Joint Pain That Moves Around: What a Montgomery Chiropractor Checks First
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In my experience, what often prevents people from booking a first chiropractic appointment is not the discomfort itself but a lack of understanding about the procedure involved. Most of the people who come to my clinic in Montgomery, Alabama have already tried resting the area on their own, and the discomfort has kept returning. So this article is chiropractic adjustments explained, step by step, including the audible joint sound that patients ask me about more than anything else. My aim is that you know what the procedure involves before you ever sit down.
An adjustment involves applying a controlled and precise force with my hands or with a specialized instrument. Each adjustment targets a specific joint in the spine or a joint elsewhere in the body. The movement is described by chiropractors as "high velocity, low amplitude," which means that I move the joint quickly but very shallowly, not deeply and not with excessive strength. It is closer to a gentle flick than to a forceful twist.
The aim is to restore normal movement to a joint that is restricted or moving improperly, so that it can work the way it is supposed to. This is not a rough or improvised maneuver. It is a deliberate technique built on training and practice. It is easy to confuse an adjustment with massage or with stretching, both of which we sometimes also use, but they are different things. Massage kneads muscle tissue. Stretching lengthens muscles and tendons. An adjustment is concerned specifically with the movement of a joint.
I do not move straight to an adjustment without first working out what is actually going on. Understanding the root cause of your discomfort is the part that matters, so I begin by taking your health history and by looking closely at your posture and how you move. Where it is indicated, we take digital X-rays here in the clinic, which is exactly why diagnosis comes before any adjustment in the way I run my practice. Imaging on site means I can look at the actual structure before I decide anything.
The reason for this care is straightforward. The same symptom can arise from different structural causes. An adjustment that suits one of those causes may not suit another. Working from the diagnosis rather than from the symptom is what allows the care plan to be built on evidence rather than on assumption.
Once I understand the root cause and how it relates to your actual structure, I can set out a course of care that is chosen deliberately for your situation. Each step is considered against concrete findings rather than against a general impression.
The process begins with positioning, so that we can work on the specific joint that needs attention without loading other areas of your body. This usually means lying face down or on your side, depending on which part of the spine is involved. We use a treatment table designed for this, and some sections of it can drop a short distance so that the table takes the force rather than your body. Positioning is what isolates the joint being treated.
Next comes contact, which is a matter of precision. I locate one specific bony landmark rather than pressing broadly across an area, so that the force goes exactly where it is meant to go. Before anything else happens, I will often move the joint gently to the end of its normal range, which is called taking up the slack.
The adjustment itself is quick and shallow and is over almost immediately. Delivered by hand, it is a small, brief motion in one specific direction, and the depth of it is very small. Some adjustments are instead delivered with a small handheld spring-loaded instrument, which applies a lighter and more targeted force. That can be a better fit for some patients and some joints, depending on what the examination shows.
Once the adjustment is done, the next steps are procedural. I check how the joint is moving again. Depending on what I find, I may then work on an adjacent area. After that I talk you through what I found and what the plan is from here.
The thing patients raise with me most often is that recognizable popping sound, so let me set out plainly what it is. The sound is called a cavitation. Your joints are enclosed by a capsule containing fluid, and that fluid holds dissolved gas. When the joint surfaces are moved apart quickly, the pressure inside the capsule drops, the gas comes out of solution rapidly, and that is what produces the popping or cracking noise.
It is worth being just as clear about what the sound is not. It is not bones cracking. It is not bones grinding against each other. Nothing is breaking, and nothing is being forced back into place.
The sound is also not a measure of anything. A joint can be adjusted correctly and make no sound at all, and hearing it does not mean the adjustment did more. Instrument adjustments frequently make no sound whatsoever.
If the thought of hearing that noise is what is putting you off, say so. There are approaches that do not produce it, and there is no reason for anyone to sit through something that makes them uneasy without mentioning it.
An adjustment is often assumed to be the same thing as having someone crack your back. It is not, and it is not something to have done by a person without the training to do it. Each adjustment is specific to the individual and is determined by the findings from the examination. The contact point, the angle, the depth, and whether an instrument is used instead of my hands are all decisions that come out of what was found.
It is also worth saying that not every visit involves an adjustment. Sometimes the findings point to a different approach altogether. Alongside adjustments, my clinic also uses shockwave therapy, low level laser therapy, interferential therapy, and flexion distraction. Shockwave therapy delivers high-energy sound waves to tissue using pressure pulses generated by an electromagnetic source. Low level laser therapy uses coherent light directed at the treatment area, and this light-tissue interaction is known as photobiomodulation. Interferential therapy applies electrical currents of differing frequencies that meet at a targeted depth in the body. Flexion distraction uses a table with a moveable section that applies a slow, controlled stretch along the lower spine. Having several methods available means the method can be chosen to fit the diagnosis, and if you want the fuller mechanical picture I have set out how a chiropractic adjustment works in more detail elsewhere on the site.
Some presentations sit outside what an adjustment should be used for, and part of my examination is deciding whether to proceed at all. If there has been significant trauma such as a fall or a collision, severe pain with swelling, numbness or weakness travelling into an arm or a leg, pain alongside fever, loss of bladder or bowel control, or a sudden severe headache unlike any you have had before, then the right first step is a medical doctor, and that is what I will tell you.
Referring you to a physician in those circumstances is not me passing you along. Chiropractic care and medical care are not in competition, and there are findings that belong with a physician. Certain conditions affecting bone density or circulation also change what is appropriate, which is a further reason the examination and the imaging come before any treatment decision.
Q: Does a chiropractic adjustment hurt?
A: Many patients describe the sensation as pressure rather than pain, though this varies from person to person. Some areas can be tender to contact, and I would rather you told me what you are experiencing as we go than sat quietly through it. The procedure itself is brief.
Q: Do I have to hear the popping sound for it to have worked?
A: No. The sound is not an indicator of anything, and in many cases, particularly with instrument adjustments, there is no sound at all.
Q: Will I be adjusted on my first visit?
A: Not by default. The first visit is your history, the examination, and imaging where it is indicated, because those findings are what determine whether an adjustment is appropriate and what form it should take.
Q: Can I keep seeing my regular doctor?
A: Yes, and I would encourage it. If at any point the findings call for another healthcare provider to be involved, I will refer you without hesitation.
An adjustment is a controlled, targeted force, quick and shallow, applied to one specific joint that is not moving as it should. The popping sound is dissolved gas coming out of the joint fluid, and it is not bone. Nothing in my clinic gets adjusted until the examination and, where it is indicated, in-house digital X-ray have shown what is actually going on, because the diagnosis is what the plan is built on.
If you have questions about your own back, neck, or joint discomfort, you are welcome to book a consultation at the clinic here in Montgomery. Call us at (334) 997-7463 and we will get you booked in.
