I have a question about hyper mobility, and or releasing pent up gasses between vertebrae. In other words, I creek and crack a lot after 40 years of skiing, and swimming, and biking, and throwing myself off cliffs and cracking ribs, you know, that sort of thing. Should I ask it on your blog? When I do “crack” my neck, or lower back by stretching, it feels fantastic! I am in no pain, unless I sleep wrong, and this releases it. What is this?
-Adam

FIrst, I should begin by saying, that if the ‘crack’ does not induce pain, it is probably not doing you any harm. My grandmother used to tell me that cracking my knuckles would cause arthritis, and in spite of this, I did it anyway (sorry Grandma.) When I was in medical school, I started to wonder if this was true, and after exhaustive research employing a whole host of medical student lackies, I can state that there is no evidence that cracking your knuckles (or your back) will cause you arthritis.

Now, there have been informal studies that have shown that when you crack your own back, that you are usually unable to ‘self-correct’ the segment of your spine which actually needs to be moved- you are cracking the ones above or below it. It may provide you some relief, but ultimately it may not fix your underlying problem and you may find yourself in the same discomfort an hour, a day, or a week later. Having the correct segments adjusted by your Osteopath or Chirppractor may give you longer lasting and ultimately more satisfying results.

As for the release of pent up gasses- yes, there is a school of thought that believes that the sound you hear when you have your spine corrected is actually the shifting of nitrogen bubbles within the joint. After further research (and more lackies) I have found that there is no conclusive evidence about what that crack may actually be. As an aside, in my own practice, i do relatively little ‘cracking’ of the spine as my approach is based more on gentle mobilization. You would not believe how often I hear sounds of disappointment when patients realize they are not going to hear that loud ‘CRACK’ when I adjust them- they have come to associate that sound with relief.

I hope this answers your question. Thanks for visiting the blog.

-Andy

And once again, the stately grounds of Chez What are blanketed with snow.

If you are an Osteopathic Physician, Chiropractor, Massage Therapist, or other type of body work specialist- purchase an adjustable height table (well worth the investment), and vary the height throughout your work day. Certainly there is a range of height appropriate for the patient you have on your table, but by moving it around, you will prevent yourself from structural compromise over time.

Stop back tomorrow for tips on making commuting a back friendly endeavor!

-Andy

I was seeing a 32 year old mother of 3 for her back pain- let’s call her ‘Sue’- and after seeing her weekly for about 8 weeks, I managed to get her essentially pain free. We discussed her workout regimen, some home exercises I wanted her to do, some ergonomic things she could do around the house, and a few other things before I sent her home.

When I get someone to the point they are feeling pretty good, my goal is to see them for occasional maintenance, perhaps every 6-9 months- with the option of them coming in sooner if they ever had an exacerbation. I never got into the whole ‘I need to see you every week for the rest of your life’ thing (the exception being some of the professional athletes I work with who put themselves in harms way pretty regularly.) I booked Sue for six months, and she was so happy for her relief.

I came into my office one morning about 3 weeks later, and there was Sue- looking none-too-happy with me.

I asked Sue what brought her in. She had full return of her pain, and was incredibly frustrated by her setback. I didn’t want to discuss this in the waiting room, and scare off other patients, so we went back into the treatment room.

Had she fallen, been injured, over did it in the gym?  No- none of the above- her pain was back and she was pissed.

She got up on my treatment table and I began to palpate her spine. Lo and behold, her spine was right back where we had started. It was as though I had done nothing at all. It was at this point, I pursued a different line of questions….

Had Sue taken any of the ergonomic suggestions we discussed for her house? No.

Had Sue been doing any of the specific exercises I had prescribed to help keep her back moving? No.

Had Sue changed her child care situation to involve her husband a little more, so she wouldn’t be the only one picking them up? Nope.

Basically, she left my office the previous visit feeling great- did none of the things we discussed to help maintain her wellness, and was really annoyed when her pain came back.

Here’s the bottom line: If you are going to a Chiropractor, Osteopath  -or anyone else who does manual medicine or body work- you are wasting your time and money if you don’t address the lifestyle issues which caused your back pain in the first place. Back pain is not just a structural  thing. I talk about the pain triad with many of my patients- that is the essential 3 things which I feel contribute to back pain. They are as follows:

Structural issues: These are what they sound like- problems associated with basic structure and function. These things can usually be measured or imaged with x-rays or MRIs, and they can usually be fixed with manual medicine, therapy, and addressing underlying ergonomic concerns.

Psychological Amplifier: This is the part of your mind which gets frustrated or annoyed with the effect back pain has on your life, and can actually make it worse.

The Learned Neurological Response: This is the part of your central nervous system which controls modification of your normal body mechanics in order to find less painful ways of functioning following an injury or compromise, and sometimes has a difficult time resetting once the structural cause of pain has been addressed.

Almost all of my patients have each of these factors contributing to their discomfort- perhaps to different degrees, but they are all there.

For you to really control your back pain, rather than having it control you- you need to look into each of the components of your back & neck pain, otherwise you will forever be at the mercy of physicians and therapists to find relief from your discomfort- and throwing money out the window. Really- give this some thought the next time you experience an exacerbation. Take your practitioners suggestions and information- and use them!! This is the only way you will find lasting relief.

Best,

Andy

One week to the Philadelphia Flower Show- Spring is four weeks away!

Throughout your day, vary the height of your treatment table- not only to accommodate the size of your patients/clients, but also to keep your spine from getting acclimated to one position. There are many older practitioners out there with severe kyphosis due to the limited movement of their treatment tables- take advantage of the tools you have available, and change the height of your table throughout the day.

Best,

Andy

In the mean time, I hope you will find my series on back pain informative- Please share any surgical experiences you have had here on BackWords. Your thoughts and contributions help to keep the blog interesting.

Be well!

-Andy