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What is a Chiropractic adjustment or manipulation?

Crack, pop, snap...
What is that sound?

Chiropractic Adjustment or Manipulation

What is going on there?

Bones aren't cracking and joints aren't being put back into place or moved out of place. We would be in serious trouble if that were happening!

A surprisingly good explanation on Operation Ouch, found by my 6 year old boy... it's a great show, not going to lie!

Our joints contain synovial fluid within a capsule, when a joint is moved to the point of an adjustment or manipulation, there is a sudden change in joint pressure, leading to the formation and collapse of gas bubbles within the synovial fluid. The exact mechanism behind joint cavitation is still not fully understood and is an area of ongoing research. This is what we call this a cavitation (1, 2, 3).

The aim of an adjustment is not the noise itself
it's the movement

 

A sudden, controlled movement in the joint stretches the surrounding soft tissue (ligaments, tendons and muscles), which activates muscle spindles, a type of sensory receptor present within muscles, The spindle fibers then send signals to the spinal cord and brain. This sensory input is integrated with other sensory information, such as touch and position sense, to create a coordinated motor response and influence proprioception, increases range of motion and decreases pain (4, 5, 6).

  • increased awareness of the body's position in space 
  • reflexive muscular relaxation of surrounding muscle
  • temporary joint space separation
  • increased range of motion
  • decreased pain

The pain gate theory proposes that the chiropractic mobilisation or adjustment may help to modulate pain by stimulating non-painful sensory fibers which activate interneurons in the spinal cord. The interneurons reduce the transmission of painful input to the central nervous system, reducing the perception of pain. The exact mechanisms are still being investigated, and the pain gate theory is just one potential explanation.

Before any adjustment or manipulation, Chiropractors typically perform a thorough evaluation of the musculoskeletal system, taking into account the medical history, symptoms, and specific goals. This assessment helps chiropractors determine the most appropriate techniques and adjustments for each individual.

The adjustment or manipulation is only one of the tools in a Chiro's toolbox. Chiropractic care involves a multimodal approach, combining adjustments with other interventions such as therapeutic exercises, soft tissue therapy, lifestyle modifications, and patient education. These additional components aim to optimize the effectiveness of treatment and promote long-term improvements in function and overall well-being.

The sum total effects of a chiropractic adjustment or mobilisation can offer a window of opportunity, not a quick fix.

The window of opportunity is a time where we can increase exercise or load tolerance for certain movements.

 

 This is where the work begins!

References

  1. Kawchuk, G. N. et al. Real-time visualization of joint cavitation. PLoS ONE. 2015. 10(4), e0119470.

  2. Ross, J. K., et al. Changes in back muscle activity after osteopathic manipulation: A pilot study using MRI and EMG. Journal of the American Osteopathic Association. 2004. 104(6), 255-265.

  3. Dishman, J. D. et al. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology. 2018. 38, 96-102.

  4. Haavik-Taylor, H. et al. Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study. Clinical Neurophysiology. 2007. 118(2), 391-402.

  5. Pickar, J. G. et al. Reflex changes in trapezius muscle activity following spinal manipulation of the cervical spine. Journal of the American Chiropractic Association. 1993. 30(11), 11-14.

  6. Bialosky, J. E., et al. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual Therapy, 2009. 14(5), 531-538.

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