Curious about whether you should consider getting your back “cracked”? Ever feel like your back is especially stiff and just needs a good “pop”? Physiotherapists who have undergone advanced training might be able to help you out. This “crack” or “pop” is called a manipulation.
A manipulation is a skillful passive high velocity, low amplitude, minimal force thrust. Essentially, the physiotherapist will move a joint quickly a short amount. The goal of this technique is to restore motion and function.
When is a manipulation potentially a good idea? There are several different scenarios.
First, when a joint is fixated, or in simpler terms, when a joint has lost some of it’s normal mobility. This can occur when there is a limitation in the small, involuntary motions that happen inside the joint when you move voluntarily. These motions are described as a glide, roll or spin that occurs between the two bones against each other. A fixated joint can also be caused by muscle tension, inflammation or injury.
Second, a manipulation may be a good option when your treatment has begun to plateau with other treatment options. It can help to rupture adhesions inside the joint that may be limiting the mobility of the joint. It can also help to increase the mobility when there is an extensible scar, or a meniscoid – small, flap-like piece of connective tissue - entrapment.
Now that we know why a manipulation may be helpful, are there any reasons it may not be a done idea? With all treatment techniques, there are certain times when they are not safe and should not be performed. Let’s review some of the reasons you may not find this technique helpful in your healing journey.
If you are unable to fully relax or experience pain in the position prior to the manipulation you should not have it done. You are also not a good candidate if you have a recent trauma that resulted in a bone fracture or dislocation, any past or present cancers that may metastasize, or any active infections.
Other potential reasons to not have a manipulation include any neurological contraindications. These would include disease or injury to the nervous system, numbness/tingling in your arms or legs, bladder and/or bowel dysfunction, or difficulty speaking or swallowing to name a few.
Manipulations are not appropriate for children or some elderly people. Children lack the skeletal maturity for it to be safe and the elderly have an increased risk of osteoporosis, vascular disease and spinal stenosis.
If you have any collagen issues that are present in conditions such as Ehlers-Danlos syndrome, Marfan’s syndrome, or benign hypermobility you might also not be a good candidate.
Finally, certain medications can be harmful to your bone integrity, increasing your risk of having a fracture post manipulation. Some of these medications include: corticosteroids, tamoxifen, methotrexate, and thyroid hormones.
