Self Manipulation

Keywords; self manipulation, tingling in arms and hands, uncovertebral joint; arm pain.

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. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

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. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

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.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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