Patients commonly ask how Chiropractic care works, and what makes the “cracking” sound during manipulation. The answers to both questions are complicated, because the mechanisms of musculoskeletal dysfunction and disease are themselves complicated; many factors must be considered in any particular case study. The science of spinal and joint manipulation can be explained in several steps, none too difficult to understand; but the benefits of manipulation must be seen in the broad context of these steps to truly understand how it works.
When a joint is properly manipulated, it is placed into the physiologically beneficial range of motion, at the taut limits of the ligaments that hold the joint in position. When this is done correctly, the joint is stressed into the direction that is most restores correct motion in that particular region. The doctor first applies an appropriate pre-stress to the joint. At this point, the patient naturally has apprehension (tenses up); when the doctor senses an ebb in this apprehension, he or she applies an instantaneous thrust into the joint plane to make the beneficial correction. The patient’s willingness to let go of their apprehension and allow the doctor to perform the technique is necessary for a speedy and successful recovery from the chief complaint. Therefore, joint manipulation is not something the doctor does to the patient; rather, it is something that the doctor and patient do together.
At the instant of the corrective thrust, the joint undergoes a radical physiologic shift by creating a rapid lessening of pressure in the joint space, activating a protective mechanism in the joint, and creating the popping or cracking sound that is audible upon manipulation. Your joints have a viscous substance called synovial fluid which acts as a lubricant and a source of nourishment to the cartilage that lines the joint surfaces. When the joint is stressed correctly, this fluid accommodates the change in joint volume by instantly releasing dissolved gases, resulting in the sound waves that we hear. During the twenty minutes or so that it takes for the gas to dissolve back into synovial fluid, the dysfunctional joint is stretched into the correct position. This is one of the first mechanisms of manipulation that is beneficial to you; in fact, there is really no other way to deal with lost range of motion at a ligamentous level in the joint, since during conventional stretching programs, the larger overlying musculature will come to tension sooner.
The next beneficial mechanism is the one that provides the immediate and noticeable relief following manipulation. Your body has a system of joint monitoring known as proprioception; it’s one of the ways your body knows where it is in space. If you close your eyes and touch your fingertip to your nose, you finger finds it way through proprioception. This system is comprised of what is known as mechano-receptors; they monitor movement and relay that information to your brain. These receptors are abundant in the musculo-tendionous regions of your body, such as where the muscles are attached to the bones. One of these receptors in known as the Golgi Tendon Organ; it monitors the rate of change of length of a muscle. If the Golgi Tendon Organ senses an excessively rapid change in length, it will trip a reflex in your spinal cord, to cause instantaneous relaxation in the muscle overlying that particular joint or region of your body. When your body has a musculoskeletal injury, muscle spasms occur around the area in an attempt to protect it. However, they can actually cause further injury to your joints, not to mention being a source of great suffering to you. If these spasms continue, they may even become self propagating; they are then known as focal dystonias. These focal dystonias will continue until outside measures are taken to bring them back under the normal control of your body. When manipulation is directed correctly to areas plagued by spasms, the relaxation mechanism of the Golgi Tendon Organ instantly breaks these focal dystonias, and patients will see a noticeable reduction in pain. The specific nature of the complaint and the factors causing the underlying problem dictate the treatment regime and the number of times the treatments must be performed; so, the doctor needs to find the causes of the problem and treat the cause as much as the symptoms.
Chiropractic care generally helps people reduce pain in three ways. First is the severity of the pain; this is a measure of how much the pain hurts on a scale out of 1-10, with 10 being the worst pain you’ve ever experienced. The second is the frequency of the pain; this is how often you experience pain. This can be classified into seldom (25% of the time or less), intermittent, (25% – 50% of the time), frequent (50-75% of the time), and finally constant (75% – 100% of the time, including sleeping). Lastly there is the duration of the pain; this is how long the pain persists. If you are in active treatment for your complaint, Chiropractic care should reduce all these variables.
Patients’ injuries can generally be classified as acute or chronic. Acute injury patients are otherwise pain-free individuals that have very recently incurred some form of pain related to the muculoskeletal system, and will rapidly return to normal with a minimum of correct Chiropractic treatments (usually one to five treatments). Their body has not had sufficient time to undergo permanent changes from ongoing neglected musculoskeletal stress. Chronic pain sufferers, by contrast, are disabled by degenerative conditions that have lead to long-term complaints that will not completely resolve. However, they can make acceptable improvement with correct care. Patients with degenerative arthritis are a prime example of this group. In these patients, changes in the joints’ internal structures do not allow for the proper functioning of the joint, and cause activation of stress responses forming frequent and continued muscle spasms. If left unattended, this cycle of muscle spasm will become more frequent to the point where pain is felt all the time. There are many systems of health care to deal with these patients, and often combinations of several health care systems are necessary to bring the patient to the highest level of functioning with the lowest level of pain. Chiropractic care uses joint manipulation in combination with exercise therapy to bring the joints to a more normal level of functionality, thus reducing the nature of suffering to an acceptable level. In these cases, it is necessary to perform several weeks to several months of proper care to retrain the muscles overlying the dysfunctional joints to return to normal service. The length of treatment depends on the seriousness of the individual pain complaint. The doctor monitors for appropriate improvement, and determines when the patient is reaching maximum medical improvement. Patients that are active participants in their treatment plans and comply with the specific recommendations by their doctor can anticipate subjective improvements of between 60% – 100% of their pain complaint. Once the initial treatment regime has delivered its maximum level of relief, the doctor notifies the patient that further improvement is not likely, and explains the need for attenuation of treatment and the need for supportive care. Supportive care is manipulation and therapy delivered intermittently to maintain the initial level of improvement, and will vary from patient to patient depending on the severity and the specific nature of the complaint. Its frequency is determined by the frequency at which the patients slip back to the symptomatic phase.