A quick thought on success…
There is no absolute standard of success.
Only you can decide what success looks like for yourself.
Elon Musk and Warren Buffett are staples in the top 5 of Forbe’s Billionaires list, but their family lives are far from what I consider successful.
There’s no amount of money that could get me to trade lives with them, because my definition of success is different than theirs.
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A deep dive on spine adjustments
“Yeah, I go to see the chiropractor once or twice a week, so he can adjust my ankle and my back.”
One of my athletes, Dustin, told me this during a training session a few years ago. I didn’t know he was having any pain, so I felt like a bad coach for not keeping up with him.
Me: “Oh really, do they hurt?”
Dustin: “No. When I go in, he tells me that my spine is out of place and my talus in my ankle is popping out, then adjusts them.”
“So… they don’t hurt?”
Dustin: “No, I can never feel when they’re out.”
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That, my friends, is quackery.
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“But, my spine is out of place.”
Is it, really, though?
Research is clear. If you get an x-ray of your spine, then get adjusted, and then get another x-ray, nothing has changed. There’s no movement in the position of your spine.
The only way your spine is “out of place” is if you have a serious fracture. No adjustment would help that.
Furthermore, let’s consider the consequences of what would occur if an adjustment actually did change the position of your spine.
A chiropractic adjustment peaks somewhere between 200 and 1,600 N of force on your spine.
Simply blocking a sled in football places over 8,000 N of force on your spine.
Swinging a golf club has been shown to place forces over 8x body weight on the spine. If a golfer is 180 lbs, that’s 6,405 N of force on their spine.
If an adjustment was able to move your spine even a centimeter, then your back would snap in half every time you swung a golf club or hit a practice dummy.
Imagine what would happen when you got laid out by a middle linebacker on a crossing route.
The same is true for your hips, ankle, elbow, or whatever body part some clinician is telling you is “out of place.” It’s just not possible.
If your talus was out of place, your ankle would be dislocated and you wouldn’t be walking.
That’s not to say “adjustments” are useless though. (Manipulation and adjustment mean the same thing, I’ll use them interchangeably.)
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Sometimes I feel better after an adjustment, so what the heck do they actually do then?
First, we have to address the burning question that everyone cares about the most- what is the popping sound from an adjustment?
It’s not the joints moving back into place. Nor is it the sudden popping of a cavitation bubble as was long believed. It’s currently thought to be the result of a process called tribonucleation.
The two joint surfaces resist separating until a critical point, then they separate rapidly creating sustained gas cavities. The sound is the formation of the cavitation bubbles, rather than the popping of them.
Now that we’ve got the cracking noise figured out, how does an adjustment change pain?
Would the answer “we don’t really know” shock you?
Certainty and exactitude are less commonplace in healthcare than you might think.
But, we’ve got some solid theories.
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Neurophysiological response
Big word, huh? It really just means that the adjustment may alter the way your nervous system interprets the information it’s given.
As a massively oversimplified explanation, the adjustment is a novel stimulus to your nervous system and makes it “reset.”
There are a ton of different proposed mechanisms on how exactly that happens. I found this article to be a good overview if you really want to nerd out.
In reality, pain reduction is likely a result of a combination of those mechanisms. Different mechanisms play different roles in different people.
In some people, none of the mechanisms come into play and it just doesn’t work.
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​The placebo effect
Placebo is basically your mind playing tricks on you. If you feel like something is supposed to work, even if it has no therapeutic value, then sometimes it actually does work.
It’s incredible to see how powerful the placebo effect can be. Patients given nothing but a sugar pill have reported improvements in depression, fatigue, allergies, IBS, Parkinson’s disease, and pain.
Don’t get it twisted, though. I’m all for maximizing the power of the placebo effects. If “fake” treatment can get real results, does it really matter if there are solid physiological underpinnings?
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Mechanical changes
While we’re very sure that your joints aren’t re-aligning when you get adjusted, there’s a lot of evidence that does show that you have more range of motion after the adjustment.
