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Throughout history, adjustments, or spinal manipulations, have been performed to help relieve people of back and neck pain. Hippocrates,} the father of modern medicine, utilized spinal manipulation in his practice 2,500 years ago. For more than 100 years Chiropractors have been the specialists in spinal adjustments. About 95% of all spinal adjustments today are performed by Chiropractors. Doctors of Chiropractic are highly trained and skilled in the art of adjustments and manipulations.



What Is An Adjustment?

Adjustments and manipulations are techniques used to restore motion to joints that have lost their ability to move normally. To fully understand, we must first learn about normal joint mechanics.

All joints have an active and passive range of motion. Active range of motion is the movement a joint makes using only your muscles. Move a finger back and forth and notice how far it moves. At the end of its motion you can push on your finger and it will move a little farther. This extra motion is the passive range of motion. The joint should give or spring as you push it into the passive range.

At the end of the passive range of motion is an area called the paraphysiological zone. The goal of adjustments is to move the joint beyond the passive range of motion and into the paraphysiological zone.

As the joint is moved into this special zone a popping sound is usually heard. This requires great speed and skill and should only be done by someone who has had extensive training. Adjustments may be used on any joint of the body that has lost its normal joint motion. Doctors of Chiropractic are specialists in performing adjustments.



What Makes The Popping Sound?

When a joint is adjusted the two surfaces of the joint separate. The popping sound is not made from the bones, but is the collapse of a gas bubble formed in the joint fluid as the joint is separated. It takes approximately

20 minutes for the joint surfaces to return to their previous position and pressure. This is why many patients feel "loose" after an adjustment. Adjustments allow the joint to have more freedom and a greater passive range of motion.



How Do Adjustments Work?

The effects of adjustments are very broad. They include various mechanical, or direct, and reflex, or indirect, mechanisms. These include:

  • Increasing joint motion (mechanical) which causes a decrease of pain (reflex). You have different types of nerves that sense different types of sensations. The nerves that sense motion, heat, cold, and vibration will override the nerves that sense pain. This is why people will feel okay while they are active, but when they sit down and relax their pain may come back. As the brain receives information about movement and other sensations, it closes the gate on the nerves that sense pain.

  • Stimulating a joint with an adjustment (mechanical) causes relaxation of the muscles around the joint (reflex).

  • Chronic pain results in decreased joint mobility, shortening of joint tissues, and the formations of adhesions. Adjustments stretch shortened tissues and break joint adhesions. This results in increased joint motion causing the reflexes noted above.

  • Sometimes a tag of joint tissue will become trapped in neck or back joints. This may cause irritation in both the affected and neighboring joints, which leads to muscle spasms and a locked neck or back. Adjustments can release these joint tags (mechanical).

  • Spinal adjustments stimulates the autonomic nervous system (reflex), which regulates the function of the organs. Some of the effects include changes in blood circulation, skin temperature, blood pressure, blood chemistry, and the diameter of the pupils.

  • Correcting abnormal joint mechanics provides relief of chronic nerve compression and irritation. Some patients have a combination of stenosis, or narrowing of the canals that the nerves pass through, and decreased joint motion. Adjustments will increase joint motion and relieve compression of the nerves, resulting in reflex effects that reduce pain and muscle dysfunction.



Chiropractors have sometimes been criticized throughout the past century for their use and claims of the benefits of spinal adjustments. Every Chiropractor has witnessed "miracles" in his or her office. Patients not only describe relief of pain but also changes in their vision, bowels, amount of dizziness, breathing, and sleeping. The list goes on and on. Each year there are more research studies being done to explain these dramatic results.

In the 1980's, there was an explosion of research on the treatment of back and neck pain; specifically concerning the effectiveness of spinal adjustments. These research studies have been used to establish US and UK clinical guidelines for the management of low back pain.

These government sponsored multidisciplinary guidelines recommend spinal adjustments, over-the-counter drugs, and hot or cold treatments as the only proven treatments as acute low back pain. The US guideline recommends against most traditional, and unproven, medical treatments including muscle relaxers and prescription drugs, bed rest, traction, TENS units, ultrasound, and various injections.

Chiropractic was once considered unorthodox and simply a placebo. Today, research has proven Chiropractic to be the treatment of choice for many conditions. Tomorrow's research will only tell how far reaching spinal adjustments can be.



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