The Zen Corner

Science, Art, and Philosophy of Chiropractic


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What happens when my Low Back Pain makes Clicks and Clunks?

Recently this article came across the Gonstead Clinical Study Society database. The title was “Clicks and Clunks with Low Back Pain: What Do They Mean?” This article was a literature review by the International Musculoskeletal Medicine in April of 2009. Dr. Steve Tanaka D.C summarized this article review.

Summary of the article:

To review knowledge about noises arising from the joints of the back, which can be felt or heard by back pain patients or those undergoing treatment for back pain. Materials and methods: A literature search relating to the clicks and clunks that can be heard or felt by patients with back pain either with normal movement or during manipulation. The databases searched were Pubmed, Embase, TRIP, CINAHL, and Amed. The text terms click, clunk, and pop was used. In addition, experimental work was reviewed which aimed to elucidate the mechanism by which noises can be produced in synovial joints.

The Conclusion of the Review:

Most of the literature deals with the mechanisms of clicks in joints in general and in finger joints in particular. In the spine, there are many references to the ‘popping’ of facet joints in the spine as a result of manipulative therapy. Research has centered around an examination of cavitation and the formation of a gas bubble in the joint cavity when the joint surfaces are distracted. There was scant information about clicks and clunks in relationship to the presentation of back and neck pain. Studies have found no correlation between clicks and the typical electromyographic changes produced at manipulation, nor with therapeutic benefit. Conclusion: The significance of clicks and clunks in joints, whether occurring naturally or during treatment, remains uncertain.

Discussion of the Topic:

Unless something more finite comes along, most people accept the idea that a gas cavity or bubble of carbon dioxide forms. When it collapses or cavitates, a sound is produced. Some have brought up the concept of capsular ligament “snap-back.”

Many studies have been done on the metacarpophalangeal joints. Some studies have been done on the cervical spine, lumbar spine, and sacroiliac joints. Most agree that the sound comes from the zygapophyseal joints. In sacroiliac joint and lumbar manipulation studies, the sound has been found to come from the lumbar spine, and sometimes from multiple levels ( due to the use of “lumbar roll”?).

Comments from Gonstead Clinical Study Society:

“I wonder what actually accounts for the difference between a well-done Gonstead adjustment and the higher pitched sound of many manipulative treatments and less than effective Gonstead adjustment attempts? We say what we think it is—sound of adjusting through the disc, rather than the apophyseal joints.” Dr. Steve Tanaka D.C.

Clicks and Clunks With Low Back Pain

The last comment by Dr. Steve Tanaka mentions between adjusting through the disc rather than the apophyseal joints is a technical comment that most Gonstead chiropractors would understand.

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The apophyseal joints location in the spine is mainly a synovial joint that has fluid that can produce gas cavity or bubble from organic gases from carbon dioxide. Most people will hear this popping noise when there is a slight movement or a quick movement in the joint. These rapid movements with a popping noise are thought to be chiropractic adjustment.

A well-done Gonstead adjustment has a specific force with control into the person’s spine. The goal of the Gonstead adjustment is setting the spinal segment with the health of the disc in mind instead of restriction and movement.

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Forceful Cracking

Many people have seen cracking, snapping, and popping in their necks and backs. There are too many homemade tutorials that claim to be therapeutic and relaxing. Some would teach to do on their own, which can be very dangerous because this can cause other health problems as previous blogs have mentioned.

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Forceful cracking of the neck and back by an unprofessional can cause unwanted side effects because there is no knowledge and experience from a professional. So people who learn forceful cracking the neck and back on youtube, rely on their muscle force and override the resistance of another. There is a sheer force of mass and speed that overrides the person’s response to guard and move the joints in order to create the sound effects. Which this sound is often mistaken for the therapeutic product for relaxation and removing pain. While there is a cracking, popping, and snapping going on, there is also the possibility of damaging structures.

  1. Sprain the local muscle groups, which can cause soreness, sharp pains, and dull achiness from damaging the muscles from the sudden shear force.
  2. Damage the disc from twisting the disc and tearing the annular fibers of the disc, which can endanger the person to have disc herniations in the future.
  3. Fracture the spine and causing more permanent damages. Bones in the spine can be in a delicate situation and professionals who take x-rays will know this possibility.

