What Does a Chiropractic Adjustment Do?

This is such a common question, is continually being researched, and is so rarely answered well, that I thought it would be good to create a full page to the answer.  I will also update it periodically?  When I do update it I will create a post about the update so that you can be kept up to date, and the information will be all in one place.

In my first post on this topic.  I decided to leave out some reasons for space limitations (I try to keep my blogs under 400 words, not that I’m always successful), and some for the lack of research, some for  them being controversial, and many others I just don’t know about.

So, here goes…

Chiropractic manipulation is not just joint popping. In fact the audible pop doesn’t even need to occur for a successful manipulation, though it often does, and some patients and doctors like to hear it. Research has found that “pop” or not, the same benefits are experienced.

The mechanism of why manipulation works is not completely understood. One thing that is understood is that it does work. Most of the simple explanations are incomplete or just plain wrong. The most recent research points to a more complex reason for the therapeutic effects of chiropractic manipulation. It is suggested that many things are occurring at the same time that provide the benefits.

Here are some of the known things that can begin to explain why manipulation works.

1. Proprioceptive stimulation triggers the release of endorphins. These endorphins cause a near instant and temporary relief similar to pain medication making you less aware of the problem. This “trick” of the body can cause a secondary benefit, that of relaxing local tissues such as trigger points or tight musculature that may be “pinching” nerves.

2. Manipulation provides improved nutrient supply. The cartilage and other structures inside of a joint have no blood supply. These structures get their nutrients through motion. The blood supply goes to the outside of the joint and nutrients move into the synovial fluid of the joint. Joint motion moves this fluid around thus providing fresh nutrients to all parts of the joint. If a joint becomes “locked down” by muscle spasm, scar tissue, a cast, or any other means for a prolonged period of time the joint begins to feel stiff. You know the feeling of needing to stretch after sitting in the car for a long time.

The facet joints in your spine are particularly vulnerable to this problem because they work in tandem and because of the body’s amazing ability to compensate. Your facet joints all work together, if one is injured it can become locked down to prevent further injury. When this happens you may get the desire to stretch or move your back. This usually works, but if all of the other joints compensate for the problem joint and take that added stress of movement on themselves then the problem joint stays locked down. Specific manipulation induces full range of motion and synovial fluid movement.

3. Your nervous system is the control center of your body, and it is not without weaknesses.  Nerves and nerve bundles are soft tissue.  They don’t function well under physical pressure.  In fact it has been shown that inflammation, a bulging disc, or fragment floating around can interfere with proper nerve conduction.  The “stuck” joint as discussed previously can also physically be stuck pressing on a nerve, or could be causing inflammation that is pressing on the nerve, or could just be moving in a way that rubs the nerve.  In any case.  The adjustment can cause a relief of this pressure. through movement of the joint to the correct position, or motion.

4. The brain also records these proprioceptive signals from the joints motion. Especially for chronic conditions the brain is in need of retraining regarding the motion of that joint. Manipulation takes a joint through its full range of motion. This new input is then stored and replayed in the brain, similar to muscle retraining that physical therapists will do, or physical training of athletes, when the body has done the motion enough times it “remembers” it. This retraining provides a functional correction that may provide pain relief.

Here are some of the more controversial observations, benefits, and mechanisms of chiropractic. (I must note that just because we don’t know how it works doesn’t mean that it doesn’t.)

Somatovisceral effects – That they exist are not so much controversial as the predictability.  We know that the spine can effect the visceral organs, but we can’t really say that if you adjust this level this often in this way that you will get the pancreas to work again.  The mechanism, more likely, is one of many things acting on the organs.  As with everything else in the body it is more complicated than one single interaction.

Reduced high blood pressure – WebMD research article more research needed, and mechanism unknown.

Improved immune system response – I have yet to see a great side by side study of people who receive chiropractic care next to a control group who doesn’t to see who gets a cold and how long they last.  However there are articles and case studies out there.  Even if chiropractic does benefit the immune system, we don’t know the mechanism of how.

Decreased colic in babies – I’ve seen an association, and I’ve read studies that show that there is an effect.  I don’t know the mechanism, and I’ve not seen anything more than theories.

Many other benefits have been observed, and still others suspected. Research is still going on and much more is needed.  I will add them and any new or additional documentation as I find them, and as my time permits.

Emergency-Room Chiropractor

By John Cerf, DC

Original Article

It is unlikely that you became a chiropractor to work in an ER. Imagine my surprise when members of our hospital’s chiropractic department were asked to take a call in the emergency department (ED)! We are now in our second year of providing chiropractic coverage to the ED.

