chiropractic adjustment

Chiropractic Care Facts vs. Fiction

From sitcoms to movie depictions, the chiropractic profession has certainly earned its ‘good sport’ award as we’ve watched actors enact what they believe to be a re-creation of a chiropractic adjustment accompanied by a very loud series of noises.      

In reality, though, one of the most commonly asked questions in a chiropractic office is “What is that sound?” Patients are often inquisitive about the ‘popping’ and ‘cracking’ sounds and different types of chiropractic adjustments that can be utilized.      

Many patients have visualized that chiropractic care is ‘one thing’ and done only one way. They may expect back-wrenching positions like they see with sitcom stereotypes. They may expect loud noises. They may think that just anyone can provide an adjustment. These notions, however, are far removed from the actual patient experience in a chiropractic office.

The Science Behind the Sound

Doctors of chiropractic (DCs) adjust diarthrodial joints. These are freely moveable joints created by two bones surrounded by a joint capsule. The capsule is filled with a lubricant called synovial fluid. Synovial fluid also serves as a source of nutrients for the cells that maintain the joint cartilage. Within its contents, synovial fluid also contains dissolved gases of oxygen, nitrogen and carbon dioxide.  

Facet joints (also called zygapophyseal joints) are synovial joints that are found between vertebral bones along the length of the spine, on both sides and at the top and bottom of each vertebral segment. They allow for the variety of bending, arching and twisting motions that come from our spine. Facet joints are the most common joint type adjusted in the chiropractic office.

The formal term for noise when moving a joint is ‘joint cavitation.’ When a joint capsule is stretched to a point of resistance, it creates pressure within the fluid that causes the exchange of dissolved gases. Recent studies indicate that the process may actually create a cavity within the capsule fluid allowing this to happen

DCs will often explain this to first-time patients so they are not alarmed. It’s important for patients to know that their bones are not literally ‘cracking.’  

Patients may ask questions such as:

  • Is the sound from bones grinding together?
  • Is the popping sound causing damage?
  • There was no sound, did the adjustment happen?
  • Can I safely adjust myself or have a friend do it?

As we just described, the sound itself is not bones rubbing together. The sound certainly does not indicate damage or we wouldn’t adjust people. The presence of a noise, or lack of it, in no way indicates the success of an adjustment, it is normal and expected should it occur; and lastly, only a trained provider should attempt the procedures.

Types of Adjustments

Despite common lingo about ‘back-cracking,’ chiropractors do not ‘crack’ the spine. A chiropractic adjustment is a safe, controlled force applied to a joint/joints to restore proper function and mobility

Adjustments provided by DCs are very precise corrections that address the way a joint has shifted. Unlike popping your knuckles to simply make a noise, DCs examine and palpate the spine to determine the exact joints involved and the x-y-z axis (three-dimensional space) of how they have moved out of alignment. They are then able to issue a gentle controlled adjustment with a precise line of drive applied to the particular joints that are involved.

Chiropractic is not limited to only the spine. DCs also understand the complex anatomy associated with the joints of the extremities: shoulder, elbow, hand, hips, knees and feet. They are specifically trained to evaluate and adjust all areas of the human skeleton.

To accomplish this goal, there are a wide variety of effective techniques that DCs learn and implement. These include popular hands-on techniques or may utilize special tables with pieces that drop away, and/or instruments. Though joint noise does often occur, different types of adjustments will have different levels of cavitation. Many methods will not have any noise at all but they are as equally as effective in correcting joint alignment. There are many named techniques out there, and your DC will pick one or a combination that they feel is best suited to your individual needs. A broad overview and explanation of what you might experience are given here:

Hands-on Techniques: There are a variety of techniques that go by different names to delineate different hands-on manual adjustment methodologies. With some of them, you may lay on a table, with others you may sit in a chair or use a piece of equipment designed for the low back. Your body will be positioned according to what joints are being addressed and which method is being utilized. With these techniques you may be more apt to hear a cavitation noise, however, it is also not unusual for a bone to silently slip into place during the procedure. 

