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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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.