Spinal adjustments, also known as chiropractic adjustments, are a core component of chiropractic care. These adjustments involve the skilled application of a controlled force to specific joints in the spine and other areas of the body. In this blog, we will discuss what an adjustment is, what that popping sound is and what to expect during your first visit and first adjustment. We will also go over some common myths about chiropractic adjustments and lay out the facts about what the science says.
The Chiropractic Adjustment
A chiropractic adjustment is a technique that chiropractors will use as part of the treatment of spinal and extremity conditions. An adjustment starts by the chiropractor choosing the joint that needs to be adjusted, taking that joint to its end range where the chiropractor then delivers a high velocity, low amplitude thrust to the joint. This is where the “cracking” sound typically occurs.
There are many theories as to what the effect of chiropractic adjustments have on the body. Some of these theories include (1):
1. Resetting muscle spindles to allow the body to overcome muscle spasms
2. Stimulate mechanoreceptors
3. Break up scar tissue and other adhesions within the joint
4. Removal of acute joint locking
5. Restoration of movement to help improve joint nutrition and lubrication
6. Release of endorphins from the central nervous systems
While any one or all these theories are correct, we do know that chiropractic adjustments are and can be beneficial for those experience pain, stiffness and dysfunction within their joints. Before being adjusted, It is important that you get assessed by a licensed chiropractor to help determine that you are a candidate for an adjustment and there are no contraindications.
The “Cracking” Sound During Adjustments
The “cracking” or “popping” sound that some patients hear during a chiropractic adjustment is a common occurrence. This sound is often associated with the release of gas from within the joint, particularly the synovial fluid. Synovial fluid is found within joints, and helps to lubricate the joint to ensure the two bones move smoothly.
When a joint is adjusted, it creates a sudden change in pressure within the joint space. This change in pressure can cause gases (primarily carbon dioxide and nitrogen) that have dissolved in the synovial fluid to form bubbles. When these bubbles rapidly collapse, it produces the characteristic sound that people consider to be “cracking”. You can re-create this phenomenon by “cracking” your knuckles!
The production of this sound is a natural phenomenon and is generally not a cause for concern. It should also be noted that the “cracking” noise does not indicate the success or failure of the adjustment, but may provide some sensory feedback for both the chiropractor and the patient.
Dispelling Common Myths
Myth: Spinal Adjustments are Painful
Fact: Studies indicate that spinal adjustments are generally well-tolerated and not painful. In fact, a 2018 study published in the Journal of Chiropractic Medicine found that patients experienced reduced pain and improved range of motion following adjustments (1). Chiropractors employ precise techniques to ensure patient comfort.
Myth: Spinal Adjustments are Dangerous
Fact: Research consistently supports the safety of chiropractic care. A systematic review published in the journal Chiropractic & Manual Therapies in 2018 examined data from 118 scientific articles and concluded that chiropractic adjustments were associated with low risk. Serious complications are exceedingly rare, and the benefits often outweigh the potential risks (2).
Myth: Chiropractic Care is Only for Back Pain
Fact: While many patients seek chiropractic care for back pain, it offers a broader range of benefits. A 2019 review published in the Journal of Manipulative and Physiological Therapeutics demonstrated the effectiveness of chiropractic care in managing conditions like migraine, tension-type headaches and musculoskeletal pain in various areas of the body like the shoulders, elbows, wrists, hips, knees, ankles and feet (3).
What to Expect During Your First Visit to New Era Wellness
Our team of Chiropractors at New Era Wellness prides itself on getting to the root cause of your unique issue/condition, and that’s why each initial visits starts with a thorough evaluation. This analysis utilizes current scientific literature and ultimately aims to address any dysfunction that is found along the way. A full break down of what an initial visit will look like can be found below:
1. Evaluation:
History - Your chiropractor will take a detailed health history to gain insight to how this issue occurred and gather information that can help determine if you are a good candidate for an adjustment. If there are underlying pathologies or other serious health conditions, you may not be a candidate for a spinal adjustment or in some cases, may need to be referred to another healthcare practitioner.
