So what exactly is a spinal adjustment?
Basically, it is a hand-delivered force into an improperly moving joint done to make it move normally. Vertebrae can get “stuck” in a rotated or bent position by numerous ways, such as sleeping on your stomach with neck twisted or a sports injury. This can feel very uncomfortable and may even cause sharp pain, arm numbness or headaches.
It is roughly estimated that about one million adjustments are done in the U.S. every business day, mostly by chiropractors. It is their “bread and butter” treatment because chiropractic is based on the belief that abnormal spinal alignment contributes to poor health, and manually correcting the alignment can improve health. Because they do it the most, chiropractors are considered the specialists most proficient at spinal adjustments/ manipulation.
According to ShareCare, about 30 million people see a chiropractor each year, mostly for various types of musculoskeletal pain and dysfunction. The benefit is improved range of motion (flexibility) and decreased discomfort/pain. Some patients experience other symptomatic improvement such as cessation of a headache or clearance of congested sinuses (there are medical models to explain this, but this isn’t the focus for this particular article). While there are pockets of naysayers, it is fair to say that getting your neck and back adjusted can be good for you.
Are You Actually “Adjusting” Yourself When You Crack Your Neck Yourself?
If you or someone you know “crack” your joints by twisting your neck or low back until you hear a pop. I personally know someone who has a daily routine for this, using her hands to forcibly twist her neck by grabbing the top of her head and chin like in the picture above, and rotating her head far to the left, then right; and then twisting her spine while sitting. I noticed that she gets an unusual amount of popping when she does this; seemingly with little effort. This excessive popping indicates that the spinal facet joints have become hypermobile from overstretching—they’ve lost some of the ligamentous support, allowing the joint to move more than it was designed to. Hypermobility of joints accelerates wear and tear, leading to bone spurring and disc thinning, which can eventually press on nerves inside the spine causing pain and weakness in the extremities. Although, as far as I know, there are no conclusive studies on the benefits or harm of cracking your neck often, I believe that it is best not to do it for these reasons.
The next question is, if you are able to pop your own neck or low back by forcibly twisting it, are you essentially adjusting it? Are you getting the same benefit as an actual chiropractic adjustment?
This is not easy to answer, because in order to get a scientific-based answer to this, a large study (many people) is necessary, which hasn’t been done to my knowledge. Also, the outcome (result of cracking vs. adjusting) is difficult to measure. As a chiropractor myself, here is my explanation of the difference between “cracking” your own neck and getting a chiropractic adjustment:
When you “crack” your neck yourself, you are essentially twisting or bending (depending how you do it) all your neck vertebrae at the same time. At some point, you get cavitation—the popping sound made by collapsing pockets of dissolved gases in the small facet joints of the cervical vertebrae, due to the expansion of those joints as you bend your neck to the side. There is a sense of pressure release and improved neck flexibility afterwards. Sometimes it can be verified by checking range of motion before and after; sometimes not. People who do it will typically say “it feels good,” or “it relieves pressure.”
On the other hand, a chiropractic adjustment to the neck targets just one vertebrae—the problematic one identified by palpation and/or x-ray, so it is more precise. It also incorporates an external force—the hand thrust—that forces the vertebrae into the direction where it is deficient; i.e forces it back to its normal range of motion.
Most people will tell you that the feeling after a neck adjustment is very different that the one you get by merely twisting your neck: it is a focused, louder sound and you feel a heightened sense of things immediately afterwards, similar to having a wax earplug removed or clogged nasal sinuses suddenly cleared. This may be explained by improved nerve firing, better circulation and restored neck muscle balance.
So these are the differences between cracking your own neck and having a chiropractor adjust your neck. But again, there are no studies I can reference that proves the superiority of one over the other. Currently, the evidence is subjective, or anecdotal.
Is It Easy to Do Adjustments Yourself?
If you have ever been to a chiropractor, you know that it does not take long for the chiropractor to do an adjustment – about 5 seconds total, including the palpation (feeling for the joint’s movement) and set-up of the thrust. On the surface, an adjustment seems like a relatively simple procedure to do (although more subtleties are involved that you don’t notice). In other words, it’s not brain surgery. This apparent simplicity is what encourages some people to try it on themselves or their housemate, partner or friend. They take note of what their chiropractor does and perhaps watch YouTube videos of chiropractors adjusting patients to see how it’s done. I even made a video on chiropractic adjusting a couple of years ago which you can see here. I will venture to guess that a lot of “adjusting” occurs outside of chiropractic and physical therapy offices.
So, is self-adjusting, or adjusting a housemate safe? Can it be beneficial? Most would say no, for the obvious reasons—you need to get proper training, it could be dangerous and you could hurt someone, etc.
There can also be legal implications to this, such as practicing without a license.
Obviously, the best solution is to seek the services of a licensed, experienced chiropractor who knows the ins and outs of adjusting. However, I do understand that some people cannot afford to see a chiropractor, or don’t have access to one; or simply don’t want to see one for personal reasons but still desire to obtain the benefits of spinal adjustments. As a big believer and advocate of self-care for managing musculoskeletal pain, I have an atypical perspective on this, which I’m sure most chiropractors won’t agree with. My view is that, with proper guidance, every day people can learn to do modified adjustments, or joint mobilizations to relieve pain and discomfort on themselves and others. These are basically targeted stretches that have elements of joint mobilization. Before I describe them, I will explain the distinctions between adjustments, joint mobilization and stretches.
An adjustment is a short lever, high velocity manual thrust into a joint. Short lever means that you contact a small protuberance of a bone and use it as a lever to move the whole bone (see diagram below). If it’s a spinal vertebra, you can use the bone’s transverse processes or spinal process as a lever to move the whole vertebra. You locate these structures, contact them with your hands, decide which direction you wish to move the bone, and thrust in the appropriate angle and depth.
The term joint mobilization is used to describe longer lever, lower velocity force applied to a joint; for instance, using the femur bone for leverage to manually circumduct the hip joint.
Stretches of course apply to the soft tissues—muscles, ligaments and tendons. They are done to elongate contracted fibers to increase flexibility, and are done by isolating the muscle and elongating it with movement. Stretching ligaments requires you to move the joint to its end range of motion, and then a few degrees past it.
Together, adjustments, joint mobilization and stretches are the three, primary tools of manual therapy for the musculoskeletal system. Note, however, that soft tissue mobilization is a term used to describe various forms of deep tissue/sports massage, and can also be considered manual therapy.
In my opinion, it is fine for someone to learn how to do modified forms of adjustments. Manual therapy is one of the safest forms of therapeutic intervention; even safer than taking aspirin. So if you’re an athletic trainer, massage therapist, acupuncturist or anyone else who is interested in learning how to adjust yourself or someone else, know that there are options. I believe the time has come for people to learn how to do basic manual therapy for the benefit of others. The trend may lead to a dramatic decline in neck and back pain in the population, much like how the fitness craze starting in the 80’s made people more lean and fit.
In the coming days, I will explain how to do some basic adjustments and joint mobilization moves that you can try—on yourself, and others. The key to doing these is to do them slowly and stay focused on what you are doing. Avoid sudden jerks especially to the neck. It’s not an issue when people stretch themselves and help stretch others. The techniques that I believe are safe and appropriate for non-trained people to do are similar in scope and complexity, but with some focus on moving the joints. Stay tuned!
