A question we are asked frequently in clinic is “what is “cracking” and why do we do it”. So, we’ve asked our osteo Dr Chris to delve into the topic of joint manipulation (cracking) – a technique frequently used in osteopathic practice to explain what it is, why we do it and what are the benefits for musculoskeletal health.
What Is Joint Manipulation?
Joint manipulation, also known as spinal manipulation or High Velocity Thrust (HVT), is a technique which involves the Osteopath applying a controlled force to a joint in the body, which may be in the spine or other joints such as an elbow or foot. The goal is to improve range of motion, reduce pain, and enhance overall function of the joint and surrounding tissues.
I often use the following analogy when explaining to my patients when I would choose to do joint manipulation for optimal benefit (as a general base rule):
It is about finding the right person/approach for the issue. In this example, it makes no sense for a paramedic to be driving a fire truck, for a police officer to be driving an ambulance, and for a fireman to be driving a police car. I use this to help explain why an Osteopath may choose a certain technique for an area of the body instead of another.
If the Osteopath chooses to manipulate a joint when the issue is a nearby muscle, for example, you may not improve a lot following your treatment. This is where getting the history of what happened to cause the pain in the first place, as well as assessing the area, gives the Osteopath the information needed to choose the best technique to suit the patient in order to provide the best possible outcome post-treatment.
More or less, joint manipulation is mainly used as a prioritized technique for presentations when we assess that a joint is the primary issue causing the pain or dysfunction. For presentations we assess are more due to a strained muscle, soft tissue/muscular approaches may be of more benefit, and similarly for ligament sprains, joint articulation/mobilization and myofascial release techniques may be better suited compared to joint manipulation.
How Does Joint Manipulation Work?
The underlying principle of joint manipulation lies in restoring proper alignment and movement to joints that may be restricted or not moving optimally. This can occur due to various reasons such as injury, overuse, poor posture, or degenerative changes. By applying a quick and controlled force to the joint, osteopaths aim to break up adhesions, stretch tight muscles, and stimulate the associated nervous system structures to promote healing and relieve pain.
The quick, controlled force applied during manipulation can cause a temporary decrease in pressure inside the joint, which may lead to the release of gases (such as carbon dioxide and nitrogen) from the joint fluids. This release is often accompanied by the characteristic popping or cracking sound. It’s important to note that this cracking sound isn’t necessary for the manipulation to be effective! Often your practitioner will reassess the range of movement of the joint after the manipulation to test its effectiveness (as the aim is to increase movement).
What Causes the “Cracking” Sound in Joint Manipulation?
A question we are asked frequently in the clinic is, “What is ‘cracking’ and why do we do it?” The cracking sound heard during joint manipulation is typically due to the release of gases like carbon dioxide and nitrogen from the joint fluids. This occurs when there is a temporary reduction in joint pressure. It’s important to understand that this sound is not an indicator of the treatment’s success or effectiveness.
Benefits of Joint Manipulation
- Pain Relief: Many patients experience immediate relief from joint pain following manipulation.
- Improved Range of Motion: Enhances flexibility and mobility in the affected joint.
- Enhanced Function: Helps joints function more efficiently, also assisting associated tissues such as attaching muscles, ligaments, tendons, and connective tissue to decrease in tone (becoming less tight).
- Natural Approach: Can avoid the need for ongoing medications or potentially more invasive approaches.
- Complementary Therapy: Often used in conjunction with other treatments like exercise prescription and remedial massage.
Why Doesn’t Everyone Experience Cracking During Joint Manipulation?
Not everybody cracks! Some people have been cracking their own knuckles for years and are very used to it, whereas some people haven’t ever cracked anything in their body. The latest research suggests ‘ligament laxity’ around a joint is the best indicator for an individual joint’s ability to cavitate, or crack. Some people who are either very tense, have a lot of soft tissue tightness surrounding the area, or people who have seemingly ‘always been tight’ (genetically), are often difficult to manipulate.
Aftercare for Joint Manipulation: Tips for Recovery
Following joint manipulation, it’s common to experience mild soreness or stiffness, which usually resolves within a day or two. Your osteopath may recommend ice/heat application, gentle stretches, or specific exercises to complement the treatment and promote healing.
Conclusion: Is Joint Manipulation Right for You?
Joint manipulation is a valuable tool in osteopathic care, offering effective relief for various presentations. It’s important to note that joint manipulation is only one type of technique that osteopaths use and isn’t the be-all and end-all! As osteopaths, we have a very wide range of techniques that we use for the differing pain presentations that come in.
Feel free to ask your osteopath about joint manipulation if you haven’t had it before, and whether it is suitable to help with your pain.