392 | What is a joint adjustment or joint manipulation? Is it putting me back in place?

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen. And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

[00:00:29] This is such an important episode and you're going to hear so much about the physiology that I hope that you share this out and really understand how it's helping the body, but know that it's not fixing the body. If we really want to make long-term change, we have to take our control into our own hands. We have to change movement patterns. We have to do something different throughout the day. And this is why I created Jen Health. I wanted plans available that you could just click, follow. It's going to keep track of your progress.

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[00:02:37] All right, welcome back, everyone. So diving right into a topic that I think is a super hot topic. It's that snap, crackle and pop that you get from those adjustments and what is actually happening. And do we need those to get rid of our pain or to be able to put ourselves back in place?

[00:02:53] I think this is such a good episode to really explain what it even is, the beliefs around it. And then we really want to empower you with the tools because like you just said, you know, when you couldn't go see someone, what are you supposed to do?

[00:03:10] Are you supposed to try to figure out how to pop yourself? Are you supposed to just not get help for a year and feel in pain forever? Like, you know, and especially this idea of alignment.

[00:03:23] And I think, you know, that's where we as physical therapists name it something different than the chiropractic community that uses the word adjustment, where physical therapists traditionally were trained in using the word manipulation, which is really just a high velocity mobilization.

[00:03:45] And that's just a little pet peeve of mine itself. It's like when we get into these little details of terminology, and I did like different lobbying for different legislation where it's just like, we literally have to pass laws that just use the word high, like thrust, high velocity mobilization, because in some states, you can't use manipulation and some states you can and I'm just like, it's all a bunch of BS because the body is the same.

[00:04:11] You know, our physiology transfers between people. And so we're essentially addressing the same system, the human body. We're just calling it something different. So I encourage all providers to like get out of your box and get out of your scope a little bit here and just start to view this all as us addressing the human body.

[00:04:31] Exactly. I mean, I remember even working, I think it was in Nevada when I was a student and the physical therapy assistant could not go past level four minute mobilization. So they could not do the high thrust manipulation. And it's so funny because my body that is, is a little bit more hypermobile from gymnastics, someone can put me into the position and I will go.

[00:04:54] So I, you will get a manipulation and adjustment out of my neck or out of my back. Like I was the person in class that everyone practiced on because you literally just put me in the position and I crack. Yeah. It makes you feel good as a provider when you get someone to crack. And as a patient or a client, when you hear the crack, that's a huge thing that like what that makes you think, oh, the crack, I heard it. Right. I must be better now. I know. But that's what makes me laugh too. It's like, you know, we, we talk about all these different levels and all these

[00:05:24] different adjustment versus mobilization versus manipulation. It's like, essentially we're trying to get the same result, you know, and we're going to talk about what that is, is an adjustment actually adjusting something into place. And I think that is the belief that we really want to start to break down. Taking a quick pause from this episode to talk about something that's been absolutely essential to both Jen and my health and the health of our little boys. I'm talking about needed prenatals. They're the prenatal vitamins that Jen took when we were looking to conceive.

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[00:06:48] That's T-H-I-S-I-S-N-E-E-D-E-D.com and make sure you use code optimal for 20% off your first order. All right, let's get back into the episode. So really, what is that crack? What is that pop that you hear? What is that even? Yeah, I think a lot of people approach it as, so a joint has a certain amount of space in it, right? When it's at its resting state. And when we do some sort of mobilization or manipulation of that space,

[00:07:17] we're going to change the amount of pressures in there, right? So say we increase the space in that joint, you know, that's going to cause the tissues to stretch a little bit. And anytime we increase the amount of space in something, it reduces the pressure in that space. Chemistry. Chemistry, physics, a lot of science going on here.

[00:07:37] And a lot of the times what we hear then is that pop, which is just, a lot of people say it's like this release of gas or this release of this pressure that has built up that causes this popping noise. Which is called a cavitation. That is that pop that you hear. And, you know, we were taught in school too, you can do the end range positioning and you could do hold relaxations.

