hear people say all of the time that they are scared to go and see a chiropractor as they do not want to get “cracked”. This statement is made too often with many people unaware of what the cracking or popping noise actually is that happens during an adjustment. During an initial assessment I usually find myself having this discussion with patients to help educate them and ensure they have a thorough understanding prior to receiving treatment. This topic is so important to understand and it is my job as a chiropractor to educate patients and explain what is actually happening when you hear that popping sound.
The manual therapy that chiropractors can utilize which causes the popping sound is referred to as an adjustment or a joint manipulation. The actual sound that is heard during the manipulation is called a cavitation.
The first thing that needs to be discussed are a few MYTHS about adjustments that many of us have been told to be true over the years. The first myth is that the popping noise produced during a manipulation is the sound of a bone breaking. Many people believe if they go and see a chiropractor they are going to get their bones cracked, which is not true.
The second myth that needs to be mentioned is that adjustments DO NOT put a bone back in place. A joint may be restricted and not moving well however it is not as some like to say “out of place”. When a bone or joint is out of place that is referred to as a dislocation, which would require a different type of treatment.
Some FACTS about a chiropractic manipulation and the things that you should know are as follows:
A joint manipulation is targeted and specific to a restricted joint. Now you may ask what is a restricted joint? Remember that a joint is the connection made between two or more adjacent bones. When a joint becomes tight or loses its full range of motion the entire joint structure can become affected and we refer to this as a restriction. Every joint should be able to move freely and independently.
The popping sound is the result of a gas bubble forming. Now you are probably wondering what we mean by gas bubble. A study that examined joint manipulations using an MRI established that the cracking/popping sound is due to the formation of gas bubbles within the joint. The bubble is formed due to an increase in volume within the joint, causing a drop in pressure (a process known as tribonucleation). Without getting too scientific, when two closely opposed surfaces are separated that are surrounded by fluid, the viscous liquid creates tension and resists the separation. When the distraction force overcomes the adhesive force the surfaces separate and rapidly create a negative pressure creating the popping sound.
A manipulation can restore the range of motion of the joint, can relax muscles and can relieve pain. Restoring motion in a joint is not only important for regaining range of motion but it also improves joint nutrition and lubrication. In order to minimize the detrimental effects of friction in a joint, our synovial joints are bathed in synovial fluid. For this fluid to be maintained in a functional manner, movement of the joint is required. In theory such a mechanism could delay or prevent cartilage degeneration.
It is important to know that just because you go to see a chiropractor does NOT mean that you have to be adjusted. If you are still not comfortable with joint manipulations and do not want to be adjusted then no problem! Chiropractors are highly trained in various treatment methods such as mobilizations, soft tissue therapy, exercise, rehab, acupuncture, modalities and the list goes on. If a patient is not comfortable with a manipulation we can create a treatment plan specific to their comfort level and get the joint mobilized in alternate ways. Remember that a clinician is responsible for providing the patient with all of the information and evidence related to their injury. We can recommend what would be the best or ideal treatment to help reach your goals and get out of pain however that does not mean you have to agree.
The other big question many patients ask is when would an adjustment be necessary or be beneficial for their injury/pain. As primary health care providers, chiropractors are required to complete a thorough history and physical examination to properly diagnose and formulate an appropriate treatment plan based upon the diagnosis. It is at this point where a chiropractor can discuss whether or not an adjustment would be beneficial in accordance with best practice guidelines.
Hopefully this will answer some of the questions you may of had regarding joint manipulations and prevent you from remembering the myths when thinking of getting an adjustment or visiting a chiropractor. Remember that you should always be educated on not only the diagnosis of your injury but also the treatment you are receiving.
Kawchuk GN, Fryer J, Jaremko JL, Zeng H, Rowe L, Thompson R. Real-time visualization of joint cavitation. PloS one. 2015 April 15;10(4):e0119470
Demoulin C, Baeri D, Toussaint G, Cagnie B, Beernaert A, Kaux JF, Vanderthommen M. Beliefs in the population about cracking sounds produced during spinal manipulation. Joint Bone Spine. 2018 Mar 1;85(2):239-42