Chiropractic adjustments

Many of us hold beliefs about health that are passed down from generation to generation, often unquestioningly. For instance, have you ever stopped yourself from visiting someone because you have a cold and you worry they will catch it? Yet the reality is germs and bugs are found everywhere in the environment and they only have a detrimental impact on your health when your body is particularly fatigued and run-down.

Here is another common belief: if you are in pain and you take a pill and the pain goes away, you must be healthy again. However, usually the symptoms themselves are not the real problem; they indicate how your body is adapting to lifestyle stressors and are, in fact, a message that change is needed. In many cases, medications camouflage these symptoms and cause you to avoid finding true healing strategies.

These types of beliefs stem from another, more damaging belief: that you should not question “expert” opinions or be able to navigate and strengthen your own health. This belief is ingrained in us because, throughout Western history, people have been given information by a select minority. When it comes to health, for instance, previous generations never questioned the manner or methodology of the family doctor.

Yet times are changing. Many people today appreciate that there is a diverse range of health practitioners available and our modern technology allows us to access a broad range of data on procedures and products. Many people use the internet as a vehicle to investigate and empower their health choices, such as understanding potential side-effects of prescriptive or over-the-counter drugs. A growing awareness of health risks associated with many medical procedures and prescriptive drugs has led to consumers demanding more safety and quality from products and providers than ever before.

It is this assertiveness that has prompted many health consumers over the past two decades to explore allied health services such as chiropractic, physiotherapy and Chinese medicine. Federal and state governments are now keenly encouraging the utilisation of such therapies, which have been shown to safely return workers to the workplace at a lower cost and with better rates of recovery than drugs and surgery.

However, even though allied health practitioners are university trained and government regulated, a common criticism from vocal detractors is that these professions are based on non-scientific principles. Despite mounting evidence supporting the safety and efficacy of these holistic approaches, the detractors claim that short-lived studies funded by pharmaceutical companies are integral and of superior standard.

Adding to the confusion is that practitioners (whether orthodox or allied health) can hold closed-minded belief systems about their own style of treatment, thereby refusing to take a collaborative approach to helping a patient because they hold an elitist mentality. Yet surely all health practitioners can fulfil their niche roles, offering their wisdom and skills set in order to address our nation’s rising rate of chronic disease? Indeed, all health practitioners should hold the needs of the patient above their own needs or their own fixed belief systems.

In past years, it was not uncommon to hear claims that chiropractors were “quacks”. Fortunately, the shift in awareness has been due to the advanced educational standards of chiropractors today, the expanding body of research supporting the efficacy and safety of chiropractic, and the high public demand for chiropractic care. In fact, chiropractors often receive referrals from proactive GPs, midwives and hospital staff.

“Adjustment” and “manipulation”

Some people believe chiropractors manipulate necks and backs; however, a manipulation is very different from a chiropractic adjustment. A manipulation uses a high degree of force and sickening, unspecific wrenching and rotation of the neck or spine.  A manipulation might be what your drunken aunt inflicts on you at a party when you complain of a headache, or what you receive from an untrained masseur or therapist.

If you have ever witnessed or had a manipulation, you will know it to be a crude and dreadful experience. Many joints of the spine at many different levels will cavitate or “pop” and often the recipient feels light-headed and nauseous. (Note: some osteopaths use the term “manipulate” to describe their techniques but these professionals are well trained and apply strict guidelines to their delivery.)

A chiropractic adjustment, on the other hand, can take many forms. Sometimes the spine is kept in a neutral position and light pressure is applied solely to the ligamentous or dural attachments of the spinal cord. This method is often used with babies, young children, the elderly or any client who may prefer these “tonal” techniques.

Other techniques may require the spine to be flexed or tilted as a low-force thrust is applied at high speed to a specific spinal joint, at a specific spinal level, without affecting neighbouring joints. This is important as there are six individual joints for every spinal joint and these can move in a complex arrangement when compensating for the modern lifestyle; for example, when sitting for long hours, using repetitive postures and lifting — all of which a strenuous toll on the spine.

It takes detailed training and diagnostic skill to work out the best way to adjust these joints for better function. Most Australian and American chiropractors graduate with a double degree, requiring at least five years of university education with extensive study in anatomy, physiology, pathology, radiology, body mechanics, nutrition, paediatrics and adjusting techniques.

Why adjust?

Irrespective of the technique used by the chiropractor, their focus is always to detect “dysfunctional spinal segments” where movement is functionally restricted in at least one direction, altering the nerve messages travelling to the cortex of the brain and resulting in neuroplastic changes. There is also typically tenderness when this joint is palpated and this type of functional lesion is known by a variety of terms, such as joint dysfunction, fixation or subluxation.