[00:08:02] You don't even have to go into the thrust mechanic of getting that manipulation or adjustment. And you can still provide the same result. And the reason that it kind of creates the same result is because we're just talking to the tissues. Everything we do is talking to the tissues. Anything, anytime I put my hands on you, I'm talking to the tissues. So really when we get that cavitation, that sound that is happening, we're causing this reflexive relaxation of the system and all the muscles that kind of surround that area.

[00:08:31] And it makes you feel like, oh my gosh, I have more space. I can move. I have freedom in this joint. Yeah. And what you mentioned with bringing someone to an end range and just kind of have them lightly contracting against it. Again, we're just talking to the tissues, talking to the nerves, which then is perceived by the brain command control up there. And again, when we as a provider, again, Jen and I, we're not against manual techniques. I hope that we've said enough. Like we both love to get manual techniques done on ourselves.

[00:08:59] We both love to do it to other people, but there's always has to be more. It's the yes and thing that there's always something that's going to go with that. Well, and it's the education and intention behind it. Totally. And that's what we want to provide you. Totally. And so when we talk to those nerves, again, we help the system achieve a place it may not have gotten to recently or may not have gotten to in a long time. And that kind of lights our brain up. It lights up all these cortical areas.

[00:09:27] Cortical, the cortex is just a part of the brain that we see when we do manipulations specifically, even more so than some other manual techniques. And some of the research we looked at, it really helps our brain light up and say, oh, like we've found something new here. Right. But a lot of those are short lived. A lot of those benefits are short term.

[00:09:49] And that's the trick that a lot of providers, physios and chiros will use to say, okay, come back in three times a week. I'll do this to you three times a week for the rest of your life all until eternity. And then you'll be fixed because you'll always be coming to me, you know, and it starts to preach this message of dependence on that. I know that we've talked a lot about during quarantine, especially when quarantine started and a lot of clinics shut down.

[00:10:19] The message that we heard is I'm helpless. I can't do this. I can't make myself feel better until I can get back in with my chiro or my physio or my whoever. I need that adjustment. I need that thing. And I hope by understanding this definition of, you know, what a joint really encapsulates, which is the joint capsule that holds all this fluid, which causes that stretch and that change of pressure, that cavitation to happen.

[00:10:49] So if it is a change of pressure, if it's a stretching of a joint capsule, if it's a change in what's happening in the fluids, then we know that we're not actually adjusting something back into place. And I'm sorry to like break any, you know, I'm sorry if that's what you've been told or that's what you believe. Like I, we do have a lot, we hold a lot of space for you here, right?

[00:11:18] Because I think growing up too, I believed that. I believed that I was being put back into place or something was happening, something was shifting in the vertebrae. And what the mind starts to believe is that these two vertebrae that are stacked on top of each other are completely slipped, right? And if I get that adjustment, I'm going to align it back into place. It's a mechanical force that is happening with that sound, with that pop.

[00:11:48] And all we're saying is that that's not true. Yeah. I mean, whether it's the spine or if it's the SI joint or the hip or ribs attaching into our sternum, like whatever it is, our body's super smart and our body knows and remembers what we do long term. And if we get that pop or that crack, yes, it might give our system a little bit more slack for a short amount of time.

[00:12:16] And yes, it might allow us to achieve different mobility or different ranges of motion. You know, like we said, when our brain starts to perceive what's happening in that area differently. But again, if we go home right after that and do nothing and don't do anything, our body's going to be like, well, okay, we're going to go back to our safe space and anchor down there again, which is kind of where we will get those same tightnesses or same pains that just creep right back in. Exactly.

[00:12:46] And just like, I love the way that you said it too, because the body is craving safety always, unless we teach it something different. And so especially if you feel like you have chronic low back tightness, if your low back feels like it's spasming on you and you do love to go get that manipulation or that adjustment because it helps to relieve that pressure.

[00:13:05] And you feel like you're stacked, you're, you can stand better, you can ease the pressure because it allowed for those tissues for that moment to feel that relaxed state, to release that tension. But hopefully you've heard in our other podcasts, there's a way to do that on its own. And if the body is constantly craving that tightness, if it's constantly feeling the need to be tight, it's not just about stretching it. It's not just about adjusting it, but it's about creating safety in a different way.

