Self Manipulation

Keywords; self manipulation.

Whether it's using forcible means, as in the photo below, or simply cocking your neck into hyperflexion and extension and making it pop, repeated forceful self manipulation, without distraction, is very damaging to the spine.

Should you ask any chiropractor, and they will tell you that the most difficult patient in the practice is the one who begins to click their own neck, or any other joint for that matter. It leads progressively to increased neck pain, paresthesias in the arms, and degenerative arthritis.

The most vulnerable parts are the so called joints of Luschka, also known as the uncovertebral joints.

The uncinate process or uncus is a small piece of bone that serves to protect the nerve root from a slipped disc. It forms the delicate uncovertebral joint.

Chiropractic manipulation uses joint distraction, something the self manipulator cannot do, to prevent cartilage on cartilage trauma during the adjustment.

The tiny joints of Luschka, also known as uncovertebral joints,  are also designed to protect the nerve root, by preventing any lateral movement of the bones in the neck. They only exist in the lower cervical spine. But injury to the cartilage in these joints releases harmful chemicals that inflame the spinal nerves roots; vague, constant, and very irritating pain in the neck results.

Self Manipulation

One wonders how people could possibly start popping their necks in the crazy and dangerous manner. Deaths have been recorded.

Researchers have now established beyond doubt that the hyaline cartilage in all joints is utterly dependent on movement for its proper nutrition. Immobilisation of any joint leads within a very short time, read hours in white mice anyway, to progressive, irreversible arthritic changes in the tissues.

Immobilisation of a joint inhibits the normal flow of nutrients and oxygen to the cartilage; and removal of the toxic waste products of cartilage metabolism. The nett result is always arthritic degeneration.

Fixation of the joints is what occurs after trauma, as in the neck after whiplash such as in motor vehicle accidents, diving into shallow  water, or cracking your head against the bottom of the pool; a fall down the staircase, falls and collisions in various contact sports and so on. However it can occur to any part of the spine, and the little joints in the ankle after a sprain, for example. Uncorrected such injuries lead invariably to arthritis.

Starving the cartilage endplates of oxygen and nutrients causes an insidious discomfort and irritation in the joint. Enter self manipulation.

Uncovertebral joints or uncinate joints

Arm pain

Very soon sufferers discover that turning and wriggling their heads, and sometimes manipulating their necks brings relief from the real discomfort associated with degenerating cartilage and irritated nerves. Nothing will be seen on xrays for five or more years, but the cartilage in the spines of mice, where fixations have been mechanically made, has under the microscope, histologically, has been seen to begin degenerating within thirteen hours.

Manipulation by your chiropractor; can there be too much of that also?

The problem? The relief is very temporary, and within an hour sufferers need to manipulate their spines again, repeatedly.

See folk contorting and trying to pop their own necks like this? It's a sign that fixated joints are starving the cartilage of oxygen and nutrients. Specialists now acknowledge that early on there is little to be seen on xray in the progressive development of neck arthritis.

Whilst this self manipulation may bring very temporary relief, inevitably there will be progressive injury to the nerve roots leading to severe arm pain. 

There is regrettably no research on this difficult question, but there is no doubt in my mind that too many adjustments of any single joint, simply adds to the problem rather than the solution. Just as rebound headache is actually caused by over use of analgesics, too many adjustments, in my opinion, can cause rebound cervical spine pain and ultimately radiating arm pain.

That is simply my own opinion, based on nothing more than over thirty years in practice, that adjustment of any joint more than twenty to thirty times in a twelve month period, is probably too much manipulation. Others would disagree. I do it very occasionally in exceptionally difficult cases, but reluctantly, with the knowledge that my treatment may have become, through over-manipulation, part of the problem, rather than the solution.

Is this creating doubt in your mind? Well, just as you need to be doubtful of surgery and drugs, you need to consider just how much Chiropractic adjustment of your spine is healthy. Just as there are doctors who will give you umpteen prescriptions of anti inflammatory drugs I can promise you there are chiropractors who will happily manipulate your spine fifty, or even one hundred times in a year.

And self manipulation ten times every day? Sheer madness.

Tingling in arms and hands

Most self manipulators seem to find themselves popping their own necks ten or more times every day. Put differently, in two to three days they manipulate their joints more than I consider healthy in a whole year. Inexorably there is injury to the cartilage lining the uncovertebral joint Lushka and contributing to the cervical facet syndrome. The net result is more and more neck pain, and ultimately pain and tingling in the arms and hands as the nerves are injured.

How to stop popping your own neck is a vexed question. It's become ingrained as a habit, over and above any temporary relief you may get.

The spine has already had too much manipulation, manipulation done without distraction, injuring the hyaline cartilage that lines the bones in the joint. Yet if your chiropractor doesn't adjust your spine occasionally, and regularly, you will start manipulating it ten or more times a day again.

My solution:

  1. Have a regular massage; perhaps ask your chiropractor to show your spouse how to give you a gentle relaxing massage. Then it can be done several times a week. Keep it short, say 2-5 minutes.
  2. Every day do our stiff neck exercises for neck pain ...
  3. When you feel the need to click your neck, do these exercises and/or ask for a massage. Leave the computer, get up, walk...
  4. Go for a proper chiropractic adjustment of the offending joint, occasionally and regularly. How often? Work that out with your chiropractor.

If you don't stop there's trouble coming, and probably BIG trouble. Complications of surgery ...

Cervical facet syndrome

The small joints that guide your neck every time you turn, look up or tilt your head are very prone to injury when there's been trauma such as falls on the trampoline or off a horse. Self manipulation is another of those traumas.

The cervical facet syndrome is one of the more common conditions treated at the chiropractic coalface.  Apart from pain in the neck it often leads to tingling in the arms and hands.


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Mrs T looked like the leaning tower of Pisa; she had a slipped disc at L5 making her lean towards the opposite side. It's called the postero lateral disc hernia; she's much better after two weeks of treatment and will go back to work next week, part time. Lateral discs are more difficult; both take a minimum of six weeks to heal. In my opinion, antalgic patients need what I call exercising bed rest. Sit and it won't get better.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months. He has a pincer deformity in the hip causing the groin pain, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your lower back is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her hip, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Hypermobility is more difficult that too stiff in my opinion. Chiropractic is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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