There are reasons why physical assessments and having a professional licensure is required for a Chiropractor to adjust the spine. Many people assume it is easy what a Chiropractor does and mimics their chiropractic adjustment. As mentioned in previous blogs before, chiropractic isn’t like using a hammer and slamming the bent nail in. A professional knows that we have to be careful and effective. Tapping and directing carefully to put the nail where it needs to be.

landing2A chiropractic adjustment is often confused with moving spine; like it is moving an inanimate object. The problem is that that moving the spine involves a living person. Which means this bone isn’t an object but a living object. So forcefully cracking or moving a spine will be difficult if the person who is receiving it wasn’t so willing to allow it to move. This will be like hitting a brick wall. So then person pushes harder and harder and the person receiving the push will get stiffer and stiffer. Once the person receiving the push gives in a little, one can imagine the amount of force may have caused some problems.

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A Chiropractic legend Dr. Sigafoose retold his story about his encounter with Dr. Gonstead. Dr. Gonstead was an icon for chiropractors.  If you wanted to be the best, you have to adjust like Dr. Gonstead. He sat next to him at a conference and was told from Dr. Gonstead that one must be one with the bone to adjust the bone. Many of his students that experienced his adjustments mentioned his hands were like pillows and never suspected anything forceful. Dr. Gonstead had rheumatoid arthritis that was cured with chiropractic when he was young. Since then he because of a chiropractor, developed a specific chiropractic technique and a system to do chiropractic adjustment that did not require a forceful maneuver.

Chiropractic adjustment is an Art of Ease

Chiropractic adjustments seem like a physical maneuver only, but it is a cooperation between the chiropractor and the person who is receiving the chiropractic adjustment. Chiropractic adjustment was never meant to be a forceful maneuver but a gentle guided touch with slight speed. Dr. Gonstead was never known to be a forceful chiropractor, he was known for his gentle pillow like hands that will help the nervous system to ease.

The less force utilized in a chiropractic adjustment of the spine, there is more skill and finesse. Using brute force often does not produce the same result compared to a professional, specific, diligent chiropractic adjustment. These skills take many years to master and continued training. There are skill levels in chiropractors compared to a novice or amateur who is trying to copy the chiropractic adjustment.

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When critics argue that they do not need training and that they can produce the same result as a professional, that depends on what they are looking for. If a forceful cracking of the neck and back is the product you want then you might be able to reproduce that. When the condition is more complex, severe pain is involved, and daily activity is diminished, the forceful cracking may or may not beneficial to the person in pain. Examination and assessment are needed for a specific adjustment.

 


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Good, Bad, and the Ugly. Crack My Neck for Relieving Pain.

There are many situations where your spine will crack on its own or intentionally cracking them. The cracking of the spine in any different situations has an effect that can be good, bad, or ugly.

Good:

After a certain time period of a Chiropractic adjustment, the spine tends to realign the other vertebra on their own. Most likely the other vertebra was not in the right position are starting to go in the right position by themselves. When your body introduces any kind of force, such as when you are doing light stretching, turning, bending the spine realign. There is nothing to fear but to let your Chiropractor know what happened. Check out the former blog about this topic: https://zenchiropractic.wordpress.com/2012/11/29/what-happens-when-my-spine-goes-pop/

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When your spine pops and pain follows immediately then the joint became unstable and causing inflammation and muscle spasm. Even if you didn’t put much stress or any motion on the spine something pops and then the muscles around are creating spasms and sharp pain. Often times these situations are the vertebra was already starting to fall out of place and it was a matter of time when it went out of position. In this case, put ice on the area and get to a Chiropractor that will use x-ray, neurological exams, and education on what has happened and properly adjust that vertebra.

Ugly:

The unprofessional person intentionally twisting of the neck or low back of themselves or to others may create the cracking noise but then they will cause tendon and ligament to tear and create more instability. Over twisting the neck without proper examinations and professional skill then people are at risk possibly damaging artery integrity that is already weakened and may cause cardiovascular problems in the brain. The mistake is to think that by over twisting the joint the crack is more intense and the better you feel.

