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A typical chiropractor will perform adjustments for perceived spine subluxations. Although subluxations cannot be seen on X-ray, most chiropractors give every patient an X-ray at their first visit, use this to demonstrate to the patient that subluxations exist, and perform a chiropractic adjustment to address the subluxations. The patient returns several times per week for this adjustment, for weeks or months at a time. In the mean time, no effort is being made to correct the symptom long term via corrective movements and strength training of muscles that caused the perceived subluxation. Now let’s look at a physical therapy treatment.

On the other hand, our physical therapist will perform a thorough exam of not only the spine, but the whole body including musculature,  without any imaging such as X-rays, and will develop an individualized treatment plan based on the results of the 30-45 minute evaluation. The treatment plan typically includes soft tissue joint mobilization for areas of myofascial tightness and tenderness around the symptomatic joint, some type of spine mobilization in an attempt to improve spine motion, exercises to improve mobility, full body strength, and stabilization of the spine, and training on posture, ergonomics, and body mechanics training to help prevent the pain from re-occurring.

The primary treatment difference between a manual physical therapist and a chiropractor is that the goal of the physical therapist is to empower the patient to care for themselves through the performance of a home exercise program performed daily and instruction in posture and how to change faulty movement patterns that caused the pain to begin with. 

With 60 minute appointments, the result is full relief of back,  neck or joint pain symptoms, with no or infrequent flares, so the patient can manage any further care on their own for the rest of their life.

While many people feel good pain relief from chiropractic care, their symptoms frequently return in the weeks, months, or years after their treatments have ended due to lack of long term patient education on the importance of continued active care at home.  Chiropractors do not typically include exercise instruction, since the length of their appointments is brief and do not allow time for this. There comes a time for many patients when chiropractic care is no longer resulting in the long term symptom relief, which is when a complete physical therapy program that includes hands-on manual therapy treatment and an individualized exercise program can be very helpful.

What is  Physical Therapy mobilization?

Mobilization refers to applying pressure around  joints at varying degrees of needed intensity in order for the joint to move more freely.

What is an adjustment or manipulation? 

 If the joint needs a stronger movement (aggressive mobilization or manipulation), it can be performed in effective ways with varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement within or at end range of motion. You most commonly see this in chiropractic treatments. 

THE “POP” of an Adjustment

The audible joint “pop” or “crack” phenomenon associated with a chiropractic adjustment has been investigated in a principal study, namely Roston and Haines.  They discuss findings from the application of increasing tension at the metacarpal-phalangeal joint of the third finger and monitoring the amount of joint separation with intermittent radiographs. This study showed that when a critical amount of tension is reached to produce a joint “pop,” a sudden increase in joint separation is noted. Roston and Haines interpreted the space noted after the cracking as a “partial vacuum occupied by water vapor and blood under reduced pressure”.  A joint that has been “cracked” is not typically capable of being re-manipulated for 20 minutes which is due the the gases needing to be reabsorbed before the joint can be audibly cavitated again.

Popping joints is often associated with chiropractic treatments.  Although traditional chiropractic philosophy is based on detection and correction of spinal subluxations and realignment, no valid research has shown that subluxations/positional faults correlate with pain or are a cause of lack of mobility in the spine. As seen above in the research of the metacarpal-phalangeal joint, the audible pop is associated with negative pressure in the joint in conjunction with blood gases and not mal-alignment.

Beneficial effects of the manipulation are not dependent on the audible “crack” of the joint. Flynn et al compared immediate effects of a lumbopelvic manipulation for patients who did and did not have a joint sound with manipulation. Comparing the response to the two groups, Flynn et all reported no difference in outcomes. Therefore, creation of a joint sound should not be the primary goal and focus of a manipulation technique.