In our hospital, DCs do not work as pseudo-medical physicians. Hospitals and EDs do not need “want-to-be” medical physicians. While trained in diagnosis and knowledgeable of medical procedures, chiropractors in the ED provide services as chiropractors to increase the satisfaction of the most important people in the hospital – the patients. Perhaps you should also consider taking steps to provide care for patients in your local hospital.

In November 2000, Meadowlands Hospital Medical Center in Secaucus, New Jersey began offering chiropractic care in the ED. In an effort to satisfy the Joint Commission on Hospital Accreditation’s mandate to better address pain management, Meadowlands ED Director Gina Puglisi,MD, and Albert Cataffi,DC, former chiropractic department chief, developed and instituted a “chiropractor on-call” program. Dr. Puglisi readied the chiropractors with an orientation program to define the roles of the chiropractors and the rest of the ED in treating neck and back pain patients.

Patients who present to the ED with neck or back pain are screened by the attending ED physician, who is responsible for ruling out serious pathology, fracture, neurological deficit, and other findings that might contraindicate spinal manipulation. The ED physician may order x-rays, blood work or other diagnostic tests. When a severe condition presents, orthopedists, neurologists or neurosurgeons are enlisted to take over the case. Historically, all patients without serious pathology were given prescriptions and discharged from the hospital, with or without adequate relief. With our chiropractor-on-call program, the ED physician now has the option of calling for a chiropractic consultation, which gives the patient the opportunity to receive additional relief.

The typical chiropractic patient in the ED is one that would present only on occasion in a chiropractic office. One such patient was a 33-year-old man who reported injuring his lower back by lifting a heavy airplane tire at work. He found himself immobilized by pain and supine on the cement floor of the aircraft hangar. He remained on his back for four hours before he would admit that he was not going to be able to get up. His coworkers called for the ambulance and he was brought into our emergency department. Following evaluation by the ED physician and radiographic examination, the patient was given injections of Toradol for pain and Flexeril to relax muscles. Due to his persistent inability to ambulate, he was later given an injection of Demerol, a narcotic analgesic. As the patient was still unable to move about, the ED physician called for a chiropractic consultation.

Upon my arrival, the ED physician gave me a summary of the patient’s history, examination findings, and treatment. I reviewed the chart and the available x-ray films and test results. Upon meeting the patient, he was still unable to get out of bed. I performed a detailed history and physical examination to clarify the nature of the patient’s disorder and to further rule out contraindications and the need for additional tests. I performed an analysis to determine the most appropriate type of chiropractic care.

The patient complained of severe lower back pain and paresthesia that radiated down his posterior left lower limb to his foot. My examination revealed severe muscle spasms and vertebral joint fixation. Orthopedic testing was positive for a strain/sprain injury to the lumbar spine. The patient was neurologically intact, with normally responsive deep tendon reflexes, equal bilateral dermatome sensations, +5/5 bilateral great toe strength, and a down-going Babinski’s reflex.

This patient is a good example of a minor injury, by emergency department standards, accompanied by severe incapacitating pain. The medication had not given him sufficient relief. The attending ED physician did not want to resort to stronger narcotic analgesia or hospitalization. The patient would have obviously avoided additional diagnostic testing if something were done to relieve the severity of his pain.

Having determined that chiropractic care was both warranted and safe, I began treatment with the application of electrical muscle stimulation to the lumbar paraspinal muscles. The purpose of the adjunctive therapy was provided to supplement the effects of the medication to relieve spasm and reduce pain and make it easier to perform lumbar chiropractic adjustments. The patient and I discussed his injury and how his body was overreacting with severe pain and muscle spasms. We talked about how this would be an appropriate response if a vertebra had been fractured. He appeared to understand how his body’s overreaction of pain, spasm, anxiety and joint fixation would slow his healing and prevent the quick resolution of his pain. I advised the patient of what I was going to do and what he could expect. I told him to alert me if he felt he would not be able to tolerate continuing the treatment.

The patient moved slowly to a lateral recumbent position in preparation for a side-posture adjustment. As he moved into position, I checked to see that he was not in additional pain. I performed a stretch in the side-posture position to check for patient tolerance. I demonstrated an adjusting thrust to his shoulder so he would know what to expect. As he exhaled, I performed a quick, light, lumbar adjustment to the fixated segments, and noticed a modest release. The patient did not report relief, but he was able to tolerate the procedure without complication. I performed the same procedure on the other side, with a good release noted. Returning to the first side, I repeated the procedure – this time with a good release.

