How Joint Manipulation May Ease Your Pain


The occurrence of “cracks” or “pops” in our joints can be common. Sometimes the popping of the joint is intentional and other times it is random and unexpected. Often, this “pop” leads to a decrease in pressure or discomfort in that particular joint.

There are many definitions of manipulation, but the overall consensus is that it is a manual physical therapy technique in which a passive movement is applied to a joint with small amplitude and in a quick fashion. This is also known as high-velocity, low-amplitude thrust manipulation. The origin of the resulting cavitation, or “pop”, is not entirely known. The most widely accepted theory revolves around the production of gas bubbles as the joint space is increased followed by the collapse of the gas bubbles, which produces the “popping” sound.

Having a joint manipulated or “popped” can be intimidating. However, when performed correctly by a skilled physical therapist, it is extremely safe. In regards to the spine, according to one study, the risk of worsening a lumbar-disc herniation is 1 in 3.7 million.

Your therapist will screen you for any red flags or contra-indications, which may exclude you from being a candidate for manipulation. Once it is deemed that you are appropriate for manipulation, the therapist will place you in the proper position depending on which joint is being manipulated. They will then apply a small, but rapid force to the joint, causing a cavitation in which you will likely feel one or multiple “pops.” These manipulations can be performed at various levels of the spine —the lumbar (low back), thoracic (mid back) or cervical (neck) —, as well as joints away from the spine. Your physical therapist will decide the proper area to manipulate based on your individual symptoms.

Many are familiar with manipulation of the spine, but, “peripheral”, or joints away from the spine, can be manipulated as well. Both of these areas can be useful in treating a number of injuries and are often used in conjunction with each other. For example, lateral epicondylitis (tennis elbow), is a common injury which presents with pain in the outside area of the elbow. Research has shown that manipulation of the elbow, as well as the cervical spine, or neck, can improve outcomes with this condition.

In addition to spinal and peripheral manipulation, you will receive other manual therapy techniques and exercise in order to re-enforce the effects of the manual techniques performed and help you on your way to recovery.

The intentional manipulation of the spine and peripheral joints can be used as a physical therapy treatment to facilitate movement and relieve pain for a variety of conditions. You are a potential candidate for spinal and peripheral manipulation if you have been diagnosed with or are experiencing low-back pain, neck pain, mid-back pain, headaches, jaw pain, disc bulge, lateral epicondylitis, shoulder impingement, hip pain, as well as other conditions. Schedule an appointment and one of our physical therapists will walk you through the process.


Scott Sassaman

DPT | Arrowhead Location