[00:13:35] And a lot of times we do that through stability and strength. Yeah. And that's where, again, if you're seeing somebody who does these types of techniques on you, it's not immediately and inherently bad. No. But if they're not giving you anything that you can do at home, if you can't immediately see them and run in and get the adjustment, that allows you to do something similar at home.

[00:13:59] Or immediately after they work on you, say, okay, go home and do these things because it's going to help teach your system to access that new slack we've given it. Because these mobilizations are shown to, yes, in the immediate bring down some of our pain sensitivities. Yeah. To allow us to have a little bit more range of motion. All these different things that then, amazing.

[00:14:22] Now let's take advantage of what that technique has done for us with some stability exercises, with some controlled mobility through those ranges. Because that's when we're going to start typing the different message up into our brain to say, you can move through this range and access this range on your own. A hundred percent. I mean, I think that is the thing that we need to always be seeking. And knowing that, like we said, it doesn't just have to be an adjustment.

[00:14:51] It doesn't have to be the crock and it doesn't have to be the pop. That allows you to have that same ability or that same access into your body. And a great provider will teach you how to do that on your own. Again, not necessarily needing the pop, but teaching you a different way to achieve that tension release, to achieve that relaxation in the system.

[00:15:14] So that then you can add those necessary stabilization strengthening exercises that are actually going to teach the system a different technique, a different safety, a different zone of support. And really, I think that's what's most important. And when we did dive into some of the studies and some of the research, and again, we bring up the studies, but know that there's always so much out there.

[00:15:41] And it depends on exactly what technique was done and exactly what the type of provider was. And what they're comparing it against. Like some are comparing it against just cold laser sham. Or some are comparing it against, you know, exercise or just mobile. You know, there's just so much. So that's why you're human. We're going to bring this up just so you start to understand what current research is saying, but it's not end all be all. And I think that's an important thing to just know.

[00:16:09] I think one thing that we saw when we were looking through just studies and whatnot was that, what is it? Three quarters of people actually believe, have that belief that when they hear the crack, that it's realigning things. That crack itself is their bones being put back into position. And time and time again, with all of the best imaging studies, we are realizing that that is not the case. That's far from the case. It's more so all of the things we just went over.

[00:16:39] Yeah. It's just talking to your nervous system. Everything we do, every touch, every stimulation, every movement. Which is the sad thing because that's what a lot of providers use to rope people in. I'm going to put your hip back in place. I'm going to fix your SI joint. I am going to realign your spine and neck. And it's just so hard to see those things as a provider. It pains me.

[00:16:59] When you know that's not the truth, but people are using it to manipulate people, manipulate people's minds, in order to continue manipulating their bodies for as long as they can. And it's really tough to know that's the reality. And the biggest thing, like I have run across just going through YouTube. I don't watch YouTube, but you know, if I'm posting or I'm doing something and I'll see a popular video pop up and it's this chiropractor who has millions of views.

[00:17:28] It's millions of views because the whole treatment is just, let me see how you're doing. Let me do all these crazy pops and cracks and get all these loud noises. And everyone's going to be so amazed. And then the person obviously gets off the table. They feel loosey-goosey. They feel so much better. Maybe they've had a change in alignment because of the way that they feel in their body. You know, and all of a sudden, that's what's most popular. That's what's in my face. That's what I need.

[00:17:57] And though it looks sexy. And quick and easy. That's not the thing. Yeah. No, that's not the thing that's going to be our long-term ability to be able to have some self-maintenance, be able to be in your home and say, ah, this is coming up for me. What can I do? For me, I have some issues with wanting to crack my neck or wanting to crack some different spots in my back. And I feel an immediate, ooh, yeah, there we go. I've released whatever pressure it was in the area.

