Your back is not out!!!

Ok, this is potentially going to upset a few people…

Mostly because what we are discussing today will go against some long held beliefs of many practitioners and their patients.

The old “structural” model of understanding in relation to joint position and related pain is far too simplistic and lacking in understanding of modern pain science to hold the water that we once thought it did.

Practitioners claiming to be “adjusting bones back to where they should be” to reduce pain and improve function are ignoring a plethora of evidence suggesting that it is simply NOT the case.

But I hear you saying that your patients feel better after having their joints adjusted, so how can it be false?

Or that as soon as I felt that joint go pop, my range of motion returned…

The truth is that pain is impacted by a number of factors, and a poorly positioned joint does not always result in pain or dysfunction, so its position does not automatically correlate to a problem.

Research tells us that when a joint is manipulated or mobilised, the main driving factors for change are related to the sensory input that the structures around the joint are receiving.

From there, we can have a spinal or higher brain related response that can dramatically reduce pain perception, but also improve functional motor control of that joint.

But what about that POP and the immediate change in how the joint feels?

It is true that when a cavitation occurs (popping sensation) that there is a release of gas in the joint, which can decrease pressure and thus improve joint movement. However, the problem is that many people still believe that the pop is the joint going “back into place”, and that is why they feel so much better.

The science says it is simply not the case.

This is further supported by the fact that when a joint is mobilised instead of manipulated, (i.e. passive accessory glide) we can see the same beneficial outcomes that occur when it receives a high velocity, low amplitude (HVLA) thrust.

To get a better understanding of the mechanisms at play and to explore this topic in more detail, check out this video discussion we recorded on the topic.

I completely respect that there may be different beliefs and understandings on this topic, and hope that this article and video serves to push this conversation further and challenge all of us in how we think about the care of our patients.

In the video I reference three research articles that you may find interesting.

You can find them in our free Research Library, along with with dozens of others.

Here are their direct links:
👉 Chiropractic Science: A Contemporary Neurophysiologic Paradigm
👉 The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control
👉 Paradigm shift in manual therapy

Kind regards,
Shaun Brewster.