chiropractors – Are we Spine Doctors specializing in conservative spinal care or are we just back crackers?
Back crackers, crackyourbacktor, bone cruncher, I have heard it all. If I am going to get a nick name I kind of prefer Spine Doc, just in case you care. The title Chiropractor is even a kind of a nick name. When I was done with Chiropractic college at CMCC I left with a paper (a very expensive piece of paper mind you) that said Spencer W.R. Devenney has fulfilled all the requirements for a degree as a Doctor of Chiropractic. So there you have it! See my previous post regarding my education and what the title of Doctor is.
So what’s with all the nick names? Well, that probably has something to do with the go to treatment of many Doctors of Chiropractic, lets just use the more familiar Chiropractor for the rest of this post. Chiropractors are well trained in the art of spinal manipulation. There are several terms used for that type of treatment including: Manual therapy, Chiropractic manipulation, or the term I like to use an adjustment. Adjustments fit into what it is that I think that I am doing when I work with a spine. More on that shortly. Chiropractic treatment includes much more than adjusting or manipulation of the spine. But for the post today, lets discuss what an adjustment is, and what is happening, and why it is that Chiropractors along with other manual therapists use it as a treatment for spinal pain.
What is an adjustment anyway?
An adjustment is quite simply a very fast but not very hard manipulation of a spinal segment. If we are going to use the technical biomechanical physicics type terms an adjustment is a high velocity low amplitude thrust. Okay, what the heck is that and why does it help my back pain or my neck pain or my headaches or etc etc etc. I guess I have a fairly new school approach to what an adjustment should be used for, and what exactly is happening. I just realized this might get into a lengthy post because I am thinking about all the anatomy that I kind of have to explain to get this idea thoroughly understood. I’ll try to make this as simple as possible hold on to your seats we’re going to go back to school.
Spinal anatomy 101:
Okay lets break down what makes up the spine. There are 7 neck bones that make up the cervical spine, there are 12 bones or vertebrae that make up the thoracic spine, or the mid back. The mid back is unique in that there are ribs are attached. Then there are 5 spinal segments or vertebrae that make up the lumbar spine. We often shorten the general areas of the spine to C-Spine T-Spine or L-Spine, the sacrum and the coccyx are the last 2 spinal sections. the sacrum is 5 vertebra that are fused together, and the coccyx is 3 small vertebrae that are not fused and are know as the tail bone. Each vertebra has a spinal disc between it and its neighbor (aside from the sacrum its fused remember, and the coccyx with is sore of an afterthought at least as functional spinal anatomy goes. There are also a plethora of nerves, muscles, ligaments etc that help to support and move our spine. Okay so enough about the anatomy of the spine… lets talk about what it does.
Spinal physiology 101: (Spinal Function 101)
First and foremost the spine along with the skull is a cage for arguably our most important asset; our Central Nervous System or CNS. Thank goodness the spine and the skull help to protect such an important system in our body. The second function of the spine is an anchor for motion. The spine and the ever popular “core” are basically in-divisible. There is also a hierarchy of importance here, if there is every any question about which job is more important IE either deal with the job of motion or protect our spinal cord thank goodness the body will do everything it can to protect the spinal cord as its number one priority in a traumatic situation. Okay so the spine is the anchor for motion, and it is a cage for our CNS. Those are global notions of what the spine does. Each spinal level consisting of, in the most simple terms, a vertebra and a disc, have what we call segmental motion. IE each segment or level of the spine moves on its own (relatively speaking). What happens when that motion goes wrong is what the highlight of this article is about.
Segmental physiology 101: (More specific function)
Okay gather round, story time with Spine Doc… One day I went to bed feeling perfectly fine, and the next morning I can’t move my neck! SOMETHING IS BROKEN! Certainly something isn’t working the same way it was last night, because last night I could turn my head without feeling like I was going to DIE! Okay I didn’t say I was a good story teller. I have heard this story in my practice more times that I would like to count. I have also experienced the same thing before my self. What the heck happened? I use the example of a condition called torticollis because it is often a very dramatic onset, one night everything is fine, and the next morning not so much. Substitute my neck hurts for my lower back hurts or under my shoulder blade hurts, often the “offending trauma” is so insignificant, like bending over to pick up a pen that we don’t connect it with our current pain. Sometimes the little trauma is like the straw that broke the camels back.
Have you broken your back picking up a pen before?
