To Pop or not to Pop? An Explanation of Manipulation

  Many of my clients are past chiropractor patients and have asked my opinion on the practice of manipulation. I feel this is a very important topic to address. Statistics show many people have been injured during this type of treatment if hypo-mobile segments of the spine are not isolated correctly. Gross manipulative practices can come with great risks. There are incidences of death with upper cervical manipulation due to vertebral artery rupture. Joint manipulation causes an immediate release, sending endorphins (feel good hormones)to your brain from type 1 and 2 mechanoreceptors. This feeling is temporary (creating a dependance on the treatment) and can create hyper mobility. This in turn will lead to arthritic changes as your body produces bone and tissue to protect and attempt to stabilize those segments that are being repeatedly thrust past their physiologic end range. When the feeling wears off the muscles feel “tight” again….this can also be our bodies’ way of attempting to stabilize a hypermobile joint. That tightness leads to the patient seeking out another manipulation which will then cause a temporary release and feeling of relief. It can be a vicious never ending cycle leading to dependence and hyper mobility. With that being said , there are many good chiropractors/practitioners out there that have an updated practice and have abandoned the original views established years ago. Not all chiropractors perform gross manipulation on a regular basis. No matter what route of treatment you decide to seek, the person performing the treatment should be able to tell you what they are doing, and why they are doing it. If it does not make sense or they do not have an explanation regarding their treatment… then take caution. I also believe that mobilization and segmentally specific manipulation under the control of the patient is appropriate in certain joints in the body (thoracic and sacro-ilial) and in certain circumstances. It is a matter of not repeatedly subjecting your body to undue stress that may create problems down the road. I believe that patients should be given education and the tools to treat and maintain any manual therapy treatments at home. My job as a PT is to give you the tools so that you don’t need Physical Therapy.