Chiropractic treatment includes much more than an adjustment or manipulation of the spine. For now, let's discuss exactly what an adjustment is, what happens during the adjustment, 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 gentle manipulation of a spinal segment. If we use technical biomechanics terminology, an adjustment is a high-velocity low amplitude thrust. So why does it help alleviate back pain, neck pain, or headaches? To make this explanation as simple as possible-we’re going back to school.
Spinal Anatomy 101:
First, we'll break down what makes up the spine. There are 7 neck bones that make up the cervical spine and 12 bones or vertebrae that make up the thoracic spine, or 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 made up of 5 vertebrae that are fused together, and the coccyx is 3 small vertebrae that are not fused and are known as the 'tail bone'. Each vertebra has a spinal disc between it and its neighboring vertebra (not including the sacrum as it is fused, and the coccyx). There are also a plethora of nerves, muscles, ligaments, etc that help to support and move our spine. Now that we know the basics of the spine, let's talk about what it does.
Our Spinal Function
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 to act as 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 ever any question about which job is more important (i.e. either deal with the job of motion or protect our spinal cord) the body will always do everything it can to protect the spinal cord as its number one priority in a traumatic situation.
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 (each segment, or level, of the spine, moves on its own (relatively speaking)). So what happens when that motion goes wrong?
The Straw that Broke the Camel's Back
One day I went to bed feeling perfectly fine, and the next morning I couldn’t move my neck! SOMETHING IS BROKEN! Clearly, something changed, because I could previously turn my head without feeling like I was going to DIE!
I have heard this story in my practice more times than I can count. I have also experienced the same thing before myself. What on earth happened? This is an example of a condition called torticollis. I use it as an example because it is often a very dramatic onset; one night everything is fine, and the next morning.. not so much. You can substitute "my neck hurts" with "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 that little trauma is like the straw that broke the camel's back.
Have you experienced pain virtually overnight?
How can picking up a pen take a perfectly functioning back or neck and have it go so completely wrong overnight? Well, as far as the saying "the straw that broke the camel's back" goes, it is not the straw itself that was too much, it simply happened to be the last few grams that overloaded an already loaded system to the point of failure. Clinically we call this insidious onset. Often our back pain occurs because our spinal joints (i.e. those spinal segments we talked about) aren’t functioning the way they should. For the sake of simplicity (and believe me that this is oversimplifying), we can break the spinal segmental motion into 3 basic categories. Normal spinal motion, too much spinal motion (hyper-mobility), and too little spinal motion (hypo-mobility). Here’s where we get to the fun stuff that I do at work.
If I were to tell you that a spinal adjustment takes a vertebral level and helps it move more completely through its ideal range of motion (ROM), could you tell me which type of spinal motion would benefit from that type of therapy? That's right - a joint that isn’t moving enough would benefit from a spinal adjustment treatment. That's where chiropractors come in. Essentially, chiropractors use manipulation or adjustments to work on a jammed-up or hypo (not moving enough) subset of abnormal spinal mechanics.
A common question we get asked is, "what is that crazy popping sound that often happens during an adjustment?" I use the term "often" because the popping sound isn’t actually the goal. Improved segmental motion is the goal. Sometimes things won’t pop and sometimes they will. The popping sound that can be heard during an adjustment is simply gas being released from the fluid that coats each of our spinal joints. We have come to this conclusion as a medical community because there is a refractory period - a time period during which if we were to adjust the same vertebra again, there would be no pop because there is no gas left in the fluid to be released.
The answer to the question you've been waiting for
So 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, unfortunately, it isn’t as simple as treating one segment in isolation. If one spinal joint is jammed up and not moving, what is likely happening to the spinal segment above or below it? Our bodies, and our spine, in particular, are fantastic at picking up the slack from a dysfunctional neighbor. 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. The trick for us as chiropractors is to recognize that the joint that is screaming the loudest is not necessarily the one that needs to be adjusted.
Most of us have that one friend who goes to a chiropractor for their back pain, who loves them and swears by their work and another friend who appears to have similar back pain, who has also gone to see a chiropractor and had a bad experience. Likely, that friend now hates chiropractic care, because they didn’t get better, or maybe even got worse. Well, what may have happened is that they had a spinal segment that was moving too much as the cause of their back or neck pain, and a couple of helpful spinal segment neighbors locked themselves up to hold on to that poor wobbly vertebra.
The Puzzle of Our Spine
Here is the puzzle chiropractors have to solve daily. Since there will almost always be compensations made for dysfunctional vertebra "neighbors", how are we supposed to distinguish which segment is the true trouble maker? This is no easy feat.
What are our options? A trial of therapy. If we adjust a tight joint and the patients' symptoms get worse over time, it is likely that the hypermobile (too much motion) segment is the culprit. In this case, you as the patient have homework, usually in the form of at-home spinal/core strengthening exercises. I often recommend core stability homework to all of my lower back pain patients anyway, because having a stronger core (through correct strengthening exercises) can only ever help.
The spine is an intricate and important part of our body that requires a trained eye and in-depth knowledge of its proper motion to treat correctly. Chiropractors have the complex task of finding solutions to puzzles like this so that you can get back to your life, ideally with well-oiled pain-free motion in all of your spinal segments.
About the author
Author Dr. Spencer Devenney is a Chilliwack Chiropractor, who graduated in 2009 from the Canadian Memorial Chiropractic College (CMCC) He has a clinical interest in all things mechanical (i.e. his motto is if it hurts to move it, bring it to your chiropractor.)