However, within this quest to share information and hopefully provide people with information to help them get better, I can sometimes be met with resistance.  This resistance comes from the patients current beliefs.  This presents a very difficult scenario and one in which myself, and other healthcare professionals I may add, have to tread very carefully.

As healthcare providers we have a moral obligation to provide evidence based practice which is designed to treat and cure patients.  We do this througha  variety of methods BUT there comes a point where the ethical side of healthcare becomes apparent.

Take for instance spinal pain and manipulation of the spine.  What I am about to say may come as a surpise to many, but our beliefs surrounding back cracking and adjustments are maybe not quite as true as once thought.  In fact, the theory of ‘putting something back in place’ has been disputed since the 1980’s and at present it is widely understood in the medical world that things ‘cannot be put back in place’.

But it doesn’t stop us believing it….

The questions is then, to what responsibility do we as healthcare providers have to inform our patients of the facts.  As Clinic owner and employer of all therapists, I am confident that if anyone who asks what actually occurs that they will be given a full and honest answer.  I mean, why lie? What do we have to achieve?……But that is just it.  A paper in 1984 stated that should a patients pain not be reduced in their treatment via a modality that they expect to work then the patient would deem the treatment unsuccessful and potentially label the therapist as incompetent and then go and seek another healthcare professional to carry out the same job.

I am not for a minute saying that this is what any of our patients would do, but it has certainly happened to me in the past when I was certain and sure that the treatment based approach I chose was based on scientific and evidenced based facts.  Instead of carrying out the ‘click into place’ method expected I explained that it wasn’t doing what they thought and instead based my treatment on exercise therapy which is supported by tons of research and proven to work.  I know this particular individual then sought treatment from a fellow healthcare professional who carried out said ‘adjustment’ and the patient was convinced that this was the solution.

This experience here then made me question what I believed in.  Not in terms of the science and biomechanical evidence that exists surrounding both modalities (adjustments and exercise) but whether I should have just ‘clicked’ things into place to satisfy the needs of the patient.  Part of me wants to say I should have but the ethical consequences of ‘teaching’ someone something that is false would have stood against everything I firmly believe in.

So to end things here, I want you all to think about your beliefs in everything that you currently do and ask yourself is there an alternative answer that you could come up with as to why you do something or why you believe it works.

I want to leave you with this final image below.  This is taken from a paper in 2018 which looked at 100 selected inividuals and highlighted their thoughts/beliefs on what actually happens when spines are ‘cracked’ or ‘adjusted’.  Hopefully some of you will find something in there that you can resonate with! I will give you a little spolier alert too…..only 9% of those asked actually got the CORRECT ANSWER!!

And for those that are actually interested, the ‘crack that you hear is actually ascribed to cavitation, which is the formation of vapour bubbles in a fluid when a mechanical effect induces a pressure drop. There is no rise in temperature. During traction (the gapping of a joint basically) or manipulation, the joint surfaces are separated from each other, causing an increase in volume and, consequently, a drop in pressure. Beyond a pressure threshold, chemical changes convert part of the synovial fluid to gas, producing a cracking sound. I can go on further here regarding the concept of pain relief but I may save that for another time.