So you’re afraid to go to a chiropractor? Learn why getting your back “cracked” actually works!

If you’ve ever been to a chiropractor before, you’ve likely experienced the chiropractic adjustment. The adjustment is when the doctor “cracks” the joints in your spine. Let me make something perfectly clear though. The use of the word “crack” or the phrase “cracks your back” is an extremely poor description of what we do as chiropractors, and I prefer it not be used, because it’s nondescript. It’s a misnomer. It doesn’t help anyone  — especially the patient or other medical professionals — intuitively understand exactly what is happening therapeutically.

I am going to clear it all up right here. My hope is that you will have a completely new understanding of chiropractic medicine and how it helps the body. I am writing this for the average person who simply wishes to better understand how chiropractic medicine works, because quite honestly, I don’t think the chiropractic profession does a good job of properly communicating how it helps the human body.

In proceeding, we must first understand why people get back pain.

What happens when you hurt your back
When you strain — for example — a lower back muscle while bending over to lift your child, or you wake up in the morning with a painfully stiff neck, you have injured/damaged/irritated bones, ligaments, or muscles. In most cases you’ve only damaged the muscle tissue, but in other cases you may have damaged the ligaments in the joint as well. When the muscles and the joints are injured, your body responds by producing inflammation.

Inflammation is the body’s natural response to injury and its job is to begin the process of repairing the damage. It is this damage-repair-process that results in the muscle and joint stiffness you feel, the reduced range of motion preventing you from turning  or bending, and all of the acute and chronic pain that goes along with tissue injury.

One of the first ways your nervous system responds to repair the damage is to instruct the muscles surrounding the damaged area to become tight. Your pain-sensing nerves also become hypersensitive so that even the smallest movements hurt a lot. This is the body’s way of protecting itself from further damage. If it’s painful to move a muscle even a little, you’re not going to want to move it at all.

In other cases the ligaments in the nearest joint become damaged as well. Once the muscle and/or ligament is damaged, and the inflammation and pain process is started, your nervous system directs your body’s inflammatory cells to surround and encapsulate the damaged region. If this region happens to be a joint, it will be painful to move your head left to right or up and down, or bending forward to get up from a chair may cause severe pain in your lower back.

This is where chiropractic medicine can be incredibly beneficial. This dis-ease manifests as inflammation, and may occur in the joints. When it gets into joints, they become more painful. The inflammation acts kind of like a “glue,” creating scar tissue to stabilize the joint and repair the damage. This “glue” limits the ability of the joint to move through its full range of motion.

The next thing you know, when you try and move your neck to the left or right, it doesn’t want to move as far as it did before. It has less range. It feels stiff. It’s painful.

How a chiropractic adjustment restores function and reduces your back pain
As I mentioned above, “cracking” the joints is not what chiropractors do. What we do is “adjust” (or mobilize) the joints. The “cracking” sound is simply gas being released from the fluid within the joint. Kind of like when you open a soda bottle. The sound is not bone rubbing against bone as many people seem to think.

A chiropractic adjustment helps relieve the pain in the following ways.

