Thoughts from the Chiropractor

First we have to define the difference between getting checked and getting adjusted.  Getting checked is having a chiropractor analyze your spine to see if bones are out of place.  Getting adjusted is the process of the chiropractor moving the bones from a misaligned position to their proper alignment.   

Answering how often should I get adjusted is easy; whenever there is a bone out of place, you should get adjusted. 

Answering how often to get checked is a bit more subjective.  When patients walk in my door in acute situations, it may require getting checked multiple times per week.  For the completely healthy individual who is seeking to maintain the health of their spine, I recommend getting checked once per week.  Bones move out of place because we are living our lives, playing sports, sitting with poor posture, driving our cars, sleeping in funny positions in our beds, and playing with our kids.  Because we do these things, our bones move.  We move a lot so we need to check our spines frequently to make sure they are ok.  If nothing is out of place, great, no adjustment.  The only way to know if our spines are out of place is to get them checked.   

To reiterate,

Everyone, from 1 minute old to 100 years old should get their spine checked once per week to make sure that everything is where it should be. 

You should get checked more frequently when injured or stressing your body more than normal.

 If vertebrae are out of place, adjust as needed.

A lot of times as my patients are warming up to get adjusted, they tell me that they did my job for me because their spine just popped, but there is a big difference between popping a joint, and a chiropractic adjustment.

To understand the difference, we first have to start with a little anatomy lesson of the joints of our bodies.  A joint is formed when two bones come together and articulate with each other.  Around the joint we have soft tissue that is called the joint capsule which provides a little bit of stability, but primarily produces fluid that is inside the joint space called synovial fluid which acts as a lubricant for the joint, almost like oil does for your car engine.  Through our daily activity, the synovial fluid produces the gases oxygen, nitrogen, and carbon dioxide that build up in the joint space.

When we flex our joints far enough that the gas can escape from the joint space, it creates a “popping” sound that we call cavitation.  This can happen through any number of normal daily motions like squatting down to pick something up and your knees or ankles may pop, or when you lay in bed and roll over and your spine might pop.  The nice thing about cavitation is that it also triggers your body to release endorphins, which are feel good hormones, so it actually feels good when this happens.  This is the reason that people obsessively pop their knuckles or twist in their chairs to get their spine to pop, it feels good and it is easy to understand why people might think that they just adjusted themselves!

The difference between a pop and an adjustment, is that the purpose of the adjustment is to actually move the bone from a misaligned position to its proper position to take pressure off of the nervous system.  To do that, you need to be able to identify which bones are misaligned, where they need to go, and then have the skill to put it in the proper position.  That is the special skill set that chiropractors go to so many years of school to learn.  It is not possible to adjust your own spine, even if you are a chiropractor, which is why I go to a chiropractor too.  Now most times when we deliver adjustments to the spine, the joint space does flex enough for the gas to escape and make a popping noise, but that is just a byproduct of what we are doing.  I joke and describe it as a fart for your spine.  The purpose behind an adjustment is to move the bone, if it pops that’s great because of the fun sound and the endorphin release making it feel good, but if it doesn’t pop, that is fine too as long as the bone goes where it is supposed to and takes pressure off of the nerves.

I had initially planned on writing today about what to expect for first timers getting adjusted, but my new patient last night was a great example of why it is important to do a good history with clients at their first visit. 

The patient came in with a sore neck that had been going on for at least 3 weeks, causing him to struggle sleeping at night and overall making every day difficult.  A little back story on this man;  he is your stereotypical good ole boy from the South, fairly rough around the edges, and a tough guy.  I describe him this way, not to be mean (he is awesome), but because that is what comes through the door sometimes.  As we started to discuss his condition, I knew that I was going to have to pry in order to get this man to open up about what was really going on with him.  As the layers of the onion started to peel back, it turned out that this man's neck pain was also complete numbness in his left arm to the point of having no feeling in his hand at all (HUGE RED FLAG).  There was also swelling above the shoulder blade that looked like the awful masses that you see Dr. Pimple Popper work on.  I asked this man if he had been to see anyone else about this condition prior to coming in my office to which he said that his GP had sent him to an orthopedist.  The ortho did an MRI of his shoulder followed by a cortisone injection which caused no change.  They then wanted to do an MRI of his neck, but the patient had been in my office years ago with great results, so he elected to come here first. 

