If you’ve never been to a chiropractor before, what holds you back? Fear of it not working? Fear of injury? Or maybe you’re just not sure how exactly it might help you.
More and more, people are turning to chiropractic care as a way to treat painful conditions without drugs or surgery. In fact, about half of American adults have visited a chiropractor; of the estimated 35 million who visit annually, 95 percent report that it is effective.
Chiropractic therapy is a form of medicine that focuses on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Chiropractors use hands-on manipulation to provide treatment for many conditions, including neck and back pain, headaches and migraines, pain in the extremities and for injuries. Other methods of treatment such as muscle stimulation, therapeutic ultrasound, lasers, decompression traction, massage and exercise may be involved.
What then, does a chiropractor do? And what exactly is going on in your body when you have what’s commonly called an “adjustment?”
When working on a patient, chiropractors are looking for blockages that affect the spinal joints, says Dr. Robert Pinto, a chiropractor at Pinto Chiropractic & Rehabilitation in Williamsburg, Va. The blockages are usually accompanied by inflammation of the joint and surrounding tissues along with spasming of surrounding muscles. Chiropractors refer to this disturbance of the normal vertebral motion or position as a subluxation.
This blockage/misalignment doesn’t just happen in the spine, but can happen in any joint — such as wrists, hips, feet, knees, ankles, ribs and the temporomandibular joint (TMJ). “Just about anywhere there’s a moveable joint, it can become blocked and lose its mobility,” Pinto says.
There are many different types of adjustments used by chiropractors, but the most common is referred to as HVLA, or a high-velocity, low-amplitude maneuver. This adjustment uses a quick, but not very forceful, impulse to produce movement in the joint.
It works like this: a joint is comprised of two surfaces surrounded by a capsule, which is air- and watertight. Inside, there’s a fluid called synovial fluid. The chiropractor works with the motion of the joint and pushes it until it won’t go further, then pushes just a little more, causing the joint surfaces to separate. It’s then you hear a “popping” sound, which is known as cavitation. It creates bubbles in the fluid, which makes the joint more malleable and allows the chiropractor to move the joint further.
Think of the process a bit like a rusty hinge on a door. You push to force open the door a little way, and immediately there’s more movement in the door than there was before.
Once you start restoring some of the lost motion to a joint, you start stimulating nerve endings called mechanoreceptors. Because your brain is more concerned about mechanical stimulation than pain, the brain focuses on the stimulation first, thereby blocking the perception of pain. It’s a phenomenon called “pain-gating,” or the gate control theory of pain. For example: If you bump your elbow and rub it, it feels better.
The release in the joint also releases endorphins, which are natural pain relievers. Once the joint is moving better, the movement tends to pump out inflammation, which also decreases pain. “Inflammation is a big pain stimulator,” Pinto says. “If you can lessen the inflammation, there’s less pain.”
Many people will try to adjust themselves, or self-manipulate. And it can feel good — if your neck is stiff and you stretch it back and forth to pop it, there’s an endorphin release. But a short time later, the pain and stiffness will usually come back.
“The difference is that the art of chiropractic is finding that blocked joint,” Pinto says. “When you do a self-adjustment, rarely do you release the blocked joint. It takes a lot of time and practice to learn palpation skills, to feel the blockage.”
For people who worry that going to a chiropractor once means committing to repeated visits, Pinto says they should instead think of it as part of a commitment to long-time health: “People realize you feel better when you go.” Also, studies show using chiropractic therapy as part of a wellness plan results in fewer surgeries and doctor visits and means taking fewer drugs.
One study, published in the journal Topics of Clinical Chiropractic, found that elderly patients who had chiropractic care reported having less arthritis, were more likely to do strenuous exercise and less likely to end up hospitalized or living in a nursing home.
A big part of chiropractic care is rehabilitation, because you can’t normalize a joint with one treatment, Pinto says. “There’s a tendency for muscles to go back into spasms, because they’re still trying to protect the joint,” he says. “What we do is try to rehabilitate the area and strengthen it. We teach patients how to move correctly and how to activate muscles.”
And what about the concern that you’ll end up injured? It’s very unlikely, Pinto says.
“There’s some fear out there, but chiropractic itself is among the safer treatments for neuro-musculoskeletal pain,” he says. “It’s safer than taking nonsteroidal drugs like Ibuprofen. The use of NSAIDs/aspirin carries a risk of serious side effects of 153 in 1 million, while chiropractic has been reported at about 1 in 5.85 million. Chiropractors typically pay far less in malpractice premiums than other physicians due to their low injury rate.”
What’s the bottom line? “If you have ever thought about seeing a chiropractor, you ought to give it a try,” Pinto says. “If you haven’t thought about it, you might want to. The movement is on.”