The majority of my patients have never had manipulation before, and naturally they have a lot of questions. First and foremost is, “What happens when the joints of the spine ‘pop’ or ‘crack?’”
It turns out that is not a simple question. It has been debated for years by doctors of chiropractic, osteopathy and others who do manipulation. One school of thought is the treatment puts a bone that had been slightly out of position back into place. When you really need a treatment, that is exactly how it feels.
I started chiropractic care as a teen because of low-back and leg pain, and I recall the big “pop,” the feeling of something going back into place, and the instant relief from my back pain after my first treatment. Patients who are familiar with the treatment often ask me to “put it back in” when they have a new injury or flare-up. For some doctors, the bone is out of place and the thrust realigns it.
The other theory is that the joints stiffen and become restricted, similar to a tight muscle, and the manipulation releases the stiffness in the joint. I recall a class in chiropractic school where we were trained to assess the normal play of nearly every joint in the body, from the top of the neck to the low back, even the joints of the arms and legs. The stiffness in the joint can be very subtle, and it takes training and practice to feel it. But if the joint does not move properly, it will become inflamed and painful. Every joint has its own “feel.” When you are trained to evaluate for it, you can quickly pick up problems that do not show on a regular exam, an X-ray, even an MRI. If the manipulation is successful, the doctor can feel the joint is looser, and it continues to improve until it is normalized.
The key part of the manipulation is the quick, shallow thrust. But the treatment does not need to be done exclusively by hand. It can also be done with special tables with built-in “drop” sections. These sections can be raised about an inch under the problem area. When the doctor gives a quick push, the table drops, delivering a thrust to the joint that is quicker and gentler than the typical manual style. Even gentler — often used for seniors, young children, patients in acute pain or those who are very nervous about manipulation — is a handheld tool that thrusts into the joint faster than any hand can. When you increase the speed of the treatment, the amount of force needed is much less.
Joint problems underlie most back and neck pain, as well as pain in other joints. They need to be treated specifically. Muscle treatments, like “core” strengthening, stretching or massage will help somewhat but will not solve the joint problem. I have seen patients endure years of treatment directed toward reducing inflammation, strengthening or relaxing muscles, surgery or just controlling pain with only partial relief. With many of them, treating the joint with manipulation gives the best relief for their pain and disability.
Despite how effective and safe it is, there is still a lot of fear and ignorance around manipulation. Patients have all kinds of concerns. Will it break my neck? Absolutely not. Is it dangerous? No, it is even safer than taking aspirin. Will it help my problem? That depends on whether there is a problem in the joint, and the only way to determine that is by having the area evaluated by someone who has been trained in it.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at email@example.com.