What Happens During a Chiropractic Adjustment

There are more than 70,000 registered doctors of chiropractic (DCs) in the United States caring for an estimated 35 million Americans (adults and children) each year. For those of us that receive chiropractic adjustments as part of our health strategy, we know how invigorated chiropractic care can make us feel.

Patient satisfaction as a result of chiropractic care is nothing new. Studies and surveys spanning over the last four decades have continually shown that chiropractic care is well received. One of the most significant, a 2018 Gallup-Palmer College of Chiropractic report, Managing Neck and Back Pain in America, reported that nine out of 10 adults who saw a DC in the past 12 months reported positive patient experiences, with a whopping 93% stating that their DC listens and provides convenient, quick access to care.

Whether you are addressing pain or headaches, healing from a personal injury or simply engaging in a check-up, what is happening physiologically during an adjustment is very specific.

 Getting Specific

A chiropractic adjustment is a safe, controlled force applied to a joint to restore proper function and mobility. To accomplish this goal, there are a wide variety of effective adjusting techniques that DCs learn and implement. These include popular hands-on techniques, or may utilize special tables and/or instruments.

The adjustments provided by DCs are very precise corrections that address the way a joint has shifted. Unlike popping your knuckles to simply make a noise, DCs examine and palpate the spine to determine the exact joints involved and the x-y-z axis of how they have moved out of place. They are then able to issue a gentle controlled adjustment with a precise line of drive applied to the particular joints that are involved.

It is important to note that though DCs are commonly known for their work with the spine and pelvis, a great number of DCs also address other joints in the body found in the upper and lower extremities and cranium.

 What’s That Sound?

Everyone wants to know what the popping noise is that is experienced during some adjustments. Though minds may race to bones cracking and rubbing together, the answer is much softer. DCs adjust diarthrodial joints. These are freely moveable joints created by two bones surrounded by a joint capsule. The capsule is filled with a lubricant called synovial fluid. Synovial fluid also serves as a source of nutrients for the cells that maintain the joint cartilage. Within its contents, synovial fluid also contains dissolved gases of oxygen, nitrogen, and carbon dioxide. 

Facet joints (also called zygapophyseal joints) are synovial joints that are found between vertebral bones along the length of the spine, on both sides and at the top and bottom of each vertebral segment. They allow for the variety of bending, arching and twisting motions that come from our spine. Facet joints are by far the most common joint type adjusted in the chiropractic office.

When a joint capsule is stretched to a point of resistance, it creates pressure within the fluid that causes the exchange of dissolved gases. Recent studies have shown that the process may actually create a cavity within the capsule fluid allowing this to happen. This type of popping noise should not be confused with the bone-on-bone grinding heard with some types of arthritic degeneration, nor should it be confused with the popping of a tendon or meniscus such as might be seen with a knee injury.

DCs will often explain to first-time patients, especially children, that they may hear a sound, so that the noise isn’t alarming. It’s important for patients to know that their bones are not cracking! An analogy to something less frightening (bubble wrap releasing pressure, or likening the sound to popcorn) can also be helpful.

Beyond the Noise

The formal term for the popping noise is ‘joint cavitation’ which is the audible exchange of gas within the joint. It is important to note that the amount of cavitation does not determine the success of an adjustment. Though joint noise does often occur, different types of adjustments will have different levels of cavitation. Many low impact adjustments will not have any noise at all but they are as equally as effective in correcting joint alignment.

Again, a popping noise does not equal success. A diarthrodial joint provides the ability for movement but it also limits movement to prevent injury. It isn’t difficult to pop a knuckle and stretch a joint capsule to make a noise, but a well-meaning friend trying to pop your spine could actually over-stretch the capsule or move joints in the wrong direction and cause more harm. This is why only trained professionals should ever attempt to adjust your spine and extremities.

Most importantly, when done correctly, adjustments go way beyond a sound show. Specific adjusting affords multiple benefits. Primary benefits include a variety of physiological changes such as:

●     The restoration of normal range of motion.

●     The normalization of local nerve function (or even vascular function) for those structures that might be directly impacted.

●     The relaxation of muscles adjacent to the joint as they are able to stop ‘protecting’ the joint through spasm and resume their natural position.

●     A decrease in inflammation when the stress on the joint capsule is resolved.

●     A decrease in pain through the release of endorphins at the region of care.

 What happens during a chiropractic adjustment is multifold and holds the advantage of not only properly correcting the joint with an adjustment, but also providing the patient relief from the many symptoms associated with it, naturally.