A subluxation results in altered joint motion and impaired nerve function. Your nervous system co-ordinates all bodily functions, including your breathing, digestion and immune responses. The nervous system is the master controller of your body and, if its communication channels become fuzzy, distorted or damaged, you may experience communication errors that can manifest in all sorts of ways, including poor sleep, developmental delays, digestion issues, asthma, mood problems, low energy, inability to concentrate, headaches etc.

Many subluxations are pain-free and you may not even realise they are present, but if they are left uncorrected, the body’s capacity for health may deteriorate. Adjustments allow the nervous system to co-ordinate itself freely, which in turn allows the body to self-regulate and heal. While chiropractic may help with a number of health issues, chiropractors do not cure any ailment — the body always heals itself.

What causes vertebral subluxations?

Subluxations may be caused by physical, chemical or mental stress. Physical stress ranges from sustained postures (such as sitting) to knocks and falls to whiplash trauma. For babies, the birth process exerts pressure on the spine and nervous system and the use of forceps and ventouse may create further physical stress.

Chemical stress includes ingesting too much alcohol, sugar, toxins and preservatives, absorbing toxins from personal-care products and breathing environmental pollutants. These toxins will upset body chemistry, disrupting the tone of both muscles and ligaments and potentially resulting in subluxations.

Mental stress may result from work or relationship pressures, causing ligaments and muscles to tighten. If this stress is sustained, our bodies undergo significant physiological changes, such as increases in blood pressure, heart rate, blood glucose and cholesterol.

What is that popping noise?

The most widely accepted explanation for the audible popping sound (also coined “articular pop”, “clunk” or “joint click”) created during some forms of adjustments (and certainly with manipulations) is a process known as cavitation. This is an engineering term used to describe the formation and activity of bubbles (or cavities) within fluid, which are formed when tension is applied to the fluid as a result of a local reduction in pressure. A cavitation causes a freeing of motion and a release of joint tension.

Do adjustments cause strokes?

There is a misconception that chiropractic adjustments can cause a stroke, but did you know that there has never actually been any scientifically valid data to validate this!

Misleading reports have seen the terms “chiropractic” and “chiropractor” used in articles when it was known that the therapist was not a chiropractor. For instance, the Australian Medical Association (AMA) published a document discussing complications of chiropractic manipulation, yet when the references and original reports were examined carefully and refuted (Terrett JMPT), the “chiropractors” referred to included, among others, a blind, unlicensed masseur at a local health club and a barber in India.

A research review published in the Journal of Manipulative and Physiological Therapies has shown that the association between stroke and chiropractic is so small and so rare it would take a study of tens of millions of patients to even attempt to determine a direct link.

Most studies undertaken and reported in the media have looked for associations between chiropractic and VBA (vertebrobasilar) stroke. But associations are different from causes (for instance, the association between ambulances and injured people does not mean ambulances cause the injuries). Some of the most publicised studies asked VBA stroke patients if they’d visited a chiropractor a week or 30 days before their stroke. The incidence of this association was extremely rare. In the actual population, the number of people who went to a chiropractor and never had a stroke is vast, as is the proportion of people who never went to a chiropractor and had a stroke. This overall perspective is not conveyed by these studies, creating a picture that is misleading and incomplete.

The European Spine Journal recently looked for an association between chiropractic visits and VBA stroke and an association between GP visits and VBA stroke. They compared the two and found no difference: patients having spinal manipulation did not have a greater rate of stroke than patients having primary medical care with a GP. The study concluded that the main reason for any association was most likely due to patients seeking care for neck pain and headache before their stroke, since these are very common precursory symptoms.

Most VBA strokes are classified as “spontaneous” (no triggering activity identified) followed by “trivial trauma” or “mundane common activities of daily living”, such as walking, kneeling to pray and household chores. Other implicated activities include motor vehicle collisions, turning the head while driving, sports, lifting, working overhead, falls, sneezing and coughing.

Two things are important to consider here: first, all stroke patients will be exposed to mundane common activities of daily living. Second, research has found that the force transmitted to the vertebral artery during a chiropractic adjustment represents less force than when turning the head within its normal range of movement.

In other words, chiropractic adjustments have been shown to be gentler on the vertebral arteries than common activities of daily living.

Who should see a chiropractor?

Just as a tooth cavity may have no symptoms, the same principle applies to a vertebral subluxation. Chiropractors are experts in the care of the spine and nervous system and recommend that, just as people regularly have dental check-ups, regular spinal check-ups are important to health. Chiropractic is the largest, most regulated, drug-free, primary healthcare profession in the Western world and millions of people, including infants and seniors, are benefiting from this proactive and natural approach to strengthening health and vitality.

Dr Jennifer Barham-Floreani is a mother of four, a chiropractor and a best-selling family health author.