Following the treatment, the patient appeared surprised, noting that his pain had lessened significantly, and that he no longer felt an abnormal sensation in his left lower limb. He was able to get out of bed, dress himself and be discharged from the hospital. On his way out, he stopped at the nurse’s station. The nurses were equally surprised to see that the patient was able to leave the ED under his own power. Not only had the patient improved, but the improvement was witnessed by our medical counterparts.

In the past, it was rare for me to see a patient in this much pain in my office. The ambulance doesn’t bring acute agonizing patients to the chiropractor’s office. I would have likely suggested that the patient be seen first in the ED. Now, as part of that department’s team, I can participate in the early treatment of the severe patient with the backup of a well-staffed and equipped hospital.

John Cerf,DC
Chief, Department of Chiropractic, Meadowlands Hospital Medical Center
Secaucus, New Jersey

Chiropractic & Stroke

Chiropractic has never been shown to cause stroke, though it has also never been definitively ruled out either.  The plain fact is that it is so rare that it is nearly impossible to study enough to prove causality.  However there have been recent studies that indicate that chiropractic may lower your risk for stroke by decreasing hypertension.  “This procedure [Chiropractic manipulation of the Atlas] has the effect of not one, but two blood-pressure medications given in combination,” study leader George Bakris, MD, told WebMD. “And it seems to be adverse-event free. We saw no side effects and no problems,” adds Bakris, director of the University of Chicago hypertension center. Full Article Here

There is a group out there the “Chiropractic Stroke Awareness Group LLC” who claim to make people aware of the risks of chiropractic.  To clarify there are risks associated with chiropractic treatment.  Those risks are less than the risk you take by taking a dose of Asprin, but they do exist.  According to recent studies the risk of stroke following a chiropractic adjustment (not because of, but following) is 1 in 5.85 million.  For perspective here is a comparative list:

Proven Possible Side Effects of…


Chiropractic Manipulative Therapy

  • allergic reaction: hives, difficulty breathing, swelling of your face, lips, tongue, or throat
  • black, bloody, or tarry stools, GI bleeding
  • Liver toxicity
  • coughing up blood or vomit that looks like coffee grounds
  • severe nausea, vomiting, or stomach pain
  • fever lasting longer than 3 days
  • swelling, or pain lasting longer than 10 days
  • hearing problems, ringing in your ears.
  • upset stomach, heartburn, ulcerations, abdominal pain
  • drowsiness, weakness, dizziness
  • headache
  • rash, kidney impairment
  • temporary discomfort in area treated
  • headache, or tiredness.
  • sprain, dislocation or  fracture
Each year, use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs such as Aspirin) accounts for an estimated 7,600 deaths and 76,000 hospitalizations in the United States.

Here are some recent articles on the topic:

Stroke risk not raised by chiropractic treatment – January 25, 2008 – BC Local News

Chiropractic care and stroke are not connected – Posted 1 February 2008 – By Dr. Stuart Kinsinger

Is Chiropractic Treatment Dangerous?

Posted by EditorsChoice
Sunday, 30 September 2007

We’ve all heard stories about someone who was crippled or even killed by a Chiropractor. Sometimes we’re even warned by our family doctor not to let our Chiropractor adjust us as it may cause a stroke. Even the L.A. Times recently called the safety of manipulation into question. Just how safe is chiropractic treatment? What are the facts?

1. Due to the extreme rarity of injuries caused by Chiropractic treatment and its unequaled safety record, chiropractic doctors pay only a fraction (i.e. 1/10 to 1/50) the malpractice rates compared to medical physicians. (1)

2. Only 19 deaths have been attributed to Chiropractic treatment worldwide over the latest 65 years studied (1934-1999). In fact, the risk of “serious injury” from anti-inflammatory medication including Aspirin and Advil is 400 times greater than from manipulation. (2)

In other words, it’s much safer to have a chiropractic treatment for your neck pain or headache then taking medicine (over the counter or prescribed).

3. Nearly 10,000 studies have been performed on manipulation (making it the most thoroughly studied form of treatment for back pain) and the great majority have found the following when compared to medical treatment:

a. Increased patient satisfaction.
b. Shortened time to return to activities or work.
c. Less permanent disability.
d. Less costly.

The governments of several countries, including the United States (A.H.C.P.R.) and Canada (Manga), have found manipulation to be the most effective form of treatment for back pain. In fact, the Canadian report suggested that Chiropractors be the “gate keepers” for back pain saying that it would save Canada hundreds of millions of dollars if their citizens saw Chiropractor’s first. After reviewing all published studies, it was determined that there were “no medical procedures that were as safe as Chiropractic treatment.”

The British Medical Journal and the U.S. Department of Health and Human Services found similar results. In fact, the U.S. government reported that physical therapy and acupuncture were not “cost effective” and that surgery was useful in only 1% of cases.

