Do you ever “pop” or “crack” your back by twisting? Does this ever truly resolve or keep you from needing to do this again? If the answer is “no,” then why would it be any different to have someone else do that to your spine? This article discusses what is missing when only this thrusting type of treatment is given and why I do not feel it is effective in giving permanent relief of pain and stiffness most of the time.
People often describe osteopathic physicians as “chiropractors who can prescribe medications.” Although not accurate, part of this perception is because both osteopathic manipulation specialists and chiropractors use thrusting techniques that are aimed at ‘popping’ joints. As an osteopathic manipulative medicine (OMM) specialist, I am trained in thrusting techniques, however, I rarely, if ever, use them. Let me first say that this is my point of view and does not represent the view of any other osteopathic physician or osteopathic organization. I want to explain why I have not found thrusting techniques effective in resolving pain and stiffness.
Just like most of you who have suffered with pain, tightness and stiffness, I have experienced the sensation that if I could only get a particular joint to ‘pop,’ then I would feel better. Sometimes I am successful at ‘popping’ the joint, but often find the result not to be quite as gratifying as I had hoped. Most of the time, the feeling to ‘pop’ that particular joint returns in a short amount of time. Herein lies the problem, we feel like joints need to ‘pop’ and sometimes we do it ourselves or we go to an osteopath, chiropractor or anyone else who may ‘pop’ them. The only problem is that it rarely resolves anything long-term. The result is temporary. We then go back to these practitioners on a regular basis having the same routine treatment for temporary relief.
Many never consider to stop and ask why there is not overall improvement. This may be because perhaps that individual is unaware of other treatments, does not believe there is more that can be done, or because if the joint feels like it has to ‘pop’ it should be ‘popped’ and that is the solution. I consider myself lucky because I have experienced treatments that have led to long-term resolution of the pain and stiffness, which is far more gratifying than the temporary relief of a ‘pop.’ Furthermore, as long-term resolution was achieved, I noticed that the joints I used to try to ‘pop’ on a regular basis no longer had that sensation of needing to be ‘popped.’ Let me also state that the best treatments that brought permanent resolution of my aches, pains and tension did not involve any thrusting or aggressive techniques.
So in order to answer the question of why thrusting techniques are not effective in permanent resolution of pain and stiffness, we need to discuss what is occurring in the body. A vertebra or any bone that is out of place and does not willingly move back into its normal position, is out of place for a reason. What I am saying is that the bone is out of place as a result of a problem elsewhere that the body is trying to deal with. It does not randomly have a tendency to go out of place. The practitioner who gets permanent relief understands this and finds the cause of the problem and addresses it. The tricky issues with this are that the underlying cause could be anywhere in the body from the head to the feet and could be a structure that cannot be treated by thrusting and the cause may not draw significant attention to the patient and requires a lot more skill to find. Otherwise, the bone is being ‘forced’ back into place without addressing the underlying cause and nothing is really resolved. As a result, the problem will just come back. I find this to be true in all cases regardless of how long the issue has been there.
I find this to be the case with acute or chronic pain or tension. I have had osteopathic physicians and chiropractors argue that a chronic issue must be thrust back into place many times to resolve that dysfunction. I disagree because when I successfully treat the underlying cause with gentle techniques that do not involve thrusting for my patients with chronic issues, they too get long-lasting pain relief. Sometimes, there may be multiple causes that need to be resolved and that takes longer. Most of the time, a chronic issue is a problem that people have been trying to resolve for much too long without getting to the underlying cause. The principles, however, are the same. Ultimately, the reason why having joints ‘popped’ does not resolve the problem permanently is because the cause of the problem is not being addressed. The underlying cause can be anything from a muscle, joint, tendon, connective tissue, organ or nerve to name a few. Finding and treating the correct structure is what is important, the technique used to normalize the structure, as long as it is appropriate for the tissue, is insignificant.
“One asks, how must we pull a bone to replace it? I reply, pull it to its proper place and leave it there. One man advises you to pull all the bones you attempt to set until they pop. That popping is no criterion to go by. Bones do not always pop when they go back to their proper places nor does it mean they are properly adjusted when they do pop.” Andrew Taylor Still, Osteopathy Research & Practice 1910