  1. If the inflammation results in scar tissue (adhesions) within the joint, forcing the joint back through its full range of motion breaks up the scar tissue. This is what happens when the chiropractor ever so slightly adjusts the neck. In most cases following the adjustment, you will be able to turn your head with more range and less pain. If you could only turn it about 60 degrees (80 degrees is normal) before the adjustment, in many cases you will now be able to turn it 65, 70, and in some cases back to its full 80 degrees of range. Improved range of motion immediately reduces some of the pain, because the already tight and painful muscles around the joint do not need to work as hard to move it. Think about it. If a joint is stiff with inflammation and scar tissue, the muscle requires more force to move it through it’s normal range. Since the muscle is already stiff, achy and closer to the pain threshold, just a small movement induces quite a lot of pain.
  2. Another thing the adjustment does is force (disperse) inflammation out of the joint. Inflammation tends to form in pockets; that is, little pools of inflammatory fluids. These small, yet dense pools of inflammation cause the joints and tissues to be very painful. Moving the joint as we do causes some of the inflammation to flow out of the pocket. Each time you come in for the adjustment, the mechanical action of moving the joint generates a pumping action and induces more and more of that inflammation out of the region, reducing scar tissue buildup and restoring normal function. The next thing you know, your neck is feeling better.
  3. There are also neurological effects as a result of a chiropractic adjustment. When a joint is adjusted, the muscles and tendons attached to that joint are carefully stretched. This stretch signals sensors within the muscle and tendon to relax the muscle even more. Again, this is a protective response by the nervous system to keep the muscle from being damaged. Chiropractors are expertly trained to coax this action from the nervous system to improve function of the tissues and reduce pain, without causing further injury.
  4. Inflammation, adhesion, and muscle spasms combined irritate the nerves that are exiting the spinal joints. When a nerve is irritated, there are a number of things that can happen. A pocket of inflammatory fluid surrounding a nerve can increase pressure on that nerve. If adhesions are attached to, or adhered to the nerve, they can pull, and torque, and stretch the nerve. If so, you may experience tingling or numbness that travels down your leg or into your hands. This is called paraesthesia. On the other hand, if you get an aching feeling that travels down an arm or a leg without tingling or numbness, then you are likely experiencing referral pain from a tight and fatigued muscle. Referral pain is usually a result of a tight muscle compressing nerves that descend downward into other muscles.
    With all of the benefits of an adjustment; reduced inflammation, muscle relaxation, and the breaking-up of adhesions, the nerves and muscles are — in essence — freed up. When the nerves are free from irritation by surrounding tissue, things like tingling, numbness, or referral pain are often reduced and in many instances completely eliminated.

Addressing the muscles more thoroughly – Going the extra mile
Joints are attached to muscles and muscles are attached to joints. That means one or the other (and in most cases both) are involved. It is my opinion that both the muscles and the joints should be treated when you go to a chiropractor’s office. The body functions as a system and moving a joint requires the action of a muscle. It therefore does not make sense to address one without addressing the other.

As I previously mentioned, muscles can be directly injured.  That is, you can get a muscle pull/strain/tear without any damage occurring at the joint. If the lower back pain you are feeling is a result of lumbar muscle strain, then it’s important to restore health to the muscle directly. This is done using a number of different methods. Myofascial therapy is one of the best. Myofascial therapy is a soft tissue technique (similar to massage) that helps break up the scar tissue buildup in muscle.

Scar tissue (aka, adhesion) is a rigid fibrous repair material that the body produces. It does a great job of reconnecting torn muscles fibers. There can be a problem with its rigidity though. Scar tissue is analogous to using duct tape to repair a broken elastic exercise band. If you take an exercise band and snap it in half, then attach the two pieces together with a piece of duct tape, both ends of the band will be elastic and flexible, while the duct tape holding them together will be very rigid and inflexible. The inflexibility and rigidity of scar tissue within a muscle is analogous to duct tape. It causes discomfort and pain. By using myofascial therapy to manually break up the scar tissue, chiropractors can restore elasticity and flexibility to the muscle. When you restore the elasticity and flexibility, pain is reduced.

But, a tight or spasmed muscle is painful for a number of reasons. When it’s tight you can’t move it very well without activating pain-sensing nerves. When it stays tight for a very long time, the muscle then starts to fatigue. Muscles are rather strong, but in the back they are designed more for  endurance than they are power. When they have been tight and fatigued for far too long, they eventually become weak.  At this point, spasm and pain are likely. By manually moving/compressing/stretching the muscles by hand, the muscle can relax. When the muscle relaxes blood vessels within it increase diameter, improving blood flow, and increasing oxygen and other nutrients to the muscle. The result is a muscle that has been forced back into its relaxed functional state. This means less pain or no pain.

Conclusion
I believe this description is a more thorough and understandable example of how chiropractic medicine helps the human body. What we as chiropractors do — for the most part — is mechanical by nature. We restore mobility to tissues and joints that are to some degree immobile. When you mobilize damaged tissue and stimulate nervous system structures, a good chiropractor can rapidly restore normal function and improve recovery time.