Is it OK to get your back cracked? Dr. Alex Earl explains all you need to know.
There is something satisfying about hearing the sound of the spine "popping". As a chiropractic physician, I was taught how specifically we can get with our treatments to best help serve the needs of our patients. But without fail, every month at our Carol Stream clinic, new patients ask us why it feels SO good to get your back "cracked"? In fact, there are social media accounts specifically showing real life spinal adjustments creating an audible "crack" followed shortly thereafter with a relaxing "ahh" feeling by the patient.
In our opinion, it is an important question which needs to be properly answered.
What actually happens to create the audible noise starts within the spinal joints. In a physiological process known as "tribonucleation", which is when two opposing surfaces resist separation, specifically in this case the spinal joints but can apply to any synovial joint in the body. This resistance of separation eventually reach a critical point whereby a force causes the joint surfaces to quickly and briefly separate.
When this separation takes place, the lubricant within the joint, called synovial fluid, immediately has an increase in space as well as the new addition of a tiny gas bubble. It is the creation of this small gas pocket within the joint that is responsible for the audible popping sound. Back in 2015, researchers were tasked with capturing this physiological phenomenon, which they successfully did with the help of an MRI scan. Check out the 6 second video of a finger below.
So there is the physiological explanation as to the mechanism behind the audible noise, but what actually happens that makes getting your back "cracked" feel so good.
A few weeks ago, when setting up to adjust a patient on his side to adjust his low back, my shoulder "popped" while pulling him into the final position BEFORE adjusting the patient. What happened next was interesting...
The patient let out an audible, "Ahhh" with a lengthy and very relaxing exhale.
But it was my shoulder that cavitated (or "popped").
Why would he experience a feeling when it wasn't his joint which "popped"?
There is no doubt that the mind plays a part, and if one is expecting an audible pop then one will be more aware and alert when the sound of one is heard, regardless of where it came from.
If this audible release creates a wonderful pain-modifying effect, then should we all just be popped our neck and back all day? Probably not, as we are not advocates for reliance on one treatment as an end-all-be-all guide to eliminating pain.
Usually, back cracking on your own is harmless. There is no evidence this "popping" causes arthritis. Expert doctors and therapists all agree: an ideal treatment approach is one that encompasses more active than passive. If your doctor or therapist is heavily reliant on massage, electric stimulation, heat/ice, kinesiotaping, and posture correction, that is a red flag.
At our Carol Stream clinic, we utilize spinal adjustments regularly - when it is clinically indicated and within the guidelines for expert care. Every patient comes into our office looking to identify WHY they have back or neck pain, and our methods include stretching, flexibility, mobility, strengthening, and overall body awareness through individualized treatment and exercise routines.
In our opinion, treatment plans which rely on spinal adjustments, massages, vibration beds, and lasers are NOT addressing the underlying issue but rather masking the symptoms and provide short-term symptom modification.
If you, or someone you know has been suffering with back pain, which prevents them from doing the activities they love then please forward this article over to them. Why? Because we believe that everyone in pain should have a chance at learning how to get back to the most fulfilling parts of their lives'. We'll help you get there.
Former Chief Editor of the number one orthopedic technique journal, Dr. Brian Day, MD, specifically mentions the Delphi device in his editorial. Dr. Robert LaPrade, formerly of the Steadmon Philipon clinic in Vail, Colorado, the expert on knee multi-ligament repair, also mentions the same Delphi device used in our Carol Stream clinic.
"I still have knee pain and my ACL surgery was two years ago." -AHR past patient
Since 2000, when researchers Cook and Koltyn coined the term, “exercise induced hypoalgesia”, doctors and physical therapists have pushed exercise as an effective method for reducing a patient’s pain.
More recently, additional information came to light, which should get your attention if you are currently experiencing any pain or discomfort.
The research has shown that the addition of BFR to resistance training for the lower leg produced a significant reduction in pain levels, when compared to low intensity exercise alone for the lower leg.
We see this effect every day in our office with patients who can’t physically play soccer, basketball, or football to their specific needs.
One such collegiate football player came to our office with a nagging ankle issue. He wasn’t able to run an “out route” from the backfield and, on a dime, cut when he reached the sideline and sprint upfield. Due to his ankle mobility issue, he was rounding his runs and ran out of bounds each time. Frustrated, he came to our office to work on his ankle, but what we ended up figuring out along the way shocked us both.
