As a Chiropractor for over 27 years a lot of information I’ve seen about chiropractic adjustments has been misleading or just plain wrong. So, for this article I’ve used plain language and easy to understand diagrams to show what chiropractic adjustments do and answer most of the questions you may have.
The basic spinal problems adustments correct
The issues these problems cause
How adjustments are used to correct them
To understand what chiropractic adjustments do it helps to understand the spinal problems they correct. Chiropractors have used descriptions ranging from a simple “bone out of place” or “misaligned vertebrae” through to lengthy descriptions of “vertebral subluxation complexes”. The simplistic descriptions are just plain wrong, while the lengthy descriptions tend to be a long list of causes, symptoms and effects that make it almost impossible to get a clear picture of what’s actually going on.
In this section we look at:
The best way to describe what happens is by showing you what spines normally do, then how this changes when problems develop.
As this diagram shows in a normal spine the vertebrae balanced in a neutral position, and when the spine bends they should all move about the same amount.
Rather than going out of place or becoming misaligned, what actually happens is individual joints become stiffened, and often tilted or twisted slightly. In this typical example the bottom joint has stiffened and tilted to the left. Let’s look at what happens as a result
When the spine is bending to the left everything looks completely normal because the problem vertebrae is already tilted this way.
When the spine is neutral you can see the bottom vertebrae cannot straighten normally and is sitting slightly tilted to the left. The joint above is tilted back the other way to compensate.
With the bottom joint stiffened and still tilting slightly to the left the joints above the problem vertebrae above are forced to move a lot more in compensation.
This condition is called a “dysfunction” which is the technical term meaning functioning abnormally. To keep things easy to understand we’ll just use the simple term “functioning abnormally”.
There are many ways a spinal joint can stiffen up and possibly become slightly tilted or twisted.
In this section we will look at the secondary problems this abnormal function causes.
Basic anatomy of your spine
Pressure on joints
Protective muscle spasm
Tension on muscles
Compensation
Disc problems
x/ray changes: degeneration and arthritis
Nerves
As you can see from this diagram the tilting of a vertebrae puts a lot of extra pressure on the two small sliding joints marked with the red dots. This causes the following (1,2):
Implications for treatment
Over time these joints usually become irritated, inflamed or injured, and when this happens you will start getting pain in your spine. This often becomes sharp and pinching when you move around. Too often this pain is just treated with rest, anti-inflammatory drugs and maybe injections. These give temporary relief, but of course do absolutely nothing to relieve the abnormal pressure so further pain and long term deterioration of your spine is usually inevitable.
Your nervous system will detect this damage and automatically tighten your back muscles like a splint to restrict movement.
Implications for treatment
The muscle tightness can do a great job protecting your spine so you get no pain from your spine, but the muscle tightness itself becomes a painful spasm. Doctors will treat this by prescribing muscle relaxant drugs. This can give relief from the painful muscle spasm, but of course the protection for your spine is removed and damage continues.
A tilted vertebrae will cause the spine above lean to that side. As shown in the diagram above, to maintain balance and so you do not topple over the muscles on the opposite side will automatically tighten to straighten and balance your spine. Those muscles will be constantly tight. As discussed in this article , constant tightness causes continual stress and a restriction of blood flow which leads to muscular pain and deterioration.
Implications for treatment
When those tight muscles eventually become painful massage and stretching are often used to relieve them. However, as long as a vertebrae is tilted your body will automatically re-tighten the muscles to straighten and balance.
As shown in this diagram, with one joint stiffened and possibly tilted or twisted the joints above and below are forced to move extra to compensate. Often they can be forced to bend or twist far more than they were ever designed to, which leads to rapid deterioration and possibly injury.
Implications for treatment- exercises will cause damage
Spines with these problems usually have some loss of movement or function. Doctors and therapists will try and address this by prescribing exercises. The problem is that when doing these exercises the stiffened or seized joints will remain stiffened and the compensating joints will be forced to do extra work. Long term this will:
- increase the wear in the compensating joints leading to severe joint degeneration,
- possibly resulting in catastrophic failure.
Discs sit between your vertebrae to provide some cushioning, and some flexibility to allow you to bend. As this diagram shows they are a bit like car tires only filled with jelly rather than air. Like a car tyre abnormal stress and wear can cause the outer casing to weaken and rupture. This can an cause two main problems.
There are two ways abnormal spinal function can cause disc problems.
The first is really obvious. The compensating joints are forced to bend way more than they were meant to which puts tremendous stress on the fibres in the walls of the discs, so over time they will weaken and fail.
The not so obvious way a stiffened joint can destroy a disc is through a lack of movement. There are no blood vessels inside a disc so it relies on movement to pump through nutrients. If it’s not moving there’s no pumping. With no pumping there’s no nutrients. With no nutrients the inside of the disc dies (2–4).
We’ve mentioned how abnormal spinal function puts extra pressure on individual sliding joints and causes discs to deteriorate. Over time this causes changes that can be seen on x-rays.
This x-ray shows a typical example where the stress caused by abnormal function has caused severe degeneration and arthritic changes to one joint while the other joints look in excellent condition.
In the deteriorated joint the space between the rectangular blocks (vertebrae) has become thinner, and the things that look like parrot beaks are bone spurs.