[00:18:27] I can also, if I'm conscious and stop myself before I crack myself, position myself and take a big, huge inhale into my ribs and exhale and now get that same feeling in my body. And that's something that I get to continue to come back around and remind myself about that. I don't need to crank my neck into its end range and get a pop.

[00:18:48] I just need to find more safety and stability because it's generally happening when I'm running through a really stressful day and not giving my body any sort of attention. Stress. Habit. Yeah. That is huge. I mean, who gets in the, if you're listening, have you ever gotten the habit of cracking your knuckles? Yeah. I have. Or like just cracking your neck, like, oh, you're working at the desk and you're like, you just like kind of turn your neck and you've heard a crack before. And so you go back and you do it again.

[00:19:18] And it's kind of like there's, there's sayings too. So this is why sometimes I don't like to adjust clients or manipulate clients because once you pop the fun, don't stop. Or what is the other one? I don't, I can't remember, but it's those catchy terms, you know, of like. Rack them and crack them. I always hear people say rack them and crack them and then they'll come back. Yeah. I mean, it's true.

[00:19:40] It's like when, when you get that psychological change of like, I heard something, that's why it must be fixing it. Yeah. And that's what we're trying to fight against. You don't have to hear something in order for it to be progressing and you don't have to hear something for it to make it bad. Right. We did another episode on like hip popping, hip cracking, knees, knee crepitus and knee pain. The noises that you hear doesn't always mean it's bad. Also doesn't always mean that it's fixing you.

[00:20:10] Yeah. And people who have stability issues or mobility, if you're hyper stable, like I am in certain places, or if you're hyper mobile. Yeah. Both of those types of people can respond super well to hearing that crack and feeling that crack. But what was it? The Cirque woman said. Dr. Jen Crane. She's amazing. Yeah. And she was talking through how a lot of dancers or a lot of acrobats will have a lot of hip popping issues and people will feel better when they do it.

[00:20:38] Well, if the underlying cause is that you have stability issues throughout that amazing range of motion that you have, then why don't we address that first? Exactly. And then see if we are needing to feel that need or desire even to crack ourselves as much once we've taught our body to be safe throughout that whole range. Oh, exactly. I mean, coming from a gymnastics background, a hundred percent, like- I see you do your hip cracks.

[00:21:05] We'd be like standing in line waiting to go for a tumble pass or something and you just lean and crack your hip, crack your hip. And it was just something that became habitual, something that became natural that you did all the time. And so again, whether that's stress right before you're going to go tumble that pass or just your habit within your body.

[00:21:24] And so understanding that, and we even had a friend one time and he did say actually his chiropractor helped him to realize that him feeling the need to crack his neck all the time or come back and get his neck adjusted was a stressor that he was actually experiencing, a psychological stressor that made him feel that that's what he needed. And he was such a revelation for him, right? And it was cool.

[00:21:49] You know, he got proper education to understanding why he was actually doing those things and realizing, oh, I don't actually mechanically, physiologically need that to feel something different. I guess he's in the one quarter that now doesn't believe that it's putting his neck back in place. Right. You know, a lot of the other studies that you'll see, they'll compare spinal manipulation against like other types of manual therapy.

[00:22:15] Or they'll compare spinal manipulation and exercise versus just supervised exercise versus a home exercise program. And a lot of what we're finding in those types of studies is that, okay, spinal manipulation might have a marginal significant, you know, decrease in pain or whatever over other manual techniques. But long term, we don't see that last. Yep.

[00:22:39] If it's just like a one-time treatment or a six-week period that they're getting treatment and then they stop long-term follow-up, they'll see, oh, there's not a significant difference five years down the road because of that six, you know, month or six-week program. But my thing is, again, if you're only getting spinal manipulation or manual therapy in the first place, that's a problem. It's got to be something else in there once you get those techniques that I believe would be much better than all those. And I think that there's research to back that up as well.

[00:23:08] A hundred percent. And again, like we said, it's that psychological belief of like, if you're just going in to hear that manipulation or that crack, then you're believing that you're getting better. But if you had nothing else to help with that, then what's actually going to help it hold? Yeah. Or headaches. So many people get headaches. And, you know, I know my headache routine when I do manual therapy on people with headaches and it always helps them feel better, you know, 30 minutes later.