Two years prior, this athlete suffered a torn anterior cruciate ligament (ACL) on the same leg. Even two years after the surgical procedure, he still reported tenderness and the occasional pain episode in the knee. Not convinced that the affected leg had healed fully, we investigated further to find out significant discrepancies between the left and right leg on this athlete. He had still not yet gotten his affected leg back up to 100% his pre-ACL strength baseline. And yet he was cleared to play.
With some moderate amount of swelling in his ankle joint, we decided to pursue a rigorous course of manual therapy, soft-tissue work and BFR to minimize any muscle deficits, since he was unable to continue to perform his team’s usual in-season weight lifting program.
Enter BFR and the rest of the story….
We began using BFR three times a week at a consistency of 3-4 exercises per session. The athlete reported that he had never experienced such rigorous exercises previously and greatly appreciated the intensity, as it felt like he was getting “back to where” he needed to be to play again.
About the fourth session in, this athlete reported that his anterior knee pain, the ache and tenderness was gone. Not just reduced, but gone, completely. He had a grin on his face from ear to ear and was ecstatic at the current state of his knee.
After a few more sessions, he was back on the field, cutting and helping his team make it all the way to the quarterfinals of the National tournament. His contribution to the team was immense and we are extremely proud of his mentality and his ability to work hard for his team.
So what’s the take home message here? BFR is an effective strategy to reduce pain even in areas outside of the targeted tissue. As mentioned in our case study, our athlete eliminated his knee pain when he came to us for an ankle mobility issue.
Now, there is no doubt that a heavy resistance and strengthening program would have gotten him to his desired state at some point, but unfortunately, athletes and clients fall into the “Doom Loop” all too often.
The Doom Loop goes like this: A region or part of the body hurts, so you don’t use it (so as to not hurt it further), and since you don’t use it very often, then when you do go to use it, it hurts and doesn’t feel normal - so you don’t use it anymore! And the cycle goes on and on and on…
When BFR enters the picture, it offers a safe, effective method of interrupting the “Doom Loop” by getting you moving again safely. Simple range of motion exercises with BFR is a great place to start, and also slowly starts to reverse the effects of a lack of mobility on that problematic area. Once tolerance has been built up, we slowly add bands and weights to the exercises to really create an amplified effect on muscle.
Since our office utilizes the Gold Standard BFR device, called the Delphi Personalized Tourniquet System, you can be rest assured that the device is safe and extremely effective. In fact, nearly 90% of all the research studies conducted on BFR use the same Delphi device we use right here at our Carol Stream clinic.
In fact, some of the world leaders in surgical procedures have authored editorial papers specifically mentioning and encouraging outpatient use of the Delphi device for post-operative conditions such as ACL, meniscus, labral repair, rotator cuff surgery, and many others.
If you, or someone you know, has previously had a surgical procedure done BUT still is experiencing tenderness and discomfort, like our football stud was, then please call our office today to see if BFR is right for you. Call (630) 480-0113 now!
While taking new patients medical history, we frequently hear a phrase in our Carol Stream clinic: "I've had a bad back ever since I slipped a disc." This is really an interesting way of communicating a complex system of the body. While providers typically don't always agree with how patients and society word or phrase their pain and discomfort, I believe a stance should be started on the topic.
In short, my answer is: yes, disc material can slip.
The spine does NOT slip in relation to itself (bar any extreme trauma such as a motor vehicle accident). For example, one patient of ours visually showed us, with his hands, a mechanism of action whereby he believed his spine "slipped into two pieces" when he lifted snow with a shovel and experienced his excruciating symptoms. While this mechanism makes ideological sense to patients who currently have low back pain, for example, it is important to note that the spine is not fragile, is quite robust and was design to move, bend, lift, and flex.
One of the definitions of the word slip is "go or move quietly or quickly, without attracting notice". In this sense, we would argue that yes, disc material does slip.
We have seen a plethora of research showing disc material, specifically the nucleus pulposus, migrate outside of the standard disc space. In fact, after small cracks in the annular fibers, which serve as the outer-most layer of disc material, and is quite tough. Compared to the annulus fibrosus, the nucleus pulposus is quite soft and it resonates the same substance as toothpaste.
Since this progression of disc material outside of its original position, and WITHOUT notice of symptoms (especially pain), we would argue the usage of the word "slip" is accurate. The disc material slips through the annular fibers into the nearby joint space. The most shocking bit to patients is when we tell them that this does NOT always produce pain. The disc material must make contact with the nearby nerve root for the sensation of discomfort to be triggered.
