Chiropractic treatment

Joint manipulative therapies

By Dr. Vic Weatherall
Updated December 2014

Unfortunately, there is often great confusion in terminology and understanding within the various health care professions, especially about joint manipulative therapies. This is likely due to the fact that different professions look at the same action from different perspectives and educational experiences. However, the goal in manual therapy remains the same: the use of a therapist’s hands to relax and stretch joints and muscles to provide pain relief and restore proper joint operation at the joint itself and throughout the body.

Joint “mobilization” is a subtype of joint manipulative therapy in which the therapist moves the joints in specific directions and depths with, or without, the patient’s assistance, to stretch the joint and its surrounding tissues.

Mobilization is different from the high-velocity, low amplitude (HVLA) thrust joint manipulation employed by chiropractors and other manual therapists. Chiropractors refer to HVLA thrust manipulation as a chiropractic  “adjustment,” spinal manipulative therapy (SMT), or simply “manipulation.”

Thrust manipulation involves rapidly moving the joint beyond its physiologic or normal operating range of motion but below its anatomical or maximum limit of motion. This rapid distraction or gapping of the facet joint surfaces (see diagram below) is often accompanied by an audible “crack” or “pop” caused by the formation and collapse of tiny gas bubbles (this is called cavitation) in the joint fluid.1 This sound and the gas bubbles have no therapeutic properties but may indicate a clean separation of the joint surfaces.2 This audible is distinct from ligaments or tendons snapping over other tissues and joint crepitus due to degeneration.

Spinal column segment
Spinal column segment 3

Like other forms of manipulation, thrust manipulation provides pain relief and helps restore normal joint function. It does this by

  • releasing pinched joint capsules
  • reflexively relaxing tight muscles
  • breaking down adhesions (scarring) in and around the joint
  • unbuckling mechanically locked joint segments2

The major difference in the action of mobilization and thrust manipulation is that during mobilization, reflex muscle relaxation—a key component in pain relief—does not occur.4 Also, thrust manipulation has been shown to provide much more rapid pain relief.5

All chiropractors are trained in the use of thrust and non-thrust joint manipulative techniques: chiropractic is not only thrust manipulation. This is a notion sometimes promoted by its competitors or detractors. However, the primary focus of the manipulative therapy training of chiropractors, and hence the most common form of chiropractic treatment, is thrust manipulation. This form of manual therapy is by far the most difficult to learn and perform skillfully. Other techniques also require great skill, but are essentially variations on the theme of stretching the joint.

Chiropractors employ a variety of different forms of manipulation from a basic holding stretch (also known as myofascial release) to thrust manipulation. All are effective in the appropriate application and the choice of which form of manipulation to use depends on the patient’s informed consent and several factors.

These include, but are not limited to

  • the patient’s specific problem; for example, a herniated spinal disc may or may not preclude the use of manipulation
  • the patient’s underlying condition(s); for example, severe joint degeneration or osteoporosis
  • the likelihood of potential problems or patient reactions with a particular form of manipulation; for example, the patient not relaxing during treatment or the degree of muscle spasm being too great

It is important to note that you must provide your informed consent to treatment prior to any treatment.

References

  1. James Dunning J, Mourad F, Barbero M, Leoni D, Cescon C, and Butts R. Bilateral and multiple cavitation sounds during upper cervical thrust manipulation. BMC Musculoskeletal Disorders 2013, 14:24.
  2. Evans DW. Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: Previous theories. J Manipulative Physiol Ther. 2002;25:251-262.
  3. Vertebra Posterolateral” by BodyParts3D/Anatomography – This file is lacking source information. Please edit this file’s description and provide a source. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
  4. Herzog W, Conway PJ, Zhang YT, Gal J, Guimaraes AC. Reflex responses associated with manipulative treatments on the thoracic spine: a pilot study. J Manipulative Physiol Ther.
    1995;18(4):233-236.
  5. Cassidy JD, Lopes AA, Yong-Hing K. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. J Manipulative Physiol Ther. 1992;15(9):570-575.