Special Tables: For certain techniques, special tables may be indicated. Some chiropractic tables will maneuver patients from a standing position, and lower them to a position lying face down. These tables are to maintain the weight-bearing position that a patient had standing, and also to make it more convenient for patients that may have trouble maneuvering positions.

Some tables may have moving pieces that the DC will use to facilitate the adjustment. These require less body positioning. Patients will hear the sound of the moving pieces during the adjustment and may feel a slight shift in the position of a table piece. Other tables may have features that move to provide traction and/or bend to address specific spinal joints or spinal areas. 

Instruments: Small hand-held instruments are used by many DCs. They are spring-loaded mechanisms and provide rapid low-force impulses to targeted areas. The goal is to issue rapid impulses in the direction of correction before the muscles have a chance to tense up. The impulses can be calibrated to be extremely light or heavier depending on the patient and region or joint being addressed. Instrument adjusting is less likely to result in cavitation.

Care vs. Comedy

A diarthrodial joint provides the ability for movement but it also limits movement to prevent injury. It isn’t difficult to pop a knuckle and stretch a joint capsule to make a noise, but a well-meaning friend trying to pop your spine (like on a sitcom) could actually over-stretch the capsule or move joints in the wrong direction and cause more harm. This is why only trained professionals should ever attempt to adjust your spine and extremities.

When care is implemented by a trained provider, such as a DC, specific adjusting affords multiple benefits including:  

  • The restoration of optimal range of motion.
  • The normalization of local nerve function (or even vascular function) for those structures that might be directly impacted.
  • The relaxation of muscles adjacent to the joint as they are able to stop ‘protecting’ the joint through spasm and resume their natural position.
  • A decrease in inflammation when the stress on the joint capsule is resolved. 
  • A decrease in pain through the release of endorphins at the region of care.

As we get joints moving, a chiropractic adjustment is multifold and holds the advantage of not only properly optimizing joint function but also providing patients relief from the many symptoms associated with it.

Woman in yellow high heels shoes.

Balancing the Hype and Harm of High Heels

Balancing the Hype and Harm of High Heels

The appeal of the high heel has spanned centuries, but what is the motivation to strap a 4-inch peg on the back of your foot and try to walk around? Psychological science says that incentives are multi-faceted and can range in a spectrum from utility to vanity and include reasoning such as:

  • Wanting to be taller/reach things/feel more powerful in groups.
  • The desire to seem more attractive/sexier gait/enhancing the appearance of the calf muscle/the illusion of elongating the legs or looking slimmer.
  • Aspiring to be on top of fashion trends/help clothes hang better/status symbol/look more affluent.

Whatever the reason, high heels are big business. The global high heel footwear market is projected to grow by USD $2.39 billon by 2027. But what is the real cost for consumers who regularly buy and wear high heels?

Paying the Physical Price

Each foot is comprised of three arches, 26 bones, 30 joints and more than 100 muscles, tendons and ligaments. When you slip on a pair of heels, the biomechanical changes that occur in the feet and up the kinetic chain are immediate. With gait, changes were found in the rollover function of the foot, ankle, knee joints and lower back. Step length and balance are also compromised which increases the risk for falls, stress fractures and sprain/strain injuries of the ankle.

An increase in heel height forces the foot into more pronounced plantar flexion (pointing the toes toward the ground) which, in turn, affects the knee and the curve in the lower back. Low back and leg pain are common due to compressive forces and as major joints all the way up the kinetic chain become affected from the unnatural shift in heel height

In the long term, pain and deformity are very real concerns. When you think of the shape of most high heels, the deformities fit like puzzle pieces as individuals force their feet to adapt to the shape of their shoes:

  • Hallux valgus (aka a bunion on the inside of the foot near the big toe) has been noted in heel wearers as is a deformity of the pinky toe creating a similar situation on the outside of the foot
  • Haglund’s deformity occurs as a lump on the back of the heel(s) near the Achilles tendon attachment which can then lead to pain and bursitis. Since it often develops in people who wear pump-style heels, it is also referred to as ‘pump bump.’
  • Wearers are also at higher risk of developing hammer toes, corns, heel spurs, plantar fasciitis, flattened arches, stress fractures, knee damage and low back pain. 