Each week at our office in Carol Stream, Illinois, we help men, women and adolescents overcome disc injuries. If you, or someone you know, are suffering with a slipped disc, like I described above, then please know we can help. Most of our patients come to us after going to see a physical therapist, or their primary care physician, only to be discouraged by a lack of progress or the recommendation of pain pills and muscle relaxers. We know, and our patients know, these are NOT effective long-term strategies for spine pain.
Secondly, most of our patients come to us with a specific goal in mind. If you have a health or fitness related goal, and this spine pain is currently preventing you from doing your favorite activities, such as soccer, football, golf, CrossFit, running, etc, then I have good news for you - we are here specifically for you.
If you enjoyed this article, please share it with you friends and family so they too can learn more about this all-to-common topic.
Lastly, if you are currently suffering from spine pain and it is severe enough that it prevents you from being yourself and doing the activities you love, then please call our office TODAY to talk with our amazing AHR Team to see if you would be a good fit for our office. You can call us today at (630) 480-0113
Dr. Alex Earl, DC
1. Do understand your pain is very real
Oftentimes, persistent pain involving the lower back is quite complex. This can be caused with or without the presence of tissue damage. Since our tissues might not incur any new damage, this can lead many people suffering with back pain to feel as if their pain isn't real. Persistent low back pain should be viewed through the same lens as other complex conditions such as diabetes, where many factors are constantly involved - not just one single influence. We now know factors including sleep, nutrition, hydration, stress (both emotional and social) all play a part in low back health in addition to physical activity and fitness.
Regardless of which factor "ticked off" your lower back, your pain is REAL.
2. Do Remain Physically Active
One of the toughest bits of advice we give to our patients with acute low back pain, is to continue to stay active. It sounds contradictory to standard medical advice of "rest and recover" but bear with me for a minute.
While there is no "hack" or "curative" exercise for low back pain, there are dozens of strategies to effective mitigate long-lasting pain. One of those strategies is to continue to simply move. How frequently, how intense, how long is entirely up to you, but know this: there is no amount of exercise that is too little. (Griffin, O'Sullivan)
"Small strokes fell great oaks" is a favorite quote around the office. We appreciate the little roots of effort which have yet to bear fruit. But much like a plant slowly grows and eventually bears much fruit, your movement should also be slow and progressive. Our job at AHR is to make sure you are placed in the right soil.
3. Do Sit, Stand, and Slouch in Various Positions
We are not the posture police. Oftentimes, patients preemptively defend their posture and depict seated, driving and standing postures they believe we are going to tell them they "need" to be like.
Controversial Statement #1: We believe that movement is dynamic and variable, and so is posture.
We view posture to have many positions, including slouching, bending, and arching. Common healthcare and fitness warnings to avoid a specific movement of the spine are void of any evidence currently published. Additionally, this propagates fear of an otherwise normal, every day motion, such as bending forward to touch your toes.
4. Do Continue to Enjoy Meaningful Activities
Suffering with low back pain can be overwhelming. Focusing on anything other than the painful experience can be quite a challenge (I have a few personal experiences with "hot" low back episodes in recent years, and it was difficult to focus on much else during those intense days).
Our advice is to focus on the tasks or activities that add value to your life. For me, it was going on a family walk with my wife and our children. My pain was lost while focus on our kids and the conversation with my wife.
An important take home message about meaningful activities and low back pain is this: It is possible to do both. You can have pain AND enjoy meaningful activities & experiences. We had a patient at our office with an acute episode of low back pain AND he was still able to participate in family hunting trip at the same time. The hunting trip took priority over the pain.
I am writing this today to publicly give you, your family and your enjoyable life priority over your pain.
5. Do Maintain Your Social Life
Oftentimes, people experiencing low back issues feel secluded. The avoid going out with friends, and they oftentimes miss social interactions at work if they are forced to stay home. As mentioned earlier, this feeling of seclusion can add addition layers to the multifactorial components of pain, such as stress or lack of sleep. This "loop" can only lengthen the time is takes for recovery.
One of our favorite treatment plan ideas is to have patients nurture meaningful relationships. Getting lunch with a close friend, coffee with a spouse, or a phone call to an old friend are all ways we can connect with other people and share memories. Oftentimes, it's within these close relationships that we can be honest with ourselves, receive valuable insights, and much needed encouragement.
