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.

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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…

Aspirin

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

Chiropractic for Military Personnel

Christopher Duncan DC
March 2007

With the recent inadequacies found within the military healthcare system and Walter Reed Hospital, there have been many attempts to determine how far the lack of care for our soldiers goes. According to a 2006 report by the Veterans Administration, “42.7 percent of veterans who sought VA health care after returning from duty in the Middle East or Southwest Asia were diagnosed with a musculoskeletal condition…making it the most common diagnosis among the subject population.” This diagnosis is understandable when considering that these soldiers stand, march, and run around in combat zones wearing, at times, over 80 pounds of gear. That additional weight adds extreme stress and strain on the back and on the body over all.

The Department of Defense (DoD) has done research and determined the most cost effective and efficacious method of treating these conditions. Yet the DoD does not make it available to the soldiers deployed overseas, and stateside its use is limited if even possible to receive when they return home. This treatment is Chiropractic. Chiropractic care has been shown to be extremely effective in treatment of musculoskeletal conditions. As far back as 1986 research done by the DoD has shown the efficacy of chiropractic in regard to musculoskeletal conditions, the number one complaint of returning soldiers.

The research was so conclusive that in 2001 the National Defense Authorization Act replaced the demonstration program. According to the Tricare (the DoD health insurance company) website, “Chiropractic care became a permanent benefit for active duty at designated sites on October 1, 2001. The Chiropractic Care Program is currently available at 42 Military Treatment Facilities.” The website also lists a total of 236 treatment facilities. That means that there are 194 facilities where returning soldiers cannot receive this proven and cost effective treatment for their number one health care complaint.

Utah soldiers do not really have the option. Those preparing to mobilize, returning home, and those stationed here receive treatment at Hill Air Force Base Medical Facility. The closest authorized chiropractic facility for our fighting forces in Utah would be in Colorado over an 8 hour drive. These soldiers are not left without care, according to Tricare soldiers, family members, and non-active duty personnel, “…may seek chiropractic care in the local community at their own expense,” because, “Chiropractic care received outside of the designated locations is not covered under the Chiropractic Care Program.”

Due to the nature of their work and for force security many of our Special Forces troops can’t reveal their identity. One such is a veteran of the war in Afganistan. He is a Staff Sgt. and served in Afganistan from 2001 to 2002. The US Military does an excellent job of making sure that all their soldiers are in peak condition because a unit can only move as well as its slowest component. When asked about his training he said, “We train hard, and we’re in good shape.” However even these soldiers after all that training can get injured, especially when they are carrying their daily load of 150 pounds with ammo. When asked if he and others in his unit suffered any musculoskeletal injuries his response was, “oh yeah, but we don’t complain.” This soldier never received treatment for his back and knee injuries from the military. When he came home they were bad enough that he sought chiropractic care at ALIGN Rehab and Wellness Center, a local Provo based clinic. Because the military doesn’t cover chiropractic outside of the designated locations, he had to pay out of his own pocket.

Dr. Christopher Duncan, a chiropractor at ALIGN where this soldier was treated, comments on the injuries that are seen with these returning soldiers and the success that they have had with chiropractic treatment. “Most of the injuries that we see are overloading or repetitive stress injuries. These types of problems are the bread and butter of chiropractic. It’s what we do. We have seen a great success with the soldiers who come to us with these problems. In fact these soldiers are in such good shape beforehand that their recovery if not delayed is faster than normal. It really is a shame that Tricare doesn’t extend coverage to local chiropractors in the same manor that other insurance plans do. That way, if these soldiers don’t live near a designated military facility they could go to their local doctor, get the care that they need and still be covered for it.”

The US Military is the finest in the world, with soldiers well trained and well armed. Congress has already granted all active duty soldiers chiropractic coverage in their health care package. Here in Utah, overseas, and in 194 military stations with access to medical services, they just can’t use it.

UPDATE: Legislation Would Provide More Chiropractors at VA Centers Nationwide

Obstetricians and Chiropractors Working Together

Christopher Duncan DC
February 2007

Low back pain and pregnancy can go hand in hand.  In fact, studies show, as many as 80% of pregnant women experience low back pain.  However, just because it is common does not mean that it should be viewed as normal or untreatable.  Like back pain during pregnancy, poor eyesight is extremely common today, but we don’t just endure it.  Optometry can provide relief to those with bad eyesight.  Similarly there is effective treatment and relief for low back pain during pregnancy; it does not simply need to be endured, but that is just what is happening.  In a recent study at Yale it was found that only 32% of women report their low back pain to their healthcare provider despite the pain being so severe that it caused sleep problems and impaired their daily activities.

Because pregnant women cannot use standard medical approaches to reduce the pain, due to the possible effects on the unborn child of prescribed medication, they often do nothing.  Some providers don’t know the different ways available to treat this problem.  Some just recommend stretching and hot baths.  A few providers have discovered a way to help their patients without the use of drugs.  Obstetric physicians and midwives are increasingly utilizing chiropractic and massage therapy for their patients along with educating their patients regarding home care options that can provide relief. In conjunction with traditional medical care chiropractic and massage have been found to decrease pregnancy pains, decrease labor times, improve the quality of life while pregnant, and decrease the risk of serious complications overall.

Pregnancy is a time when a woman’s body is going through drastic changes and often pain. There are many reasons for back pain during pregnancy. Most women gain between 20-35lbs during pregnancy which adds stress to joints. Hormonal changes in a woman’s body causes joint laxity, which aids in the birthing process, but also contributes to decreased support for the joints. As the dimensions of her body change so does her center of gravity. Her body is not used to this new position and her muscles attempt to compensate for the change.This can lead to muscular imbalances, increased muscle fatigue, and abnormal strain.

The largest difficulty in getting these women treatment is a lack of knowledge.  If you have poor eyesight everyone knows you go to the eye doctor.  Not everyone knows about chiropractic and what it can do for pregnant women even their care providers may not know.  Here in Utah County some doctors are trying to change that.  Working with obstetricians, midwives, and birth educators I am trying to get the word out.  I am giving lectures on pregnancy and back pain in clinics and guest speaking in childbirth education classes.  If you treat pregnant women or know someone who is pregnant do them a favor and let them know that they don’t have to suffer through the pain.  There is help.

House passes directive on chiropractic care

House passes directive on chiropractic care

May 29, 2008 — The U.S. House of Representatives has approved a directive that orders the Pentagon to make chiropractic care a standard benefit for all active-duty military personnel. The legislation is contained in H.R. 5658, a bill authorizing defense programs in fiscal year 2009, and is based in part on recommendations from the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC).

The bill — passed by the Armed Services Committee on May 14 and the full House on May 22 — also contains language allowing for chiropractic demonstration projects at overseas military locations and clarifies that chiropractic care at U.S. military facilities is to be performed only by a doctor of chiropractic.

In 2000, Congress passed and the president signed a

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similar authorization bill, which contained language calling on the secretary of defense to develop a plan to get the chiropractic benefit to all active-duty service members

To date, DC are at 49 military bases around the country; however, according to a 2005 Government Accountability Office (GAO) report, only 54 percent of servicemen and women eligible for chiropractic care can reasonably access the benefit. This most recent legislation shelves the plan approach and simply states that chiropractic care is a standard healthcare benefit.

According to ACA sources, the House Armed Services committee also expressed concern that there were no doctors of chiropractic stationed at overseas military facilities.  The language contained within H.R. 5658 allows the Pentagon to conduct demonstration projects to implement chiropractic care at these sites.

Source: American Chiropractic Association, http://www.acatoday.com