I have been practicing chiropractic for about 20 years now and have been exposed to, and taught a number of techniques to help realign and stabilize joints in the body.
One thing I have noticed is that none of the techniques* I have learned or studied have a grading system for the adjustments. Mostly it tends to be a functional matter; pain decreases, mobility increases, etc. But each adjustment can be so different and get the exact same results. Likewise, the same adjustment, even on the same person, can get different results each time. I generally use what is called a "diversified" technique, which really is not a technique at all, but a collection of procedures to move a vertebrae or other joint where you think and feel it should go. Most of the time, we get a 'pop', but not always.
When doing such adjustments (especially the spine) I am always looking for how well it worked. I have my own grading system... the "click, clack, clunk" range. When you perform a simple P-A adjustment (pushing on the back when the patient is face down) you typically get a sound as the joint 'cavitates' (More on that later). This results in a click if it is a surface joint, like the facets, a 'clack' if it is a deeper joint like the rib head or neck, and a distinct 'Clunk' with the deeper part, that being the disc.
Now, I have absolutely no research on this, and there are no studies that I know of that have researched if this is at all true. But, empirically, IN MY experience I see this as true. I figure I have done well over 75,000 adjustments in my career and that is what I base my info here on. I have also found that when we get the 'Clunk' the patient almost always has a great release of tension and takes a much needed and happy sigh.
Having said all that, the Click, Clack, or Clunk are really just sounds. I prefer to get the right sound at the right time for the right reason. This is all about personal preference of the patient, their goal for treatment and my sense of the issue at hand. Sometimes a 'clunk' would be a bad idea for someone that has never felt a real adjustment before, or for someone that has lots of pain. Again, I use common sense, compassion and experience...
The 'feel' of the adjustment. With practice, palpation skills become very refined. With chiropractic care, the patient too becomes more refined in knowing how a joint segment feels before, during and after a manipulation or adjustment. In the case of the doctor; I am feeling for misalignment as well as muscle tone around that segment as well as the slight motion of the segment areas as I move the patient's neck, torso or lumbar area with some simple passive range of motion testing. With that we can both feel the restriction, the tightness, the resistence etc. Once the adjustment is delivered it may not even give any audible clue like the 'click, clack, clunk', but be an improvement in both subjective and objective findings like feel, tenderness, alignment, range of motion and segmental motion.
We must also understand though, an 'audible' or pop, click, clack, or clunk is NOT at all necessary to have a good result. In fact, many techniques offer no such sound but have all the benefit of the later. Since anyone can push or hug someone and get a pop, that is not really doing an adjustment. An adjustment is a very specific intentional movement of a joint just past it's fixation point to bring about more normal physiology in the area (as well as cut the pain spasm cycle). Sometimes now called a 'High Velocity, Low Amplitude' (HVLA) manipulation, or in the physical therapy sense, a grade 5 manipulation or mobilization. To perform these types of treatments takes great skill and practice as well as a keen sense of anatomy of the area and possible pathological issues that may make the adjustment/treatment contraindicated... Most are pretty obvious and do not need to be reviewed.
Although there is no necessity of an audible click, clunk or clack as I described, there is a change in the physiology of that sesgment, the bones do move, the ligaments are challenged, the tendons and muscles stretched and the area soothed. It is a good way to explain to patients the value of a timely adjustment as well as the stiffness that they reported as being verifiable in my evaluation. Something like 'yes, I can tell how tight it is, it only clicked, when we get a deeper adjustment it is more often a clunk'. This of course is not limited to just the lumbar area, but can be seen in all areas of the spine, ribs and appendicular skeleton.
Feel free to contact me at 720-325-9886 or send me an email with any questions or comments. Thanks!
Techniques that are used by chiropractors vary as wide as personalities it seems. You can find a list anywhere. Here are some that I use; Diversified, Gonstead, Full Spine Specific, Meric, Thompson, Cox Flexion Distraction, SOT, Activator, Motion Palpation, English Bone Setting, Tui Na, Mobilization, among others...
Of the techniques I use these are the ones that usually have no audible sound; SOT, Activator, and English Bone Setting.
