In recent weeks, joint manipulation or in lay terms ‘cracking’ or “popping” the spine, has been the topic of much discussion in the media. It is a technique common to Osteopathy, Physiotherapy and Chiropractic but has attracted somewhat negative attention across all professions who use the technique. Today I will discuss why, as Osteopaths, we may use the technique during our treatments and give you all the information you need to make an informed decision as to whether it may suit you at your next visit.

High Velocity Low Amplitude (HVLA), typically known as joint manipulation, is commonly applied during Osteopathic treatment. It is a specific technique which aims to achieve an increase in range of motion and a reduction in pain in a given area, typically in the spine. Rather than achieving movement at all joints in the area, your practitioner will adjust the technique in order to positively impact the joints with the primary issue. Rather than the notion of ‘getting cracked from head to toe’ or ‘getting cracked back into alignment’ it is a technique ideally applied as locally and to as few spinal segments as possible . Further, it is one of many techniques employed by Osteopaths to treat your injury or pain, and subsequently will never be used in isolation during your appointment.

The audible cavitation or ‘crack’ that you may hear is not your bones breaking or grinding together. Studies have hypothesised that it is due to the release of a gas bubble from the joint capsule when the ‘thrust’ is applied. Although this noise can be loud, it is not of concern.

Symptomatic relief following joint manipulation will vary from patient to patient. Generally an immediate sense of more movement is expected. Some temporary side effects may include local pain/discomfort, stiffness, dizziness or light headedness, and are likely to subside within 24 hours of treatment. This can also be as a result of the treatment itself rather than the manipulation in isolation.

Most people do not experience significant adverse events following HVLA. The risk despite being very minimal is important to note when making your decision. The incidence of a significant vascular incident (stroke) was found to be 1 in 2,000,000 with joint manipulation (Terrett, A.G, 2001). Comparatively, when taking the oral contraceptive pill the risk of stroke is 83 times higher (Gillium et al, 2000) than joint manipulation, and taking anti-inflammatory medications increases that risk to a substantial 1,666 times higher (Tramer et al, 2000).

With these figures in mind, while it puts it into perspective, your Osteopath will always ensure that the technique is safe for you. At each appointment a thorough clinical history and assessment will be completed. This will govern as to whether joint manipulation is an appropriate technique for you or your presentation as manipulation is appropriate in many but not all situations or injuries. It is also important to note that your practitioner has undertaken 5 years of study at a university level, and is highly trained to identify when you are not able to receive this technique.

In light of recent debate querying the application of spinal manipulation in the general population, patients can be assured that it is the policy of Osteopaths at Camberwell Sports and Spinal Medicine to never use spinal manipulation on children or infants.

If you have any further questions, your Osteopath will be happy to answer them for you at your next visit.

Stoke incidence following spinal manipulation is 1 in 2,000,000 Terret AG. Current Concepts In Vertebrobasilar Complications following Spinal Manipulation. Des Moines, Iowa: National Chiropractic Mutual Insurance Company, 2001.

Stroke related to birth control pill is 1 in 24,000 (83 times higher) Gillium LA, Mamidipudi AK, Johnston, SC. Ischemic Stroke Risk with Oral Contraceptives, a Meta-analysis. Journal of the American medical Association 2000; (84)1

Stroke related to use of NSAIDs (aspirin, ibuprofen) is 1 in 1,200 (1,666 times higher) Tramer MR, Moore RA, Reynolds JAM, McQuay HJ. Quantitative Estimation of Rare Adverse Events Which Follow a Biological Progression: A New Model Applied to Chornic NSAIDs Use. Pain 2000; 85: 169-182

Posted 25th May 2016