What's the Crack?
The Science and Safety of Joint Manipulation in Osteopathy
Patients often have numerous questions about the intriguing "cracking" or “popping” sounds that often accompany joint manipulations. These sounds can evoke a wide range of reactions - some patients dislike them, while others find them oddly satisfying. But what exactly are these sounds, and what causes them?
In this blog post, we're going to chat about joint manipulation, what it's all about, why it's used, and we'll bust some common myths. We'll also have a good look at the safety aspects, and we'll dig into other reasons your joints might make those clicking sounds.
So what makes that pop?
I'm sure you'll be glad and maybe surprised to know that the audible sound is not due to any bones crunching or muscles snapping. Nor is it due to the practitioner ‘popping your joints back into place’ or ‘realigning your spine'.
The source of the popping or cracking sound resulting from joint manipulation remains a subject of ongoing debate. Recent research indicates that the sound arises from the release of gases within the joint when the joint capsule is stretched. Most of the body's joints are enclosed within a joint capsule that holds synovial fluid containing oxygen, nitrogen, and carbon dioxide gases. During a manipulation technique, the joint capsule is stretched, causing a rapid release of these gases, which generates the popping sound. This theory explains why you need to wait a while before you can successfully crack your knuckles again, as the gases need time to return within the synovial fluid.
Why is spinal manipulation used?
Research has shown spinal manipulation treatment (SMT) to be useful in decreasing pain and improving function within the back and neck joints 4,5,6. SMT can be delivered as a standalone therapy. However, within osteopathic treatment, SMT is more likely to be integrated into a more extensive treatment package, often in conjunction with exercise therapy, soft tissue release, and joint mobilisation.
Is it safe to ‘crack’ my own joints?
As an osteopathic practitioner, I frequently encounter the question, "Is it safe to crack my joints?" You might recall warnings from your childhood, with people cautioning you against cracking your knuckles, claiming it could lead to arthritis. However, research has debunked this old wives' tale and provided evidence that cracking your hand joints does not contribute to arthritis. A 2011 study found that a history of habitual knuckle cracking was not a risk factor for hand osteoarthritis (2); a later study in 2016 (3) also confirmed these results. So as the research demonstrates knuckles cracking can be harmless. However when it comes to self-manipulation of the neck or back, it's important to note that there is a lack of comprehensive studies, making it challenging to definitively determine the effects of self-manipulation of the back and neck on your health.
Is spinal manipulation safe?
Although the long-term advantages of spinal manipulation remain unclear, it has demonstrated its effectiveness in offering short-term relief for specific types of back and neck discomfort.
When performed by qualified osteopaths, chiropractors and physiotherapists, joint manipulation is generally safe and well-tolerated. Below are some key safety considerations:
Professional Training
Osteopaths, chiropractors and physiotherapists, undergo rigorous training, including extensive anatomy and physiology education, to develop the skills and knowledge necessary to perform SMT safely.
Individualised Treatment
Osteopathic practitioners tailor their techniques to each patient's specific needs. They consider the patient's health history and any contraindications to ensure a safe treatment.
Gentle Techniques
Spinal manipulation techniques are gentle, precise, and controlled.
Informed Consent
Practitioners explain the treatment and its potential benefits and risks to patients, ensuring they understand and consent to the procedure.
In 2017 a comprehensive review of 250 scientific publications concerning the risks and side effects associated with spinal manipulation reached the following conclusions (7):
Following spinal manipulation, it is not uncommon to experience transient mild-to-moderate side effects, which typically include increased pain, discomfort, stiffness, or even headaches. Fortunately, these side effects are usually short-lived, and they tend to dissipate within 24 hours.
While serious side effects, such as significant spinal or neurological issues, or strokes involving the arteries in the neck, have been reported, it's essential to note that such occurrences are exceedingly rare. Accurate estimates of their frequency are unavailable.
It's worth noting that the likelihood of experiencing a severe side effect may be somewhat higher in individuals who have preexisting health conditions that elevate their risk of injury. For this reason it is important that the patient shares honestly about their health conditions and medications.
You know, even though spinal manipulation offers a bunch of benefits, there are folks out there who really cringe at the idea of their backs making those clicking sounds. And you know what? That's perfectly okay. When it comes to your treatment, you, as the patient, always have the choice to skip any part of it that you're not comfortable with.
When it comes to spinal manipulation, your osteopath will conduct a comprehensive assessment and decide if spinal manipulation is appropriate. They will then provide a clear explanation of the potential benefits and risks associated with each spinal manipulation before proceeding.
And it's essential to know that spinal manipulation is just one of the many tricks up our sleeves as osteopaths to help you feel better and move easier. So, it's all about what works best for you!
What else can cause clicking in the body?
Sometimes, you might find that your joints make these unexpected popping sounds all on their own. And if it's not because someone's intentionally manipulating them, then there are a few other common reasons behind it:
Ligament or tendon movement
The movement of ligaments or tendons over bony surfaces can produce clicking or snapping sounds during joint manipulation.This does not normally cause pain.
Osteoarthritis
As we age, our spine often begins to exhibit some age related changes – just a normal part of the ageing process. So, what happens is, as the cartilage in our spine starts to reduce down, it doesn't provide as much protection and cushioning for the bones. This can lead to those bones rubbing against each other, which in turn can produce those 'cracking,' 'popping,' or even 'grinding' sounds. This can sometimes cause pain.
Joint manipulation in osteopathy is a safe technique used to manage pain, improve mobility, and promote natural healing. When performed by qualified practitioners, SMT is an effective way to address various musculoskeletal issues. The audible sounds associated with joint manipulation, such as cracking and clicking, are generally harmless and can be attributed to natural processes within the joint. If you're considering osteopathic treatment, you can trust in the expertise and safety of well-trained osteopathic practitioners who can guide you on your journey to better health and wellness.
References
Deweber, K., Olszewski, M., & Ortolano, R. Knuckle cracking and hand osteoarthritis. Journal of the American Board of Family Medicine. 2011.24(2), 169–174
Chandran Suja, V., Barakat, A. Mathematical model for the sounds produced by knuckle cracking. Scientific Reports. 2018. 8, 4600
Powers, T., Kelsberg, G., & Safranek, S. Clinical Inquiry: Does knuckle popping lead to arthritis?. The Journal of family practice. 2016. 65(10), 725–726.
Chaibi, A., Stavem, K., & Russell, M. B. (2021). Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Journal of clinical medicine, 10(21), 5011.
Coulter, I. D., Crawford, C., Vernon, H., Hurwitz, E. L., Khorsan, R., Booth, M. S., & Herman, P. M. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain physician. 2019.22(2), E55–E70.
Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., Branson, R., Tang, B., Morton, S. C., & Shekelle, P. G. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA. 2017 317(14), 1451–1460.
Swait, G., & Finch, R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropractic & manual therapies. 2017. 25, 37.
