Their posts have garnered millions of views on social media. But like the Californian@Occhiropractor, aka Dr Alex, these influencers do not talk about fashion or food. No, these are chiropractors. Stars across the Atlantic on Instagram, they “crack” their patients’ bodies, sometimes from head to toe. Sound “cracks” that divide viewers into two categories: those who revel in them ASMR style, and those who are horrified both by the noise and by the manipulation itself.
What’s the use of getting your body cracked (by a professional)? Is this a sign of efficiency or should we be concerned about it?
But first, why does the body creak in this way under their hands? “The actions performed by chiropractors are adjustments. And among them, there are HVLA manipulations (high velocity, low amplitude), pressure exerted on different points of the body that will crack the joints,” explains Elodie Rousset, chiropractor and vice-president of theFrench Association of Chiropractic. By what mechanism? “In a joint, there are two bones, between which is the synovial fluid, with a viscous texture, she continues. To make a “crack”, the two bones are moved apart, which creates a gaseous void, called the synovial cavity, which produces this characteristic sound. Most joints in the body are synovial, so you can crack them.”
Increase joint mobility and relieve pain
What is the interest for the body? “Patients often come to see us for musculoskeletal disorders,” points out Elodie Rousset. Our field is the joints: joint pain, osteoarthritis, sciatica, lumbago or headaches related to a cervical problem. This manipulation is used because it increases joint mobility, creates instant muscle relaxation and calms pain locally. It is one tool among others. It is the most impressive method, and a bit our trademark”. On Instagram, Dr. Alex stages it perfectly with the help of a microphone, delighting his 634,000 subscribers with very sound “cracks”.
“Crack”, an increasingly popular practice
But is there any point in doing it from head to toe, as we can see throughout the video? Neck, vertebrae, shoulders, wrists, hips, knees, ankles: on some posts, everything is “cracked” on the same patient. “According to the foundations of chiropractic, we seek to work on the patient as a whole. For example, in the event of a badly healed knee sprain, in addition to painful discomfort when walking, the back suffers, and muscle tension appears in other places, describes the chiropractor. We can therefore be led to restore mobility to joints other than the one that hurts”.
And these videos are emulated. “They make the profession known, demystify our acts, by showing what our practice consists of, recognized in France since 2002, like certain videos of surgical interventions, welcomes Elodie Rousset. I also have patients who come to the office after having seen them on the networks. they want to be crushed everywhere, tell themselves that it will unblock them. In this, these videos are double-edged: it should not be a show, we do care, it is a medical act, she insists. I’m not sure that all of them are filmed in the interest of the patient. You have to understand why he is there: what is his health history, his daily life, his working conditions, his sports practice…? The “crack” in itself is not a magic act”.
Risks associated with cervical manipulations
A non-magical act, therefore, and which can be damn impressive, even creepy. In many posts, chiropractors crack the neck, sometimes using a strap (Y strap), in a pulling movement that moves the body a few centimeters back. “We don’t learn that in French chiropractic schools,” says Elodie Rousset. I’m not a fan, it increases the risk of getting out of a joint-friendly movement. Crack to crack, no”.
Handling, manual or with a strap, usually goes very well. But in very rare cases, it can go wrong. In an article published in 2019 in the Journal of critical care medicine, doctors from the Reims University Hospital described the case of a 34-year-old patient who developed locked-in syndrome after a cervical manipulation session by a chiropractor. The young woman, who had consulted for neck pain, saw her pain intensify after the session, without any other symptoms. Three weeks later, she began to suffer from severe headaches and tingling, before becoming aphasic and quadriplegic, falling into a coma and undergoing a tracheostomy. Verdict: vertebro-basilar vascular accident, a form of stroke. “All it takes is mishandling or malformation for the walls of the artery to peel off. This causes a hematoma, then a stroke. For this patient, the sequelae were irreversible,” commented Dr Guillaume Giordano Orsini, emergency physician and resuscitator at the CHU de Reims, and co-author of the article. Disabled for life, his patient uses a wheelchair.
A challenge that irritates the profession. “The chiropractor sent the patient to the emergency room, suspecting something concerning. But it is because she suffered from a delay in treatment, due in particular to the difficulty of making a diagnosis, that she suffered a loss of opportunity, replies Elodie Rousset. The chiropractor was exonerated by the expert during the trial”. However, she recognizes that “as with any medical procedure or taking medication, chiropractic involves risks, although very low, in particular fractures in patients with bone fragility. More serious and much rarer still, there are risks of stroke in patients with arterial risks. This does not mean that the practitioner twists the neck to the point of causing a stroke, but that there is a fragility of the cervical which, during a rotational movement, can trigger a stroke”.
Warning signs and precautions
To prevent these risks, “we systematically question patients, indicates Elodie Rousset, to find out their history. Many of them should not be handled if they suffer from osteoporosis, joint fragility or cancer. In addition, the stroke can cause neck pain, so if a patient consults for this reason, it is necessary to know how to make the distinction, and identify other symptoms associated with the stroke: dizziness and loss of sensitivity in the arm alert on the fact that it’s not just neck pain”.
Still, not all chiropractor patients want to be “cracked”. “Some want it, some hate it, in which case I use other methods. And some chiropractors don’t like it either and never crack: chiropractic isn’t just about “crack”.