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“My [neck, back, hip] is out! Can you put it back in?”

The latest literature about the causes of facet and sacroiliac joint pain is fascinating given what we believed was going on for the longest time. I’m going to use this as an opportunity to attempt to clear up the confusion about those little joints in the back and how they are interpreted as painful by your brain. Lets start by clearing the air. Your back didn’t go out…and if it did…let me know when it comes back! Subsequently, if you have received spinal manipulation (adjustments) as a treatment it is important to understand that the joints aren’t being put back into “alignment” either. So…what is going on back there?

Lets go over what happens with normal, healthy spines and their respective facet joints. There are receptors in the joint surfaces, muscles, and ligaments all throughout your spine. These receptors are called mechanoreceptors and as the name suggests, they transmit “mechanical” type stimuli [touch, stretch, tension, etc] to the brain so that your brain has an idea of where your body is in space and how to move accordingly as you interact with the world around you. These mechanical stimuli do not result in pain … normally [another topic, i.e. chronic pain sensitivity]. There are another set of receptors in the joint surfaces, muscles and ligaments in your spine. These receptors are known as nociceptors and they transmit “noxious” or “threatening” sensations that have the potential to be projected as a pain experience by your brain.

Mechanoreceptors and nociceptors are currently believed to be in a state of balance with each other. The normal mechanical stimuli actually block the “threatening” stimuli from being transmitted to the brain for interpretation. Joint pain is theorized to occur when there is a movement abnormality within the affected joint (and the muscles around the joint). It isn’t out of place, but that joint may be stiff and exhibit restricted movement. If you’ve ever had joint pain and stiffness in your back or neck, you know what this feels like. When this occurs, the normal mechanical stimuli from the joint are decreased and it allows for greater input from the type of stimuli that have the potential to be interpreted as threatening and subsequently painful. For those who have received spinal manipulation (formerly known as adjustments) from a chiropractor, physical therapist or osteopath in the past, here is a more accurate video demonstrating what is occurring in the joint. This is called joint gapping (or quickly opening and closing the joint, so to speak).

If the environment is right in your brain, it has the ability to take these potentially threatening stimuli and project a painful experience that can leave you in moderate and occasionally severe discomfort. What am I talking about when I use the word “environment” as it pertains to your brain and pain? That is a topic of discussion all by itself and you’ll have to check back for my next blog which will address this question specifically.

“Be the change you wish to see in the world.” ~ Mahatma Ghandi

Join the movement. Primary Spine Care is a growing movement with the goal of changing how we deliver spine care services to patients in the United States. Partner with a Primary Spine Practitioner today for your spine care needs!

Hans W. Bottesch II, D.C., completed his clinical training as an evidence-informed Chiropractor in the Veterans’ Affairs Medical Centers (VAMCs) of upstate New York. He has been trained as a Primary Spine Practitioner and has published articles in the lay press community. He currently practices out of Bloomsburg Spine & Sport. You can contact him at

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