26real_450That cracking noise is not what Chiropractic is defined by but that is a very big misunderstanding. Cracking in your joints creates an endorphin response that gives you a euphoria for a moment but does not solve the actual joint problem. Properly correcting your spine takes a long training from a graduate level school and getting a state license. A grand total of 4485 hours of clinic hours with health science education. Many people attempt cracking their neck and low back themselves or ask others that are not professionals to crack their spine.

There are many other professional and non-professionals that try to say that they do chiropractic. Professionals such as massage therapists, physical therapists, sports therapists, and even some medical doctors to copy chiropractic because they know how effective Chiropractic care is. Non-professionals such as your friends, families, people you meet at the bar or parties, or any individual that offer to crack your spine or neck on the street. This is why people have an incidence of having a very bad experience with cracking their neck or back because they think it is just cracking is what helps the person. People could get damage to their muscles and ligaments, and damage to the artery structure in the neck.

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Dr. Gonstead’s Story:

Dr. Gonstead once had a farmer couple come to his office. The wife of this farmer was in a lot of back pain. Dr. Gonstead found the problem after careful analysis and adjusted the spine and told them to come back next week. The former couple did not come back. In fact, they didn’t come back for months. Then the farmer couple came back and the wife of the farmer was in a lot worse back pain. Dr. Gonstead analyzed again and it was much worse condition than before, so he asked the wife what happened. The farmer’s wife confessed that her husband tried to copy Dr. Gonstead after watching him adjust his wife after they went back home. They thought they could do the adjustment themselves not knowing how much science and careful skill that Chiropractic adjustment involved.

Summary:

There are many occasions were your spine will crack on its own. Some are fine because it is the process of our body to correct and heal itself. Some are bad because the spine got very unstable and finally went out of place. The worse is just because you want to feel the euphoria and cracking your neck or low back and causing a major set back of unstable joints does not help yourselves or the person you are trying to help. You could even cause serious damage to yourself or to others. It is not about cracking your neck and it is not about being a crack dealer for people. If it is about helping people, you should become a Chiropractor or go seek one to help your friend. They will find the cause and stabilize the situation.


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What is Chiropractic Treatment?

Chiropractic care is always misunderstood with medical care. Once the symptoms are gone, then the client tends to think that they have no need of care. This is a medical understanding of Chiropractic care. Chiropractic is originally was more concerned about the function of the body and the cause of the symptoms. Chiropractic should not be misunderstood as treatment care or therapy because they remedy the symptoms. Chiropractic is all about finding the cause and finding solutions instead of covering up the symptoms. Chiropractic doesn’t treat symptoms but rather they observe the cause of the symptoms and when the cause is gone then there is no need to do any chiropractic adjustments.

What are they really looking for? Chiropractors are looking for the cause of the symptoms which is subluxations. Subluxations are slight dislocation of the spinal segment that chokes the nerve and limits or interrupts the communication and function of individual nerves that connects to muscles movements, heart functions, and many more! Once these subluxations are gone, there is nothing to change. If there are signs of subluxations then that is what Chiropractors adjust and restore and monitor. If there are signs of subluxations then the Chiropractic adjustments continue.

How do Chiropractors monitor subluxations? Many Chiropractors do a physical examination of a range of motion, pain scale questionnaire, orthopedic tests to measure that the symptoms are gone. Although this method is still only measuring symptoms so in this set of examination they are only looking to cover up the symptoms. There are Chiropractors that go further and take radiological examinations and have x-ray films to see the spine and re-take x-ray films after a certain amount of time. The public and normal people are not educated in looking at x-ray films and anatomy of our skeletal structures. That means we are at the mercy of the Chiropractor to tell us if we are progressing well. Most often times they say that there is progress and we just agree because we don’t want to look like we have no idea what they are saying. There are also other assessments for subluxations such as monitoring spinal thermographs, a static electromyograph, electrocardiographs, and many more assessment tools.

