It’s a sound and picture that some people associate with bliss, while others with pure fear and horror. But for better or for worse, chiropractors will always be associated with that famous “crack.” Regardless of everything else that I do as part of my treatment plans, the most common question that I get by far as a chiropractor is:
“So what’s the deal with that noise?”
I think it’s always fun to bust some myths. Maybe it’s because they get under my skin just a bit, or maybe it’s because I like the idea of people learning something new. My goal here is not to offend anybody, so just realize that all of these ideas that I’m sharing with you is what is currently expressed in the scientific literature. I owe it to you to be completely honest, and if presented with contrary evidence I’m always excited to alter my position.
I wanted to start with this one because I have both seen chiropractors and have had patients that have seen chiropractors that told them this. Before we go any further I want to state that if you truly had a bone “out of place in your spine,” you have some serious problems to worry about, and my office is the last place you should be. The logic and simplicity of this idea definitely amuses me though, and I find myself almost wishing that it were true. Such a simple concept! You have something out of place, you come see me, I push it back in, and that’s that! Unfortunately, the phenomenon of pain and movement dysfunction isn’t that straightforward.
This is another hot topic that’s primarily fueled by those outside of the profession. I’ve had many medical professionals mention to me the inherent danger of manipulating the neck in particular. My response is always the same. Manipulation is dangerous to those presenting with contraindications to manipulation. If you were a nutritionist, would you recommend one of your clients eat walnuts if they were deathly allergic to nuts? If you were a medical doctor, would you recommend running to a patient who just broke their leg? Of course not. There is nothing inherently dangerous about walnuts or running, but prescribed to the wrong person, it becomes deadly. The same applies for any rehabilitative interventions. We perform examinations to determine what treatments would work, and which to stay away from.
A number of high quality peer reviewed papers have come out in the last decade reinforcing the safety of spinal manipulation. The bottom line is that while the optics of spinal manipulation may look extreme, they do not provide any inherent risk. However, just as a medical doctor should not throw a prescription at you without first doing an examination, the same rings true about chiropractors and spinal manipulation.
While there are numerous reasons why this myth has become so commonly espoused, the primary reason is likely due to the fact that for a lot of people, manipulation can have a pain relieving effect (more on this later). Now, if you change nothing else about your routine, lifestyle, or exercise regimen, then it would make sense to me why manipulation would seem addicting, as your pain generator would likely return over and over again, without any intervention to stop the cycle. There is a common saying amongst the best rehab professionals:
“Simply treating the symptoms over and over again will get you nowhere”
It’s not until you address the cause that real lasting change will occur. We’re in the business of creating lasting change, so while it may not be the best business model, we’re actually interested in keeping you AWAY from our office.
So, then what actually happens during manipulation?
First let’s start with the noise. The phenomenon that creates that famous “cracking” sound is actually carbon dioxide gas being forced out of solution and forming a bubble when the joint spaces are moved quickly apart. The study that highlighted this used an MRI machine in real time while an individual cracked their finger knuckles. If you want to impress somebody at a dinner party, the word for this is tribonucleation. There are also some other useful things to know about why having your joints cracked feels so good! In what appears to be a majority of people, manipulation can help reduce pain sensation by stimulating a specific portion of your brain. Along with this, it also temporarily increases the range of motion of the given joint as well as increasing the ability for the muscles around the area to contract and stabilize that body region.
We utilize manipulation as a tool here in the exact ways given above. To increase range of motion, increase stabilization, and reduce pain… temporarily. That part is important. We use it as a bridge in order to allow you to function at a higher level so we can get you moving and training in a strength and conditioning setting and back to 100% and beyond. The reason that we like manipulation is that it is a drug free approach to reducing pain and can provide many people the confidence that they need to get moving again. If you have more questions about the topic feel free to reach out to us at info.apollopc@gmail.com!
Until Next Time - Brett Poniros DC, CSCS
