Updated: May 4
I thought that, over the next few weeks, I would address a few common questions that I am often asked by our patients. Let’s start with the most common one!
WHAT’S THAT SOUND?
The most common question that patients ask me is about joint manipulation, “What is that cracking or popping sound I hear when you adjust my back, and are you sure it is ok”? The answer to this question is surprisingly simple.
The sound that you hear during joint manipulation comes from the release of accumulated gas (80% carbon dioxide) within the joint. In fact, about 15% of our joint volume (where the synovial fluid is located) is made up of gases. (1)
Secondly, that sound you hear during joint manipulation is NOT harmful — no matter what your mother may have told you.
BENEFITS OF JOINT CAVITATION
Joint cavitation (releasing the joint) has several benefits.
The most immediate benefit that you will notice is an increased range-of-motion in the joint.
In addition, you will find some very beneficial neurological effects. Essentially, cavitation of the joint is a very effective way of initiating a neurological response known as a Reflex Action (from the periarticular receptors - which are the neurological receptors surrounding the joint).
Let me explain. Most back problems involve both the joints and the soft-tissue structures that surround the joint (paraspinal muscles, ligaments, tendons, fascia, joint capsules, etc). Essentially, when you are injured, the neurological receptors around your joints (mechanoreceptors and nocieptors) cause your joints and muscles to become very hypertonic (increased capsule tension, increased nerve ending sensitivity, and tight restricted muscles) —all of which causes pain.(2)
When a spinal joint is manipulated, it creates a reflex action in all the surrounding neurological joint receptors (mechanoreceptors and nocieptors). (2)
This in turn causes the surrounding joint capsule to release, allowing hypertonic muscle to relax, and allows the nerve endings to become less sensitive
The end result is decreased levels of pain.
Therefore, you should consider the sound of joint cavitation to be a very positive occurrence. Joint cavitation is an indication that the “Neurological Reflex Response” has been activated. With this sound, you know that you will now have increased range-of-motion in the joint, decreased soft-tissue tension and best of all, a decrease in pain.
MANIPULATION VS. MOBILIZATION
As a musculoskeletal practitioner, my success rate would be greatly reduced if I did not address spinal joint restrictions. In fact, NONE of the many soft-tissue techniques that we use in practice (MSR, Graston, ART, etc.) can activate the periarticular “Neurological Reflex Reponse” the way that joint cavitation can. Joint manipulation in the hands of a trained practitioner is a highly effective and safe form of therapy.
That being, said yes we do have alternatives to joint manipulation. The alternative is called joint mobilization! Mobilization is the NO SOUND alternative. Both forms of therapy are effective!
It is important to inform patients about the alternatives to manipulation for the cervical, thoracic and the lumbar spine. The following videos discuss the subject of joint manipulation Vs. mobilization and give you examples of mobilization in different spinal areas.
Warning: Only trained licensed practitioner.
Neck Adjustment or Neck Mobilization: Patients have options! When you are suffering from neck pain do you need a Neck Adjustment or Neck Mobilization? Will Soft Tissue Therapy achieve the same results?
Cervical Joint Mobilization - MSR: In this video I will show you examples of Cervical Joint Mobilization. This are examples of some of the procedures that we teach in our Motion Specific Release (MSR) courses. Please note MSR procedures are to be performed only by certified MSR Practitioners!
Thoracic Joint Mobilization - Childs Pose: In this video we demonstrate some of the MSR procedures we use for thoracic joint mobilization. Good joint integrity and function is required to maintain our capacity to execute an unlimited variety of movements.
Lumbar Spine Joint Mobilization - MSR: In this video we demonstrate some of the MSR procedures we use for lumbar joint mobilization. Our capacity to produce an unlimited variety of movements requires good joint integrity. No joint ever works in isolation. An injury in one joint often results in bio-mechanical compensations occurring in both adjacent and distant joints.
Joint Manipulation or Joint Mobilization it's Your Choice
Your spinal and peripheral joints make up a key component of your body’s kinetic web. Joints restrictions make up a significant component of most injuries and should not be overlooked.
Whether you would prefer joint manipulation or joint mobilization is totally up to you.
Don't be deterred by the sound of joint manipulation, it is an indication that you will now have increased range-of-motion in the joint, decreased soft-tissue tension and best of all, a decrease in pain.
If the sound is something that you would like to avoid just tell us, and we will use mobilization procedures. The choice you always yours!
The audible release associated with joint manipulation. J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):155-64. Brodeur R. http://www.ncbi.nlm.nih.gov/pubmed/7790795 .
Spinal manipulative therapy and somatosensory activation. J Electromyogr Kinesiol. 2012 Oct;22(5):785-94. doi: 10.1016/j.jelekin.2012.01.015. Epub 2012 Feb 19. Pickar JG1, Bolton PS. http://www.ncbi.nlm.nih.gov/pubmed/22349622 .
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publications which will be available later this year.