Further, the report was emphatic that they should be employed only after conservative approaches (like manipulation) were first exhausted.

So why are there still news reports of the dangers of Chiropractic? Lets take a look at the last article that was reported by the journal, “Neurology”, and reported in the L.A. Times.

The study found that seven out of the 51 people questioned who had a stroke were adjusted by a Chiropractor in the previous month. This compared to two of those in the control group. So an association was drawn between manipulation and strokes. The problem with making such an opinion is that headaches and neck pain are the early symptoms of this type of stroke. So of course more people with neck pain and headaches sought chiropractic care versus those who were in the control group who were pain free.

This illustrates the problem with association-type studies. They don’t show the cause only association. For example, the following is a common example taught in research courses that warn against making conclusions from such studies.

Since there are more churches in violent neighborhoods, churches lead to violence. Actually, establishing churches are a reaction to people living in a violent neighborhood, not a cause.

In fact, another study published by the same journal, “Neurology,” found fewer people having strokes if they were adjusted than the control group that wasn’t. Unfortunately, that never made the newspapers nor did most of the other studies which showed chiropractic treatment far safer than all other medical treatments.

Why the media prints inflammatory stories while ignoring others that would put your mind at ease is beyond the scope of this paper. But it is unfortunate that people are being scared away from a treatment that is absolutely safer and more effective and by default being directed to one that has significantly greater risks.

Personally, between Dr. Murray and myself, we have practiced about 40 years and have never injured anyone (more than some temporary soreness as part of the treatment). The real danger comes from having musculoskeletal problems that are covered-up with drugs and surgery. Since the cause is not addressed this way, the patients often get worse, more discouraged and depressed and there are often side effects.

We use only the safest of all procedures and specifically screen for all risk factors that make manipulation unsafe. I’m sure you have already noted how thorough we are. This is the only way that you should be treated by any of your doctors. If you ever have questions about the risks or benefits of any procedure, always feel free to speak to us directly.

(1) Malpractice Statistics from the National Chiropractic Mutual Insurance Company, West Des Moines, Iowa.

(2) Terrett, A, Current Concepts in Vertebrobasilar Complications, NCMIC Group, Inc., 2001, p 199.

Article Source: http://www.articlesbase.com/health-articles/is-chiropractic-treatment-dangerous-222924.html

About the Author:
Dr. Rick Morris is the founder of the The Morris Spinal Stenosis and Disc Center in Santa Monica, Ca. You can read more of his health articles or contact him at his website and find out about his non-surgical treatment of low back pain disorders

Mainstream Makes Adjustments

By Buzz McClain
Special to The Washington Post
Tuesday, July 17, 2007; Page HE01

The sound of cavitation is music to my ears. That’s the popping noise made when a joint is taken past its normal range of motion and a bubble of gas emerges in the surrounding synovial fluid. Keep twisting or pulling and eventually the bubble bursts, relieving pressure on the joint.

And it feels good.

And here it comes again. I’m facedown on a brown padded table, my nose positioned in an opening so I can breathe. My arms hang loosely to the floor and my legs are extended behind me.

It’s comfy here, and I could nap, except Glenn Loebig is probing a tender spot on my lower right back with one of his preternaturally muscular thumbs.

“There it is,” he announces, making me wince with a poke. With his open hands, he presses on my lower back, leans in and with a swift push . . .

Ah, cavitation. And not just one pop but a short, quick sequence of them, creating a snap, crackle, pop effect. “That was a good one!” Loebig says enthusiastically, as if even he’s surprised at the intensity. “That’s going to feel better now.”

Chiropractic medicine has been derided as a fringe practice or worse since founder Daniel David Palmer began adjusting spines just over a century ago. For decades, anyone who wanted chiropractic treatments for backaches or other ailments had to find them on his own and pay for them out of pocket. But times are changing. While the medical profession remains deeply skeptical of chiropractic as a comprehensive health-care approach, more doctors are referring patients to chiropractors to treat lower-back and other musculoskeletal pain.

“I’m an orthopedic spine surgeon, so I treat all sorts of back problems, and I’m a big believer in chiropractic,” says William Lauerman, chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital. “I’m more of a believer for acute problems like short-term back pain, although I know [chiropractic] can be helpful for some cases of more-chronic conditions.”

Chiropractic treatment for short-term back pain — “three or four days, can’t get out of bed, that sort of thing” — Lauerman says, “is one of the few things that has been demonstrated to significantly alter the natural history of acute back pain. . . . People get better quicker if they go to a chiropractor for a few visits.”

