Question
QUESTION: I am 30, and regularly visit a chiropractor for general wellness and mobility. I always wondered how you determine which vertebrae joints specifically need to be adjusted? Every time my chiropractor adjusts me, there are multiple cracking noises. I'm not complaining because the results for me are clear, but how do chiropractors diagnose and isolate specific joints? They are so close together. Wouldnt a properly aligned vertebrae joint become subluxed if it was also adjusted along with the one that really needs it? Ive just always wondered that, and never remember to ask him when Im there. Thanks

ANSWER: James,

This is a very astute question!   The problem stems from the outdated definitions of what a subluxation is, and the outdated and invalid concept of re-aligning bones.    It used to be thought that the vertebra misaligned, that the misalignments could be seen on x-ray or felt by hand, and that the adjustment would put the bones back in place.   It all sounded good, but the reality is that bones do not pop out of place and get put in place like a child's block set.    Around the late 1970's a chiropractor started the Motion Palpation Institute, with a notable paradigm shift away from the bone out of place idea to a dynamic, motion or fixation concept.   I believe MPI still exists.    So, now, we have evidence that bones cannot be x-rayed and determined to be misaligned.   Either you have a dislocation, or a true subluxation (where one bone is slid off another but not dislocated), or you don't.      So what DC's feel are joints that are stiff, stuck, lack movement, are tight, restricted, or have surrounding soft tissue that is tense, fibrotic, adhered, or congested.     Joints like these often are tender or uncomfortable as well.   Though, sometimes they are not tender and are only stiff (for example).    The adjustment simply dynamically moves a joint (and likely those around it) past the barrier of fixation.   The popping sounds can come from joints anywhere in the region.   Any joint that gets jostled or stretched can make a popping sound regardless if it is stiff or stuck or malfunctioning in some way.   The joints get pushed at high velocity, for a very short excursion, but within their normal range of motion.   Thus, if you have a middle thoracic spine that was palpated by the DC to have a few joints that are stiff, stuck, congested, with little knots, etc, and that DC does a high velocity thrust into that joint system (likely moving a few joints under his/her hand) the surrounding joints don't get pushed out of place:  because it is not about in place or out of place.   It's not about "alignment."  It's about ease of movement or regaining ability to move.    Does this make sense now?    Freeing up stiff joints with an adjustment  does not push bones/joints into ranges they are not supposed to go.  Otherwise, it would sprain the joint.     So, modern DC's often chuck the term "Subluxation" because it is an outdated term that has caused a bunch of problems, including the confusion that led you ask me this question in the first place.  

'Hope this helps.

Dr. G

---------- FOLLOW-UP ----------

QUESTION: That helps a lot, but I have surrounding questions. I strive for a massage every month or so, as I believe the benefit from the general reduction in muscle tension is connected to so many more processes in the body than is commonly ackknowledged.

Long ago after I shoulder injury I discovered ART and became a raving fan. I understand the method and the ideology, and have even read massage books and palpatation guides for the pleasure of understanding and applying where possible.

So I think I understand the different tissues and the roles they play in acute, reoccuring injury, lack of range of motion, and up until now, what I thought the role of subluxations played.

I dont have much knowledge of joint tissue or connectivity for that matter. The role of adhesions, posture, flexibility, etc... all make sense to me, as well as how to treat them. But now that I understand a joint is not out of place per se... the way I've connected these theories doesnt make as much sense!

I understand that soft tissues and muscles have a lot to do treatment and prevention, but what is the  direct result of spinal manipulations? If the bones are not out of place enough for an xray, can they really impact nerve function substantially? Isnt soft tissue the underlying factor?

When the joints themselves are stiff, is it outside of connective tissue tension? Is the joint tissue itself physiologically changed?

If, in a very general sense, a manipulation is just a forced motion of the joints within normal range of motion, how come leaning back in my office chair and cracking the same areas the chiropractor does not yield the same immediate or lasting relief?

Thanks again! This is fun for me.

Answer
Hi James,

Leaning back in a chair and getting joints to pop is not the same a skilled high velocity thrust into a dysfunctioning joint system.   If it were, I'd be out of a job, maybe doing TV cooking shows or something...  ;-D   There's something unique about a well-placed, targeted, skilled, high velocity thrust to get a joint system to do what you want.   There is an art to it, and, believe me as I've been doing it for about 25 years, there are many subtle nuances to it.   That's why some DC's are really good with their hands and some are not.   ART is cool, but don't get sucked into all the hoopla.  Lots of us have been doing active forms of myofascial release without buying into the heavily marketed ART crap.   Many DC's sign on to the ART bandwagon just to say they do ART and market themselves, then never really do ART or do it well.   There's more out there.  Check out FAKTR.com for a different perspective.   

'Hope this was helpful.

Dr. G