Physical Exam – Once a detailed health history has been obtained, a physical exam will take place to help find the appropriate diagnosis for your condition. Your chiropractor will go over the benefits and risks of the physical exam and obtain your consent before proceeding. The main risk of the physical exam is a temporary worsening of pain due to the fact the structures that are causing your pain will be stressed. It is important to note that this physical exam aims to recreate your pain so that the chiropractor can formulate a diagnosis. This is not for the purpose of intentionally causing you more pain. By recreating your chief complaint, your chiropractor can properly diagnose your condition and create a unique treatment plan that is tailored to you and the pain you are in.
2. Report of Findings:
Once a diagnosis is formulated, a report of findings will be delivered to help you understand what your chiropractor found and how they will go about treating you. A report of findings will typically include the following information:
A summary of your health history and current pain characteristics
A review of the physical exam and the findings from pertinent tests
Your diagnosis
Treatment plan – which includes:
Duration of the plan and frequency of visits (often listed in number of times per week or month)
The modalities with which you will be treated – at New Era Wellness, our chiropractors use a wide range of therapies that include:
Spinal and Extremity Manipulative Therapy or Adjustments
Mobilizations
Soft tissue therapy
Vibration/percussion therapy
Low Level Laser Therapy
Stretches and Exercises
Your prognosis, or how the chiropractor believes your treatment plan and/or condition will play out
**It is important to note that each chiropractor conducts their report of findings in their own way. A typical report of findings was shown above to help you to generally understand what to expect**
3. Treatment:
At New Era Wellness, our chiropractors take a personalized approach to your treatment. It will often consist of any or all the modalities that were listed above. But let’s go over the adjustment, specifically.
Depending on what is being adjusted, the chiropractor may ask you to stand, sit, lay on the chiropractic table on your side, face up or face down to ensure proper positioning. Once in these general positions, you may be instructed to reposition, or the chiropractor may help to reposition before the adjustment occurs. From there the chiropractor may use their hands or specialized instrument to deliver a precise adjustment to the joint that needs to be adjusted.
Sensations:
As mentioned above, cracking or popping sounds can be heard during the adjustment and is generally caused by the formation and collapse of gas bubbles within the joint. While these sounds can be a normal occurrence, it should be noted that these popping or cracking sounds are not needed for the adjustment to have an effect on the joint. So if you don’t hear a cracking sound, it doesn’t mean that the adjustment wasn’t successful.
In addition to these sounds, many patients report a sense of relief, increased mobility and relaxation after an adjustment. Some individuals may experience mild soreness, similar to post-exercise muscle soreness, which is often temporary. If you do feel any soreness after an adjustment, please let your chiropractor know so that they can provide follow-up instructions.
4. Follow-up:
After your first treatment, your chiropractor will book you in for your next appointment. The number of visits will be discussed during the report of findings and will vary depending on your condition and prognosis. Follow-up visits typically occur weekly, bi-weekly or monthly as a general reference point. Again, our chiropractors create individualized treatment plans, so your follow-up appointment schedule will be unique to you!
In conclusion, scientific research supports the efficacy and safety of chiropractic care, including spinal adjustments. If you considering chiropractic care, we hope you trust the team at New Era Wellness to help you get back to being you! To book your first appointment, click the “Book Online” tab found above. We hope to see you soon!
Dr. Jared Borosch, BSc., DC.
References:
1. Ross K. The Chiropractic Theories: How Does Spinal Manipulation Exert it's Clinical Effect? [Unpublished lecture notes]. CP2203: Foundations of Spinal Manipulation and Manual Therapies, Canadian Memorial Chiropractic College; lecture given in 2021
2. Bialosky, J. et al. (2018). The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Journal of Chiropractic Medicine, 17(1), 24- 37
3. Carnes, D., et al (2018). Adverse events and manual therapy: a systematic review. Chiropractic & manual therapies, 26, 45.
4. Coulter, I. et al. (2019). Manipulation and mobilixation for treating chronic musculoskeletal pain: a systematic review and meta-analysis. Journal of Manipulative and Physiological Therapeutics, 42(4), 289-302
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