Studies have shown that regular high heel use may compromise muscle efficiency in walking causing wearers to often experience discomfort and muscle fatigue due to structural and functional changes in the muscles of the lower leg. A 2022 study concluded that balance control was affected for regular wearers not only while in the shoes, but also it did not correct itself in a natural barefoot state which is evidence of lasting change.

Because of the stress and wear and tear to the cartilage of joints, osteoarthritis is another concern. High heels cause stress to the entire foot and the change in foot strike translates up the kinetic chain. Knee osteoarthritis in particular has been an ongoing finding due to altered biomechanics.  

In healthcare offices low back pain has also been an ongoing and prevalent finding in women who wear heels. With your toes plantar-flexed, the joint function of the foot is altered, the hips shift forward and your spine has to balance out the weight by overarching backwards, all of these changes start with the unnatural stresses on the foot joints which move all the way up the kinetic chain to the spine.

Tips for Balancing High Heels with Health

It’s clear that high heels are here to stay and you don’t have to give them up altogether. However, there are several strategies that you can take to mitigate the risks involved with wearing them. 

  • Choose flexible shoes with a wider toe box.
  • Try not to go over two inches. Even a heel as low as 3/4 inch has
    been found to increase the pressure on the forefoot by as much as 22%.
  • Select a wider heel base (vs. skinny heels) to disperse weight and increase balance.
  • Be mindful of how often you wear heels. Only wear them occasionally/when absolutely necessary. Wear comfortable shoes to and from the office and only put the heels on for meetings, presentations or special occasions.
  • Perform exercises to keep the stabilizing muscles of your foot strong and your calf muscles stretched.

Wearers may also find benefit from custom orthotics to maximize the support of the foot while wearing heels. A study published in the Archives of Physical Medicine and Rehabilitation found that 40% of patient participants had increased function and a significant reduction in low back pain through a combination of custom orthotics and chiropractic care. Your doctor of chiropractic (DC) understands the complex structure of the foot and can support healthy foot function through evaluating and adjusting the joints of the foot, knee, hip and low back (up the kinetic chain) to reduce pain and keep joints functioning optimally. DCs can also advise on footwear, demonstrate exercises for foot stability and help you to obtain custom orthotics for your heels so that you can maximize function, balance and strength when wearing them.

Aging Strong

Aging Strong: Maximizing Stability to Diminish Fall Risk

The deterioration of skeletal muscle with age (affecting mass, function, strength and stability) has increasingly been referred to as ‘sarcopenia’ and it is one of the most significant causes of functional decline and loss of independence in older adults

Muscle mass accounts for up to 60% of body mass. As we grow older, muscle mass decreases approximately 3-8% per decade after the age of 30. After the age of 60, the rate of decline is even higher. In fact, by the eighth decade of life up to 50% of muscle mass may be lost

Maintaining strength and stability is paramount to maintaining independence. A meta-analysis from 2020 that included ten studies concluded that sarcopenia was significantly associated with a higher risk of falls among independent community-dwelling older people.

Skeletal muscle not only contributes to our strength and balance, it is a metabolically active tissue that, when diminished, can have profound consequences for older adults on a variety of levels. It is important to note that a decrease in muscle mass is correlative to an increase in fat mass. This change in body composition is also associated with an increased incidence of insulin resistance in the elderly. These changes in our physiology can affect bony density, joint stiffness and have implications for conditions such as type 2 diabetes, obesity, heart disease and osteoporosis.

