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Understanding Manipulation

By Lewis Clarke

If you’ve ever been to an Osteopath, Physiotherapist or Chiropractor and they have initiated a movement which resulted in your body giving off a noise, be it a crack or pop, you may well have had a joint manipulation. or more specifically a High Velocity Low Amplitude Thrust (HVLAT).  These are very common techniques throughout the world of manual therapy and have been used extensively for the treatment of musculoskeletal related injuries.

It is uncommon, however, that patients themselves fully understand the technique and/or why the noise occurs. These noises are then usually synonymous with anxious stigma against said techniques.

First of all lets discuss the ‘how’ and then, and more importantly, we will discuss the ‘why’.

‘How’

We will generally find that people will assume that due to the unnerving sound of cracking, that there is a change happening within the bones themselves. I assure you, if this were the case, then pain would follow at an alarming rate. However the noise you are quite rightly hearing should better be referred to as a ‘pop’. The reason for this is, that the sound is actually coming from nitrogen gas bubbles within joints themselves. In this instance we will talk about the spine as it will the most likely place that someone will administer these techniques.

For ease of explanation we will mention the two main joints in the spinal column. The first being the intervertebral joint, which is the joint at the front of the spine and has your spinal discs articulating with the vertebral bodies (please see pictured). This joint’s primary function is to weight-bare. The other joint we will talk about is the facet joint, AKA zygo-apophyseal joint. These joints sit further back and will be mainly involved in directed motion. It is these joints that give the sound. Now, because they move, they will have a closed capsule surrounding them which is made up of ligament material. Within this joint is a lubricant, known as synovial fluid, and will have within that the aforementioned nitrogen gas bubbles.

To create the sound these bubbles must undergo a change in pressure. A good analogy to use, is that if you were to take a fizzy drinks bottle and then shake, the bubbles within would expand and the bottle will feel tighter. This is similar to putting strain onto the facet joints and them becoming stiff. Then to release the pressure within the  bottle you would release the cap, slowly of course. Now unfortunately it is not so easy when it comes the joints in your spine, as it is needed to be done with specific care and consideration of your pain and presentation. Therefore to create this pressure change the therapist will need to use a specific movement whilst you’re joints are under a certain pressure.

‘Why’

Ultimately the main and only reason you should have a manipulation is to promote better range of motion at that particular segment. However it has been known that people with other injures like muscular sprain and soft tissue damage can benefit from the change in pressure at these joints.

As an Osteopath i would look to manipulate certain joints that I would deem beneficial to your presentation. It is important to remember that good mobility of your spine is vital for blood to move around your body uninterrupted. High pressurised areas or areas of low mobility in the body create lead to poor circulation and thus lead to a poor ability to heal damaged tissues.

A good example of this is when you are on a long haul flight, you would have been told to pump your feet up and down, usually to stop the incidence of deep vein thromboses (DVT). The reason for this is because you are in high pressurised cabin within a low pressurised atmosphere, and blood or any fluid will move well around the body. Luckily you have a heart which pumps high pressed blood around the body (arterial flow) but returning back in a low pressured system (venous drainage). This needs a little help, so moving your feet generally create an artificial pump to do just that. Now, DVT’s can occur anywhere, but they are much more likely in your calves and feet due to it being the place with the least amount of venous pressure and therefore a higher chance of a thrombus to occur.

Please note that I am not suggesting that spinal manipulation helps with DVT’s, merely using it as an example as to why mobility is important for blood flow.

As a patient it is sometimes daunting to have someone push into your back and make sounds that are more akin to negative than positives. Though I hope with a better understanding of the reason ‘why’ it may be beneficial for you can help curb those scared thoughts. A good therapist should discuss the reasons why it is beneficial and also rule out reason why you should not receive one. As there are a few contraindicating conditions that would not allow you to undergo spinal manipulation. Please speak to your therapist before treatment to ensure you do not fall into this bracket.

Blog by Lewis Clarke

Osteopath at Pea Green Physio

Lewis’s clinics are: Tuesdays and Wednesdays 3.30pm-8.30pm

To book in for a treatment with any of our therapists, please call 01869241411

 

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no more ouch... give the team a call: 01869 241411 or
pop us an email: [email protected] and we’ll get back to you

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