Manipulations- Are they all they're cracked up to be

October 17, 2017

Spinal manipulation (the thing that causes the cracking noises) is one of the treatment methods mostly associated with Osteopaths. However, depending on the Osteopath you're talking to, some will agree or disagree with this. Regardless of this, manipulation is something that is taught at all Osteopathic teaching institutions and is one of the treatment methods that Osteopaths are trained to use. 




But what is that cracking noise?


Manipulation as a technique is targeted at synovial joints, the joints of the body that allow movement in all directions. When a manipulation is performed, the practitioner (Osteopath, chiropractor, physiotherapist etc) will target a specific joint by moving the patient to direct forces to that joint. This build up of various forces creates a stretch on the joint and its capsule, resulting in a change of pressure within it. This change of pressure is what causes the 'pop' or 'crack', but there is a current dispute in literature as to whether this is due to a cavity being formed or cavity collapsing within the joint. 


The theory of a gas bubble popping or forming is the same for all synovial joints in the body, from your knuckles to your neck. 


Whether it is the formation or collapse of gas bubbles in the joint is  irrelevant. What is more important to inform people about is what manipulation isn't. 


It isn't;

  • Correcting your joint alignment 

  • Putting bones back into places

  • Bones hitting or grinding together

  • The sound of your intervertebral disc popping back into place


So why do you manipulate joints?


There are a number of theories proposed as to why spinal manipulation works. And no, because it puts your joints back in places is not one...


The short answer is that no one is 100% certain as to how or why manipulation helps, especially in peripheral joints as most studies focus on spinal manipulation alone. 


One theory suggests that spinal manipulation influences the central nervous system and the way that it processes pain. While other similar theories agree with this, they also add on that spinal manipulation can influence local neurophysiology by influencing structures around the 'manipulated joint' which then has an influence on the central nervous system as a result. 


Other theories suggest a much simpler approach, that manipulation causes sudden proprioceptive stimulation (the sense of your body moving) which influences biomechanics. This is kind of similar to that feeling of needing to stretch your legs after being sat down for a long period of time. We know that pain distorts how our body perceives itself, and is why we sometimes feel that swelling is actually bigger than it really is or that we feel slightly 'wonky'. The theory that manipulation influences proprioception may go some way to explain why it provides that feeling that some people report of a 'joint going back in' or something being 'unstuck'. 


The honest answer is that no one really knows how or why manipulation works, and this probably explains the reason why there is currently no definitive research on this topic. Further understanding and research is required into the topic before we can start to give more answers. 


So why do you actually use it then?


Manipulation benefits a lot of patients, for whatever reason that may be. If a type of treatment is effective at relieving symptoms in a certain patient then I feel that is enough of an indication for it's use. This could be massage, mobilisation/articulation, stretching, muscle energy techniques etc. This said, we will always ensure that patients treated with manipulation are always suitable and are at no risk for any of the potential detrimental effects that can be associated with it. 


On top of this, we know that the effects of manual therapy techniques can be short-lived. Although this may be useful in helping acute aches and pains, at Alpha Health we will always ensure that there is a long term recovery program in place to ensure that the benefits you receive from treatment continue. This usually involves more active interventions such as exercise, which helps boost long term positive outcomes for both pain and function. 



Have any questions about Osteopathy? Leave a comment or give us a message and we'll be more than happy to answer. 


Please call 020 8304 7237 to book an appointment or book online HERE.

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