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Some chiropractors use x-rays mostly as a scare tactic to make you fearful of your condition and sign up for chiropractic adjustments and never use them. Very caring, objective and scientific Chiropractors are always looking at them when the client comes in and analyzing and comparing the x-rays to the client as a reference. Most of the time Chiropractors want to see if there are specific conditions such as fractures, malformation of the bone structures, and degeneration. This will help to specify the Chiropractic adjustments for more efficient structure in the body so that adaptation to stress is more efficient. When x-rays are taken, many Chiropractors are not being careful of positioning the client and sometimes create scoliosis like an appearance to the x-ray. Which means they are adjusting the spine thinking there is scoliosis but there really was a misinterpretation.

The most important part of using x-ray in the progress of care is to see if the Chiropractic adjustments are improving degeneration, changing the structure of the spine, and further specify the chiropractic adjustments for the clients.

Neurological/Physical Examination:

hc_epilepsy_diagnosis_neurological_exam_articleMany Chiropractors check for pain levels, sensations on different areas of your arms, feet, orthopedic tests, neurological reflexes, checking the range of motion of the neck or low back. Many times these tests are necessary for very severe conditions and not always accurate for subluxations. Most of these tests are orthopedic medical doctor’s procedures and is not designed for assessing subluxations. Often times these exams are initially examined but it is not too often that the results are re-examined again. The results are not explained and do not correlate very well with the client’s problems. Many health insurances require the Chiropractors to do these tests for insurance to cover the chiropractic adjustments.

Computerized Neurological Examination:

There are many emerging assessment technologies for subluxations to make the chiropractic adjustments to be specific and have the better idea of the progress of the personal health. Subluxation Station from Chiropractic Leadership Alliance has been in the industry for more than 20 years. Most common assessment has been measuring heat patterns of the spinal areas called Spinal thermography. Subluxations have inflammation of the nerve and the spinal thermography detect areas of subluxations and the conditions and progress of each nerve. Another common assessment is measuring the state of muscle spasms with static electromyograph. Subluxations cause muscle spasms with imbalanced contraction of muscles. By using the static electromyographs we can see the how new or old the subluxations are. After a number of chiropractic adjustments, the muscle condition can show us how our body is adapting to our stressful environments. A recent technology has been used for assessing subluxation is electrocardiographs. This is measuring the variability of our heart rate to assess how our body is adapting to the environment. Our body is dynamic and constantly adapting to different environments. Electrocardiographs will help chiropractors to assess their chiropractic adjustments are getting rid of the subluxations and helping people to have their body to adapt to the environment.

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Chiropractic Adjustment:

In the media, the chiropractic adjustment is often confused with twisting the neck or low back quickly and making a cracking noise that reduces the pain. First ever chiropractic adjustment was not as such. D.D. Palmer investigated the medical history of a partially deaf man, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a ‘pop’ in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which he believed was a spinal misalignment and a possible cause of Lillard’s poor hearing. Palmer claimed to have corrected the misalignment and that Lillard’s hearing improved. Two important things from this D. D. Palmer: Chiropractic was not discovered to help back pain, Chiropractic was discovered because chiropractic adjustment helped restored the function of the body.

Chiropractic adjustment and Osteopathic Manipulation Therapy

Often times Chiropractic adjustment is confused with osteopathic manipulation therapy. Chiropractic has always been about restoring spinal misalignment and correcting subluxation only. Osteopathic manipulation therapy is a broader spectrum of therapeutic options in addition to thrust techniques, among which are myofascial release, muscle energy, counterstrain, visceral manipulation, prescribe medication, and surgery.

Chiropractic Adjusting Devices vs. Chiropractic Manual Adjustments

Chiropractic adjustments have various techniques and some useful tools to adjust the spine. Traditionally, chiropractic adjustment was performed by hand only. In the latest century, there were many devices innovated to do the adjustment such as an activator, adjustor, and much more is out there. Many people prefer the chiropractic devices because they seem safer. Although, there are controversies whether the chiropractic devices help people. With Chiropractor’s adjusting manually by hand only, the experience is the best indicator of getting best results for clients with specific conditions. Younger the chiropractor doesn’t mean less experience because some people will practice and discipline themselves to learn how to sharpen their skills.