An Uneasy Truce

Such referrals come despite the still-thin evidence for chiropractic’s effectiveness. The National Center for Complementary and Alternative Medicine (NCCAM) describes studies of chiropractic for back pain as of “uneven quality and insufficient to allow firm conclusions.” A meta-analysis in the 2003 Annals of Internal Medicine found that spinal manipulative therapy relieved back pain better than sham therapy but no better than other standard treatments.

Chiropractic students study a minimum of 4,200 hours, according to the U.S. Department of Labor, with most states requiring a four-year undergraduate degree and four years of postgraduate training at an accredited chiropractic college. Chiropractors also must pass national and state licensing exams before practicing. But just as in mainstream medicine, sometimes things go wrong. In 2003, a 43-year-old woman in Mahopac, N.Y., suffered a stroke after a routine neck adjustment. The case is headed to court.

“[That stroke] is a rare occurrence, but it is something we have to be concerned about as a responsible profession,” says William Morgan, one of two chiropractors at the Bethesda Naval Medical Center. “We’ll study the risk and will do everything we can to minimize the risk.”

Chiropractic patients now number about 22 million, thanks to medical referrals and the fact that “87 percent of all American workers who have insurance have plans that include chiropractic service,” says Kevin Corcoran, executive vice president of the American Chiropractic Association, based in Arlington. The ACA represents 16,000 of the country’s estimated 60,000 practicing chiropractors.

That doctors refer patients to any of them is a sea change from 1990, when the U.S. Supreme Court refused to hear an appeal of a lower court’s ruling that the medical establishment was trying to put the chiropractic industry out of business through a campaign of denigration. The case, Wilk v. American Medical Association, prompted the AMA to change its code of ethics in 1992 regarding chiropractors.

“I think the majority of MDs recognize the value chiropractors bring,” Corcoran says.

The American College of Physicians, which includes about 120,000 internists and medical students, agrees the doctor-chiropractor relationship is no longer a hot topic. “It just isn’t on our radar,” ACP spokeswoman Susan Anderson says.

The AMA declined to comment beyond noting its revised policy, which says, among other things, “It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient.”

Chiropractors can’t prescribe drugs or perform surgery, but “we are trained to recognize and diagnose and send patients to the appropriate care if it’s something beyond our scope,” says William Lauretti, an assistant professor at the New York Chiropractic College in Seneca Falls, N.Y., and a former chiropractor in suburban Maryland. Some cancers, for instance, “can present as low-back pain. We’re trained to tell the difference when there’s something more serious and more urgent than the basic muscle or joint problem.”

Morgan, a former Navy petty officer, has been working under contract alongside staff physicians at the Bethesda Naval Medical Center for nine years, trying to relieve symptoms and reduce dependence on medication. In many cases, he’s the first chiropractor his patients have ever seen.

“They trust their physician a great deal, and if they think I can help make them better, they’ll trust me, too,” he says. “And if I can’t make them better, then we’ll find someone who can.”

Making Adjustments

When I stand up, I see that Loebig is right. It does feel better. What had been a nagging bundle of deadline tensions and bad posture knotted up on the inside of the right hip is now a pressure-free zone of happiness that gladly accepts its fair share of weight distribution. I twist from side to side. My hips glide with newfound ease.

A study conducted over seven years by a physician and a chiropractor and reported in June’s Journal of Manipulative and Physiological Therapeutics showed that patients who turned first to chiropractors and other alternative-medicine professionals for care were hospitalized and had surgery 60 percent less often and spent 85 percent less on pharmaceuticals than those with medical doctors as primary care providers.

And that’s what I’m counting on. After three spinal surgeries since 2002, two lumbar and 2004’s brutally intrusive cervical fusion, which put a piece of cadaver bone in my neck in a procedure that was supposed to correct chronic shoulder and arm pain — and didn’t — I’m hoping to minimize my time under the knife.

My neurologist, who is trying to find the right combination of chemicals to control that pain, prescribed chiropractic as part of his treatment. Loebig focuses on my shoulder and arm, finishing each visit with adjustments to the neck and lower back.

“That should help your golf swing,” Loebig says with a pat on the back as he makes marks on my chart.

I’ve been adjusted, and not just my back and golf swing but my outlook as well. I step into the bright sunshine outside Loebig’s Great Falls office a little lighter on my feet, a little less aware of the chronic pain in my right shoulder. My head feels looser on my neck, and I feel taller. The sensation of well-being won’t last, I know. It could be a matter of days, or even hours, before the pressure builds again and my joints stiffen with stress and tension. But for now, I’ll take it. ·

Buzz McClain is a Washington area freelance writer. Comments:health@washpost.com.