Complications with COVID-19 

Prolonged quarantines due to COVID-19 created even more of a problem for slips and falls for older adults by facilitating more sedentary lifestyles and severely diminishing normal activity outside of the home. The extended time indoors contributed to a more prevalent decline in muscle mass. Slips and falls were reported as the most common mechanism for hip fracture during the pandemic outbreak.

Studies have revealed that atypical symptoms of COVID-19 also may include: falls, delirium, confusion, dizziness and usual fatigue. Disorientation, loss of strength and dizziness all put older adults at an increased risk for falls. If an otherwise healthy adult becomes dizzy, weak, suffers imbalance or falls down, they should visit their health provider for appropriate testing. 

Movement to Build Strength and Resilience

The first step to avoid fall risk is to get moving. To combat decreasing muscle mass we need to use our muscles. Remember that the tendons from skeletal muscle attach to bones. Muscle work creates resistance to help bones remain dense and become stronger to avoid frailty. Your chiropractor can help guide you through any/all of the exercise types listed here.

A regimen of exercises can help keep muscles strong and flexible which also aids in maintaining good balance. Many Medicare-Advantage Plans and some Medicare Supplement Insurance Plans may include a fitness component. Ask your agent if ‘SilverSneakers’ is part of your benefit and if it is, take advantage of what the program offers at your local gym facility. If this is not available to you, take heart that exercises to keep toned muscles don’t require a gym membership or any elaborate equipment and can be performed at home.

Weight-Bearing Exercises: These are performed on your feet. Gravity exerts a force on your bones while you remain upright. Your muscles and tendons are forced to pull on the bones which then stimulates activity in the bone cells. Examples include activities like: dancing, aerobics, hiking, power-walking, jumping rope or climbing stairs.

Strength/Resistance Training: These are accomplished lifting free-weights or using exercise tubing that you pull to create resistance. To tone muscles use low weight/high repetitions. For resistance strength training utilize higher weights with fewer repetitions to target specific areas that may be prone to fracture. If you don’t have weights, start with soup cans from your pantry. 

  • Perform wall push-ups to use your body weight.
  • Pick a stair and stabilize with the railing, raise up and down on the balls of your feet to work your lower legs.
  • For your core, lay on your back on your bed and hold your straightened legs in the air. Try laying on your back and moving your legs as though you are on a bike. If you can get on your hands and knees on the floor, practice planks. From hands and knees you can also stretch one leg out straight behind you in the air and hold the position, then switch legs to increase balance and engage deep back muscles.

Isometric Training: These are completely static exercises. This means your muscles contract without your joints actually moving. If you suffer from joint pain or need more low-impact styles of exercise, isometrics are a great option to build bone strength and density, they help to build and maintain muscle mass and improve balance and coordination.

Strategies to Avoid Falls

As we age there are a variety of approaches that we can use to avoid falls: 

  • Implement a regimen of exercise to stay flexible and maintain muscle strength. 
  • Maintain optimum nutrition. Ensure ample Vitamin D3, Calcium, Magnesium to support your muscles and bones. Collagen peptides may also contribute to better bone mineral density
  • Invest in comfortable shoes with good support. Custom orthotics are an option available at many chiropractor’s offices.
  • Always use a shopping cart at stores to enhance stability.
  • Ensure you use handrails for all stairs and install them in the bathroom (in the slippery shower and next to the toilet).
  • Rise slowly from bed (whether it is morning or during the night to use the restroom). Rising slowly to a seated position and then waiting a moment will give time for blood flow to reach your brain and avoid the dizziness that could occur from getting up too fast.

Chiropractic care can help you stay strong by maintaining proper joint alignment through neuromusculoskeletal care. Doctors of chiropractic (DCs) also can advise on nutritional support for your muscle, bone and joint health, and can demonstrate exercises that can help you optimize muscle strength, proprioception (balance) and bone health to promote resilience and reduce your risks for slips and falls

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