Specific Chiropractic Technique websites such as Gonstead Clinical Studies Society shows the Gonstead technique practitioners when they attended the last seminars and how many years they are in practice. This may not always be the best indicator of how much practice and skill a chiropractor has. If anyone is looking for a skilled chiropractor, please contact the office.

Office:952-500-8733

http://www.zenchiropracticinc.com


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How does a Chiropractor know where to fix?

“The right number and right kind of adjustments can set the stage for nature to heal; too many adjustments in the wrong place can undo any good that was done and slow down the healing mechanism…..Chiropractic is not easy. It is a scientific approach. In order to get those things right, they have to be so right. None of us can be too careful. Too many of the chiropractors are unwilling to really study enough to truly understand spinal mechanics.” Dr. Clarence Gonstead

Who is Dr. Gonstead? For those who have not looked at my website, he is nicknamed as the “miracle man”. He is a Chiropractor that has developed a very detailed and specific adjusting system named after himself. The Gonstead technique is widely known to be very comprehensive and specific technique in analysis and adjustments with less force. He was so busy that he had to build an airstrip for people into his small town in Mount Horeb, WI, and a hotel to accommodate the clients that came to see him from around the world. After seeing 7 million people in his chiropractic career, he was well known to be a Chiropractor of Chiropractors. Dr. Gonstead passed away in 1978 and left an amazing legacy and many students to keep on his teachings.

Not everyone was fortunate to get see Dr. Gonstead for chiropractic adjustments. Most people who had chiropractic adjustments from chiropractors that did not follow to the level of specificity of the technique of Dr. Gonstead had mixed feelings or mixed results after chiropractic adjustments. Some felt nothing changed or worse for that matter.

As you read the quote from Dr. Gonstead in the first paragraph, there are chiropractors that adjust too many and in the wrong place. As a Chiropractor, practicing on each other during Chiropractic school is essential to be a better chiropractor. Also the price of paying with your own spine on getting adjusted on the wrong areas. There was one experience of mine where the student adjusted my spine with a huge cracking noise and he felt the adjustment went well. Although, I had great pain in my low back with radiating pain down my leg for 6 months. So hearing a huge noise does not mean the chiropractic adjustment is the right one, it is the results afterward that determines if the chiropractic adjustment is right or wrong.

Dr. Gonstead said, “…too many chiropractors are adjusting the wrong one!” What is the wrong one is referred to as a compensation for the real problem called subluxation? Subluxation is the misalignment of the spine causing impingement of the nerve that causes loss of function and healing. Compensation is misalignment that is caused by subluxation and creates symptoms like pain. Compensations are very misleading to people who have them and for people who are correcting subluxation. Many people think the most painful spot is the problem and most often times it is not.

“A vertebra which is misaligned because of a subluxation elsewhere is considered a compensation.” Roger W. Herbst D.C. Gonstead Chiropractic Science & Art

Many chiropractors adjust from 7-10 segments in the spine. The most common reason is that if the segment in the spine is not moving, let’s give it motion and then it will feel better. Motion is life! This common philosophy does not distinguish compensation and subluxation. Who has this idea typically adjust everything and anything?  Their thinking might be anything that is misaligned put it back so that the spine is in perfect shape.

Most chiropractors are trying to give everyone the perfect spine. In the Gonstead method, we only care about finding the subluxation and allowing the person’s spine adapt and heal on their own. Some spines look like a bad scoliosis curvature but it is not the Chiropractor’s job to fix scoliosis. Once the body is free from subluxations then the starts to change shapes or adapts better to the person’s stress levels. This may change the spine’s shape to the more efficient structure to the stress that is put on to the spine.

Dr. Gonstead made sure to find the right one and re-analyze after he adjusted a spinal segment. Just to check if the adjustment was enough or too much force. Dr. Gonstead was able to determine whether the disc was acute or chronic, the position of the disc herniation, and much more information on the condition of the nervous system. Dr. Gonstead also used radiological films, observed postural changes, skin inflammation analysis, and listened to your symptoms. Then he put all that information together to find the one or two segments that were the subluxation. This gave future generations of chiropractors that followed Dr. Gonstead to reproduce what he was able to do. That was adjusted about 7 million people in his life and help very difficult conditions that even medical doctors were not able to help.