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Spinal Manipulation…What Exactly Is It?

Most of us would have heard of spinal manipulation or “cracking joints” before, but what is actually happening and why does it make a noise? You may know the answer or have some idea in mind. A recent study sought to find out what people thought the cracking sound meant from both those who had spinal manipulative therapy and those who hadn’t.

The researchers recruited subjects who had and hadn’t had spinal manipulative therapy in the past, as well as patients with and without current back pain. Questions included ‘What is the sound heard during spinal manipulation (where does it come from?)’ and ‘Does the sound indicate a successful spinal manipulation’?

Spinal manipulative therapy which involves a joint “click” or “crack” is a technique sometimes used by chiropractors, osteopaths and some Physiotherapists. It involves the application of a high velocity, low amplitude movement (ie. fast and small) that produces joint surface separation. There may be an associated cracking or clicking noise. In more recent years’ evidence has shown the cracking sound is due to gas bubble formation in the synovial fluid of the joint being manipulated. This goes against the previous mechanical theory of joint surfaces being realigned, and more towards a neurophysiological response, in regards to pain reduction.

Results of the study showed the following:

49% of people believed the cracking sound was due to spinal realignment

23% of people believed it was due to friction between two vertebrae (bones)

5% of people believed it was due to a ligament being released

14% of people either didn’t know or believed some other structures within the spine were either rubbing or adjusting in some way

9% correctly identified a gas bubble forming as the cause

40% of participants believed that the sound was evidence of a successful manipulation

These often incorrect beliefs about spinal manipulation may promote the idea that the spine is weak, unstable and can easily slip out of place, which simply isn’t true. This highlights the need for clinicians to keep updated with the latest research and educate their patients appropriately.

If you have spinal pain or want to know more about treatment options for the spine book in to see one of our experienced Spinal Physiotherapists at Bend + Mend in Sydney’s CBD. We have Master’s-Trained Physio’s who specialise in Manipulative Physiotherapy.

Nicklaus Vincent

About Nicklaus Vincent

Nick graduated from the University of Sydney with a Bachelor of Exercise and Sports Science and a Master of Physiotherapy. Since graduating Nick has worked in a private practice setting in Sydney’s CBD helping patients recover from a variety of acute and chronic conditions. He has a keen interest in extreme sports and all water-based sports, having previously competed at a national level in swimming. Nick is a strong advocate for strength training and pain science and regularly uses dry needling in his hands-on approach to treatment. Nick has worked with grass roots to elite level water polo and enjoys working with patients from all walks of life.

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