1. Don't Fight it - It is NOT a Sign of Weakness
Pain affects people of all ages, so it is important to note that you and I are not exempt and shouldn't attempt to fight it. This can create a "Vicious Cycle" in which a hyper-vigilant person attempts to fight the pain, which can lead to more regular "flare ups", which can yield less physical activity, low mood, sleep disruptions, frustrations, and more intense reliance on pain medications and over the counter.
Rather than focusing on defeating pain, we (I say "we" because I need to hear this too!) should focus our energy and minds on what we CAN control. We can control our attitudes about our pain and our decisions around our life, such as to exercise or not to exercise. Once a decision as been made, reward yourself for taking steps in the right direction - regardless of whether they were successful or not.
2. Don't Assume Persistent Pain is Due to Tissue Damage
Pain is an effective protector. Therefore, if you've injured an area before, pain acts like an accurate protective sensation warning of potential or worsening damage. Just like if the fire alarm goes off in the house, one doesn't know where the fire is or, more importantly, the severity of the fire. Did someone just cook on the stovetop with olive oil again and the whole kitchen is smoky? That's not the same intensity as if there were an actual fire coming from the stove.
And yet, it is the same fire alarm that goes off for both situations...
The alarm doesn't tell us where the fire is, nor how severe it is. Pain is the same.
3. Don't Rush If You Flare Up
The journey to recover from pain is full of peaks and valleys. Patients frequently describe "good days" and "bad days". This is completely normal.
Rather than viewing painful flare ups as a re-injury or a "setback", we can take this time to evaluate specific triggers and situations which provoked it. Factors such as a poor night's sleep, stressful week at work, or a fight with your spouse. The point is not to feel guilty about WHAT played a part in the flare up, but to observe it, address it, and learn from it.
Healthy Low Back Tip: Place a sticky-note on your refrigerator which states, "A flare up will come. I will be OK."
4. Don't Believe Everything You Hear, Read, or See (especially on social media!)
When pain reaches a certain point, most people are willing to try just about ANYTHING.
With the rapid increase in online influencers, it has become increasingly challenging for patients suffering with low back pain to sift through the vast amount of opinions, myths, and information online. There are snake-oil salesmen out there selling their remedies, so be on the lookout. When listening, reading or watching someone discuss ways, it is best to be extremely cautious and wary of anyone who claims to "cure" low back pain. Whether that is a chiropractor claiming to cure low back pain with a specific adjustment or technique, or a physical therapist claiming to cure it with a specific manual therapy method. Be wary, very wary. (This coming from a chiropractic physician!)
Therefore, before choosing a particular provider, treatment or approach it is important to research, discuss and investigate your options. What we do in our office is sit down with patients - or stand if that's more comfortable :) and we go through what is called Informed Consent, which we map out for them using the acronym "BRAN":
B: Benefits, as in, "Here's the benefit of exercises for low back pain."
R: Risks, as in "Here are the inherent and potential risks of each method we prescribe."
A: Alternative Options, as in, "In addition to chiropractic & physical therapy, another option is..." (which also includes benefits and risk for EACH option. Most providers RARELY disclose these and it proves to be quite costly for both time and effort.)
N: Nothing, as in, "Here's what you expect if you do nothing for your low back."
5. Don't Rely on X-rays or MRIs
While medical images, such a X-rays, MRIs and CTs are helpful in certain clinical situations, only a small number of people actually need them. A thorough patient history and physical examination will effectively dictate the medical necessity for an image. Providers who over-prescribe MRIs and X-rays for every low back patient are going against the current clinical practice guidelines (Which were put together by leading experts in chiropractic, physical therapy, neurosurgery, and medical researchers... So, basically, the authority figures on the topic and NONE of them recommend obtaining an X-ray on every low back pain patient. If you are in a medical office and X-rays are recommended, without explanation, as part of the practices Standard Operating Procedures (SOPs), you have my permission to quietly walk out of the appointment.
Here's why the reliance on medical imaging has become problematic. One study showed that 40% of people over the age of 30 and 50% of people over the age of 40 have lumbar spine (low back) disc bulges on MRI. These people were asymptomatic!
So, it is important we don't equate what we see on the x-ray or MRI to the relevance of the person.
Reference: Derek Griffin, PhD, and Professor Peter O'Sullivan (Two of the world's leaders in managing and treating low back conditions and pain research.)
