The Skinny on the Pop!
What is the significance of the sound we hear during an adjustment?
The skinny on the pop!
What causes the pop? This is one of my favorite stories related to chiropractic. The story as I heard it in grad school was in the early days of FMRI (Functional Magnetic Resonance Imaging: basically moving MRI's). There was a group of grad students sitting around in their imaging lab and one of them was a habitual knuckle cracker. As he was cracking his knuckles one of the guys said, "Hey, I wonder if we can see what's actually going on when that sound is made?" and for the first time in human history they had the tools to investigate. Now this is just the story I heard about how the study came to be, but you can find the associated paper along with a video showing what they saw. I'll try here to explain their findings in a much simpler way than the paper puts it.
For starters, every joint in your body has a "joint capsule," a wrapping of connective tissue that holds the joints together and holds the synovial fluid, the lubricating fluid inside the joint. The synovial fluid is pressurized within the wrapping of the joint capsule, and when you stretch that capsule, you increase the space of that pressurized system causing some of the nitrogen in the synovial fluid to form bubbles inside the joint and making the "popping" or "cracking" sound.
Is it a good or bad thing?
In my opinion, the sound is just a sound. It isn't good or bad in and of itself. It's definitely a signal of something happening. Sometimes it's a good thing like a chiropractic adjustment; sometimes it's a bad thing, like when someone turns too quickly while running, or lands poorly from a jump, or is tackled and it stretches their knee enough to tear one of the ligaments inside the joint. The sound is just a sound, if you feel looser, or more relaxed after it's probably a good thing. If you notice pain, or swelling around the area of the sound afterward it's probably time to call a doc.
So what does this mean for chiropractic and my adjustment?
Absolutely nothing. The fact is that as chiropractors, we shouldn't be looking for the audible. When we adjust, what we are doing is attempting to put a stretch on the joint in order to fire off nerves in the connective tissue and muscles attached to the specific joint (golgi tendon organs in the connective tissue, and the muscle spindles). This feeds information about the adjusted joint and muscles surrounding the joint to the brain and causes a reflexive relaxation of the surrounding muscles. Oftentimes if you have a joint that isn't moving efficiently the joint capsule will be so tight that it doesn't take much stretching to make those nitrogen bubbles form. In some cases the capsule is so stiff that it would take a reckless amount of velocity
to stretch it enough to get those bubbles to form. Conversely, sometimes they're so loose that those bubbles already exist and there isn't enough nitrogen left in solution in the synovial fluid for more to form. So if you "didn't hear it go," that's okay.
Most of you who are already my patients will notice that I will usually check a joint, adjust it, and then recheck it. When I do this I'm looking to see if the joint is looser and moving more freely. If I hear the pop, then I know there's a good chance that I put enough stretch on the joint to fire off those nerves. Occasionally though, the joint stretched wasn't the one I was actually trying to stretch. This is why rechecking the joint after the adjustment can be important and can sometimes lead to attempting to adjust the joint again. The pop, or lack thereof, tells me nothing about whether the adjustment was successful or not. To know that, I need to compare the mobility of the joint before and after the adjustment.
So, whether you love the “pop” or hate it, the “pop” in and of itself is irrelevant. There are ways that I, as your chiropractor, can work to reduce, or increase the chances of hearing the noise, but there’s no guarantee whether you will hear one or not, regardless of what I do. More importantly; you can rest assured that no matter how I’m adjusting you, I will be doing my best to fire off those stretch receptors and restore optimal motion to the muscles and connective tissue surrounding the joint!
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