How can picking up a pen take a perfectly functioning back or neck and have it go so completely wrong literally overnight (okay well like the straw that broke the camels back it is not the straw that did anything it was simply that last few grams that overloaded an already loaded system to the point of failure). Clinically we call this incideous onset. That being said often our back pain happens because our spinal joints (IE those spinal segments that I talked about previously) aren’t functioning the way they should be. Now for simplicity sake and believe me that this is over simplifying; I break spinal segmental motion into 3 categories. Normal spinal motion, to0 much spinal motion (hyper-mobility), and too little spinal motion (hypo-mobility). Here’s where we get to the fun stuff. Have you ever had one friend who goes to a chiropractor for their back pain and loves them and swears by their Chiropractor, and another friend who appears to have the same back pain, who has gone to a Chiropractor and had a bad experience? who now hates Chiropractic because they got worse or maybe just didn’t get better? (SIDE NOTE & a small RANT! – why is it that if a person has a bad experience with one chiropractor [usually their 1st chiropractor] they are unlikely to ever use a Chiropractor again, and even worse tell all their friends how Chiropractic doesn’t work. Lets get real here, if I went to a dentist and we didn’t click or even worse if they weren’t able to help, or heaven forbid something felt worse when we were done would I never go to another dentist again? or even worse tell all my friends not to go to a dentist? of course not… Okay RANT OVER) Where was I… oh yeah Normal, hyper or hypomobile joint motion. Now if I were to tell you that a spinal adjustment takes a vertebral level and makes it move more completely through its ideal range of motion or ROM could you tell me which type of spinal motion would benefit from that type of therapy? okay it doesn’t take a rocket scientist (maybe just a neuroscientist or biomechanic) to see that a joint that isn’t moving enough would benefit from a treatment like that. So essentially manipulation or adjustments works on jammed up or hypo or not moving enough subset of abdomral spinal mechanics.
Segmental physiology 102:
Why is it that 90% of the people that walk through my door get adjusted? (certainly not every spinal problem is a hypomobility problem… well my friend I am glad you asked its because it isn’t as simple as one segment in isolation. Imagine this if one spinal joint is all jammed up and not moving what do you think is likely happening to the spinal segment above or below it? Ding ding ding, you’re so smart or SMRT as homer Simpson would say it. Our bodies in general and our spine in particular is fantastic on picking up the slack from a dysfunctional neighbor, kind of like Flanders making sure Bart has pants. If there is a spinal segment that is not moving enough it is very likely that there are spinal segments above and below it that are going to move just a little bit more to make up for the motion that is lacking. So sometimes the trick for us Chiropractors is to recognize that the joint that is screaming the loudest is not the one that needs to be adjusted. remember your one friend who hates chiropractors? What may have happened is that they had a spinal segment that was moving too much as the cause of their back pain or neck pain, and remember those helpful neighbors in that case there was likely a couple of spinal buddies locking themselves up to hold on to that poor wobbly vertebra. Now here is the rub, because almost always there will be compensation for dysfunctional neighbors how are we suppose to be able to tell which one is the trouble maker? This is the tough part… it is really difficult to determine which came first the chicken or the egg, or in this case the stuck segment or the sloppy segment. This notion of hypermobility vs hypomobility is a relatively new field of study but we have found that there are tests which help to hint at which came first in a patients spine, the loose or the tight segment. I think that to demonstrate that a video is probably the best, so look for that at a later date. Suffice it to say, even those aren’t perfect. So what are we left with? A trial of therapy, If we adjust a tight joint and the patients symptoms get worse over time it is likely that the hypermobile segment is the culprit. And in this case Homework (usually at home spinal/core strengthening exercises are recommended) To be perfectly honest I often will give core stability homework to all of my lower back pain patients because having a stronger core isn’t going to make anything worse Unless you go about strengthening your core incorrectly, more on that in a later post.
SCHOOLS OUT! (lets sum this lecture up already Doc)
WOW, that was a LONG course! okay now the real question, what is that dang popping that often happens with an adjustment? (and I say often because the poppig isn’t the goal, improved segmental motion is, sometimes things won’t pop and sometimes they will) The popping sound is where a lot of our nicknames have come from like crack-your-back-tor. As far as we can tell the popping that is heared during an adjustment is simply gas being released from the fluid that coats each of our spinal joints. The reason that we think this is because there is what is called a refractory period, a point in time that if we were to adjust the same vertebra again, there would never be a pop, why, because there is no gas left in the fluid to be released. Check this out… it shows a guy getting water to boil IE changing water from a liquid to a gas simply by putting the water into a vacuum.
Again be nice… and leave a comment below
Okay, that was a long post if you made it to the end enjoy the science type video and leave some comments below, only my wife commented on the last one, and that was only to point out some issues with my grammar/spelling. That’s okay too, but let me know about your Chiropractic story, that’s way more fun!