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What Is A Chiropractic Adjustment?

27 Jul
Posted by: Sani Kohen
Category: Chiropractic Sports Medicine
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Chiropractic Adjustment

What Is A Chiropractic Adjustment?

By Dr.SaniKohen / March 7, 2022

Chiropractic adjustment/manipulation is a manual therapy technique where the doctor applies a controlled, high-velocity low-amplitude (HVLA) thrust in a specific vector of a given dysfunctional joint, that is determined through the palpation process, to restore the joint/s’ proper function and related neuromusculoskeletal tissues.

*HVLA thrust- A thrust that is applied very quickly over a short distance.

Joint manipulation takes the joint into what’s called the “paraphysiological space”. It is within the paraphysiological space that joint cavitation, the “popping” sound, occurs.

Chiropractic Adjustment

What Happens During And After A Chiropractic Adjustment?

With more and more emerging scientific studies, we now know more about the neurophysiological effects of a joint manipulation than we ever have before. Turns out manipulation not only changes biomechanics of the joint but also has various neuromusculoskeletal effects!

  • Biomechanical changes caused by spinal manipulation, are thought to have physiological consequences by means of their effects on the inflow of sensory information to the central nervous system. Muscle spindle afferents, which are receptors that get stimulated by stretching, and Golgi tendon organ afferents, which get stimulated by pressure, are up-regulated by spinal manipulation. These receptors play a crucial role in proprioception (your brain’s ability to know where your body parts are in relation to your environment) as well as decreasing the risk of injury.
  • There is a phenomenon called central facilitation which basically means a “hypervigilant” nervous system. This is most commonly seen in patients who suffer from chronic pain syndrome. This phenomenon enables either subthreshold or innocuous stimuli (a stimulus which should not cause any pain under normal circumstances) access to central pain pathways and cause individual to experience pain that is unproportionate to the stimuli. Numerous studies show that spinal manipulation increases pain tolerance or its threshold.
  • Spinal manipulation is also thought to affect reflex neural outputs to both muscle and visceral organs therefore improving their function. Substantial evidence demonstrates that spinal manipulation evokes paraspinal muscle reflexes and alters motor neuron excitability. To put simply, manipulation will increase the power output of the muscles that is either innervated by the exiting nerve roots from the spinal joint segment that is adjusted or muscles that are, anatomically speaking, close to the joint being manipulated.
  • The effects of spinal manipulation on these somatosomatic reflexes may be quite complex, producing excitatory and inhibitory effects. Meaning that if a muscle is “hyperactive”, joint manipulation will bring it back to its “optimal” state and if a muscle is “underactive”, again joint manipulation will bring it to its “optimal” state. Both overactive and underactive muscles will have overlapping symptoms such as aching, burning, trigger points, fatigue and not being able to produce the “normal” amount of force that is required of that muscle. In addition to these symptoms a hyperactive muscle will feel “tight” and underactive muscle will have hyperactive muscles surrounding it as a compensation pattern. So we can think of joint manipulation as a “reset button” that brings these dysfunctional joints and related muscles to their optimal state via various neurochemical mechanisms.
  • There are four main theories of biomechanical changes elicited by spinal manipulation. These include release of entrapped synovial folds or meniscoids, restoration of buckled motion segments, reduction in articular or periarticular adhesions, and normalization of ‘‘hypertonic” muscle by reflexogenic effect. This plays a crucial role when it comes to restoring normal/optimal joint function.
  • Pain-spasm-pain cycle: pain causes muscular hyperactivity (spasm) and muscle spasm reflexively produces pain, establishing a self-perpetuating cycle. Joint manipulation is proven to break this cycle through various reflex pathways such as capsule mechanoreceptor and muscle spindle pathway.
  • Spinal manipulation leads to neural plastic changes, altering the net excitability of the low-threshold motor units, changing the synaptic efficacy of the Ia synapse and increasing corticospinal excitability. This leads to increase in muscle strength and cortical drive (brain activity) occurring in various brain structures such as the cerebellum, basal ganglia, prefrontal cortex, primary sensory cortex and primary motor cortex.
  • Last but not least, via its effect on the autonomic nervous system, joint manipulation leads to opioid independent analgesia. It’s a natural pain killer!
Chiropractor
(Gyer, Michael, Inklebarger & Tedla, 2019)

Who Needs A Chiropractic Adjustment?

The earliest historical reference to the practice of manipulative therapy in Europe dates back to 400 BCE. Initially the spinal manipulation or manipulation of any other joint for that matter, was thought to correct a structural deficit of a given joint. Meaning that whenever there was a structural abnormality whether it was scoliosis, subluxation or even dislocation, joint manipulation was performed in order to correct these “dysfunctions”. Later on it was discovered that the nerve roots, essentially what connects our central nervous system (brain) to the rest of our body (muscles, bones, organs etc…), came out of these little spaces called “neural foramen” that are found along both sides of our spinal column. Based on the best scientific evidence available back then, as well as anecdotal evidence, it was thought that these joint dysfunctions, particularly the joint dysfunctions found in the spine, could have an effect on the exiting nerve roots, and potentially disrupt the function of these different innervated tissues. Therefore joint manipulation started to be performed not only for structural issues but also organ dysfunctions. Now with more recent studies it has been shown that joint manipulation has far more benefits than we ever thought. These benefits include central neuroplastic changes in the brain (improved brain function and pain processing capability), alterations in motor neuron excitability (reducing muscle spasm), improved muscle strength, increase in cortical drive (improved neuromuscular connection), activation of the descending pain modulation (natural pain killer effect), and central sensitization (optimization of pain processing). If you want to know whether you need a chiropractic adjustment or not, go and get checked by your doctor of chiropractic!

Our Approach

At Functional Restoration Institute, we utilize evidence-based motion palpation protocols that are specific to each joint of human body. The doctor will determine the dysfunctional joints through these particular motion palpation protocols that will require the patient to dynamically move through different motion planes that are specific to the joint in question. Based on the motion palpation results, the doctor will perform a joint manipulation on the dysfunctional joint segments. Once the manipulation is completed, the doctor will then repalpate/reassess the joint segments that were found to be dysfunctional to see if the manipulation was successful.

References

Cassidy, J. D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F. L., & Bondy, S. J. (2008). Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. European Spine Journal, 17(Suppl 1), 176–183. https://doi.org/10.1007/s00586-008-0634-9

Daligadu J, Haavik H, Yielder PC, Baarbe J, Murphy B. Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation. J Manipulative Physiol Ther 2013;36(8):527–37.

Evans DW, Breen AC. A biomechanical model for mechanically efficient cavitation production during spinal manipulation: prethrust position and the neutral zone. J Manipulative Physiol Ther 2006;29(1):72–82.

Gyer, G., Michael, J., Inklebarger, J., & Tedla, J. (2019). Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation. Journal Of Integrative Medicine, 17(5), 328-337. doi: 10.1016/j.joim.2019.05.004

Pettman, E. (2007). A History of Manipulative Therapy. Journal Of Manual & Manipulative Therapy, 15(3), 165-174. doi: 10.1179/106698107790819873

Pickar, J. (2002). Neurophysiological effects of spinal manipulation. The Spine Journal, 2(5), 357-371. doi: 10.1016/s1529-9430(02)00400-x

Taylor HH, Murphy B. Altered central integration of dual somatosensory input after cervical spine manipulation. J Manipulative Physiol Ther 2010;33 (3):178–88.

Author: Sani Kohen
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