What causes the ‘cracking sound’ produced with spinal manipulation
What is manipulation:
Manipulation is a high velocity, low amplitude movement producing the joint surface to separate. Some evidence has shown that manipulation produces a gas bubble formation within the synovial joint and this may cause the ‘cracking sound’. Previously some schools of thought were that joint surfaces were being realigned, but we are now starting to move away from this theory (Bialosky et al, 2009).
A study by Demoulin et al, (2018) looked to assess the beliefs in the population about cracking sounds produced during spinal manipulation. The study included 100 participants, 40 who had received manipulation and 60 who had not. The study was more of a subjective one and asked open-ended questions including “What is the sound usually heard during spinal manipulation (where does it come from)?”; and: “Does the sound indicate successful spinal manipulation?”.
The results from the study showed 72% of the participants believed the cracking sound was due to vertebrae returning to their normal position or vertebrae rubbing against each other. Additionally, it found 40% of participants believe that the sound was evidence of a successful manipulation.
Clinical Research has demonstrated short lasting effects of manipulation on the spine compare to no treatment, and little to no effect compared to a sham treatment.
What does this mean for patients?
This belief can potentially be harmful as individuals believe the spine is fragile and susceptible to damage. This negative belief that is often associated with backs may hinder improvements from treatment and aid in the development of chronic back pain (Kamper, 2019). It’s important for patients to remember the back is a very strong structure in the body and can heal just like the rest of the body.
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References:
Bialosky, J.., Bishop, M., Price, D., 2009. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual Therapy, 14:531–8.
Demoulin, C., Baer,i D., Toussaint, G., Cagnie, B., Beernaert, A., Kaux, J-F., Vanderthommen, M. 2018. Beliefs in the population about cracking sounds produced during spinal manipulation. Joint Bone Spine, 85:239-42.
Kamper, S. 2019. Beliefs in the population about cracking sounds produced during spinal manipulation. The Physio Network, 12-14.