To any chiropractors out there, DO NOT WORK ON SOMEONE WITH THESE SYMPTOMS.  Too often do I hear stories of chiropractors who think they can solve every single problem that walks through their doors.  Sometimes I think this is because of pride, more often is because of taking a bad history, but most often I think this is because they are trying to pay their bills and have forgotten that the patient's health needs to always come first.

Anyone who knows anything about symptoms associated with cervical disc herniations can tell you that the big indicator is radiating symptoms down the arms.  Sometimes this can be as minor as weakness with grip strength, or it can be as obvious as this man who lost all sensation in his entire arm/hand.  A disc herniation is when there is a hole in the side of the disc and the material on the inside is leaking out.  This is a huge health concern, especially in a chiropractic office.  If I had chosen to work on this man, there is a 50% chance that his symptoms improve through regaining mobility in his joints and allowing the disc material to centralize and remove pressure from his nerves.  Unfortunately, there is also a 50% chance that through the adjustment more disc material comes out, puts more pressure on his nerves or spinal cord, and results in permanent nerve damage, a more invasive surgery, or in the worst possible case, paralysis.  When it comes to percentages in health care, 50/50 is not good. 

The decision was made to hold off on working on this man until he has had a cervical MRI.  Could I be wrong? Of course.  Could it be something completely different that is causing his symptoms? Of course.  Could it have been completely safe for me to work on him?  Possibly, but without that MRI, I cannot be more than 50% sure, and that is not a risk that anyone should take. 

Had I not asked the right questions, it could have opened the door for a very bad result.  The symptoms are easy to recognize, you just have to ask the right questions in order to protect the patient, and yourself as the doctor. 

The question I want to answer today is, what is chiropractic?  In the past, chiropractic care was viewed mostly unfavorably by the public, and although the perception and understanding of this form of healthcare has come a long way, most people still think that chiropractic is all about neck pain, back pain, and “popping” joints.  I’m always annoyed when people who are unfamiliar with chiropractic believe that way, but the only ones to blame for the public not understanding what we do, is ourselves.  Chiropractors are notorious for mixing a lot of other forms of healthcare into their practices, doing a terrible job of explaining what we really do, or not educating their patients at all.

So here it is, chiropractic care is a form of healthcare centered around the alignment of the vertebrae in your spine.  It is pretty common knowledge that chiropractors work on backs, but what makes chiropractic care special is WHY we work on backs.  The bones of our spine, including our skull, serve the purpose of protecting our nervous system.  The nervous system consists of the brain which is inside of our skull, the brain stem and spinal cord, which are protected by our vertebrae, and the nerves that connect to all the organs of our body.  The nerves exit from the spinal cord between the vertebrae of the spine and carry communication from the brain to the body and from the body back to the brain.  When the bones of our spine are in the proper position, there is room for the nerves to exit, but when those bones move out of their normal position, the bones can actually impede on the nerves, which can alter or even block the transmission from the brain to the body part that the nerve travels to.  The brain controls every single function of the body, including your hormones, immune system, heart, lungs, digestion, sense of feeling, and even your skin healing.  So when the vertebrae of your spine move out of position and start interfering with your nerves, it could mean something as simple as having some numbness in your fingers or toes, but it also could mean something as serious as your heart or lungs not working properly.  The goal behind a chiropractic adjustment is to align the vertebrae of the spine, for the sole purpose of removing nerve interference.  So when I hear people ask me the question, “Can chiropractic help with…,” the simple answer is always yes.  Not because we are treating cancer, ear infections, skin conditions, digestive issues, or even back pain, but because removing interference from the brain to the body allows your body to heal itself, the way that God intended it to.