Can You Crack My Back?

Have you ever wondered what it actually means to “have your back cracked’? Or what causes that distinct “popping” sound everyone seems to associate with pain relief? And most importantly… is having it done to actually safe?

The formal name for this type of treatment is spinal manipulation. While it is most often associated with chiropractic medicine, it is also frequently used by other licensed professionals, including certain physiatrists, osteopathic physicians and… physical therapists!

Now what exactly is a spinal manipulation and why do we do it? A manipulation is a technique in which a “High-Velocity, Low Amplitude” (HVLA) thrust is applied to a joint while it is in a specific position. In other words, it is a force applied to a joint very rapidly, but that occurs through only a small range of movement. The speed of this movement allows a “quick stretch” to occur around the joints and their capsules. The speed is important because it allows the motion to occur at the joint before the surrounding muscles are able to kick in and begin guarding. Inside the joint itself, the volume increases quickly which causes a sudden drop in pressure. This rapid pressure change sometimes results in an audible “POP”, similar to the sensation of your ears popping with changes in atmospheric pressure. Many studies have shown that this pop is NOT actually required for a successful manipulation. They have found that the same effect can occur regardless of whether a pop is heard, as long as the technique is done correctly. This is because the processes occurring outside the joint are what make the true difference. A neurophysiologic response to the quick stretch leads to muscle relaxation, a decreased pain threshold, and improved nerve conduction. In a way, it’s like a neurologic reset for that area.

Although effective as a treatment, the immediate relief experienced after a manipulation is not a long-term solution. In some cases, the improvements have been shown to last only 20-30 minutes if treated with manipulation alone. When combined with the correct stretches and exercises, however, the results can last substantially longer.

Other Fun Facts about manipulations:

• It’s not just for your back!

  • Although manipulative therapy is most known for those performed on the back and neck, manipulations exist for most of the joints in your body, including some for your hands, feet, elbows, ribs, and more.

• You do not always need to manipulate the exact location of pain for it to work

  • For example, multiple research studies have determined that manipulating the thoracic spine can improve symptoms in the shoulder, cervical spine, and TMJ

• Having a joint manipulated does NOT increase your risk of arthritis in that location

  • This is an old myth that has since been proven inaccurate

• When performed by a trained health care professional, the risk of serious injury with these techniques is very low

  • There is always a risk associated with manual techniques, just like there is always a risk of injury during workouts. However, as long as your clinician has been properly trained in these techniques and has ruled out any contraindications, there is a very low risk of serious injury. Talk to your PT or other provider if you have concerns prior to manipulation

References:

- Myerson J, Grimes J. THRUST MANIPULATION FOR UPPER QUARTER DYSFUNCTION: A Case Based Approach. Partners 4 Rehab Excellence. 2021. Course Manual

- Clark, B. C., Goss, D. A., Walkowski, S., Hoffman, R. L., Ross, A., & Thomas, J. S. (2011). Neurophysiologic effects of spinal manipulation in patients with chronic low back pain. BMC Musculoskeletal Disorders, 12(1). https://doi.org/10.1186/1471-2474-12-170

- Spinal manipulation. Physiopedia. (n.d.). Retrieved January 13, 2022, from https://www.physio-pedia.com/Spinal_Manipulation

- U.S. Department of Health and Human Services. (n.d.). Spinal manipulation: What you need to know. National Center for Complementary and Integrative Health. Retrieved January 13, 2022, from https://www.nccih.nih.gov/health/spinal-manipulation-what-you-need-to-know