You don’t just have more range of motion in the area that was manipulated though, you have more range of motion in other joints as well. Even those far away from the adjustment site.
How can that be? Well, it probably ties in with the neurophysiological changes we talked about above.
The manipulation tones down the nervous system, which temporarily reduces pain and increases range of motion everywhere.
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When are they not appropriate?
Before we dive into when adjustments are appropriate, we have to be clear about when adjustments are NOT appropriate. This is not an exhaustive list, nor is it meant for medical use. Some of these are absolute contraindications, while some are relative. Seek professional guidance.
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- Suspected fracture or dislocation.
This is especially pertinent in youth/HS athletes, where around 30% of those with low back pain are going to have pars stress fractures.
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- Signs of ligamentous instability.
​Hypermobile people, please read. There are rare instances where your bones could change position when you get an adjustment. This isn’t a good thing.
Most specifically, we’re concerned about the transverse ligament. If there is instability in the transverse ligament in your neck, the dens could move and compress your spinal cord. This would be really bad.
​​Even if you’re not hypermobile, after any neck injuries, make sure that your practitioner ensures your transverse ligament is secure before even considering adjusting your neck.
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- Anything that makes bones weaker
This can be osteoporosis, cancer, infection, arthropathy, rheumatic diseases, and more.
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- Significant neurological symptoms and vascular diseases
This can be cauda equina syndrome, myelopathy, significant radiculopathies, and more.
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When are they appropriate?
Adjustments are never really necessary, but that doesn’t mean they’re never helpful.
If you have no contraindications, you believe an adjustment might help, and it is not a significant financial or time burden to get it done, then go for it!
I’ll manipulate our athletes when it’s appropriate. It’s quick for us, since they’re already coming to see me regularly.
Just don’t expect long-term changes. The adjustment opens up a window of opportunity by temporarily reducing pain and improving range of motion.
You can use that window to start being more functional and confidently build up work capacity.
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An extra note on pseudo-science
Sometimes my comments and thoughts are misconstrued, so I want to be clear- I am not anti-chiropractor.
I am anti-pseudo science.
I think there are really good chiropractors out there who do a phenomenal job of providing evidence-based care.
There are also some real quacks out there. This is true for any field; quackery just seems to be more common in the chiropractic field.
This is probably because chiropractic got its start as a pseduo-science, alternative medicine in the 1880s when DD Palmer claimed to heal a deaf janitor’s hearing by shoving a vertebrae back into place. (No, I’m not joking. Read more about the absurd origins of chiropractic here.)
I will reiterate, there are really good clinicians in the chiropractic profession. Just be diligent in finding ones that are evidence-based and not spreading misinformation.
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An extra extra note on x-rays to show “misalignment”
I won’t mince words here- chiropractors who take x-rays of kids’ spines for the purpose of demonstrating that it is “out of alignment” should be charged with child endangerment.
The evidence is an open and shut case that your spine doesn’t go out of alignment (without fractures) and that adjustments don’t change the position of your spine. This isn’t up for debate.
The evidence also shows that frequent exposure to radiation increases the chance of a kid developing cancer later in life.
Is one x-ray going to give your child cancer later in life? No, not at all.
But, we have to be vigilant in deciding when imaging is important and when it is not. We have to ask “would the results of this imaging significantly change the course of care?”
The answer to the above scenario is a resounding no. Imaging for the purpose of identifying “misalignment” provides zero benefit and compounds future risk. It’s merely a scare tactic to convince you about how much you need their treatment.
Imaging is appropriate if we suspect there might be a fracture or some other significant pathology that would require us to alter the rehab process.
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That’s a wrap!
Please share this newsletter with anyone you think might be interested in learning how to help their kid get faster, stronger, healthier and ready for real-word success through long-term athlete development.
It means more than you know!
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Be >,
Zach
Dr. Zach Guiser, PT, DPT, CSCS