Alex Earl, DC is a board certified chiropractic physician, who helps athletes and active individuals stay healthy, increase performance and reduce the risk of injury.
"We have to get our athlete's into BEAST MODE during physical therapy & recovery, otherwise, we are NOT challenging skeletal muscle nearly enough." -Johnny Owens, DPT Owens Recovery Sciences
When we first introduced Blood Flow Restriction (BFR) to our patients, invariable, the question came up: "What is this doing?"
Blood flow restriction is a novel, albeit not new, concept whereby arterial blood is restricted (not occluded) via a pneumatic tourniquet (similar to a standard blood pressure cuff) into a limb for a brief period of time.
By reducing the amount of oxygenated blood entering into the limb, either the arm or the leg, the affected limb quickly becomes stressed due to the lack of oxygen...
This stress has a significant effect on skeletal muscle, which oftentimes has become resistant to increasing in size and therefore strength. The stressful feeling in the limb with the tourniquet on feel eerily similar to the experience when we were kids and rode our bikes everywhere. Well, if you were like me, you rode your bike EVERYWHERE. Well, the feeling of riding a bike up a steep, steep hill was not one which many particularly enjoy.
That heaviness felt in the thighs while riding up a steep, steep hill are almost exactly the feelings that can be felt in the legs during a BFR session.
Needless to say, our patients have grown skeletal muscle, increased metabolic efficiency and seen tremendous progress by using BFR. Most importantly, upon completion of the rigorous BFR Plan of Care, every single patient has returned (safely) to their specific activity - running, weightlifting, football, lacrosse, soccer - you name it.
BFR has truly become a game-changer when it comes to proper rehabilitation and performance goals. But don't be fooled but other products on the market right now. The Delphi System we use at our office is a medical grade surgical tourniquet device, passing all the medical standards to be used in an operating room.
Unfortunately, not all devices are created equally. There are a lot of cheaper options on the market, which yield poor results (sadly). If you want to use a cheaper BFR device, our office is not the place for you.
Who is BFR for?
BFR is PERFECT for patients is perfect for 2 types of individuals; post-operative patients and recently injured individuals.
Post-operative BFR :
Unfortunately, traditional "PT" and "Chiro" treatment use colored bands and dumbbells, which are NOT enough to create stress in a limb that has undergone a surgical procedure. Picture a knee-ACL patient, with tons and tons of muscle atrophy (decrease) in the thigh region. Will a 3 pound ankle weight for 12 week REALLY help that person re-gain strength? We don't think so either. Enter the tourniquet. With the same 3 pound weight, BUT only 20% blood flowing into the limb, now we can metabolic stress muscle and therefore INCREASE it. Now we have improved muscle function and we are on our way to getting that person back to their sport/event/activity.
Acute Injuries & BFR:
Frequently, the phrase, "There's nothing we can do until the swelling goes down" is uttered around sports injuries. Picture the tweaked knee, the swollen ankle or the irritated shoulder. When an injury occurs, the swelling, which is the local inflammatory process, is actually a part of the healing process around the injured tissue. We don't really want to hurry that process up! However, the dichotomy here is that we also do not want to lose our hard-earned skeletal muscle. In some cases, this hard-earned muscle mass took YEARS to achieve, and, sadly, within 24 hours of not using it, the muscle begins to "waste" away (atrophy). What if there was a way we could maintain the muscle mass but not affect the tissue healing process? Enter BFR. With BFR, we can achieve something truly remarkable. We can place a tourniquet on the limb for ~20 minutes and mitigate skeletal muscle loss. Pretty cool (as long as you have the gold-standard BFR device, which we do!)
If you, or someone you know, has suffered with knee pain, hip pain or shoulder pain, BFR could be the vital approach to getting you back to your previous activity levels. It happens all the time at our office.
BUT, before you finish reading this, I need you to know that BFR is NOT for everybody. It is intense. You will experience complete muscle failure. This can leave individuals feeling totally uncomfortable - temporarily. Once the cuff is deflated, the feeling goes away. BUT, the warning needs to be heeded. This is NOT for individuals who enjoy sitting on a table getting massages and stretches for 45-60 minutes per session.
This is for those of you, who want to get better, so that you can get back out onto the field, court, rink, or trail and simply GET AFTER IT.
If that's your goal, we can help.
Call our office TODAY to schedule a BFR Demo just for you - (630) 923-5049.