The easiest way to see the treatment implications is by using a simple analogy of having a car with one worn tyre while the rest are normal. A tyre shop would advise you that you had a wheel alignment problem causing that tyre to wear abnormally. Instead when doctors see an x-ray with some joints badly worn while the others are in excellent condition they often do the following.
While a degenerated arthritic joint can become a problem in its own right it is still secondary to the underlying functional problem.
The normal joints are the same age, yet they are fine. The arthritic changes are caused by abnormal stresses over time as a result of functional problems.
This is like the tyre repair shop just changing the tyre but not correcting the wheel alignment.
The final issue caused by abnormal spinal function is interference to your nervous system. The original Chiropractors described this as pressure on a nerve causing a blockage. It is now known that interference to your nervous system is much more complex, but the principles are very simple. Issues with your spine can cause:
We used examples of interference to the nerves that allow feeling and control of your muscles. These are well understood. However, as this diagram shows your nervous system helps control every function in your body so the same blockages or “static” can cause a wide range of problems including potentially wide reaching and seemingly unrelated effects. For more info please see Dr Graeme’s brief summary video below.
The goal of chiropractic adjustments and spinal correct is simple. If the normal movement is restored to those individual stiffened tilted/twisted joints then your spine is free to re-balance and function normally. Then:
We have seen when a spine has a stiffened joint and functions abnormally attempts at restoring movement such as exercises result in the compensating joints moving rather than the stiffened joints. As shown in this diagram a chiropractic adjustment is a very specific force directed at the stiffened joint, designed to restore movement in this joint only.
The joints of your spine are complex and the overworked compensating joints are generally very close to the stiffened joints. It takes a huge amount of training and practice to be able to analyse the individual joint movements, then deliver the exact thrust in the exact direction without adversely affecting the often damaged adjacent joints. This is an adjustment.
There are a lot of people ranging from “back yard” practitioners through to medical practitioners who have done a week end course that deliver thrusts to spines. They can often make impressive cracking noises and sometimes give short term relief.
Unfortunately as this diagram shows, without the extensive training of a professional such as a Chiropractor, Osteopath of a Physiotherapist with specialist post graduate training (5–8) these forces will most likely be non-specific. The force will most likely have it’s greatest affect at the already over stressed compensating joint. These are manipulations
Chiropractic adjustments often give instantaneous and dramatic relief. However, the abnormal spinal function will have caused changes that make it impossible for the spine to just return to normal straight away. You need a correction program to help reverse these changes over time. The following are examples of these changes.
In the basic diagrams we see that when a joint is tilted the space between the levers becomes smaller on one side and larger on the other. Over time the tissues change in length to adapt.
Where a joint is not moving the tissues around that joint stiffen, while the muscles that move that joint weaken with disuse.
Over time your nervous system will adapt and get used to doing the compensatory movements.
Very simply repeated adjustments are used. Each adjustment adds a small amount to the movement of movement of the stiffened joints. In between the adjustments we need to do things to help maintain that movement and encourage the necessary changes.
We want the spine to start using the restricted joints, but not cause the compensating joint to compensate. Appropriate exercises are usually repeated movements designed to take the spine through comfortable ranges of movement, but not try and force extra movement.
There are many other therapies that can help the muscles and other tissues recover and adapt. An excellent example is massage. As discussed below you will usually benefit from large amounts of this over time, so in the section below we show you the best self care options that will not cost a fortune and require you to make huge numbers of appointments.
Note that this is just an overview. An actual correction program is complex and should be managed by a professional such as a Chiropractor, Osteopath, or a Physiotherapist with specialist post graduate qualifications.
Requirements vary, but for a typical spinal correction program it is often good to have a week or two between adjustments to allow time for the tissues to adapt, but have several applications of massage or soft tissue in between. If using professional services this would be prohibitively expensive and time consuming. However, as discussed in our article How to release trigger points yourself there is a highly effective self massage therapy.
Also, as discussed below there are critical small muscles around your spine that cannot be massaged with conventional massage, so are too often completely overlooked. However these can easily be treated using the self therapy mentioned above.
As shown in this diagram the really important muscles that control the movement of the individual vertebrae sit very deep between the levers coming out from your spine. As well as being very deep those levers might only be 1cm apart. Because of that it’s physically impossible for a massage therapists examine them or to dig in deep enough to massage them.
However, they can be easily reached by the vibrations of an effective vibration massager such as our General Purpose Massager . This is how we have used them in practice.
You cannot feel these muscles and examine them conventionally. However, when they are tight they restrict the movement of the spinal joints. Professionals like myself can examine for this.
Once we have identified the restricted movement we can place the vibration massager directly over the muscles involved and leave it on for say 60 seconds. The vibrations will penetrate down deep between the levers and have their therapeutic effects.
After applying the vibration massage you usually find that the joint movement has improved, indicating the the vibration has relaxed those deep muscles.
Of course patients cannot do these examinations on their own spines. However, a professional can easily show them where the issues are.
As discussed in our article Do massage guns actually work percussion massagers are designed to drive their heads into muscles rather than deliver vibrations. Massage guns cannot drive their heads in deep enough to reach the small muscles surrounding the vertebrae, but you could do a lot of damage trying.
DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.
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