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      "body": "As I delve into the blogosphere, or whatever the blog world is called, I figured I would start off with the most obvious, debated and controversial topic within the Chiropractic Profession, the spinal manipulation/adjustment or “cracking bones.” This can be performed by a trained Doctor of Chiropractic, Osteopathic Doctor or a Doctor of Physical Therapy. Most of the time, Chiropractors are the most trained and most likely to perform a manipulation but some DO's and PT's go through extra training to perform it as well. Before considering Chiropractic as a potential career path, my only experience with the profession was in an episode of the Simpson’s where Homer kept throwing people onto a garbage can to “crack their back”. Realistically, this probably isn’t the best look for the profession, but at least the people got better. So what is that cracking sound? It is actually just gas leaving the synovial fluid of the joint. Below is a picture of the standard structure of a synovial type joint.  \n\n\t\n\n![907_Synovial_Joints.jpg](https://cdn.steemitimages.com/DQma1yBFhjLUtYNcjUaJLYeNvwJLFVeC7JkwrtejvNP377g/907_Synovial_Joints.jpg)\n\nExamples of a synovial type joint are the elbow, knee, toes, hips, shoulders and the Facet Joints in the spine. As pictured above, between the two bone surface’s is a synovial capsule filled with fluid. Sometimes the joint can get a little “locked up” leading to a decrease in your range of motion or movement. This issue is often called a joint restriction. Sometime’s a patient experiencing this may describe a stiffness, where they just feel off, locked up or like it needs to pop. Of course, not all pain is the same and can have numerous causes. \n\tNow, the manipulation is when the Physician restores range of motion to that joint with a quick small thrust. This can lead to a pop as the joint capsule expands changing the pressure and releasing some gas from within it. Sometimes there can be adhesions in the capsule so it may take more than one manipulations to restore proper range of motion, however, most of the manipulation results are for short term relief or for overall wellness. It is just one tool in the trained Physicians toolbox, with proper activity modification and active rehabilitative exercises being the most supported for long term success. \n\tConditions that I will often use the spinal manipulation for are Facet Syndrome, SI joint dysfunction, Lumbar Disc Derangement, Degenerative Disc Disease and any joint that is having mobility issues. It can also have some success with Disc Herniations depending on your movement preferences. If you have any of these issues, or any musculoskeletal pain in general, make sure you see a qualified provider who does a thorough exam before they get rack'n and crack'n. Not all low back pain is the same, and not all will benefit from the manipulation.",
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      "body": "In my previous blog post I discussed the spinal manipulation. It was a brilliant story of love, hardship, struggle and eventually overcoming pain via some good old fashioned Rack’n Crack. As many of you may not know, throughout these blogs you will see that I am anything but a Rack’n Crack physician. I personally love the manipulation, but don’t think it is the solution to all low back and neck pain. You will see later that I will come out bashing “non specific low back pain, and non specific neck pain (lumbago and cervicalgia)” and I think that the “manipulate vs don’t manipulate” conversation needs to be discussed around much more specific terms. For the purpose of this blog post, I will discuss the manipulation for other regions of the body.\n\nIf you read the previous blog, I mentioned the existence of synovial joints. If this doesn't make sense, go read it.  The synovial joints in the spine that Manual Practitioners manipulate are called Facet Joints. On that note, there are many synovial joints throughout the body such as in the Hip, Shoulder, Knee, Ankle, Hand and Foot. A skilled practitioner can manipulate every synovial joint in the body. This includes the carpometacarpal joint of the thumb and even the big toe. For instance, often times runners have very poor toe off from bashing their feet into the ground repetitively. A great treatment approach for this is to mobilize and manipulate the big toe, along with some myofascial release to the musculature around it. The goal being, improve big toe mobility. \n\nThe process works very similar to the spine, the practitioner will take the joint through its proper Range of motion, then performing a quick small thrust to the joint in question in order to restore or improve the joint mobility. Some of my favorite joints to mobilize are the ankles, too often we roll our ankles repeatedly and never restore that mobility. Scar tissue locks down and the joint slowly loses range of motion. Based on the joint by joint approach to rehabilitation and prehabilitation this loss of motion will go up the chain. For instance if your ankle is not moving through its appropriate range, that movement will then occur in the knee. Our knee is actually designed to have very little lateral movement and thus is supposed to be stable. What do you think happens when too much movement goes into the knee? Thats right, you put yourself at increased risk for an ACL tear. Research has shown the best way to prevent ACL tearing is to improve ankle mobility and hip stability. The manipulation is a fantastic way to start improving ankle mobility. As I always say half sarcastically, “Adjust it and trust it.”",
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