[00:23:34] But again, if we suddenly get them up off the table and say, okay, go back into your stressful life, you know, and then they get in the car into traffic and then our body immediately is going to revert back to the place that it thinks it's safe that is actually perpetuating that headache.

[00:23:50] So again, whether you're just getting spinal manipulation or a different manual technique for your headaches, we got to start doing something different like breathing, like finding those different exercises and positional things that help you downregulate that stress that might be at hand when you start getting those symptoms. Yeah.

[00:24:12] And that's why, you know, again, within like the challenges that we do or the optimal body membership, it's not just about physical movement. A hundred percent that that plays a huge role in repatterning the safety patterns within our body. Yes. And and building that stability, building that support and that strength. However, we also have to address our mind.

[00:24:35] We get to address what's happening in how that like when am I thinking about the pain? When is that pain coming on? How is that related to what's happening in my day? How is that related to my stress? We also we we throw in your recipes because the foods that we put in our body also can add stress to our system and make it work harder or allow it to process better. The sleep that we're getting the people that we're you know, again, we've talked about this in other podcasts.

[00:25:05] When it relates to pain, pain is not just mechanical. It's not just physical. And if you're just using an adjustment, thinking that it's putting you back into place, it's not the answer. It's so fun. It's cool that you bring that up, you know, about mindset, because I was going over with one of the people on our team today, just our vision and our vision statement.

[00:25:24] And the first component of our vision statement is to shift mindsets, you know, because if we don't do that, if we don't address people up in the head and in their heart, we're never going to be able to touch optimizing their body, optimizing their movement, increasing the function of how they do things. We have to, as people shift our mindset to the I can, I am able to impact my own symptoms. Otherwise, we're never going to be able to touch the physical stuff. A hundred percent.

[00:25:52] And I know in like the first week of the Move to Improve Challenge this last time when we had, it's talking about clarity and just getting clear, like kind of pulling off all the BS and understanding what's happening deeper in our pain. And, and I, you know, I write about it, I talk about it, and then we, we do a little exercise about it. And I immediately in the first week got feedback of someone who said that I just cried. Like I finally was able to understand my body.

[00:26:22] I was finally able to understand where this pain is coming from. And no one had ever explained it that way. And that just makes me want to cry, you know, and warms my heart because it's, it's working. I might not be there with you in person, but if you're able to start to feel these things and know that you don't have to rely on me as, as someone hands-on, but you get to learn from me as a guide, that is, that is everything.

[00:26:47] And it's the same of like, if you're going to a psychotherapist and someone who's helping you, they're not in your life fixing problems for you. They're guiding you. Yeah. They're helping you do all the work. They're helping you do the processing. And even as a provider, when I was seeing people regularly in the room, like I know the people that I had the biggest impact on, know that I didn't do anything for them physically.

[00:27:13] I helped them start to realize and perceive and process things differently by the way that I asked them questions and got them to think through things themselves. And those are the same people that still reach out to me this day, whether they were in Minnesota or whether they were someone I saw when I came here to Southern California. They're still the ones that will DM me saying like, Hey, I had something come up and I know, I just know that if I talked to you for five minutes, you can help me process through this differently.

[00:27:40] And again, I don't want people to know that they have to come talk to me. You always have that ability to, like you said, journal or do some directed journaling and thought to work through that. But that's where I generally bring people first before I put hands on anyone. Oh my God. It's so important. And so reality of listening to all of this, right, is manipulation adjustment. It's not bad. It's not going to give you arthritis if you keep cracking joints.

[00:28:08] However, why are you feeling the need for it and how often? And I think starting to become real with that and observing that and observing your beliefs around it is going to be a huge process in actually helping you to start to feel something different in the body. There you have it.

[00:28:30] Another deep dive on manipulations, the snaps, the cracks, how we fit that into our daily routine and how it could potentially help you find your optimal body. Leave us any questions or comments below, any other topics that you might want us to cover. And we'll see you next time.